AHIP FINAL EXAM REVISION QUESTIONS
AND ANSWERS COMPLETE AND RATED A.
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?
✔✔The Medicare Prescription Payment Plan helps spread out beneficiary
cost-sharing payments but does not decrease the total amount owed.
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?
✔✔In general, he must select a single Part D premium payment
mechanism that will be used throughout the year.
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?
✔✔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.
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?
,✔✔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.
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?
✔✔If a Part D benefit is offered through her plan she may choose to enroll
in that plan or a standalone PDP.
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?
✔✔Part D enrollees can opt into the Medicare Prescription Payment Plan at
the beginning of the plan year or any point during the year.
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?
✔✔She may fill prescriptions for covered drugs at non-network
pharmacies, but likely at a higher cost than paid at an in-network
pharmacy.
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?
✔✔The Medicare Advantage plan received a 5-star rating in customer
service and care coordination with an overall performance rating of 4
stars.
, 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?
✔✔You must have her sign a scope of appointment form, indicating which
products she wishes to discuss. You may then proceed with the discussion.
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?
✔✔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.
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?
✔✔This could be considered discriminatory activity and a prohibited
practice.
Agent Jennings makes a presentation on Medicare advertised as an
educational event. Agent Jennings distributes materials that are solely
educational. However, she gives a brief presentation that mentions plan-
specific premiums. Is this a prohibited activity at an event that has been
advertised as educational?
✔✔Yes. When an event has been advertised as "educational," discussing
plan-specific premiums is impermissible.
AND ANSWERS COMPLETE AND RATED A.
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?
✔✔The Medicare Prescription Payment Plan helps spread out beneficiary
cost-sharing payments but does not decrease the total amount owed.
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?
✔✔In general, he must select a single Part D premium payment
mechanism that will be used throughout the year.
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?
✔✔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.
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?
,✔✔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.
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?
✔✔If a Part D benefit is offered through her plan she may choose to enroll
in that plan or a standalone PDP.
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?
✔✔Part D enrollees can opt into the Medicare Prescription Payment Plan at
the beginning of the plan year or any point during the year.
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?
✔✔She may fill prescriptions for covered drugs at non-network
pharmacies, but likely at a higher cost than paid at an in-network
pharmacy.
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?
✔✔The Medicare Advantage plan received a 5-star rating in customer
service and care coordination with an overall performance rating of 4
stars.
, 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?
✔✔You must have her sign a scope of appointment form, indicating which
products she wishes to discuss. You may then proceed with the discussion.
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?
✔✔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.
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?
✔✔This could be considered discriminatory activity and a prohibited
practice.
Agent Jennings makes a presentation on Medicare advertised as an
educational event. Agent Jennings distributes materials that are solely
educational. However, she gives a brief presentation that mentions plan-
specific premiums. Is this a prohibited activity at an event that has been
advertised as educational?
✔✔Yes. When an event has been advertised as "educational," discussing
plan-specific premiums is impermissible.
