AHIP MODULE 2
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If Dr. Tavenner does not contract with the PFFS plan, but
accepts the plan's terms and conditions for payment, how will she be paid?
- the PFFS plan will pay Dr. Tavenner directly the same amount Original Medicare
- would pay her.
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?
- 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
Ms. Snowe would like to
know what monthly premiums she must pay if she signs up for one of the Private
Fee-for-Service (PFFS) plans in her area. Which of the following would you tell
- Generally, she must continue to pay her Part B premium to remain eligible for the PFFS plan along with a monthly PFFS plan
Ms. 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?
- a Medicare beneficiary with limited income and resources she may contact her
- state Medicaid agency to apply for assistance paying for the Part B premium and
- cost sharing and Part D prescription drug coverage.
Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan
might affect her access to services since she receives some assistance for her
health care costs from the State. What should you tell her?
- may provide additional benefits, but Medicaid will coordinate benefits only
- with Medicaid participating providers
Mr. Schumer 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?
- have special programs for enrollees with chronic conditions, like Mr. Schumer,
- and they provide prescription drug coverage that could be very helpful as
Mr. Loper 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 this program. What should you tell him about the types of
health plans that are available through the Medicare Advantage program?
- are Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
Mr. Bizzo is considering a Medicare Advantage HMO and has
questions about his ability to access providers. What should you tell
- most Medicare Advantage HMOs, Mr. Bizzo must obtain his services only from
- providers who have a contractual relationship with the plan (except in an
Mrs. McCain likes a PFFS plan available in her area that does
not offer drug coverage. She wants to enroll in the plan and enroll in a
stand-alone prescription drug plan. What should you tell her?
- could enroll in a PFFS plan and a stand-alone Medicare prescription drug
Mr. Baucus and his neighbor are considering signing up for
the same PFFS plan. What should Mr. Baucus know about selecting a
hospital under the PFFS plan?
- Except in an emergency, Mr. Baucus must inform a non-network hospital before receiving services that he is a member of the PFFS plan so the hospital can decide
- whether to accept the plan’s terms and conditions.
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