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Entertaining AHIP 2025 Exam 2025 Questions With Completed & Verified Solutions.
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Entertaining AHIP 2025Medicare Prescription Payment Plan - ANS Beginning in 2025, the prescription drug law, known
as the Inflation Reduction Act, requires all Medicare prescription drug plans (Medicare Part D
plans) — including both standalone Medicare prescription drug plans and Medicare Advantage
plans with prescription drug coverage — to offer enrollees the option to pay out-of-pocket
prescription drug costs in the form of capped monthly payments instead of all at once at the
pharmacy.
Benefits of Medicare Prescription Payment Plan - ANS Expanding benefits, lowering drug costs,
and improving the sustainability of the Medicare program
What is the Medicare Prescription Payment Plan? - ANS Offers Part D enrollees the option to
pay out-of-pocket prescription drug costs in the form of capped monthly payments instead of all
at once to the pharmacy under the Medicare Prescription Payment Plan.
How does the Medicare Prescription Payment Plan work? - ANS For beneficiaries facing high
costs on their prescriptions, it provides them with the option of paying out-of-pocket drug costs
in installments. It does not offer a discount, just manageable payments
A client enjoys a comfortable retirement income. He recently had surgery 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 some
services and items he thought would be fully covered. He called you to ask what he could do?
What could you tell him? - ANS Medicare Advantage (MA) plan enrollees have a right to obtain
a review (appeal) to certain decisions about health care payment, coverage of services, or
prescription drug coverage. Medicare health plans must provide enrollees with a written
description of the appeals process.
A client is enrolled in her state's Medicaid program in addition to Medicare. What should she be
aware of when considering enrollment in a Medicare Advantage (MA) plan? - ANS The client is
a dual-eligible. Dual-eligible beneficiaries may enroll in any type of MA plan except a MA
Medical Savings Account (MSA) plan.
A beneficiary recently lost her employer group health and drug coverage and now she wants to
enroll in a PPO that does not include drug coverage. What should you tell her about obtaining
drug coverage? - ANS She can enroll in a PPO without drug coverage. However, If a beneficiary
enrolls in a MA plan that is an HMO or PPO plan that does not include Part D coverage, the
beneficiary cannot join a standalone Prescription Drug Plan (PDP).
, A potential client has heard that he can sign up for a product called "Medicare Advantage" but is
not sure about what type of plan designs are available through this program. What should you
tell him about the types of health plans that are available through the Medicare Advantage
program? - ANS There are coordinated care Medicare Advantage plans that include HMOs and
PPOs. There are also Private-Fee-for-Service (PFFS), Medicare Savings Account (MSA), and
Special Needs Plans (SNPs)
A potential client calls and asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her? - ANS To be eligible to enroll in Medicare
Advantage, an individual must be entitled (not enrolled) to Part A and enrolled in Part B.
Your mom wants to know generally how the benefits under Original Medicare might compare to
the benefits package of a Medicare Advantage Plan before she starts looking at specific plans.
What could you tell her? - ANS Some Medicare Advantage Plans offer extra benefits that
Original Medicare does not cover. Also, Original Medicare does not have a maximum
out-of-pocket limit.
Which of the following statement(s) is/are correct about a Medicare Savings Account (MSA)
Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of $500
indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would pay them
as payment in full.
Question 7Answer 1,2,4
a. II and III only
b. I, II, and III only
c. I, II, and IV only
d. I and II only - ANS I, II, and IV only
Happy 420Camper, age 65, is entitled to Part A but has not yet enrolled in Part B. She is
considering enrollment in a Medicare Advantage plan (Part C). What should you advise Happy
to do before she can enroll in a Medicare Advantage plan? - ANS Eligibility to enroll in a
Medicare Advantage plan requires entitlement to benefits under Part A and enrollment in Part B.
Nick Joynus, your neighbor is a retiree with substantial income. He is enrolled in an MA-PD plan
and was disappointed with the service he received from her primary care physician because he
was told he would have to wait five weeks to get an appointment when he was feeling ill. He
called you to ask what he could do so he would not have to put up with such poor access to
care. What could you tell him? - ANS Enrollees or their representatives may file a grievance if
they experience problems with their health care services, such as timeliness, appropriateness,
access to, and/or setting of a provided health service, procedure, or item.
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