AHIP 2024 Final Exam Test Questions and Answers

AHIP 2024 Final Exam Test Questions and Answers (Verified Answers)

• 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 toenroll 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 tohave both the employer's plan and the MA-PD, so he would have no out- of-pocketexpenses.

• 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 andcondition 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

notoffer such as vision, hearing, and dental services and must include a maximum out-of-pocket limit on Part A and Part B services.

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• 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.

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