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AHIP CERTIFICATION MOD 3 TEST QUESTIONS WITH COMPLETE ANSWERS
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AHIP CERTIFICATION MOD 3 TEST QUESTIONS WITH COMPLETE ANSWERS
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AHIP CERTIFICATION MOD 3 TESTQUESTIONS WITH COMPLETE
ANSWERS
Drug plans for HMO or PPO can be obtained by: - Answer-Only through their HMO or
PPO
How can Medicaid beneficiaries obtain a drug plan? - Answer-Only through Medicaid
Part D Plan Types - Answer--Stand Alone Prescription Drug Plans (PDP)
-Medicare Advantage Prescription Drug (MA-PD)
-Cost PD Plans
-PACE Plans: Medicare/Medicaid plans
Who can enroll in stand alone Part D? - Answer--MA-MSA
-PFFS
-Cost Plans
How can beneficiaries of PACE get a stand-alone Part D? - Answer-Only through that
plan
Regarding MA-PD plans; How is Jan 1, 2021, significant? - Answer-ESRD coverage
stops
Regarding MA-PD plans; Can someone eligible for chronic care SNP get Part D? -
Answer-Yes
Formularies - Answer-A list of Part D drugs
- must have 2 drugs in each category
- can be genetic & brand named
Pard D Exclusions - Answer-- Drugs covered under Part A & B, even if you don't have it
- Blue pills (unless permitted by plan)
Actuarial Equivalent - Answer-The value of Part D benefits must be at least the same as
standard coverage.
Alternative Coverage - Answer-Not standard coverage
- Prescription drug coverage that is at least equivalent to standard
- Has a deductible & cost sharing that does not exceed standard plan
Coverage Phases - Answer-- The deductible
, - Initial coverage: between deductible & initial coverage gap: between initial coverage
limit & out of pocket (the "donut hole")
- Catastrophic phase: after annual out of pocket is reached.
** Some phases in "alternative" benefits
Enhanced Alternative Benefits - Answer-- Part D that may include reduced deductible
- May include reduction of deductible
- May include coverage of excluded drugs or increase in coverage limit.
Part D | 2021 - Answer--Deductible $445
-Co Pay 25%
-Genetic Drugs 25%
-Brand Name Drugs 25%
TROOP - Answer-True out of pocket costs
COVERED:
-Calculated annually
-Must be on the list called the formulary & purchased at network pharmacy
-Manufacturer discounts
- Drugs paid by AIDS & Indian Health Svc.
-Amounts paid by assistance programs
NOT COVERED:
-Drugs not on the formulary list (unless exception is given)
-Over the counter drugs
-Drugs purchased out of network
-Drugs that are reimbursed
-Drugs purchased outside the US
When does 2021 Part D catastrophic coverage begin? - Answer-When out of pocket
costs reach $6550.
- After that; co pay is as follows:
$3.70 generic
$9.20 brand name, or 5% (whichever is greater)
Part D Pharmacy Networks - Answer--Generally contracted pharmacies w/in the
network
-PFFS can get drugs anywhere
-Can be retail or mail order co's
-W/I the network, there are preferred pharmacies that cost less
-If outside network pharmacy is needed, cost may be higher.
Part D Premium Payments - Answer--CkW/D from checking
-Auto W/D from SS check (2-3 mos to begin)
-Direct monthly billing from plan (default plan)
-Must stay in billing plan for the year.
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