{"id":120053,"date":"2023-09-20T10:28:26","date_gmt":"2023-09-20T10:28:26","guid":{"rendered":"https:\/\/learnexams.com\/blog\/?p=120053"},"modified":"2023-09-20T10:28:29","modified_gmt":"2023-09-20T10:28:29","slug":"ahip-final-exam-final-exam-1-final-exam-2-latest-passed-a-rated-guide-new-full-exam","status":"publish","type":"post","link":"https:\/\/www.learnexams.com\/blog\/2023\/09\/20\/ahip-final-exam-final-exam-1-final-exam-2-latest-passed-a-rated-guide-new-full-exam\/","title":{"rendered":"AHIP Final Exam ,Final Exam 1, Final Exam 2 (Latest ) | Passed | A+ Rated Guide | New Full Exam"},"content":{"rendered":"\n<p>2023 AHIP Final Exam 1<br>Complete Answers 100% Correct<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare<br>prescription drug plan you represent and simply give you a check to cover his<br>premiums for the entire year. What should you tell him?:<br>He will need to mail in his payment with his enrollment form.<\/li>\n\n\n\n<li>Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her areathat<br>does not include drug coverage. She wants to enroll in the plan and enroll in a<br>stand-alone prescription drug plan.What should you tell her?:<br>Shecould enroll in a PFFS plan and a stand-alone Medicare prescription drug<br>plan.<\/li>\n\n\n\n<li>Mrs. Roswell is a new Medicare beneficiary who has just retired from retailwork.<br>She is interested in selecting a Medicare Part D prescription drug plan. She takes<br>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<br>change to new drugs that would be covered and asks what she should do. What<br>should you tell her?:<\/li>\n<\/ul>\n\n\n\n<p>Every Part D drug plan is required tocover a single one-month fill of her existing<br>medications sometime during a 90-daytransition period.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Mr. Robinson was quite ill recently and forgot to pay his monthly premiumfor his MA-PD plan. He is worried that he will lose his coverage now when he needs it<br>the most. He is certain his plan will disenroll him because that iswhat happened<br>to a friend of his in a similar type of plan. What can you tell Mr. Robinson about<br>his situation?:<br>Plan sponsors have the option to do nothingwhen a plan member does not pay<br>their premiums or disenroll the member after agrace period and notice.<\/li>\n\n\n\n<li>Mrs. Allen has a rare condition for which two different brand name drugsare<br>the only available treatment. She is concerned that since no generic prescription<br>drug is available and these drugs are very high cost, she will notbe able to find a<br>Medicare Part D prescription drug plan that covers either one of them. What<br>should you tell her?:<br>Medicare prescription drug plans are required to cover drugs in each therapeutic<br>category. She should be able to enrollin a Medicare prescription drug plan that<br>covers the medications she needs.<\/li>\n\n\n\n<li>One of your clients, Lauren Nichols, has heard about a Medicare conceptfrom<br>one of her neighbors called TrOOP. She asks you to explain it. What do you<br>say?:<br>TrOOP stands for true out-of-pocket expenses that count toward the Medicare<br>Part D catastrophic limit and include not only expenses paid by a beneficiary but<br>also in some instances drug manufacturer discounts.<\/li>\n\n\n\n<li>Mrs. Fiore is a retired federal worker with coverage under a Federal Employee Health Benefits (FEHB) plan that includes creditable drug coverage.<br>She is ready to turn 65 and become Medicare eligible for the first time.What<br>issues might she consider about whether to enroll in a Medicare prescriptiondrug<br>plan?:<br>She could compare the coverage to see if the Medicare Part D planoffers better<br>benefits and coverage than the FEHB plan for the specific medicationsshe needs<br>and whether any additional benefits are worth the Part D premium costson top of<br>her FEHB contribution.<\/li>\n\n\n\n<li>Mrs. Shields is covered by Original Medicare. She sustained a hip fractureand<br>is being successfully treated for that condition. However, she and her physicians<br>feel that after her lengthy hospital stay she will need a month<br>or two of nursing and rehabilitative care. What should you tell them about<\/li>\n\n\n\n<li><\/li>\n<\/ul>\n\n\n\n<p>2023 AHIP Final Exam<br>(ACTUAL TEST ) Questions and Answers<br>(Solved)<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare<br>prescription drug plan you represent and simply give you a check to cover his<br>premiums for the entire year. What should you tell him?:<br>He will need to mail in his payment with his enrollment form.<\/li>\n\n\n\n<li>Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her areathat<br>does not include drug coverage. She wants to enroll in the plan and enroll in a<br>stand-alone prescription drug plan.What should you tell her?:<br>Shecould enroll in a PFFS plan and a stand-alone Medicare prescription drug<br>plan.<\/li>\n\n\n\n<li>Mrs. Roswell is a new Medicare beneficiary who has just retired from retailwork.<br>She is interested in selecting a Medicare Part D prescription drug plan. She takes<br>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<br>change to new drugs that would be covered and asks what she should do. What<\/li>\n<\/ul>\n\n\n\n<p>should you tell her?:<br>Every Part D drug plan is required tocover a single one-month fill of her existing<br>medications sometime during a 90-daytransition period.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Mr. Robinson was quite ill recently and forgot to pay his monthly premiumfor his MA-PD plan. He is worried that he will lose his coverage now when he needs it<br>the most. He is certain his plan will disenroll him because that iswhat happened<br>to a friend of his in a similar type of plan. What can you tell Mr. Robinson about<br>his situation?:<br>Plan sponsors have the option to do nothingwhen a plan member does not pay<br>their premiums or disenroll the member after agrace period and notice.<\/li>\n\n\n\n<li>Mrs. Allen has a rare condition for which two different brand name drugsare<br>the only available treatment. She is concerned that since no generic prescription<br>drug is available and these drugs are very high cost, she will notbe able to find a<br>Medicare Part D prescription drug plan that covers either one of them. What<br>should you tell her?:<br>Medicare prescription drug plans are required to cover drugs in each therapeutic<br>category. She should be able to enrollin a Medicare prescription drug plan that<br>covers the medications she needs.<\/li>\n\n\n\n<li>One of your clients, Lauren Nichols, has heard about a Medicare conceptfrom<br>one of her neighbors called TrOOP. She asks you to explain it. What do you<br>say?:<br>TrOOP stands for true out-of-pocket expenses that count toward the Medicare<br>Part D catastrophic limit and include not only expenses paid by a beneficiary but<br>also in some instances drug manufacturer discounts.<\/li>\n\n\n\n<li>Mrs. Fiore is a retired federal worker with coverage under a Federal Employee Health Benefits (FEHB) plan that includes creditable drug coverage.<br>She is ready to turn 65 and become Medicare eligible for the first time.What<br>issues might she consider about whether to enroll in a Medicare prescriptiondrug<br>plan?:<br>She could compare the coverage to see if the Medicare Part D planoffers better<br>benefits and coverage than the FEHB plan for the specific medicationsshe needs<br>and whether any additional benefits are worth the Part D premium costson top of<br>her FEHB contribution.<\/li>\n\n\n\n<li>Mrs. Shields is covered by Original Medicare. She sustained a hip fractureand<br>is being successfully treated for that condition. However, she and her physicians<br>feel that after her lengthy hospital stay she will need a month<br>or two of nursing and rehabilitative care. What should you tell them about<\/li>\n<\/ul>\n\n\n\n<p>2023 AHIP FINAL EXAM 2<br>| Passed | A+ Rated Guide | New Full Exam<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Insurer vs Insured:<\/li>\n\n\n\n<li>insurer is a company that provides plan<\/li>\n\n\n\n<li>insured are the people that buy into the plan<\/li>\n\n\n\n<li>Group health insurance:<br>Health coverage provided by employers to membersof a group.<\/li>\n\n\n\n<li>Group health insurance &#8211; types of coverage:<br>You can choose among severalor just one depending on your employer<\/li>\n\n\n\n<li>dental, vision, medical benefits, managed care, fee-for-service insurance<\/li>\n\n\n\n<li>dental:<\/li>\n\n\n\n<li>basic\/preventative services, restorative services, comprehensive or stand-alone,<br>ACA (children, some adults)<\/li>\n\n\n\n<li>vision:<\/li>\n\n\n\n<li>basic exams and prescription glasses, ACA (children, some adults)<\/li>\n<\/ul>\n\n\n\n<p>^ both are employer-sponsored voluntary group plans<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Premium tax-credit:<br>a subsidy that reduces the amount that consumers mustpay<\/li>\n\n\n\n<li>tax credit that will lower monthly premium based on income and household info<\/li>\n\n\n\n<li>advanced premium tax-credit (aptc)<\/li>\n\n\n\n<li>self employed workers:<br>can deduct health insurance premiums from theirfederal taxable income &#8211;<br>important tax savings<\/li>\n\n\n\n<li>contracts\/health insurance policy: between insurer and insured<\/li>\n\n\n\n<li>consideration:<br>specifically termed agreement w\/ promise to do something in return for a<br>valuable benefit (employer\/insured premium payments to the insurer)<\/li>\n\n\n\n<li>Covered services:<br>insurance policy will clearly state their covered services andtheir exlusions<\/li>\n\n\n\n<li>proactive, preventative, and reactive services<\/li>\n\n\n\n<li>cost-sharing:<br>a situation where insured individuals pay a portion of the health-care costs, such<br>as deductibles, coinsurance or co-payments<\/li>\n\n\n\n<li>insured is reimbursed for some but not all of the costs<\/li>\n\n\n\n<li>reimbursement depends on policy<\/li>\n\n\n\n<li>Deductible\/coinsurance:<br>Money paid out of pocket before insurance coversthe remaining costs.<br>% of medical bill that insured pays out of pocket<\/li>\n\n\n\n<li>copay:<br>a fixed fee you pay for specific medical services<\/li>\n\n\n\n<li>government sponsored plans:<br>federal and state gov<\/li>\n\n\n\n<li>medicare and medicaid<\/li>\n\n\n\n<li>medicare &#8211;&gt; 65+ or younger w\/ disabilities or severe kidney problems<\/li>\n\n\n\n<li>medicaid &#8211;&gt; low-income individuals<\/li>\n\n\n\n<li>employer sponsored plans:<\/li>\n\n\n\n<li>employer determines coverage<\/li>\n\n\n\n<li>company&#8217;s HR dept answers employee questions<\/li>\n\n\n\n<li>excluded services:<br>services not covered in a medical insurance contract likeexperimental or noncontracted providers, elective or cosmetic surgery<\/li>\n\n\n\n<li>Health Care Philosophy:<\/li>\n\n\n\n<li>good quality = cost effective<\/li>\n\n\n\n<li>more expensive does not mean good healthcare<\/li>\n\n\n\n<li>cost vs care balance<\/li>\n\n\n\n<li>good benefits priced appropriately<\/li>\n\n\n\n<li>less cost, more quality<br>triangle &#8211;&gt; cost, access, quality<br>*more medical care does not mean better outcomes<\/li>\n\n\n\n<li>managed care improves cost\/access\/quality:<br>cost: limited provider net- works, inventing new ways to pay physicians,<br>requiring referrals for specialty care<br>quality: credentialing providers, evidence-based medical policies, grading<br>providers on their quality outcomes, comparing providers to their peers<br>access: reigning in premium increases and reducing unnecessary care to make<br>additional provider time available<\/li>\n\n\n\n<li>annual increase in premiums:<\/li>\n\n\n\n<li>result from consumer\/government limitationsplaced on managed care<\/li>\n\n\n\n<li>other factors: higher provider fees, increased use of tech in delivery of care, health<\/li>\n<\/ul>\n\n\n\n<p>AHIP Final Exam (Latest 2023 &#8211; 2024)<br>| Passed | A+ Rated Guide | New Full Exam<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Mr. Zachow has a condition for which three drugs are available. He has tried<br>two but had an allergic reaction to them. Only the third drug works forhim and it<br>is not on his Part D plan&#8217;s formulary. What could you tell him to do?:<br>Mr. Zachow has a right to request a formulary exception to obtain coveragefor<br>his Part D drug. He or his physician could obtain the standardized request formon<br>the plan&#8217;s website, fill it out, and submit it to his plan.<\/li>\n\n\n\n<li>Mr. Polanski likes the cost of an HMO plan available in his area, but wouldlike<br>to be able to visit one or two doctors who aren&#8217;t participating providers.He wants<br>to know if the Point of Service (POS) option available with some HMOs will be of<br>any help in this situation.What should you tell him?:<br>The POSoption might be a good solution for him as it will allow him to visit out-ofnetwork providers, generally without prior approval. However, he should be<br>aware that it<br>is likely he will have to pay higher cost-sharing for services from out-of-network<br>providers.<\/li>\n\n\n\n<li>Mr. Barker had surgery recently and expected that he would have certain<br>services and items covered by the plan with minimal out-of-pocket costs be-cause<br>his MA-PD coverage has been very good. However, when he receivedthe bill, he<br>was surprised to see large charges in excess of his maximum out-of-pocket limit<br>that included a number of services and items he thoughtwould be fully covered.<br>He called you to ask what he could do? What couldyou tell him?:<br>You can offer to review the plans appeal process to help him ask the plan to<br>review the coverage decision.<\/li>\n\n\n\n<li>Ms. Stuart has heard about a special needs plan (SNP) that one of her friends<br>is enrolled in and is interested in that product. She wants to be sureshe also has<br>coverage for prescription drugs. Would she be able to obtain drug coverage if<br>she enrolled in the SNP?:<br>a. Yes. All SNPs are required to provide Part D coverage for prescription drugs.<br>b.Yes, but only if she qualifies for Part D prescription drug coverage under her state<br>Medicaid program.<br>c. No. Medicare beneficiaries who enroll in an SNP must always obtain their drug<br>coverage through a stand-alone Part D Medicare prescription drug plan that they<br>sign up for independent of their enrollment in the SNP.<\/li>\n<\/ul>\n\n\n\n<p>d. Maybe. Some SNPs offer Part D coverage for prescription drugs and some do<br>not.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Phiona works in the IT Department of BestCare Health Plan. Phiona is placed<br>in charge of BestCare&#8217;s efforts to facilitate electronic enrollment in its Medicare<br>Advantage plans. In setting up the enrollment site, which of the<br>following must Phiona consider?:<br>II. All data elements required to complete anenrollment request must be<br>captured.<br>III. The process must include a clear and distinct step that requires the applicant<br>to activate an &#8220;Enroll Now&#8221; or &#8220;I Agree&#8221; type of button or tool.<\/li>\n\n\n\n<li>Ms. Lewis understands that Medicare prescription drug plans may use various<br>methods to control the use of specific drugs. She has heard about a technique<br>called &#8220;step therapy&#8221; and is wondering if you can explain whatthat is.What should<br>you tell her?:<br>Step therapy involves using one or more lowerpriced drugs before trying a more<br>expensive drug when all are used to treat the same condition.<\/li>\n\n\n\n<li>Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his<br>area has an attractive premium. He wants to know if he must use doctors<br>in a network as his current HMO plan requires him to do. What should youtell<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>2023 AHIP Final Exam 1Complete Answers 100% Correct Every Part D drug plan is required tocover a single one-month fill of her existingmedications sometime during a 90-daytransition period. 2023 AHIP Final Exam(ACTUAL TEST ) Questions and Answers(Solved) should you tell her?:Every Part D drug plan is required tocover a single one-month fill of her existingmedications [&hellip;]<\/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-120053","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/120053","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=120053"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/120053\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=120053"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=120053"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=120053"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}