STUDENTS SUCCESS
Revision Examination Tests
“Come all for this Greatness”
... 100% Correct Ans ...
AHIP Final Exam Latest 2025 Questions and Correct Answers
Complete GRADED 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?
Ans: 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.
,Quiz 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?
Ans: 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.
Quiz 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?
Ans: You can offer to review the plans appeal process to help him ask the plan to review the
coverage decision.
Quiz 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?
Ans: 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.
= ?????
Quiz 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?
Ans: 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.
Quiz 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?
Ans: 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.
Quiz 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?
Revision Examination Tests
“Come all for this Greatness”
... 100% Correct Ans ...
AHIP Final Exam Latest 2025 Questions and Correct Answers
Complete GRADED 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?
Ans: 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.
,Quiz 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?
Ans: 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.
Quiz 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?
Ans: You can offer to review the plans appeal process to help him ask the plan to review the
coverage decision.
Quiz 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?
Ans: 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.
= ?????
Quiz 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?
Ans: 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.
Quiz 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?
Ans: 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.
Quiz 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?
