AHIP Module 2 Test
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. 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 coordinate
benefits only with Medicaid participating providers.
3. Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree
group health plan that includes drug coverage with nominal copays. He heard about a
neighbor’s MA-PD plan that you represent and because he takes numerous prescription drugs,
he is considering signing up for it. What should you tell him?
He should compare the benefits in his employer-sponsored retiree group health
plan with the benefits in his neighbor’s MA-PD plan to determine which one will
provide sufficient coverage for his prescription needs.
4. 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).
5. 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
6. Which of the following statement is/are correct about a Medicare Savings Account (MSA)
Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of
$500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would pay
them as payment in full.
I, II, and IV only
, 7. 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?
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.
8. Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her?
Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare
Advantage.
9. 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?
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.
10. 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?
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 a part of the PPO network.
11. Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. In
mid- February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD).
What options will Mrs. Davenport have regarding her MA plan during the next open
enrollment season?
She may remain in her ABC MA plan, enroll in another MA plan in her service area,
or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is
available in her area.
12. 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.
13. 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
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. 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 coordinate
benefits only with Medicaid participating providers.
3. Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree
group health plan that includes drug coverage with nominal copays. He heard about a
neighbor’s MA-PD plan that you represent and because he takes numerous prescription drugs,
he is considering signing up for it. What should you tell him?
He should compare the benefits in his employer-sponsored retiree group health
plan with the benefits in his neighbor’s MA-PD plan to determine which one will
provide sufficient coverage for his prescription needs.
4. 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).
5. 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
6. Which of the following statement is/are correct about a Medicare Savings Account (MSA)
Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of
$500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would pay
them as payment in full.
I, II, and IV only
, 7. 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?
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.
8. Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her?
Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare
Advantage.
9. 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?
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.
10. 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?
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 a part of the PPO network.
11. Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. In
mid- February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD).
What options will Mrs. Davenport have regarding her MA plan during the next open
enrollment season?
She may remain in her ABC MA plan, enroll in another MA plan in her service area,
or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is
available in her area.
12. 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.
13. 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
