AHIP Module 2
(2022\2023)
1.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?: c.
They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.Correct 2.Mr.WellsistryingtounderstandthedifferencebetweenOriginal
Medicare and Medicare Advantage. What would be a correct description?:
- Medicare Advantage is a way of covering all the Original Medicare
benefits through private health insurance companies. Correct 3.Mrs. Radford asks whether there are any special eligibility requirements
for Medicare Advantage. What should you tell her?: b. Mrs. Radford
must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. Correct 4.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 is not
eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Correct
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5.Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs. Billings have in regard to her MA
plan during the next open enrollment season?: a. She may remain in
her ABC MA plan or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. Correct 6.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?: a. C-SNP Correct
7.Mr. Kumar is considering a Medicare Advantage HMO and has ques- tions about his ability to access providers. What should you tell
him?:
- In most Medicare Advantage HMOs, Mr. Kumar must obtain his
services only from providers who have a contractual relationship with the plan (except in an emergency). Correct 8.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?: b. 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 part of the PPO network. Correct
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