MEDICARE AHIP MODULE 2 WITH
ACCURATE SOLUTIONS
Mrs. Wang 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? - ANSWER-Medicare Advantage
Plans may offer extra benefits that Original Medicare does not offer such as vision,
hearing, and dental services. It must include a maximum out-of-pocket limit on Part A
and Part B services.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by 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 to see large charges in excess of
his maximum out-of-pocket limit that included some 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 the plans appeal process to help him ask the
plan to review the coverage decision.
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
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, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible
of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would
pay them as payment in full. - ANSWER-I, II and IV only
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
IV. Non-network providers must accept the same amount that Original Medicare would
pay them as payment in full.
Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from
his investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan
(SNP). His friend has mentioned that the SNP charges very low cost-sharing amounts
and Mr. Greco would like to join that plan. What should you tell him? - ANSWER-SNPs
ACCURATE SOLUTIONS
Mrs. Wang 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? - ANSWER-Medicare Advantage
Plans may offer extra benefits that Original Medicare does not offer such as vision,
hearing, and dental services. It must include a maximum out-of-pocket limit on Part A
and Part B services.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by 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 to see large charges in excess of
his maximum out-of-pocket limit that included some 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 the plans appeal process to help him ask the
plan to review the coverage decision.
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
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, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible
of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would
pay them as payment in full. - ANSWER-I, II and IV only
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
IV. Non-network providers must accept the same amount that Original Medicare would
pay them as payment in full.
Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from
his investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan
(SNP). His friend has mentioned that the SNP charges very low cost-sharing amounts
and Mr. Greco would like to join that plan. What should you tell him? - ANSWER-SNPs
