AHIP 2023 Module 2 Questions and
Answers Graded A
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? ✔✔He 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? ✔✔She
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? ✔✔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.
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? ✔✔She 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? ✔✔To 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? ✔✔Medicaid 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? ✔✔In 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
Answers Graded A
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? ✔✔He 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? ✔✔She
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? ✔✔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.
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? ✔✔She 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? ✔✔To 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? ✔✔Medicaid 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? ✔✔In 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
