AHIP Module 2
1. Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items coveredby the plan with minimal out-
of-pocket costs because his MA-PD coverage has been very good. However, when he
received the bill, he was surprised tosee large charges in excess of his maximum out-of-pocket
limit that includedsome services and items he thought would be fully covered. He called you
to ask what he could do? What could you tell him?
Answer: You can offer to review theplans appeal process to help him ask the plan to review
the coverage decision.
2. Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-incomelevel. 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 doctorrecently prescribed several expensive
medications. Currently, she is enrolledin 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 standalonePart D
prescription drug plan.
3. Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored
retiree group health plan that includes drug coverage withnominal copays. He heard about a
neighbor's MA-PD plan that you representand because he takes numerous prescription drugs, he
is considering signingup 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-PDplan to determine which one will provide sufficient
coverage for his prescription needs.
4. Hank's Fish Store, Inc. is a small company with just 15 employees locatedin Florida.
Hank, the store owner, has provided excellent health benefits to the store's workforce.
William, one of the store's long-time employees, will soon be reaching age 65 and eligible for
Medicare. William is in good health.He intends to remain an active full-time employee,
working several years after becoming eligible for Medicare.What type(s) of retiree health
benefit willHank's Fish Store be able to offer William?
Answer: Hank's can continue to offer William the same employee health benefit plan, or, if
William enrolls in Medicare Part B, itcan enroll him in a Medicare Advantage plan that is
offered to the public.
1. Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items coveredby the plan with minimal out-
of-pocket costs because his MA-PD coverage has been very good. However, when he
received the bill, he was surprised tosee large charges in excess of his maximum out-of-pocket
limit that includedsome services and items he thought would be fully covered. He called you
to ask what he could do? What could you tell him?
Answer: You can offer to review theplans appeal process to help him ask the plan to review
the coverage decision.
2. Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-incomelevel. 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 doctorrecently prescribed several expensive
medications. Currently, she is enrolledin 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 standalonePart D
prescription drug plan.
3. Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored
retiree group health plan that includes drug coverage withnominal copays. He heard about a
neighbor's MA-PD plan that you representand because he takes numerous prescription drugs, he
is considering signingup 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-PDplan to determine which one will provide sufficient
coverage for his prescription needs.
4. Hank's Fish Store, Inc. is a small company with just 15 employees locatedin Florida.
Hank, the store owner, has provided excellent health benefits to the store's workforce.
William, one of the store's long-time employees, will soon be reaching age 65 and eligible for
Medicare. William is in good health.He intends to remain an active full-time employee,
working several years after becoming eligible for Medicare.What type(s) of retiree health
benefit willHank's Fish Store be able to offer William?
Answer: Hank's can continue to offer William the same employee health benefit plan, or, if
William enrolls in Medicare Part B, itcan enroll him in a Medicare Advantage plan that is
offered to the public.
