AHIP Final & Module 1–5 Test Bank |
Verified Questions and Answers Study
Pack Graded A+ Success
• 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.
• 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.
• 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.
• 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.
• 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.
• 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).
• 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 employees 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.
, • 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.
• 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
• 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.
• 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? -
Verified Questions and Answers Study
Pack Graded A+ Success
• 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.
• 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.
• 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.
• 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.
• 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.
• 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).
• 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 employees 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.
, • 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.
• 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
• 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.
• 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? -
