AHIP Final Exam Test Questions and Answers (2022/2023) Rated A+ Answers Correct/Verified, Exams of Nursing

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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 ,answers; Medicare,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 answers; She ,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 answers :Most ,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.

AHIP Final Exam Test Questions and Answers

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

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 ,answers; Mrs. Gonzalez ,cannot ,purchase ,a ,Medigap ,plan ,that ,covers ,drugs,,but ,she ,could ,keep ,her ,Medigap ,policy ,and ,enroll ,in ,a ,Part ,D ,prescrip tion ,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 ,answers; Medicare 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 ,answers; Under ,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.

AHIP Final Exam Test Questions and Answers

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

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? correct answers; To ,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 answers; He ,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

AHIP Final Exam Test Questions and Answers

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

,respond? correct ,answers; Juan ,is ,likely ,to ,be eligible ,for ,Medicare ,once ,he ,turns ,age , 65 ,and ,if ,he ,enrolls ,Medicare ,would ,become ,the,primary ,payor ,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 answers; Medicare ,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 ,answers; Beneficiaries ,under,Original ,Medicare ,have ,no ,cost-sharing ,for ,most ,preventive ,services ,which ,include immunizations ,such ,as ,annual ,flu ,shots.

AHIP Final Exam Test Questions and Answers

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

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 answers; Mrs. ,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 ,answers; It ,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 ,answers; She 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?

AHIP Final Exam Test Questions and Answers

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

correct ,answers; Medicare will ,cover ,a ,total ,of , 190 ,days ,of ,inpatient ,psychiatric ,care ,during ,Mr. ,Rainey's ,entire lifetime. 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

AHIP Final Exam Test Questions and Answers

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

,tell ,him? correct ,answers; Part,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 ,answers; Tell 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 ,answers; After ,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.

AHIP Final Exam Test Questions and Answers

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

What ,should ,you ,tell ,him? correct ,answers; Medicare ,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 ,obtaini ng ,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?

AHIP Final Exam Test Questions and Answers

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

correct ,answers; He ,could ,enroll ,either ,in ,one ,of the ,MA ,plans that ,include ,prescription ,drug ,coverage ,or ,Original ,Medicare 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

AHIP Final Exam Test Questions and Answers

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,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 answers; Mrs. ,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 answers; He 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 answers; Dr. ,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.

AHIP Final Exam Test Questions and Answers

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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 ,answers; 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. Mr. ,Wells ,is ,trying ,to ,understand ,the ,difference ,between ,Original ,Medicare ,and Medicare ,Advantage. ,What ,would ,be ,the ,correct ,description? correct answers; Medicare 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 ,answers; Mrs. ,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?

AHIP Final Exam Test Questions and Answers

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

correct ,answers; C- SNP

AHIP Final Exam Test Questions and Answers

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

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 ,answers; She 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 answers; SNPs ,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 ,answers; Mrs. ,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.

AHIP Final Exam Test Questions and Answers

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What ,should ,you ,tell ,her? correct ,answers; Medicaid ,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 answers; He ,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 ,answers; She ,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 answers; 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).ur ,clients, ,Lauren ,Nichols, ,has ,heard ,about ,a ,Medica

AHIP Final Exam Test Questions and Answers

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

AHIP Final Exam Test Questions and Answers

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,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 answers; You ,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.

AHIP Final Exam Test Questions and Answers

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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.

AHIP Final Exam Test Questions and Answers

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

AHIP Final Exam Test Questions and Answers

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

,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.

AHIP Final Exam Test Questions and Answers

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

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

AHIP Final Exam Test Questions and Answers

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

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

AHIP Final Exam Test Questions and Answers

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

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%.

AHIP Final Exam Test Questions and Answers

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

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

AHIP Final Exam Test Questions and Answers

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

,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

AHIP Final Exam Test Questions and Answers

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

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.

AHIP Final Exam Test Questions and Answers