Exam (elaborations)
AHIP Questions ( Latest 2024 / 2025 ) Actual Questions and Answers 100% Correct
- Course
- Institution
AHIP Questions ( Latest 2024 / 2025 ) Actual Questions and Answers 100% Correct
[Show more]
Content preview
AHIP QuestionsBy ExamNavigator
, AHIP Questions
1. 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?
Answer: They areMedicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
2. (W) Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be a correct description?-
Answer: Medicare Advantage is a way of covering all of the Original Medicare benefits
through private health insurance companies.
3. During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a
type of Medicare health plan known as Private Fee-for-Ser-vice (PFFS). She wants to know if
this would be available to her. What shouldyou tell her about PFFS plans?
Answer: A PFFS plan is one of various types of MedicareAdvantage plans offered by private
entities and she may enroll in one if it is availablein her area.
4. (W) Mrs. Radford asks whether there are any special eligibility requirementsfor Medicare
Advantage. What should you tell her?
Answer: Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare
Advantage
5. Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B buthas recently
stopped paying his Part B premium. He would like to enroll in a Medicare Advantage (MA)
plan and is still covered by Part A. What should youtell him?
Answer: He is not eligible to enroll in a Medicare Advantage plan until he re-enrollsin Medicare
Part B
6. (W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan severalyears ago.
Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What options
does Mrs. Billings have in regard to her MA planduring the next open enrollment season?
Answer: She may remain in her ABC MA planor enroll in a Special Needs Plan (SNP) for
individuals suffering from ESRD if one is available in her area
7. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability
to access providers. What should you tell him?
Answer: In most Medicare Advantage HMOs, Mr. Kumar must obtain his services only from
providerswho have a contractual relationship with the plan (except in an emergency).
8. 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 tellher?
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.
9. Mr. 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 Medicare Advantage
Special Needs Plans (SNPs). What could youtell him?
Answer: SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair,
and they provide prescription drug coverage that could be very helpfulas well
10. (W) Mr. 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 MedicareAdvantage Special Needs Plan
(SNP). His friend has mentioned that the SNPcharges very low cost-sharing amounts and Mr.
Greco would like to join thatplan. What should you tell him?
Answer: SNPs limit enrollment to certain sub-populationsof beneficiaries. Given his current
situation, he is unlikely to qualify and would not be able to enroll in the SNP.
11. (W) Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full
time, and paid taxes during that entire period. She is concerned that she will not qualify for
coverage under part A because she was not bornin the United States. What should you tell her?
Answer: Most individuals who are citizensand over age 65 are covered under Part A by virtue
of having paid Medicare taxeswhile working, though some may be covered as a result of paying
monthly premiums.
12. (W) Mr. Bauer is 49 years old, but eighteen months ago he was declared dis- abled by the
Social Security Administration and has been receiving disability payments. He is wondering
whether he can obtain coverage under Medicare.What should you tell him?
Answer: After receiving such disability payments for 24 months,he will be automatically
enrolled in Medicare, regardless of age.
13. (W) Mr. Davis is 49 years old and has been receiving disability benefits fromthe Social
Security Administration for 12 months. Can you sell him a MedicareAdvantage or Part D
Prescription Drug policy?
Answer: No, he cannot purchase a Medicare Advantage or Part D policy because he has not
received Social Securityor Railroad Retirement disability benefits for 24 months.
14. (W) Ms. Henderson believes that she will qualify for Medicare coverage when she turns
65, without paying any premiums, because she has been working for 40 years and paying
Medicare taxes. What should you tell her?
Answer: Inorder to obtain Part B coverage, she must pay a standard monthly premium, thoughit
is higher for individuals with higher incomes
15. (W) Mr. Diaz continued working with his company and was insured underhis employer's
group plan until he reached age 68. He has heard that there is a premium penalty for those
who did not sign up for Part B when first eligible and wants to know how much he will have
to pay. What should you
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller ExamNavigator. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
73091 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now