AHIP 2023 Modules 5 Exam Questions and Verified Answers| 100% Correct| Latest Update
1. Mrs. Johnson calls to tell you she has not received her new
... [Show More] plan ID card yet, but she needs to see a doctor. What can she expect to receive from the plan after the plan has received her enrollment form?
~ Answer: b. Evidence of plan membership, information on how to obtain services, and the effective date of coverage
2. Mrs. Reynolds just signed up for a Medicare Advantage plan on the second of the month. She is leaving for vacation in two weeks and wants to know if her new coverage will start before she leaves. What should you tell her?
~ Answer: a. Typically her coverage would begin on the first day of the next month, so she should not expect her coverage to begin before she leaves
3. You meet with Mrs. Wilson to complete her enrollment in a Medicare Advantage plan. You tell her that there will be an enrollment verification process to confirm that she is enrolled in the plan that she requested and understands the plan features and rules. What should Mrs. Wilson expect regarding the verification process?
~ Answer: a. Mrs. Wilson will be contacted by the plan sponsor within 15 calendar days of receipt of the enrollment request
4. Mrs. Burton is in an MA-PD plan and was disappointed in the service she received from her primary care physician because she was told she would have to wait five weeks to get an appointment when she was feeling ill. She called you to ask what she could do so she wouldn't continue to have to put up with such poor access to care. What could you tell her?
~ Answer: b. She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment
5. 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: b. You can offer to review the plans appeal process to help him ask the plan to review the coverage decision
6. Mrs. Disraeli is enrolled in Original Medicare (Parts A and B) and a standalone Part D prescription drug plan. She has recently developed diabetes and has suffered from heart disease for several years. She has also recently learned that her area is served by a SNP for individuals suffering from such a combination of chronic diseases (C-SNP). Mrs. Disraeli is concerned however, that she will have few rights or protections if she enrolls in a C-SNP. How would you respond?
~ Answer: b. Enrollees in SNPs must have access to provider networks that include enough doctors, specialists, and hospitals to provide all covered services necessary to meet enrollee needs within reasonable travel time [Show Less]