1. 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?
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.
2. Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug
coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what
circumstances can she do this?
If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not
offer drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this.
3. 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.
I, II, and III only
4. 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. She currently does not have creditable coverage. What could you
tell her about the implications of such a decision?
If she does not sign up for a Medicare prescription drug plan as soon as she is
eligible to do so, and if she does sign up at a later date, her premium will be
permanently increased by 1% of the national average premium for every month
that she was not covered.
5. Mr. Hutchinson has drug coverage through his former employer’s retiree plan. He is concerned
about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but
does not want to purchase extra coverage that he will not need. What should you tell him?
If the drug coverage he has is not expected to pay, on average, at least as much
as Medicare’s standard Part D coverage expects to pay, then he will need to enroll
in Medicare Part D during his initial eligibility period to avoid the late enrollment
penalty.
, 6. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. In addition
to drugs on his plan’s formulary he takes several other medications. These include a
prescription drug not on his plan’s formulary, over-the-counter medications for colds and
allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to promote hair
growth and reduce joint swelling. His neighbor recently told him about a concept called TrOOP
and he asks you if any of his other medications could count toward TrOOP should he ever reach
the Part D catastrophic limit. What should you say?
None of the costs of Mr. Wingate’s other medications would currently count
toward TrOOP but he may wish to ask his plan for an exception to cover the
prescription not on its formulary.
7. Mrs. McIntire is enrolled in her state’s Medicaid plan and has just become eligible for Medicare
as well. What can she expect will happen to her drug coverage?
Unless she chooses a Medicare Part D prescription drug plan on her own,
she will be automatically enrolled in one available in her area.
8. 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?
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.
9. Mr. Shultz was still working when he first qualified for Medicare. At that time, he had employer
group coverage that was creditable. During his initial Part D eligibility period, he decided not to
enroll because he was satisfied with his drug coverage. It is now a year later and Mr. Shultz
has lost his employer group coverage within the last two weeks. How would you advise him?
Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage
in order to avoid a premium penalty.
10. 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?
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.
11. Which of the following individuals is most likely to be eligible to enroll in a Part D Plan?
Jose, a grandfather who was granted asylum and has worked in the United
States for many years.
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