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AHIP Module 3 - Questions And Answers
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AHIP Module 3 - Questions And AnswersMr. Carlini has heard that Medicare prescription drug plans are only offered
through private companies under a program known as Medicare Advantage
(MA), not by the government. He likes Original Medicare and does not want
to sign up for an MA product, but he also wants prescription drug coverage.
What should you tell him? Correct Ans - b. Mr. Carlini can stay with
Original Medicare and also enroll in a Medicare prescription drug plan
through a private company that has contracted with the government to
provide only such drug coverage to eligible Medicare beneficiaries. Correct
Mrs. Mulcahy is concerned that she may not qualify for enrollment in a
Medicare prescription drug plan because, although she is entitled to Part A,
she is not enrolled under Medicare Part B. What should you tell her? Correct
Ans - d. Everyone who is entitled to Part A or enrolled under Part B is
eligible to enroll in a Medicare prescription drug plan. As long as Mrs.
Mulcahy is entitled to Part A, she does not need to enroll under Part B before
enrolling in a prescription drug plan. Correct
Mrs. Lopez is enrolled in a Medicare Advantage cost plan. She has recently
lost creditable coverage previously available through her husband's
employer. She is interested in enrolling in a Medicare Part D prescription
drug plan (PDP). What should you tell her? Correct Ans - a. If a Part D
benefit is offered through her plan she may choose in enroll in that plan or a
standalone PDP. Correct
Which of the following statements about Medicare Part D are correct?
I. Part D plans must enroll any eligible beneficiary who applies regardless of
health status except in limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy
network but may choose to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may
only obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan. Correct Ans - b. I, II, and III only
Correct
All plans must cover at least the standard Part D coverage or its actuarial
equivalent. What costs would a beneficiary incur for prescription drugs in
2019 under the standard coverage? Correct Ans - c. Standard Part D
coverage would require payment of an annual deductible, 25% cost-sharing
up to the coverage gap, a portion of costs for both generics and brand-name
, drugs in the coverage gap, and co-pays or co-insurance after the coverage
gap. Correct
Mrs. Andrews was preparing a budget for next year because she takes quite
a few prescription drugs, she will reach the coverage gap, and wants to be
sure she has enough money set aside for those months. She received
assistance calculating her projected expenses from her daughter who is a
pharmacist, but she doesn't think the calculations are correct because her
out-of-pocket expenses would be lower than last year. She calls to ask if you
can help. What might you tell her? Correct Ans - d. It would not be
unusual for her costs to be a bit less because the Bipartisan Budget Act of
2018 moved up the date for closing the so-called "donut hole" for brand
name drugs to 2019. Correct
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? Correct Ans -
a. Medicare Part D drug plans may have different benefit structures, but on
average, they must all be at least as good as the standard model established
by the government. Correct
Ms. Edwards is enrolled in a Medicare Advantage plan that includes
prescription drug plan (PDP) coverage. She is traveling and wishes to fill two
of her prescriptions that she has lost. How would you advise her? Correct
Ans - d. She may fill prescriptions for covered drugs at non-network
pharmacies, but likely at a higher cost than paid at an in-network pharmacy.
Correct
What types of tools can Medicare Part D prescription drug plans use that
affect the way their enrollees can access medications? Correct Ans - c.
Part D plans do not have to cover all medications. As a result, their
formularies, or lists of covered drugs, will vary from plan to plan. In addition,
they can use cost containment techniques such as tiered co-payments and
prior authorization. Correct
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? Correct Ans - a. Medicare
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. Correct
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