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AHIP - Final examination 2024/2025 already graded A+
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AHIP - Final examination 2024/2025 already graded A+
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AHIP-
Final
examination
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?
-
ANSMr.
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?
-
ANSThe
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?
-
ANSYou
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?
-
ANSa.
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?
-
ANSII.
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?
-
ANSStep
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?
-
ANSHe
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?
-
ANSMr.
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?
-
ANS
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?
-
ANSa.
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.
?????
Mr.
Prentice
has
many
clients
who
are
Medicare
beneficiaries.
He
should
review
the
Centers
for
Medicare
&
Medicaid
Services'
communication
and
Marketing
Guidelines
to
ensure
he
is
compliant
for
which
type
of
products?
-
ANSMedicare
Advantage
(MA)
and
Prescription
Drug
(PDP)
plans
Correct
Ms.
Hernandez
has
marketed
several
different
types
of
insurance
products
in
her
home
state
and
has
typically
sought
approval
of
her
materials
from
her
State
Department
of
Insurance.
What
would
you
advise
her
regarding
seeking
such
approval
for
materials
she
uses
to
market
Medicare
Advantage
plans?
-
ANSa.
States
often
volunteer
to
review
marketing
materials
on
behalf
of
the
Medicare
agency.
She
should
check
with
her
Department
of
Insurance
to
see
if
such
a
review
is
available
and
would
satisfy
CMS
requirements.
b.
Materials
for
marketing
Medicare
health
plans
to
individuals
are
subject
to
Medicare's
uniform
national
requirements.
They
do
not
need
to
be
reviewed
by
the
state,
but
the
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