AHIP - Final examination 2024/2025 already graded A+

AHIP - FINAL EXAMINATION 2024/2025
ALREADY GRADED A+



1. Mr.Zachowhasaconditionforwhichthreedrugsareavailable.Hehastried two but had an allergic reaction to them. Only the
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f third drug works for him andit is not on his Part D plan's formulary.What could you tell him to do?
f f f f f f f f f f f f f f f f f f f f f answer>>>:Mr. Zachow f f




has a right to request a formulary exception to obtain coverage for his Part
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f Ddrug.Heorhisphysiciancouldobtainthestandardizedrequestformontheplan's website, fill it out, and submit it to his plan.
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2. Mr. Polanski likes the cost of an HMO plan available in his area, but would liketobeabletovisitoneortwodoctorswhoaren't
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participatingproviders.He wants to know if the Point of Service (POS) option available with some HMOs will be of any help in this
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situation.What should you tell him?
f f f f f f answer>>>::ThePOS option might beagoodsolutionforhim asitwillallowhim tovisitout-of- f f f f f f f f f f f f f f f f f f




network providers, generallywithout prior approval.However, heshouldbeawarethat it is likelyhe will have to pay higher cost-sharing for
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f services from out-of-network providers.
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3. Mr. Barker had surgery recently and expected that he would have certain services and items covered by the plan with
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,f minimal out-of-pocket costs because his MA-PD coverage has beenverygood.However,whenhe received the bill, he was
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f surprised to see large charges in excess of his maximum
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out-of-pocket limit that included a number of services and items he thought would be fully covered. He called you to ask what
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f he could do?What could you tell him?
f f f f f f f answer>>>::Youcanoffertoreviewtheplansappealprocesstohelphimaskthe plan to f f f f f f f f f f f f f f f f




f review the coverage decision.
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4. Ms.Stuarthasheardaboutaspecialneedsplan(SNP)thatoneofherfriends is enrolled in and is interested in that product. She
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f wants to be sure she
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also has coverage for prescription drugs.Would she be able to obtain drug coverage if she enrolled in the SNP?:
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answer>>>:a.Yes.All SNPs are required to provide Part D coverage for prescription drugs. f f f f f f f f f f f f f




b. Yes,butonlyifshequalifiesforPartDprescriptiondrugcoverageunderherstate Medicaid program.
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c. No. Medicare beneficiaries who enroll in an SNP must always obtain their drug coverage through a stand-alone Part D Medicare
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prescription drug plan that they sign up for independent of their enrollment in the SNP.
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d. Maybe.SomeSNPsofferPartDcoverageforprescriptiondrugsandsomedonot.
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= ?????
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5. Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of BestCare's efforts to facilitate
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f electronic enrollment in its Medicare Advantage plans.In setting up the enrollment site,which of the following must Phiona
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f consider?: answer>>>:II.All data elements required to complete an enrollment request must be captured. f f f f f f f f f f f f f

, 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
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f tool.


6. Ms. Lewis understands that Medicare prescription drug plans may use various methods to control the use of specific
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f drugs. She has heard about a technique called "step therapy" and is wondering if you can explain what
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that is.What should you tell her?
f f f f f f answer>>>::Step therapyinvolves using one or more lower priced drugs before trying a more f f f f f f f f f f f f f f




f expensive drug when all are used to treat the same condition. f f f f f f f f f f




7. Mr.Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to
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f know if he must use doctors f f f f f




in a network as his current HMO plan requires him to do.What should you tell him?:
f f f f f f f f f f f f f f f f answer>>>: He may receive health f f f f




f care services from ANY doctor allowed to bill Medicare, as long as he shows the doctor the plan's identification card and the
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f doctoragreestoacceptthePFFSplan'spaymenttermsandconditions,whichcould include balance billing.
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8. Mr.Wuis eligible for Medicare.He has limited financial resources but failed toqualifyforthePartDlow-
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incomesubsidy.Wheremightheturnforhelpwith his prescription drug costs?
f f f f f f f f f f f f answer>>>:: Mr.Wu may still qualify for help f f f f f f f




f in paying Part D costs through his State Pharmaceutical Assistance Program.
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9. You have decided to focus on doing in-home presentations to market the MedicareAdvantage(MA)plansyou
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represent.Beforeyouconductsuchsales presentations, what must you do?:
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10. Mr.Wong is a single individual. He has had a successful business career
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f andisnowabletoretirewithacomfortableincome.Mr.Wong'staxableincome is in excess of $100,000.Mr.Wong has health coverage
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fthrough his employer but will sign-up Medicare Part A, Part B and Part D when he leaves the work- force. How would you advise
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f him as he budgets for Medicare premiums?
f f f f f f answer>>>:: a. Due to the provisions of MACRA, his Part B and D coverage will f f f f f f f f f f f f f f