AHIP 2025 Updated Exams STUDY BUNDLE WITH
SOLUTIONS Qs & As| 100% Correct| Grade A (Verified
Answers)
You are mailing invitations to new Medicare beneficiaries for a marketing event. You
want an idea of how many people to expect, so you would like to request RSVPs.
What should you keep in mind? - ANSWERou may request RSVPs, but you are not
permitted to require contact information.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy. Where might he turn for help with his
prescription drug costs? - ANSWERMr. Wu may still qualify for help in paying Part D
costs through his State Pharmaceutical Assistance Program.
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? - ANSWERC-SNP
Dr. Elizabeth Brennan does not contract with the 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? - ANSWERDr. 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 percent of the Medicare rate.
Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-Service
(PFFS) plan. As part of that discussion, what should you be sure to tell her? -
ANSWERPFFS plans may choose to offer Part D benefits but are not required to do
so.
Which of the following statement is correct about 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 eligible for health care benefits through the Veteran's
Administration may enroll in an MSA.
IV. Non-network providers must accept the same amount that Original Medicare
would pay them as payment in full. - ANSWERI, II, and IV only
For which of the following individuals would a Cost Plan be most appropriate? -
ANSWERMs. Baker who is enrolled in Medicare Part B and is willing to continue
paying Part B premiums plus any plan premiums.
, Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare.
What should she be aware of when considering enrollment in a Medicare Health
Plan? - ANSWERShe can enroll in any type of Medicare Advantage (MA) plan except
an MA Medical Savings Account (MSA) plan.
Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered
by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA)
PPO plan. Later he sees an out-of-network doctor to receive a Medicare covered
service. How much may the doctor collect from Mr. Rivera? - ANSWERThe doctor
may only collect from Mr. Rivera the cost sharing allowable under the state's
Medicaid program.
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.
IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan. - ANSWERI, II, and III only
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 2019 under the
standard coverage? - ANSWERStandard 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? - ANSWERIt would
not be unusual for her costs to be a bit less because the Bipartisan Budget Act of
2018 moved up the date for closing the so-called "donut hole" for brand name drugs
to 2019.
Which of the following steps may a Part D sponsor adopt for beneficiaries who are at
risk of misusing or abusing frequently abused drugs?
I. Identifying at risk individuals by using criteria that includes the number of opioid
prescriptions the beneficiary has and the number of prescribers who have written
those prescriptions.
II. Locking an at-risk beneficiary into one pharmacy.
III. Locking an at-risk beneficiary into one prescriber.
SOLUTIONS Qs & As| 100% Correct| Grade A (Verified
Answers)
You are mailing invitations to new Medicare beneficiaries for a marketing event. You
want an idea of how many people to expect, so you would like to request RSVPs.
What should you keep in mind? - ANSWERou may request RSVPs, but you are not
permitted to require contact information.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy. Where might he turn for help with his
prescription drug costs? - ANSWERMr. Wu may still qualify for help in paying Part D
costs through his State Pharmaceutical Assistance Program.
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? - ANSWERC-SNP
Dr. Elizabeth Brennan does not contract with the 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? - ANSWERDr. 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 percent of the Medicare rate.
Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-Service
(PFFS) plan. As part of that discussion, what should you be sure to tell her? -
ANSWERPFFS plans may choose to offer Part D benefits but are not required to do
so.
Which of the following statement is correct about 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 eligible for health care benefits through the Veteran's
Administration may enroll in an MSA.
IV. Non-network providers must accept the same amount that Original Medicare
would pay them as payment in full. - ANSWERI, II, and IV only
For which of the following individuals would a Cost Plan be most appropriate? -
ANSWERMs. Baker who is enrolled in Medicare Part B and is willing to continue
paying Part B premiums plus any plan premiums.
, Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare.
What should she be aware of when considering enrollment in a Medicare Health
Plan? - ANSWERShe can enroll in any type of Medicare Advantage (MA) plan except
an MA Medical Savings Account (MSA) plan.
Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered
by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA)
PPO plan. Later he sees an out-of-network doctor to receive a Medicare covered
service. How much may the doctor collect from Mr. Rivera? - ANSWERThe doctor
may only collect from Mr. Rivera the cost sharing allowable under the state's
Medicaid program.
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.
IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan. - ANSWERI, II, and III only
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 2019 under the
standard coverage? - ANSWERStandard 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? - ANSWERIt would
not be unusual for her costs to be a bit less because the Bipartisan Budget Act of
2018 moved up the date for closing the so-called "donut hole" for brand name drugs
to 2019.
Which of the following steps may a Part D sponsor adopt for beneficiaries who are at
risk of misusing or abusing frequently abused drugs?
I. Identifying at risk individuals by using criteria that includes the number of opioid
prescriptions the beneficiary has and the number of prescribers who have written
those prescriptions.
II. Locking an at-risk beneficiary into one pharmacy.
III. Locking an at-risk beneficiary into one prescriber.
