2025/2026 AHIP MODULE 2 QUESTIONS
WITH VERIFIED ANSWERS
Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What s
hould you tell her? - correct answer-
Mrs. Radford must be entitled to Part AKand enrolled in Part B to enroll in Medicare Advantage.
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.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under
Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNP
s). What could you tell him? - correct answer-
SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide pres
cription drug coverage that could be very helpful as well
, Mrs. Lyons is in good health, uses a single prescription, and lives independently 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? - correct answer-
All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be obta
ined by also enrolling in a separate prescription drug plan.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditi
ons for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge? -
correct answer-
Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan's terms an
d condition of payment which may include balance billing up to 15%of the Medicare rate.
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 h
ave a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO network.
WITH VERIFIED ANSWERS
Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What s
hould you tell her? - correct answer-
Mrs. Radford must be entitled to Part AKand enrolled in Part B to enroll in Medicare Advantage.
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.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under
Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNP
s). What could you tell him? - correct answer-
SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide pres
cription drug coverage that could be very helpful as well
, Mrs. Lyons is in good health, uses a single prescription, and lives independently 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? - correct answer-
All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be obta
ined by also enrolling in a separate prescription drug plan.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditi
ons for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge? -
correct answer-
Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan's terms an
d condition of payment which may include balance billing up to 15%of the Medicare rate.
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 h
ave a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO network.
