AHIP first test Already Graded A+

Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for-Service (PFFS) plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts consider before selecting a PFFS plan? Choose one answer. a. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D prescription drug coverage, a PFFS plan offering only medical benefits, or a PFFS plan in combination with a stand-alone prescription drug plan. b. A stand-alone prescription drug plan in combination with a PFFS plan or a PFFS Medigap Supplemental Insurance plan. c. A PFFS plan offering only medical benefits or a PFFS Medigap Supplemental Insurance plan. d. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D prescription drug coverage, a PFFS plan offering only medical benefits, or PFFS Medigap Supplemental Insurance plan. Question2 Marks: 1 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 MLS MISC AHIP first test. 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? Choose one answer. a. 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. b. 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. c. 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. d. 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. Question3 Marks: 1 Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to be most appropriate for him? Choose one answer. a. D-SNP b. C-SNP c. FIDE-SNP d. I-SNP Question4 Marks: 1 You are doing a sales presentation for Ms. Duarte and her son. Ms. Duarte has some cognitive impairment and her son informs you that he has power of attorney to make financial decisions for her. Can he execute the enrollment for her? Choose one answer. a. No, he cannot execute the enrollment for her. Only Ms. Duarte can sign the form, regardless of her mental capacities. b. Yes, he can execute the enrollment for her. He can do so because he is an immediate family member. No power of attorney is necessary. c. Yes, he can execute the enrollment for her. A financial power of attorney is sufficient. d. No, he cannot execute the enrollment for her. He must have a legal authorization, under state law that explicitly allows him to make health care decisions for his mother. Question5 Marks: 1 Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he looks at information on various plans available in his area, he sees a wide range in what they charge for deductibles, premiums, and cost sharing. How can you explain this to him? Choose one answer. a. The Part D standard model’s importance is that it is the only type of plan into which low-income beneficiaries can enroll and still receive any extra help for which they may qualify. b. The government allows Part D plans to adopt any benefit structure as long as the list of covered drugs meets their approval. c. The government bases its payments to Part D plans on the standard benefit model. For Part D plans to receive the full government payment, they must offer the standard model, however, they can take a risk and revise their benefit structure to attract more beneficiaries. d. Medicare Part D drug plans may have different benefit structures, but on average, they must all be at least as good as the standard model established by the government. Question6 Marks: 1 Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her? Choose one answer. a. Part D covers prescription drugs and she should look at her premiums, formulary, and cost-sharing among other factors to see if they have changed. b. Part D covers long-term care services and she shouldn’t worry because there has been no change in coverage. c. Part D covers hospital and home health services and the cost sharing has changed this year. d. Part D covers physician and non-physician practitioner services and the deductible has not changed this year, but the physician charges may go up. Question7 Marks: 1 Mr. Jackson just turned 65. He has been seeing the same general practitioner for annual check-ups for the past 15 years, likes these yearly visits, and would like to continue obtaining these services as a Medicare beneficiary. What should you tell him about annual check-ups? Choose one answer. a. Medicare will cover only a one-time “Welcome to Medicare” wellness visit. b. He can have as many preventive physical exams as he feels that he needs. They will all be covered by Medicare. c. Physical exams, in the absence of readily observable illness or injury, are never covered under any circumstances. d. Medicare will cover an annual wellness visit, even if he has no illnesses or injuries. Question8 Marks: 1 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? Choose one answer. a. When medication costs exceed a certain threshold amount, which rises each year, a Medicare prescription drug plan is permitted to exclude coverage for all but the least expensive of the medications in a given category. Mrs. Allen will need to encourage her physician to prescribe the least expensive of the two alternatives. b. 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. c. Medicare prescription drug plans are allowed to restrict their coverage to generic drugs. She will need to pay for her brand name medications out of pocket. d. Medicare prescription drug plans are required to include only a certain percentage of brand name drugs among those they cover. It may be possible that plans available in her area have opted not to include in their formularies the brand name drugs she needs. She may need to pay for this particular medication out of pocket. Question9 Marks: 1 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? Choose one answer. a. Materials need only be reviewed and approved by the company(s) she represents. b. 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. c. Obtaining approval of her materials from the State Department of Insurance is a good practice and she should continue it with materials for the Medicare health plans she represents. d. 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 company she represents must obtain approval from the Medicare agency (CMS) for any materials she uses. Question10 Marks: 1 Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period. In mid-January of the following year, she wants to switch back to Original Medicare and enroll in a stand-alone prescription drug plan. What should you tell her? Choose one answer. a. During the MA Open Enrollment Period, from January 1 – March 31, she may disenroll from the MA-PD plan into Original Medicare and also may add a stand￾alone prescription drug plan. b. During the MA Open Enrollment Period, from January 1 – March 31, she may only disenroll from a MA or MA-PD plan, but cannot enroll in a stand-alone Part D plan. c. During the MA Open Enrollment Period, from January 1 – March 31, she may only add or drop Part D coverage, so she cannot switch back to Original Medicare. d. During the MA Open Enrollment Period, from January 1 – March 31, she may drop a MA or MA-PD plan and go back to Original Medicare, but she may only enroll in a stand-alone prescription drug plan if she also purchases a Medigap policy. Question11 Marks: 1 Agent Willis had several clients who disenrolled from the plans he represents during the AEP to try new Medicare Advantage plans. Agent Willis believes that the choices they made are not ideal for them and would like to get their business back during the Medicare Advantage Open Enrollment Period (MA-OEP). What can agent Willis do? Choose one answer. a. He can send them information about the MA-OEP along with a flyer on the plans he represents. b. He can e-mail them in January and ask them to let him know if they are not happy with their new plans. c. He can wait until October and send them information about the plans he represents. d. He can call them to let them know that if they do not like their new plans, they can change back during the MA-OEP