2024 AHIP FINAL EXAM PRACTICE QUESTIONS.
1. 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 for- mulary, 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?: 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.
2. Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not
include drug coverage and also enroll in a stand-alone Medicare prescription drug plan.
Under what circumstances can she do this?: If the Medicare Advantage plan is a Private Fee-
for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account plan,
Mrs. Berkowitz can do this.
3. 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?: 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.
4. All plans must cover at least the standard Part D coverage or its actuarial equivalent.
Which of the following statements best describes some of the costs a beneficiary would
incur for prescription drugs under the standard cov erage?: Standard Part D coverage would
require payment of an annual deductible, and once past the catastrophic coverage
threshold, the beneficiary pays whichever is greater of either the co-pays for generic and
brand name drugs or coinsurance of 5%.fMci
5. 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?: Unless she
chooses a Medicare Part D prescription drug plan on her own, she will be automatically
enrolled in one available in her area.
6. 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?: 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.
,7. 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?: If
a Part D benefit is offered through her plan she may choose to enroll in that plan or a
standalone PDP.
8. 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?: 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.
9. 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?: 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.
10. Ms. Edwards is enrolled in a Medicare Advantage plan that includes pre- scription
drug plan (PDP) coverage. She is traveling and wishes to fill two of the prescriptions that
she has lost. How would you advise her?: She may fill prescriptions for covered drugs at
non-network pharmacies, but likely at a higher cost than paid at an in-network pharmacy
11. 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?:
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.
12. 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?: 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.
13. Which of the following individuals is most likely to be eligible to enroll in a Part D
Plan?: Jose, having been granted asylum, is legally present in the United States thus meeting
one of the criteria for Part D eligibility.
14. What types of tools can Medicare Part D prescription drug plans use that affect the
way their enrollees can access medications?: 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. (not b)
15. 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, premi ums, and cost sharing. How can you
explain this to him?: 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.
16. 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?: In general, he must select a single Part D premium payment
mechanism that will be used throughout the year.
17. 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?: 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.
18. 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?: 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. (not a)
19. Which of the following statements about Medicare Part D are correct?: I, II, and III
only
1. 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 for- mulary, 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?: 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.
2. Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not
include drug coverage and also enroll in a stand-alone Medicare prescription drug plan.
Under what circumstances can she do this?: If the Medicare Advantage plan is a Private Fee-
for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account plan,
Mrs. Berkowitz can do this.
3. 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?: 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.
4. All plans must cover at least the standard Part D coverage or its actuarial equivalent.
Which of the following statements best describes some of the costs a beneficiary would
incur for prescription drugs under the standard cov erage?: Standard Part D coverage would
require payment of an annual deductible, and once past the catastrophic coverage
threshold, the beneficiary pays whichever is greater of either the co-pays for generic and
brand name drugs or coinsurance of 5%.fMci
5. 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?: Unless she
chooses a Medicare Part D prescription drug plan on her own, she will be automatically
enrolled in one available in her area.
6. 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?: 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.
,7. 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?: If
a Part D benefit is offered through her plan she may choose to enroll in that plan or a
standalone PDP.
8. 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?: 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.
9. 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?: 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.
10. Ms. Edwards is enrolled in a Medicare Advantage plan that includes pre- scription
drug plan (PDP) coverage. She is traveling and wishes to fill two of the prescriptions that
she has lost. How would you advise her?: She may fill prescriptions for covered drugs at
non-network pharmacies, but likely at a higher cost than paid at an in-network pharmacy
11. 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?:
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.
12. 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?: 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.
13. Which of the following individuals is most likely to be eligible to enroll in a Part D
Plan?: Jose, having been granted asylum, is legally present in the United States thus meeting
one of the criteria for Part D eligibility.
14. What types of tools can Medicare Part D prescription drug plans use that affect the
way their enrollees can access medications?: 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. (not b)
15. 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, premi ums, and cost sharing. How can you
explain this to him?: 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.
16. 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?: In general, he must select a single Part D premium payment
mechanism that will be used throughout the year.
17. 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?: 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.
18. 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?: 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. (not a)
19. Which of the following statements about Medicare Part D are correct?: I, II, and III
only
