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

A series of questions and answers related to medicare, covering various aspects of the program, including eligibility, coverage, costs, and enrollment. It is a valuable resource for individuals seeking to understand medicare and its intricacies.

Typology: Exams

2024/2025

Available from 01/10/2025

profsmith
profsmith 🇺🇸

572 documents

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(2022/2023) Rated A+ Answers Correct/Verified

AHIP Final Exam Test Questions and Answers

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 ,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.

(2022/2023) Rated A+ Answers Correct/Verified

AHIP Final Exam Test Questions and Answers

Mrs. ,Gonzalez ,is ,enrolled ,in ,Original ,Medicare ,and ,has ,a ,Medigap ,policy ,as ,well, ,but ,it provides ,no ,drug ,coverage. ,She ,would ,like ,to ,keep ,the ,coverage ,she ,has ,but ,replace her ,existing ,Medigap ,plan ,with ,one ,that ,provides ,drug ,coverage. ,What ,should ,you ,tell ,her?correct ,answersMrs. ,Gonzalez ,cannot ,purchase ,a ,Medigap ,plan ,that ,covers ,drugs,,but ,she ,could ,keep ,her ,Medigap ,policy ,and ,enroll ,in ,a ,Part ,D ,prescription ,drug ,plan. Mrs. ,West ,wears ,glasses ,and ,dentures ,and ,has ,enjoyed ,considerable ,pain ,relief ,from arthritis ,through ,massage ,therapy. ,She ,is ,concerned ,about ,whether ,or ,not ,Medicare ,will,cover ,these ,items ,and ,services. ,What ,should ,you ,tell ,her?correct ,answersMedicare does ,not ,cover ,massage ,therapy, ,or, ,in ,general, ,glasses ,or ,dentures. Mr., Patel ,is ,in ,good ,health ,and ,is ,preparing ,a ,budget ,in ,anticipation ,of ,his ,retirement when ,he ,turns ,66. ,He ,wants ,to ,understand ,the ,health ,care ,costs ,he ,might ,be ,exposed ,to,under ,Medicare ,if ,he ,were ,to ,require ,hospitalization ,as ,a ,result ,of ,an ,illness. ,In ,general terms, ,what ,could ,you ,tell ,him ,about ,his ,costs ,for ,inpatient ,hospital ,services under ,Original ,Medicare?correct ,answersUnder ,Original ,Medicare, ,there ,is ,a ,single deductible ,amount ,due ,for ,the ,first , 60 ,days ,of ,any ,inpatient ,hospital ,stay, ,after ,which ,it converts ,into ,a ,per-day ,coinsurance ,amount ,through ,day ,90. ,After ,day ,90, ,he ,would ,pay,a ,daily ,amount ,up ,to , 60 ,days ,over ,his ,lifetime, ,after ,which ,he ,would ,be ,responsible ,for all ,costs. Ms. ,Henderson ,believes ,that ,she ,will ,qualify ,for ,Medicare ,Coverage ,when ,she ,turns ,65, ,without ,paying ,any ,premiums, ,because ,she ,has ,been ,working

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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

Mrs. ,Duarte ,is ,enrolled ,in ,Original ,Medicare ,Parts ,A ,and ,B. ,She ,has ,recently ,reviewed her ,Medicare ,Summary ,Notice ,(MSN) ,and ,disagrees ,with ,a ,determination ,that ,partially denied ,one ,of ,her ,claims ,for ,services. ,What ,advice ,would ,you ,give ,her?correct answersMrs. ,Duarte ,should ,file ,an ,appeal ,of ,this ,initial ,determination ,within , 120 ,days ,of,the ,date ,she ,received ,the ,MSN ,in ,the ,mail. Mr. ,Capadona ,would ,like ,to ,purchase ,a ,Medicare ,Advantage ,(MA) ,plan ,and ,a ,Medigap,plan ,to ,pick ,up ,costs ,not ,covered ,by ,that ,plan. What ,should ,you ,tell ,him?correct ,answersIt ,is ,illegal ,for ,you ,to ,sell ,Mr. ,Capadona ,a ,Medigap ,plan ,if ,he ,is ,enrolled ,in ,an ,MA ,plan, ,and ,besides, ,Medigap ,only ,works ,with,Original ,Medicare. Mrs. ,Park ,is ,an ,elderly ,retiree. ,Mrs. ,Park ,has ,a ,low ,fixed ,income. ,What ,could ,you ,tell ,Mrs. ,Park ,that ,might ,be ,of ,assistance?correct ,answersShe ,should ,contact ,her ,state Medicaid ,agency ,to ,see ,if ,she ,qualifies ,for ,one ,of ,several ,programs ,that ,can ,help ,with,Medicare ,costs ,for ,which ,she ,is ,responsible. Mr. ,Rainey ,is ,experiencing ,paranoid ,delusions ,and ,his ,physician ,feels ,that ,he ,should ,be,hospitalized. ,What ,should ,you ,tell ,Mr. ,Rainey ,(or ,his ,representative) ,about ,the ,length ,of an ,inpatient ,psychiatric ,hospital ,stay ,that ,Medicare ,will ,cover?correct ,answersMedicare will ,cover ,a ,total ,of , 190 ,days ,of ,inpatient ,psychiatric ,care ,during ,Mr. ,Rainey's ,entire lifetime.

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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

What ,should ,you ,tell ,him?correct ,answersMedicare ,covers ,the ,periodic ,performance ,of,a ,range ,of ,screening ,tests ,that ,are ,meant ,to ,provide ,early ,detection ,of ,disease. ,Mr. Buck ,will ,need ,to ,check ,specific ,tests ,before ,obtaining ,them ,to ,see ,if ,they ,will ,be,covered. Which ,of ,the ,following ,statement ,is/are ,correct ,about ,a ,Medicare ,Savings ,Account,(MSA) ,Plans? I. MSAs ,may ,have ,either ,a ,partial ,network, ,full ,network, ,or ,no ,network ,of ,providers. II. MSA ,plans ,cover ,Part ,A ,and ,Part ,B ,benefits ,but ,not ,Part ,D ,prescription ,drug ,benefits.,III. ,An ,individual ,who ,is ,enrolled ,in ,an ,MSA ,plan ,is ,responsible ,for ,a ,minimal ,deductible of ,$500 ,indexed ,for ,inflation. IV. ,Non-network ,providers ,must ,accept ,the ,same ,amount ,that ,Original ,Medicare ,would,pay ,them ,as ,payment ,in ,full. ,correct ,answers ,I, ,II, ,and ,IV ,only Mr. ,Lombardi ,is ,interested ,in ,a ,Medicare ,Advantage ,(MA) ,PPO ,plan ,that ,you ,represent. It ,is ,one ,of ,three ,plans ,operated ,by ,the ,same ,organization ,in ,Mr. ,Lombardi's ,area. ,The MA ,PPO ,plan ,does ,not ,include ,drug ,coverage, ,but ,the ,other ,two ,plans ,do. ,Mr. ,Lombardi,likes ,the ,PPO ,plan ,that ,does ,not ,include ,drug ,coverage ,and ,intends ,to ,obtain ,his ,drug coverage ,through ,a ,stand-alone ,Medicare ,prescription ,drug ,plan. ,What ,should ,you ,tell him ,about ,this ,situation?correct ,answersHe ,could ,enroll ,either ,in ,one ,of ,the ,MA ,plans that ,include ,prescription ,drug ,coverage ,or ,Original ,Medicare

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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

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?correct ,answersHe ,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. Mr. ,Wells ,is ,trying ,to ,understand ,the ,difference ,between ,Original ,Medicare ,and Medicare ,Advantage. ,What ,would ,be ,the ,correct ,description?correct ,answersMedicare Advantage ,is ,a ,way ,of ,covering ,all ,the ,Original ,Medicare ,benefits ,through ,private ,health,insurance ,companies. 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?correct ,answersMrs. ,Chi ,may ,enroll ,in ,a ,MA ,MSA ,plan ,and ,remain ,in ,her ,current ,standalone ,Part ,D ,prescription ,drug ,plan. Daniel ,is ,a ,middle-income ,Medicare ,beneficiary. ,He ,has ,chronic ,bronchitis, ,putting ,him at ,severe ,risk ,for ,pneumonia. ,Otherwise, ,he ,has ,no ,problems ,functioning. ,Which ,type ,of,SNP ,is ,likely ,to ,be ,most ,appropriate ,for ,him?correct ,answers.

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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

What ,should ,you ,tell ,her?correct ,answersMedicaid ,may ,provide ,additional ,benefits, ,but,Medicaid ,will ,coordinate ,benefits ,only ,with ,Medicaid ,participating ,providers. Mr. ,Castillo, ,a ,naturalized ,citizen, ,previously ,enrolled ,in ,Medicare ,Part ,B ,but ,has recently ,stopped ,paying ,his ,Part ,B ,premium. ,Mr. ,Castillo ,is ,still ,covered ,by ,Part ,A. ,He,would ,like ,to ,enroll ,in ,a ,Medicare ,Advantage ,(MA) ,plan ,and ,is ,still ,covered ,by ,Part ,A. ,What ,should ,you ,tell ,him?correct ,answersHe ,is ,not ,eligible ,to ,enroll ,in ,a ,Medicare Advantage ,plan ,until ,he ,re-enrolls ,in ,Medicare ,Part ,B. Mrs. ,Davenport ,enrolled ,in ,the ,ABC ,Medicare ,Advantage ,(MA) ,plan ,several ,years ,ago. In ,mid-February ,of ,2021, ,her ,doctor ,confirms ,a ,diagnosis ,of ,end-stage ,renal ,disease ,(ESRD). ,What ,options ,will ,Mrs. ,Davenport ,have ,regarding ,her ,MA ,plan ,during ,the ,next open ,enrollment ,season?correct ,answersShe ,may ,remain ,in ,her ,ABC ,MA ,plan, ,enroll ,in ,another ,MA ,plan ,in ,her ,service ,area, ,or ,enroll ,in ,a ,Special ,Needs ,Plan ,(SNP) ,for individuals ,suffering ,from ,ESRD ,if ,one ,is ,available ,in ,her ,area. Mr. ,Kumar ,is ,considering ,a ,Medicare ,Advantage ,HMO ,and ,has ,questions ,about ,his ability ,to ,access ,providers. ,What ,should ,you ,tell ,him?correct ,answersIn ,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).ur ,clients, ,Lauren ,Nichols, ,has ,heard ,about ,a ,Medica

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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. ,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 ,answersMr. ,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. ,Bickford ,did ,not ,quite ,qualify ,for ,the ,extra ,help ,low-income ,subsidy ,under ,the Medicare ,Part ,D ,Prescription ,Drug ,program ,and ,he ,is ,wondering ,if ,there ,is ,any ,other ,option ,he ,has ,for ,obtaining ,help ,with ,his ,considerable ,drug ,costs. ,What ,should ,you ,tell him?correct ,answersHe ,could ,check ,with ,the ,manufacturers ,of ,his ,medications ,to ,see ,if,they ,offer ,an ,assistance ,program ,to ,help ,people ,with ,limited ,means ,to ,obtain ,the medications ,they ,need. ,Alternatively, ,he ,could ,check ,to ,see ,whether ,his ,state ,has ,a pharmacy ,assistance ,program ,to ,help ,him ,with ,his ,expenses. Mr. ,and ,Mrs. ,Vaughn ,both ,take ,a ,specialized ,multivitamin ,prescription ,each ,day. ,Mr. ,Vaughn ,takes ,a ,prescription ,for ,helping ,to ,regrow ,his ,hair. ,They ,are ,anxious ,to ,have their ,Medicare ,prescription ,drug ,plan ,cover ,these ,drug ,needs. ,What ,should ,you ,tell them?correct ,answersMedicare ,prescription ,drug ,plans ,are ,not ,permitted ,to ,cover ,the prescription ,medications ,the ,Vaughns ,are ,interested ,in ,under ,Part ,D ,coverage, however, ,plans ,may ,cover ,them ,as ,supplemental ,benefits ,and ,the ,Vaughn's ,could ,look,into ,that ,possibility.

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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.

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AHIP Final Exam Test Questions and Answers

Mrs. ,Allen ,has ,a ,rare ,condition ,for ,which ,two ,different ,brand ,name ,drugs ,are ,the ,only available ,treatment. ,She ,is ,concerned ,that ,since ,no ,generic ,prescription ,drug ,is available ,and ,these ,drugs ,are ,very ,high ,cost, ,she ,will ,not ,be ,able ,to ,find ,a ,Medicare ,Part,D ,prescription ,drug ,plan ,that ,covers ,either ,one ,of ,them. ,What ,should ,you ,tell her?correct ,answersMedicare ,prescription ,drug ,plans ,are ,required ,to ,cover ,drugs ,in each ,therapeutic ,category. ,She ,should ,be ,able ,to ,enroll ,in ,a ,Medicare ,prescription ,drug ,plan ,that ,covers ,the ,medications ,she ,needs. Mrs. ,Quinn ,has ,just ,turned ,65, ,is ,in ,excellent ,health ,and ,has ,a ,relatively ,high ,income. She ,uses ,no ,medications ,and ,sees ,no ,reason ,to ,spend ,money ,on ,a ,Medicare prescription ,drug ,plan ,if ,she ,does ,not ,need ,the ,coverage. ,She ,currently ,does ,not ,have creditable ,coverage. ,What ,could ,you ,tell ,her ,about ,the ,implications ,of ,such ,a decision?correct ,answersIf ,she ,does ,not ,sign ,up ,for ,a ,Medicare ,prescription ,drug ,plan as ,soon ,as ,she ,is ,eligible ,to ,do ,so, ,and ,if ,she ,does ,sign ,up ,at ,a ,later ,date, ,her ,premium,will ,be ,permanently ,increased ,by ,1% ,of ,the ,national ,average ,premium ,for ,every ,month that ,she ,was ,not ,covered. Mr. ,Shultz ,was ,still ,working ,when ,he ,first ,qualified ,for ,Medicare. ,At ,that ,time, ,he ,had employer ,group ,coverage ,that ,was ,creditable. ,During ,his ,initial ,Part ,D ,eligibility ,period, he ,decided ,not ,to ,enroll ,because ,he ,was ,satisfied ,with ,his ,drug ,coverage. ,It ,is ,now ,a year ,later ,and ,Mr. ,Shultz ,has ,lost ,his ,employer ,group ,coverage ,within ,the ,last ,two weeks. ,How ,would ,you ,advise ,him?correct ,answersMr. ,Schultz ,should ,enroll ,in ,a ,Part ,D,plan

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AHIP Final Exam Test Questions and Answers

,before ,he ,has ,a , 63 - day ,break ,in ,coverage ,in ,order ,to ,avoid ,a ,premium ,penalty.

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AHIP Final Exam Test Questions and Answers

Mrs. ,Mulcahy, ,age ,65, ,is ,concerned ,that ,she ,may ,not ,qualify ,for ,enrollment ,in ,a ,Medicare ,prescription ,drug ,plan ,because, ,although ,she ,is ,entitled ,to ,Part ,A, ,she ,is ,not enrolled ,under ,Medicare ,Part ,B. ,What ,should ,you ,tell ,her?correct ,answersAn ,individual,who ,is ,entitled ,to ,Part ,A ,or ,enrolled ,under ,Part ,B ,is ,eligible ,to ,enroll ,in ,a ,Medicare prescription ,drug ,plan. ,As ,long ,as ,Mrs. ,Mulcahy ,is ,entitled ,to ,Part ,A, ,she ,does ,not ,need,to ,enroll ,under ,Part ,B ,before ,enrolling ,in ,a ,prescription ,drug ,plan. What ,types ,of ,tools ,can ,Medicare ,Part ,D ,prescription ,drug ,plans ,use ,that ,affect ,the ,way,their ,enrollees ,can ,access ,medications?correct ,answersPart ,D ,plans ,do ,not ,have ,to cover ,all ,medications. ,As ,a ,result, ,their ,formularies, ,or ,lists ,of ,covered ,drugs, ,will ,vary from ,plan ,to ,plan. ,In ,addition, ,they ,can ,use ,cost ,containment ,techniques ,such ,as ,tiered co-payments ,and ,prior ,authorization. All ,plans ,must ,cover ,at ,least ,the ,standard ,Part ,D ,coverage ,or ,its ,actuarial ,equivalent. Which ,of ,the ,following ,statements ,best ,describes ,some ,of ,the ,costs ,a ,beneficiary ,would,incur ,for ,prescription ,drugs ,under ,the ,standard ,coverage?correct ,answersStandard ,Part,D ,coverage ,would ,require ,payment ,of ,an ,annual ,deductible, ,and ,once ,past ,the ,catastrophic ,coverage ,threshold, ,the ,beneficiary ,pays ,whichever ,is ,greater ,of ,either ,the co-pays ,for ,generic ,and ,brand ,name ,drugs ,or ,coinsurance ,of ,5%.

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AHIP Final Exam Test Questions and Answers

Mr. ,Jacob ,understands ,that ,there ,is ,a ,standard ,Medicare ,Part ,D ,prescription ,drug benefit, ,but ,when ,he ,looks ,at ,information ,on ,various ,plans ,available ,in ,his ,area, ,he ,sees,a ,wide ,range ,in ,what ,they ,charge ,for ,deductibles, ,premiums, ,and ,cost ,sharing. ,How ,can,you ,explain ,this ,to ,him?correct ,answersMedicare ,Part ,D ,drug ,plans ,may ,have ,different benefit ,structures, ,but ,on ,average, ,they ,must ,all ,be ,at ,least ,as ,good ,as ,the ,standard model ,established ,by ,the ,government. Mr. ,Carlini ,has ,heard ,that ,Medicare ,prescription ,drug ,plans ,are ,only ,offered ,through private ,companies ,under ,a ,program ,known ,as ,Medicare ,Advantage ,(MA), ,not ,by ,the government. ,He ,likes ,Original ,Medicare ,and ,does ,not ,want ,to ,sign ,up ,for ,an ,MA product, ,but ,he ,also ,wants ,prescription ,drug ,coverage. ,What ,should ,you ,tell ,him?correct,answersMr. ,Carlini ,can ,stay ,with ,Original ,Medicare ,and ,also ,enroll ,in ,a ,Medicare prescription ,drug ,plan ,through ,a ,private ,company ,that ,has ,contracted ,with ,the government ,to ,provide ,only ,such ,drug ,coverage ,to ,eligible ,Medicare ,beneficiaries. Which ,of ,the ,following ,individuals ,is ,most ,likely ,to ,be ,eligible ,to ,enroll ,in ,a ,Part ,D ,Plan?correct ,answersJose, ,a ,grandfather ,who ,was ,granted ,asylum ,and ,has ,worked ,in,the ,United ,States ,for ,many ,years. 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?correct ,answersIf ,the ,drug ,coverage ,he ,has ,is ,not expected ,to ,pay, ,on ,average, ,at

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AHIP Final Exam Test Questions and Answers

,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

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AHIP Final Exam Test Questions and Answers

period ,to ,avoid ,the ,late ,enrollment ,penalty. Mrs. ,McIntire ,is ,enrolled ,in ,her ,state's ,Medicaid ,plan ,and ,has ,just ,become ,eligible ,for ,Medicare ,as ,well. ,What ,can ,she ,expect ,will ,happen ,to ,her ,drug ,coverage?correct answersUnless ,she ,chooses ,a ,Medicare ,Part ,D ,prescription ,drug ,plan ,on ,her ,own, ,she,will ,be ,automatically ,enrolled ,in ,one ,available ,in ,her ,area. Mrs. ,Berkowitz ,wants ,to ,enroll ,in ,a ,Medicare ,Advantage ,plan ,that ,does ,not ,include ,drug,coverage ,and ,also ,enroll ,in ,a ,stand-alone ,Medicare ,prescription ,drug ,plan. ,Under ,what circumstances ,can ,she ,do ,this?correct ,answersIf ,the ,Medicare ,Advantage ,plan ,is ,a Private ,Fee-for-Service ,(PFFS) ,plan ,that ,does ,not ,offer ,drug ,coverage ,or ,a ,Medical Savings ,Account ,plan, ,Mrs. ,Berkowitz ,can ,do ,this. Which ,of ,the ,following ,statements ,about ,Medicare ,Part ,D ,are ,correct? I. Part ,D ,plans ,must ,enroll ,any ,eligible ,beneficiary ,who ,applies ,regardless ,of ,health,status ,except ,in ,limited ,circumstances. II. Private ,fee-for-service ,(PFFS) ,plans ,are ,not ,required ,to ,use ,a ,pharmacy ,network ,but,may ,choose ,to ,have ,one. III. Beneficiaries ,enrolled ,in ,a ,MA-Medical ,Savings ,Account ,(MSA) ,plan ,may ,only ,obtain,Part ,D ,benefits ,through ,a ,standalone ,PDP.