AHIP - 2
Study online at https://quizlet.com/_9lc9i9
1. Mr. Wells is trying to understand the dif- Medicare Advantage is a way of cover-
ference between Original Medicare and ing all the Original Medicare benefits
Medicare Advantage. What would be the cor- through private health insurance com-
rect description? panies.
2. Mr. Lopez has heard that he can sign up for They are Medicare health plans such as
a product called "Medicare Advantage" but is HMOs, PPOs, PFFS, and MSAs.
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 Ad-
vantage program?
3. Mr. Kumar is considering a Medicare Advan- In most Medicare Advantage HMOs, Mr.
tage HMO and has questions about his ability Kumar must generally obtain his ser-
to access providers. What should you tell him? vices 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 He is not eligible to enroll in a Medicare
enrolled in Medicare Part B but has recently Advantage plan until he re-enrolls in
stopped paying his Part B premium. Mr. Castil- Medicare Part B.
lo 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?
5. Mrs. Walters is enrolled in her state's Med- She cannot enroll in an MA Medical Sav-
icaid program in addition to Medicare. What ings Account (MSA) plan.
should she be aware of when considering en-
rollment in a Medicare Advantage (MA) plan?
1/8
, AHIP - 2
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6. Daniel is a middle-income Medicare beneficia- C-SNP
ry. 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?
7. Mrs. Burton is a retiree with substantial in- She could file a grievance with her plan
come. She is enrolled in an MA-PD plan and to complain about the lack of timeliness
was disappointed with the service she re- in getting an appointment.
ceived from her primary care physician be-
cause 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?
8. Mr. Greco is in excellent health, lives in his SNPs limit enrollment to certain sub-
own home, and has a sizeable income from populations of beneficiaries. Given his
his investments. He has a friend enrolled in current situation, he is unlikely to qualify
a Medicare Advantage Special Needs Plan and would not be able to enroll in the
(SNP). His friend has mentioned that the SNP SNP.
charges very low cost-sharing amounts and
Mr. Greco would like to join that plan. What
should you tell him?
9. Ms. Gibson recently lost her employer group She can enroll in the PPO, but she will
health and drug coverage and now she wants not be able to purchase a stand-alone
to enroll in a PPO that does not include drug Medicare Part D prescription drug plan.
coverage. What should you tell her about ob-
taining drug coverage?
10.
2/8
Study online at https://quizlet.com/_9lc9i9
1. Mr. Wells is trying to understand the dif- Medicare Advantage is a way of cover-
ference between Original Medicare and ing all the Original Medicare benefits
Medicare Advantage. What would be the cor- through private health insurance com-
rect description? panies.
2. Mr. Lopez has heard that he can sign up for They are Medicare health plans such as
a product called "Medicare Advantage" but is HMOs, PPOs, PFFS, and MSAs.
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 Ad-
vantage program?
3. Mr. Kumar is considering a Medicare Advan- In most Medicare Advantage HMOs, Mr.
tage HMO and has questions about his ability Kumar must generally obtain his ser-
to access providers. What should you tell him? vices 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 He is not eligible to enroll in a Medicare
enrolled in Medicare Part B but has recently Advantage plan until he re-enrolls in
stopped paying his Part B premium. Mr. Castil- Medicare Part B.
lo 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?
5. Mrs. Walters is enrolled in her state's Med- She cannot enroll in an MA Medical Sav-
icaid program in addition to Medicare. What ings Account (MSA) plan.
should she be aware of when considering en-
rollment in a Medicare Advantage (MA) plan?
1/8
, AHIP - 2
Study online at https://quizlet.com/_9lc9i9
6. Daniel is a middle-income Medicare beneficia- C-SNP
ry. 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?
7. Mrs. Burton is a retiree with substantial in- She could file a grievance with her plan
come. She is enrolled in an MA-PD plan and to complain about the lack of timeliness
was disappointed with the service she re- in getting an appointment.
ceived from her primary care physician be-
cause 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?
8. Mr. Greco is in excellent health, lives in his SNPs limit enrollment to certain sub-
own home, and has a sizeable income from populations of beneficiaries. Given his
his investments. He has a friend enrolled in current situation, he is unlikely to qualify
a Medicare Advantage Special Needs Plan and would not be able to enroll in the
(SNP). His friend has mentioned that the SNP SNP.
charges very low cost-sharing amounts and
Mr. Greco would like to join that plan. What
should you tell him?
9. Ms. Gibson recently lost her employer group She can enroll in the PPO, but she will
health and drug coverage and now she wants not be able to purchase a stand-alone
to enroll in a PPO that does not include drug Medicare Part D prescription drug plan.
coverage. What should you tell her about ob-
taining drug coverage?
10.
2/8
