AHIP MODULE 2 | QUESTIONS AND VERIFIED 100%
CORRECT ANSWERS| LATEST UPDATE 2026/2027 |
GRADED A+
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her?
- ANSWER: Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in
Medicare Advantage.
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored
retiree group health plan that includes drug coverage with nominal copays. He heard
about a neighbor's MA-PD plan that you represent and because he takes numerous
prescription drugs, he is considering signing up for it. What should you tell him?
- ANSWER: He should compare the benefits in his employer-sponsored retiree group
health plan with the benefits in his neighbor's MA-PD plan to determine which one will
provide sufficient coverage for his prescription needs.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has
received under Original Medicare, but he would like to know more about Medicare
Advantage Special Needs Plans (SNPs). What could you tell him?
- ANSWER: SNPs have special programs for enrollees with chronic conditions, like Mr.
Sinclair, and they provide prescription drug coverage that could be very helpful as well
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her
own home. She is attracted by the idea of maintaining control over a Medical Savings
Account (MSA) but is not sure if the plan associated with the account will fit her needs.
What specific piece of information about a Medicare MSA plan would it be important for
her to know, prior to enrolling in such a plan?
- ANSWER: All MSAs cover Part A and Part B benefits, but not Part D prescription drug
benefits, which could be obtained by also enrolling in a separate prescription drug plan.
, Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's
terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How
much may Dr. Brennan charge?
- ANSWER: Dr. Brennan can charge Mary Rogers no more than the cost sharing
specified in the PFFS plan's terms and condition of payment which may include balance
billing up to 15%of the Medicare rate.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her?
- ANSWER: Mrs. Ramos can obtain care from any provider who participates in Original
Medicare, but generally will have a higher cost-sharing amount if she sees a provider
who/that is not a part of the PPO network.
Ms. Gibson recently lost her employer group health and drug coverage and now she
wants to enroll in a PPO that does not include drug coverage. What should you tell her
about obtaining drug coverage?
- ANSWER: She can enroll in the PPO, but she will not be able to purchase a stand-alone
Medicare Part D prescription drug plan.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like
to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should
you tell him?
- ANSWER: He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls
in Medicare Part B.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She
wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also
wants to have prescription drug coverage since her doctor recently prescribed several
expensive medications. Currently, she is enrolled in Original Medicare and a standalone
Part D plan. How would you advise Mrs. Chi?
- ANSWER: Mrs. Chi may enroll in a MA MSA plan and remain in her current
standalone Part D prescription drug plan.
CORRECT ANSWERS| LATEST UPDATE 2026/2027 |
GRADED A+
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her?
- ANSWER: Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in
Medicare Advantage.
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored
retiree group health plan that includes drug coverage with nominal copays. He heard
about a neighbor's MA-PD plan that you represent and because he takes numerous
prescription drugs, he is considering signing up for it. What should you tell him?
- ANSWER: He should compare the benefits in his employer-sponsored retiree group
health plan with the benefits in his neighbor's MA-PD plan to determine which one will
provide sufficient coverage for his prescription needs.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has
received under Original Medicare, but he would like to know more about Medicare
Advantage Special Needs Plans (SNPs). What could you tell him?
- ANSWER: SNPs have special programs for enrollees with chronic conditions, like Mr.
Sinclair, and they provide prescription drug coverage that could be very helpful as well
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her
own home. She is attracted by the idea of maintaining control over a Medical Savings
Account (MSA) but is not sure if the plan associated with the account will fit her needs.
What specific piece of information about a Medicare MSA plan would it be important for
her to know, prior to enrolling in such a plan?
- ANSWER: All MSAs cover Part A and Part B benefits, but not Part D prescription drug
benefits, which could be obtained by also enrolling in a separate prescription drug plan.
, Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's
terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How
much may Dr. Brennan charge?
- ANSWER: Dr. Brennan can charge Mary Rogers no more than the cost sharing
specified in the PFFS plan's terms and condition of payment which may include balance
billing up to 15%of the Medicare rate.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her?
- ANSWER: Mrs. Ramos can obtain care from any provider who participates in Original
Medicare, but generally will have a higher cost-sharing amount if she sees a provider
who/that is not a part of the PPO network.
Ms. Gibson recently lost her employer group health and drug coverage and now she
wants to enroll in a PPO that does not include drug coverage. What should you tell her
about obtaining drug coverage?
- ANSWER: She can enroll in the PPO, but she will not be able to purchase a stand-alone
Medicare Part D prescription drug plan.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like
to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should
you tell him?
- ANSWER: He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls
in Medicare Part B.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She
wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also
wants to have prescription drug coverage since her doctor recently prescribed several
expensive medications. Currently, she is enrolled in Original Medicare and a standalone
Part D plan. How would you advise Mrs. Chi?
- ANSWER: Mrs. Chi may enroll in a MA MSA plan and remain in her current
standalone Part D prescription drug plan.
