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AHIP 2023 Final/50 Answered Questions/100% Verified!!
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AHIP 2023 Final/50 AnsweredQuestions/100% Verified!!
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare
prescription drug plan you represent and simply give you a check to cover
his premiums for the entire year. What should you tell him? - -He will need
to mail in his payment with his enrollment form.
-Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area
that does not include drug coverage. She wants to enroll in the plan and
enroll in a stand-alone prescription drug plan. What should you tell her? - -
She could enroll in a PFFS plan and a stand-alone Medicare prescription drug
plan.
-Mrs. Roswell is a new Medicare beneficiary who has just retired from retail
work. She is interested in selecting a Medicare Part D prescription drug plan.
She takes a number of medications and is concerned that she has not been
able to identify a plan that covers all of her medications. She does not want
to make an abrupt change to new drugs that would be covered and asks
what she should do. What should you tell her? - -Every Part D drug plan is
required to cover a single one-month fill of her existing medications
sometime during a 90-day transition period.
-Mr. Robinson was quite ill recently and forgot to pay his monthly premium
for his MA-PD plan. He is worried that he will lose his coverage now when he
needs it the most. He is certain his plan will disenroll him because that is
what happened to a friend of his in a similar type of plan. What can you tell
Mr. Robinson about his situation? - -Plan sponsors have the option to do
nothing when a plan member does not pay their premiums or disenroll the
member after a grace period and notice.
-Mrs. Allen has a rare condition for which two different brand name drugs
are the only available treatment. She is concerned that since no generic
prescription drug is available and these drugs are very high cost, she will not
be able to find a Medicare Part D prescription drug plan that covers either
one of them. What should you tell her? - -Medicare prescription drug plans
are required to cover drugs in each therapeutic category. She should be able
to enroll in a Medicare prescription drug plan that covers the medications
she needs.
-One of your clients, Lauren Nichols, has heard about a Medicare concept
from one of her neighbors called TrOOP. She asks you to explain it. What do
you say? - -TrOOP stands for true out-of-pocket expenses that count toward
, the Medicare Part D catastrophic limit and include not only expenses paid by
a beneficiary but also in some instances drug manufacturer discounts.
-Mrs. Fiore is a retired federal worker with coverage under a Federal
Employee Health Benefits (FEHB) plan that includes creditable drug
coverage. She is ready to turn 65 and become Medicare eligible for the first
time. What issues might she consider about whether to enroll in a Medicare
prescription drug plan? - -She could compare the coverage to see if the
Medicare Part D plan offers better benefits and coverage than the FEHB plan
for the specific medications she needs and whether any additional benefits
are worth the Part D premium costs on top of her FEHB contribution.
-Mrs. Shields is covered by Original Medicare. She sustained a hip fracture
and is being successfully treated for that condition. However, she and her
physicians feel that after her lengthy hospital stay she will need a month or
two of nursing and rehabilitative care. What should you tell them about
Original Medicare's coverage of care in a skilled nursing facility? - -Medicare
will cover Mrs. Shield's skilled nursing services provided during the first 20
days of her stay, after which she would have a copay until she has been in
the facility for 100 days.
-Madeline Martinez was widowed several years ago. Her husband worked for
many years and contributed into the Medicare system. He also left a
substantial estate which provides Madeline with an annual income of
approximately $130,000. Madeline, who has only worked part-time for the
last three years, will soon turn age 65 and hopes to enroll in Original
Medicare. She comes to you for advice. What should you tell her? - -You
should tell Madeline that she will be able to enroll in Medicare Part A without
paying monthly premiums due to her husband's long work record and
participation in the Medicare system. You should also tell Madeline that she
will pay Part B premiums at more than the standard lowest rate but less than
the highest rate due her substantial income.
-Winthrop Brokerage wishes to place an advertisement in the local
newspaper that says: "We offer Medicare Advantage plans offered by AB
Health and Top Choice Health. Contact us if you would like to learn more."
Which of the following best describes the obligation(s) of Winthrop Brokerage
regarding the advertisement? - -Winthrop Brokerage does not need to
submit the advertisement to CMS for prior approval because it does not
include information about the plans' benefits structures, cost-sharing, or
information about measures or ranking standards.
-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
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