AHIP FINAL EXAM LATEST EXAM 2024 WITH UPDATED QUESTIONS AND DETAILED CORRECT ANSWERS (GRADED A+)

AHIP FINAL EXAM LATEST EXAM 2024
WITH UPDATED QUESTIONS AND
DETAILED CORRECT ANSWERS (GRADED
A+)
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? - ANSWER-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.
One of your clients, Lauren Nichols, has heard about a Medicare
concept from one of her neighbors called TrOOP. She asks you to
explain it. What do you say? - ANSWER-TrOOP stands for true
out-of-pocket expenses that count toward the Medicare Part D
catastrophic limit and include not only expenses paid by a
beneficiary but also in some instances drug manufacturer
discounts. Mr. Lopez, who is fairly well-off financially, would like to
enroll in a Medicare prescription drug plan you represent and
simply give you a check to cover his premiums for the entire year.
What should you tell him? - ANSWER-He will need to mail in his
payment with his enrollment form.
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Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in
her area that does not include drug coverage. She wants to enroll
in the plan and enroll in a stand-alone prescription drug plan.
What should you tell her? - ANSWER-She could enroll in a PFFS
plan and a stand-alone Medicare prescription drug plan.
Mrs. Roswell is a new Medicare beneficiary who has just retired
from retail work. She is interested in selecting a Medicare Part D
prescription drug plan. She takes a number of medications and is
concerned that she has not been able to identify a plan that
covers all of her medications. She does not want to make an
abrupt change to new drugs that would be covered and asks what
she should do. What should you tell her? - ANSWER-Every Part
D drug plan is required to cover a single one-month fill of her
existing medications sometime during a 90-day transition period.
Mr. Robinson was quite ill recently and forgot to pay his monthly
premium for his MA-PD plan. He is worried that he will lose his
coverage now when he needs it the most. He is certain his plan
will disenroll him because that is what happened to a friend of his
in a similar type of plan. What can you tell Mr. Robinson about his
situation? - ANSWER-Plan sponsors have the option to do
nothing when a plan member does not pay their premiums or
disenroll the member after a grace period and notice.
Mrs. Fiore is a retired federal worker with coverage under a
Federal Employee Health Benefits (FEHB) plan that includes
creditable drug coverage. She is ready to turn 65 and become
Medicare eligible for the first time. What issues might she
consider about whether to enroll in a Medicare prescription drug
plan? - ANSWER-She could compare the coverage to see if the
Medicare Part D plan offers better benefits and coverage than the
FEHB plan for the specific medications she needs and whether
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any additional benefits are worth the Part D premium costs on top
of her FEHB contribution.
Mrs. Shields is covered by Original Medicare. She sustained a hip
fracture and is being successfully treated for that condition.
However, she and her physicians feel that after her lengthy
hospital stay she will need a month or two of nursing and
rehabilitative care. What should you tell them about Original
Medicare's coverage of care in a skilled nursing facility? -
ANSWER-Medicare will cover Mrs. Shield's skilled nursing
services provided during the first 20 days of her stay, after which
she would have a copay until she has been in the facility for 100
days.