AHIP Final Examination With Correct
Solutions 2024
Mr. hZachow hhas ha hcondition hfor hwhich hthree hdrugs hare havailable. hHe hhas htried htwo hbut
hhad han hallergic hreaction hto hthem. hOnly hthe hthird hdrug hworks hfor hhim hand hit his hnot hon hhis
hPart hD hplan's hformulary. hWhat hcould hyou htell hhim hto hdo? h- hcorrect hanswer.Mr. hZachow
hhas ha hright hto hrequest ha hformulary hexception hto hobtain hcoverage hfor hhis hPart hD hdrug.
hHe hor hhis hphysician hcould hobtain hthe hstandardized hrequest hform hon hthe hplan's hwebsite,
hfill hit hout, hand hsubmit hit hto hhis hplan.
Mr. hPolanski hlikes hthe hcost hof han hHMO hplan havailable hin hhis harea, hbut hwould hlike hto hbe
hable hto hvisit hone hor htwo hdoctors hwho haren't hparticipating hproviders. hHe hwants hto hknow hif
hthe hPoint hof hService h(POS) hoption havailable hwith hsome hHMOs hwill hbe hof hany hhelp hin
hthis hsituation. hWhat hshould hyou htell hhim? h- hcorrect hanswer.The hPOS hoption hmight hbe ha
hgood hsolution hfor hhim has hit hwill hallow hhim hto hvisit hout-of-network hproviders, hgenerally
hwithout hprior happroval. hHowever, hhe hshould hbe haware hthat hit his hlikely hhe hwill hhave hto
hpay hhigher hcost-sharing hfor hservices hfrom hout-of-network hproviders.
Mr. hBarker hhad hsurgery hrecently hand hexpected hthat hhe hwould hhave hcertain hservices
hand hitems hcovered hby hthe hplan hwith hminimal hout-of-pocket hcosts hbecause hhis hMA-PD
hcoverage hhas hbeen hvery hgood. hHowever, hwhen hhe hreceived hthe hbill, hhe hwas hsurprised
hto hsee hlarge hcharges hin hexcess hof hhis hmaximum hout-of-pocket hlimit hthat hincluded ha
hnumber hof hservices hand hitems hhe hthought hwould hbe hfully hcovered. hHe hcalled hyou hto
hask hwhat hhe hcould hdo? hWhat hcould hyou htell hhim? h- hcorrect hanswer.You hcan hoffer hto
hreview hthe hplans happeal hprocess hto hhelp hhim hask hthe hplan hto hreview hthe hcoverage
hdecision.
Ms. hStuart hhas hheard habout ha hspecial hneeds hplan h(SNP) hthat hone hof hher hfriends his
henrolled hin hand his hinterested hin hthat hproduct. hShe hwants hto hbe hsure hshe halso hhas
hcoverage hfor hprescription hdrugs. hWould hshe hbe hable hto hobtain hdrug hcoverage hif hshe
henrolled hin hthe hSNP? h- hcorrect hanswer.a. hYes. hAll hSNPs hare hrequired hto hprovide hPart hD
hcoverage hfor hprescription hdrugs.
b. hYes, hbut honly hif hshe hqualifies hfor hPart hD hprescription hdrug hcoverage hunder hher hstate
hMedicaid hprogram.
c. hNo. hMedicare hbeneficiaries hwho henroll hin han hSNP hmust halways hobtain htheir hdrug
hcoverage hthrough ha hstand-alone hPart hD hMedicare hprescription hdrug hplan hthat hthey hsign
hup hfor hindependent hof htheir henrollment hin hthe hSNP.
d. hMaybe. hSome hSNPs hoffer hPart hD hcoverage hfor hprescription hdrugs hand hsome hdo hnot.
= h?????
, Phiona hworks hin hthe hIT hDepartment hof hBestCare hHealth hPlan. hPhiona his hplaced hin
hcharge hof hBestCare's hefforts hto hfacilitate helectronic henrollment hin hits hMedicare
hAdvantage hplans. hIn hsetting hup hthe henrollment hsite, hwhich hof hthe hfollowing hmust hPhiona
hconsider? h- hcorrect hanswer.II. hAll hdata helements hrequired hto hcomplete han henrollment
hrequest hmust hbe hcaptured.
III. hThe hprocess hmust hinclude ha hclear hand hdistinct hstep hthat hrequires hthe happlicant hto
hactivate han h"Enroll hNow" hor h"I hAgree" htype hof hbutton hor htool.
Ms. hLewis hunderstands hthat hMedicare hprescription hdrug hplans hmay huse hvarious
hmethods hto hcontrol hthe huse hof hspecific hdrugs. hShe hhas hheard habout ha htechnique hcalled
h"step htherapy" hand his hwondering hif hyou hcan hexplain hwhat hthat his. hWhat hshould hyou htell
hher? h- hcorrect hanswer.Step htherapy hinvolves husing hone hor hmore hlower hpriced hdrugs
hbefore htrying ha hmore hexpensive hdrug hwhen hall hare hused hto htreat hthe hsame hcondition.
Mr. hGomez hnotes hthat ha hPrivate hFee-for-Service h(PFFS) hplan havailable hin hhis harea hhas
han hattractive hpremium. hHe hwants hto hknow hif hhe hmust huse hdoctors hin ha hnetwork has hhis
hcurrent hHMO hplan hrequires hhim hto hdo. hWhat hshould hyou htell hhim? h- hcorrect hanswer.He
hmay hreceive hhealth hcare hservices hfrom hANY hdoctor hallowed hto hbill hMedicare, has hlong
has hhe hshows hthe hdoctor hthe hplan's hidentification hcard hand hthe hdoctor hagrees hto haccept
hthe hPFFS hplan's hpayment hterms hand hconditions, hwhich hcould hinclude hbalance hbilling.
Mr. hWu his heligible hfor hMedicare. hHe hhas hlimited hfinancial hresources hbut hfailed hto hqualify
hfor hthe hPart hD hlow-income hsubsidy. hWhere hmight hhe hturn hfor hhelp hwith hhis hprescription
hdrug hcosts? h- hcorrect hanswer.Mr. hWu hmay hstill hqualify hfor hhelp hin hpaying hPart hD hcosts
hthrough hhis hState hPharmaceutical hAssistance hProgram.
You hhave hdecided hto hfocus hon hdoing hin-home hpresentations hto hmarket hthe hMedicare
hAdvantage h(MA) hplans hyou hrepresent. hBefore hyou hconduct hsuch hsales hpresentations,
hwhat hmust hyou hdo? h- hcorrect hanswer.
Mr. hWong his ha hsingle hindividual. hHe hhas hhad ha hsuccessful hbusiness hcareer hand his hnow
hable hto hretire hwith ha hcomfortable hincome. hMr. hWong's htaxable hincome his hin hexcess hof
h$100,000. hMr. hWong hhas hhealth hcoverage hthrough hhis hemployer hbut hwill hsign-up
hMedicare hPart hA, hPart hB hand hPart hD hwhen hhe hleaves hthe hworkforce. hHow hwould hyou
hadvise hhim has hhe hbudgets hfor hMedicare hpremiums? h- hcorrect hanswer.a. hDue hto hthe
hprovisions hof hMACRA, hhis hPart hB hand hD hcoverage hwill hbe hcombined hand hcovered
hthrough ha hlow-cost hMedigap hpolicy hto hsupplement hhis hPart hA hcoverage.
b. hDue hto hhis hparticipation hin hthe hworkforce hhe hwill hnot hhave hto hpay hpremiums hfor hPart
hA hand hhe hwill hpay hthe hlowest hmonthly hpremium hrates hfor hPart hB hand hPart hD.
c. hDue hto hhis hparticipation hin hthe hworkforce hhe hwill hnot hhave hto hpay hpremiums hfor hPart
hA hbut hhe hwill hpay hhigher hpremiums hfor hPart hB hand hPart hD hdue hto hthe hamount hof hhis
hincome.
d. hDue hto hhis hparticipation hin hthe hworkforce hhe hwill hnot hhave hto hpay hpremiums hfor hPart
hA hand hwill hpay hreduced hpremiums hfor hPart hB hand hPart hD.
?????
Solutions 2024
Mr. hZachow hhas ha hcondition hfor hwhich hthree hdrugs hare havailable. hHe hhas htried htwo hbut
hhad han hallergic hreaction hto hthem. hOnly hthe hthird hdrug hworks hfor hhim hand hit his hnot hon hhis
hPart hD hplan's hformulary. hWhat hcould hyou htell hhim hto hdo? h- hcorrect hanswer.Mr. hZachow
hhas ha hright hto hrequest ha hformulary hexception hto hobtain hcoverage hfor hhis hPart hD hdrug.
hHe hor hhis hphysician hcould hobtain hthe hstandardized hrequest hform hon hthe hplan's hwebsite,
hfill hit hout, hand hsubmit hit hto hhis hplan.
Mr. hPolanski hlikes hthe hcost hof han hHMO hplan havailable hin hhis harea, hbut hwould hlike hto hbe
hable hto hvisit hone hor htwo hdoctors hwho haren't hparticipating hproviders. hHe hwants hto hknow hif
hthe hPoint hof hService h(POS) hoption havailable hwith hsome hHMOs hwill hbe hof hany hhelp hin
hthis hsituation. hWhat hshould hyou htell hhim? h- hcorrect hanswer.The hPOS hoption hmight hbe ha
hgood hsolution hfor hhim has hit hwill hallow hhim hto hvisit hout-of-network hproviders, hgenerally
hwithout hprior happroval. hHowever, hhe hshould hbe haware hthat hit his hlikely hhe hwill hhave hto
hpay hhigher hcost-sharing hfor hservices hfrom hout-of-network hproviders.
Mr. hBarker hhad hsurgery hrecently hand hexpected hthat hhe hwould hhave hcertain hservices
hand hitems hcovered hby hthe hplan hwith hminimal hout-of-pocket hcosts hbecause hhis hMA-PD
hcoverage hhas hbeen hvery hgood. hHowever, hwhen hhe hreceived hthe hbill, hhe hwas hsurprised
hto hsee hlarge hcharges hin hexcess hof hhis hmaximum hout-of-pocket hlimit hthat hincluded ha
hnumber hof hservices hand hitems hhe hthought hwould hbe hfully hcovered. hHe hcalled hyou hto
hask hwhat hhe hcould hdo? hWhat hcould hyou htell hhim? h- hcorrect hanswer.You hcan hoffer hto
hreview hthe hplans happeal hprocess hto hhelp hhim hask hthe hplan hto hreview hthe hcoverage
hdecision.
Ms. hStuart hhas hheard habout ha hspecial hneeds hplan h(SNP) hthat hone hof hher hfriends his
henrolled hin hand his hinterested hin hthat hproduct. hShe hwants hto hbe hsure hshe halso hhas
hcoverage hfor hprescription hdrugs. hWould hshe hbe hable hto hobtain hdrug hcoverage hif hshe
henrolled hin hthe hSNP? h- hcorrect hanswer.a. hYes. hAll hSNPs hare hrequired hto hprovide hPart hD
hcoverage hfor hprescription hdrugs.
b. hYes, hbut honly hif hshe hqualifies hfor hPart hD hprescription hdrug hcoverage hunder hher hstate
hMedicaid hprogram.
c. hNo. hMedicare hbeneficiaries hwho henroll hin han hSNP hmust halways hobtain htheir hdrug
hcoverage hthrough ha hstand-alone hPart hD hMedicare hprescription hdrug hplan hthat hthey hsign
hup hfor hindependent hof htheir henrollment hin hthe hSNP.
d. hMaybe. hSome hSNPs hoffer hPart hD hcoverage hfor hprescription hdrugs hand hsome hdo hnot.
= h?????
, Phiona hworks hin hthe hIT hDepartment hof hBestCare hHealth hPlan. hPhiona his hplaced hin
hcharge hof hBestCare's hefforts hto hfacilitate helectronic henrollment hin hits hMedicare
hAdvantage hplans. hIn hsetting hup hthe henrollment hsite, hwhich hof hthe hfollowing hmust hPhiona
hconsider? h- hcorrect hanswer.II. hAll hdata helements hrequired hto hcomplete han henrollment
hrequest hmust hbe hcaptured.
III. hThe hprocess hmust hinclude ha hclear hand hdistinct hstep hthat hrequires hthe happlicant hto
hactivate han h"Enroll hNow" hor h"I hAgree" htype hof hbutton hor htool.
Ms. hLewis hunderstands hthat hMedicare hprescription hdrug hplans hmay huse hvarious
hmethods hto hcontrol hthe huse hof hspecific hdrugs. hShe hhas hheard habout ha htechnique hcalled
h"step htherapy" hand his hwondering hif hyou hcan hexplain hwhat hthat his. hWhat hshould hyou htell
hher? h- hcorrect hanswer.Step htherapy hinvolves husing hone hor hmore hlower hpriced hdrugs
hbefore htrying ha hmore hexpensive hdrug hwhen hall hare hused hto htreat hthe hsame hcondition.
Mr. hGomez hnotes hthat ha hPrivate hFee-for-Service h(PFFS) hplan havailable hin hhis harea hhas
han hattractive hpremium. hHe hwants hto hknow hif hhe hmust huse hdoctors hin ha hnetwork has hhis
hcurrent hHMO hplan hrequires hhim hto hdo. hWhat hshould hyou htell hhim? h- hcorrect hanswer.He
hmay hreceive hhealth hcare hservices hfrom hANY hdoctor hallowed hto hbill hMedicare, has hlong
has hhe hshows hthe hdoctor hthe hplan's hidentification hcard hand hthe hdoctor hagrees hto haccept
hthe hPFFS hplan's hpayment hterms hand hconditions, hwhich hcould hinclude hbalance hbilling.
Mr. hWu his heligible hfor hMedicare. hHe hhas hlimited hfinancial hresources hbut hfailed hto hqualify
hfor hthe hPart hD hlow-income hsubsidy. hWhere hmight hhe hturn hfor hhelp hwith hhis hprescription
hdrug hcosts? h- hcorrect hanswer.Mr. hWu hmay hstill hqualify hfor hhelp hin hpaying hPart hD hcosts
hthrough hhis hState hPharmaceutical hAssistance hProgram.
You hhave hdecided hto hfocus hon hdoing hin-home hpresentations hto hmarket hthe hMedicare
hAdvantage h(MA) hplans hyou hrepresent. hBefore hyou hconduct hsuch hsales hpresentations,
hwhat hmust hyou hdo? h- hcorrect hanswer.
Mr. hWong his ha hsingle hindividual. hHe hhas hhad ha hsuccessful hbusiness hcareer hand his hnow
hable hto hretire hwith ha hcomfortable hincome. hMr. hWong's htaxable hincome his hin hexcess hof
h$100,000. hMr. hWong hhas hhealth hcoverage hthrough hhis hemployer hbut hwill hsign-up
hMedicare hPart hA, hPart hB hand hPart hD hwhen hhe hleaves hthe hworkforce. hHow hwould hyou
hadvise hhim has hhe hbudgets hfor hMedicare hpremiums? h- hcorrect hanswer.a. hDue hto hthe
hprovisions hof hMACRA, hhis hPart hB hand hD hcoverage hwill hbe hcombined hand hcovered
hthrough ha hlow-cost hMedigap hpolicy hto hsupplement hhis hPart hA hcoverage.
b. hDue hto hhis hparticipation hin hthe hworkforce hhe hwill hnot hhave hto hpay hpremiums hfor hPart
hA hand hhe hwill hpay hthe hlowest hmonthly hpremium hrates hfor hPart hB hand hPart hD.
c. hDue hto hhis hparticipation hin hthe hworkforce hhe hwill hnot hhave hto hpay hpremiums hfor hPart
hA hbut hhe hwill hpay hhigher hpremiums hfor hPart hB hand hPart hD hdue hto hthe hamount hof hhis
hincome.
d. hDue hto hhis hparticipation hin hthe hworkforce hhe hwill hnot hhave hto hpay hpremiums hfor hPart
hA hand hwill hpay hreduced hpremiums hfor hPart hB hand hPart hD.
?????
