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2025 AHIP MODUEL 2 BRAND
NEW OFFICIAL QUESTIONS
WITH ANSWERS.
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? - correct answer -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.
Mrs. Wang wants to know generally how the benefits under
Original Medicare might compare to the benefits package of a
Medicare Advantage Plan before she starts looking at specific
plans. What could you tell her? - correct answer -Medicare
Advantage Plans may offer extra benefits that Original Medicare
does not offer such as vision, hearing, and dental services. It
must include a maximum out-of-pocket limit on Part A and Part B
services.
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Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in
her area that does not include drug coverage. She wants to enroll
in the plan and enroll in a stand-alone prescription drug plan.
What should you tell her? - correct answer -She could enroll in a
PFFS plan and a stand-alone Medicare prescription drug plan.
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? - correct answer -There are
Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
Mr. Barker enjoys a comfortable retirement income. He recently
had surgery and expected that he would have certain services
and items covered by the plan with minimal out-of-pocket costs
because his MA-PD coverage has been very good. However,
when he received the bill, he was surprised to see large charges
in excess of his maximum out-of-pocket limit that included some
services and items he thought would be fully covered. He called
you to ask what he could do? What could you tell him? - correct
answer -You can offer to review the plans appeal process to help
him ask the plan to review the coverage decision.
2025 AHIP MODUEL 2 BRAND
NEW OFFICIAL QUESTIONS
WITH ANSWERS.
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? - correct answer -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.
Mrs. Wang wants to know generally how the benefits under
Original Medicare might compare to the benefits package of a
Medicare Advantage Plan before she starts looking at specific
plans. What could you tell her? - correct answer -Medicare
Advantage Plans may offer extra benefits that Original Medicare
does not offer such as vision, hearing, and dental services. It
must include a maximum out-of-pocket limit on Part A and Part B
services.
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Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in
her area that does not include drug coverage. She wants to enroll
in the plan and enroll in a stand-alone prescription drug plan.
What should you tell her? - correct answer -She could enroll in a
PFFS plan and a stand-alone Medicare prescription drug plan.
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? - correct answer -There are
Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
Mr. Barker enjoys a comfortable retirement income. He recently
had surgery and expected that he would have certain services
and items covered by the plan with minimal out-of-pocket costs
because his MA-PD coverage has been very good. However,
when he received the bill, he was surprised to see large charges
in excess of his maximum out-of-pocket limit that included some
services and items he thought would be fully covered. He called
you to ask what he could do? What could you tell him? - correct
answer -You can offer to review the plans appeal process to help
him ask the plan to review the coverage decision.
