AHIP FINAL EXAM VERSION 1 - EXAMINATION
COMPLETE QUESTIONS AND DETAILED SOLUTIONS
LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: Mrs. Roswell is a new Medicare beneficiary who has
just retired from retail work. She is interested in selecting a
Medicare Part D prescription drug plan. She takes a number of
medications and is concerned that she has not been able to identify
a plan that covers all of her medications. She does not want to
make an abrupt change to new drugs that would be covered and
asks what she should do. What should you tell her?
Answer:
Every Part D drug plan is required to cover a single one-month fill of her
existing medications sometime during a 90-day transition period.
Question 2: 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?
Answer:
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.
,Question 3: 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?
Answer:
She may fill prescriptions for covered drugs at non-network pharmacies,
but likely at a higher cost than paid at an in-network pharmacy.
Question 4: Which of the following statements about Medicare Part
D are correct?
Answer:
I, II, and III only -I. Part D plans must enroll any eligible beneficiary who
applies regardless of health status except in limited circumstances. II.
Private fee-for-service (PFFS) plans are not required to use a pharmacy
network but may choose to have one. III. Beneficiaries enrolled in a
MA-Medical Savings Account (MSA) plan may only obtain Part D
benefits through a standalone PDP.
Question 5: One of your clients, Lauren Nichols, has heard about a
Medicare concept from one of her neighbors called TrOOP. She
asks you to explain it. What do you say?
Answer:
TrOOP stands for true out-of-pocket expenses that count toward the
Medicare Part D catastrophic limit and include not only expenses paid by
a beneficiary but also in some instances drug manufacturer discounts.
,Question 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?
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.
Question 7: 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%.
Question 8: 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 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.
Question 9: 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.
Question 10: 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.
Question 11: Mr. Hutchinson has drug coverage through his former
employer's retiree plan. He is concerned about the Part D premium
COMPLETE QUESTIONS AND DETAILED SOLUTIONS
LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: Mrs. Roswell is a new Medicare beneficiary who has
just retired from retail work. She is interested in selecting a
Medicare Part D prescription drug plan. She takes a number of
medications and is concerned that she has not been able to identify
a plan that covers all of her medications. She does not want to
make an abrupt change to new drugs that would be covered and
asks what she should do. What should you tell her?
Answer:
Every Part D drug plan is required to cover a single one-month fill of her
existing medications sometime during a 90-day transition period.
Question 2: 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?
Answer:
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.
,Question 3: 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?
Answer:
She may fill prescriptions for covered drugs at non-network pharmacies,
but likely at a higher cost than paid at an in-network pharmacy.
Question 4: Which of the following statements about Medicare Part
D are correct?
Answer:
I, II, and III only -I. Part D plans must enroll any eligible beneficiary who
applies regardless of health status except in limited circumstances. II.
Private fee-for-service (PFFS) plans are not required to use a pharmacy
network but may choose to have one. III. Beneficiaries enrolled in a
MA-Medical Savings Account (MSA) plan may only obtain Part D
benefits through a standalone PDP.
Question 5: One of your clients, Lauren Nichols, has heard about a
Medicare concept from one of her neighbors called TrOOP. She
asks you to explain it. What do you say?
Answer:
TrOOP stands for true out-of-pocket expenses that count toward the
Medicare Part D catastrophic limit and include not only expenses paid by
a beneficiary but also in some instances drug manufacturer discounts.
,Question 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?
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.
Question 7: 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%.
Question 8: 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 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.
Question 9: 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.
Question 10: 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.
Question 11: Mr. Hutchinson has drug coverage through his former
employer's retiree plan. He is concerned about the Part D premium
