AHIP QUESTIONS AND VERIFIED
ANSWERS WITH RATIONALE |
GRADED AND RATED A+|
2024/2025 GUIDE
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 can enroll in a Medicare Advantage plan but it will pay
only the benefits associated with Medicare Part A.
b. He is not eligible to enroll in a Medicare Advantage plan until
he re-enrolls in Medicare Part B.
c. He is not eligible to enroll in a Medicare Advantage as a
naturalized citizen.
d. He can enroll in a Medicare Advantage plan if he has
dropped Part B less than 90 days ago.
- Correct Answer - b. He is not eligible to enroll in a Medicare
Advantage plan until he re-enrolls in Medicare Part B.
,Rationale: In order to enroll in a Medicare Advantage (MA)
plan, an individual must be entitled to Part A and enrolled in
Part B. Mr. Castillo is covered by Plan A but no longer enrolled
in Medicare Part B so he cannot enroll in MA plan until he re-
enrolls in Part B.
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?
a. SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug
coverage that could be very helpful as well.
b. Since SNPs don't cover prescription drugs Mr. Sinclair
should consider a different option.
c. SNPs are essentially the same as Original Medicare and are
not likely to have a noticeable impact on how Mr. Sinclair
receives his care.
d. SNPs offer care from any doctor or hospital Mr. Sinclair
would like to use and his costs will always be lower than in
Original Medicare.
- Correct Answer - a. SNPs have special programs for
enrollees with chronic conditions, like Mr. Sinclair, and they
,provide prescription drug coverage that could be very helpful as
well.
Rationale: Chronic condition SNPs (C-SNPs) restrict enrollment
and tailor services to individuals with chronic conditions, such
as Mr. Sinclair. All SNPs include prescription drug coverage.
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 a number of services and items he thought would be
fully covered. He called you to ask what he could do? What
could you tell him?
a. You could remind him that he cannot do anything until the
next Annual Election Period when he will have an opportunity to
change plans.
b. You can offer to review the plans appeal process to help him
ask the plan to review the coverage decision.
c. You could suggest he call the doctor who performed the
surgery to complain about the costs and ask for a discount on
the charges.
, d. You could reassure him that such charges are
- Correct Answer - b. You can offer to review the plans appeal
process to help him ask the plan to review the coverage
decision.
Rationale: Medicare Advantage (MA) plan enrollees have a
right to obtain a review (appeal) to certain decisions about
health care payment, coverage of services, or prescription drug
coverage. Medicare health plans must provide enrollees with a
written description of the appeals process.
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?
a. State Medicaid programs do not coordinate any of their
coverage with Medicare Advantage plans.
b. She can submit any bills she has for co-payments under
Medicare to the state's Medicaid program and they will always
be fully covered.
c. She cannot enroll in an MA Medical Savings Account (MSA)
plan.
d. If a provider accepts her Medicare Advantage plan coverage,
that provider is legally obligated to also accept her Medicaid
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