AHIP 2022 Module 3/ AHIP 2024 Questions
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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? - -correct ans- -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. 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? -
correct ans- -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
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 - -correct ans- -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
Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums
with an automatic monthly withdrawal from his savings account until it is exhausted, and then
have his premiums withheld from his Social Security check. What should you tell him? - -correct
ans- -In general, he must select a single Part D premium payment mechanism that will be used
throughout the year
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? - -correct ans-
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
Which of the following statements about Medicare Part D are correct? - -correct ans- -Part D
plans must enroll any eligible beneficiary who applies regardless of health status except in
limited circumstances
Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose
to have one
Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D
benefits through a standalone PDP
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? - -correct ans- -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 beneficiarie
Which of the following individuals is most likely to be eligible to enroll in a Part D Plan? - -correct
ans- -Jose, a grandfather who was granted asylum and has worked in the United States for many
years
Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP)
coverage. She is traveling and wishes to fill two of the prescriptions that she has lost. How would
you advise her? - -correct ans- -She may fill prescriptions for covered drugs at non-network
pharmacies, but likely at a higher cost than paid at an in-network pharmacy
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? -
correct ans- -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.
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? - -correct ans- -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
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? - -correct ans- -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
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? - -correct ans- -Unless she
chooses a Medicare Part D prescription drug plan on her own, she will be automatically enrolled
in one available in her area
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently lost creditable
coverage previously available through her husband's employer. She is interested in enrolling in a
Medicare Part D prescription drug plan (PDP). What should you tell her? - -correct ans- -If a Part
D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP.
What types of tools can Medicare Part D prescription drug plans use that affect the way their
enrollees can access medications? - -correct ans- -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
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? -
correct ans- -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. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part
D Prescription Drug program and he is wondering if there is any other option he has for
obtaining help with his considerable drug costs. What should you tell him? - -correct ans- -He
could check with the manufacturers of his medications to see if they offer an assistance program
to help people with limited means to 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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