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2018 AHIP/50 QUESTIONS AND ANSWERS
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2018 AHIP/50 QUESTIONS AND ANSWERS
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2018 AHIP/50 QUESTIONS AND ANSWERSWhich of the following steps may a Part D sponsor adopt for beneficiaries
who are at risk of misusing or abusing frequently abused drugs? - -I.
Identifying at risk individuals by using criteria that includes the number of
opioid prescriptions the beneficiary has and the number of prescribers who
have written those prescriptions.
II. Locking an at-risk beneficiary into one pharmacy.
III. Locking an at-risk beneficiary into one prescriber.
-Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain
relief from arthritis through acupuncture. She is concerned about whether or
not Medicare will cover these items and services. What should you tell her? -
-Medicare does not cover acupuncture, or, in general, glasses or dentures.
-Which statement best describes PACE plans? - -It includes comprehensive
medical and social service delivery systems using an interdisciplinary team
approach in an adult day health center, supplemented by in-home and
referral services.
-Mr. Shultz was still working when he first qualified for Medicare. At that
time, he had employer group coverage that was creditable. During his initial
Part D eligibility period, he decided not to enroll because he was satisfied
with his drug coverage. It is now a year later and Mr. Shultz has lost his
employer group coverage. How would you advise him? - -Mr. Schultz should
enroll in a Part D plan before he has a 63-day break in coverage in order to
avoid a premium penalty.
-For which of the following individuals would a Cost Plan be most
appropriate? - -Ms. Baker who is enrolled in Medicare Part B and is willing to
continue paying Part B premiums plus any plan premiums.
-Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not
include drug coverage and also enroll in a stand-alone Medicare prescription
drug plan. Under what circumstances can she do this? - -If the Medicare
Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer
drug coverage or a Medical Savings Account, Mrs. Berkowitz can do this.
-Ms. Goldstein is required by the plan she represents to obtain enrollment
forms that have carbon copies in the back. She gives one to the beneficiary,
sends another to the plan and retains the third. What should she do with her
copies of the enrollment forms? - -She should make every effort to
safeguard the beneficiary information on those enrollment forms.
, -Mr. Lopez takes several high cost prescription drugs. He would like to enroll
in a standalone Part D prescription drug plan that is available in his area. In
what type of Medicare Health Plan can he enroll? - -Private Fee-for-Service
(PFFS) plan that does not include drug coverage.
-Mr. Block is currently enrolled in a Medicare Advantage plan that includes
drug coverage. He found a stand-alone Medicare prescription drug plan in his
area that offers better coverage than that available through his MA-PD plan
and in addition has a low premium. It won't cost him much more and,
because he has the means to do so, he wishes to enroll in the stand-alone
prescription drug plan in addition to his MA-PD plan. What should you tell
him? - -If Mr. Block enrolls in the stand-alone Medicare prescription drug
plan, he will be disenrolled from the Medicare Advantage plan.
-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? - -Most
individuals who are citizens and over age 65 are covered under Part A by
virtue of having paid Medicare taxes while working, though some may be
covered as a result of paying monthly premiums.
-Mrs. Lopez is enrolled in a Medicare Advantage cost plan. She has recently
lost creditable coverage previously available through her husband's
employer. She is interested in enrolling in a Medicare Part D prescription
drug plan (PDP). What should you tell her? - -If a Part D benefit is offered
through her plan she must enroll in this plan.
-Mr. Schmidt 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? - -Part A, which covers hospital, skilled nursing facility, hospice and
home health services and Part B, which covers professional services such as
those provided by a doctor are covered under Original Medicare.
-Mrs. Wellington is enrolled in Parts A and B of Original Medicare. A friend
recently told her that there is an excellent Medicare Advantage (MA) plan
with a five-star rating serving her area. On January 15 she comes to you for
advice as to what options, if any, she has. What should you say regarding
special enrollment periods (SEPs)? - -Mrs. Wellington is eligible for a SEP that
may be used once until November 30 to enroll in the five-star plan.
-Mr. Shapiro gets by on a very small fixed income. He has heard there may
be extra help paying for Part D prescription drugs for Medicare beneficiaries
with limited income. He wants to know whether he might qualify. What
should you tell him? - -The extra help is available to beneficiaries whose
income and assets do not exceed annual limits specified by the government.
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