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2019 AHIP Test Review Questions
Pharmacology (NUR 3145)
Santa Fe College
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- Mrs. Park is an elderly retiree. She has a low, fixed income. What could you tell Mrs. Park that might be of assistance? a should not sign up for a Medigap or Medicare Advantage plan. Incorrect b should only seek help from private organizations to cover her Medicare costs. Incorrect c can apply to the Medicare agency for lower premiums and cost-sharing. Incorrect
d should contact her state Medicaid agency to see if she qualifies for one of several programs that can help with Medicare costs for which she is responsible. Correct 2. 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? a. Wu may still qualify for help in paying for Part D costs through the local Office of the Aging. Incorrect b. Wu has no alternative but to liquidate his remaining assets and apply for coverage through his state’s Medicaid program. Incorrect
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c. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. Correct d. Wu may still qualify for help in paying for Part D costs through the Federal Pharmaceutical Assistance Program. Incorrect
- Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? What could you tell him?
a A, which covers hospital, skilled nursing facility, hospice, and home health services and Part B, which covers professional services such as those provided by a doctor are covered under Original Medicare. Correct b C, which always covers dental and vision services, is covered under Original Medicare. Incorrect c A, which covers long term custodial care services, is covered under Original Medicare. Incorrect
d D, which covers prescription drug services, is covered under Original Medicare. Incorrect
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result of an illness. In general terms, what could you tell him about his costs for inpatient hospital services under Original Medicare? a Original Medicare, the inpatient hospital co-payment is a flat per-day amount that remains the same throughout the first 60 days of a beneficiary’s stay. After day 60 the amount gradually increases until day 90. After 90 days he would pay the full amount of all costs. Incorrect
b Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over his lifetime, after which he would be responsible for all costs Correct c Original Medicare, the inpatient hospital co-payment is a percentage of allowed charges. The percentage increases after 60 days and again after 90 days. Incorrect d Original Medicare, if the inpatient hospital service is provided by a participating Medicare provider, the co-payment is waived. Co-payments are only charged when a beneficiary opts to receive care from a non-participating provider. Incorrect 6. Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability
AHIP UNIT NURSING EXAM QUESTIONS WITH
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payments. He is wondering whether he can obtain coverage under Medicare. What should you tell him? a who become eligible for such disability payments only have to wait 12 months before they can apply for coverage under Medicare. Incorrect b became eligible for Medicare when his disability eligibility determination was first made. Incorrect
c receiving such disability payments for 24 months he will be automatically enrolled in Medicare, regardless of age. Correct d receiving such disability payments from the Social Security Administration continue to receive those payments, but only become eligible for Medicare upon reaching age 65. Incorrect 7. Mrs. Roberts has just received a new Medicare identity card in the mail. She is concerned that it is a forgery since it does not have her Social Security number on it. What should you tell her? a card is indeed a forgery since all identity cards are being phased out in favor of a new electronic identity system developed by the Social Security Administration. Incorrect b card she received is valid but she should keep her old card for at least two years and present it whenever she receives health care. Incorrect
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for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover. Correct
c. Medicare Supplemental Insurance would help cover his Part A and Part B cost sharing in Original Fee-
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- Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs. What could you tell Mr. Moy? a Supplemental Insurance would cover his dental, vision and hearing services only. Incorrect b Supplemental Insurance would cover all of his IRS approved health care expenditures not covered under Original Fee-for-Service (FFS) Medicare. Incorrect
d. Medicare Supplemental Insurance would cover his long-term care services. Incorrect MEDICARE HEALTH PLANS PART 2
- Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him? a. Kumar will be able to obtain routine care outside of the plan’s service area, but will pay a higher co-payment (except in an emergency). Incorrect
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b most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from providers who have a contractual relationship with the plan (except in an emergency or where care is unavailable within the network). Correct c Medicare Advantage HMO plans, services provided by primary care physicians are covered at 100%, but those of specialists are covered at 80%. Incorrect d any Medicare Advantage HMO, Mr. Kumar will be able to see any provider he likes, so long as that provider participates in Original Medicare. Incorrect 2. Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her?
a. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. Correct b if Mrs. Radford has end-stage renal disease, she will be able to enroll in any Medicare Advantage plan in her service area. Incorrect c. Radford must apply to the Medicare Advantage plan, which will include a medical review, prior to being accepted and enrolled. Incorrect
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b SNPs don’t cover prescription drugs Mr. Sinclair should consider a different option. Incorrect c offer care from any doctor or hospital Mr. Sinclair would like to use and his costs will always be lower than in Original Medicare. Incorrect
d have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as well. Correct 5. Walters is enrolled in her state’s Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare Advantage plan? a can submit any bills she has for co-payments under Medicare to the state’s Medicaid program and they will always be fully covered. Incorrect b a provider accepts her Medicare Advantage plan coverage, that provider is legally obligated to also accept her Medicaid coverage, so she does not need to worry about finding providers who participate in both Medicare and Medicaid. Incorrect c Medicaid programs do not coordinate any of their coverage with Medicare Advantage plans. Incorrect
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d can enroll in any type of Medicare Advantage (MA) plan except an MA Medical Savings Account (MSA) plan. Correct 6. 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? a-SNP Incorrect
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a must immediately drop her ABC MA plan and enroll in Original Medicare. Incorrect
b may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. Correct c must immediately drop her ABC MA plan and enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. Incorrect d must remain enrolled in her ABC MA plan unless the plan terminates. Incorrect 9. Mr. McTaggart notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know what makes them different from an HMO or a PPO. What should you tell him? a a PFFS enrollee shows his/her card when obtaining services from a provider who participates in Original Medicare, then that provider is required to accept the plan’s terms and conditions. Incorrect b offered, beneficiaries can select a stand-alone Part D prescription drug plan (PDP) with an HMO or a PPO, but not with a PFFS plan. Incorrect
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c in a PFFS plan can obtain care from any provider in the U. who accepts Original Medicare, as long as the provider has a reasonable opportunity to access the plan’s terms and conditions and agrees to accept them. Correct d plans are the same as Medicare supplement plans and he may obtain care from any provider in the U. Incorrect
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something called TrOOP. What should you tell her when she asks you about TrOOP? a are out-of-pocket costs that count toward the annual out-of-pocket threshold to move into catastrophic coverage and generally include, in addition to the annual deductible, costs for drugs not on the Part D plan's formulary and drugs purchased outside the United States. Incorrect b is calculated on a cumulative basis and consists of the sum of an enrollee's out-of-pocket deductibles from the date of his or her enrollment in Part D plus outlays for over-the-counter drugs. Incorrect
c are out-of-pocket costs that count toward the annual out-of-pocket threshold to move into catastrophic coverage and generally include the annual deductible(s) and costs for drugs on the plan's formulary purchased at a plan's participating pharmacy. In some instances, amounts not directly paid by the enrollee (like manufacturer discounts) count toward TrOOP. Correct d is calculated on an annual basis and consists of an enrollee's out-of- pocket deductible plus any amounts paid on behalf of an enrollee by Medicaid. Incorrect 2. Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he looks at information on various plans available in his area, he sees a wide range in what they charge for deductibles, premiums, and cost sharing. How can you explain this to him?
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a government bases its payments to Part D plans on the standard benefit model. For Part D plans to receive the full government payment, they must offer the standard model, however, they can take a risk and revise their benefit structure to attract more beneficiaries. Incorrect b Part D standard model’s importance is that it is the only type of plan into which low-income beneficiaries can enroll and still receive any extra help for which they may qualify. Incorrect
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a should wait to fill her prescriptions until she is back home since only her local pharmacy is likely to be in her plan’s network. Incorrect
b may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an in-network pharmacy. Correct c may fill one prescription out-of-network per year and it will be fully covered. Her second prescription will require her to pay the full cost out- of-pocket. Incorrect d may fill both prescriptions and they will be fully covered at in-network pricing due to the fact that she is traveling. Incorrect 5. Mr. Rice has coverage for medical services and medications through his employer’s retiree plan. He is considering switching to a Medicare prescription drug plan because his retiree plan does not cover two important medications. What should he consider before making a change? a his drug coverage through the retiree plan is “creditable” he should not switch, even though it is possible to do so. Incorrect b. Rice can only receive his prescription drug coverage through a Medicare Advantage prescription drug plan so he should drop his employer coverage. Incorrect
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c Mr. Rice drops his drug coverage through the retiree plan, he may not be able to get it back and he also may lose his medical health coverage. Correct
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2019 AHIP Test Review Questions
Course: Pharmacology (NUR 3145)
University: Santa Fe College
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