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 thi
...
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.
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