AHIP 2025 MOD II| ALL QUESTIONS & 100% CORRECT
VERIFIED ANSWERS
1. Mrs. Lyons is in good health, uses a single prescription, and lives indepen-
dently in her own home. She is attracted by the idea of maintaining control
over a Medical Savings Account (MSA) but is not sure if the plan associated
with the account will fit her needs. What specific piece of information about a
Medicare MSA plan would it be important for her to know, prior to enrolling in
such a plan? ANS >> All MSAs cover Part A and Part B benefits, but not Part D
prescription drug benefits, which could be obtained by also enrolling in a separate
prescription drug plan.
2. Mrs. Velasquez cares for her frail elderly mother, Maria, who lives in North
Carolina. She is worried that without additional support, her mother will need
to go into a nursing home. Mrs. Velasquez asks you if there is any Medicare
plan that might allow her mother to remain in the community rather than
going into a nursing home. How should you advise Mrs. Velasquez? ANS >>
There are Programs of All-Inclusive Care for the Elderly (PACE) for frail elderly
beneficiaries certified as needing a nursing home level of care but are able to live
safely in the community at the time of enrolment.
3. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts
the plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan
for treatment. How much may Dr. Brennan charge? ANS >> Dr. Brennan can
charge Mary Rogers no more than the cost sharing specified in the PFFS plan's
terms and condition of payment which may include balance billing up to 15%of the
Medicare rate.
4. Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income
level. 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 doctor
recently prescribed several expensive medications. Currently, she is enrolled
https://www.stuvia.com/user/Mboffin 1/6
, in Original Medicare and a standalone Part D plan. How would you advise Mrs.
Chi? ANS >> Mrs. Chi may enroll in a MA MSA plan and remain in her current
standalone Part D prescription drug plan.
5. Mr. Lopez has heard that he can sign up for a product called "Medicare
Advantage" but is not sure about what type of plan designs are available
through this program. What should you tell him about the types of health
plans that are available through the Medicare Advantage program? ANS >>
There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
6. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that
you represent. It is one of three plans operated by the same organization
in Mr. Lombardi's area. The MA PPO plan does not include drug coverage,
but the other two plans do. Mr. Lombardi likes the PPO plan that does not
include drug coverage and intends to obtain his drug coverage through a
https://www.stuvia.com/user/Mboffin 2/6
VERIFIED ANSWERS
1. Mrs. Lyons is in good health, uses a single prescription, and lives indepen-
dently in her own home. She is attracted by the idea of maintaining control
over a Medical Savings Account (MSA) but is not sure if the plan associated
with the account will fit her needs. What specific piece of information about a
Medicare MSA plan would it be important for her to know, prior to enrolling in
such a plan? ANS >> All MSAs cover Part A and Part B benefits, but not Part D
prescription drug benefits, which could be obtained by also enrolling in a separate
prescription drug plan.
2. Mrs. Velasquez cares for her frail elderly mother, Maria, who lives in North
Carolina. She is worried that without additional support, her mother will need
to go into a nursing home. Mrs. Velasquez asks you if there is any Medicare
plan that might allow her mother to remain in the community rather than
going into a nursing home. How should you advise Mrs. Velasquez? ANS >>
There are Programs of All-Inclusive Care for the Elderly (PACE) for frail elderly
beneficiaries certified as needing a nursing home level of care but are able to live
safely in the community at the time of enrolment.
3. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts
the plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan
for treatment. How much may Dr. Brennan charge? ANS >> Dr. Brennan can
charge Mary Rogers no more than the cost sharing specified in the PFFS plan's
terms and condition of payment which may include balance billing up to 15%of the
Medicare rate.
4. Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income
level. 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 doctor
recently prescribed several expensive medications. Currently, she is enrolled
https://www.stuvia.com/user/Mboffin 1/6
, in Original Medicare and a standalone Part D plan. How would you advise Mrs.
Chi? ANS >> Mrs. Chi may enroll in a MA MSA plan and remain in her current
standalone Part D prescription drug plan.
5. Mr. Lopez has heard that he can sign up for a product called "Medicare
Advantage" but is not sure about what type of plan designs are available
through this program. What should you tell him about the types of health
plans that are available through the Medicare Advantage program? ANS >>
There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
6. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that
you represent. It is one of three plans operated by the same organization
in Mr. Lombardi's area. The MA PPO plan does not include drug coverage,
but the other two plans do. Mr. Lombardi likes the PPO plan that does not
include drug coverage and intends to obtain his drug coverage through a
https://www.stuvia.com/user/Mboffin 2/6
