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 health plans such as HM
...
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 health 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.
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