Medicare AHIP Module 2 questions and 100% verified correct answers
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? - Correct 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? - Correct 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? - Correct 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. - Correct 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? - Correct Answer
SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current
situation, he is unlikely to qualify and would not be able to enroll in the SNP.
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? -
Correct Answer He should compare the benefits in his employer-sponsored retiree
group health plan with the benefits in his neighbor's MA-PD plan to determine which one
will provide sufficient coverage for his prescription needs.
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? - Correct 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? - Correct 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? - Correct 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. - Correct 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? - Correct Answer
SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current
situation, he is unlikely to qualify and would not be able to enroll in the SNP.
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? -
Correct Answer He should compare the benefits in his employer-sponsored retiree
group health plan with the benefits in his neighbor's MA-PD plan to determine which one
will provide sufficient coverage for his prescription needs.
