AHIP - Final examination EXAM QUESTIONS AND ANSWER / GRADED A /LATEST VERSION
1 view 0 purchase
Course
AHIP -
Institution
AHIP -
AHIP - Final examination EXAM
QUESTIONS AND ANSWER / GRADED A
/LATEST VERSION
Mr. Zachow has a condition for which three drugs are available. He has
tried two but had an allergic reaction to them. Only the third drug
works for him and it is not on his Part D plan's formulary. What could
...
AHIP - Final examination EXAM
QUESTIONS AND ANSWER / GRADED A
/LATEST VERSION
Mr. Zachow has a condition for which three drugs are available. He has
tried two but had an allergic reaction to them. Only the third drug
works for him and it is not on his Part D plan's formulary. What could
you tell him to do? - CORRECT ANSWER Mr. Zachow has a right to
request a formulary exception to obtain coverage for his Part D drug. He
or his physician could obtain the standardized request form on the
plan's website, fill it out, and submit it to his plan.
Mr. Polanski likes the cost of an HMO plan available in his area, but
would like to be able to visit one or two doctors who aren't
participating providers. He wants to know if the Point of Service (POS)
option available with some HMOs will be of any help in this situation.
What should you tell him? - CORRECT ANSWER The POS option might
be a good solution for him as it will allow him to visit out-of-network
providers, generally without prior approval. However, he should be
aware that it is likely he will have to pay higher cost-sharing for services
from out-of-network providers.
Mr. Barker had surgery recently and expected that he would have
certain services and items covered by the plan with minimal out-of-
pocket costs because his MA-PD coverage has been very good.
,However, when he received the bill, he was surprised to see large
charges in excess of his maximum out-of-pocket limit that included a
number of services and items he thought would be fully covered. He
called you to ask what he could do? What could you tell him? -
CORRECT ANSWER You can offer to review the plans appeal process to
help him ask the plan to review the coverage decision.
Ms. Stuart has heard about a special needs plan (SNP) that one of her
friends is enrolled in and is interested in that product. She wants to be
sure she also has coverage for prescription drugs. Would she be able to
obtain drug coverage if she enrolled in the SNP? - CORRECT ANSWER a.
Yes. All SNPs are required to provide Part D coverage for prescription
drugs.
b. Yes, but only if she qualifies for Part D prescription drug coverage
under her state Medicaid program.
c. No. Medicare beneficiaries who enroll in an SNP must always obtain
their drug coverage through a stand-alone Part D Medicare prescription
drug plan that they sign up for independent of their enrollment in the
SNP.
d. Maybe. Some SNPs offer Part D coverage for prescription drugs and
some do not.
= ?????
Phiona works in the IT Department of BestCare Health Plan. Phiona is
placed in charge of BestCare's efforts to facilitate electronic enrollment
in its Medicare Advantage plans. In setting up the enrollment site,
which of the following must Phiona consider? - CORRECT ANSWER II.
, All data elements required to complete an enrollment request must be
captured.
III. The process must include a clear and distinct step that requires the
applicant to activate an "Enroll Now" or "I Agree" type of button or tool.
Ms. Lewis understands that Medicare prescription drug plans may use
various methods to control the use of specific drugs. She has heard
about a technique called "step therapy" and is wondering if you can
explain what that is. What should you tell her? - CORRECT ANSWER
Step therapy involves using one or more lower priced drugs before
trying a more expensive drug when all are used to treat the same
condition.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in
his area has an attractive premium. He wants to know if he must use
doctors in a network as his current HMO plan requires him to do. What
should you tell him? - CORRECT ANSWER He may receive health care
services from ANY doctor allowed to bill Medicare, as long as he shows
the doctor the plan's identification card and the doctor agrees to accept
the PFFS plan's payment terms and conditions, which could include
balance billing.
Mr. Wu is eligible for Medicare. He has limited financial resources but
failed to qualify for the Part D low-income subsidy. Where might he turn
for help with his prescription drug costs? - CORRECT ANSWER Mr. Wu
may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller GREATSTUDY. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $15.49. You're not tied to anything after your purchase.
