AHIP2024 MODULE 2 Updated Questions
and Answers (2024/2025) (Verified
Answers)
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? - Ans>> 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.
Juan Hernandez is turning 65 next month, Juan legally entered the
United States over twenty years ago but is not a citizen. Since his entry
into the country, Juan has worked at Smallcap Incorporated and
contributed to the Medicare system. Juan suffers from diabetes. He will
soon retire and asks you if he can enroll in a Medicare Advantage plan
that you represent. How would you respond? - Ans>> Juan is eligible to
enroll in a Medicare Advantage as long as he is entitled to Part A and
enrolled in Part B. Juan should go to the Social Security website to
enroll in Medicare Part A and B if he has not done so already. Once he
is enrolled, he can choose a Medicare Advantage plan.
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? -
, Ans>> He is not eligible to enroll in a Medicare Advantage plan until he
re-enrolls in Medicare Part B.
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? - Ans>> 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. Kumar is considering a Medicare Advantage HMO and has
questions about his ability to access providers. What should you tell
him? - Ans>> In Medicare Advantage HMO plans, services provided by
primary care physicians are covered at 100%, but those of specialists
are covered at 80% ?
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-
income level. She wishes to enroll in a MA MSA plan that she heard
about from her neighbor. She also wants to have prescription drug
coverage since her doctor recently prescribed several expensive
medications. Currently, she is enrolled in Original Medicare and a
standalone Part D plan. How would you advise Mrs. Chi? - Ans>> Mrs.
Chi may enroll in a MA MSA plan and remain in her current standalone
Part D prescription drug plan.
Mr. Wells is trying to understand the difference between Original
Medicare and Medicare Advantage. What would be a correct
and Answers (2024/2025) (Verified
Answers)
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? - Ans>> 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.
Juan Hernandez is turning 65 next month, Juan legally entered the
United States over twenty years ago but is not a citizen. Since his entry
into the country, Juan has worked at Smallcap Incorporated and
contributed to the Medicare system. Juan suffers from diabetes. He will
soon retire and asks you if he can enroll in a Medicare Advantage plan
that you represent. How would you respond? - Ans>> Juan is eligible to
enroll in a Medicare Advantage as long as he is entitled to Part A and
enrolled in Part B. Juan should go to the Social Security website to
enroll in Medicare Part A and B if he has not done so already. Once he
is enrolled, he can choose a Medicare Advantage plan.
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? -
, Ans>> He is not eligible to enroll in a Medicare Advantage plan until he
re-enrolls in Medicare Part B.
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? - Ans>> 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. Kumar is considering a Medicare Advantage HMO and has
questions about his ability to access providers. What should you tell
him? - Ans>> In Medicare Advantage HMO plans, services provided by
primary care physicians are covered at 100%, but those of specialists
are covered at 80% ?
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-
income level. She wishes to enroll in a MA MSA plan that she heard
about from her neighbor. She also wants to have prescription drug
coverage since her doctor recently prescribed several expensive
medications. Currently, she is enrolled in Original Medicare and a
standalone Part D plan. How would you advise Mrs. Chi? - Ans>> Mrs.
Chi may enroll in a MA MSA plan and remain in her current standalone
Part D prescription drug plan.
Mr. Wells is trying to understand the difference between Original
Medicare and Medicare Advantage. What would be a correct
