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AHIP - Final Examination (Latest Update) With ALL correct Answers (Actual Test 100% Satisfied)
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AHIP - Final Examination (Latest Update) With ALL correct Answers (Actual Test 100% Satisfied)
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AHIP - Final Examination (Latest Update 2022) With ALL correct Answers(Actual Test 100% Satisfied)
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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