AHIP 2023 Final Exam Test Questions and Answers

AHIP 2023 Final Exam Test Questions and Answers (Verified Answers)

• Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect

her access to services since she receives some assistance for her health care costs from the State. What should you tell her ANS Medicaid may provide additional benefits, but Medicaid will coordinate benefits only with Medicaid participating providers.

• Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled

in Part B because he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do ANS He will have to enroll in Part B.

• 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 ANS They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.

• Mr. Romero is 64, retiring soon, and considering enrollment in his em-

ployer-sponsored retiree group health plan that includes drug coverage with 1 / 3

nominal copays. He heard about a neighbor's MA-PD plan that you represent and because he takes numerous prescription drugs, he is considering signing up for it. What should you tell him ANS When possible, it is always the best option to have both the employer's plan and the MA-PD, so he would have no out- of-pocket expenses.

• Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts

the plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge ANS Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan's terms and condition of payment which may include balance billing up to 15%of the Medicare rate

• Mrs. Willard wants to know generally how the benefits under Original

Medicare might compare to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans. What could you tell her ANS

• Medicare Advantage Plans may offer extra benefits that Original Medicare does

not offer such as vision, hearing, and dental services and must include a maximum out-of-pocket limit on Part A and Part B services.

• Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She

is considering enrollment in a Medicare Advantage plan (Part C). What should you advise her to do before she will be able to enroll in a Medicare Advantage plan ANS To join a Medicare Advantage plan, she also must enroll in Part B. 2 / 3

• Which of the following statement(s) is/are correct about a Medicare Savings

Account (MSA) Plans?I. MSAs may have either a partial network, full network,

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