AHIP Medicare Training with questions
and answers.
,Which of the following statements about Medicare Part D is/are correct?
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 an MA-Medical Savings Account (MSA) plan may
only obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in an MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan. - correct ans:I, II, and III only
Mr. Aguilar 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?
Question 2Answer - correct ans:None of the costs of Mr. Aguilar'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.
What types of tools can Medicare Part D prescription drug plans use that
affect the way their enrollees can access medications? - correct ans: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 step therapy.
Mrs. Esmeralda Avila is a Medicare beneficiary enrolled in a MA-PD plan you
represent. Her neighbor recently suffered from a painful case of shingles.
Mrs. Avila hopes to avoid such an illness through vaccination. She asks you
whether the cost of the shingles vaccination will be covered under the plan
you represent. What should you say? - correct ans:Yes, there is no cost
sharing for the shingles vaccine even in the deductible phase of her
, prescription drug plan because it is an adult vaccine recommended by the
Advisory Committee on Immunization Practices (AICP)
Mrs. Sharma 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. Sharma consider before selecting a PFFS plan? -
correct ans:A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that
combines medical benefits and Part D prescription drug coverage, a PFFS
plan offering only medical benefits, or a PFFS plan in combination with a
stand-alone prescription drug plan.
Mrs. Nguyen 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? - correct ans: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.
Mrs. Wood, age 65, is concerned that she may not qualify for enrollment in a
Medicare prescription drug plan because, although she is entitled to Part A,
she is not enrolled under Medicare Part B. What should you tell her? - correct
ans:An individual who is entitled to Part A or enrolled under Part B is eligible
to enroll in a Medicare prescription drug plan. As long as Mrs. Wood is
entitled to Part A, she does not need to enroll under Part B before enrolling in
a prescription drug plan.
Ms. Ramos 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? - correct
ans:She may fill prescriptions for covered drugs at non-network pharmacies,
but likely at a higher cost than paid at an in-network pharmacy.
and answers.
,Which of the following statements about Medicare Part D is/are correct?
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 an MA-Medical Savings Account (MSA) plan may
only obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in an MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan. - correct ans:I, II, and III only
Mr. Aguilar 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?
Question 2Answer - correct ans:None of the costs of Mr. Aguilar'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.
What types of tools can Medicare Part D prescription drug plans use that
affect the way their enrollees can access medications? - correct ans: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 step therapy.
Mrs. Esmeralda Avila is a Medicare beneficiary enrolled in a MA-PD plan you
represent. Her neighbor recently suffered from a painful case of shingles.
Mrs. Avila hopes to avoid such an illness through vaccination. She asks you
whether the cost of the shingles vaccination will be covered under the plan
you represent. What should you say? - correct ans:Yes, there is no cost
sharing for the shingles vaccine even in the deductible phase of her
, prescription drug plan because it is an adult vaccine recommended by the
Advisory Committee on Immunization Practices (AICP)
Mrs. Sharma 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. Sharma consider before selecting a PFFS plan? -
correct ans:A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that
combines medical benefits and Part D prescription drug coverage, a PFFS
plan offering only medical benefits, or a PFFS plan in combination with a
stand-alone prescription drug plan.
Mrs. Nguyen 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? - correct ans: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.
Mrs. Wood, age 65, is concerned that she may not qualify for enrollment in a
Medicare prescription drug plan because, although she is entitled to Part A,
she is not enrolled under Medicare Part B. What should you tell her? - correct
ans:An individual who is entitled to Part A or enrolled under Part B is eligible
to enroll in a Medicare prescription drug plan. As long as Mrs. Wood is
entitled to Part A, she does not need to enroll under Part B before enrolling in
a prescription drug plan.
Ms. Ramos 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? - correct
ans:She may fill prescriptions for covered drugs at non-network pharmacies,
but likely at a higher cost than paid at an in-network pharmacy.
