AHIP Practice Test Questions & Answers 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?: They
are Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs 2.(W) Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be a correct description?-
: Medicare Advantage is a way of covering all of the Original
Medicare benefits through private health insurance companies.
3.During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a type of Medicare health plan known as Private Fee- for-Ser- vice (PFFS). She wants to know if this would be available to
her. What should you tell her about PFFS plans?: A PFFS plan is one of
various types of Medicare Advantage plans offered by private entities and she may enroll in one if it is available in her area.
- (W) Mrs. Radford asks whether there are any special eligibility require-
ments for Medicare Advantage. What should you tell her?: Mrs. Radford
must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage
- Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B
but has recently stopped paying his Part B premium. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A.
What should you tell him?: He is not eligible to enroll in a Medicare
Advantage plan until he re-enrolls in Medicare Part B
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- (W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan
sev- eral 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?: 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 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 emer- gency).
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?: Mrs. Ramos can obtain care from any provider
who participates in Original
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Medicare, but generally will be charged a lower co-payment if she goes to one of the plan's preferred providers.
9.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?: 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 10.(W) Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would
like to join that plan. What should you tell him?: SNPs limit enrollment to
certain sub-populations of beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP.
11.(W) Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxes during that entire period. She is concerned that she will not qualify for coverage under part A because she
was not born in the United States. What should you tell her?: Most
individuals who are citizens and over age 65 are covered under Part A by virtue of having paid Medicare taxes while working, though some may be covered as a result of paying monthly premiums.
12.(W) Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving dis- ability payments. He is wondering whether he can obtain
coverage under Medicare. What should you tell him?: After receiving
such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.
- (W) Mr. Davis is 49 years old and has been receiving disability
benefits from the Social Security Administration for 12 months. Can you
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sell him
a Medicare Advantage or Part D Prescription Drug policy?: No, he
cannot purchase a Medicare Advantage or Part D policy because he has not received Social Security or Railroad Retirement disability benefits for 24 months.
14.(W) Ms. Henderson believes that she will qualify for Medicare coverage when she turns 65, without paying any premiums, because she has been
working for 40 years and paying Medicare taxes. What should you tell her?:
In order to obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes
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