This BUNDLE contains five (5) – America’s Health Insurance Plans (AHIP) Module 1 – Module 5 Questions & Answers
AHIP Module 1 Q & A
Mrs. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare. What can you tell her about Medigap as an option to address this
concern?
- Medigap plans help beneficiaries cover coinsurance, co-payments, and/or
deductibles for medically necessary services.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it
provides no drug coverage. She would like to keep the coverage she has, but replace
her existing Medigap plan with one that provides drug coverage. What should you tell
her? - Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she
could keep her Medigap policy and enroll in a Part D prescription drug plan.
Mr. Kelly has substantial financial means. He enrolled in Original Medicare and
purchased a Medigap policy many years ago that offered prescription drug coverage.
The prescription drug coverage has not been comparable to that offered by Medicare
Part D for several years and despite notification, Mr. Kelly took no action. Which of the
following statements best describes what will occur if Mr. Kelly now decides to enroll in
Medicare Part D? - He will incur a late enrollment penalty.
Mr. Cappadonna would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by that plan. What should you tell him? - It is illegal for you to sell Mr. Cappadonna a Medigap plan if he is enrolled in
an MA plan, and besides, Medigap only works with Original Medicare
AHIP Module 2 Q & A
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?
- 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.
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? - C-SNP
Mr. Kumar is considering a Medicare Advantage HMO and has questions 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 emergency).
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
Medicare, but generally will have a higher cost-sharing amount if she sees a
provider who/that is not part of the PPO network.
AHIP Module 3 Q & A
Mrs. Quinn has just turned 65, is in excellent health, and has a relatively high income.
She uses no medications and sees no reason to spend money on a Medicare
prescription drug plan if she does not need the coverage. What could you tell her about
the implications of such a decision?
- If she does not sign up for a Medicare prescription drug plan as soon as she
is eligible to do so, if she does sign up at a later date, her premium will be
permanently increased by 1% of the national average premium for every
month that she was not covered.
Mr. Torres has a small savings account. He would like to pay for his monthly Part D
premiums with an automatic monthly withdrawal from his savings account until it is
exhausted, and then have his premiums withheld from his Social Security check. What
should you tell him? - In general, he must select a single Part D premium payment mechanism that
will be used throughout the year.
Mr. Katz reached the Part D coverage gap in August last year. His prescriptions have not
changed, he is keeping the same Part D plan and the benefits, cost-sharing, and
coverage of his drugs are all the same as last year. He asked what to expect for this year
about his out-of-pocket costs. What could you tell him? - Because he reached the coverage gap last year, he will probably reach it
again this year close to the same time.