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2024 AHIP CERTIFICATION PART 2 EXAM WITH CORRECT ANSWERS
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2024 AHIP CERTIFICATION PART 2 EXAM WITH CORRECT ANSWERS
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2024 AHIP CERTIFICATION PART 2EXAM WITH CORRECT ANSWERS
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?
a. They are long-term care plans for people with Medicare.
b. They are major medical policies, but are only for low-income beneficiaries
with Medicare.
c. They are Medigap Supplemental plans that fill in the gaps not covered by
Medicare.
d. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. -
CORRECT-ANSWERSd
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?
a. Medicaid beneficiaries are not eligible for enrollment into a PFFS plan.
They must obtain their care through their state's Medicaid program.
b. If Mrs. Andrews joins a PFFS plan, the State will not cover any of her
medical expenses because she will be using only Medicare providers.
c. Medicaid will cover all of her PFFS out-of-pocket costs and Medicaid
providers will accept amounts paid by the PFFS plan as payment in full.
d. Medicaid may provide additional benefits, but Medicaid will coordinate
benefits only with Medicaid participating providers. - CORRECT-ANSWERSd
Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus
covered by both Medicare and Medicaid. He decides to enroll in a Medicare
Advantage (MA) PPO plan. Later he sees an out-of-network doctor to receive
a Medicare covered service. How much may the doctor collect from Mr.
Rivera?
a. The doctor may only collect the amount allowable under Medicare plus 15
percent balance billing.
, b. The doctor may only collect from Mr. Rivera the cost sharing allowable
under the state's Medicaid program.
c. The doctor may only collect the amount allowable under Medicare
Advantage (MA) PPO plan cost sharing for non-QMB enrollees.
d. The doctor may only collect the amount allowable under Medicare plus 25
percent balance billing. - CORRECT-ANSWERSb
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?
a. He cannot enroll in a stand-alone prescription drug plan because you do
not represent such a plan.
b. He could enroll in one of the MA plans that include prescription drug
coverage or a Medigap plan and a stand-alone prescription drug plan, but he
cannot enroll in the MA-only PPO plan and a stand-alone prescription drug
plan.
c. He could enroll in the MA-only PPO plan and a stand-alone Medicare
prescription drug plan.
d. He could enroll in the MA-only plan a - CORRECT-ANSWERSb
Mrs. Chou likes a 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?
a. She could enroll in the PFFS plan and a Medigap plan that offers drug
coverage, but not in a stand-alone Medicare prescription drug plan.
b. She could enroll in a PFFS plan and a stand-alone Medicare prescription
drug plan.
c. If she wants drug coverage and a PFFS plan, she could only enroll in a
PFFS plan that includes Medicare prescription drug coverage.
d. She could enroll in a PFFS plan, but not in a stand-alone drug plan. -
CORRECT-ANSWERSb
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 new name for the Original Medicare program.
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