AHIP 2024 Module 3 - Part D Enrollee Costs and Assistance
Programs Complete Guide
Question 1: Mr. Katz is concerned about his out-of-pocket costs for prescription drugs this year. He
reached the Part D coverage gap last year. What can you tell him?
Answer: Because he reached the coverage ga...
AHIP 2024 Module 3 - Part D Enrollee Costs and Assistance
Programs Complete Guide
Question 1: Mr. Katz is concerned about his out-of-pocket costs for prescription drugs this year. He
reached the Part D coverage gap last year. What can you tell him?
Answer: Because he reached the coverage gap last year, he will probably reach it again this year close to
the same time.
Question 2: Mrs. Grant is trying to determine when she'll qualify for catastrophic coverage. What
expenses count towards the out-of-pocket limit that qualifies her for catastrophic coverage?
Answer: Prescription drugs she purchases when in the Part D coverage gap.
Question 3: Mr. Shapiro has a small fixed income and heard about extra help paying for Part D
prescription drugs. Does he qualify?
Answer: The extra help is available to beneficiaries whose income and assets do not exceed annual
limits specified by the government.
Question 4: Mrs. Fields is unsure if applying for the Part D low income subsidy is worth the effort. What
could you tell her?
Answer: The Part D low income subsidy could substantially lower her overall costs. She can apply by
contacting her state Medicaid office, or calling the Social Security Administration.
Question 5: Mr. Bickford didn't qualify for the extra help low-income subsidy and is looking for other
options. What should you tell him?
Answer: He could check with the manufacturers of his medications to see if they offer an assistance
program to help people with limited means obtain the medications they need. Alternatively, he could
check to see whether his state has a pharmacy assistance program to help him with his expenses.
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