AHIP Medicare Training | UPDATED Questions with 100%
Verified Answers
Q1: 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.
A: I, II, and III only
Q2: 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
A: 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.
Q3: What types of tools can Medicare Part D prescription drug
plans use that affect the way their enrollees can access
medications?
A: 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.
Q4: 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?
, A: 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)
Q5: 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?
A: 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.
Q6: 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?
A: 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.
Q7: 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?
A: 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.
Q8: 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?
A: She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a
higher cost than paid at an in-network pharmacy.
Q9: Mr. Sutton 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?
A: In general, he must select a single Part D premium payment mechanism that will be used
throughout the year
, Q10: Mrs. Russo 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?
A: Yes. Mrs. Russo must be entitled to Part A and/or enrolled in Part B to be eligible for
coverage under the Medicare prescription drug program.
Q11: Mr. Chen 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. Chen has lost his
employer group coverage within the last two weeks. How
would you advise him?
A: Mr. Chen should enroll in a Part D plan before he has a 63-day break in coverage in order
to avoid a premium penalty.
Q12: Mrs. Strickland 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 several
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?
A: 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.
Q13: Mrs. Castro 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?
A: 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.
Q14: Mrs. Kelly 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?
Verified Answers
Q1: 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.
A: I, II, and III only
Q2: 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
A: 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.
Q3: What types of tools can Medicare Part D prescription drug
plans use that affect the way their enrollees can access
medications?
A: 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.
Q4: 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?
, A: 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)
Q5: 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?
A: 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.
Q6: 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?
A: 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.
Q7: 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?
A: 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.
Q8: 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?
A: She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a
higher cost than paid at an in-network pharmacy.
Q9: Mr. Sutton 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?
A: In general, he must select a single Part D premium payment mechanism that will be used
throughout the year
, Q10: Mrs. Russo 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?
A: Yes. Mrs. Russo must be entitled to Part A and/or enrolled in Part B to be eligible for
coverage under the Medicare prescription drug program.
Q11: Mr. Chen 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. Chen has lost his
employer group coverage within the last two weeks. How
would you advise him?
A: Mr. Chen should enroll in a Part D plan before he has a 63-day break in coverage in order
to avoid a premium penalty.
Q12: Mrs. Strickland 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 several
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?
A: 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.
Q13: Mrs. Castro 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?
A: 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.
Q14: Mrs. Kelly 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?
