AHIP Module 2 Exam Review – Medicare
Advantage Plans, SNPs, HMOs, PPOs &
PFFS|Verified Questions Provided with
A+|| LATEST UPDATE
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.
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?
She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.
Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-
service (PFFS) plan. What questions would you need to ask to determine his
eligibility?
You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he
lives in the PFFS plan's service area.
, 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.
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.
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?
There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
Mrs. Velasquez cares for her frail elderly mother, Maria, who lives in North
Carolina. She is worried that without additional support, her mother will need to
go into a nursing home. Mrs. Velasquez asks you if there is any Medicare plan
that might allow her mother to remain in the community rather than going into a
nursing home. How should you advise Mrs. Velasquez?
There are Programs of All-Inclusive Care for the Elderly (PACE) for frail elderly
beneficiaries certified as needing a nursing home level of care but are able to live safely
in the community at the time of enrolment.
Advantage Plans, SNPs, HMOs, PPOs &
PFFS|Verified Questions Provided with
A+|| LATEST UPDATE
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.
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?
She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.
Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-
service (PFFS) plan. What questions would you need to ask to determine his
eligibility?
You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he
lives in the PFFS plan's service area.
, 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.
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.
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?
There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
Mrs. Velasquez cares for her frail elderly mother, Maria, who lives in North
Carolina. She is worried that without additional support, her mother will need to
go into a nursing home. Mrs. Velasquez asks you if there is any Medicare plan
that might allow her mother to remain in the community rather than going into a
nursing home. How should you advise Mrs. Velasquez?
There are Programs of All-Inclusive Care for the Elderly (PACE) for frail elderly
beneficiaries certified as needing a nursing home level of care but are able to live safely
in the community at the time of enrolment.
