AHIP 2023 Module 2, AHIP 2023 Module 1, AHIP 2023 Module 3, AHIP 202
module 4, AHHIP 2023 Module 5
Study online at https://quizlet.com/_c07pp8
1. Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled
in Part B because he has coverage through an employer plan. If he wants to
enroll in a Medicare Advantage plan, what will he have to do?: He will have to enroll in
Part B.
2. 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 Advantage (MA) plan?: She cannot enroll in an MA Medical Savings Account (MSA) plan.
3. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his
area has an attractive premium. He wants to know if he must use doctors in
a network as his current HMO plan requires him to do. What should you tell
him?: He 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 agrees to accept the PFFS plan's payment terms and conditions, which
could include balance billing.
4. Ms. Gibson recently lost her employer group health and drug coverage and
now she wants to enroll in a PPO that does not include drug coverage. What
should you tell her about obtaining drug coverage?: She can enroll in the PPO, but she will
not be able to purchase a stand-alone Medicare Part D prescription drug plan.
5. Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She
is considering enrollment in a Medicare Advantage plan (Part C). What should
you advise her to do before she will be able to enroll in a Medicare Advantage
plan?: To join a Medicare Advantage plan, she also must enroll in Part B.
6. 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 only pay for these services if they are furnished by Medicaid participating providers.
7. 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 generally obtain his services only from providers within the plan's network (except
in an emergency or where care is unavailable within the network).
8. Juan Perez, who is turning age 65 next month, intends to work for several
more years at Smallcap, Incorporated. Smallcap has a workforce of 15 employ-
, AHIP 2023 Module 2, AHIP 2023 Module 1, AHIP 2023 Module 3, AHIP 202
module 4, AHHIP 2023 Module 5
Study online at https://quizlet.com/_c07pp8
ees and offers employer-sponsored healthcare coverage. Juan is a naturalized
citizen and has contributed to the Medicare system for over 20 years. Juan asks
you if he will be entitled to Medicare and if he enrolls how that will impact his
employer-sponsored healthcare coverage. How would you respond?: Juan is likely
to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his
healthcare claims and Smallcap does not have to continue to offer him coverage comparable to those under age 65
under its employer-sponsored group health plan.
9. 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?: 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.
10. Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis,
putting him at severe risk for pneumonia. Otherwise, he has no problems
functioning. Which type of SNP is likely to be most appropriate for him?: C-SNP
11. 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
stand-alone Medicare prescription drug plan. What should you tell him about
this situation?: He could enroll either in one of the MA plans that include prescription drug coverage or Original
Medicare with a Medigap plan and standalone Part D prescription drug coverage, but he cannot enroll in the MA-only
PPO plan and a stand-alone prescription drug plan.
12. Mr. Romero is 64, retiring soon, and considering enrollment in his em-
ployer-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?: 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.
, AHIP 2023 Module 2, AHIP 2023 Module 1, AHIP 2023 Module 3, AHIP 202
module 4, AHHIP 2023 Module 5
Study online at https://quizlet.com/_c07pp8
13. 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?: 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.
14. 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 (SNPs). What could you
tell him?: SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide
prescription drug coverage that could be very helpful as well.
15. Mrs. Willard 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?: Medicare
Advantage Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental
services and must include a maximum out-of-pocket limit on Part A and Part B services.
16. 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 in
Original Medicare and a standalone Part D plan. How would you advise Mrs.
Chi?: Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D prescription drug plan.
17. 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?: They are Medicare health
plans such as HMOs, PPOs, PFFS, and MSAs.
18. Which of the following statement(s) is/are correct about a Medicare Savings
Account (MSA) Plans?
module 4, AHHIP 2023 Module 5
Study online at https://quizlet.com/_c07pp8
1. Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled
in Part B because he has coverage through an employer plan. If he wants to
enroll in a Medicare Advantage plan, what will he have to do?: He will have to enroll in
Part B.
2. 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 Advantage (MA) plan?: She cannot enroll in an MA Medical Savings Account (MSA) plan.
3. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his
area has an attractive premium. He wants to know if he must use doctors in
a network as his current HMO plan requires him to do. What should you tell
him?: He 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 agrees to accept the PFFS plan's payment terms and conditions, which
could include balance billing.
4. Ms. Gibson recently lost her employer group health and drug coverage and
now she wants to enroll in a PPO that does not include drug coverage. What
should you tell her about obtaining drug coverage?: She can enroll in the PPO, but she will
not be able to purchase a stand-alone Medicare Part D prescription drug plan.
5. Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She
is considering enrollment in a Medicare Advantage plan (Part C). What should
you advise her to do before she will be able to enroll in a Medicare Advantage
plan?: To join a Medicare Advantage plan, she also must enroll in Part B.
6. 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 only pay for these services if they are furnished by Medicaid participating providers.
7. 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 generally obtain his services only from providers within the plan's network (except
in an emergency or where care is unavailable within the network).
8. Juan Perez, who is turning age 65 next month, intends to work for several
more years at Smallcap, Incorporated. Smallcap has a workforce of 15 employ-
, AHIP 2023 Module 2, AHIP 2023 Module 1, AHIP 2023 Module 3, AHIP 202
module 4, AHHIP 2023 Module 5
Study online at https://quizlet.com/_c07pp8
ees and offers employer-sponsored healthcare coverage. Juan is a naturalized
citizen and has contributed to the Medicare system for over 20 years. Juan asks
you if he will be entitled to Medicare and if he enrolls how that will impact his
employer-sponsored healthcare coverage. How would you respond?: Juan is likely
to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his
healthcare claims and Smallcap does not have to continue to offer him coverage comparable to those under age 65
under its employer-sponsored group health plan.
9. 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?: 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.
10. Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis,
putting him at severe risk for pneumonia. Otherwise, he has no problems
functioning. Which type of SNP is likely to be most appropriate for him?: C-SNP
11. 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
stand-alone Medicare prescription drug plan. What should you tell him about
this situation?: He could enroll either in one of the MA plans that include prescription drug coverage or Original
Medicare with a Medigap plan and standalone Part D prescription drug coverage, but he cannot enroll in the MA-only
PPO plan and a stand-alone prescription drug plan.
12. Mr. Romero is 64, retiring soon, and considering enrollment in his em-
ployer-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?: 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.
, AHIP 2023 Module 2, AHIP 2023 Module 1, AHIP 2023 Module 3, AHIP 202
module 4, AHHIP 2023 Module 5
Study online at https://quizlet.com/_c07pp8
13. 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?: 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.
14. 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 (SNPs). What could you
tell him?: SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide
prescription drug coverage that could be very helpful as well.
15. Mrs. Willard 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?: Medicare
Advantage Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental
services and must include a maximum out-of-pocket limit on Part A and Part B services.
16. 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 in
Original Medicare and a standalone Part D plan. How would you advise Mrs.
Chi?: Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D prescription drug plan.
17. 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?: They are Medicare health
plans such as HMOs, PPOs, PFFS, and MSAs.
18. Which of the following statement(s) is/are correct about a Medicare Savings
Account (MSA) Plans?
