AHIP Final Exam Practice Questions and 100% Correct Verified Answers| | 2023/ 2024 Update
QUESTION
Mrs. Burton is a retiree with substantial income.
... [Show More] She is enrolled in an MA-PD plan and was disappointed with the service she received from her primary care physician because she was told she would have to wait five weeks to get an appointment when she was feeling ill. She called you to ask what she could do so she would not have to put up with such poor access to care. What could you tell her?
Answer:
She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment.
QUESTION
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?
Answer:
He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.
QUESTION
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS) plan. What questions would you need to ask to determine his eligibility?
Answer:
You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS plan's service area.
QUESTION
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?
Answer:
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.
QUESTION
Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a PPO that does not include drug coverage. What should you tell her about obtaining drug coverage?
Answer:
She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan.
QUESTION
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. What should you tell him?
Answer:
He may receive health care services from any doctor allowed to bill Medicare, as long as he shows the doctor the plan's identification card and the doctor agrees to accept the PFFS plan's payment terms and conditions, which could include balance billing.
QUESTION
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?
Answer:
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 a part of the PPO network.
QUESTION
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. She is attracted by the idea of maintaining control over a Medical Savings Account (MSA) but is not sure if the plan associated with the account will fit her needs. What specific piece of information about a Medicare MSA plan would it be important for her to know, prior to enrolling in such a plan?
Answer:
All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be obtained by also enrolling in a separate prescription drug plan.
QUESTION
Which of the following statement(s) is/are correct about a Medicare Savings Account (MSA) Plans?
Answer:
MSAs may have either a partial network, full network, or no network of providers. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits. Non-network providers must accept the same amount that Original Medicare would pay them as payment in full.
QUESTION
Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her?
Answer:
Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
QUESTION
Mrs. Wang wants to know generally how the benefits under Original [Show Less]