AHIP FINAL EXAM | STUDY QUESTIONS AND VERIFIED ANSWERS | RATED A+ | 2024/2025 GUIDE
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AHIP FINAL EXAM | STUDY QUESTIONS AND VERIFIED ANSWERS | RATED A+ | 2024/2025 GUIDE
AHIP FINAL EXAM | STUDY QUESTIONS AND VERIFIED ANSWERS | RATED A+ | 2024/2025 GUIDE
AHIP FINAL EXAM | STUDY
QUESTIONS AND VERIFIED
ANSWERS | RATED A+ | 2024/2025
GUIDE
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?
- Correct Answer - You can offer to review the plans appeal
process to help him ask the plan to review the coverage
decision.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan
available in his area has an attractive premium. He wants to
know if he must use doctors in a network as his current HMO
plan requires him to do. What should you tell him?
,- Correct Answer - He may receive health care services from
any doctor allowed to bill Medicare, as long as he shows the
doctor the plan's identification card and the doctor agrees to
accept the PFFS plan's payment terms and conditions, which
could include balance billing.
Mr. Wells is trying to understand the difference between
Original Medicare and Medicare Advantage. What would be the
correct description?
- Correct Answer - Medicare Advantage is a way of covering all
the Original Medicare benefits through private health insurance
companies.
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?
- Correct Answer - 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 a part of the PPO network.
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?
- Correct 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.
Mrs. Davenport enrolled in the ABC Medicare Advantage (MA)
plan several years ago. In mid-February of 2021, her doctor
confirms a diagnosis of end-stage renal disease (ESRD). What
options will Mrs. Davenport have regarding her MA plan during
the next open enrollment season?
- Correct Answer - She may remain in her ABC MA plan, enroll
in another MA plan in her service area, or enroll in a Special
Needs Plan (SNP) for individuals suffering from ESRD if one is
available in her area.
Mrs. Lyons is in good health, uses a single prescription, and
lives independently in her own home. She is attracted by the
idea of maintaining control over a Medical Savings Account
(MSA) but is not sure if the plan associated with the account
will fit her needs. What specific piece of information about a
, Medicare MSA plan would it be important for her to know, prior
to enrolling in such a plan?
- Correct Answer - All MSAs cover Part A and Part B benefits,
but not Part D prescription drug benefits, which could be
obtained by also enrolling in a separate prescription drug plan.
Mrs. Burton is a retiree with substantial income. She is enrolled
in an MA-PD plan and was disappointed with the service she
received from her primary care physician because she was told
she would have to wait five weeks to get an appointment when
she was feeling ill. She called you to ask what she could do so
she would not have to put up with such poor access to care.
What could you tell her?
- Correct Answer - She could file a grievance with her plan to
complain about the lack of timeliness in getting an appointment.
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?
- Correct Answer - C-SNP
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