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AHIP Final Exam Version 1 Newest 2026/2027 Exam Complete
Questions And Correct Detailed Answers (Verified Answers)
|Already Graded A+ || Sure Pass!!!
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? - ANSWER-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.
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 coverage? - ANSWER-
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%.
Mr. Shapiro gets by on a very small amount of fixed income. He
has heard there may be extra help paying for Part D prescription
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drugs for Medicare beneficiaries with limited income. He wants
to know whether he might qualify. What should you tell him? -
ANSWER-The extra help is available to beneficiaries whose
income and assets do not exceed annual limits specified by the
government.
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? - ANSWER-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.
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? - ANSWER-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.
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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? -
ANSWER-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.
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? - ANSWER-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.
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
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then have his premiums withheld from his Social Security check.
What should you tell him? - ANSWER-In general, he must select
a single Part D premium payment mechanism that will be used
throughout the year.
What types of tools can Medicare Part D prescription drug plans
use that affect the way their enrollees can access medications? -
ANSWER-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. 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? - ANSWER-
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.
AHIP Final Exam Version 1 Newest 2026/2027 Exam Complete
Questions And Correct Detailed Answers (Verified Answers)
|Already Graded A+ || Sure Pass!!!
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? - ANSWER-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.
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 coverage? - ANSWER-
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%.
Mr. Shapiro gets by on a very small amount of fixed income. He
has heard there may be extra help paying for Part D prescription
,2|Page
drugs for Medicare beneficiaries with limited income. He wants
to know whether he might qualify. What should you tell him? -
ANSWER-The extra help is available to beneficiaries whose
income and assets do not exceed annual limits specified by the
government.
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? - ANSWER-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.
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? - ANSWER-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.
,3|Page
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? -
ANSWER-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.
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? - ANSWER-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.
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
, 4|Page
then have his premiums withheld from his Social Security check.
What should you tell him? - ANSWER-In general, he must select
a single Part D premium payment mechanism that will be used
throughout the year.
What types of tools can Medicare Part D prescription drug plans
use that affect the way their enrollees can access medications? -
ANSWER-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. 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? - ANSWER-
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.
