AHIP Certification 2025: Module 3
Test Bank with Verified Q&A | Your
Key to Passing First Time
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? - CORRECT ANSWERSHe will have to enroll
in Part B.
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? - CORRECT ANSWERSShe 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? - CORRECT
ANSWERSHe 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? - CORRECT ANSWERSShe 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? - CORRECT
ANSWERSTo 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? - CORRECT ANSWERSMedicaid 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? - CORRECT ANSWERSIn 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? - CORRECT ANSWERSJuan 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? - CORRECT ANSWERSDr. 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? - CORRECT ANSWERSC-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? - CORRECT ANSWERSHe 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? -
CORRECT ANSWERSHe 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.
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 ANSWERSAll 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.
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? - CORRECT
ANSWERSSNPs have special programs for enrollees with chronic conditions, like Mr.
Sinclair, and they provide prescription drug coverage that could be very helpful as well.
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? - CORRECT ANSWERSMedicare
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.
Test Bank with Verified Q&A | Your
Key to Passing First Time
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? - CORRECT ANSWERSHe will have to enroll
in Part B.
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? - CORRECT ANSWERSShe 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? - CORRECT
ANSWERSHe 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? - CORRECT ANSWERSShe 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? - CORRECT
ANSWERSTo 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? - CORRECT ANSWERSMedicaid 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? - CORRECT ANSWERSIn 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? - CORRECT ANSWERSJuan 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? - CORRECT ANSWERSDr. 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? - CORRECT ANSWERSC-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? - CORRECT ANSWERSHe 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? -
CORRECT ANSWERSHe 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.
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 ANSWERSAll 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.
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? - CORRECT
ANSWERSSNPs have special programs for enrollees with chronic conditions, like Mr.
Sinclair, and they provide prescription drug coverage that could be very helpful as well.
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? - CORRECT ANSWERSMedicare
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.
