AHIP - FINAL EXAMINATION EXAM WITH
QUESTIONS AND ANSWERS LATEST UPDATE
2024/2025 RATED A+, EXAMS OF NURSING
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 before trying a more expensive drug when
all are used to treat the same condition.
QUESTIONS AND ANSWERS LATEST UPDATE
2024/2025 RATED A+, EXAMS OF NURSING
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 before trying a more expensive drug when
all are used to treat the same condition.
