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AHIP Module 2 QUESTIONS AND ANSWERS

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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? Correct Answer: c. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. Correct Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be a correct description? Correct Answer: a. Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies. Correct Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her? Correct Answer: b. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. Correct 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? Correct Answer: a. He is not eligible to enroll in a Medicare Advantage plan until he re- enrolls in Medicare Part B. Correct 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? Correct Answer: 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 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? Correct Answer: a. C-SNP Correct Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him? Correct Answer: d. 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 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? Correct Answer: 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.

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