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AHIP – 3- QUIZ GUIDE QUESTIONS AND ANSWERS
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AHIP – 3- QUIZ GUIDE QUESTIONS AND ANSWERS
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AHIP – 3- QUIZ GUIDE QUESTIONS ANDANSWERS
Mrs. Mulcahy, age 65, 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-An individual 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.
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-I, II, and III only
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of
her neighbors called TrOOP. She asks you to explain it. What do you say? - Answer-
TrOOP stands for true out-of-pocket expenses that count toward the Medicare Part D
catastrophic limit and include not only expenses paid by a beneficiary but also in some
instances drug manufacturer discounts.
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-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.
Mrs. Walters is entitled to Part A and has medical coverage without drug coverage
through an employer retiree plan. She is not enrolled in Part B. Since the employer plan
does not cover prescription drugs, she wants to enroll in a Medicare prescription drug
plan. Will she be able to? - Answer-Yes. Mrs. Walters must be entitled to Part A and/or
enrolled in Part B to be eligible for coverage under the Medicare prescription drug
program.
Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. She 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-
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.
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? -
Answer-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.
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? - Answer-Medicare prescription drug plans are not permitted to cover the
prescription medications the Vaughns are interested in under Part D coverage,
however, plans may cover them as supplemental benefits and the Vaughn's could look
into that possibility.
What types of tools can Medicare Part D prescription drug plans use that affect the way
their enrollees can access medications? - Answer-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.
Mrs. Fields wants to know whether applying for the Part D low-income subsidy will be
worth the time to fill out the paperwork. 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.
Mr. Schultz 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. Schultz has lost his employer group coverage within the last two
weeks. How would you advise him? - Answer-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.
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?
- Answer-None of the costs of Mr. Wingate's other medications would currently count
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