AHIP TRAINING MODULE #2, Questions with accurate answers. 2022 version. Graded A+

Document Content and Description Below

AHIP TRAINING MODULE #2, Questions with accurate answers. 2022 version. Graded A+ LOPEZ has heard that he can sign up for a product called MA, but is not sure about what type of plan designs are ... available through this program (MA plan, types) - ✔✔They are Medicare health plans such as HMO, PPO, PFFS, SNP AND MSA WHALEN is trying to understand the difference between Original Medicare and MA. (MA vs Original Medicare) - ✔✔MA is a way of covering ALL of the Original Medicare benefits through private health insurance companies. During a sales presentation in Ms. Sully's home, she tells you that she has hearing about a type of Medicare plan known as PFFS. She wants to know if this would be available to her. (MA-PFFS) - ✔✔A PFFS plan is one of various types of MA plans offered by private entities and she may enroll in one if it is available in her area. RADFORD asks whether there are any special eligibility requirement s for MA (MA requirements/eligibility) - ✔✔Mrs. Radford MUST be entitled to Part A and enrolled in Part B to enroll in MA. BASS lives on a limited fixed income and is concerned about the cost of healthcare. What should you tell her about the sort of help available to low income individuals under the Medicare program? (Help for individuals with limited income/resources) - ✔✔As a Medicare beneficiary with limited income/resources she may contact her State Medicaid agency to apply for assistance paying for the Part B premium and cost sharing and Part D Rx coverage. KUMAR is considering MA HMO and has questions about his ability to access providers. (MA HMO providers) - ✔✔In MOST MA HMO's, Mr. Kumar MUST obtain his services only from providers who have a contractual relationship with the plan (Except in an Emergency) RAMOS is considering a MA PPO and has questions about which providers she can go to for her health care. (MA PPO providers) - ✔✔Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally will be charged a lower co-payment if she goes to one of the plan's PREFERRED providers. 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 MA SNP. (MA SNP eligibility) - ✔✔SNP's have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide Rx coverage that could be very helpful as well. 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 MA SNP. His friend has mentioned that the SNP charges very low cost sharing amts. and Mr. Greco would like to join the plan. (MA SNP eligibility) - ✔✔SNP 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 GOMEZ notes that a PFFS plan available in his area has an attractive premium. He wants to know if he must use doctors in a network like his current HMO plan requires him to do. (MA PFFS providers) - ✔✔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. LEE is discussing with you the possibility of enrolling in a PFFS plan. As part of the discussion, what should you be sure to tell her? (MA PFFS) - ✔✔If she uses NON-NETWORK providers, he doctors and hospital could decide whether to treat her on a VISIT BY VISIT basis. McTAGGERT notes that a PFFS plan available in his area has an attractive premium. He wants to know what makes them different from an HMO or a PPO. (MA PFFS vs. HMO or PPO) - ✔✔Enrollees in a PFFS plan can obtain care from ANY provider in the US, who accepts Original Medicare, as long as the provider has a reasonable opportunity to access the plan's terms and conditions and agrees to accept them. Dr. Elizabeth Brennan does not contract with the PFFS plan, but accepts the plan's terms and conditions for payment, how will she get paid? (MA PFFS provider payment) - ✔✔Generally, the PFFS plan will pay Dr. Brennan directly the same amt. Original Medicare would pay her. LYONS is in good health, uses a single Rx, and lives independently in her own home. She is attracted by the idea of maintaining control over a MSA, but is not sure if the plan associated with the acct. will fit her needs. (MA MSA) - ✔✔ALL MSA's cover Part A and Part B benefits, but NOT Part D Rx benefits, which could be obtained by also enrolling in a separate Rx plan. DAVIES is turning 65 next month. he would like to enroll in a Medicare health plan, but does not want to be limited in terms of where he obtains his care. What should you tell him about how a Medicare cost plan might fit his needs. (MA costs) - ✔✔Cost plan enrollees can choose to receive Medicare covered services under the plan's benefits by going to plan network providers and paying plan cost sharing, or may receive services from Non-network providers and pay cost-sharing due under Original Medicare. ROMERO is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group health plan that includes Rx coverage with nominal copays. He heard about a neighbor's MA-PD plan that you represent and because he takes numerous Rx's, he is considering signing up for it. (MA-PD_ - ✔✔It is ALWAYS the best option to talk with his benefits administrator to see whether he needs both an employer sponsored plan and a private MA-PD and what might happen if he were to sign up for both. [Show More]

Last updated: 2 years ago

Preview 1 out of 8 pages