AHIP - 2
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.
3 multiple choice options
We have an expert-written solution to this problem!
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 multiple choice options
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).
3 multiple choice options
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.
3 multiple choice options
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.
3 multiple choice options
, 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
3 multiple choice options
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.
3 multiple choice options
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.
3 multiple choice options
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.
3 multiple choice options
We have an expert-written solution to this problem!
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for
treatment. How much may Dr. Brennan charge?
Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the
PFFS plan's terms and condition of payment which may include balance billing up to
15%of the Medicare rate.
3 multiple choice options
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.
3 multiple choice options
We have an expert-written solution to this problem!
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 multiple choice options
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).
3 multiple choice options
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.
3 multiple choice options
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.
3 multiple choice options
, 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
3 multiple choice options
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.
3 multiple choice options
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.
3 multiple choice options
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.
3 multiple choice options
We have an expert-written solution to this problem!
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for
treatment. How much may Dr. Brennan charge?
Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the
PFFS plan's terms and condition of payment which may include balance billing up to
15%of the Medicare rate.
3 multiple choice options
