AHIP MODULE 3 LATEST UPDATE
aMr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he
looks at information on various plans available in his area, he sees a wide range in what they charge for
deductibles, premiums and cost sharing. How can you explain this to him? - Medicare Part D drug plans
may have different benefit structures, but on average, they must all be at least as good as the standard
model established by the government.
What type of tools scan Medicare Part D prescription drug plans use that affect the way their enrollees
can access medications - 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.
Mrs. Edwards is enrolled in a Medicare advantage plan that includes prescription drug plan 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.
Mrs. Mulcahy 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? - 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. Mulcahy is entitled to Part A, she does not need to
enroll under Part B before enrolling in a prescription drug plan.
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? - 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.
Which of the following statements about Medicare Part D are correct? - I, II and III only
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.
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? - 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.
aMr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he
looks at information on various plans available in his area, he sees a wide range in what they charge for
deductibles, premiums and cost sharing. How can you explain this to him? - Medicare Part D drug plans
may have different benefit structures, but on average, they must all be at least as good as the standard
model established by the government.
What type of tools scan Medicare Part D prescription drug plans use that affect the way their enrollees
can access medications - 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.
Mrs. Edwards is enrolled in a Medicare advantage plan that includes prescription drug plan 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.
Mrs. Mulcahy 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? - 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. Mulcahy is entitled to Part A, she does not need to
enroll under Part B before enrolling in a prescription drug plan.
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? - 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.
Which of the following statements about Medicare Part D are correct? - I, II and III only
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.
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? - 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.
