AHIP FINAL EXAM WITH QUESTIONS
AND VERIFIED ANSWERS LATEST
UPDATE|RATED 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? -
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.
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? - ANSWER >>>>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.
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? - ANSWER >>>>You can offer to review the plans
, appeal process to help him ask the plan to review the
coverage decision.
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? - ANSWER >>>>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.
= ?????
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? - ANSWER >>>>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.
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? - ANSWER >>>>Step
therapy involves using one or more lower priced drugs
AND VERIFIED ANSWERS LATEST
UPDATE|RATED 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? -
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.
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? - ANSWER >>>>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.
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? - ANSWER >>>>You can offer to review the plans
, appeal process to help him ask the plan to review the
coverage decision.
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? - ANSWER >>>>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.
= ?????
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? - ANSWER >>>>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.
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? - ANSWER >>>>Step
therapy involves using one or more lower priced drugs
