AHIP Final Exam Test Questions and Answers (2022/2023), Exams of Nursing

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AHIP Final Exam Test Questions and Answers

AHIP FINAL EXAM TEST Questions

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Mr., Moy’s, wife ,has ,a ,Medicare ,Advantage ,plan, ,but ,he ,wants ,to ,understand ,what coverage ,Medicare ,Supplemental ,Insurance ,provides ,since ,his ,health ,care ,needs ,are,different ,from ,his ,wife's ,needs. ,What ,could ,you ,tell ,Mr. ,Moy?correct ,answersMedicare,Supplemental ,Insurance ,would ,help ,cover ,his ,Part ,A ,and ,Part ,B ,deductibles ,or coinsurance ,in ,Original ,Fee-for- Service ,(FFS) ,Medicare ,as ,well ,as ,possibly ,some services ,that ,Medicare ,does ,not ,cover. Mrs. ,Peňa ,is , 66 ,years ,old, ,has ,coverage ,under ,an ,employer ,plan, ,and ,will ,retire ,next year. ,She ,heard ,she ,must ,enroll ,in ,Part ,B ,at ,the ,beginning ,of ,the ,year ,to ,ensure ,no ,gap,in ,coverage. ,What ,can ,you ,tell ,her?correct ,answersShe ,may ,enroll ,at ,any ,time ,while ,she ,is ,covered ,under ,her ,employer ,plan, ,but ,she ,will ,have ,a ,special ,eight-month enrollment ,period ,after ,the ,last ,month ,on ,her ,employer ,plan ,that ,differs ,from ,the ,standard ,general ,enrollment ,period, ,during ,which ,she ,may ,enroll ,in ,Medicare ,Part ,B. Mrs. ,Chen ,will ,be , 65 ,soon, ,has ,been ,a ,citizen ,for ,twelve ,years, ,has ,been ,employed ,full time, ,and ,paid ,taxes ,during ,that ,entire ,period. ,She ,is ,concerned ,that ,she ,will ,not ,qualify,for ,coverage ,under ,part ,A ,because ,she ,was ,not ,born ,in ,the ,United ,States. ,What ,should,you ,tell ,her?correct

AHIP Final Exam Test Questions and Answers

,answersMost ,individuals ,who ,are ,citizens ,and ,age , 65 ,or ,over ,are covered ,under ,Part ,A ,by ,virtue ,of ,having ,paid ,Medicare ,taxes ,while ,working, ,though some ,may ,be ,covered ,as ,a ,result ,of ,paying ,monthly ,premiums.

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AHIP Final Exam Test Questions and Answers

,for , 40 ,years ,and ,paying ,Medicare ,taxes. ,What ,should ,you ,tell ,her?correct ,answersTo ,obtain ,Part ,B ,coverage, she ,must ,pay ,a ,standard ,monthly ,premium, ,though ,it ,is ,higher ,for ,individuals ,with ,higher,incomes. 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 ,expect ,to ,encounter ,when ,enrolling into ,a ,standard ,MedicarePart ,D ,prescription ,drug ,plan. ,What ,should ,you ,tell ,him?correct,answers ,He ,generally ,would ,pay ,a ,monthly ,premium, ,annual ,deductible, ,and ,per- prescription ,cost-sharing. Mr. ,Davis ,is , 52 ,years ,old ,and ,has ,recently ,been ,diagnosed ,with ,end-stage ,renal ,disease,(ESRD) ,and ,will ,soon ,begin ,dialysis. ,He ,is ,wondering ,if ,he ,can ,obtain ,coverage ,under Medicare. ,What ,should ,you ,tell ,him?correct ,answersHe ,may ,sign-up ,for ,Medicare ,at any ,time ,however ,coverage ,usually ,begins ,on ,the ,fourth ,month ,after ,dialysis ,treatments start. Juan ,Perez, ,who ,is ,turning ,age , 65 ,next ,month, ,intends ,to ,work ,for ,several ,more ,years ,at,Smallcap, ,Incorporated. ,Smallcap ,has ,a ,workforce ,of ,employees ,and ,offers employer-sponsored ,healthcare ,coverage. ,Juan ,is ,a ,naturalized ,citizen ,and ,has contributed ,to ,the ,Medicare ,system ,for ,over , 20 ,years. ,Juan ,asks ,you ,if ,he ,will ,be entitled ,to ,Medicare ,and ,if ,he ,enrolls ,how ,that ,will ,impact ,his ,employer-sponsored healthcare ,coverage. ,How ,would ,you ,respond?correct ,answersJuan ,is ,likely ,to ,be eligible ,for ,Medicare ,once ,he ,turns ,age , 65 ,and ,if ,he ,enrolls ,Medicare ,would ,become ,the,primary ,payor

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AHIP Final Exam Test Questions and Answers

,of ,his ,healthcare ,claims ,and ,Smallcap ,does ,not ,have ,to ,continue ,to ,offer him ,coverage ,comparable ,to ,those ,under ,age , 65 ,under ,its ,employer- sponsored ,group ,health ,plan. Ms. ,Moore ,plans ,to ,retire ,when ,she ,turns , 65 ,in ,a ,few ,months. ,She ,is ,in ,excellent ,health and ,will ,have ,considerable ,income ,when ,she ,retires. ,She ,is ,concerned ,that ,her ,income will ,make ,it ,impossible ,for ,her ,to ,qualify ,for ,Medicare. ,What ,could ,you ,tell ,her ,to ,address,her ,concern?correct ,answersMedicare ,is ,a ,program ,for ,people ,age , 65 ,or ,older ,and those ,under ,age , 65 ,with ,certain ,disabilities, ,end-stage ,renal ,disease, ,and ,Lou ,Gehrig's disease ,so ,she ,will ,be ,eligible ,for ,Medicare. Mr. ,Xi ,will ,soon ,turn ,age , 65 ,and ,has ,come ,to ,you ,for ,advice ,as ,to ,what ,services ,are provided ,under ,Original ,Medicare. ,What ,should ,you ,tell ,Mr. ,Xi ,that ,best ,describes ,the health ,coverage ,provided ,to ,Medicare ,beneficiaries?correct ,answersBeneficiaries ,under,Original ,Medicare ,have ,no ,cost-sharing ,for ,most ,preventive ,services ,which ,include immunizations ,such ,as ,annual ,flu ,shots.

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AHIP Final Exam Test Questions and Answers

Mr. ,Schmidt ,would ,like ,to ,plan ,for ,retirement ,and ,has ,asked ,you ,what ,is ,covered ,under ,Original ,Fee-for-Service ,(FFS) ,Medicare? ,What ,could ,you

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AHIP Final Exam Test Questions and Answers

,tell ,him?correct ,answersPart,A, ,which ,covers ,hospital, ,skilled ,nursing ,facility, ,hospice, ,and ,home ,health ,services ,and,Part ,B, ,which ,covers ,professional ,services ,such ,as ,those ,provided ,by ,a ,doctor ,are covered ,under ,Original ,Medicare. Agent ,John ,Miller ,is ,meeting ,with ,Jerry ,Smith, ,a ,new ,prospect. ,Jerry ,is ,currently enrolled ,in ,Medicare ,Parts ,A ,and ,B. ,Jerry ,has ,also ,purchased ,a ,Medicare ,Supplement (Medigap) ,plan ,which ,he ,has ,had ,for ,several ,years. ,However, ,the ,plan ,does ,not ,provide,drug ,benefits. ,How ,would ,you ,advise ,Agent ,John ,Miller ,to ,proceed?correct ,answersTell prospect ,Jerry ,Smith ,that ,he ,should ,consider ,adding ,a ,standalone ,Part ,D ,prescription drug ,coverage ,policy ,to ,his ,present ,coverage. Mr. ,Bauer ,is , 49 ,years ,old, ,but ,eighteen ,months ,ago ,he ,was ,declared ,disabled ,by ,the Social ,Security ,Administration ,and ,has ,been ,receiving ,disability ,payments. ,He ,is ,wondering ,whether ,he ,can ,obtain ,coverage ,under ,Medicare. ,What ,should ,you ,tell him?correct ,answersAfter ,receiving ,such ,disability ,payments ,for , 24 ,months, ,he ,will ,be,automatically ,enrolled ,in ,Medicare, ,regardless ,of ,age. Mr. ,Buck ,has ,several ,family ,members ,who ,died ,from ,different ,cancers. ,He ,wants ,to,know ,if ,Medicare ,covers ,cancer ,screening.

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AHIP Final Exam Test Questions and Answers

,with ,a ,Medigap ,plan ,and standalone ,Part ,D ,prescription ,drug ,coverage, ,but ,he ,cannot ,enroll ,in ,the ,MA-only ,PPO plan ,and ,a ,stand-alone ,prescription

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AHIP Final Exam Test Questions and Answers

,drug ,plan. Mrs. ,Ramos ,is ,considering ,a ,Medicare ,Advantage ,PPO ,and ,has ,questions ,about ,which,providers ,she ,can ,go ,to ,for ,her ,health ,care. ,What ,should ,you ,tell ,her?correct answersMrs. ,Ramos ,can ,obtain ,care ,from ,any ,provider ,who ,participates ,in ,Original Medicare, ,but ,generally ,will ,have ,a ,higher ,cost- sharing ,amount ,if ,she ,sees ,a ,provider ,who/that ,is ,not ,a ,part ,of ,the ,PPO ,network. Mr. ,Romero ,is ,64, ,retiring ,soon, ,and ,considering ,enrollment ,in ,his ,employer-sponsored retiree ,group ,health ,plan ,that ,includes ,drug ,coverage ,with ,nominal ,copays. ,He ,heard about ,a ,neighbor's ,MA-PD ,plan ,that ,you ,represent ,and ,because ,he ,takes ,numerous prescription ,drugs, ,he ,is ,considering ,signing ,up ,for ,it. ,What ,should ,you ,tell ,him?correct answersHe ,should ,compare ,the ,benefits ,in ,his ,employer-sponsored ,retiree ,group ,health ,plan ,with ,the ,benefits ,in ,his ,neighbor's ,MA-PD ,plan ,to ,determine ,which ,one ,will ,provide sufficient ,coverage ,for ,his ,prescription ,needs. Dr. ,Elizabeth ,Brennan ,does ,not ,contract ,with ,the ,ABC ,PFFS ,plan ,but ,accepts ,the ,plan's,terms ,and ,conditions ,for ,payment. ,Mary ,Rodgers ,sees ,Dr. ,Brennan ,for ,treatment. ,How much ,may ,Dr. ,Brennan ,charge?correct ,answersDr. ,Brennan ,can ,charge ,Mary ,Rogers no ,more ,than ,the ,cost ,sharing ,specified ,in ,the ,PFFS ,plan's ,terms ,and ,condition ,of payment ,which ,may ,include ,balance ,billing ,up ,to ,15% ,of ,the ,Medicare ,rate.

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AHIP Final Exam Test Questions and Answers

C-SNP

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AHIP Final Exam Test Questions and Answers

Mrs. ,Burton ,is ,a ,retiree ,with ,substantial ,income. ,She ,is ,enrolled ,in ,an ,MA-PD ,plan ,and was ,disappointed ,with ,the ,service ,she ,received ,from ,her ,primary ,care ,physician because ,she ,was ,told ,she ,would ,have ,to ,wait ,five ,weeks ,to ,get ,an ,appointment ,when she ,was ,feeling ,ill. ,She ,called ,you ,to ,ask ,what ,she ,could ,do ,so ,she ,would ,not ,have ,to put ,up ,with ,such ,poor ,access ,to ,care. ,What ,could ,you ,tell ,her?correct ,answersShe could ,file ,a ,grievance ,with ,her ,plan ,to ,complain ,about ,the ,lack ,of ,timeliness ,in ,getting ,an,appointment. Mr. ,Greco ,is ,in ,excellent ,health, ,lives ,in ,his ,own ,home, ,and ,has ,a ,sizeable ,income ,from,his ,investments. ,He ,has ,a ,friend ,enrolled ,in ,a ,Medicare ,Advantage ,Special ,Needs ,Plan,(SNP). ,His ,friend ,has ,mentioned ,that ,the ,SNP ,charges ,very ,low ,cost-sharing ,amounts and ,Mr. ,Greco ,would ,like ,to ,join ,that ,plan. ,What ,should ,you ,tell ,him?correct answersSNPs ,limit ,enrollment ,to ,certain ,subpopulations ,of ,beneficiaries. ,Given ,his current ,situation, ,he ,is ,unlikely ,to ,qualify ,and ,would ,not ,be ,able ,to ,enroll ,in ,the ,SNP. Mrs. ,Radford ,asks ,whether ,there ,are ,any ,special ,eligibility ,requirements ,for ,Medicare Advantage. ,What ,should ,you ,tell ,her?correct ,answersMrs. ,Radford ,must ,be ,entitled ,to,Part ,A ,and ,enrolled ,in ,Part ,B ,to ,enroll ,in ,Medicare ,Advantage. Mrs. ,Andrews ,asked ,how ,a ,Private ,Fee-for-Service ,(PFFS) ,plan ,might ,affect ,her ,access,to ,services ,since ,she ,receives ,some ,assistance ,for ,her ,health ,care ,costs ,from ,the ,State.

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AHIP Final Exam Test Questions and Answers

Mr. ,Barker ,enjoys ,a ,comfortable ,retirement ,income. ,He ,recently ,had ,surgery ,and expected ,that ,he ,would ,have ,certain ,services ,and ,items

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AHIP Final Exam Test Questions and Answers

,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 ,some ,services ,and ,items ,he ,thought would ,be ,fully ,covered. ,He ,called ,you ,to ,ask ,what ,he ,could ,do? ,What ,could ,you ,tell him?correct ,answersYou ,can ,offer ,to ,review ,the ,plans ,appeal ,process ,to ,help ,him ,ask the ,plan ,to ,review ,the ,coverage ,decision. Mr. ,Sinclair ,has ,diabetes ,and ,heart ,trouble ,and ,is ,generally ,satisfied ,with ,the ,care ,he has ,received ,under ,Original ,Medicare, ,but ,he ,would ,like ,to ,know ,more ,about ,Medicare Advantage ,Special ,Needs ,Plans ,(SNPs). ,What ,could ,you ,tell ,him?correct ,answersSNPs,have ,special ,programs ,for ,enrollees ,with ,chronic ,conditions, ,like ,Mr. ,Sinclair, ,and ,they provide ,prescription ,drug ,coverage ,that ,could ,be ,very ,helpful ,as ,well. Mr. ,Lopez ,has ,heard ,that ,he ,can ,sign ,up ,for ,a ,product ,called ,"Medicare ,Advantage" ,but,is ,not ,sure ,about ,what ,type ,of ,plan ,designs ,are ,available ,through ,this ,program. ,What should ,you ,tell ,him ,about ,the ,types ,of ,health ,plans ,that ,are ,available ,through ,the ,Medicare ,Advantage ,program?correct ,answersThey ,are ,Medicare ,health ,plans ,such ,as,HMOs, ,PPOs, ,PFFS, ,and ,MSAs. Mr. ,Sanchez ,has ,just ,turned , 65 ,and ,is ,entitled ,to ,Part ,A ,but ,has ,not ,enrolled ,in ,Part ,B because ,he ,has ,coverage ,through ,an ,employer ,plan. ,If ,he ,wants ,to ,enroll ,in ,a ,Medicare Advantage ,plan, ,what ,will ,he ,have ,to ,do?correct ,answersHe ,will ,have ,to ,enroll ,in ,Part ,B.

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AHIP Final Exam Test Questions and Answers

Mr. ,Wingate ,is ,a ,newly ,enrolled ,Medicare ,Part ,D ,beneficiary ,and ,one ,of

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AHIP Final Exam Test Questions and Answers

,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 ,formulary, ,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?correct ,answersNone ,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. Ms. ,Edwards ,is ,enrolled ,in ,a ,Medicare ,Advantage ,plan ,that ,includes ,prescription ,drug plan ,(PDP) ,coverage. ,She ,is ,traveling ,and ,wishes ,to ,fill ,two ,of ,the ,prescriptions ,that ,she,has ,lost. ,How ,would ,you ,advise ,her?correct ,answersShe ,may ,fill ,prescriptions ,for covered ,drugs ,at ,non- network ,pharmacies, ,but ,likely ,at ,a ,higher ,cost ,than ,paid ,at ,an ,in- ,network ,pharmacy. Mrs. ,Lopez ,is ,enrolled ,in ,a ,cost ,plan ,for ,her ,Medicare ,benefits. ,She ,has ,recently ,lost creditable ,coverage ,previously ,available ,through ,her ,husband's ,employer. ,She ,is interested ,in ,enrolling ,in ,a ,Medicare ,Part ,D ,prescription ,drug ,plan ,(PDP). ,What ,should,you ,tell ,her?correct ,answersIf ,a ,Part ,D ,benefit ,is ,offered ,through ,her ,plan ,she ,may choose ,to ,enroll ,in ,that ,plan ,or ,a ,standalone ,PDP.