AHIP FINAL EXAM VERSION 2 - EXAMINATION
COMPLETE QUESTIONS AND DETAILED SOLUTIONS
LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: Mr. Hildalgo complains to you that because he takes
multiple expensive drugs, he has trouble paying his cost sharing
for his prescription drugs, particularly at the beginning of the year
during the deductible phase. He is happy with his plan and does
not want to change. However, he said he had heard about a new
program called the Medicare Prescription Payment Plan and asked
whether it might help. What do you tell him?
Answer:
The Medicare Prescription Payment Plan helps spread out beneficiary
cost-sharing payments but does not decrease the total amount owed.
Question 2: Mr. Torres has a small savings account. He would like
to pay for his monthly Part D premiums with an automatic monthly
withdrawal from his savings account until it is exhausted, and then
have his premiums withheld from his Social Security check. What
should you tell him?
Answer:
In general, he must select a single Part D premium payment mechanism
that will be used throughout the year.
,Question 3: One of your clients, Lauren Nichols, has heard about a
Medicare concept from one of her neighbors called TrOOP. She
asks you to explain it. What do you say?
Answer:
TrOOP stands for true out-of-pocket costs that count toward the
Medicare Part D catastrophic limit and include not only expenses paid by
a beneficiary but also in some instances amounts paid by or through
qualified State Pharmaceutical Assistance Programs.
Question 4: 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?
Answer:
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.
Question 5: Mrs. Lopez is enrolled in a cost plan for her Medicare
benefits. She has recently lost creditable coverage previously
available through her husband's employer. She is interested in
enrolling in a Medicare Part D prescription drug plan (PDP). What
should you tell her?
Answer:
If a Part D benefit is offered through her plan she may choose to enroll in
that plan or a standalone PDP.
,Question 6: Mrs. Hernandez is one of your clients. She has read
that there is a new program that may help her manage prescription
drug costs. What do you tell her about the Medicare Prescription
Payment Plan?
Answer:
Part D enrollees can opt into the Medicare Prescription Payment Plan at
the beginning of the plan year or any point during the year.
Question 7: Ms. Edwards is enrolled in a Medicare Advantage plan
that includes prescription drug plan (PDP) coverage. She is
traveling and wishes to fill two of the prescriptions that she has
lost. How would you advise her?
Answer:
She may fill prescriptions for covered drugs at non-network pharmacies,
but likely at a higher cost than paid at an in-network pharmacy.
Question 8: During a sales presentation to Ms. Daley for a Medicare
Advantage plan that has a 5-star rating in customer service and
care coordination, and received an overall plan performance rating
of a 4-star, which of the following would be the best statement to
say to her?
Answer:
The Medicare Advantage plan received a 5-star rating in customer
service and care coordination with an overall performance rating of 4
stars.
, Question 9: A Medicare beneficiary has walked into your office and
requested that you sit down with her and discuss her options under
the Medicare Advantage program. Before engaging in such a
discussion, what should you do?
Answer:
You must have her sign a scope of appointment form, indicating which
products she wishes to discuss. You may then proceed with the
discussion.
Question 10: While making an appointment to discuss Medicare
Advantage (MA) and Part D plans with a potential enrollee, you are
asked to describe other types of insurance products that your
client might wish to purchase. What additional types of insurance
can you present during the MA and Part D marketing
appointments?
Answer:
You can present only health care related lines of business but must
obtain the beneficiary's permission to do so before the presentation
occurs and document that you have obtained that permission.
Question 11: One of your colleagues argues that it is better to
focus your time and energy exclusively on neighborhoods with
single-family homes. He further argues that their older owners are
more likely to have higher incomes and purchase the Medicare
Advantage products you represent compared to those living in
apartment complexes. How should you respond?
Answer:
COMPLETE QUESTIONS AND DETAILED SOLUTIONS
LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: Mr. Hildalgo complains to you that because he takes
multiple expensive drugs, he has trouble paying his cost sharing
for his prescription drugs, particularly at the beginning of the year
during the deductible phase. He is happy with his plan and does
not want to change. However, he said he had heard about a new
program called the Medicare Prescription Payment Plan and asked
whether it might help. What do you tell him?
Answer:
The Medicare Prescription Payment Plan helps spread out beneficiary
cost-sharing payments but does not decrease the total amount owed.
Question 2: Mr. Torres has a small savings account. He would like
to pay for his monthly Part D premiums with an automatic monthly
withdrawal from his savings account until it is exhausted, and then
have his premiums withheld from his Social Security check. What
should you tell him?
Answer:
In general, he must select a single Part D premium payment mechanism
that will be used throughout the year.
,Question 3: One of your clients, Lauren Nichols, has heard about a
Medicare concept from one of her neighbors called TrOOP. She
asks you to explain it. What do you say?
Answer:
TrOOP stands for true out-of-pocket costs that count toward the
Medicare Part D catastrophic limit and include not only expenses paid by
a beneficiary but also in some instances amounts paid by or through
qualified State Pharmaceutical Assistance Programs.
Question 4: 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?
Answer:
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.
Question 5: Mrs. Lopez is enrolled in a cost plan for her Medicare
benefits. She has recently lost creditable coverage previously
available through her husband's employer. She is interested in
enrolling in a Medicare Part D prescription drug plan (PDP). What
should you tell her?
Answer:
If a Part D benefit is offered through her plan she may choose to enroll in
that plan or a standalone PDP.
,Question 6: Mrs. Hernandez is one of your clients. She has read
that there is a new program that may help her manage prescription
drug costs. What do you tell her about the Medicare Prescription
Payment Plan?
Answer:
Part D enrollees can opt into the Medicare Prescription Payment Plan at
the beginning of the plan year or any point during the year.
Question 7: Ms. Edwards is enrolled in a Medicare Advantage plan
that includes prescription drug plan (PDP) coverage. She is
traveling and wishes to fill two of the prescriptions that she has
lost. How would you advise her?
Answer:
She may fill prescriptions for covered drugs at non-network pharmacies,
but likely at a higher cost than paid at an in-network pharmacy.
Question 8: During a sales presentation to Ms. Daley for a Medicare
Advantage plan that has a 5-star rating in customer service and
care coordination, and received an overall plan performance rating
of a 4-star, which of the following would be the best statement to
say to her?
Answer:
The Medicare Advantage plan received a 5-star rating in customer
service and care coordination with an overall performance rating of 4
stars.
, Question 9: A Medicare beneficiary has walked into your office and
requested that you sit down with her and discuss her options under
the Medicare Advantage program. Before engaging in such a
discussion, what should you do?
Answer:
You must have her sign a scope of appointment form, indicating which
products she wishes to discuss. You may then proceed with the
discussion.
Question 10: While making an appointment to discuss Medicare
Advantage (MA) and Part D plans with a potential enrollee, you are
asked to describe other types of insurance products that your
client might wish to purchase. What additional types of insurance
can you present during the MA and Part D marketing
appointments?
Answer:
You can present only health care related lines of business but must
obtain the beneficiary's permission to do so before the presentation
occurs and document that you have obtained that permission.
Question 11: One of your colleagues argues that it is better to
focus your time and energy exclusively on neighborhoods with
single-family homes. He further argues that their older owners are
more likely to have higher incomes and purchase the Medicare
Advantage products you represent compared to those living in
apartment complexes. How should you respond?
Answer:
