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
... [Show More] this program. What should you tell him about the types
of health plans that are available through the Medicare Advantage program?
{{Correct 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?
{{Correct 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?
{{Correct 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 whetherthere are any special eligibility requirements for Medicare Advantage.
What should you tell her?
{{Correct 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?
{{Correct 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?
{{Correct 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?
{{Correct 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?
{{Correct Ans- Mrs. Ramos can obtain care from any provider 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.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under
Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans
(SNPs). What could you tell him?
{{Correct Ans- SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and
they provide prescription drug coverage that could be very helpful as well [Show Less]