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AHIP MEDICARE TRAINING Q AND A

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AHIP MEDICARE TRAINING Q AND A

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AHIP - 2027
fv fv

Studyfvonlinefvatfvhttps://quizlet.com/
_jp65r9

AHIP MEDICARE TRAINING Q AND A

WhichfvoffvthefvfollowingfvstatementsfvaboutfvMedicarefvPartfvDfvis/arefvcorrect?
I.fvPartfvDfvplansfvmustfvenrollfvanyfveligiblefvbeneficiaryfvwhofvapplies,fvregardlessfvoffvhealthfvstatus,fvexceptfvinfvlimitedf
vcircumstances.

II.fvPrivatefvfee-for-
servicefv(PFFS)fvplansfvarefvnotfvrequiredfvtofvusefvafvpharmacyfvnetworkfvbutfvmayfvchoosefvtofvhavefvone.
III.fvBeneficiariesfvenrolledfvinfvanfvMA-
MedicalfvSavingsfvAccountfv(MSA)fvplanfvmayfvonlyfvobtainfvPartfvDfvbenefitsfvthroughfvafvstandalonefvPDP.
IV.fvBeneficiariesfvenrolledfvinfvanfvMA-
PPOfvmayfvobtainfvPartfvDfvbenefitsfvthroughfvafvstandalonefvPDPfvorfvthroughfvtheirfvplan.fv-fvanswer--I,fvII,fvandfvIIIfvonly

Mr.fvAguilarfvisfvafvnewlyfvenrolledfvMedicarefvPartfvDfvbeneficiaryfvandfvonefvoffvyourfvclients.fvInfvadditionfvtofvdrugsfvonfv
hisfvplan'sfvformulary,fvhefvtakesfvseveralfvotherfvmedications.fvThesefvincludefvafvprescriptionfvdrugfvnotfvonfvhisfvplan'sf
vformulary,fvover-the-counterfvmedicationsfvforfvcoldsfvandfvallergies,fvvitamins,fvandfvdrugsfvfromfvanfvInternet-

basedfvCanadianfvpharmacyfvtofvpromotefvhairfvgrowthfvandfvreducefvjointfvswelling.fvHisfvneighborfvrecentlyfvtoldfvhimfv
aboutfvafvconceptfvcalledfvTrOOPfvandfvhefvasksfvyoufviffvanyfvoffvhisfvotherfvmedicationsfvcouldfvcountfvtowardfvTrOOPfv
shouldfvhefveverfvreachfvthefvPartfvDfvcatastrophicfvlimit.fvWhatfvshouldfvyoufvsay?
Questionfv2Answerfv-fvanswer--
NonefvoffvthefvcostsfvoffvMr.fvAguilar'sfvotherfvmedicationsfvwouldfvcurrentlyfvcountfvtowardfvTrOOPfvbutfvhefvmayfvwishfvt
ofvaskfvhisfvplanfvforfvanfvexceptionfvtofvcoverfvthefvprescription,fvnotfvonfvitsfvformulary.

WhatfvtypesfvoffvtoolsfvcanfvMedicarefvPartfvDfvprescriptionfvdrugfvplansfvusefvthatfvaffectfvthefvwayfvtheirfvenrolleesfvcanfv
accessfvmedications?fv-fvanswer--
PartfvDfvplansfvdofvnotfvhavefvtofvcoverfvallfvmedications.fvAsfvafvresult,fvtheirfvformularies,fvorfvlistsfvoffvcoveredfvdrugs,fvw
illfvvaryfvfromfvplanfvtofvplan.fvInfvaddition,fvtheyfvcanfvusefvcostfvcontainmentfvtechniquesfvsuchfvasfvtieredfvco-
paymentsfvandfvstepfvtherapy.

Mrs.fvEsmeraldafvAvilafvisfvafvMedicarefvbeneficiaryfvenrolledfvinfvafvMA-
PDfvplanfvyoufvrepresent.fvHerfvneighborfvrecentlyfvsufferedfvfromfvafvpainfulfvcasefvoffvshingles.fvMrs.fvAvilafvhopesfvtofv
avoidfvsuchfvanfvillnessfvthroughfvvaccination.fvShefvasksfvyoufvwhetherfvthefvcostfvoffvthefvshinglesfvvaccinationfvwillfvbef
vcoveredfvunderfvthefvplanfvyoufvrepresent.fvWhatfvshouldfvyoufvsay?fv-fvanswer--

Yes,fvtherefvisfvnofvcostfvsharingfvforfvthefvshinglesfvvaccinefvevenfvinfvthefvdeductiblefvphasefvoffvherfvprescriptionfvdrugfv
planfvbecausefvitfvisfvanfvadultfvvaccinefvrecommendedfvbyfvthefvAdvisoryfvCommitteefvonfvImmunizationfvPracticesfv(AI
CP)

Mrs.fvSharmafvhasfvOriginalfvMedicarefvandfvwouldfvlikefvtofvenrollfvinfvafvPrivatefvFee-for-
Servicefv(PFFS)fvplan.fvAllfvtypesfvoffvPFFSfvplansfvarefvavailablefvinfvherfvarea.fvWhichfvoptionsfvcouldfvMrs.fvSharmafvc
onsiderfvbeforefvselectingfvafvPFFSfvplan?fv-fvanswer--AfvMedicarefvAdvantagefvPrescriptionfvDrugfv(MA-
PD)fvPFFSfvplanfvthatfvcombinesfvmedicalfvbenefitsfvandfvPartfvDfvprescriptionfvdrugfvcoverage,fvafvPFFSfvplanfvoffering
fvonlyfvmedicalfvbenefits,fvorfvafvPFFSfvplanfvinfvcombinationfvwithfvafvstand-alonefvprescriptionfvdrugfvplan.



Mrs.fvNguyenfvisfvafvretiredfvfederalfvworkerfvwithfvcoveragefvunderfvafvFederalfvEmployeefvHealthfvBenefitsfv(FEHB)fvpl
anfvthatfvincludesfvcreditablefvdrugfvcoverage.fvShefvisfvreadyfvtofvturnfv65fvandfvbecomefvMedicarefveligiblefvforfvthefvfirst
fvtime.fvWhatfvissuesfvmightfvshefvconsiderfvaboutfvwhetherfvtofvenrollfvinfvafvMedicarefvprescriptionfvdrugfvplan?fv-

fvanswer--

ShefvcouldfvcomparefvthefvcoveragefvtofvseefviffvthefvMedicarefvPartfvDfvplanfvoffersfvbetterfvbenefitsfvandfvcoveragefvtha
1fv/
fv14

, AHIP - 2027
fv fv

Studyfvonlinefvatfvhttps://quizlet.com/
_jp65r9
nfvthefvFEHBfvplanfvforfvthefvspecificfvmedicationsfvshefvneedsfvandfvwhetherfvanyfvadditionalfvbenefitsfvarefvworthfvthefv
PartfvDfvpremiumfvcostsfvonfvtopfvoffvherfvFEHBfvcontribution.

Mrs.fvWood,fvagefv65,fvisfvconcernedfvthatfvshefvmayfvnotfvqualifyfvforfvenrollmentfvinfvafvMedicarefvprescriptionfvdrugfvpl
anfvbecause,fvalthoughfvshefvisfventitledfvtofvPartfvA,fvshefvisfvnotfvenrolledfvunderfvMedicarefvPartfvB.fvWhatfvshouldfvyouf
vtellfvher?fv-fvanswer--

AnfvindividualfvwhofvisfventitledfvtofvPartfvAfvorfvenrolledfvunderfvPartfvBfvisfveligiblefvtofvenrollfvinfvafvMedicarefvprescription
fvdrugfvplan.fvAsfvlongfvasfvMrs.fvWoodfvisfventitledfvtofvPartfvA,fvshefvdoesfvnotfvneedfvtofvenrollfvunderfvPartfvBfvbeforefvenr

ollingfvinfvafvprescriptionfvdrugfvplan.

Ms.fvRamosfvisfvenrolledfvinfvafvMedicarefvAdvantagefvplanfvthatfvincludesfvprescriptionfvdrugfvplanfv(PDP)fvcoverage.fv
Shefvisfvtravelingfvandfvwishesfvtofvfillfvtwofvoffvthefvprescriptionsfvthatfvshefvhasfvlost.fvHowfvwouldfvyoufvadvisefvher?fv-
fvanswer--Shefvmayfvfillfvprescriptionsfvforfvcoveredfvdrugsfvatfvnon-

networkfvpharmacies,fvbutfvlikelyfvatfvafvhigherfvcostfvthanfvpaidfvatfvanfvin-networkfvpharmacy.

Mr.fvSuttonfvhasfvafvsmallfvsavingsfvaccount.fvHefvwouldfvlikefvtofvpayfvforfvhisfvmonthlyfvPartfvDfvpremiumsfvwithfvanfvauto
maticfvmonthlyfvwithdrawalfvfromfvhisfvsavingsfvaccountfvuntilfvitfvisfvexhausted,fvandfvthenfvhavefvhisfvpremiumsfvwithhe
ldfvfromfvhisfvSocialfvSecurityfvcheck.fvWhatfvshouldfvyoufvtellfvhim?fv-fvanswer--
Infvgeneral,fvhefvmustfvselectfvafvsinglefvPartfvDfvpremiumfvpaymentfvmechanismfvthatfvwillfvbefvusedfvthroughoutfvthefvye
ar

Mrs.fvRussofvisfventitledfvtofvPartfvAfvandfvhasfvmedicalfvcoveragefvwithoutfvdrugfvcoveragefvthroughfvanfvemployerfvretir
eefvplan.fvShefvisfvnotfvenrolledfvinfvPartfvB.fvSincefvthefvemployerfvplanfvdoesfvnotfvcoverfvprescriptionfvdrugs,fvshefvwant
sfvtofvenrollfvinfvafvMedicarefvprescriptionfvdrugfvplan.fvWillfvshefvbefvablefvto?fv-fvanswer--
Yes.fvMrs.fvRussofvmustfvbefventitledfvtofvPartfvAfvand/
orfvenrolledfvinfvPartfvBfvtofvbefveligiblefvforfvcoveragefvunderfvthefvMedicarefvprescriptionfvdrugfvprogram.

Mr.fvChenfvwasfvstillfvworkingfvwhenfvhefvfirstfvqualifiedfvforfvMedicare.fvAtfvthatfvtime,fvhefvhadfvemployerfvgroupfvcovera
gefvthatfvwasfvcreditable.fvDuringfvhisfvinitialfvPartfvDfveligibilityfvperiod,fvhefvdecidedfvnotfvtofvenrollfvbecausefvhefvwasfvsa
tisfiedfvwithfvhisfvdrugfvcoverage.fvItfvisfvnowfvafvyearfvlaterfvandfvMr.fvChenfvhasfvlostfvhisfvemployerfvgroupfvcoveragefvwit
hinfvthefvlastfvtwofvweeks.fvHowfvwouldfvyoufvadvisefvhim?fv-fvanswer--
Mr.fvChenfvshouldfvenrollfvinfvafvPartfvDfvplanfvbeforefvhefvhasfvafv63-
dayfvbreakfvinfvcoveragefvinfvorderfvtofvavoidfvafvpremiumfvpenalty.

Mrs.fvStricklandfvisfvafvnewfvMedicarefvbeneficiaryfvwhofvhasfvjustfvretiredfvfromfvretailfvwork.fvShefvisfvinterestedfvinfvsele
ctingfvafvMedicarefvPartfvDfvprescriptionfvdrugfvplan.fvShefvtakesfvseveralfvmedicationsfvandfvisfvconcernedfvthatfvshefvha
sfvnotfvbeenfvablefvtofvidentifyfvafvplanfvthatfvcoversfvallfvoffvherfvmedications.fvShefvdoesfvnotfvwantfvtofvmakefvanfvabruptfv
changefvtofvnewfvdrugsfvthatfvwouldfvbefvcoveredfvandfvasksfvwhatfvshefvshouldfvdo.fvWhatfvshouldfvyoufvtellfvher?fv-
fvanswer--EveryfvPartfvDfvdrugfvplanfvisfvrequiredfvtofvcoverfvafvsinglefvone-

monthfvfillfvoffvherfvexistingfvmedicationsfvsometimefvduringfvafv90-dayfvtransitionfvperiod.

Mrs.fvCastrofvhasfvjustfvturnedfv65,fvisfvinfvexcellentfvhealthfvandfvhasfvafvrelativelyfvhighfvincome.fvShefvusesfvnofvmedica
tionsfvandfvseesfvnofvreasonfvtofvspendfvmoneyfvonfvafvMedicarefvprescriptionfvdrugfvplanfviffvshefvdoesfvnotfvneedfvthefvc
overage.fvShefvcurrentlyfvdoesfvnotfvhavefvcreditablefvcoverage.fvWhatfvcouldfvyoufvtellfvherfvaboutfvthefvimplicationsfvoff
vsuchfvafvdecision?fv-fvanswer--

IffvshefvdoesfvnotfvsignfvupfvforfvafvMedicarefvprescriptionfvdrugfvplanfvasfvsoonfvasfvshefvisfveligiblefvtofvdofvso,fvandfviffvshef
vdoesfvsignfvupfvatfvafvlaterfvdate,fvherfvpremiumfvwillfvbefvpermanentlyfvincreasedfvbyfv1%fvoffvthefvnationalfvaveragefvpre

miumfvforfveveryfvmonthfvthatfvshefvwasfvnotfvcovered.

Mrs.fvKellyfvwantsfvtofvenrollfvinfvafvMedicarefvAdvantagefvplanfvthatfvdoesfvnotfvincludefvdrugfvcoveragefvandfvalsofvenrol
lfvinfvafvstand-alonefvMedicarefvprescriptionfvdrugfvplan.fvUnderfvwhatfvcircumstancesfvcanfvshefvdofvthis?fv-fvanswer--
2fv/
fv14

Información del documento

Subido en
2 de julio de 2026
Número de páginas
14
Escrito en
2025/2026
Tipo
Examen
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