AHIP Module 3 QUESTIONS AND
ANSWERS
1. All plans must cowl at the least the usual Part D insurance or its actuarial equal. What
expenses might a beneficiary incur for pharmaceuticals in 2019 below the usual
insurance? - ANSWER-c. Standard Part D coverage might require price of an
annual deductible, 25% fee-sharing as much as the coverage hole, a part of fees
for each generics and brand-name tablets in the insurance gap, and co-can pay or
co-insurance after the insurance gap. Correct
2. Mr. And Mrs. Vaughn both take a specialised multivitamin prescription every day. Mr.
Vaughn takes a prescription for supporting to regrow his hair. They are nerve-racking to
have their Medicare prescription drug plan cover those drug desires. What need to you
tell them? - ANSWER-b. Medicare prescription drug plans are not accepted to
cover the prescription medicines the Vaughns are interested in beneath Part D
coverage, but, plans may also cover them as supplemental advantages and the
Vaughn's may want to look into that opportunity. Correct
3. Mr. Bickford did not quite qualify for the extra help low-income subsidy underneath the
Medicare Part D Prescription Drug program and he is questioning if there's some other
choice he has for acquiring help along with his big drug charges. What have to you
inform him? - ANSWER-a. He could check with the producers of his medicinal
drugs to look if they offer an assistance program to assist human beings with
constrained manner attain the medications they need. Alternatively, he ought to
test to see whether his kingdom has a pharmacy help program to assist him
together with his fees. Correct
4. Mr. Carlini has heard that Medicare prescription drug plans are most effective presented
thru non-public corporations beneath a application called Medicare Advantage (MA),
now not by using the authorities. He likes Original Medicare and does now not want to
join an MA product, but he additionally needs prescription drug insurance. What have to
you inform him? - ANSWER-b. Mr. Carlini can stay with Original Medicare and
additionally join in a Medicare prescription drug plan through a private
organization that has shriveled with the authorities to provide most effective such
drug insurance to eligible Medicare beneficiaries. Correct
5. Mr. Hutchinson has drug coverage via his former company's retiree plan. He is involved
about the Part D top rate penalty if he does now not join in a Medicare prescription drug
plan, however does no longer want to purchase extra coverage that he will no longer
want. What have to you inform him? - ANSWER-b. If the drug insurance he has isn't
anticipated to pay, on average, at least as an awful lot as Medicare's fashionable
Part D insurance expects to pay, then he's going to need to sign up for Medicare
Part D during his initial eligibility length to avoid the late enrollment penalty.
Correct
, 6. Mr. Jacob is aware that there is a general Medicare Part D prescription drug benefit,
however whilst he looks at data on various plans available in his location, he sees a
extensive variety in what they price for deductibles, charges and fee sharing. How are
you able to give an explanation for this to him? - ANSWER-a. Medicare Part D drug
plans may also have unique gain structures, however on common, they ought to
all be at least as good as the same old model established by using the
government. Correct
7. Mr. Katz reached the Part D insurance gap in August final year. His prescriptions have
not changed, he's maintaining the equal Part D plan and the advantages, price-sharing,
and insurance of his capsules are all similar to ultimate yr. He asked what to expect for
this 12 months about his out-of-pocket fees. What ought to you inform him? -
ANSWER-d. Because he reached the coverage gap last year, he'll possibly reach it
again this year close to the identical time. Correct
8. Mr. Rice has insurance for medical services and medications through his organisation's
retiree plan. He is thinking about switching to a Medicare prescription drug plan because
his retiree plan does no longer cowl important medications. What need to he bear in
mind before making a trade? - ANSWER-c. If Mr. Rice drops his drug insurance via
the retiree plan, he won't be capable of get it again and he also can also lose his
clinical health coverage. Correct
9. Mr. Shapiro receives by means of on a totally small constant income. He has heard there
may be greater assist paying for Part D prescribed drugs for Medicare beneficiaries with
constrained earnings. He wants to realize whether or not he may qualify. What must you
tell him? - ANSWER-b. The extra help is to be had to beneficiaries whose income
and property do not exceed annual limits distinctive through the authorities.
Correct
10.Mr. Shultz was nonetheless operating whilst he first certified for Medicare. At that point,
he had company group coverage that become creditable. During his initial Part D
eligibility duration, he determined not to enroll due to the fact he became satisfied with
his drug coverage. It is now a year later and Mr. Shultz has misplaced his enterprise
group insurance. How might you advise him? - ANSWER-b. Mr. Schultz ought to
enroll in a Part D plan before he has a sixty three-day damage in coverage so that
you can keep away from a top class penalty. Correct
11.Mr. Torres has a small financial savings account. He would love to pay for his
month-to-month Part D premiums with an automated monthly withdrawal from his
financial savings account till it is exhausted, after which have his rates withheld from his
Social Security test. What have to you inform him? - ANSWER-c. In preferred, he must
choose a unmarried Part D top class charge mechanism with a purpose to be used
at some stage in the 12 months. Correct
12.Mr. Zachow has a condition for which 3 drugs are to be had. He has attempted , however
had an allergy to them. Only the 1/3 drug works for him and it isn't on his Part D plan's
formulary. What should you inform him to do? - ANSWER-a. Mr. Zachow has a proper
to request a formulary exception to achieve insurance for his Part D drug. He or
his doctor ought to acquire the standardized request shape at the plan's internet
site, fill it out, and post it to his plan. Correct
ANSWERS
1. All plans must cowl at the least the usual Part D insurance or its actuarial equal. What
expenses might a beneficiary incur for pharmaceuticals in 2019 below the usual
insurance? - ANSWER-c. Standard Part D coverage might require price of an
annual deductible, 25% fee-sharing as much as the coverage hole, a part of fees
for each generics and brand-name tablets in the insurance gap, and co-can pay or
co-insurance after the insurance gap. Correct
2. Mr. And Mrs. Vaughn both take a specialised multivitamin prescription every day. Mr.
Vaughn takes a prescription for supporting to regrow his hair. They are nerve-racking to
have their Medicare prescription drug plan cover those drug desires. What need to you
tell them? - ANSWER-b. Medicare prescription drug plans are not accepted to
cover the prescription medicines the Vaughns are interested in beneath Part D
coverage, but, plans may also cover them as supplemental advantages and the
Vaughn's may want to look into that opportunity. Correct
3. Mr. Bickford did not quite qualify for the extra help low-income subsidy underneath the
Medicare Part D Prescription Drug program and he is questioning if there's some other
choice he has for acquiring help along with his big drug charges. What have to you
inform him? - ANSWER-a. He could check with the producers of his medicinal
drugs to look if they offer an assistance program to assist human beings with
constrained manner attain the medications they need. Alternatively, he ought to
test to see whether his kingdom has a pharmacy help program to assist him
together with his fees. Correct
4. Mr. Carlini has heard that Medicare prescription drug plans are most effective presented
thru non-public corporations beneath a application called Medicare Advantage (MA),
now not by using the authorities. He likes Original Medicare and does now not want to
join an MA product, but he additionally needs prescription drug insurance. What have to
you inform him? - ANSWER-b. Mr. Carlini can stay with Original Medicare and
additionally join in a Medicare prescription drug plan through a private
organization that has shriveled with the authorities to provide most effective such
drug insurance to eligible Medicare beneficiaries. Correct
5. Mr. Hutchinson has drug coverage via his former company's retiree plan. He is involved
about the Part D top rate penalty if he does now not join in a Medicare prescription drug
plan, however does no longer want to purchase extra coverage that he will no longer
want. What have to you inform him? - ANSWER-b. If the drug insurance he has isn't
anticipated to pay, on average, at least as an awful lot as Medicare's fashionable
Part D insurance expects to pay, then he's going to need to sign up for Medicare
Part D during his initial eligibility length to avoid the late enrollment penalty.
Correct
, 6. Mr. Jacob is aware that there is a general Medicare Part D prescription drug benefit,
however whilst he looks at data on various plans available in his location, he sees a
extensive variety in what they price for deductibles, charges and fee sharing. How are
you able to give an explanation for this to him? - ANSWER-a. Medicare Part D drug
plans may also have unique gain structures, however on common, they ought to
all be at least as good as the same old model established by using the
government. Correct
7. Mr. Katz reached the Part D insurance gap in August final year. His prescriptions have
not changed, he's maintaining the equal Part D plan and the advantages, price-sharing,
and insurance of his capsules are all similar to ultimate yr. He asked what to expect for
this 12 months about his out-of-pocket fees. What ought to you inform him? -
ANSWER-d. Because he reached the coverage gap last year, he'll possibly reach it
again this year close to the identical time. Correct
8. Mr. Rice has insurance for medical services and medications through his organisation's
retiree plan. He is thinking about switching to a Medicare prescription drug plan because
his retiree plan does no longer cowl important medications. What need to he bear in
mind before making a trade? - ANSWER-c. If Mr. Rice drops his drug insurance via
the retiree plan, he won't be capable of get it again and he also can also lose his
clinical health coverage. Correct
9. Mr. Shapiro receives by means of on a totally small constant income. He has heard there
may be greater assist paying for Part D prescribed drugs for Medicare beneficiaries with
constrained earnings. He wants to realize whether or not he may qualify. What must you
tell him? - ANSWER-b. The extra help is to be had to beneficiaries whose income
and property do not exceed annual limits distinctive through the authorities.
Correct
10.Mr. Shultz was nonetheless operating whilst he first certified for Medicare. At that point,
he had company group coverage that become creditable. During his initial Part D
eligibility duration, he determined not to enroll due to the fact he became satisfied with
his drug coverage. It is now a year later and Mr. Shultz has misplaced his enterprise
group insurance. How might you advise him? - ANSWER-b. Mr. Schultz ought to
enroll in a Part D plan before he has a sixty three-day damage in coverage so that
you can keep away from a top class penalty. Correct
11.Mr. Torres has a small financial savings account. He would love to pay for his
month-to-month Part D premiums with an automated monthly withdrawal from his
financial savings account till it is exhausted, after which have his rates withheld from his
Social Security test. What have to you inform him? - ANSWER-c. In preferred, he must
choose a unmarried Part D top class charge mechanism with a purpose to be used
at some stage in the 12 months. Correct
12.Mr. Zachow has a condition for which 3 drugs are to be had. He has attempted , however
had an allergy to them. Only the 1/3 drug works for him and it isn't on his Part D plan's
formulary. What should you inform him to do? - ANSWER-a. Mr. Zachow has a proper
to request a formulary exception to achieve insurance for his Part D drug. He or
his doctor ought to acquire the standardized request shape at the plan's internet
site, fill it out, and post it to his plan. Correct
