2022 AHIP UNIT 2
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?
a. He could enroll in the MA-only PPO plan and a stand-alone Medicare prescription drug plan
, b. 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.
c.He cannot enroll in a stand-alone prescription drug plan because you do not represent such a plan.
d.He could enroll in the MA-only plan and purchase a Medigap plan with drug coverage.
Source: Module 2, Slide - MA & Prescription Drugs.
Question 2
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would
have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD
coverage has been very good. However, when he received the bill, he was surprised to see large charges
in excess of his maximum out-of-pocket limit that included some services and items he thought would be
fully covered. He called you to ask what he could do? What could you tell him?
a.You can offer to review the plans appeal process to help him ask the plan to review the coverage
decision.
b.You could remind him that he cannot do anything until the next Annual Election Period when he will
have an opportunity to change plans.
c.You could suggest he call the doctor who performed the surgery to complain about the costs and ask
for a discount on the charges.
d.You could reassure him that such charges are typical, but if he needs assistance in paying, he should
apply to the state for Medicaid assistance.
Source: Module 2, Slide - Enrollee Protections, Slide - Enrollee Protections: Complaints, Coverage
Decisions, Appeals
Question 3
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?
a.They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
b.They are custodial long-term care plans for people with Medicare.
c.They are Medigap Supplemental plans that fill in the gaps not covered by Medicare.
d.They are major medical policies but are only for low-income beneficiaries with Medicare.
Source: Module 2, Slide - Medicare Advantage Plans (Overview).
Question 4
Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What
should you tell her?
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?
a. He could enroll in the MA-only PPO plan and a stand-alone Medicare prescription drug plan
, b. 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.
c.He cannot enroll in a stand-alone prescription drug plan because you do not represent such a plan.
d.He could enroll in the MA-only plan and purchase a Medigap plan with drug coverage.
Source: Module 2, Slide - MA & Prescription Drugs.
Question 2
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would
have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD
coverage has been very good. However, when he received the bill, he was surprised to see large charges
in excess of his maximum out-of-pocket limit that included some services and items he thought would be
fully covered. He called you to ask what he could do? What could you tell him?
a.You can offer to review the plans appeal process to help him ask the plan to review the coverage
decision.
b.You could remind him that he cannot do anything until the next Annual Election Period when he will
have an opportunity to change plans.
c.You could suggest he call the doctor who performed the surgery to complain about the costs and ask
for a discount on the charges.
d.You could reassure him that such charges are typical, but if he needs assistance in paying, he should
apply to the state for Medicaid assistance.
Source: Module 2, Slide - Enrollee Protections, Slide - Enrollee Protections: Complaints, Coverage
Decisions, Appeals
Question 3
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?
a.They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
b.They are custodial long-term care plans for people with Medicare.
c.They are Medigap Supplemental plans that fill in the gaps not covered by Medicare.
d.They are major medical policies but are only for low-income beneficiaries with Medicare.
Source: Module 2, Slide - Medicare Advantage Plans (Overview).
Question 4
Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What
should you tell her?
