AHIP 2025 Module 2, AHIP 2025 Module 1, AHIP 2025
Module 3, AHIP 2025 module 4, AHHIP 2025 Module 5
Practice Questions and Answers
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 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.
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✔✔-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.
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? - ANSWER✔✔-C-SNP
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of three
plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not include drug
coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does not include drug
coverage and intends to obtain his drug coverage through a stand-alone Medicare prescription drug
plan. What should you tell him about this situation? - ANSWER✔✔-He could enroll either in one of the
MA plans that include prescription drug coverage or Original Medicare with a Medigap plan and
standalone Part D prescription drug coverage, but he cannot enroll in the MA-only PPO plan and a stand-
alone prescription drug plan.
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