AHIP FINAL EXAM WITH QUESTIONS
AND VERIFIED ANSWERS LATEST
UPDATE|RATED A+ 2026/2027
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? - ANSWER >>>>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? - 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.
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? - ANSWER >>>>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? - ANSWER >>>>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? - ANSWER >>>>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? - ANSWER >>>>Step therapy involves using one or more
lower priced drugs
AND VERIFIED ANSWERS LATEST
UPDATE|RATED A+ 2026/2027
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? - ANSWER >>>>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? - 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.
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? - ANSWER >>>>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? - ANSWER >>>>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? - ANSWER >>>>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? - ANSWER >>>>Step therapy involves using one or more
lower priced drugs
