AHIP Module 2 QUESTIONS AND
ANSWERS
1. Dr. Elizabeth Brennan does not agreement with the ABC PFFS plan but accepts the
plan's terms and situations for price. Mary Rodgers sees Dr. Brennan for remedy. How a
good deal may also Dr. Brennan charge? - ANSWER-Dr. Brennan can charge Mary
Rogers no more than the cost sharing distinct in the PFFS plan's phrases and
circumstance of payment which can also consist of balance billing as much as
15percentof the Medicare rate.
2. Hank's Fish Store, Inc. Is a small company with simply 15 employees positioned in
Florida. Hank, the shop proprietor, has furnished terrific fitness benefits to the store's
staff. William, certainly one of the shop's long-time personnel, will soon be accomplishing
age 65 and eligible for Medicare. William is in excellent fitness. He intends to stay an
energetic full-time employee, running numerous years after turning into eligible for
Medicare. What kind(s) of retiree fitness advantage will Hank's Fish Store be able to
provide William? - ANSWER-Hank's can keep to provide William the identical
worker fitness benefit plan, or, if William enrolls in Medicare Part B, it is able to
sign up him in a Medicare Advantage plan that is offered to the public.
3. Mr. Barker enjoys a comfy retirement earnings. He recently had surgical procedure and
anticipated that he could have certain services and items protected by means of the plan
with minimum out-of-pocket prices due to the fact his MA-PD insurance has been very
good. However, while he received the invoice, he became surprised to look massive
charges in extra of his most out-of-pocket restrict that covered a few services and
gadgets he thought would be fully blanketed. He called you to invite what he could do?
What ought to you tell him? - ANSWER-You can provide to review the plans appeal
process to assist him ask the plan to review the insurance decision.
4. Mr. Kelly wants to recognise whether or not he's eligible to join a private fee-for-provider
(PFFS) plan. What questions could you need to invite to decide his eligibility? -
ANSWER-You would want to ask Mr. Kelly if he is entitled to Part A, enrolled in
Part B, and if he lives in the PFFS plan's service place.
5. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan which you
represent. It is one of 3 plans operated through the equal company in Mr. Lombardi's
place. The MA PPO plan does now not include drug insurance, but the other plans do.
Mr. Lombardi likes the PPO plan that doesn't consist of drug insurance and intends to
reap his drug insurance through a stand-on my own Medicare prescription drug plan.
What should you tell him approximately this example? - ANSWER-He may want to sign
up both in one of the MA plans that include prescription drug insurance or
Original Medicare with a Medigap plan and standalone Part D prescription drug
insurance, but he can't sign up inside the MA-only PPO plan and a stand-alone
prescription drug plan.
ANSWERS
1. Dr. Elizabeth Brennan does not agreement with the ABC PFFS plan but accepts the
plan's terms and situations for price. Mary Rodgers sees Dr. Brennan for remedy. How a
good deal may also Dr. Brennan charge? - ANSWER-Dr. Brennan can charge Mary
Rogers no more than the cost sharing distinct in the PFFS plan's phrases and
circumstance of payment which can also consist of balance billing as much as
15percentof the Medicare rate.
2. Hank's Fish Store, Inc. Is a small company with simply 15 employees positioned in
Florida. Hank, the shop proprietor, has furnished terrific fitness benefits to the store's
staff. William, certainly one of the shop's long-time personnel, will soon be accomplishing
age 65 and eligible for Medicare. William is in excellent fitness. He intends to stay an
energetic full-time employee, running numerous years after turning into eligible for
Medicare. What kind(s) of retiree fitness advantage will Hank's Fish Store be able to
provide William? - ANSWER-Hank's can keep to provide William the identical
worker fitness benefit plan, or, if William enrolls in Medicare Part B, it is able to
sign up him in a Medicare Advantage plan that is offered to the public.
3. Mr. Barker enjoys a comfy retirement earnings. He recently had surgical procedure and
anticipated that he could have certain services and items protected by means of the plan
with minimum out-of-pocket prices due to the fact his MA-PD insurance has been very
good. However, while he received the invoice, he became surprised to look massive
charges in extra of his most out-of-pocket restrict that covered a few services and
gadgets he thought would be fully blanketed. He called you to invite what he could do?
What ought to you tell him? - ANSWER-You can provide to review the plans appeal
process to assist him ask the plan to review the insurance decision.
4. Mr. Kelly wants to recognise whether or not he's eligible to join a private fee-for-provider
(PFFS) plan. What questions could you need to invite to decide his eligibility? -
ANSWER-You would want to ask Mr. Kelly if he is entitled to Part A, enrolled in
Part B, and if he lives in the PFFS plan's service place.
5. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan which you
represent. It is one of 3 plans operated through the equal company in Mr. Lombardi's
place. The MA PPO plan does now not include drug insurance, but the other plans do.
Mr. Lombardi likes the PPO plan that doesn't consist of drug insurance and intends to
reap his drug insurance through a stand-on my own Medicare prescription drug plan.
What should you tell him approximately this example? - ANSWER-He may want to sign
up both in one of the MA plans that include prescription drug insurance or
Original Medicare with a Medigap plan and standalone Part D prescription drug
insurance, but he can't sign up inside the MA-only PPO plan and a stand-alone
prescription drug plan.
