AHIP CWA EXAM MODULE 1-5, NONDISCRIMINATION, FWA,
COMPLIANCE 2023-2024 ACTUAL EXAM 300 QUESTIONS AND
CORRECT DETAILED ANSWERS (100% CORRECT AND VERIFIED
ANSWERS) |AGRADE
VERSION A
Mr. Sanchez has just turned 65 and is entitled to Part A but has not
enrolled in Part B because he has coverage through an employer plan. If
he wants to enroll in a Medicare Advantage plan, what will he have to
do? – ANSWER- He will have to enroll in Part B.
Mr. Kumar is considering a Medicare Advantage HMO and has
questions about his ability to access providers. What should you tell
him? – ANSWER- In most Medicare Advantage HMOs, Mr. Kumar
must generally obtain his services only from providers within the plan’s
network (except in an emergency or where care is unavailable within the
network).
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. Andrews asked how a Private Fee-for-Service (PFFS) plan might
affect her access to services since she receives some assistance for her
health care costs from the State. What should you tell her? – ANSWERMedicaid may provide additional benefits, but Medicaid will coordinate
benefits only with Medicaid participating providers.
Juan Perez, who is turning age 65 next month, intends to work for
several more years at Smallcap, Incorporated. Smallcap has a workforce
of 15 employees and offers employer-sponsored healthcare coverage.
Juan is a naturalized citizen and has contributed to the Medicare system<\/p>\n\n\n\n
for over 20 years. Juan asks you if he will be entitled to Medicare and if
he enrolls how that will impact his employer-sponsored healthcare
coverage. How would you respond? – ANSWER- Juan is likely to be
eligible for Medicare once he turns age 65 and if he enrolls Medicare
would become the primary payor of his healthcare claims and Smallcap
does not have to continue to offer him coverage comparable to those
under age 65 under its employer-sponsored group health plan.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan
that you represent. It is one of three plans operated by the same
organization in Mr. Lombardi’s area. The MA PPO plan does not include
drug coverage, but the other two plans do. Mr. Lombardi likes the PPO
plan that does not include drug coverage and intends to obtain his drug
coverage through a stand-alone Medicare prescription drug plan. What
should you tell him about this situation? – ANSWER- He could enroll
either in one of the MA plans that include prescription drug coverage or
Original Medicare with a Medigap plan and standalone Part D
prescription drug coverage, but he cannot enroll in the MA-only PPO
plan and a stand-alone prescription drug plan.
Mr. Lopez has heard that he can sign up for a product called “Medicare
Advantage” but is not sure about what type of plan designs are available
through this program. What should you tell him about the types of health
plans that are available through the Medicare Advantage program? –
ANSWER- They are Medicare health plans such as HMOs, PPOs, PFFS,
and MSAs.
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? – ANSWER- C-SNP
Ms. Gibson recently lost her employer group health and drug coverage
and now she wants to enroll in a PPO that does not include drug
coverage. What should you tell her about obtaining drug coverage? –<\/p>\n\n\n\n
ANSWER- She can enroll in the PPO, but she will not be able to
purchase a stand-alone Medicare Part D prescription drug plan.
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part
B. She is considering enrollment in a Medicare Advantage plan (Part C).
What should you advise her to do before she will be able to enroll in a
Medicare Advantage plan? – ANSWER- To join a Medicare Advantage
plan, she also must enroll in Part B.
Mrs. Radford asks whether there are any special eligibility requirements
for Medicare Advantage. What should you tell her? – ANSWER- Mrs.
Radford must be entitled to Part A and enrolled in Part B to enroll in
Medicare Advantage.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with
the care he has received under Original Medicare, but he would like to
know more about Medicare Advantage Special Needs Plans (SNPs).
What could you tell him? – ANSWER- SNPs have special programs for
enrollees with chronic conditions, like Mr. Sinclair, and they provide
prescription drug coverage that could be very helpful as well.
Mrs. Willard wants to know generally how the benefits under Original
Medicare might compare to the benefits package of a Medicare
Advantage Plan before she starts looking at specific plans. What could
you tell her? – ANSWER- Medicare Advantage Plans may offer extra
benefits that Original Medicare does not offer such as vision, hearing,
and dental services and must include a maximum out-of-pocket limit on
Part A and Part B services.
All plans must cover at least the standard Part D coverage or its actuarial
equivalent. Which of the following statements best describes some of the
costs a beneficiary would incur for prescription drugs under the standard
coverage? – ANSWER- Standard Part D coverage would require
payment of an annual deductible, and once past the catastrophic<\/p>\n\n\n\n
coverage threshold, the beneficiary pays whichever is greater of either
the co-pays for generic and brand name drugs or coinsurance of 5%.
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 onemonth fill of her existing medications sometime during a 90-day
transition period.
Mrs. Fields wants to know whether applying for the Part D low-income
subsidy will be worth the time to fill out the paperwork. What could you
tell her? – ANSWER- The Part D low-income subsidy could
substantially lower her overall costs. She can apply by contacting her
state Medicaid office or calling the Social Security Administration.
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? – ANSWERMedicare 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.
Mrs. Walters is entitled to Part A and has medical coverage without drug
coverage through an employer retiree plan. She is not enrolled in Part B.
Since the employer plan does not cover prescription drugs, she wants to
enroll in a Medicare prescription drug plan. Will she be able to? –
ANSWER- Yes. Mrs. Walters must be entitled to Part A and\/or enrolled
in Part B to be eligible for coverage under the Medicare prescription
drug program.
<\/p>\n","protected":false},"excerpt":{"rendered":"
AHIP CWA EXAM MODULE 1-5, NONDISCRIMINATION, FWA,COMPLIANCE 2023-2024 ACTUAL EXAM 300 QUESTIONS ANDCORRECT DETAILED ANSWERS (100% CORRECT AND VERIFIEDANSWERS) |AGRADEVERSION AMr. Sanchez has just turned 65 and is entitled to Part A but has notenrolled in Part B because he has coverage through an employer plan. Ifhe wants to enroll in a Medicare Advantage plan, […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-112327","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/112327","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=112327"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/112327\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=112327"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=112327"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=112327"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}