AHIP Certification Module 2 Exam with Questions and Correct
guaranteed Answers
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis,
putting him at severe risk for pneumonia. Otherwise, he has no problems
functioning. Which type of SNP is likely to be most appropriate for him? -
Answer-C-SNP
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.
Juan Hernandez is turning 65 next month, Juan legally entered the United
States over twenty years ago but is not a citizen. Since his entry into the
country, Juan has worked at Smallcap Incorporated and contributed to the
Medicare system. Juan suffers from diabetes. He will soon retire and asks
you if he can enroll in a Medicare Advantage plan that you represent. How
would you respond? - Answer- Juan is eligible to enroll in a Medicare
Advantage as long as he is entitled to Part A and enrolled in Part B. Juan
should go to the Social Security website to enroll in Medicare Part A and B
if he has not done so already. Once he is enrolled, he can choose a
Medicare Advantage plan.
Mr. Barker enjoys a comfortable retirement income. He recently had
surgery and expected that he would have certain services and items
covered by the plan with minimal out-of-pocket costs because his MA-PD
coverage has been very good. However, when he received the bill, he was
surprised to see large charges in excess of his maximum out-of-pocket
limit that included some services and items he thought would be fully
covered. He called you to ask what he could do? What could you tell him?
- Answer-You can offer to review the plans appeal process to help him ask
the plan to review the coverage decision.
