Exam (elaborations)

AHIP Module 2

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AHIP

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AHIP

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Uploaded on June 6, 2023
Number of pages 4
Written in 2022/2023
Type Exam (elaborations)
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AHIP Module 2
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? - ✔✔c. They are Medicare health plans such as HMOs,
PPOs, PFFS, and MSAs. Correct

Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be a correct description? - ✔✔a. Medicare Advantage
is a way of covering all the Original Medicare benefits through private health insurance
companies. Correct

Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? - ✔✔b. Mrs. Radford must be entitled to Part A
and enrolled in Part B to enroll in Medicare Advantage. Correct

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? - ✔✔a. He is not eligible to enroll in a Medicare Advantage
plan until he re-enrolls in Medicare Part B. Correct

Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her
doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What options
does Mrs. Billings have in regard to her MA plan during the next open enrollment
season? - ✔✔a. She may remain in her ABC MA plan or enroll in a Special Needs Plan
(SNP) for individuals suffering from ESRD if one is available in her area. Correct

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? - ✔✔a. C-SNP Correct

Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him? - ✔✔d. In most Medicare
Advantage HMOs, Mr. Kumar must obtain his services only from providers who have a
contractual relationship with the plan (except in an emergency). Correct

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

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Exam (elaborations)

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