AHIP FINAL EXAM WITH QUESTIONS c c c c
AND VERIFIED ANSWERS LATEST
c c c c
2027/2028 UPDATE|RATED A+
c c c
Mr. Zachow has a condition for which three drugs are
c c c c c c c c c
available. He has tried two but had an allergic reaction
c c c c c c c c c c
to them. Only the third drug works for him and it is not
c c c c c c c c c c c c c
on his Part D plan's formulary. What could you tell him
c c c c c c c c c c c
to do? - ANSWER >>>>Mr. Zachow has a right to
c c c c c c c c c c
request a formulary exception to obtain coverage for
c c c c c c c c
his Part D drug. He or his physician could obtain the
c c c c c c c c c c c
standardized request form on the plan's website, fill it
c c c c c c c c c
out, and submit it to his plan.
c c c c c c c
Mr. Polanski likes the cost of an HMO plan available in
c c c c c c c c c c
his area, but would like to be able to visit one or two
c c c c c c c c c c c c c
doctors who aren't participating providers. He wants to
c c c c c c c c
know if the Point of Service (POS) option available with
c c c c c c c c c c
some HMOs will be of any help in this situation. What
c c c c c c c c c c c
should you tell him? - ANSWER >>>>The POS option
c c c c c c c c c
might be a good solution for him as it will allow him to
c c c c c c c c c c c c c
visit out-of-network providers, generally without prior
c c c c c c
approval. However, he should be aware that it is likely
c c c c c c c c c c
he will have to pay higher cost-sharing for services
c c c c c c c c c
from out-of-network providers.
c c c
Mr. Barker had surgery recently and expected that he
c c c c c c c c
would have certain services and items covered by the
c c c c c c c c c
plan with minimal out-of-pocket costs because his MA-
c c c c c c c c
PD coverage has been very good. However, when he
c c c c c c c c
received the bill, he was surprised to see large charges
c c c c c c c c c c
in excess of his maximum out-of-pocket limit that
c c c c c c c c
included a number of services and items he thought
c c c c c c c c c
would be fully covered. He called you to ask what he
c c c c c c c c c c c
could do? What could you tell him? - ANSWER
c c c c c c c c c
c>>>>You can offer to review the plans c c c c c c
, appeal process to help him ask the plan to review the
c c c c c c c c c c
coverage decision.
c c
Ms. Stuart has heard about a special needs plan (SNP)
c c c c c c c c c
that one of her friends is enrolled in and is interested
c c c c c c c c c c c
in that product. She wants to be sure she also has
c c c c c c c c c c c
coverage for prescription drugs. Would she be able to
c c c c c c c c c
obtain drug coverage if she enrolled in the SNP? -
c c c c c c c c c c
ANSWER >>>>a.
c c
Yes. All SNPs are required to provide Part D coverage
c c c c c c c c c
for prescription drugs.
c c c
b. Yes, but only if she qualifies for Part D
c c c c c c c c
prescription drug coverage under her state
c c c c c c
Medicaid program.
c c
c. No. Medicare beneficiaries who enroll in an SNP
c c c c c c c
must always obtain their drug coverage through a
c c c c c c c c
stand-alone Part D Medicare prescription drug plan
c c c c c c c
that they sign up for independent of their enrollment
c c c c c c c c c
in the SNP.
c c c
d. Maybe. Some SNPs offer Part D coverage c c c c c c
for prescription drugs and some do not.
c c c c c c c
= ?????
c
Phiona works in the IT Department of BestCare Health
c c c c c c c c
cPlan. Phiona is placed in charge of BestCare's efforts
c c c c c c c c
cto facilitate electronic enrollment in its Medicare
c c c c c c
cAdvantage plans. In setting up the enrollment site, c c c c c c c
cwhich of the following must Phiona consider? -
c c c c c c c
cANSWER >>>>II. All data elements required to c c c c c c
ccomplete an enrollment request must be captured. c c c c c c
III. The process must include a clear and distinct step
c c c c c c c c c
cthat requires the applicant to activate an "Enroll Now"
c c c c c c c c
cor "I Agree" type of button or tool.
c c c c c c c
Ms. Lewis understands that Medicare prescription drug
c c c c c c
plans may use various methods to control the use of
c c c c c c c c c c
specific drugs. She has heard about a technique called
c c c c c c c c c
"step therapy" and is wondering if you can explain what
c c c c c c c c c c
that is. What should you tell her? - ANSWER >>>>Step
c c c c c c c c c c
therapy involves using one or more lower priced drugs
c c c c c c c c c
AND VERIFIED ANSWERS LATEST
c c c c
2027/2028 UPDATE|RATED A+
c c c
Mr. Zachow has a condition for which three drugs are
c c c c c c c c c
available. He has tried two but had an allergic reaction
c c c c c c c c c c
to them. Only the third drug works for him and it is not
c c c c c c c c c c c c c
on his Part D plan's formulary. What could you tell him
c c c c c c c c c c c
to do? - ANSWER >>>>Mr. Zachow has a right to
c c c c c c c c c c
request a formulary exception to obtain coverage for
c c c c c c c c
his Part D drug. He or his physician could obtain the
c c c c c c c c c c c
standardized request form on the plan's website, fill it
c c c c c c c c c
out, and submit it to his plan.
c c c c c c c
Mr. Polanski likes the cost of an HMO plan available in
c c c c c c c c c c
his area, but would like to be able to visit one or two
c c c c c c c c c c c c c
doctors who aren't participating providers. He wants to
c c c c c c c c
know if the Point of Service (POS) option available with
c c c c c c c c c c
some HMOs will be of any help in this situation. What
c c c c c c c c c c c
should you tell him? - ANSWER >>>>The POS option
c c c c c c c c c
might be a good solution for him as it will allow him to
c c c c c c c c c c c c c
visit out-of-network providers, generally without prior
c c c c c c
approval. However, he should be aware that it is likely
c c c c c c c c c c
he will have to pay higher cost-sharing for services
c c c c c c c c c
from out-of-network providers.
c c c
Mr. Barker had surgery recently and expected that he
c c c c c c c c
would have certain services and items covered by the
c c c c c c c c c
plan with minimal out-of-pocket costs because his MA-
c c c c c c c c
PD coverage has been very good. However, when he
c c c c c c c c
received the bill, he was surprised to see large charges
c c c c c c c c c c
in excess of his maximum out-of-pocket limit that
c c c c c c c c
included a number of services and items he thought
c c c c c c c c c
would be fully covered. He called you to ask what he
c c c c c c c c c c c
could do? What could you tell him? - ANSWER
c c c c c c c c c
c>>>>You can offer to review the plans c c c c c c
, appeal process to help him ask the plan to review the
c c c c c c c c c c
coverage decision.
c c
Ms. Stuart has heard about a special needs plan (SNP)
c c c c c c c c c
that one of her friends is enrolled in and is interested
c c c c c c c c c c c
in that product. She wants to be sure she also has
c c c c c c c c c c c
coverage for prescription drugs. Would she be able to
c c c c c c c c c
obtain drug coverage if she enrolled in the SNP? -
c c c c c c c c c c
ANSWER >>>>a.
c c
Yes. All SNPs are required to provide Part D coverage
c c c c c c c c c
for prescription drugs.
c c c
b. Yes, but only if she qualifies for Part D
c c c c c c c c
prescription drug coverage under her state
c c c c c c
Medicaid program.
c c
c. No. Medicare beneficiaries who enroll in an SNP
c c c c c c c
must always obtain their drug coverage through a
c c c c c c c c
stand-alone Part D Medicare prescription drug plan
c c c c c c c
that they sign up for independent of their enrollment
c c c c c c c c c
in the SNP.
c c c
d. Maybe. Some SNPs offer Part D coverage c c c c c c
for prescription drugs and some do not.
c c c c c c c
= ?????
c
Phiona works in the IT Department of BestCare Health
c c c c c c c c
cPlan. Phiona is placed in charge of BestCare's efforts
c c c c c c c c
cto facilitate electronic enrollment in its Medicare
c c c c c c
cAdvantage plans. In setting up the enrollment site, c c c c c c c
cwhich of the following must Phiona consider? -
c c c c c c c
cANSWER >>>>II. All data elements required to c c c c c c
ccomplete an enrollment request must be captured. c c c c c c
III. The process must include a clear and distinct step
c c c c c c c c c
cthat requires the applicant to activate an "Enroll Now"
c c c c c c c c
cor "I Agree" type of button or tool.
c c c c c c c
Ms. Lewis understands that Medicare prescription drug
c c c c c c
plans may use various methods to control the use of
c c c c c c c c c c
specific drugs. She has heard about a technique called
c c c c c c c c c
"step therapy" and is wondering if you can explain what
c c c c c c c c c c
that is. What should you tell her? - ANSWER >>>>Step
c c c c c c c c c c
therapy involves using one or more lower priced drugs
c c c c c c c c c
