AHIP - Final examination
Mr. Zachow has a condition for which 3 pills are to be had. He has attempted but had an
allergy to them. Only the third drug works for him and it isn't on his Part D plan's formulary.
What may want to you tell him to do? - ANSMr. Zachow has a proper to request a formulary
exception to achieve coverage for his Part D drug. He or his health practitioner should reap
the standardized request shape on the plan's website, fill it out, and post it to his plan.
Mr. Polanski likes the fee of an HMO plan available in his place, however would really like for
you to visit one or two doctors who aren't collaborating carriers. He desires to know if the
Point of Service (POS) option to be had with a few HMOs might be of any assist in this
example. What should you tell him? - ANSThe POS alternative might be a terrific solution for
him because it will permit him to go to out-of-network providers, usually with out prior
approval. However, he have to be conscious that it's miles probably he will must pay better
value-sharing for offerings from out-of-network carriers.
Mr. Barker had surgical operation these days and predicted that he could have sure offerings
and objects included via the plan with minimum out-of-pocket prices because his MA-PD
insurance has been very good. However, when he acquired the invoice, he was amazed to
peer large fees in excess of his most out-of-pocket restriction that included a number of
offerings and items he notion might be completely covered. He referred to as you to invite
what he may want to do? What should you inform him? - ANSYou can offer to check the
plans appeal manner to assist him ask the plan to check the insurance choice.
Ms. Stuart has heard about a special wishes plan (SNP) that one in all her friends is enrolled
in and is inquisitive about that product. She wants to make sure she additionally has
coverage for prescribed drugs. Would she be capable of acquire drug coverage if she
enrolled in the SNP? - ANSa. Yes. All SNPs are required to offer Part D coverage for
pharmaceuticals.
B. Yes, but handiest if she qualifies for Part D prescription drug coverage underneath her
country Medicaid program.
C. No. Medicare beneficiaries who sign up in an SNP must always gain their drug insurance
thru a stand-alone Part D Medicare prescription drug plan that they sign up for impartial in
their enrollment inside the SNP.
D. Maybe. Some SNPs offer Part D insurance for pharmaceuticals and a few do not.
= ?????
Phiona works inside the IT Department of BestCare Health Plan. Phiona is located in charge
of BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. In
putting in place the enrollment site, which of the following must Phiona do not forget? -
ANSII. All records factors required to complete an enrollment request must be captured.
III. The method ought to encompass a clear and wonderful step that requires the applicant to
prompt an "Enroll Now" or "I Agree" sort of button or tool.
, Ms. Lewis knows that Medicare prescription drug plans may use various strategies to
manipulate using unique tablets. She has heard about a method known as "step remedy"
and is questioning if you could give an explanation for what this is. What ought to you tell
her? - ANSStep remedy includes using one or more less expensive drugs before attempting
a extra pricey drug while all are used to deal with the same condition.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his region has an
attractive top rate. He desires to recognize if he have to use medical doctors in a network as
his contemporary HMO plan calls for him to do. What have to you inform him? - ANSHe may
additionally acquire fitness care offerings from ANY doctor allowed to bill Medicare, so long
as he shows the physician the plan's identity card and the doctor concurs to just accept the
PFFS plan's price phrases and situations, which could include stability billing.
Mr. Wu is eligible for Medicare. He has restricted financial resources but failed to qualify for
the Part D low-earnings subsidy. Where would possibly he flip for assist with his prescription
drug expenses? - ANSMr. Wu can also still qualify for help in paying Part D expenses via his
State Pharmaceutical Assistance Program.
You have determined to awareness on doing in-domestic displays to marketplace the
Medicare Advantage (MA) plans you constitute. Before you behavior such sales displays,
what must you do? - ANS
Mr. Wong is a unmarried man or woman. He has had a a success commercial enterprise
career and is now able to retire with a comfy income. Mr. Wong's taxable earnings is in extra
of $one hundred,000. Mr. Wong has health insurance thru his agency but will sign-up
Medicare Part A, Part B and Part D while he leaves the staff. How could you advocate him
as he budgets for Medicare charges? - ANSa. Due to the provisions of MACRA, his Part B
and D coverage can be blended and protected through a low-price Medigap policy to
supplement his Part A coverage.
B. Due to his participation in the group of workers he'll not must pay charges for Part A and
he pays the lowest month-to-month premium fees for Part B and Part D.
C. Due to his participation in the group of workers he's going to no longer ought to pay
premiums for Part A however he will pay higher charges for Part B and Part D due to the
quantity of his earnings.
D. Due to his participation within the staff he'll not should pay charges for Part A and could
pay decreased premiums for Part B and Part D.
?????
Mr. Prentice has many clients who are Medicare beneficiaries. He ought to evaluation the
Centers for Medicare & Medicaid Services' verbal exchange and Marketing Guidelines to
ensure he is compliant for which type of products? - ANSMedicare Advantage (MA) and
Prescription Drug (PDP) plans Correct
Ms. Hernandez has advertised several one of a kind forms of coverage merchandise in her
domestic country and has generally sought approval of her substances from her State
Department of Insurance. What would you recommend her regarding looking for such
approval for materials she makes use of to marketplace Medicare Advantage plans? - ANSa.
States regularly volunteer to study marketing materials on behalf of the Medicare
Mr. Zachow has a condition for which 3 pills are to be had. He has attempted but had an
allergy to them. Only the third drug works for him and it isn't on his Part D plan's formulary.
What may want to you tell him to do? - ANSMr. Zachow has a proper to request a formulary
exception to achieve coverage for his Part D drug. He or his health practitioner should reap
the standardized request shape on the plan's website, fill it out, and post it to his plan.
Mr. Polanski likes the fee of an HMO plan available in his place, however would really like for
you to visit one or two doctors who aren't collaborating carriers. He desires to know if the
Point of Service (POS) option to be had with a few HMOs might be of any assist in this
example. What should you tell him? - ANSThe POS alternative might be a terrific solution for
him because it will permit him to go to out-of-network providers, usually with out prior
approval. However, he have to be conscious that it's miles probably he will must pay better
value-sharing for offerings from out-of-network carriers.
Mr. Barker had surgical operation these days and predicted that he could have sure offerings
and objects included via the plan with minimum out-of-pocket prices because his MA-PD
insurance has been very good. However, when he acquired the invoice, he was amazed to
peer large fees in excess of his most out-of-pocket restriction that included a number of
offerings and items he notion might be completely covered. He referred to as you to invite
what he may want to do? What should you inform him? - ANSYou can offer to check the
plans appeal manner to assist him ask the plan to check the insurance choice.
Ms. Stuart has heard about a special wishes plan (SNP) that one in all her friends is enrolled
in and is inquisitive about that product. She wants to make sure she additionally has
coverage for prescribed drugs. Would she be capable of acquire drug coverage if she
enrolled in the SNP? - ANSa. Yes. All SNPs are required to offer Part D coverage for
pharmaceuticals.
B. Yes, but handiest if she qualifies for Part D prescription drug coverage underneath her
country Medicaid program.
C. No. Medicare beneficiaries who sign up in an SNP must always gain their drug insurance
thru a stand-alone Part D Medicare prescription drug plan that they sign up for impartial in
their enrollment inside the SNP.
D. Maybe. Some SNPs offer Part D insurance for pharmaceuticals and a few do not.
= ?????
Phiona works inside the IT Department of BestCare Health Plan. Phiona is located in charge
of BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. In
putting in place the enrollment site, which of the following must Phiona do not forget? -
ANSII. All records factors required to complete an enrollment request must be captured.
III. The method ought to encompass a clear and wonderful step that requires the applicant to
prompt an "Enroll Now" or "I Agree" sort of button or tool.
, Ms. Lewis knows that Medicare prescription drug plans may use various strategies to
manipulate using unique tablets. She has heard about a method known as "step remedy"
and is questioning if you could give an explanation for what this is. What ought to you tell
her? - ANSStep remedy includes using one or more less expensive drugs before attempting
a extra pricey drug while all are used to deal with the same condition.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his region has an
attractive top rate. He desires to recognize if he have to use medical doctors in a network as
his contemporary HMO plan calls for him to do. What have to you inform him? - ANSHe may
additionally acquire fitness care offerings from ANY doctor allowed to bill Medicare, so long
as he shows the physician the plan's identity card and the doctor concurs to just accept the
PFFS plan's price phrases and situations, which could include stability billing.
Mr. Wu is eligible for Medicare. He has restricted financial resources but failed to qualify for
the Part D low-earnings subsidy. Where would possibly he flip for assist with his prescription
drug expenses? - ANSMr. Wu can also still qualify for help in paying Part D expenses via his
State Pharmaceutical Assistance Program.
You have determined to awareness on doing in-domestic displays to marketplace the
Medicare Advantage (MA) plans you constitute. Before you behavior such sales displays,
what must you do? - ANS
Mr. Wong is a unmarried man or woman. He has had a a success commercial enterprise
career and is now able to retire with a comfy income. Mr. Wong's taxable earnings is in extra
of $one hundred,000. Mr. Wong has health insurance thru his agency but will sign-up
Medicare Part A, Part B and Part D while he leaves the staff. How could you advocate him
as he budgets for Medicare charges? - ANSa. Due to the provisions of MACRA, his Part B
and D coverage can be blended and protected through a low-price Medigap policy to
supplement his Part A coverage.
B. Due to his participation in the group of workers he'll not must pay charges for Part A and
he pays the lowest month-to-month premium fees for Part B and Part D.
C. Due to his participation in the group of workers he's going to no longer ought to pay
premiums for Part A however he will pay higher charges for Part B and Part D due to the
quantity of his earnings.
D. Due to his participation within the staff he'll not should pay charges for Part A and could
pay decreased premiums for Part B and Part D.
?????
Mr. Prentice has many clients who are Medicare beneficiaries. He ought to evaluation the
Centers for Medicare & Medicaid Services' verbal exchange and Marketing Guidelines to
ensure he is compliant for which type of products? - ANSMedicare Advantage (MA) and
Prescription Drug (PDP) plans Correct
Ms. Hernandez has advertised several one of a kind forms of coverage merchandise in her
domestic country and has generally sought approval of her substances from her State
Department of Insurance. What would you recommend her regarding looking for such
approval for materials she makes use of to marketplace Medicare Advantage plans? - ANSa.
States regularly volunteer to study marketing materials on behalf of the Medicare
