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AHIP Certification Exam Module 3 With Correct Solutions 2024
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AHIP Certification Exam Module 3 With Correct Solutions 2024
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AHIP Certification Exam Module 3 WithCorrect Solutions 2024
Drug jplans jfor jHMO jor jPPO jcan jbe jobtained jby: j- jcorrect janswer.Only jthrough jtheir jHMO
jor jPPO
How jcan jMedicaid jbeneficiaries jobtain ja jdrug jplan? j- jcorrect janswer.Only jthrough
jMedicaid
Part jD jPlan jTypes j- jcorrect janswer.-Stand jAlone jPrescription jDrug jPlans j(PDP)
-Medicare jAdvantage jPrescription jDrug j(MA-PD)
-Cost jPD jPlans
-PACE jPlans: jMedicare/Medicaid jplans
Who jcan jenroll jin jstand jalone jPart jD? j- jcorrect janswer.-MA-MSA
-PFFS
-Cost jPlans
How jcan jbeneficiaries jof jPACE jget ja jstand jalone jPart jD? j- jcorrect janswer.Only jthrough
jthat jplan
Regarding jMA-PD jplans; jHow jis jJan j1, j2021 jsignificant? j- jcorrect janswer.ESRD
jcoverage jstops
Regarding jMA-PD jplans; jCan jsomeone jeligible jfor jchronic jcare jSNP jget jPart jD? j- jcorrect
janswer.Yes
Formularies j- jcorrect janswer.A jlist jof jPart jD jdrugs
- jmust jhave j2 jdrugs jin jech jcategory
- jcan jbe jgenetic j& jbrand jnamed
Pard jD jExclusions j- jcorrect janswer.- jDrugs jcovered junder jPart jA j& jB, jeven jif jyou jdon't
jhave jit
- jBlue jpills j(unless jpermitted jby jplan)
Actuarial jEquivalent j- jcorrect janswer.The jvalue jof jPart jD jbenefits jmust jbe jat jleast jthe
jsame jas jstandard jcoverage.
, Alternative jCoverage j- jcorrect janswer.Not jstandard jcoverage
- jPrescription jdrug jcoverage jthat jis jat jleast jequivalent jto jstandard
- jHas ja jdeductible j& jcost jsharing jthat jdoes jnot jexceed jstandard jplan
Coverage jPhases j- jcorrect janswer.- jThe jdeductible
- jInitial jcoverage: jbetwn jdeductible j& jinitial jcoverage jgap: jbetwn jinitial jcoverage jlimit j&
jout jof jpocket j(the j"donut jhole")
- jCatastrophic jphase: jafter jannual jout jof jpocket jis jreached.
** jSome jphases jin j"alternative" jbenefits
Enhanced jAlternative jBenefits j- jcorrect janswer.- jPart jD jthat jmay jinclude jreduced
jdeductible
- jMay jinclude jreduction jof jdeductible
- jMay jinclude jcoverage jof jexcluded jdrugs jor jincrease jin jcoverage jlimit.
Part jD j| j2021 j- jcorrect janswer.-Deductible j$445
-Co jPay j25%
-Genetic jDrugs j25%
-Brand jName jDrugs j25%
TROOP j- jcorrect janswer.True jout jof jpocket jcosts
COVERED:
-Calculated jannually
-Must jbe jon jthe jlist jcalled jthe jformulary j& jpurchased jat jnetwork jpharmacy
-Manufacturer jdiscounts
- jDrugs jpaid jby jAIDS j& jIndian jHealth jSvc.
-Amounts jpaid jby jassistance jprograms
NOT jCOVERED:
-Drugs jnot jon jthe jformulary jlist j(unless jexception jis jgiven)
-Over jthe jcounter jdrugs
-Drugs jpurchased jout jof jnetwork
-Drugs jthat jare jreimbursed
-Drugs jpurchased joutside jthe jUS
When jdoes j2021 jPart jD jcatastrophic jcoverage jbegin? j- jcorrect janswer.When jout jof
jpocket jcosts jreach j$6550.
- jAfter jthat; jco jpay jis jas jfollows:
$3.70 jgeneric j
$9.20 jbrand jname, jor j5% j(whichever jis jgreater)
Part jD jPharmacy jNetworks j- jcorrect janswer.-Generally jcontracted jpharmacies jw/in jthe
jnetwork
-PFFS jcan jget jdrugs janywhere
-Can jbe jretail jor jmail jorder jco's
-W/I jthe jnetwork, jthere jare jpreferred jpharmacies jthat jcost jless
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