AHIP
Solution to Ahip 2025
Module 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? - 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.
Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida.
Hank, the store owner, has provided excellent health benefits to the store's workforce.
William, one of the store's long-time employees, will soon be reaching age 65 and
eligible for Medicare. William is in good health. He intends to remain an active full-time
employee, working several years after becoming eligible for Medicare. What type(s) of
retiree health benefit will Hank's Fish Store be able to offer William? - answer
✅✅Hank's can continue to offer William the same employee health benefit plan, or, if
William enrolls in Medicare Part B, it can enroll him in a Medicare Advantage plan that is
offered to the public.
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? - answer ✅✅You can offer to review the plans appeal process to help him ask the
plan to review the coverage decision.
Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-service
(PFFS) plan. What questions would you need to ask to determine his eligibility? -
answer ✅✅You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if
his doctor will accept the terms and conditions of payment of the PFFS plan.
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
Solution to Ahip 2025
Module 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? - 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.
Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida.
Hank, the store owner, has provided excellent health benefits to the store's workforce.
William, one of the store's long-time employees, will soon be reaching age 65 and
eligible for Medicare. William is in good health. He intends to remain an active full-time
employee, working several years after becoming eligible for Medicare. What type(s) of
retiree health benefit will Hank's Fish Store be able to offer William? - answer
✅✅Hank's can continue to offer William the same employee health benefit plan, or, if
William enrolls in Medicare Part B, it can enroll him in a Medicare Advantage plan that is
offered to the public.
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? - answer ✅✅You can offer to review the plans appeal process to help him ask the
plan to review the coverage decision.
Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-service
(PFFS) plan. What questions would you need to ask to determine his eligibility? -
answer ✅✅You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if
his doctor will accept the terms and conditions of payment of the PFFS plan.
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
