AHIP2024 MODULE 2 Exam Questions and
Correct Answers.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area
has an attractive premium. He wants to know if he must use doctors in a network
as his current HMO plan requires him to do. What should you tell him?
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.
Juan Hernandez is turning 65 next month, Juan legally entered the United States
over twenty years ago but is not a citizen. Since his entry into the country, Juan
has worked at Smallcap Incorporated and contributed to the Medicare system.
Juan suffers from diabetes. He will soon retire and asks you if he can enroll in a
Medicare Advantage plan that you represent. How would you respond?
Juan is eligible to enroll in a Medicare Advantage as long as he is entitled to Part A and
enrolled in Part B. Juan should go to the Social Security website to enroll in Medicare
Part A and B if he has not done so already. Once he is enrolled, he can choose a
Medicare Advantage plan.
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.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about
which providers she can go to for her health care. What should you tell her?
B. Mrs. Ramos can obtain care from any provider who participates in Original Medicare,
but generally will have a higher cost-sharing amount if she sees a provider who/that is
not part of the PPO network. Correct
Mr. Kumar is considering a Medicare Advantage HMO and has questions about
his ability to access providers. What should you tell him?
In Medicare Advantage HMO plans, services provided by primary care physicians are
covered at 100%, but those of specialists are covered at 80% ?
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level.
She wishes to enroll in a MA MSA plan that she heard about from her neighbor.
She also wants to have prescription drug coverage since her doctor recently
prescribed several expensive medications. Currently, she is enrolled in Original
Medicare and a standalone Part D plan. How would you advise Mrs. Chi?
Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D
prescription drug plan.
Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be a correct description?
Medicare Advantage is a way of covering all the Original Medicare benefits through
private health insurance companies.
Correct Answers.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area
has an attractive premium. He wants to know if he must use doctors in a network
as his current HMO plan requires him to do. What should you tell him?
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.
Juan Hernandez is turning 65 next month, Juan legally entered the United States
over twenty years ago but is not a citizen. Since his entry into the country, Juan
has worked at Smallcap Incorporated and contributed to the Medicare system.
Juan suffers from diabetes. He will soon retire and asks you if he can enroll in a
Medicare Advantage plan that you represent. How would you respond?
Juan is eligible to enroll in a Medicare Advantage as long as he is entitled to Part A and
enrolled in Part B. Juan should go to the Social Security website to enroll in Medicare
Part A and B if he has not done so already. Once he is enrolled, he can choose a
Medicare Advantage plan.
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.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about
which providers she can go to for her health care. What should you tell her?
B. Mrs. Ramos can obtain care from any provider who participates in Original Medicare,
but generally will have a higher cost-sharing amount if she sees a provider who/that is
not part of the PPO network. Correct
Mr. Kumar is considering a Medicare Advantage HMO and has questions about
his ability to access providers. What should you tell him?
In Medicare Advantage HMO plans, services provided by primary care physicians are
covered at 100%, but those of specialists are covered at 80% ?
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level.
She wishes to enroll in a MA MSA plan that she heard about from her neighbor.
She also wants to have prescription drug coverage since her doctor recently
prescribed several expensive medications. Currently, she is enrolled in Original
Medicare and a standalone Part D plan. How would you advise Mrs. Chi?
Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D
prescription drug plan.
Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be a correct description?
Medicare Advantage is a way of covering all the Original Medicare benefits through
private health insurance companies.
