AHIP 2023 Final Exam Test Questions and Answers
(Verified Answers)
1. Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect
her access to services since she receives some assistance for her health care
costs from the State. What should you tell her ANS Medicaid may provide
additionalbenefits, but Medicaid will coordinate benefits only with Medicaid
participating providers.
2. Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled
in Part B because he has coverage through an employer plan. If he wants to
enroll in a Medicare Advantage plan, what will he have to do ANS He will
have toenroll in Part B.
3. Mr. Lopez has heard that he can sign up for a product called "Medicare
Advantage" but is not sure about what type of plan designs are available
through this program. What should you tell him about the types of health
plans that are available through the Medicare Advantage program ANS They
areMedicare health plans such as HMOs, PPOs, PFFS, and MSAs.
4. Mr. Romero is 64, retiring soon, and considering enrollment in his em-
ployer-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 ANS When possible, it is always the best
option tohave both the employer's plan and the MA-PD, so he would have no out-
of-pocketexpenses.
5. 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 ANS Dr. Brennan can
charge Mary Rogers no more than the cost sharing specified in the PFFS plan's
terms andcondition of payment which may include balance billing up to 15%of the
Medicare rate
6. Mrs. Willard wants to know generally how the benefits under Original
Medicare might compare to the benefits package of a Medicare Advantage
Plan before she starts looking at specific plans. What could you tell her ANS
- Medicare Advantage Plans may offer extra benefits that Original Medicare does
notoffer such as vision, hearing, and dental services and must include a maximum
out-of-pocket limit on Part A and Part B services.
7. Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She
is considering enrollment in a Medicare Advantage plan (Part C). What should
you advise her to do before she will be able to enroll in a Medicare Advantage
plan ANS To join a Medicare Advantage plan, she also must enroll in Part B.
, 8. Which of the following statement(s) is/are correct about a Medicare Savings
Account (MSA) Plans?I. MSAs may have either a partial network, full network,
(Verified Answers)
1. Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect
her access to services since she receives some assistance for her health care
costs from the State. What should you tell her ANS Medicaid may provide
additionalbenefits, but Medicaid will coordinate benefits only with Medicaid
participating providers.
2. Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled
in Part B because he has coverage through an employer plan. If he wants to
enroll in a Medicare Advantage plan, what will he have to do ANS He will
have toenroll in Part B.
3. Mr. Lopez has heard that he can sign up for a product called "Medicare
Advantage" but is not sure about what type of plan designs are available
through this program. What should you tell him about the types of health
plans that are available through the Medicare Advantage program ANS They
areMedicare health plans such as HMOs, PPOs, PFFS, and MSAs.
4. Mr. Romero is 64, retiring soon, and considering enrollment in his em-
ployer-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 ANS When possible, it is always the best
option tohave both the employer's plan and the MA-PD, so he would have no out-
of-pocketexpenses.
5. 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 ANS Dr. Brennan can
charge Mary Rogers no more than the cost sharing specified in the PFFS plan's
terms andcondition of payment which may include balance billing up to 15%of the
Medicare rate
6. Mrs. Willard wants to know generally how the benefits under Original
Medicare might compare to the benefits package of a Medicare Advantage
Plan before she starts looking at specific plans. What could you tell her ANS
- Medicare Advantage Plans may offer extra benefits that Original Medicare does
notoffer such as vision, hearing, and dental services and must include a maximum
out-of-pocket limit on Part A and Part B services.
7. Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She
is considering enrollment in a Medicare Advantage plan (Part C). What should
you advise her to do before she will be able to enroll in a Medicare Advantage
plan ANS To join a Medicare Advantage plan, she also must enroll in Part B.
, 8. Which of the following statement(s) is/are correct about a Medicare Savings
Account (MSA) Plans?I. MSAs may have either a partial network, full network,
