AHIP - Final examination LATEST
2025/ 2026 TEST BANK| COMPLETE
ACTUAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY
GRADED A+ (BRAND NEW!!)
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? - ,,,answer,,,Mr. 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. Polanski likes the cost of an HMO plan available in his area, but would
like to be able to visit one or two doctors who aren't participating
providers. He wants to know if the Point of Service (POS) option available
with some HMOs will be of any help in this situation. What should you tell
him? - ,,,answer,,,The POS option might be a good solution for him as it
will allow him to visit out-of-network providers, generally without prior
approval. However, he should be aware that it is likely he will have to pay
higher cost-sharing for services from out-of-network providers.
Mr. Barker had surgery recently and expected that he would have certain
services and items 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 a number of services and
items he thought would be fully covered. He called you to ask what he
could do? What could you tell him? - ,,,answer,,,You can offer to review
the plans appeal process to help him ask the plan to review the coverage
decision.
Ms. Stuart has heard about a special needs plan (SNP) that one of her
friends is enrolled in and is interested in that product. She wants to be
sure she also has coverage for prescription drugs. Would she be able to
obtain drug coverage if she enrolled in the SNP? - ,,,answer,,,a. Yes. All
SNPs are required to provide Part D coverage for prescription drugs.
b. Yes, but only if she qualifies for Part D prescription drug coverage under
her state Medicaid program.
c. No. Medicare beneficiaries who enroll in an SNP must always obtain
their drug coverage through a stand-alone Part D Medicare prescription
drug plan that they sign up for independent of their enrollment in the SNP.
d. Maybe. Some SNPs offer Part D coverage for prescription drugs and
some do not.
= ?????
Phiona works in the IT Department of BestCare Health Plan. Phiona is
placed in charge of BestCare's efforts to facilitate electronic enrollment in
its Medicare Advantage plans. In setting up the enrollment site, which of
the following must Phiona consider? - ,,,answer,,,II. All data elements
required to complete an enrollment request must be captured.
III. The process must include a clear and distinct step that requires the
applicant to activate an "Enroll Now" or "I Agree" type of button or tool.
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? - ,,,answer,,,Step therapy involves using
2025/ 2026 TEST BANK| COMPLETE
ACTUAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY
GRADED A+ (BRAND NEW!!)
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? - ,,,answer,,,Mr. 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. Polanski likes the cost of an HMO plan available in his area, but would
like to be able to visit one or two doctors who aren't participating
providers. He wants to know if the Point of Service (POS) option available
with some HMOs will be of any help in this situation. What should you tell
him? - ,,,answer,,,The POS option might be a good solution for him as it
will allow him to visit out-of-network providers, generally without prior
approval. However, he should be aware that it is likely he will have to pay
higher cost-sharing for services from out-of-network providers.
Mr. Barker had surgery recently and expected that he would have certain
services and items 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 a number of services and
items he thought would be fully covered. He called you to ask what he
could do? What could you tell him? - ,,,answer,,,You can offer to review
the plans appeal process to help him ask the plan to review the coverage
decision.
Ms. Stuart has heard about a special needs plan (SNP) that one of her
friends is enrolled in and is interested in that product. She wants to be
sure she also has coverage for prescription drugs. Would she be able to
obtain drug coverage if she enrolled in the SNP? - ,,,answer,,,a. Yes. All
SNPs are required to provide Part D coverage for prescription drugs.
b. Yes, but only if she qualifies for Part D prescription drug coverage under
her state Medicaid program.
c. No. Medicare beneficiaries who enroll in an SNP must always obtain
their drug coverage through a stand-alone Part D Medicare prescription
drug plan that they sign up for independent of their enrollment in the SNP.
d. Maybe. Some SNPs offer Part D coverage for prescription drugs and
some do not.
= ?????
Phiona works in the IT Department of BestCare Health Plan. Phiona is
placed in charge of BestCare's efforts to facilitate electronic enrollment in
its Medicare Advantage plans. In setting up the enrollment site, which of
the following must Phiona consider? - ,,,answer,,,II. All data elements
required to complete an enrollment request must be captured.
III. The process must include a clear and distinct step that requires the
applicant to activate an "Enroll Now" or "I Agree" type of button or tool.
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? - ,,,answer,,,Step therapy involves using
