AHIP - Final examination Exam with
questions and answers latest update
2024/2025 RATED A+
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? - CORRECT ANSWERS
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? - CORRECT ANSWERS 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? - CORRECT ANSWERS 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? - CORRECT ANSWERS 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.
= ?????
, AHIP - Final examination Exam with
questions and answers latest update
2024/2025 RATED A+
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? - CORRECT ANSWERS 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? - CORRECT ANSWERS Step 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? - CORRECT
ANSWERS He 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? - CORRECT ANSWERS Mr. 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? - CORRECT ANSWERS
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
questions and answers latest update
2024/2025 RATED A+
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? - CORRECT ANSWERS
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? - CORRECT ANSWERS 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? - CORRECT ANSWERS 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? - CORRECT ANSWERS 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.
= ?????
, AHIP - Final examination Exam with
questions and answers latest update
2024/2025 RATED A+
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? - CORRECT ANSWERS 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? - CORRECT ANSWERS Step 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? - CORRECT
ANSWERS He 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? - CORRECT ANSWERS Mr. 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? - CORRECT ANSWERS
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
