AHIP 2022 OVERVIEW of MEDICARE PROGRAM BASICS: CHOICE, ELIGIBILTY, AND BENEFITS MEDICARE HEALTH PLANS PART 2

2022 OVERVIEW of MEDICARE PROGRAM BASICS: CHOICE, ELIGIBILTY, AND BENEFITS

MEDICARE HEALTH PLANS




PART 2

1. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to
access providers. What should you tell him?

a. Mr. Kumar will be able to obtain routine care outside of the plan’s service area, but will pay a higher
co-payment (except in an emergency). Incorrect

b. In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from providers
who have a contractual relationship with the plan (except in an emergency or where care is unavailable
within the network). Correct

c. In Medicare Advantage HMO plans, services provided by primary care physicians are covered at 100%,
but those of specialists are covered at 80%. Incorrect

d. With any Medicare Advantage HMO, Mr. Kumar will be able to see any provider he likes, so long as
that provider participates in Original Medicare. Incorrect

2. Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her?

a. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
Correct

b. Even if Mrs. Radford has end-stage renal disease, she will be able to enroll in any Medicare Advantage
plan in her service area. Incorrect

c. Mrs. Radford must apply to the Medicare Advantage plan, which will include a medical review, prior to
being accepted and enrolled. Incorrect

d. Mrs. Radford can enroll in any Medicare Advantage plan that operates within the United States.
Incorrect