AHIP - Random Assessment Test
Questions and Answers
[COMPANY NAME] [Company address]
, AHIP - Random Assessment Test
Questions and Answers
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? - correct 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? - correct 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? - correct 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? - correct 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? - correct
answer II. All data elements required to complete an enrollment request must be
captured.
Questions and Answers
[COMPANY NAME] [Company address]
, AHIP - Random Assessment Test
Questions and Answers
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? - correct 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? - correct 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? - correct 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? - correct 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? - correct
answer II. All data elements required to complete an enrollment request must be
captured.
