AHIP COMPREHENSIVE FINAL EXAM UPDATED
ACTUAL QUESTIONS AND CORRECT ANSWERS
◉ Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in
her area that does not include drug coverage. She wants to enroll in
the plan and enroll in a stand-alone prescription drug plan. What
should you tell her? Answer: She could enroll in a PFFS plan and a
stand-alone Medicare prescription drug plan.
◉ Mr. Lopez has heard that he can sign up for a product called
"Medicare Advantage" but is not sure about what type of plan
designs are available through this program. What should you tell
him about the types of health plans that are available through the
Medicare Advantage program? Answer: There are Medicare health
plans such as HMOs, PPOs, PFFS, and MSAs.
◉ Mr. Barker enjoys a comfortable retirement income. He recently
had surgery 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 some 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.
,◉ Mrs. Walters is enrolled in her state's Medicaid program in
addition to Medicare. What should she be aware of when
considering enrollment in a Medicare Advantage (MA) plan?
Answer: She cannot enroll in an MA Medical Savings Account (MSA)
plan.
◉ Mr. Shapiro gets by on a very small amount of fixed income. He
has heard there may be extra help paying for Part D prescription
drugs for Medicare beneficiaries with limited income. He wants to
know whether he might qualify. What should you tell him? Answer:
The extra help is available to beneficiaries whose income and assets
do not exceed annual limits specified by the government.
◉ Mrs. Allen has a rare condition for which two different brand
name drugs are the only available treatment. She is concerned that
since no generic prescription drug is available and these drugs are
very high cost, she will not be able to find a Medicare Part D
prescription drug plan that covers either one of them. What should
you tell her? Answer: Medicare prescription drug plans are required
to cover drugs in each therapeutic category. She should be able to
enroll in a Medicare prescription drug plan that covers the
medications she needs.
◉ Mr. Wingate is a newly enrolled Medicare Part D beneficiary and
one of your clients. In addition to drugs on his plan's formulary, he
takes several other medications. These include a prescription drug
, not on his plan's formulary, over-the-counter medications for colds
and allergies, vitamins, and drugs from an Internet-based Canadian
pharmacy to promote hair growth and reduce joint swelling. His
neighbor recently told him about a concept called TrOOP and he
asks you if any of his other medications could count toward TrOOP
should he ever reach the Part D catastrophic limit. What should you
say. Answer: None of the costs of Mr. Wingate's other medications
would currently count toward TrOOP but he may wish to ask his
plan for an exception to cover the prescription, not on its formulary.
◉ What types of tools can Medicare Part D prescription drug plans
use that affect the way their enrollees can access medications?
Answer: Part D plans do not have to cover all medications. As a
result, their formularies, or lists of covered drugs, will vary from
plan to plan. In addition, they can use cost containment techniques
such as tiered co-payments and step therapy.
◉ Mrs. Mulcahy, age 65, is concerned that she may not qualify for
enrollment in a Medicare prescription drug plan because, although
she is entitled to Part A, she is not enrolled under Medicare Part B.
What should you tell her? Answer: An individual who is entitled to
Part A or enrolled under Part B is eligible to enroll in a Medicare
prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A,
she does not need to enroll under Part B before enrolling in a
prescription drug plan.
ACTUAL QUESTIONS AND CORRECT ANSWERS
◉ Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in
her area that does not include drug coverage. She wants to enroll in
the plan and enroll in a stand-alone prescription drug plan. What
should you tell her? Answer: She could enroll in a PFFS plan and a
stand-alone Medicare prescription drug plan.
◉ Mr. Lopez has heard that he can sign up for a product called
"Medicare Advantage" but is not sure about what type of plan
designs are available through this program. What should you tell
him about the types of health plans that are available through the
Medicare Advantage program? Answer: There are Medicare health
plans such as HMOs, PPOs, PFFS, and MSAs.
◉ Mr. Barker enjoys a comfortable retirement income. He recently
had surgery 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 some 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.
,◉ Mrs. Walters is enrolled in her state's Medicaid program in
addition to Medicare. What should she be aware of when
considering enrollment in a Medicare Advantage (MA) plan?
Answer: She cannot enroll in an MA Medical Savings Account (MSA)
plan.
◉ Mr. Shapiro gets by on a very small amount of fixed income. He
has heard there may be extra help paying for Part D prescription
drugs for Medicare beneficiaries with limited income. He wants to
know whether he might qualify. What should you tell him? Answer:
The extra help is available to beneficiaries whose income and assets
do not exceed annual limits specified by the government.
◉ Mrs. Allen has a rare condition for which two different brand
name drugs are the only available treatment. She is concerned that
since no generic prescription drug is available and these drugs are
very high cost, she will not be able to find a Medicare Part D
prescription drug plan that covers either one of them. What should
you tell her? Answer: Medicare prescription drug plans are required
to cover drugs in each therapeutic category. She should be able to
enroll in a Medicare prescription drug plan that covers the
medications she needs.
◉ Mr. Wingate is a newly enrolled Medicare Part D beneficiary and
one of your clients. In addition to drugs on his plan's formulary, he
takes several other medications. These include a prescription drug
, not on his plan's formulary, over-the-counter medications for colds
and allergies, vitamins, and drugs from an Internet-based Canadian
pharmacy to promote hair growth and reduce joint swelling. His
neighbor recently told him about a concept called TrOOP and he
asks you if any of his other medications could count toward TrOOP
should he ever reach the Part D catastrophic limit. What should you
say. Answer: None of the costs of Mr. Wingate's other medications
would currently count toward TrOOP but he may wish to ask his
plan for an exception to cover the prescription, not on its formulary.
◉ What types of tools can Medicare Part D prescription drug plans
use that affect the way their enrollees can access medications?
Answer: Part D plans do not have to cover all medications. As a
result, their formularies, or lists of covered drugs, will vary from
plan to plan. In addition, they can use cost containment techniques
such as tiered co-payments and step therapy.
◉ Mrs. Mulcahy, age 65, is concerned that she may not qualify for
enrollment in a Medicare prescription drug plan because, although
she is entitled to Part A, she is not enrolled under Medicare Part B.
What should you tell her? Answer: An individual who is entitled to
Part A or enrolled under Part B is eligible to enroll in a Medicare
prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A,
she does not need to enroll under Part B before enrolling in a
prescription drug plan.
