AHIP test NUR COMMUNITY Questions and Answers
certified latest 2024/2025
Mrs. Raskin is a widow who will attain aged 65 and enroll in
Medicare in just a few weeks. She concerned about having
prescription drug coverage. Which of the following
statements provides the best advice?
Prescription drug coverage can be obtained by enrolling
in a Medicare Advantage plan that includes Part D
coverage
Mr. Hernandez is concerned that if he signs up for a
Medicare Advantage plan, the health plan may, at some time
in the future, reduce his benefits below what is available in
Original Medicare. What should you tell him about his
concern?
Medicare health plans must cover all benefits available under
Medicare Part A and Part B. Many also cover Part D
prescription drugs
Mrs. Billings enrolled in the ABC Medicare Advantage (MA)
plan several years ago. Her doctor recently confirmed a
diagnosis of end-stage renal disease (ESRD). What options
does Mrs.
Billings have in regard to her MA plan during the next open
enrollment season?
,She may remain in her ABC MA plan or enroll in a Special
Needs Plan (SNP) for individuals suffering from ESRD if
one is available in her area
Mr. Kumar is considering a Medicare Advantage HMO and
has questions about his ability to access providers. What
should you tell him?
In most Medicare Advantage HMOs, Mr. Kumar must
obtain his services only from providers who have a
contractual relationship with the plan (except in an
emergency)
,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?
Beneficiaries should check with their employer or union
group benefits administrator before changing plans to
avoid losing coverage they want to keep
Mrs. Walters is enrolled in her state’s Medicaid program in
addition to Medicare. What should she be aware of when
considering enrollment in a Medicare Health Plan?
Medicaid will coordinate benefits only with Medicaid participating
providers.
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?
Medicaid may provide additional benefits, but Medicaid
will coordinate benefits only with Medicaid participating
providers.
, Mr. Rivera has QMB-Plus eligibility and is thus covered by
both Medicare and Medicaid. He decides to enroll in a
Medicare Advantage (MA) plan. Later in the year, Mr. Rivera
needs dentures, a service only covered under Medicaid.
What action would you recommend he take in order to have
this cost covered?
He should go to a Medicaid provider or obtain the services
through a Medicaid manage care plan if he is enrolled in
one
Ms. Moore plans to retire when she turns 65 in a few months.
She is in excellent health and will have considerable income
when she retires. She is concerned that her income will
make it impossible for her to qualify for Medicare. What
could you tell her to address her concern?
Medicare is a program for people age 65 or older and those
under age 65 with certain disabilities, end stage renal disease
or Lou Gehrig’s disease, so she will be eligible for Medicare
Mrs. Willard wants to know generally how the benefits
under Original Medicare might compare to the benefit
package of a Medicare Health Plan before she starts looking
at specific plans.
certified latest 2024/2025
Mrs. Raskin is a widow who will attain aged 65 and enroll in
Medicare in just a few weeks. She concerned about having
prescription drug coverage. Which of the following
statements provides the best advice?
Prescription drug coverage can be obtained by enrolling
in a Medicare Advantage plan that includes Part D
coverage
Mr. Hernandez is concerned that if he signs up for a
Medicare Advantage plan, the health plan may, at some time
in the future, reduce his benefits below what is available in
Original Medicare. What should you tell him about his
concern?
Medicare health plans must cover all benefits available under
Medicare Part A and Part B. Many also cover Part D
prescription drugs
Mrs. Billings enrolled in the ABC Medicare Advantage (MA)
plan several years ago. Her doctor recently confirmed a
diagnosis of end-stage renal disease (ESRD). What options
does Mrs.
Billings have in regard to her MA plan during the next open
enrollment season?
,She may remain in her ABC MA plan or enroll in a Special
Needs Plan (SNP) for individuals suffering from ESRD if
one is available in her area
Mr. Kumar is considering a Medicare Advantage HMO and
has questions about his ability to access providers. What
should you tell him?
In most Medicare Advantage HMOs, Mr. Kumar must
obtain his services only from providers who have a
contractual relationship with the plan (except in an
emergency)
,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?
Beneficiaries should check with their employer or union
group benefits administrator before changing plans to
avoid losing coverage they want to keep
Mrs. Walters is enrolled in her state’s Medicaid program in
addition to Medicare. What should she be aware of when
considering enrollment in a Medicare Health Plan?
Medicaid will coordinate benefits only with Medicaid participating
providers.
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?
Medicaid may provide additional benefits, but Medicaid
will coordinate benefits only with Medicaid participating
providers.
, Mr. Rivera has QMB-Plus eligibility and is thus covered by
both Medicare and Medicaid. He decides to enroll in a
Medicare Advantage (MA) plan. Later in the year, Mr. Rivera
needs dentures, a service only covered under Medicaid.
What action would you recommend he take in order to have
this cost covered?
He should go to a Medicaid provider or obtain the services
through a Medicaid manage care plan if he is enrolled in
one
Ms. Moore plans to retire when she turns 65 in a few months.
She is in excellent health and will have considerable income
when she retires. She is concerned that her income will
make it impossible for her to qualify for Medicare. What
could you tell her to address her concern?
Medicare is a program for people age 65 or older and those
under age 65 with certain disabilities, end stage renal disease
or Lou Gehrig’s disease, so she will be eligible for Medicare
Mrs. Willard wants to know generally how the benefits
under Original Medicare might compare to the benefit
package of a Medicare Health Plan before she starts looking
at specific plans.
