1
AHIP FINAL EXAM WITH QUESTIONS AND
VERIFIED ANSWERS LATEST UPDATE|RATED A+
Mr. Zachow has acondition for which three drugs areavailable. He has tried two but had an allergic reaction tothem. 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 aright to request aformulary exception to obtain coverage for his Part D drug. Heor his physician
could obtain thestandardized requestform 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 tobeable to visit one or twodoctors who aren't
participating providers. He wants to know if thePoint ofService(POS) optionavailablewithsomeHMOswill be of any help
in this situation. What should you tellhim? - ANSWER >>>>The POS option might be agood solution for him as it
will allow him to visit out-of-network providers,generallywithoutpriorapproval.However,heshould beawarethat it is likely he
will have to payhigher cost-sharing for services from out-of-network providers.
Mr. Barker had surgery recently and expected that hewould 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 receivedthe bill,
he was surprised to see large charges in excess of his maximum out-of-pocket limit that included anumber of services and
itemshethought would befully covered. Hecalled you to ask what he could do? What could you tellhim? - ANSWER
>>>>You can offer to review the plans
, 2
appeal process to help him ask the plan to review thecoverage decision.
Ms. Stuart has heard about aspecial needs plan (SNP) that
one of her friends is enrolled in andis interested in thatproduct. She wants to be sure she also has coverage for prescription
drugs. Would she be able to obtain drug coverageifsheenrolled intheSNP? - 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 mustalways obtain their drug coverage through astand-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 HealthPlan. Phiona is placed in charge of BestCare's efforts tofacilitate
electronic enrollment in its Medicare Advantageplans. In setting up the enrollment site, which of thefollowing must Phiona
consider? - ANSWER >>>>II. All data elements required to complete an enrollment request must be captured.
III. The process must include aclear and distinct step thatrequires 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 atechnique called
"step therapy" and is wondering if you can explain what that is. What should you tell her? - ANSWER >>>>Step
therapyinvolves using oneormorelowerpriced drugs
, 3
before trying amore expensive drug when all are used totreat the same condition.
Mr. Gomez notes that aPrivate Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants
to know if he must use doctors in anetwork as his currentHMO plan requires him to do. What should you tell him? -
ANSWER >>>>Hemayreceivehealthcareservices fromANY 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? - ANSWER >>>>Mr. Wu may still qualify
for help in paying Part D costs through his StatePharmaceutical 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? - ANSWER >>>>
Mr. Wong is asingle individual. He has had asuccessful business career and is now able to retire with acomfortable
income. Mr. Wong's taxable income is in excess of $100,000. Mr. Wong has health coverage through his employer butwill
sign-up MedicarePartA,PartBandPart D when he leaves the workforce. How would you advise him as he budgets for
Medicare premiums? - ANSWER >>>>a. Due to the provisions of MACRA, his PartB and Dcoverage will be
combined and covered through alow-cost Medigap policy to supplement his Part A
coverage.
AHIP FINAL EXAM WITH QUESTIONS AND
VERIFIED ANSWERS LATEST UPDATE|RATED A+
Mr. Zachow has acondition for which three drugs areavailable. He has tried two but had an allergic reaction tothem. 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 aright to request aformulary exception to obtain coverage for his Part D drug. Heor his physician
could obtain thestandardized requestform 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 tobeable to visit one or twodoctors who aren't
participating providers. He wants to know if thePoint ofService(POS) optionavailablewithsomeHMOswill be of any help
in this situation. What should you tellhim? - ANSWER >>>>The POS option might be agood solution for him as it
will allow him to visit out-of-network providers,generallywithoutpriorapproval.However,heshould beawarethat it is likely he
will have to payhigher cost-sharing for services from out-of-network providers.
Mr. Barker had surgery recently and expected that hewould 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 receivedthe bill,
he was surprised to see large charges in excess of his maximum out-of-pocket limit that included anumber of services and
itemshethought would befully covered. Hecalled you to ask what he could do? What could you tellhim? - ANSWER
>>>>You can offer to review the plans
, 2
appeal process to help him ask the plan to review thecoverage decision.
Ms. Stuart has heard about aspecial needs plan (SNP) that
one of her friends is enrolled in andis interested in thatproduct. She wants to be sure she also has coverage for prescription
drugs. Would she be able to obtain drug coverageifsheenrolled intheSNP? - 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 mustalways obtain their drug coverage through astand-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 HealthPlan. Phiona is placed in charge of BestCare's efforts tofacilitate
electronic enrollment in its Medicare Advantageplans. In setting up the enrollment site, which of thefollowing must Phiona
consider? - ANSWER >>>>II. All data elements required to complete an enrollment request must be captured.
III. The process must include aclear and distinct step thatrequires 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 atechnique called
"step therapy" and is wondering if you can explain what that is. What should you tell her? - ANSWER >>>>Step
therapyinvolves using oneormorelowerpriced drugs
, 3
before trying amore expensive drug when all are used totreat the same condition.
Mr. Gomez notes that aPrivate Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants
to know if he must use doctors in anetwork as his currentHMO plan requires him to do. What should you tell him? -
ANSWER >>>>Hemayreceivehealthcareservices fromANY 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? - ANSWER >>>>Mr. Wu may still qualify
for help in paying Part D costs through his StatePharmaceutical 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? - ANSWER >>>>
Mr. Wong is asingle individual. He has had asuccessful business career and is now able to retire with acomfortable
income. Mr. Wong's taxable income is in excess of $100,000. Mr. Wong has health coverage through his employer butwill
sign-up MedicarePartA,PartBandPart D when he leaves the workforce. How would you advise him as he budgets for
Medicare premiums? - ANSWER >>>>a. Due to the provisions of MACRA, his PartB and Dcoverage will be
combined and covered through alow-cost Medigap policy to supplement his Part A
coverage.
