AHIP ABC 2022 For The Final EXAM
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' protected health
information to market non-health related products such as life insurance and annuities. To do so it
must obtain authorization from the enrollees. Which statement best describes the authorization
process? –
Authorization may be obtained by directing a beneficiary to a website to provide consent.
During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a 5-star rating in
customer service and care coordination, and received an overall plan performance rating of a 4-
star, which of the following would be the correct statement to say to her? - The Medicare Advantage
plan received a 5-star rating in customer service and care coordination with an overall performance
rating of 4-stars.
agent lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the open
enrollment period. Ralph's effective enrollment is January 1st. Ralph disenrolls on February 12th
because he did not understand that the plan did not cover services furnished by several of his
longtime providers. Which of the following statements best describes the impact of Ralph's action
upon Agent lopez's compensation? - Agent Lopez's entire compensation must be recouped because
Ralph disenrolled within the 3 month period.
Agent Higgins helps Mrs. O'Malley to enroll in AB Medicare Advantage plan during the Annual open
enrollment period. Mrs. O'Malley effective enrollment date is January 1st. Subsequently, Mrs.
O'Malley disenrolls on February 12th following a move outside the plan's service area. What impact
will this have on Agent Higgins compensation? - AB MA PLAN does not have to recoup Agent
Higgins compensation because she has moved away from the service area.
You plan to participate in an educational event sponsored by a large regional health care system.
One of your colleagues suggests that you do a presentation on one of the Medicare Health plans you
market, and modify it to include information about preventive screening tests showcased at the
event. How should you respond to your colleague's suggestion? - You should tell your colleague no
because participation in an educational event may not include a sales presentation.
Agent Mary Jennings makes a presentation on Medicare advertised as an educational event. Agent
Jennings distributes materials that are solely educational in nature. However, she gives a brief
presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that has
, been advertised as educational? - Yes. When an event has been advertised as "educational,"
discussing plan-specific premiums is impermissible.
What types of tools can Medicare Part D prescription drug plans use that affect the way their
enrollees can access medications? - Part 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.
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? - Medicare 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.
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? - Medicare 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
All plans must cover at least the standard Part D coverage or its actuarial equivalent. What costs
would a beneficiary incur for prescription drugs in 2018 under the standard coverage? - Standard
Part D coverage would require payment of an annual deductible, 25% cost-sharing up to the
coverage gap, a portion of costs for both generics and brand-name drugs in the coverage gap, and
co-pays or co-insurance after the coverage gap.
Mrs. Andrews was preparing a budget for next year because she takes quite a few prescription
drugs, she will reach the coverage gap, and wants to be sure she has enough money set aside for
those months. She received assistance calculating her projected expenses from her daughter who is
a pharmacist, but she doesn't think the calculations are correct because her out-of-pocket expenses
would be lower than last year. She calls to ask if you can help. What might you tell her? - It would
not be unusual for her costs to be a bit less because the Bipartisan Act of 2018 moved up the date
for closing the so-called "donut hole" for brand name drugs to 2019.
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' protected health
information to market non-health related products such as life insurance and annuities. To do so it
must obtain authorization from the enrollees. Which statement best describes the authorization
process? –
Authorization may be obtained by directing a beneficiary to a website to provide consent.
During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a 5-star rating in
customer service and care coordination, and received an overall plan performance rating of a 4-
star, which of the following would be the correct statement to say to her? - The Medicare Advantage
plan received a 5-star rating in customer service and care coordination with an overall performance
rating of 4-stars.
agent lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the open
enrollment period. Ralph's effective enrollment is January 1st. Ralph disenrolls on February 12th
because he did not understand that the plan did not cover services furnished by several of his
longtime providers. Which of the following statements best describes the impact of Ralph's action
upon Agent lopez's compensation? - Agent Lopez's entire compensation must be recouped because
Ralph disenrolled within the 3 month period.
Agent Higgins helps Mrs. O'Malley to enroll in AB Medicare Advantage plan during the Annual open
enrollment period. Mrs. O'Malley effective enrollment date is January 1st. Subsequently, Mrs.
O'Malley disenrolls on February 12th following a move outside the plan's service area. What impact
will this have on Agent Higgins compensation? - AB MA PLAN does not have to recoup Agent
Higgins compensation because she has moved away from the service area.
You plan to participate in an educational event sponsored by a large regional health care system.
One of your colleagues suggests that you do a presentation on one of the Medicare Health plans you
market, and modify it to include information about preventive screening tests showcased at the
event. How should you respond to your colleague's suggestion? - You should tell your colleague no
because participation in an educational event may not include a sales presentation.
Agent Mary Jennings makes a presentation on Medicare advertised as an educational event. Agent
Jennings distributes materials that are solely educational in nature. However, she gives a brief
presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that has
, been advertised as educational? - Yes. When an event has been advertised as "educational,"
discussing plan-specific premiums is impermissible.
What types of tools can Medicare Part D prescription drug plans use that affect the way their
enrollees can access medications? - Part 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.
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? - Medicare 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.
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? - Medicare 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
All plans must cover at least the standard Part D coverage or its actuarial equivalent. What costs
would a beneficiary incur for prescription drugs in 2018 under the standard coverage? - Standard
Part D coverage would require payment of an annual deductible, 25% cost-sharing up to the
coverage gap, a portion of costs for both generics and brand-name drugs in the coverage gap, and
co-pays or co-insurance after the coverage gap.
Mrs. Andrews was preparing a budget for next year because she takes quite a few prescription
drugs, she will reach the coverage gap, and wants to be sure she has enough money set aside for
those months. She received assistance calculating her projected expenses from her daughter who is
a pharmacist, but she doesn't think the calculations are correct because her out-of-pocket expenses
would be lower than last year. She calls to ask if you can help. What might you tell her? - It would
not be unusual for her costs to be a bit less because the Bipartisan Act of 2018 moved up the date
for closing the so-called "donut hole" for brand name drugs to 2019.
