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AHIP - Final examination/50 Complete Questions and Answers/A+ Rated
AHIP - Final examination/50 Complete Questions and Answers/A+ Rated
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AHIP - Final examination/50 CompleteQuestions and Answers/A+ Rated
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? - -
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? - -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? - -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? - -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? - -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? - -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? - -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? - -Mr. Wu may still qualify for help in paying
Part D costs through his State Pharmaceutical Assistance Program.
-You have decided to focus on doing in-home presentations to market the
Medicare Advantage (MA) plans you represent. Before you conduct such
sales presentations, what must you do? - -
-Mr. Wong is a single individual. He has had a successful business career
and is now able to retire with a comfortable income. Mr. Wong's taxable
income is in excess of $100,000. Mr. Wong has health coverage through his
employer but will sign-up Medicare Part A, Part B and Part D when he leaves
the workforce. How would you advise him as he budgets for Medicare
premiums? - -a. Due to the provisions of MACRA, his Part B and D coverage
will be combined and covered through a low-cost Medigap policy to
supplement his Part A coverage.
b. Due to his participation in the workforce he will not have to pay premiums
for Part A and he will pay the lowest monthly premium rates for Part B and
Part D.
c. Due to his participation in the workforce he will not have to pay premiums
for Part A but he will pay higher premiums for Part B and Part D due to the
amount of his income.
d. Due to his participation in the workforce he will not have to pay premiums
for Part A and will pay reduced premiums for Part B and Part D.
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