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AHIP FINAL EXAM STUDY QUESTIONS & ANSWERS
Dan is middle-income Medicare beneficiary. He has chronic bronchitis.
Which type of SNP is likely to be most appropriate for him? - CORRECT
ANSWER - C-SNP
Dr. B does not contract with ABC PFFS plans but accept the plan's terms
& conditions for payment. Mike sees Dr. B for tx. How much may Dr. B
charge? - CORRECT ANSWER - Dr. B can charge Mike no more than
the cost-sharing specified in the PFFS plans terms & conditions of
payment which may include balance billing up to 15% of the Medicare
rate.
Mr. A asked how PFFS plan might after her access to services since she
receives some assistance for her health care costs from the state. What
should you tell her? - CORRECT ANSWER - Medicaid may provides
addition benefits, but Medicaid will coordinate benefits only with
Medicaid participating providers.
Mr. A receives some help paying for his 2 generic prescr. drugs from his
employer's retiree coverage, but he wants to compare it to Part D PDP.
He asks you what costs he would generally encounter when enrolling
into a standard Medicare Pt D drug plan? what should you tell him? -
CORRECT ANSWER - He would generally pay a monthly premium,
annual ded., & prescr. cost-sharing.
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Mr. B if 49 years old, but 18 months ago he was declared disabled by SSA
& has been getting disability payments. He is wondering whether he can
get coverage under Medicare. What should you tell him? - CORRECT
ANSWER - After getting such disability payments for 24 months. he will
be automatically enrolled in Medicare, regardless of age
Mr. B is enjoying his retirement income. He recently had surgery &
expected certain items to be covered by the plan with minimal out of
pocket costs because is MAPD plan coverage has been good. But when
he got the bill, he saw large charges in excess of his MOOP limit including
some services & items he thought would be covered. What can he do?
- CORRECT ANSWER - You can offer to review the plans appeal process
to help him ask the plan to review the coverage decision.
Mr. B wants to know if Medicare covers cancer screening? What should
you tell him? - CORRECT ANSWER - Medicare covers periodic ranges
of screening tests that are meant to provide early detection of diseases.
Mr. B will have to check specific tests before getting them to see if they
will be covered
Mr. C is a citizen, previously enrolled in Medicare Pt B but has recently
stopped paying his Pt B premiums. Mr. C is still covered by Pt A & would
like to enroll in a MA plan while still covered by Pt A. What should you
tell him? - CORRECT ANSWER - He is not eligible to enroll in a MA plan
until he re-enrolls in Medicare Pt B
Mr. C would like to purchase a MA plan & a Medigap plan. what should
you tell him? - CORRECT ANSWER - It is illegal for you to sell Mr. C a
AHIP FINAL EXAM STUDY QUESTIONS & ANSWERS
Dan is middle-income Medicare beneficiary. He has chronic bronchitis.
Which type of SNP is likely to be most appropriate for him? - CORRECT
ANSWER - C-SNP
Dr. B does not contract with ABC PFFS plans but accept the plan's terms
& conditions for payment. Mike sees Dr. B for tx. How much may Dr. B
charge? - CORRECT ANSWER - Dr. B can charge Mike no more than
the cost-sharing specified in the PFFS plans terms & conditions of
payment which may include balance billing up to 15% of the Medicare
rate.
Mr. A asked how PFFS plan might after her access to services since she
receives some assistance for her health care costs from the state. What
should you tell her? - CORRECT ANSWER - Medicaid may provides
addition benefits, but Medicaid will coordinate benefits only with
Medicaid participating providers.
Mr. A receives some help paying for his 2 generic prescr. drugs from his
employer's retiree coverage, but he wants to compare it to Part D PDP.
He asks you what costs he would generally encounter when enrolling
into a standard Medicare Pt D drug plan? what should you tell him? -
CORRECT ANSWER - He would generally pay a monthly premium,
annual ded., & prescr. cost-sharing.
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Mr. B if 49 years old, but 18 months ago he was declared disabled by SSA
& has been getting disability payments. He is wondering whether he can
get coverage under Medicare. What should you tell him? - CORRECT
ANSWER - After getting such disability payments for 24 months. he will
be automatically enrolled in Medicare, regardless of age
Mr. B is enjoying his retirement income. He recently had surgery &
expected certain items to be covered by the plan with minimal out of
pocket costs because is MAPD plan coverage has been good. But when
he got the bill, he saw large charges in excess of his MOOP limit including
some services & items he thought would be covered. What can he do?
- CORRECT ANSWER - You can offer to review the plans appeal process
to help him ask the plan to review the coverage decision.
Mr. B wants to know if Medicare covers cancer screening? What should
you tell him? - CORRECT ANSWER - Medicare covers periodic ranges
of screening tests that are meant to provide early detection of diseases.
Mr. B will have to check specific tests before getting them to see if they
will be covered
Mr. C is a citizen, previously enrolled in Medicare Pt B but has recently
stopped paying his Pt B premiums. Mr. C is still covered by Pt A & would
like to enroll in a MA plan while still covered by Pt A. What should you
tell him? - CORRECT ANSWER - He is not eligible to enroll in a MA plan
until he re-enrolls in Medicare Pt B
Mr. C would like to purchase a MA plan & a Medigap plan. what should
you tell him? - CORRECT ANSWER - It is illegal for you to sell Mr. C a
