AHIP MEDICARE CERTIFICATION: MODULE 2
EXAM ASSESSMENT
1. Which of the following is a characteristic of a Medicare Advantage (Part C) HMO
plan?
A) Members can see any doctor without a referral.
B) Members are required to use a network of doctors and obtain referrals for specialist
care.
C) It does not require a primary care physician (PCP).
D) It is only available to individuals with disabilities.
Answer:
B) Members are required to use a network of doctors and obtain referrals for specialist
care.
Rationale:
Medicare Advantage HMO plans require members to use a specific network of healthcare
providers and obtain referrals for specialist care.
2. What is the main benefit of enrolling in a Medicare Advantage PPO plan over an
HMO plan?
A) Lower premiums.
B) Greater flexibility in choosing healthcare providers without referrals.
C) Coverage for dental and vision services.
D) No need to follow network restrictions.
Answer:
B) Greater flexibility in choosing healthcare providers without referrals.
Rationale:
PPO plans provide greater flexibility by allowing members to see any doctor or specialist,
both in and out of network, without a referral, although out-of-network care may cost more.
3. What is the role of a primary care physician (PCP) in a Medicare Advantage HMO
plan?
A) The PCP is responsible for managing the member's healthcare and providing
referrals to specialists.
B) The PCP only provides emergency care and is not involved in routine care.
C) The PCP is responsible for providing coverage for medications.
, D) The PCP provides all services, including hospitalization and specialty care.
Answer:
A) The PCP is responsible for managing the member's healthcare and providing
referrals to specialists.
Rationale:
In an HMO plan, the PCP manages the overall healthcare and coordinates referrals to
specialists when necessary.
4. Which of the following is NOT a benefit typically offered by Medicare Advantage
plans?
A) Prescription drug coverage.
B) Vision and dental care.
C) Hospital inpatient care.
D) Long-term care services.
Answer:
D) Long-term care services.
Rationale:
Medicare Advantage plans generally offer coverage for hospital inpatient care, outpatient
services, and sometimes extra benefits like vision and dental care, but they do not cover long-
term care services.
5. Which type of Medicare Advantage plan combines both Medicare Part A, Part B, and
often Part D coverage into one plan?
A) HMO (Health Maintenance Organization)
B) PPO (Preferred Provider Organization)
C) PFFS (Private Fee-for-Service)
D) SNP (Special Needs Plan)
Answer:
A) HMO (Health Maintenance Organization)
Rationale:
HMO plans are a type of Medicare Advantage plan that integrates coverage from Medicare
Parts A and B and often Part D into a single plan.
6. What does a Special Needs Plan (SNP) focus on?
EXAM ASSESSMENT
1. Which of the following is a characteristic of a Medicare Advantage (Part C) HMO
plan?
A) Members can see any doctor without a referral.
B) Members are required to use a network of doctors and obtain referrals for specialist
care.
C) It does not require a primary care physician (PCP).
D) It is only available to individuals with disabilities.
Answer:
B) Members are required to use a network of doctors and obtain referrals for specialist
care.
Rationale:
Medicare Advantage HMO plans require members to use a specific network of healthcare
providers and obtain referrals for specialist care.
2. What is the main benefit of enrolling in a Medicare Advantage PPO plan over an
HMO plan?
A) Lower premiums.
B) Greater flexibility in choosing healthcare providers without referrals.
C) Coverage for dental and vision services.
D) No need to follow network restrictions.
Answer:
B) Greater flexibility in choosing healthcare providers without referrals.
Rationale:
PPO plans provide greater flexibility by allowing members to see any doctor or specialist,
both in and out of network, without a referral, although out-of-network care may cost more.
3. What is the role of a primary care physician (PCP) in a Medicare Advantage HMO
plan?
A) The PCP is responsible for managing the member's healthcare and providing
referrals to specialists.
B) The PCP only provides emergency care and is not involved in routine care.
C) The PCP is responsible for providing coverage for medications.
, D) The PCP provides all services, including hospitalization and specialty care.
Answer:
A) The PCP is responsible for managing the member's healthcare and providing
referrals to specialists.
Rationale:
In an HMO plan, the PCP manages the overall healthcare and coordinates referrals to
specialists when necessary.
4. Which of the following is NOT a benefit typically offered by Medicare Advantage
plans?
A) Prescription drug coverage.
B) Vision and dental care.
C) Hospital inpatient care.
D) Long-term care services.
Answer:
D) Long-term care services.
Rationale:
Medicare Advantage plans generally offer coverage for hospital inpatient care, outpatient
services, and sometimes extra benefits like vision and dental care, but they do not cover long-
term care services.
5. Which type of Medicare Advantage plan combines both Medicare Part A, Part B, and
often Part D coverage into one plan?
A) HMO (Health Maintenance Organization)
B) PPO (Preferred Provider Organization)
C) PFFS (Private Fee-for-Service)
D) SNP (Special Needs Plan)
Answer:
A) HMO (Health Maintenance Organization)
Rationale:
HMO plans are a type of Medicare Advantage plan that integrates coverage from Medicare
Parts A and B and often Part D into a single plan.
6. What does a Special Needs Plan (SNP) focus on?
