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Entertaining AHIP 2025
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Entertaining AHIP 2025
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ENTERTAINING AHIP 2025 QUESTIONSWITH COMPLETE SOLUTION
jMedicare Prescription Payment Plan - 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 - Expanding benefits, lowering drug costs, and improving
the sustainability of the Medicare program
What is the Medicare Prescription Payment Plan? - 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? - 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? - 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? - 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? -
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? - 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? - 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? - 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 - 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? - 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? -
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.
Drew Looksatme is 64, retiring soon, and considering enrollment in his employer-sponsored retiree
group health plan that includes drug coverage with nominal copays. He heard about a neighbor's MA-PD
plan that you represent and because he takes numerous prescription drugs, he is considering signing up
for it. What should you tell him? - The type of Medicare Advantage plans offered vary by employers.
Therefore, beneficiaries should compare their employer's retiree plan with other available plan options.
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