AHIP 2018 Exam Questions with Verified Answers

AHIP 2018 Exam Questions with Verified Answers

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? - If the Medicare Advantage plan is a Private Fee-forService (PFFS) plan that does not offer drug coverage or a Medical Savings Account, Mrs.
Berkowitz can do this.
Ms. Goldstein is required by the plan she represents to obtain enrollment forms that have
carbon copies in the back. She gives one to the beneficiary, sends another to the plan and
retains the third. What should she do with her copies of the enrollment forms? - She should
make every effort to safeguard the beneficiary information on those enrollment forms.
Mr. Lopez takes several high cost prescription drugs. He would like to enroll in a standalone
Part D prescription drug plan that is available in his area. In what type of Medicare Health
Plan can he enroll? - Private Fee-for-Service (PFFS) plan that does not include drug
coverage.
Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug coverage. He
found a stand-alone Medicare prescription drug plan in his area that offers better coverage
than that available through his MA-PD plan and in addition has a low premium. It won't cost
him much more and, because he has the means to do so, he wishes to enroll in the standalone prescription drug plan in addition to his MA-PD plan. What should you tell him? - If Mr.
Block enrolls in the stand-alone Medicare prescription drug plan, he will be disenrolled from
the Medicare Advantage plan.
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? - Most individuals who are citizens and over age 65 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.
Mrs. Lopez is enrolled in a Medicare Advantage cost plan. 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? - If a Part D
benefit is offered through her plan she must enroll in this plan.
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.
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through acupuncture. She is concerned about whether or not Medicare will cover
these items and services. What should you tell her? - Medicare does not cover acupuncture,
or, in general, glasses or dentures.
Which statement best describes PACE plans? - It includes comprehensive medical and social
service delivery systems using an interdisciplinary team approach in an adult day health
center, supplemented by in-home and referral services.
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. How would you advise him? - Mr.
Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to
avoid a premium penalty.
For which of the following individuals would a Cost Plan be most appropriate? - Ms. Baker
who is enrolled in Medicare Part B and is willing to continue paying Part B premiums plus
any plan premiums.
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 tell him? - 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.
Mrs. Wellington is enrolled in Parts A and B of Original Medicare. A friend recently told her
that there is an excellent Medicare Advantage (MA) plan with a five-star rating serving her
area. On January 15 she comes to you for advice as to what options, if any, she has. What
should you say regarding special enrollment periods (SEPs)? - Mrs. Wellington is eligible for
a SEP that may be used once until November 30 to enroll in the five-star plan.
Mr. Shapiro gets by on a very small fixed income. He has heard there may be extra help
paying for Part D prescription drugs for Medicare beneficiaries with limited income. He
wants to know whether he might qualify. What should you tell him? - The extra help is
available to beneficiaries whose income and assets do not exceed annual limits specified by
the government