AHIP Practice Exam

If Mr. Cole has become Medicare eligible, which cost-sharing guidance should you provide him?

1. Medicaid can cover expenses for any provider.

2. Cost-sharing remains the same for all services known from Medicare.

3. Cost-sharing is based on the provider participating in Medicaid.

4. He won’t have to pay anything under Medicare.

The correct answer is: Cost-sharing is based on the provider participating in Medicaid.

Cost-sharing guidance for Medicare beneficiaries is crucial to help individuals like Mr. Cole understand their financial responsibilities when accessing healthcare services. The correct choice emphasizes that cost-sharing can vary depending on whether the provider participates in Medicaid. When Mr. Cole seeks medical services, if the provider is a participating Medicaid provider, he may incur different cost-sharing obligations compared to services from non-participating providers. Understanding this distinction is important because it affects out-of-pocket costs. For example, Medicaid often provides additional coverage and lower cost-sharing for beneficiaries, which can lead to reduced expenses for Mr. Cole if he chooses to utilize providers that accept Medicaid. The other options do not accurately represent the complexities of cost-sharing under Medicare. Medicaid rules do not allow for coverage of expenses for any provider, as participation is necessary to receive the additional benefits. Cost-sharing does not remain constant for all services; rather, it can differ based on several factors, including the type of service and provider participation. Lastly, it is not accurate to say that Mr. Cole won’t have to pay anything under Medicare, as there are typically premiums, deductibles, and coinsurance costs associated with various services. Therefore, understanding the connection between provider participation and cost-sharing is vital for Mr. Cole.