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AHIP 2023 Final Exam questions verified with 100% correct answers AHIP 2023 Final Exam questions verified with 100% correct answers AHIP 2023 Final Exam questions verified with 100% correct answers AHIP 2023 Final Exam questions verified with 100% correct answers AHIP 2023 Final Exam questions verified with 100% correct answers
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ANS Every Part D drug plan is required to cover a single one-month fill of her existing medications sometime during a 90-day transition period.
asks you to explain it. What do you say ANS TrOOP stands for true out-of-pocket expenses that count toward the Medicare Part D catastrophic limit and include not only expenses paid by a beneficiary but also in some instances drug manufacturer discounts.
plan ANS She could compare the coverage to see if the Medicare Part D plan offers better benefits and coverage than the FEHB plan for the specific medications she needs and whether any additional benefits are worth the Part D premium costs on top of her FEHB contribution.
You should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest rate due her substantial income. 10.Winthrop Brokerage wishes to place an advertisement in the local newspa- per that says: "We offer Medicare Advantage plans offered by AB Health and Top Choice Health. Contact us if you would like to learn more." Which of the following best describes the obligation(s) of Winthrop Brokerage regarding the advertisement ANS Winthrop Brokerage does not need to submit the advertise- ment to CMS for prior approval because it does not include information about the plans' benefits structures, cost-sharing, or information about measures or ranking standards. 11.Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no problems func- tioning. Which type of SNP is likely to be most appropriate for him ANS C-SNP 12.Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without paying any premiums, because she has been working for 40 years and paying Medicare taxes. What should you tell her ANS To obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes.
which of the following must you do ANS Clearly state that no obligation exists to enroll if a gift or prize is being offered. 14.Mrs. Paterson is concerned about the deductibles and co- payments as- sociated with Original Medicare. What can you tell her about Medigap as an option to address this concern ANS Medigap plans help beneficiaries cover Original Medicare benefits, but they coordinate with Original Medicare coverage. 15.Mrs. Johnson calls to tell you she has not received her new plan ID card yet, but she needs to see a doctor. What can she expect to receive from the plan after the plan has received her enrollment form ANS Evidence of plan membership, information on how to obtain services, and the effective date of coverage. 16.You work for Caring Health, a Medicare Advantage (MA) plan sponsor. Recently, Mrs. Garcia has completed an enrollment application for a plan offered by Caring Health, which is waiting for a reply from CMS indicating whether or not Mrs. Garcia's enrollment has been accepted. Once CMS replies, how long does Caring Health have to notify Mrs. Garcia that her enrollment has been accepted and in what format ANS The plan has 10 calendar days to notify Mrs. Garcia in writing.
17.Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug coverage since her doctor recently prescribed several expensive medications. Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi ANS Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D prescription drug plan. 18.Your colleague works at a third-party marketing organization (TMO) and she said she did not need to take the Medicare training for brokers and agents or pass a test to market Medicare plans since her contract is with the TMO, not the plans that have the products she sells. What could you say to her ANS You could tell her she is wrong, and that only agents selling employer/union group plans are permitted an exemption from testing, but some employer/union group plans may require testing to promote agent compliance with CMS marketing requirements. 19.You are mailing invitations to new Medicare beneficiaries for a marketing event. You want an idea of how many people to expect, so you would like to request RSVPs. What should you keep in mind ANS You may request RSVPs, but you are not permitted to require contact information.
20.Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Where might he turn for help with his prescription drug costs ANS Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program.
21.Mr. Cole has been a Medicaid beneficiary for some time, and recently qual- ified for Medicare as well. He is concerned about changes in his cost-sharing. What should you tell him ANS He should know that Medicaid will pay cost sharing only for services provided by Medicaid participating providers. 22.By contacting plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Fur- thermore, you see that the plan you represent has a unique benefits package. What should you do to make sure your clients know about these pieces of information ANS You may make comparisons between plans if you can support them by studies or statistical data and such comparisons are factually based. 23.What impact, if any, have recent regulatory changes had upon Medigap plans ANS The Part B deductible is no longer covered for individuals newly eligible for Medicare starting January 1, 2020. 24.Mrs. Lyons is in good health, uses a single prescription, and lives indepen- dently in her own home. She is attracted by the idea of maintaining control over a Medical Savings Account (MSA) but is not sure if the plan associated with the account will fit her needs. What specific piece of information about a
Medicare MSA plan would it be important for her to know, prior to enrolling in such a plan ANS All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be obtained by also enrolling in a separate prescription drug plan.
27.Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are met? What could you tell her ANS Original Medicare covers ambulance services.
enroll under this period. What should you tell her about how the Part D Initial Enrollment Period applies to her situation ANS Ms. Claggett has had two IEPs and missed them both. The first occurred three months before and three months after the month when she was first entitled to Part A OR enrolled in Part B. Because she was eligible for Medicare before age 65, Ms. Claggett had a second IEP based on turning age 65, which has also expired.
additional benefits, but Medicaid will only pay for these services if they are furnished by Medicaid participating providers. 34.Miles is a licensed agent who represents Colgate Health and its Medicare Advantage (MA) plans. Miles has several clients who have recently come to him for help. They are in their initial coverage period9s) (ICEP) and are inter- ested in enrolling in one of Colgate Health's MA plans. Adam will soon turn 68 and has decided to retire. Betty is about to turn 65 and has also decided to retire. Adam and Betty both currently have coverage through Colgate Health. Charles had health coverage through Colgate but dropped the coverage when he retired early to travel to Europe. Charles has just turned age 65 and is now back in the United States. Diedre, who will turn 65 next month, currently has coverage through Ditmas Health - a company that Miles also represents. Who qualifies for the opt-in simplified enrollment mechanism ANS Adam and Betty because each of them will not have a break between their non-Medicare and Medicare coverage through Colgate Health Plan.
coverage ANS Lexington can allow for Mr. Wilcox's continued enrollment for up to 12 months whether or not he is in a visitor/traveler (V/T) program since it is a PFFS plan. 36.Mr. Albert has heard about something called the Star Rating system for Medicare Advantage plans. He asks you to explain it to him since he is interested in enrolling in a plan that is newly available in his area. After you explain that it is the way for consumers to judge plan performance, what else would you say ANS New plans and part D sponsors must provide a projection of the Star Rating they will receive until they have been officially awarded an overall Star Rating by CMS. 37.Which of the following individuals has enrolled in a plan based on a fixed enrollment period ANS Ben, who enrolls in a Medicare Advantage plan during the Medicare Advantage Open Enrollment Period (MA OEP). 38.Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to purchase extra coverage that he will not need. What should you tell him ANS If the drug coverage he has is not expected to pay, on average, at least as much as Medicare's standard
Part D coverage expects to pay, then he will need to enroll in Medicare Part D during his initial eligibility period to avoid the late enrollment penalty. 39.Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him ANS In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from providers within the plan's network (except in an emergency or where care is unavailable within the network). 40.You market many different types of insurance and ordinarily you spend time each evening calling potential clients. To comply with requirements for marketing Medicare Advantage and Part D plans, what must you do about contacting potential clients to market those plans ANS You will have to avoid calling any potential client unless he or she initiates contact with you and specifically asks that you give him or her a call. 41.Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her ANS Part D covers prescription drugs and she should look at her premiums, formulary, and cost-sharing among other factors to see if they have changed. 42.Mrs. Radford asks whether there are any special eligibility
requirements for Medicare Advantage. What should you tell her ANS Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. 43.Mrs. Fields wants to know whether applying for the Part D low-income subsidy will be worth the time to fill out the paperwork. What could you tell her ANS The Part D low-income subsidy could substantially lower her overall costs. She can apply by contacting her state Medicaid office or calling the Social Security Administration. 44.Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. In addition to drugs on his plan's formulary he takes several other medications. These include a prescription drug not on his plan's for- mulary, over-the-counter medications for colds and allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to promote hair growth and reduce joint swelling. His neighbor recently told him about a concept called TrOOP and he asks you if any of his other medications could count toward TrOOP should he ever reach the Part D catastrophic limit. What should you say ANS None of the costs of Mr. Wingate's other medications would currently count toward TrOOP but he may wish to ask his plan for an exception to cover the prescription not on its formulary.
45.Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to ANS Yes. Mrs. Walters must be entitled to Part A and/or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. 46.Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he would generally ex- pect to encounter when enrolling into a standard Medicare Part D prescription drug plan. What should you tell him ANS He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing. 47.Which of the following statements about Medicare Part D are correct ANS I, II, and III only 48.Agent Harriet Walker has recently begun marketing Medicare Advantage and related products aimed at meeting the needs of senior citizens. Client Mildred Jones has expressed interest in a Medicare Advantage plan. It is now the beginning of September. If you were in Agent Walker's position, what would you do ANS Inquire whether the client qualifies for a special enrollment period, and if not, solicit an enrollment application once the annual open enrollment election period begins on October 15th. 49.Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan
available in his area has an attractive premium. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. What should you tell him ANS He may receive health care services from any doctor allowed to bill Medicare, as long as he shows the doctor the plan's identification card and the doctor agrees to accept the PFFS plan's payment terms and conditions, which could include balance billing. 50.Ms. Gardner is currently enrolled in an MA-PD plan. However, she wants to disenroll from the MA-PD plan and instead enroll in a Part D only plan and go back to Original Medicare. According to Medicare's enrollment guidelines, when could she do this ANS She may make such a change during the Annual Election Period that runs from Oct. 15 to December 7, or during the MA Open Enrollment Period which takes place from January 1- March 31 of each year.