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AHIP Final Exam Version 1 Newest 2025 Exam Complete Questions And Correct Detailed Answers (Verified Answers) |Already Graded A+
She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. - ANSWER-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?
Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. - ANSWER-Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her?
You would need 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 area.
- ANSWER-Mr. Kelly wants to know whether he is eligible to 1 / 4
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sign up for a private fee-for-service (PFFS) plan. What questions would you need to ask to determine his eligibility?
He should compare the benefits in his employer-sponsored retiree group health plan with the benefits in his neighbor's MA- PD plan to determine which one will provide sufficient coverage for his prescription needs. - ANSWER-Mr. Romero is 64, retiring soon, and considering enrollment in his employer- sponsored retiree group health plan that includes drug coverage with nominal copays. He heard about a neighbor's MA-PD plan that you represent and because he takes numerous prescription drugs, he is considering signing up for it. What should you tell him?
She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. - ANSWER-Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a PPO that does not include drug coverage. What should you tell her about obtaining drug coverage?
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. - ANSWER-Dr. Elizabeth Brennan does not 2 / 4
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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?
To join a Medicare Advantage plan, she also must enroll in Part
- - ANSWER-Mrs. Kelly, age 65, is entitled to Part A but has
not yet enrolled in Part B. She is considering enrollment in a Medicare Advantage plan (Part C). What should you advise her to do before she can enroll in a Medicare Advantage plan?
Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies. - ANSWER-Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be the correct description?
He could enroll either in one of the MA plans that include prescription drug coverage or Original Medicare with a Medigap plan and standalone Part D prescription drug coverage, but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan. - ANSWER-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 3 / 4
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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?
Medicare Advantage Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental services. It must include a maximum out-of-pocket limit on Part A and Part B services. - ANSWER-Mrs. Wang wants to know generally how the benefits under Original Medicare might compare to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans. What could you tell her?
She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. - ANSWER-Mrs. Chou likes a Private Fee-for-Service (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?
There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. - ANSWER-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.
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