AHIP Final Exam 2022 Practice Test
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about
what type
... [Show More] 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, SNPs, and MSAs
(W) Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be a correct description? - ANS Medicare Advantage is a way of covering all of
the Original Medicare benefits through private health insurance companies.
During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a type of
Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would be
available to her. What should you tell her about PFFS plans? - ANS A PFFS plan is one of various types of
Medicare Advantage plans offered by private entities and she may enroll in one if it is available in her
area.
(W) Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage.
What should you tell her? - ANS Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll
in Medicare Advantage
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying
his Part B premium. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by
Part A. What should you tell him? - ANS He is not eligible to enroll in a Medicare Advantage plan until he
re-enrolls in Medicare Part B
(W) 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? - ANS 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
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? - ANS 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? - ANS Mrs. Ramos can obtain care from any provider
AHIP Final Exam 2022 Practice Test
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. [Show Less]