AHIP Module 2 Final Review

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AHIP Module 2 Final Review 1. 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 a... bout 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. 2. 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? Answer: He will have to enroll in Part B. (To be eligible to enroll in a Medicare Advantage plan, a beneficiary must be entitled to Part A and enrolled in Part B). 3. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him? Answer: In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from providers within the plan’s network (except in an emergency or where care in unavailable within the network). 4. Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk from pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to most appropriate for him? Answer: C-SNP (Because Daniel’s bronchitis is a chronic condition, a Chronic condition SNP would be most appropriate for him to enroll in). 5. 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 do before she will be able to enroll in a Medicare Advantage plan? Answer: To join a Medicare Advantage plan, she also must enroll in Part B. (Eligibility to enroll in a Medicare Advantage plan requires entitlement to benefits under Part A and enrollment in Part B). 6. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer- sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he [Show More]

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