PSY325 325 AHIP Final Exam Questions and Answers ratedA+GuaranteedSuccess Latest Update 2024/2025

PSY325 325 AHIP Final Exam Questions and Answers ratedA+GuaranteedSuccess Latest Update 2024/2025Final Exam - Attempt 1 AGRADESTUVIA STORE 2025 ALL THE BEST AGRADESTUVIA STORE DO NOT COP 2/19 2 Mrs. Roswell is a new Medicare beneficiary and is interested in selecting a Medicare Part D prescription drug plan. She takes a number of medications and is concerned that she has not been able to identify a plan that covers all of her medications. She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. What should you tell her? Choose one answer. a. Every Part D drug plan is required to cover a single one-month fill of her existing medications sometime during a 90 day transition period. b. The Medicare Part D drug plan is required to offer her coverage of the exact same drugs that she is currently stabilized on, so she does not need to be concerned about transitioning to any new medications. c. There is no possibility of obtaining coverage for her existing medications once coverage under the Medicare Part D plan begins. She will need to have her physician help her select a new drug that is covered. d. She should use an existing prescription drug coverage to get as large a supply of her existing drugs as possible, and then pick new drugs that are covered under her Medicare plan’s formulary. 4 Marks: 1 5 Marks: 1 Mr. James has end-stage renal disease (ESRD). He has been covered under Original Medicare but would like to know if he can enroll in a MedicareAdvantage plan. What should you tell him? Choose one answer. a. Individuals with end-stage renal disease may enroll in a Medicare Advantage plan, but only if they are willing to pay an extra premium to do so. b. Individuals with end-stage renal disease can enroll in any Medicare Advantage plan that they choose without paying an extra premium. c. He will not be able to enroll in a Medicare Advantage plan because he has end-stage renal disease unless a special needs plan for beneficiaries with ESRD is available in his service area. d. Individuals with end-stage renal disease can only enroll in a Medicare Advantage plan after they have been on Mrs. Kendrick is six months away from turning 65. She wants to know what she will have to do to enroll in a Medicare Advantage (MA) plan as soon as possible. What could you tell her? Choose one answer. a. MA plans are only available to those who have been enrolled in a Medigap plan for at least six months. Therefore, before enrolling in an MA plan, she must first use a Medigap plan to supplement her Original Medicare coverage. b. She must first enroll in a Medicare Part D plan, before enrolling in a Medicare Advantage plan. c. She must have previously been enrolled in Original Fee-for-Service Medicare for at least one year before she may enroll in an MA plan. d. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. AGRADESTUVIA STORE 2025 ALL THE BEST AGRADESTUVIA STORE DO NOT COP 3/19 3 You meet with Mrs. Wilson to complete her enrollment in a Medicare Advantage plan. You tell her that there will be an enrollment verification processto confirm that she is enrolled in the plan that she requested and understands the plan features and rules. What should Mrs. Wilson expect regardingthe verification process? Choose one answer. a. Mrs. Wilson will be contacted by you within one week for a follow-up appointment to handle the verification process. b. Your assistant will contact Mrs. Wilson within seven calendar days to set up a joint call with the plan’s home officeto verify that she has enrolled in a plan of her choice and understands its features and rules. c. You will contact Mrs. Wilson within 10 calendar days to set up a joint call with the plan’s home office to verify that she has enrolled in a plan of her choice and understands its features and rules. d. Mrs. Wilson will be contacted by the plan sponsor within 15 calendar days of receipt of the enrollment request. 6 Marks: 1 Mr. Garcia was told he qualifies for a Special Enrollment Period (SEP), but he lost the paper that explains what he could do during the SEP. What canyou tell him? Choose one answer. a. If the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage. b. If the SEP is for Part D coverage, he may only drop, but not add or change, his Part D coverage one time before the SEP expires. c. If the SEP is for MA coverage, he may make as many changes to his MSA enrollment as he wants and the last choice made before the end of the SEP period will be the effective one. d. He may only use the SEP to disenroll from his MA plan and return to Original Medicare. 7 Marks: 1 8 Marks: 1 Ms. Gardner is currently enrolled in an MA-PD plan. However, she wants to disenroll from the MA-PD plan and instead enroll in a Part D only planandgo back to Original Medicare. According to Medicare's enrollment guidelines, when could she do this? Choose one answer. a. She may make such a change during the Annual Election Period that runs from Oct. 15 to December 7, or during the MA Open Enrollment Period which takes place from January 1- March 31 of each year (beginning in 2019). b. She may do it only during the MA Disenrollment Period, which runs from January 1 to February 14 of each year. c. Any time that she is dissatisfied with the plan’s network coverage or customer service she may make such a dialysis for 12 months. AGRADESTUVIA STORE 2025 ALL THE BEST AGRADESTUVIA STORE DO NOT COP 4/19 4 Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. He wants to understand the health care costshe might be exposed to under Medicare if he were to require hospitalization as a result of an illness. In general terms, what could you tell himabout his costs for inpatient hospital services under Original Medicare? Choose one answer. a. Under Original Medicare, the inpatient hospital co-payment is a percentage of allowed charges. The percentage increases after 60 days and again after 90 days. b. Under Original Medicare, the inpatient hospital co-payment is a flat per-day amount that remains the same throughout the first 60 days of a beneficiary’s stay. After day 60 the amount gradually increases until day 90. After 90days he would pay the full amount of all costs. c. Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over his lifetime, after which he would be responsible for all costs d. Under Original Medicare, if the inpatient hospital service is provided by a participating Medicare provider, the co- payment is waived. Co-payments are only charged when a beneficiary opts to receive care from a non-participating provider. 9 Marks: 1 Dr. Elizabeth Brennan does not contract with the PFFS plan but accepts the plan’s terms and conditions for payment. Mary Rodgers sees Dr. Brennanfor treatment. How much may Dr. Brennan charge? Choose one answer. a. Dr. Brennan can charge Mary Rodgers more than the cost sharing specified in the PFFS plan’s terms and conditions as long as she treats all beneficiaries the same. b. Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan’s terms and condition of payment which may include balance billing up to 15 percent of the Medicare rate. c. Dr. Brennan can charge Mary no more than the cost sharing specified in the PFFS plan’s terms and conditions of payment which may include balance billing up to 25 percent of the Medicare rate. d. Dr. Brennan can charge the benefi