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AHIP 34

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Exam of 10 pages for the course 2023 AHIP at 2023 AHIP (AHIP 34)

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2023 AHIP

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2023 AHIP

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Institution: 2023 AHIP
Course: 2023 AHIP

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Uploaded on: March 17, 2025
Number of pages: 10
Written in: 2024/2025
Type: Exam (elaborations)
Contains: Questions & answers

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ahip 34

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AHIP - FINAL EXAMINATION
QUESTIONS WITH CORRECT
ANSWERS 2025/2026
Mr.AZachowAhasAaAconditionAforAwhichAthreeAdrugsAareAavailable.AHeAhasAtriedAtwoAbutAhadAan
AallergicAreactionAtoAthem.AOnlyAtheAthirdAdrugAworksAforAhimAandAitAisAnotAonAhisAPartADAplan's

Aformulary.AWhatAcouldAyouAtellAhimAtoAdo?A-

AcorrectAanswersMr.AZachowAhasAaArightAtoArequestAaAformularyAexceptionAtoAobtainAcoverageA

forAhisAPartADAdrug.AHeAorAhisAphysicianAcouldAobtainAtheAstandardizedArequestAformAonAtheApl
an'sAwebsite,AfillAitAout,AandAsubmitAitAtoAhisAplan.

Mr.APolanskiAlikesAtheAcostAofAanAHMOAplanAavailableAinAhisAarea,AbutAwouldAlikeAtoAbeAableAtoA
visitAoneAorAtwoAdoctorsAwhoAaren'tAparticipatingAproviders.AHeAwantsAtoAknowAifAtheAPointAofA
ServiceA(POS)AoptionAavailableAwithAsomeAHMOsAwillAbeAofAanyAhelpAinAthisAsituation.AWhatAsh
ouldAyouAtellAhim?A-
AcorrectAanswersTheAPOSAoptionAmightAbeAaAgoodAsolutionAforAhimAasAitAwillAallowAhimAtoAvisitA

out-of-
networkAproviders,AgenerallyAwithoutApriorAapproval.AHowever,AheAshouldAbeAawareAthatAitAisA
likelyAheAwillAhaveAtoApayAhigherAcost-sharingAforAservicesAfromAout-of-networkAproviders.

Mr.ABarkerAhadAsurgeryArecentlyAandAexpectedAthatAheAwouldAhaveAcertainAservicesAandAitems
AcoveredAbyAtheAplanAwithAminimalAout-of-pocketAcostsAbecauseAhisAMA-

PDAcoverageAhasAbeenAveryAgood.AHowever,AwhenAheAreceivedAtheAbill,AheAwasAsurprisedAtoAse
eAlargeAchargesAinAexcessAofAhisAmaximumAout-of-
pocketAlimitAthatAincludedAaAnumberAofAservicesAandAitemsAheAthoughtAwouldAbeAfullyAcovere
d.AHeAcalledAyouAtoAaskAwhatAheAcouldAdo?AWhatAcouldAyouAtellAhim?A-
AcorrectAanswersYouAcanAofferAtoAreviewAtheAplansAappealAprocessAtoAhelpAhimAaskAtheAplanAto

AreviewAtheAcoverageAdecision.

Ms.AStuartAhasAheardAaboutAaAspecialAneedsAplanA(SNP)AthatAoneAofAherAfriendsAisAenrolledAinA
andAisAinterestedAinAthatAproduct.ASheAwantsAtoAbeAsureAsheAalsoAhasAcoverageAforAprescriptio
nAdrugs.AWouldAsheAbeAableAtoAobtainAdrugAcoverageAifAsheAenrolledAinAtheASNP?A-
AcorrectAanswersa.AYes.AAllASNPsAareArequiredAtoAprovideAPartADAcoverageAforAprescriptionAdru

gs.

b.AYes,AbutAonlyAifAsheAqualifiesAforAPartADAprescriptionAdrugAcoverageAunderAherAstateAMedicai
dAprogram.

c.ANo.AMedicareAbeneficiariesAwhoAenrollAinAanASNPAmustAalwaysAobtainAtheirAdrugAcoverageAt
hroughAaAstand-
aloneAPartADAMedicareAprescriptionAdrugAplanAthatAtheyAsignAupAforAindependentAofAtheirAenr
ollmentAinAtheASNP.

, d.AMaybe.ASomeASNPsAofferAPartADAcoverageAforAprescriptionAdrugsAandAsomeAdoAnot.

=A?????

PhionaAworksAinAtheAITADepartmentAofABestCareAHealthAPlan.APhionaAisAplacedAinAchargeAofABe
stCare'sAeffortsAtoAfacilitateAelectronicAenrollmentAinAitsAMedicareAAdvantageAplans.AInAsettingA
upAtheAenrollmentAsite,AwhichAofAtheAfollowingAmustAPhionaAconsider?A-
AcorrectAanswersII.AAllAdataAelementsArequiredAtoAcompleteAanAenrollmentArequestAmustAbeAca

ptured.

III.ATheAprocessAmustAincludeAaAclearAandAdistinctAstepAthatArequiresAtheAapplicantAtoAactivateA
anA"EnrollANow"AorA"IAAgree"AtypeAofAbuttonAorAtool.

Ms.ALewisAunderstandsAthatAMedicareAprescriptionAdrugAplansAmayAuseAvariousAmethodsAtoAc
ontrolAtheAuseAofAspecificAdrugs.ASheAhasAheardAaboutAaAtechniqueAcalledA"stepAtherapy"AandAi
sAwonderingAifAyouAcanAexplainAwhatAthatAis.AWhatAshouldAyouAtellAher?A-
AcorrectAanswersStepAtherapyAinvolvesAusingAoneAorAmoreAlowerApricedAdrugsAbeforeAtryingAaA

moreAexpensiveAdrugAwhenAallAareAusedAtoAtreatAtheAsameAcondition.

Mr.AGomezAnotesAthatAaAPrivateAFee-for-
ServiceA(PFFS)AplanAavailableAinAhisAareaAhasAanAattractiveApremium.AHeAwantsAtoAknowAifAheA
mustAuseAdoctorsAinAaAnetworkAasAhisAcurrentAHMOAplanArequiresAhimAtoAdo.AWhatAshouldAyou
AtellAhim?A-

AcorrectAanswersHeAmayAreceiveAhealthAcareAservicesAfromAANYAdoctorAallowedAtoAbillAMedica

re,AasAlongAasAheAshowsAtheAdoctorAtheAplan'sAidentificationAcardAandAtheAdoctorAagreesAtoAacc
eptAtheAPFFSAplan'sApaymentAtermsAandAconditions,AwhichAcouldAincludeAbalanceAbilling.

Mr.AWuAisAeligibleAforAMedicare.AHeAhasAlimitedAfinancialAresourcesAbutAfailedAtoAqualifyAforAth
eAPartADAlow-
incomeAsubsidy.AWhereAmightAheAturnAforAhelpAwithAhisAprescriptionAdrugAcosts?A-
AcorrectAanswersMr.AWuAmayAstillAqualifyAforAhelpAinApayingAPartADAcostsAthroughAhisAStateAPha

rmaceuticalAAssistanceAProgram.

YouAhaveAdecidedAtoAfocusAonAdoingAin-
homeApresentationsAtoAmarketAtheAMedicareAAdvantageA(MA)AplansAyouArepresent.ABeforeAyo
uAconductAsuchAsalesApresentations,AwhatAmustAyouAdo?A-AcorrectAanswers

Mr.AWongAisAaAsingleAindividual.AHeAhasAhadAaAsuccessfulAbusinessAcareerAandAisAnowAableAtoAr
etireAwithAaAcomfortableAincome.AMr.AWong'sAtaxableAincomeAisAinAexcessAofA$100,000.AMr.AW
ongAhasAhealthAcoverageAthroughAhisAemployerAbutAwillAsign-
upAMedicareAPartAA,APartABAandAPartADAwhenAheAleavesAtheAworkforce.AHowAwouldAyouAadvise
AhimAasAheAbudgetsAforAMedicareApremiums?A-

AcorrectAanswersa.ADueAtoAtheAprovisionsAofAMACRA,AhisAPartABAandADAcoverageAwillAbeAcombi

nedAandAcoveredAthroughAaAlow-costAMedigapApolicyAtoAsupplementAhisAPartAAAcoverage.

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