AHIP TRAINING MODULE #2 Q & A ALL CORRECT

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LOPEZ has heard that he can sign up for a product called MA, but is not sure about what type of plan designs are available through this program (MA plan, types) Correct Answer: They are Medicare hea... lth plans such as HMO, PPO, PFFS, SNP AND MSA WHALEN is trying to understand the difference between Original Medicare and MA. (MA vs Original Medicare) Correct Answer: MA is a way of covering ALL of the Original Medicare benefits through private health insurance companies. During a sales presentation in Ms. Sully's home, she tells you that she has hearing about a type of Medicare plan known as PFFS. She wants to know if this would be available to her. (MA-PFFS) Correct Answer: A PFFS plan is one of various types of MA plans offered by private entities and she may enroll in one if it is available in her area. RADFORD asks whether there are any special eligibility requirement s for MA (MA requirements/eligibility) Correct Answer: Mrs. Radford MUST be entitled to Part A and enrolled in Part B to enroll in MA. BASS lives on a limited fixed income and is concerned about the cost of healthcare. What should you tell her about the sort of help available to low income individuals under the Medicare program? (Help for individuals with limited income/resources) Correct Answer: As a Medicare beneficiary with limited income/resources she may contact her State Medicaid agency to apply for assistance paying for the Part B premium and cost sharing and Part D Rx coverage. KUMAR is considering MA HMO and has questions about his ability to access providers. (MA HMO providers) Correct Answer: In MOST MA HMO's, Mr. Kumar MUST obtain his services only from providers who have a contractual relationship with the plan (Except in an Emergency) RAMOS is considering a MA PPO and has questions about which providers she can go to for her health care. (MA PPO providers) Correct Answer: 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. 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 MA SNP. (MA SNP eligibility) Correct Answer: SNP's have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide Rx coverage that could be very helpful as well. GRECO is in excellent health, lives in his own home, and has a sizeable income from his investments. He has a friend enrolled in a MA SNP. His friend has mentioned that the SNP charges very low cost sharing amts. and Mr. Greco would like to join the plan. [Show More]

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