PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update, Exams of Nursing

Download PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update and more Exams Nursing in PDF only on Docsity! 1/1 Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage (MA) and Part D plans that Agent Smith sells at the regular Tuesday brunch the neighbors have for senior citizens. What should Agent Tom Smith tell Mr. Moreno about the kinds of food that can be provided to potential enrollees who attend the sales presentation? Choose one answer. a. Nothing may be provided to eat or drink during the sales presentation. Any type of meal or food is allowed, as long as it is available to the general public and not just those who are eligible to enroll in the plans. Any meal is allowed, as long as it is valued at less than $15. A meal cannot be provided, but light snacks would be permitted. 1 Marks: 1 Last year Agent Melanie Meyers marketed and enrolled several clients in Medicare Advantage (MA) health plans. This year she has decided to focus on non-MA products. What advice would you give Melanie if she wishes to continue to receive renewal fees? Choose one answer. a. All that she needs to do is avoid being terminated for cause. Melanie must remain trained, tested, licensed, and appointed, regardless of whether she is actively selling MA products. Melanie will need to do nothing to continue receiving renewal fees since the initial sale was made when she met all requirements. All that she needs to do is meet state licensure requirements moving forward. 2 Marks: 1 3 Marks: 1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2024/2025 GRADED A+ Final Exam - Attempt 1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ 2/1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2024/2025 GRADED A+ Mrs. Kendrick is six months away from turning 65. She wants to know what she will have to do to enroll in a Medicare Advantage (MA) plan as soon as possible. What could you tell her? Choose one answer. a. MA plans are only available to those who have been enrolled in a Medigap plan for at least six months. Therefore, before enrolling in an MA plan, she must first use a Medigap plan to supplement her Original Medicare coverage. b.She must first enroll in a Medicare Part D plan, before enrolling in a Medicare Advantage plan. c.She must have previously been enrolled in Original Fee- for-Service Medicare for at least one year before she may enroll in an MA plan. d.She may enroll in an MA plan beginning three months immediately before her first entitlement to both PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ 8 Marks: 1 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? Choose one answer. 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 (beginning in 2019). She may do it only during the MA Disenrollment Period, which runs from January 1 to February 14 of each year. c. Any time that she is dissatisfied with the plan’s network coverage or customer service she may make such a 5/1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2024/2025 GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ 6/1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2024/2025 GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ change. d. She may only make such a change during her “initial coverage election period,” which occurred when she first became entitled to Medicare. 7/1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2024/2025 GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ change. d. She may only make such a change during her “initial coverage election period,” which occurred when she first became entitled to Medicare. 3/20/202 0 10/1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ . PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) have upon Medigap plans? Choose one answer. The Part A deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. The Part A deductible is no longer covered under Medigap plans for all enrollees starting January 1, 2020. MACRA provides funding to help individuals age 59 and above enroll in Medigap plans. Marks: 1 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? Choose one answer. 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. Part D covers long-term care services and she shouldn’t worry because there has been no change in coverage. Part D covers physician and non-physician practitioner services and the deductible has not changed this year, but the physician charges may go up. Part D covers hospital and home health services and the cost sharing has changed this year. Marks: 1 3/20/202 0 11/1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ The Federal government facilitates competition between hospice programs to lower the price of their services for Medicare beneficiaries, but does not offer coverage for hospice services through the Medicare program. Hospice services are currently only offered under a limited demonstration project. Whether they will eventually become available nationally depends on the outcomes of the demonstration. Medicare covers hospice services and they will be available for her. 3/20/202 0 12/1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ Ms. Lopez is an independent agent under contract with MarketCo, a third-party marketing organization. MarketCo has a contract with BestCare health plan, a Medicare Advantage (MA) organization, to offer marketing services through its contracted agents and agencies. Ms. Lopez returns calls to individuals who contact MarketCo in response to its mailers promoting BestCare health plan. Which of the following best describes the responsibilities of Ms. Lopez? Choose one answer. Ms. Lopez no longer needs to be concerned about state licensure since she is marketing an MA product subject to federal rules. Ms. Lopez needs to maintain state licensure, but because she is working for a third-party marketing organization she is exempt from CMS training requirements that apply to BestCare captive agents. Ms. Lopez is considered a marketing representative of BestCare but is exempt from the marketing rules regarding approved call scripts because she works directly for MarketCo. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to comply with CMS marketing requirements, including those regarding using only approved call scripts. Marks: 1 Mr. Wong is a single individual. He has had a successful business career and is now able to retire with a comfortable income. Mr. Wong's taxable income is in excess of $100,000. Mr. Wong has health coverage through his employer but will sign-up Medicare Part A, Part B and Part D when he leaves the workforce. How would you advise him as he budgets for Medicare premiums? Choose one answer. Due to the provisions of MACRA, his Part B and D coverage will be combined and covered through a low-cost Medigap policy to supplement his Part A coverage. Due to his participation in the workforce he will not have to pay premiums for Part A and he will pay the lowest monthly premium rates for Part B and Part D. Due to his participation in the workforce he will not have to pay premiums for Part A but he will pay higher premiums for Part B and Part D due to the amount of his income. Due to his participation in the workforce he will not have to pay premiums for Part A and will pay reduced premiums for Part B and Part D. Marks: 1 3/20/202 0 2020 Final Exam: Final Exam 15/1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ Choose one answer. Medicaid will cover his cost-sharing, regardless of from which physician or hospital he receives his Medicare- covered services. He should know that Medicaid will pay cost sharing only for services provided by Medicaid participating providers. c. For Medicaid beneficiaries, Medicare reduces its cost-sharing amounts to match those charged by the state Medicaid program so there will be no change in his cost-sharing amounts. d. Medicaid will no longer pay any cost sharing once he is eligible for Medicare, so he will need to rely only on Medicare providers. Mr. Wong is a single individual. He has had a successful business career and is now able to retire with a comfortable income. Mr. Wong's taxable income is in excess of $100,000. Mr. Wong has health coverage through his employer but will sign-up Medicare Part A, Part B and Part D when he leaves the workforce. How would you advise him as he budgets for Medicare premiums? Choose one answer. Due to the provisions of MACRA, his Part B and D coverage will be combined and covered through a low-cost Medigap policy to supplement his Part A coverage. Due to his participation in the workforce he will not have to pay premiums for Part A and he will pay the lowest monthly premium rates for Part B and Part D. Due to his participation in the workforce he will not have to pay premiums for Part A but he will pay higher premiums for Part B and Part D due to the amount of his income. Due to his participation in the workforce he will not have to pay premiums for Part A and will pay reduced premiums for Part B and Part D. Marks: 1 3/20/202 0 2020 Final Exam: Final Exam 16/1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ 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? Choose one answer. He should look into the possibility of purchasing his medications through the internet from off-shore pharmacies. He should contact his neighbors and family members and let them know that any contributions they make toward his drug expenses will be tax deductible. The only option available is to reduce his income so that he can qualify for the Part D extra help or wait until next year to see if the annual limits change. He 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. Marks: 1 3/20/202 0 2020 Final Exam: Final Exam 17/1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ Ms. Lewis understands that Medicare prescription drug plans may use various methods to control the use of specific drugs. She has heard about a technique called “step therapy” and is wondering if you can explain what that is. What should you tell her? Choose one answer. Step therapy refers to incentives plans can provide to enrollees to engage in regular walking in order to reduce their need for medications treating heart and cholesterol problems. Step therapy involves slow changes in the dosages of a given drug in order to discover the correct amount. c. Step therapy involves taking somewhat larger doses but skipping every other day, resulting in lower overall consumption of the drug. d. Step therapy involves using one or more lower priced drugs before trying a more expensive drug when all are used to treat the same condition. Marks: 1 Marks: 1 Which of the following statements is correct about the appeal and grievance processes? Enrollees have a right to obtain a review (appeal) of certain decisions about prescription drug coverage. The grievance process is used for reviews of coverage decisions on plan benefits. Plans must provide a link to the Medicare.gov website where an enrollee can enter a complaint. Enrollees have a right to file complaints (sometimes called grievances) about the quality of their care. Choose one answer. II and IV only I and II only 3/20/202 0 2020 Final Exam: Final Exam 20/1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ c. I, III, and IV only d. I and III only When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan? Choose one answer. You may provide cash promotions or giveaways as long they are offered to everyone, whether they are a Medicare beneficiary or the general public. You may provide any gift to induce enrollment, as long as its retail value does not exceed $25 in value. You may provide gifts or prizes to all potential enrollees during an event that do not exceed $15 in retail value. You may give enrollees post-enrollment gifts to compensate them for their time. Marks: 1 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? Choose one answer. 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. Plans must provide Star Rating information as part of the Summary of Benefits package, but they may optionally choose to provide Star Rating information on their websites. CMS generally issues plan ratings in January of each year, and plan sponsors must update the rating information available to enrollees within 30 days. New plans and Part D sponsors that do not have any Star Rating are not required to provide Star Rating information until the next contract year. Marks: 1 3/20/202 0 2020 Final Exam: Final Exam 21/1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ Marks: 1 Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a PPO that does not include drug coverage. What should you tell her about obtaining drug coverage? Choose one answer. She can enroll in the PPO and purchase drug coverage through a Medigap plan. She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan. 3/20/202 0 2020 Final Exam: Final Exam 22/1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ Choose one answer. Private Fee-for-Service (PFFS) plan that does not include drug coverage. Medicare Advantage (MA) PPO that does not include drug coverage. Medicare Advantage (MA) HMO-POS plan that does not include drug coverage. d. Medicare Advantage (MA) HMO that does not include drug coverage. When Myra first became eligible for Medicare, she enrolled in Original Medicare (Parts A and B). She is now 67 and will turn 68 on July 1. She would now like to enroll in a Medicare Advantage (MA) plan and approaches you about her options. What advice would you give her? Choose one answer. She could enroll in an MA plan during the period including the three months before, the month of, and up to three months after turning 68. She should wait until the new year to disenroll from Original Medicare and select an MA plan between January 1 and March 31. She could immediately enroll in MA plan based on the one-time special enrollment period available to those 70 and younger. She should remain in Original Medicare until the annual election period running from October 15 to December 7, during which she can select an MA plan. Marks: 1 Mr. McTaggert notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know what makes them different from an HMO or a PPO. What should you tell him? Choose one answer. Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts Original Medicare, as long as the provider has a reasonable opportunity to access the plan’s terms and conditions and agrees to accept them. PFFS plans are the same as Medicare supplement plans and he may obtain care from any provider in the U.S. c. If a PFFS enrollee shows his/her card when obtaining services from a provider who participates in Original Medicare, then that provider is required to accept the plan’s terms and conditions. d. If offered, beneficiaries can select a stand-alone Part D prescription drug plan (PDP) with an HMO or a PPO, but not with a PFFS plan. Marks: 1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ 27/1 3/20/202 0 independent agent paid for his work by a third-party marketing organization (TMO). How do the CMS compensation rules apply to these three agents? Choose one answer. Able is subject to CMS compensation rules because he is paid directly by a health plan. Agents Baker and Charles are not because they are paid by third parties. Charles is subject to CMS compliance rules because he works for a TMO and CMS applies an extra layer of scrutiny to such organizations. Able and Baker are not. Baker and Charles are subject to CMS compensation rules because they are paid by third parties. Able is not because he is paid directly by a health plan. All three are treated as independent agents under CMS compensation rules. Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her? Choose one answer. a. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. Mrs. Radford must apply to the Medicare Advantage plan, which will include a medical review, prior to being accepted and enrolled. Mrs. Radford can enroll in any Medicare Advantage plan that operates within the United States. Even if Mrs. Radford has end-stage renal disease, she will be able to enroll in any Medicare Advantage plan in her service area. Marks: 1 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? Choose one answer. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, if she does sign up at a later date, she will have to pay a one-time penalty equal to 10% of the annual premium amount. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, if she does sign up at a later date, she will be required to pay a higher premium during the first year that she is enrolled in the Medicare prescription drug program. After that point, her premium will return to the normal amount. If she does not sign up for a Medicare prescription drug plan, she will incur no penalty, as long as she can demonstrate that she was in good health and did not take any medications. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, 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. Marks: 1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ Choose one answer. A PFFS plan is one of the various types of Medicare Advantage plans offered by private entities and she may enroll in one if it is available in her area. A PFFS plan is a type of Medicare Supplement plan and she may enroll in one if it is available in her area. c. A PFFS plan is exactly the same as Original Medicare, only offered by a private entity and she may enroll in one if it is available in her area. d. PFFS plans are designed to cover only prescription drugs and if that is the type of coverage she wants, she may enroll in one if it is available in her area. Richard is a licensed agent who represents Spartan Health Plan and its Medicare Advantage (MA) plans. Richard has several clients who have recently come to him for help who are in their initial coverage election period (ICEP) and are interested in enrolling in one of Spartan Health Plan's MA plans. Alice will soon turn 65 and retire. Alice has coverage through Spartan Health Plan offered by her employer. Bob had health coverage through Spartan but dropped the coverage when he retired early to travel overseas. Bob, who has just turned age 65, is now back in the United States. Charlotte, who will turn 65 next month, has coverage through Athena Health plan – a company Richard also represents. Who qualifies for the opt-in simplified enrollment mechanism? Choose one answer. Alice and Charlotte because each of them currently have health coverage and is in their initial coverage election period (ICEP). Alice and Bob because each of them has had coverage through Spartan Health Plan. c. Alice, Bob, and Charlotte because electronic health record interoperability will allow Richard to access any needed information for their applications. d. Alice because she will not have a break between her non-Medicare and Medicare coverage through Spartan Health Plan. Marks: 1 3/20/202 0 30/1 While making an appointment to discuss Medicare Advantage (MA) and Part D plans with a potential enrollee, you are asked to describe other types of insurance products that your client might wish to purchase. What additional types of insurance can you present during the MA and Part D marketing appointment? Choose one answer. You can present any line of business you represent as long as you obtain the beneficiary’s permission first. You can present only health care related lines of business, but must obtain the beneficiary’s permission to do so before the presentation occurs and document that you have obtained that permission. You can only present the end of life and life insurance lines of business. d. You cannot present any line of business other than MA or Part D during such a presentation, regardless of whether or not it is health care related. Marks: 1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ 3/20/202 0 31/1 Marks: 1 Ms. Jensen has heard about “Original Fee-for-Service Medicare” and “Private Fee-for-Service” plans. She wants to know what the difference is, if any. What should you tell her? PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ 32/1 2020 Final Exam: Final Exam 3/20/202 0 Choose one answer. Original Medicare and PFFS plans are essentially the same thing. PFFS plans are a type of Medicare Advantage plan offered by private companies. PFFS is a form of supplemental coverage that fills in the gaps where Original Medicare leaves off. d. PFFS plans primarily cover drugs that Original FFS Medicare does not cover. Ms. Levi is considering enrollment in a Medicare Advantage HMO plan offered in her area. Ms. Levi often travels to visit relatives and is concerned that she may need emergency care outside of her plan’s service area. What should you tell her about coverage of emergency care? Choose one answer. Plans are required to cover at least 20% of the cost of out-of-network emergency care. Plans are required to cover all charges for in-network emergency care, but coverage of out-of-network emergency care is not required. Plans are required to cover out-of-network emergency care. Plans are required to cover out-of-network emergency care only if she has the ambulance driver or ER doctor call her plan for approval prior to receiving emergency services. Marks: 1 Another agent you know has engaged in misconduct that has been verified by the plan she represented. What sort of penalty might the plan impose on this individual? Choose one answer. Plans must immediately terminate their contracts with such individuals. Her name will be reported to a publicly accessible database and could be advertised in local newspapers. c. The plan may withhold commission, require retraining, report the misconduct to a state department of insurance or terminate the contract. d. Plans do not impose penalties. Instead, the Medicare agency has specific authority to fine such individuals for each violation. Marks: 1 PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+ PSY325 325 AHIP Final Exam Questions and Answers rated A+ Guaranteed Success Latest Update 2022/2023GRADED A+