AHIP Module 2 EXAM
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? - c. They are
Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. Correct
Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be a correct description? - a. Medicare Advantage is a way of covering all
the Original Medicare benefits through private health insurance companies. Correct
Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage.
What should you tell her? - b. Mrs. Radford must be entitled to Part A and enrolled in Part B to
enroll in Medicare Advantage. Correct
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped
paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll in a
Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him? - a. He is
not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Correct
Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor
recently confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs. Billings
have in regard to her MA plan during the next open enrollment season? - a. She may remain in her
ABC MA plan or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is
available in her area. Correct
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? - a. C-SNP Correct
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? - d. In most Medicare Advantage HMOs, Mr. Kumar must
obtain his services only from providers who have a contractual relationship with the plan (except in
an emergency). Correct
, Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she
can go to for her health care. What should you tell her? - b. Mrs. Ramos can obtain care from any
provider who participates in Original Medicare, but generally will have a higher cost-sharing
amount if she sees a provider who/that is not part of the PPO network. Correct
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? - b. SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful
as well. Correct
Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his
investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend
has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join
that plan. What should you tell him? - b. SNPs limit enrollment to certain sub-populations of
beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in
the SNP. Correct
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 like his current HMO plan requires
him to do. What should you tell him? - b. 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.
Correct
Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-Service (PFFS) plan.
As part of that discussion, what should you be sure to tell her? - c. PFFS plans may choose to offer
Part D benefits but are not required to do so. Correct
Mr. McTaggert notes that a Private Fee-for-Service (PFFS) plan available in his area has an
attractive premium. He wants to know what makes them different from an HMO or a PPO. What
should you tell him? - d. Enrollees in a PFFS plan can obtain care from any provider in the U.S. who
accepts Original Medicare, as long as the provider has a reasonable opportunity to access the plan's
terms and conditions and agrees to accept them. Correct
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? - c. They are
Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. Correct
Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be a correct description? - a. Medicare Advantage is a way of covering all
the Original Medicare benefits through private health insurance companies. Correct
Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage.
What should you tell her? - b. Mrs. Radford must be entitled to Part A and enrolled in Part B to
enroll in Medicare Advantage. Correct
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped
paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll in a
Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him? - a. He is
not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Correct
Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor
recently confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs. Billings
have in regard to her MA plan during the next open enrollment season? - a. She may remain in her
ABC MA plan or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is
available in her area. Correct
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? - a. C-SNP Correct
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? - d. In most Medicare Advantage HMOs, Mr. Kumar must
obtain his services only from providers who have a contractual relationship with the plan (except in
an emergency). Correct
, Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she
can go to for her health care. What should you tell her? - b. Mrs. Ramos can obtain care from any
provider who participates in Original Medicare, but generally will have a higher cost-sharing
amount if she sees a provider who/that is not part of the PPO network. Correct
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? - b. SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful
as well. Correct
Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his
investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend
has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join
that plan. What should you tell him? - b. SNPs limit enrollment to certain sub-populations of
beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in
the SNP. Correct
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 like his current HMO plan requires
him to do. What should you tell him? - b. 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.
Correct
Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-Service (PFFS) plan.
As part of that discussion, what should you be sure to tell her? - c. PFFS plans may choose to offer
Part D benefits but are not required to do so. Correct
Mr. McTaggert notes that a Private Fee-for-Service (PFFS) plan available in his area has an
attractive premium. He wants to know what makes them different from an HMO or a PPO. What
should you tell him? - d. Enrollees in a PFFS plan can obtain care from any provider in the U.S. who
accepts Original Medicare, as long as the provider has a reasonable opportunity to access the plan's
terms and conditions and agrees to accept them. Correct
