Mr. 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. Wh...
AHIP Module 3 QUESTIONS &
SOLUTIONS(RATED A)
Mr. 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? - ANSWER 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? - ANSWER 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? - ANSWER 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. - ANSWER 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? - ANSWER 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
Under what conditions can a Medicare prescription drug plan reduce its coverage for a given drug during
the first 60 days of the year? - ANSWER a. When a formulary change is in response to a drug's removal
from the market. Correct
Which of the following steps may a Part D sponsor adopt for beneficiaries who are at risk of misusing or
abusing frequently abused drugs?
I. Identifying at risk individuals by using criteria that includes the number of opioid prescriptions the
beneficiary has and the number of prescribers who have written those prescriptions.
II. Locking an at-risk beneficiary into one pharmacy.
III. Locking an at-risk beneficiary into one prescriber.
IV. Increasing deductibles and copays for at-risk beneficiaries - ANSWER c. I, II and III only Correct
Mrs. Roswell is a new Medicare beneficiary and 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 c. Every Part D drug
plan is required to cover a single one-month fill of her existing medications sometime during a 90 day
transition period. Correct
Mr. Zachow has a condition for which three drugs are available. He has tried two, but had an allergic
reaction to them. Only the third drug works for him and it is not on his Part D plan's formulary. What
could you tell him to do? - ANSWER a. Mr. Zachow has a right to request a formulary exception to obtain
coverage for his Part D drug. He or his physician could obtain the standardized request form on the plan's
website, fill it out, and submit it to his plan. Correct
Mrs. Quinn has just turned 65, is in excellent health, and has a relatively high income. She uses no
medications and sees no reason to spend money on a Medicare prescription drug plan if she does not
need the coverage. What could you tell her about the implications of such a decision? - ANSWER b. If she
does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, if she does sign
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