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2022 AHIP UNIT 3 MEDICARE PDP
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2022 AHIP UNIT 3 MEDICARE PDPQuestion 1
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?
a.Medicare prescription drug plans are permitted to cover vitamins, but not drugs for cosmetic purposes.
b.Mr. Vaughn’s hair growth medication would only be covered under Part D if his balding resulted from
an illness or was a side effect of a treatment such as chemotherapy.
Incorrect: Even if Mr. Vaughn’s balding was the result of illness or a side effect of chemotherapy, by law
Part D plans are not permitted to provide coverage for cosmetic purposes.
c.The vitamins the Vaughns are taking will be covered under Part D because their physician suggested
they should take vitamins, but the hair loss medication cannot be covered.
, d.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.
Source: Module 3, Slide - Drugs Excluded from Part D Coverage
Question 2
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?
a.Mr. Carlini can keep Original Medicare, but if he does not sign up for an MA plan that includes
prescription drug coverage, he will only be able to obtain prescription drug coverage through a Medigap
plan.
b.To obtain prescription drug coverage, Mr. Carlini must enroll in an MA plan. The plan will cover his Part
A and Part B services, as well as provide him with the desired prescription drug coverage.
c.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.
d.Mr. Carlini can obtain drug coverage through the Federal government’s fallback plans, which are
designed to provide an alternative to privately sponsored Medicare Advantage plans.
Source: Module 3, Slide - Medicare Part D Prescription Drug Program Basic and Slide - Medicare
Prescription Drug Eligibility
Question 3
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?
a.When medication costs exceed a certain threshold amount, which rises each year, a Medicare
prescription drug plan is permitted to exclude coverage for all but the least expensive of the medications
in a given category. Mrs. Allen will need to encourage her physician to prescribe the least expensive of
the two alternatives.
b.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.
c.Medicare prescription drug plans are required to include only a certain percentage of brand name
drugs among those they cover. It may be possible that plans available in her area have opted not to
include in their formularies the brand name drugs she needs. She may need to pay for this particular
medication out of pocket.
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