AHIP FWA UPDATED ACTUAL QUESTIONS AND CORRECT
ANSWERS
✔✔Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is
considering enrollment in a Medicare Advantage plan (Part C). What should you advise
her to do before she will be able to enroll in a Medicare Advantage plan? - ✔✔To join a
Medicare Advantage plan, she also must enroll in Part B.
✔✔Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her? - ✔✔Mrs. Radford must be entitled to
Part A and enrolled in Part B to enroll in Medicare Advantage.
✔✔Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he
has received under Original Medicare, but he would like to know more about Medicare
Advantage Special Needs Plans (SNPs). What could you tell him? - ✔✔SNPs have
special programs for enrollees with chronic conditions, like Mr. Sinclair, and they
provide prescription drug coverage that could be very helpful as well.
✔✔Mrs. Willard wants to know generally how the benefits under Original Medicare
might compare to the benefits package of a Medicare Advantage Plan before she starts
looking at specific plans. What could you tell her? - ✔✔Medicare Advantage Plans may
offer extra benefits that Original Medicare does not offer such as vision, hearing, and
dental services and must include a maximum out-of-pocket limit on Part A and Part B
services.
✔✔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? -
✔✔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%.
✔✔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? -
✔✔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.
✔✔Mrs. Fields wants to know whether applying for the Part D low-income subsidy will
be worth the time to fill out the paperwork. What could you tell her? - ✔✔The Part D
low-income subsidy could substantially lower her overall costs. She can apply by
contacting her state Medicaid office or calling the Social Security Administration.
,✔✔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.
✔✔Mrs. Walters is entitled to Part A and has medical coverage without drug coverage
through an employer retiree plan. She is not enrolled in Part B. Since the employer plan
does not cover prescription drugs, she wants to enroll in a Medicare prescription drug
plan. Will she be able to? - ✔✔Yes. Mrs. Walters must be entitled to Part A and/or
enrolled in Part B to be eligible for coverage under the Medicare prescription drug
program.
✔✔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.
✔✔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? -
✔✔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.
✔✔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? -
✔✔The extra help is available to beneficiaries whose income and assets do not exceed
annual limits specified by the government.
✔✔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.
, ✔✔Mrs. Fiore is a retired federal worker with coverage under a Federal Employee
Health Benefits (FEHB) plan that includes creditable drug coverage. She is ready to turn
65 and become Medicare eligible for the first time. What issues might she consider
about whether to enroll in a Medicare prescription drug plan? - ✔✔She could compare
the coverage to see if the Medicare Part D plan offers better benefits and coverage than
the FEHB plan for the specific medications she needs and whether any additional
benefits are worth the Part D premium costs on top of her FEHB contribution.
✔✔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?
- ✔✔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.
✔✔Mr. Rice has is 68, actively working and has coverage for medical services and
medications through his employer's group health plan. He is entitled to premium free
Part A and thinking of enrolling in Part B and switching to an MA-PD because he is
paying a very large part of his group coverage premium and it does not provide
coverage for a number of his medications. Which of the following is NOT a
consideration when making the change? - ✔✔Mr. Rice's retiree plan is required to take
him back if, within 63 days of having voluntarily quit the employer's plan, he decides that
he prefers it to his Medicare Part D plan.
✔✔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? - ✔✔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. 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.
✔✔Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for-
Service (PFFS) plan. All types of PFFS plans are available in her area. Which options
could Mrs. Roberts consider before selecting a PFFS plan? - ✔✔A Medicare Advantage
Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D
ANSWERS
✔✔Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is
considering enrollment in a Medicare Advantage plan (Part C). What should you advise
her to do before she will be able to enroll in a Medicare Advantage plan? - ✔✔To join a
Medicare Advantage plan, she also must enroll in Part B.
✔✔Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her? - ✔✔Mrs. Radford must be entitled to
Part A and enrolled in Part B to enroll in Medicare Advantage.
✔✔Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he
has received under Original Medicare, but he would like to know more about Medicare
Advantage Special Needs Plans (SNPs). What could you tell him? - ✔✔SNPs have
special programs for enrollees with chronic conditions, like Mr. Sinclair, and they
provide prescription drug coverage that could be very helpful as well.
✔✔Mrs. Willard wants to know generally how the benefits under Original Medicare
might compare to the benefits package of a Medicare Advantage Plan before she starts
looking at specific plans. What could you tell her? - ✔✔Medicare Advantage Plans may
offer extra benefits that Original Medicare does not offer such as vision, hearing, and
dental services and must include a maximum out-of-pocket limit on Part A and Part B
services.
✔✔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? -
✔✔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%.
✔✔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? -
✔✔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.
✔✔Mrs. Fields wants to know whether applying for the Part D low-income subsidy will
be worth the time to fill out the paperwork. What could you tell her? - ✔✔The Part D
low-income subsidy could substantially lower her overall costs. She can apply by
contacting her state Medicaid office or calling the Social Security Administration.
,✔✔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.
✔✔Mrs. Walters is entitled to Part A and has medical coverage without drug coverage
through an employer retiree plan. She is not enrolled in Part B. Since the employer plan
does not cover prescription drugs, she wants to enroll in a Medicare prescription drug
plan. Will she be able to? - ✔✔Yes. Mrs. Walters must be entitled to Part A and/or
enrolled in Part B to be eligible for coverage under the Medicare prescription drug
program.
✔✔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.
✔✔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? -
✔✔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.
✔✔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? -
✔✔The extra help is available to beneficiaries whose income and assets do not exceed
annual limits specified by the government.
✔✔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.
, ✔✔Mrs. Fiore is a retired federal worker with coverage under a Federal Employee
Health Benefits (FEHB) plan that includes creditable drug coverage. She is ready to turn
65 and become Medicare eligible for the first time. What issues might she consider
about whether to enroll in a Medicare prescription drug plan? - ✔✔She could compare
the coverage to see if the Medicare Part D plan offers better benefits and coverage than
the FEHB plan for the specific medications she needs and whether any additional
benefits are worth the Part D premium costs on top of her FEHB contribution.
✔✔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?
- ✔✔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.
✔✔Mr. Rice has is 68, actively working and has coverage for medical services and
medications through his employer's group health plan. He is entitled to premium free
Part A and thinking of enrolling in Part B and switching to an MA-PD because he is
paying a very large part of his group coverage premium and it does not provide
coverage for a number of his medications. Which of the following is NOT a
consideration when making the change? - ✔✔Mr. Rice's retiree plan is required to take
him back if, within 63 days of having voluntarily quit the employer's plan, he decides that
he prefers it to his Medicare Part D plan.
✔✔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? - ✔✔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. 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.
✔✔Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for-
Service (PFFS) plan. All types of PFFS plans are available in her area. Which options
could Mrs. Roberts consider before selecting a PFFS plan? - ✔✔A Medicare Advantage
Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D
