AHIP Final Test Latest Updated 2024
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive
premium. He
... [Show More] wants to know if he must use doctors in a network as his current HMO plan requires him
to do. What should you tell him? - correct answersHe may receive health care services from ANY
doctor allowed to bill Medicare, as long as he shows the doctor the plan's identification card and the
doctor agrees to accept the PFFS plan's payment terms and conditions, which could include balance
billing.
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? - correct
answersMr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program.
You have decided to focus on doing in-home presentations to market the Medicare Advantage (MA)
plans you represent. Before you conduct such sales presentations, what must you do? - correct answers
Mr. Wong is a single individual. He has had a successful business career and is now able to retire with a
comfortable income. Mr. Wong's taxable income is in excess of $100,000. Mr. Wong has health coverage
through his employer but will sign-up Medicare Part A, Part B and Part D when he leaves the workforce.
How would you advise him as he budgets for Medicare premiums? - correct answersa. Due to the
provisions of MACRA, his Part B and D coverage will be combined and covered through a low-cost
Medigap policy to supplement his Part A coverage.
b. Due to his participation in the workforce he will not have to pay premiums for Part A and he will pay
the lowest monthly premium rates for Part B and Part D.
c. Due to his participation in the workforce he will not have to pay premiums for Part A but he will pay
higher premiums for Part B and Part D due to the amount of his income.
d. Due to his participation in the workforce he will not have to pay premiums for Part A and will pay
reduced premiums for Part B and Part D.
?????
Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for
Medicare & Medicaid Services' communication and Marketing Guidelines to ensure he is compliant for
which type of products? - correct answersMedicare Advantage (MA) and Prescription Drug (PDP) plans
Correct
Mr. Zachow has a condition for which three drugs are available. He has tried two but had an allergic
reaction to them. Only the third drug works for him and it is not on his Part D plan's formulary. What
could you tell him to do? - correct answersMr. Zachow has a right to request a formulary exception to
obtain coverage for his Part D drug. He or his physician could obtain the standardized request form on
the plan's website, fill it out, and submit it to his plan. [Show Less]
