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AHIP2024 MODULE 2 final questions and answers 2015/2016
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AHIP2024 MODULE 2 final1. Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at
severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of
SNP is likely to be most appropriate for him? >ANS>C-SNP
2. 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? >ANS>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.
3. 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? >ANS>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.
4. 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?
>ANS>You can offer to review the plans appeal process to help him ask the plan to
review the coverage decision.
5. 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? >ANS>He is not eligible to enroll in a Medicare Advantage plan until he
re-enrolls in Medicare Part B.
6. 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? >ANS>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.
7. 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 Medicare Advantage Special Needs Plan
(SNP). His friend has mentioned that the SNP charges very low cost-sharing amounts
and Mr. Greco would like to join that plan. What should you tell him? >ANS>SNPs limit
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