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    mrs. radford asks whether there are any special eligibility requirements for medicare advantage. what should you tell her?

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    Test 2 Flashcards

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    Test 2

    22cards Desireé S. Allied Health Health Science

    Mr. Wells is trying to understand the difference between original Medicare and Medicare advantage. Which would be the correct description

    Medicare advantage is the way of covering all of the original Medicare benefits through private insurance companies

    Mr. Lopez has heard that he can sign up for a product called Medicare advantage but is not sure what type of plan designs are available through this program

    They are Medicare health plans such as HMOs PPOs PFFSS and peas and MSAs

    Mrs. Sullivan has heard about a type of Medicare health plan known as private fee-for-service. She wants to know if this would be available to her. What should you tell her about PFFS plan?

    APFFS 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

    Mrs. Radford asks whether there are any special eligibility requirements for MA

    Must be entitled to part AN in rolled in part B to enroll in MA

    Mr. Castillo previously enrolled in Medicare part B but has recently stopped paying the premium. He would like to enroll in a Medicare advantage plan and is still covered by part a. What should you tell him

    He is not eligible to enroll in Medicare advantage unless he re-enrolls in Medicare part B

    Mrs. Billings enrolled in M a plan several years ago. Her doctor recently diagnosed her with ESRD. What options does she have during the next open enrollment season

    She may remain in her MA plan or enroll in a S and a P for individuals suffering from an ESRD if one is available in her area

    Mr. Kumar is considering A MA-HMO and has questions about his access to providers

    In most MA-hMOs they must obtain their service only from providers who have a contractual relationship with the plan unless an emergency

    Mrs. ramose is considering a MA – PPO and has questions about which providers she can go to for healthcare

    She can obtain health care from any provider who participates in original Medicare, but generally will be charged a lower copayment if she goes to one of the plans 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 MA – SNP's

    SNPs have special programs for enrollees with chronic conditions and they provide prescription drug coverage that could be very helpful as well

    Mr. Greco is in excellent health lives in his own home, and has a sizable income from his investments. He would like to join a Ma – SNP plan

    S&P's limit enrollment to certain subpopulations of beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in an SNP

    Mr. Gomez notes that a PFFS plan available in his area has an attractive premium. He wants to know if he must use doctors in the network like his HMO plan requires

    He may receive healthcare services from any doctor allowed to bill Medicare, as long as he shows doctor the plans identification card and the doctor agrees to except the PFSS plans payment in terms of condition which could include balance billing

    Mrs. Lee is discussing with you the possibility of enrolling in a PFS plan – what you should you be sure to tell her

    If she uses a non-network provider, are doctors and hospital could decide whether to treat her on a visit basis

    Mr. McTaggart notes that a PFFS Planned available in his area attractive premium. He wants to know what makes them different from an HMO or a PPO

    Enrollees and keep FF best plan can obtain care for any provider in the US except original Medicare as long as the provider has a reasonable opportunity to access the plans terms and conditions and agrees to except them

    If Dr. Elizabeth Brennan does not contract with the PSFS plan, but except the plans terms and conditions for payment, I will she be paid

    Generally, the PFFS Planned will pay Dr. running directly the same amount original Medicare would pay her

    Mrs. Lyons is in good health, it uses a single prescription, lives independently. She likes the idea of maintaining control of her medical savings account, but is not sure if the plan will fit her needs

    All MSAs cover part a and part B benefits, but not part D, which can be obtained by also enrolling in a separate PDP

    Mr. Davies is turning 65 next month. He would like to enroll any Medicare plan but does not want to be limited in terms of where he obtains care. What should you tell him about a MCP

    Call's plan and release can choose to receive Medicare covered services under the plan of benefits by going to a Planned network provider and paying Custer for me receipts services from nonnetwork matters and pay cost sharing due under original Medicare

    Mr. Romero is 64, retiring soon, and considering his employer sponsored health plan that includes drug coverage

    Beneficiaries should check with their employer reunion group benefit administrator before changing plans to avoid losing coverage they may want to keep

    Mrs. Walters is involved in her Medicaid program in addition to Medicare. What should she be aware of when considering enrollment any Medicare health plan.

    Medicaid will coordinate benefits only with Medicaid participating providers

    Source : www.chegg.com

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    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?

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    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.

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    Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her?

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    Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.

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    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?

    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.

    Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her?

    Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.

    Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan, but does not want to be limited in terms of where he obtains his care. What should you tell him about how a Medicare Cost Plan might fit his needs?

    Cost plan enrollees can choose to receive Medicare covered services under the plan's benefits by going to plan network providers and paying plan cost sharing, or may receive services from non-network providers and pay cost-sharing due under Original Medicare.

    Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him?

    In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from providers who have a contractual relationship with the plan (except in an emergency or where care is unavailable within the network).

    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?

    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.

    Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he sees an out-of-network doctor to receive a Medicare covered service. How much may the doctor collect from Mr. Rivera?

    The doctor may only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid program.

    Mrs. Davenport 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. Davenport have in regard to her MA plan during the next open enrollment season?

    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. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does not include drug coverage and intends to obtain his drug coverage through a stand-alone Medicare prescription drug plan. What should you tell him about this situation?

    He could enroll in one of the MA plans that include prescription drug coverage or a Medigap plan and a stand-alone prescription drug plan, but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan.

    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?

    C-SNP

    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?

    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.

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    AHIP Testing 2018 186 terms connor_baade7 Medicare scenarios 53 terms mamagillry AHIP Module 2

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    November 29, 2016 | Author: Randell Hines | Category: N/A

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    1 Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will have considerable income when she retires. She is concerned that her income will make it impossible for her to qualify for Medicare. What could you tell her to address her concern? Choose one answer.

    a. Eligibility for Medicare is based on whether or not a person has ever been em she or her husband were ever employed by the federal government, she can e

    b. Medicare is a program for people age 65 or older and those under age 65 w disease or Lou Gehrig’s disease, so she will be eligible for Medicare.

    c. Medicare is a program for people of all ages with specific mental health disa she would not qualify, but should instead look into her state’s Medicaid program

    d. Medicare is a program for people who have incomes and assets below spec exact financial situation before telling her whether she can obtain Medicare cov Source: Medicare Program Basics

    Question2 Mr. Styles would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? What could you tell him? Choose one answer.

    a. Part A, which covers hospital, skilled nursing facility, hospice and home heal professional services such as those provided by a doctor are covered under Or

    b. Part D, which covers prescription drug services, is covered under Original M

    c. Part C, which always covers dental and vision services, is covered under Ori

    d. Part A, which covers long term custodial care services, is covered under Ori Source: Different Ways to Get Medicare

    Question3

    Mr. Hudson is concerned that if he signs up for a Medicare health plan, the health plan may, at some time in the future, reduce his benefits below what is available in Original Medicare. What should you tell him about his concern? Choose one answer.

    a. Medicare health plans offer a menu of benefits, from which he may choos coverage, he need only contact the plan and select other options.

    b. Medicare health plans must cover all benefits available under Medicare P prescription drugs.

    c. He should not be concerned because Medicare health plans must cover a which means that all of them provide substantially greater benefits than are a Part B.

    d. Medicare health plans have the option of deciding, each year, what servic health plan could eliminate some benefits covered by Medicare and he shou Medicare health plan. Source: Different Ways to Get Medicare, cont'd

    Question4 Mrs. Geisler’s neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can’t remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her? Choose one answer.

    a. Part D covers hospital and home health services and the cost sharing has ch

    b. Part D covers prescription drugs and she should look at her premiums, form have changed.

    c. Part D covers physician and non-physician practitioner services and the ded the physician charges may go up.

    d. Part D covers long-term care services and she shouldn’t worry because ther Source: Different Ways to Get Medicare, cont'd

    Question5

    Mrs. Weems wants to know generally how the benefits under Original Medicare might compare to the benefit package of a Medicare Health Plan before she starts looking at specific plans. What could you tell her? Choose one answer.

    a. Medicare Health Plans do not necessarily have to cover all of the Original M must include a maximum out-of-pocket limit.

    b. Medicare Health Plans are not permitted to offer any benefits beyond those program and must have the same maximum out-of-pocket limit on Part A and P c. Medicare Health Plans may offer extra benefits that Original Medicare does dental services and must include a maximum out-of-pocket limit on Part A and

    d. All Medicare Health Plans offer cost-sharing that is lower than Original Medic services, but the maximum out-of-pocket limit is higher than in Original Medica Source: Part C Medicare Health Plans

    Question6 Mr. Meoni’s wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife’s needs. What could you tell Mr.Meoni? Choose one answer.

    a. Medicare Supplemental Insurance would help cover his Part A and Part B cost (FFS) Medicare as well as possibly some services that Medicare does not cover.

    b. Medicare Supplemental Insurance would cover his dental, vision and hearing s c. Medicare Supplemental Insurance would cover his long-term care services.

    d. Medicare Supplemental Insurance would cover all of his IRS approved health c Original Fee-for-Service (FFS) Medicare. Source: Medigap (Medicare Supplement Insurance)

    1

    Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxes during that entire period. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. What should you tell her? Choose one answer. a. All individuals who are citizens and over age 65 will be covered under Part A.

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