AHIP TRAINING MODULE #2 Q & A ALL CORRECT
LOPEZ has heard that he can sign up for a product called MA, but is not sure about what type of plan designs are available through this program
(MA plan, types) Correct Answer: They are Medicare health plans such as HMO, PPO, PFFS, SNP AND MSA
WHA...
lopez has heard that he can sign up for a product called ma
but is not sure about what type of plan designs are avail
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AHIP TRAINING MODULE #2 Q & A ALL CORRECT
LOPEZ has heard that he can sign up for a product called MA, but is not sure about what type of plan
designs are available through this program
(MA plan, types) Correct Answer: They are Medicare health plans such as HMO, PPO, PFFS, SNP AND
MSA
WHALEN is trying to understand the difference between Original Medicare and MA.
(MA vs Original Medicare) Correct Answer: MA is a way of covering ALL of the Original Medicare
benefits through private health insurance companies.
During a sales presentation in Ms. Sully's home, she tells you that she has hearing about a type of
Medicare plan known as PFFS. She wants to know if this would be available to her.
(MA-PFFS) Correct Answer: A PFFS plan is one of various types of MA plans offered by private entities
and she may enroll in one if it is available in her area.
RADFORD asks whether there are any special eligibility requirement s for MA
(MA requirements/eligibility) Correct Answer: Mrs. Radford MUST be entitled to Part A and enrolled in
Part B to enroll in MA.
BASS lives on a limited fixed income and is concerned about the cost of healthcare. What should you tell
her about the sort of help available to low income individuals under the Medicare program?
(Help for individuals with limited income/resources) Correct Answer: As a Medicare beneficiary with
limited income/resources she may contact her State Medicaid agency to apply for assistance paying for
the Part B premium and cost sharing and Part D Rx coverage.
KUMAR is considering MA HMO and has questions about his ability to access providers.
(MA HMO providers) Correct Answer: In MOST MA HMO's, Mr. Kumar MUST obtain his services only
from providers who have a contractual relationship with the plan (Except in an Emergency)
RAMOS is considering a MA PPO and has questions about which providers she can go to for her health
care.
(MA PPO providers) Correct Answer: Mrs. Ramos can obtain care from any provider who participates in
Original Medicare, but generally will be charged a lower co-payment if she goes to one of the plan's
PREFERRED providers.
SINCLAIR has diabetes and heart trouble and is generally satisfied with the care he has received under
Original Medicare, but he would like to know more about MA SNP.
(MA SNP eligibility) Correct Answer: SNP's have special programs for enrollees with chronic conditions,
like Mr. Sinclair, and they provide Rx coverage that could be very helpful as well.
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 MA SNP. His friend has mentioned that the SNP charges very low cost sharing
amts. and Mr. Greco would like to join the plan.
, (MA SNP eligibility) Correct Answer: SNP LIMIT enrollment to certain sub-populations of beneficiaries.
Given his current situation, he is unlikely to qualify and would NOT be able to enroll in the SNP
GOMEZ notes that a PFFS plan available in his area has an attractive premium. He wants to know if he
must use doctors in a network like his current HMO plan requires him to do.
(MA PFFS providers) Correct Answer: 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.
LEE is discussing with you the possibility of enrolling in a PFFS plan. As part of the discussion, what
should you be sure to tell her?
(MA PFFS) Correct Answer: If she uses NON-NETWORK providers, he doctors and hospital could decide
whether to treat her on a VISIT BY VISIT basis.
McTAGGERT notes that a PFFS plan available in his area has an attractive premium. He wants to know
what makes them different from an HMO or a PPO.
(MA PFFS vs. HMO or PPO) Correct Answer: Enrollees in a PFFS plan can obtain care from ANY provider
in the US, who accepts Original Medicare, as long as the provider has a reasonable opportunity to access
the plan's terms and conditions and agrees to accept them.
Dr. Elizabeth Brennan does not contract with the PFFS plan, but accepts the plan's terms and conditions
for payment, how will she get paid?
(MA PFFS provider payment) Correct Answer: Generally, the PFFS plan will pay Dr. Brennan directly the
same amt. Original Medicare would pay her.
LYONS is in good health, uses a single Rx, and lives independently in her own home. She is attracted by
the idea of maintaining control over a MSA, but is not sure if the plan associated with the acct. will fit
her needs.
(MA MSA) Correct Answer: ALL MSA's cover Part A and Part B benefits, but NOT Part D Rx benefits,
which could be obtained by also enrolling in a separate Rx plan.
DAVIES is turning 65 next month. he would like to enroll in a Medicare health plan, but does not want to
be limited in terms of where he obtains his care. What should you tell him about how a Medicare cost
plan might fit his needs.
(MA costs) Correct Answer: Cost plan enrollees can choose to receive Medicare covered services under
the plan's benefits by going to plan network providers and paying plan cost sharing, or may receive
services from Non-network providers and pay cost-sharing due under Original Medicare.
ROMERO is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group
health plan that includes Rx coverage with nominal copays. He heard about a neighbor's MA-PD plan
that you represent and because he takes numerous Rx's, he is considering signing up for it.
(MA-PD_ Correct Answer: It is ALWAYS the best option to talk with his benefits administrator to see
whether he needs both an employer sponsored plan and a private MA-PD and what might happen if he
were to sign up for both.
WALTER'S is enrolled in her state's Medicaid program in addition to Medicare. What should she be
aware of when considering enrollment in a Medicare Health plan?
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