AHIP Module 2 Test Questions with Answers
Mr. Sinclair has diabetes and heart trouble and is separate prescription drug plan.
generally satisfied with the care he has received
under Original Medicare, but he would like to know
more about Medicare Advantage Special Needs Mr. Gomez notes that a Private Fee-for-Service
Plans (SNPs). What could you tell him? - (PFFS) plan available in his area has an attractive
ANSWER -a. SNPs have special programs for premium. He wants to know if he must use doctors in
enrollees with chronic conditions, like Mr. Sinclair, a network as his current HMO plan requires him to
and they provide prescription drug coverage that do. What should you tell him? - ANSWER -c. He
could be very helpful as well. may receive health care services from any doctor
allowed to bill Medicare, as long as he shows the
doctor the plan's identification card and the doctor
Ms. Gibson recently lost her employer group health agrees to accept the PFFS plan's payment terms and
and drug coverage and now she wants to enroll in a conditions, which could include balance billing.
PPO that does not include drug coverage. What Correct
should you tell her about obtaining drug coverage? -
ANSWER -b. She can enroll in the PPO, but
she will not be able to purchase a stand-alone Mrs. Willard wants to know generally how the benefits
Medicare Part D prescription drug plan. under Original Medicare might compare to the
benefits package of a Medicare Advantage Plan
before she starts looking at specific plans. What
Mrs. Kelly, age 65, is entitled to Part A but has not could you tell her? - ANSWER -a. Medicare
yet enrolled in Part B. She is considering enrollment Advantage Plans may offer extra benefits that
in a Medicare Advantage plan (Part C). What should Original Medicare does not offer such as vision,
you advise her to do before she will be able to enroll hearing, and dental services and must include a
in a Medicare Advantage plan? - ANSWER -d. maximum out-of-pocket limit on Part A and Part B
In order to join a Medicare Advantage plan, she also services.
must enroll in Part B.
Mrs. Davenport enrolled in the ABC Medicare
Mr. Lopez has heard that he can sign up for a Advantage (MA) plan several years ago. In mid-
product called "Medicare Advantage" but is not sure February of 2021, her doctor confirms a diagnosis of
about what type of plan designs are available end-stage renal disease (ESRD). What options will
through this program. What should you tell him about Mrs. Davenport have regarding her MA plan during
the types of health plans that are available through the next open enrollment season? - ANSWER -
the Medicare Advantage program? - a. She may remain in her ABC MA plan, enroll in
ANSWER -c. They are Medicare health plans another MA plan in her service area, or enroll in a
such as HMOs, PPOs, PFFS, and MSAs. Special Needs Plan (SNP) for individuals suffering
from ESRD if one is available in her area.
Mrs. Lyons is in good health, uses a single
prescription, and lives independently in her own Mrs. Burton is a retiree with substantial income. She
home. She is attracted by the idea of maintaining is enrolled in an MA-PD plan and was disappointed
control over a Medical Savings Account (MSA) but is with the service she received from her primary care
not sure if the plan associated with the account will fit physician because she was told she would have to
her needs. What specific piece of information about a wait five weeks to get an appointment when she was
Medicare MSA plan would it be important for her to feeling ill. She called you to ask what she could do so
know, prior to enrolling in such a plan? - she would not have to put up with such poor access
ANSWER -c. All MSAs cover Part A and Part B to care. What could you tell her? - ANSWER -b.
benefits, but not Part D prescription drug benefits, She could file a grievance with her plan to complain
which could be obtained by also enrolling in a about the lack of timeliness in getting an
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Mr. Sinclair has diabetes and heart trouble and is separate prescription drug plan.
generally satisfied with the care he has received
under Original Medicare, but he would like to know
more about Medicare Advantage Special Needs Mr. Gomez notes that a Private Fee-for-Service
Plans (SNPs). What could you tell him? - (PFFS) plan available in his area has an attractive
ANSWER -a. SNPs have special programs for premium. He wants to know if he must use doctors in
enrollees with chronic conditions, like Mr. Sinclair, a network as his current HMO plan requires him to
and they provide prescription drug coverage that do. What should you tell him? - ANSWER -c. He
could be very helpful as well. may receive health care services from any doctor
allowed to bill Medicare, as long as he shows the
doctor the plan's identification card and the doctor
Ms. Gibson recently lost her employer group health agrees to accept the PFFS plan's payment terms and
and drug coverage and now she wants to enroll in a conditions, which could include balance billing.
PPO that does not include drug coverage. What Correct
should you tell her about obtaining drug coverage? -
ANSWER -b. She can enroll in the PPO, but
she will not be able to purchase a stand-alone Mrs. Willard wants to know generally how the benefits
Medicare Part D prescription drug plan. under Original Medicare might compare to the
benefits package of a Medicare Advantage Plan
before she starts looking at specific plans. What
Mrs. Kelly, age 65, is entitled to Part A but has not could you tell her? - ANSWER -a. Medicare
yet enrolled in Part B. She is considering enrollment Advantage Plans may offer extra benefits that
in a Medicare Advantage plan (Part C). What should Original Medicare does not offer such as vision,
you advise her to do before she will be able to enroll hearing, and dental services and must include a
in a Medicare Advantage plan? - ANSWER -d. maximum out-of-pocket limit on Part A and Part B
In order to join a Medicare Advantage plan, she also services.
must enroll in Part B.
Mrs. Davenport enrolled in the ABC Medicare
Mr. Lopez has heard that he can sign up for a Advantage (MA) plan several years ago. In mid-
product called "Medicare Advantage" but is not sure February of 2021, her doctor confirms a diagnosis of
about what type of plan designs are available end-stage renal disease (ESRD). What options will
through this program. What should you tell him about Mrs. Davenport have regarding her MA plan during
the types of health plans that are available through the next open enrollment season? - ANSWER -
the Medicare Advantage program? - a. She may remain in her ABC MA plan, enroll in
ANSWER -c. They are Medicare health plans another MA plan in her service area, or enroll in a
such as HMOs, PPOs, PFFS, and MSAs. Special Needs Plan (SNP) for individuals suffering
from ESRD if one is available in her area.
Mrs. Lyons is in good health, uses a single
prescription, and lives independently in her own Mrs. Burton is a retiree with substantial income. She
home. She is attracted by the idea of maintaining is enrolled in an MA-PD plan and was disappointed
control over a Medical Savings Account (MSA) but is with the service she received from her primary care
not sure if the plan associated with the account will fit physician because she was told she would have to
her needs. What specific piece of information about a wait five weeks to get an appointment when she was
Medicare MSA plan would it be important for her to feeling ill. She called you to ask what she could do so
know, prior to enrolling in such a plan? - she would not have to put up with such poor access
ANSWER -c. All MSAs cover Part A and Part B to care. What could you tell her? - ANSWER -b.
benefits, but not Part D prescription drug benefits, She could file a grievance with her plan to complain
which could be obtained by also enrolling in a about the lack of timeliness in getting an
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