Exam (elaborations)
Ahip Module 3
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Exam of 5 pages for the course Ahip Module 3 at Ahip Module 3 (Ahip Module 3)
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Ahip Module 3Mr. 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? - -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? - -a.
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? - -b. 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. - -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? - -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? - -a. 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? - -b. 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? - -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? - -b. 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? - -c. 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
-Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each
day. Mr. Vaughn takes a prescription for helping to regrow his hair. They are
anxious to have their Medicare prescription drug plan cover these drug
needs. What should you tell them? - -b. Medicare prescription drug plans are
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