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AHIP Module 2 2024
Ms. Gibson recently lost her employer group health and drug coverage and now she wants
to enroll in a PPO that does not include drug coverage. What should you tell her about
obtaining drug coverage? - ANSShe can enroll in the PPO, but she will not be able to
purchase a stand-alone Medicare Part D prescription drug plan
Mrs. Willard wants to know generally how the benefits under Original Medicare might
compare to the benefits package of a Medicare Advantage Plan before she starts looking at
specific plans. What could you tell her? - ANSMedicare Advantage Plans may offer extra
benefits that Original Medicare does not offer such as vision, hearing, and dental services
and must include a maximum out-of-pocket limit on Part A and Part B services.
Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What
should she be aware of when considering enrollment in a Medicare Advantage (MA) plan? -
ANSShe cannot enroll in an MA Medical Savings Account (MSA) plan
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? - ANSMedicaid may provide additional benefits, but Medicaid will only
pay for these services if they are furnished by Medicaid participating providers.
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering
enrollment 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? - ANSTo join a Medicare Advantage
plan, she also must enroll in Part B.
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? - ANSThey are Medicare health plans such as HMOs, PPOs, PFFS,
and MSAs.
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 you tell him? - ANSSNPs have special
programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription
drug coverage that could be very helpful as well.
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? - ANSC-SNP
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