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AHIP Entertaining Drug Plan New Full Questions and Answers ( Included ) 100% Correct
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AHIP Entertaining Drug Plan New Full Questions and Answers ( Included ) 100% Correct
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AHIP Entertaining Drug PlanBy ExamNavigator
, AHIP Entertaining Drug Plan
1. Medicare Prescription Payment Plan
Answer: Beginning in 2025, the prescription druglaw, known as the Inflation Reduction Act,
requires all Medicare prescription drug plans (Medicare Part D plans) — including both
standalone Medicare prescription drug plans and Medicare Advantage plans with prescription
drug coverage — to offer enrollees the option to pay out-of-pocket prescription drug costs in
the form ofcapped monthly payments instead of all at once at the pharmacy.
2. Benefits of Medicare Prescription Payment Plan
Answer: Expanding benefits, loweringdrug costs, and improving the sustainability of the
Medicare program
3. What is the Medicare Prescription Payment Plan?
Answer: Offers Part D enrollees theoption to pay out-of-pocket prescription drug costs in the
form of capped monthly payments instead of all at once to the pharmacy under the Medicare
Prescription Payment Plan.
4. How does the Medicare Prescription Payment Plan work?
Answer: For beneficiariesfacing high costs on their prescriptions, it provides them with the
option of paying out-of-pocket drug costs in installments. It does not offer a discount, just
manageablepayments
5. A client enjoys a comfortable retirement income. He recently had surgery and expected
that he would have certain services and items covered by the plan with minimal out-of-pocket
costs because his MA-PD coverage has beenvery good. However, when he received the bill, he
was surprised to see largecharges in excess of his maximum out-of-pocket limit that included
some services and items he thought would be fully covered. He called you to ask what he
could do? What could you tell him?
Answer: Medicare Advantage (MA) plan enrollees have a right to obtain a review (appeal) to
certain decisions about healthcare payment, coverage of services, or prescription drug
coverage. Medicare healthplans must provide enrollees with a written description of the
appeals process.
6. A client is enrolled in her state's Medicaid program in addition to Medicare.
What should she be aware of when considering enrollment in a Medicare Advantage (MA)
plan?
Answer: The client is a dual-eligible. Dual-eligible beneficiaries mayenroll in any type of MA
plan except a MA Medical Savings Account (MSA) plan.
7. A beneficiary recently lost her employer group health and drug coverage and now she
wants to enroll in a PPO that does not include drug coverage. What should you tell her about
obtaining drug coverage?
Answer: She can enroll in a PPO without drug coverage. However, If a beneficiary enrolls in
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