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AHIP MODULE #2 EXAM QUESTIONS AND ANSWERS 2024
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AHIP MODULE #2 EXAM QUESTIONS AND ANSWERS 2024
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AHIP MODULE #2 EXAM QUESTIONSAND ANSWERS 2024
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 neighbour. 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? - Answer-b. Mrs. Chi may enroll in a MA
MSA plan and remain in her current standalone Part D prescription drug plan.
MA MSA plans are prohibited from offering prescription drug coverage. If an MSA
member wants prescription drug coverage, the member must enroll in a standalone
PDP.
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-c. They are Medicare health plans such as
HMOs, PPOs, PFFS, and MSAs.
There are coordinated care Medicare Advantage plans that include HMOs and PPOs.
There are also Private-Fee-for-Service (PFFS), Medicare Savings Account (MSA), and
Special Needs Plans (SNPs).
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is
considering enrolment in a Medicare Advantage plan (Part C). What should you advise
her to do before she will be able to enroll in a Medicare Advantage plan? - Answer-. To
join a Medicare Advantage plan, she also must enroll in Part B.
Correct: Eligibility to enroll in a Medicare Advantage plan requires entitlement to
benefits under Part A and enrollment in Part B.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Small cap, Incorporated. Small cap has a workforce of 15 employees and offers
employer-sponsored healthcare coverage. Juan is a naturalized citizen and has
contributed to the Medicare system for over 20 years. Juan asks you if he will be
entitled to Medicare and if he enrolls how that will impact his employer-sponsored
healthcare coverage. How would you respond? - Answer-c. Juan is likely to be eligible
for Medicare once he turns age 65 and if he enrolls Medicare would become the primary
payor of his healthcare claims and Smallcap does not have to continue to offer him
coverage comparable to those under age 65 under its employer-sponsored group health
plan.
, 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? - Answer-c. She could enroll in a PFFS
plan and a stand-alone Medicare prescription drug plan.
Correct: An individual enrolled in a MA PFFS plan that does not include a Part D benefit
may enroll in a stand-alone Part D prescription drug plan. This is true even if the
organization offers another PFFS plan under the same MA contract that includes a Part
D benefit.
Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access
to services since she receives some assistance for her health care costs from the State.
What should you tell her? - Answer-d. Medicaid may provide additional benefits, but
Medicaid will only pay for these services if they are furnished by Medicaid participating
providers.
Correct: Dual eligible beneficiaries may enroll in any type of MA plan (except an MA
MSA). However, Medicaid will only pay for items and services if they are furnished by
Medicaid participating providers. Therefore, Mrs. Andrews should consider these factors
when enrolling in a MA plan.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B
because he has coverage through an employer plan. If he wants to enroll in a Medicare
Advantage plan, what will he have to do? - Answer-a. He will have to enroll in Part B.
Correct. To be eligible to enroll in a Medicare Advantage plan, a beneficiary must be
entitled to Part A and enrolled in Part B.
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? - Answer-d. 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.
Correct: Because Dr. Brennan accepts the plan's terms and conditions for payment, she
is permitted to charge this amount.
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her
own home. She is attracted by the idea of maintaining control over a Medical Savings
Account (MSA) but is not sure if the plan associated with the account will fit her needs.
What specific piece of information about a Medicare MSA plan would it be important for
her to know, prior to enrolling in such a plan? - Answer-d. All MSAs cover Part A and
Part B benefits, but not Part D prescription drug benefits, which could be obtained by
also enrolling in a separate prescription drug plan.
Correct: MSA enrollees must enroll in a stand-alone prescription drug plan (PDP) if they
want prescription drug benefits.
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