Mrs. Chou likes a PFFS plan available in her area that does not offer drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What should you tell her?
She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.
Mrs. Geisler's ...
ahip questionsstudy guide for ahip certification test
mrs chou likes a pffs plan available in her area that does not offer drug coverage she wants to enroll in the plan and e
Written for
AHIP
All documents for this subject (4611)
Seller
Follow
satamu
Reviews received
Content preview
2020 AHIP, 2022 AHIP, AHIP questions
Mrs. Chou likes a PFFS plan available in her area that does not offer drug coverage.
She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What
should you tell her? - Answer She could enroll in a PFFS plan and a stand-alone
Medicare prescription drug plan.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual
Medicare enrollment period because features of Part D might have changed. Mrs.
Geisler can't remember what Part D is so she called you to ask what her neighbor was
talking about. What could you tell her? - Answer Part D covers prescription drugs and
she should look at her premiums, formulary and cost-sharing among other factors to
see if they have changed.
Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage
(MA) and Part D plans that Agent Smith sells at the regular Tuesday brunch the
neighbors have for senior citizens. What should Agent Smith tell Mr. Moreno about the
kinds of food that can be provided to potential enrollees who attend the sales
presentation? - Answer A meal cannot be provided, but light snacks would be permitted.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of
an inpatient psychiatric hospital stay that Medicare will cover? - Answer Medicare will
cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the
Medicare Part D Prescription Drug program and he is wondering if there is any other
option he has for obtaining help with his considerable drug costs. What should you tell
him? - Answer He could check with the manufacturers of his medications to see if they
offer an assistance program to help people with limited means to obtain the medications
they need. Alternately, he could check to see whether his state has a pharmacy
assistance program to help him with expenses.
Mr. Wong is a single individual. He has a successful business career and is now able to
retire with a comfortable income. Mr. Wong's taxable income is in excess of $80,000.
Mr. Wong has health coverage through his employer but will sign-up for Medicare Part
A, Part B and Part D when he leaves the workforce. How would you advise him as he
budgets for Medicare premiums? - Answer Due to his participation in the workforce he
will not have to pay a premium for Part A but he will pay higher premiums for Part B and
Part D due to the amount of his income.
During an appointment scheduled to discuss a Medicare Advantage Prescription Drug
plan (MA-PD), Mr. Peters asked his agent to describe a stand-alone prescription drug
plan (Part D plan) that his neighbor told him about. What should his agent do? - Answer
Since Mr. Peters requested a description of the Part D plan, his agent must have Mr.
,Peters sign a new scope of appointment form that includes Part D, and then the agent
may discuss the Part D plan so Mr. Peters can compare plans and make an informed
enrollment choice during the appointment.
By contacting plans available in your area, you have learned that the plan you represent
has a significantly lower monthly premium than the others. Furthermore, you see that
the plan you represent has a unique benefit package. What should you do to make sure
your clients know about these pieces of information? - Answer You may make
comparisons between plans if you can support them by studies or statistical data and
such comparisons are factually based.
Mrs. Fields wants to know whether applying for the Part D low income subsidy will be
worth the time to fill out the paperwork. What could you tell her? - Answer The Part D
low income subsidy could substantially lower her overall costs. She can apply by
contacting her state Medicaid office or calling the Social Security Administration.
Mr. Decaro has looked a Medicare prescription drug plans available in his area and
noted a wide range in premiums. He thought that all drug plans were required to offer
the same standard benefits and would like you to explain why there is such a range in
premiums. What should you tell him? - Answer Some prescription drug plans may have
higher operating costs and/or may offer enhanced coverage in return for an additional
premium amount. He could look at plan designs to see if one of the enhanced plans
would serve his needs better than a plan based on the standard design.
Mrs. Wellington is enrolled in Parts A and B of Original Medicare. A friend recently told
her that there is an excellent Medicare Advantage (MA) plan with a five-star rating
serving her area. On January 5 she comes to you for advise as to what options, if any,
she has. What should you say regarding special enrollment periods (SEPs)? - Answer
Mrs. Wellington is eligible for a SEP that may be used once until November 30 to enroll
in the five-star plan.
Mr. Landry is approaching his 65th birthday. He has signed up for Medicare Part A, but
he did not enroll in Part B because he has employer-sponsored coverage and intends to
keep working for several more years. But he is considering enrolling in Part D
prescription drug coverage because he believes it is superior to his employer plan. How
would you advise him? - Answer Mr. Landry is eligible for Part D since he has Part A,
and his initial enrollment period (IEP) for Part D will continue for three months after his
65th birthday.
Ms. Gates is dually eligible for Medicare and Medicaid. She is very concerned about
being locked into a specific Medicare prescription drug plan for the entire year. what
should you tell her? - Answer Individuals who are enrolled in Medicaid can change their
Part D plans throughout the year, so if she is not satisfied with her prescription drug
plan, she can change to a different Part D plan. (NOTE: On the AHIP test this is the
best answer. However, She can change once per quarter for the first 9 months of the
year)
,You are visiting with Mr. Tully and his daughter at her request. He has advanced
Alzheimer's and is incapable of understanding the implications of choosing a Medicare
Advantage or prescription drug plan. Can his daughter fill out the enrollment form and
sign it for him? - Answer Mr. Tully's daughter can do so only if she is authorized under
state law as a court-appointed legal guardian, has a durable power of attorney for health
care decisions, or is authorized under state surrogate consent laws to make health
decisions.
Which of the following steps may a Part D sponsor adopt for beneficiaries who are at
risk of misusing or abusing frequently abused drugs?
I. Identify at risk individuals by using criteria that includes the number of opioid
prescriptions the beneficiary has and the number of prescribers who have written those
prescriptions.
II. Locking an at-risk beneficiary into one pharmacy.
III. Locking an at-risk beneficiary into one prescriber.
IV. Increasing deductibles and copays for at-risk beneficiaries - Answer I, II and III only
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and ask
you for advice as to whether this is possible. What should you tell her? - Answer
Marketing representatives may initiate electronic contact through e-mail but an opt-out
process must be provided.
Mrs. Sanchez lives in a state located near Canada. She has recently become eligible for
Medicare and is considering enrollment in Part D prescription drug coverage. One of her
friends has told her that she needs to be aware of something called TrOOP. What
should you tell her when she asks you about TrOOP? - Answer TrOOP are out-of-
pocket costs that count toward the annual out-of-pocket threshold to move into
catastrophic coverage and generally include the annual deductible(s) and costs from
drugs on teh plan's formulary purchased at a plans' participating pharmacy. In some
instances, amounts not directly paid by the enrollee (like manufacturers discounts)
count toward TrOOP.
Ms. Levi is considering enrollment in a Medicare Advantage HMO plan offered in her
area. Ms. Levi often travels to visit relatives and is concerned that she may need
emergency care outside of her plan's service area. What should you tell her about
coverage of emergency care? - Answer Plans are required to cover out-of-network
emergency.
Agent Chan is conducting a sales presentation on senior issues where he hopes to
enroll some attendees in the Medicare Advantage (MA) plans he represents. What
action(s) may Agent Change take during the event? - Answer Discuss plan specific
information such as premiums and benefits.
, Mr. Jackson just turned 65. He has been seeing the same general practitioner for
annual check-ups for the past 5 years, likes these yearly visits, and would like to
continue obtaining these services as a Medicare beneficiary. What should you tell him
about annual check-ups? - Answer Medicare will cover an annual wellness visit, even if
he has no illness or injuries.
Agent Roderick enrolls retiree Mrs. Martinez in a medicare savings account (MSA)
Medicare health plan. The MSA plan does not offer prescription drug coverage, so
Agent Roderick also enrolls Mrs. Martinez in a stand-alone prescription drug plan
(PDP). What CMS compensation rules apply to this situiation? - Answer This situation is
considered a "dual enrollment," and CMS compensation rules are applied to the two
plans at once and independently of each other.
You are doing a sales presentation for Ms. Duarte and her son. Ms. Duarte has some
cognitive impairment and her son informs you that he has power of attorney to make
financial decisions for her. Can he execute the enrollment for her? - Answer No, he
cannot execute the enrollment for her. He must have a legal authorization, under state
law that explicitly allows him to make health care decisions for his mother.
Mrs. Roberts has just received a new Medicare identity card in the mail. She is
concerned that it is a forgery since it does not have her Social Security number on it.
What should you tell her? - Answer The card she received is valid, the change has been
made to protect Medicare beneficiaries from identity theft, and she should now destroy
her old card.
If a beneficiary is enrolled in a stand-alone prescription drug plan and wants to keep that
plan, what type of Medicare health plan could the individual enroll in, without being
automatically dis-enrolled from the stand-alone prescription drug plan? - Answer The
beneficiary could enroll in a private fee-for-service (PFFS) plan that does not include
prescription drug coverage; an 1876 Cost Plan; or a Medicare Medical Savings Account
(MSA) 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? - 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.
Ms. Lopez is an independent agent under contract with MarketCo, a third-party
marketing organization. MarketCo has a contract with BestCare health plan, a Medicare
Advantage (MA) organization, to offer marketing services through its contracted agents
and agencies. Ms. Lopez returns calls to individuals who contact MarketCo in response
to its mailers promoting BestCare health plan. Which of the following best describes the
responsibilities of Ms. Lopez? - Answer Ms. Lopez is considered a marketing
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 satamu. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $20.49. You're not tied to anything after your purchase.
