AHIP – 2 COMPLETE SOLUTION

AHIP – 2 COMPLETE SOLUTION 1. Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be the correct description?: Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies. 2. 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?: They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. 3. 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 who have a contractual relationship with the plan (except in an emergency or where care is unavailable within the network). 4. 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?: He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. 5. 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. 6. 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 7. Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and was disappointed with the service she received from her primary care physician because she was told she would have to wait five weeks to get an appointment when she was feeling ill. She called you to ask what she could do so she would not have to put up with such poor access to care. What could you tell her?: She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. 8. Mr. Greco is in excellent health, lives in his own home, and has a size- able 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?: SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP.