AHIP Module 3
Mr. Carlini has heard that Medicare prescription drug plans are most effective presented thru
personal companies beneath a application called Medicare Advantage (MA), now not via the
authorities. He likes Original Medicare and does now not want to enroll in an MA product,
however he also wishes prescription drug insurance. What must you tell him? - ANSb. Mr.
Carlini can live with Original Medicare and also enroll in a Medicare prescription drug plan
through a personal corporation that has gotten smaller with the authorities to offer best such
drug coverage to eligible Medicare beneficiaries. Correct
Mrs. Mulcahy is involved that she won't qualify for enrollment in a Medicare prescription drug
plan due to the fact, although she is entitled to Part A, she is not enrolled under Medicare
Part B. What need to you inform her? - ANSd. Everyone who is entitled to Part A or enrolled
below Part B is eligible to join a Medicare prescription drug plan. As long as Mrs. Mulcahy is
entitled to Part A, she does not want to sign up beneath Part B earlier than enrolling in a
prescription drug plan. Correct
Mrs. Lopez is enrolled in a Medicare Advantage cost plan. She has currently lost creditable
insurance formerly to be had via her husband's corporation. She is inquisitive about enrolling
in a Medicare Part D prescription drug plan (PDP). What must you inform her? - ANSa. If a
Part D gain is offered through her plan she might also pick in join in that plan or a standalone
PDP. Correct
Which of the following statements about Medicare Part D are correct?
I. Part D plans need to enroll any eligible beneficiary who applies regardless of health repute
except in restrained occasions.
II. Private charge-for-service (PFFS) plans aren't required to apply a pharmacy community
but can also pick to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan might also only
acquire Part D benefits thru a standalone PDP.
IV. Beneficiaries enrolled in a MA-PPO may additionally achieve Part D benefits via a
standalone PDP or through their plan. - ANSb. I, II, and III best Correct
All plans need to cover as a minimum the usual Part D coverage or its actuarial equal. What
costs could a beneficiary incur for prescribed drugs in 2019 below the standard coverage? -
ANSc. Standard Part D coverage would require payment of an annual deductible, 25%
cost-sharing up to the coverage gap, a part of fees for both generics and emblem-name pills
inside the insurance gap, and co-will pay or co-insurance after the coverage gap. Correct
Mrs. Andrews became making ready a price range for subsequent 12 months because she
takes pretty a few prescription drugs, she can reach the coverage gap, and desires to make
certain she has sufficient cash set apart for those months. She obtained help calculating her
, projected charges from her daughter who is a pharmacist, but she doesn't assume the
calculations are accurate due to the fact her out-of-pocket fees might be decrease than last
year. She calls to invite if you may help. What would possibly you tell her? - ANSd. It might
not be uncommon for her costs to be a bit less due to the fact the Bipartisan Budget Act of
2018 moved up the date for final the so-known as "donut hollow" for emblem name pills to
2019. Correct
Mr. Jacob knows that there may be a fashionable Medicare Part D prescription drug
advantage, however when he appears at information on diverse plans available in his place,
he sees a wide range in what they charge for deductibles, charges and value sharing. How
are you able to explain this to him? - ANSa. Medicare Part D drug plans may additionally
have unique benefit structures, but on common, they must all be at the least as right as the
standard version hooked up via the authorities. Correct
Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan
(PDP) coverage. She is travelling and needs to fill two of her prescriptions that she has
misplaced. How might you advise her? - ANSd. She may additionally fill prescriptions for
included pills at non-network pharmacies, however in all likelihood at a higher cost than paid
at an in-community pharmacy. Correct
What styles of equipment can Medicare Part D prescription drug plans use that affect the
way their enrollees can get admission to medicines? - ANSc. Part D plans do no longer
should cowl all medications. As a end result, their formularies, or lists of protected pills, will
range from plan to plot. In addition, they can use cost containment techniques which include
tiered co-payments and earlier authorization. Correct
Mrs. Allen has an extraordinary circumstance for which exceptional emblem name tablets
are the handiest to be had treatment. She is involved that due to the fact no customary
prescription drug is available and those tablets are very excessive price, she will not be
capable of discover a Medicare Part D prescription drug plan that covers either one in every
of them. What must you tell her? - ANSa. Medicare prescription drug plans are required to
cover capsules in every therapeutic class. She ought to be capable of enroll in a Medicare
prescription drug plan that covers the medicines she wishes. Correct
Mr. And Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr. Vaughn
takes a prescription for assisting to regrow his hair. They are stressful to have their Medicare
prescription drug plan cowl these drug desires. What ought to you inform them? - ANSb.
Medicare prescription drug plans are not accepted to cover the prescription medications the
Vaughns are interested by under Part D insurance, however, plans may additionally cover
them as supplemental blessings and the Vaughn's should inspect that opportunity. Correct
Under what conditions can a Medicare prescription drug plan lessen its coverage for a given
drug at some stage in the first 60 days of the 12 months? - ANSa. When a formulary
exchange is in reaction to a drug's elimination from the market. Correct
Which of the following steps may a Part D sponsor adopt for beneficiaries who are prone to
misusing or abusing regularly abused capsules?
Mr. Carlini has heard that Medicare prescription drug plans are most effective presented thru
personal companies beneath a application called Medicare Advantage (MA), now not via the
authorities. He likes Original Medicare and does now not want to enroll in an MA product,
however he also wishes prescription drug insurance. What must you tell him? - ANSb. Mr.
Carlini can live with Original Medicare and also enroll in a Medicare prescription drug plan
through a personal corporation that has gotten smaller with the authorities to offer best such
drug coverage to eligible Medicare beneficiaries. Correct
Mrs. Mulcahy is involved that she won't qualify for enrollment in a Medicare prescription drug
plan due to the fact, although she is entitled to Part A, she is not enrolled under Medicare
Part B. What need to you inform her? - ANSd. Everyone who is entitled to Part A or enrolled
below Part B is eligible to join a Medicare prescription drug plan. As long as Mrs. Mulcahy is
entitled to Part A, she does not want to sign up beneath Part B earlier than enrolling in a
prescription drug plan. Correct
Mrs. Lopez is enrolled in a Medicare Advantage cost plan. She has currently lost creditable
insurance formerly to be had via her husband's corporation. She is inquisitive about enrolling
in a Medicare Part D prescription drug plan (PDP). What must you inform her? - ANSa. If a
Part D gain is offered through her plan she might also pick in join in that plan or a standalone
PDP. Correct
Which of the following statements about Medicare Part D are correct?
I. Part D plans need to enroll any eligible beneficiary who applies regardless of health repute
except in restrained occasions.
II. Private charge-for-service (PFFS) plans aren't required to apply a pharmacy community
but can also pick to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan might also only
acquire Part D benefits thru a standalone PDP.
IV. Beneficiaries enrolled in a MA-PPO may additionally achieve Part D benefits via a
standalone PDP or through their plan. - ANSb. I, II, and III best Correct
All plans need to cover as a minimum the usual Part D coverage or its actuarial equal. What
costs could a beneficiary incur for prescribed drugs in 2019 below the standard coverage? -
ANSc. Standard Part D coverage would require payment of an annual deductible, 25%
cost-sharing up to the coverage gap, a part of fees for both generics and emblem-name pills
inside the insurance gap, and co-will pay or co-insurance after the coverage gap. Correct
Mrs. Andrews became making ready a price range for subsequent 12 months because she
takes pretty a few prescription drugs, she can reach the coverage gap, and desires to make
certain she has sufficient cash set apart for those months. She obtained help calculating her
, projected charges from her daughter who is a pharmacist, but she doesn't assume the
calculations are accurate due to the fact her out-of-pocket fees might be decrease than last
year. She calls to invite if you may help. What would possibly you tell her? - ANSd. It might
not be uncommon for her costs to be a bit less due to the fact the Bipartisan Budget Act of
2018 moved up the date for final the so-known as "donut hollow" for emblem name pills to
2019. Correct
Mr. Jacob knows that there may be a fashionable Medicare Part D prescription drug
advantage, however when he appears at information on diverse plans available in his place,
he sees a wide range in what they charge for deductibles, charges and value sharing. How
are you able to explain this to him? - ANSa. Medicare Part D drug plans may additionally
have unique benefit structures, but on common, they must all be at the least as right as the
standard version hooked up via the authorities. Correct
Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan
(PDP) coverage. She is travelling and needs to fill two of her prescriptions that she has
misplaced. How might you advise her? - ANSd. She may additionally fill prescriptions for
included pills at non-network pharmacies, however in all likelihood at a higher cost than paid
at an in-community pharmacy. Correct
What styles of equipment can Medicare Part D prescription drug plans use that affect the
way their enrollees can get admission to medicines? - ANSc. Part D plans do no longer
should cowl all medications. As a end result, their formularies, or lists of protected pills, will
range from plan to plot. In addition, they can use cost containment techniques which include
tiered co-payments and earlier authorization. Correct
Mrs. Allen has an extraordinary circumstance for which exceptional emblem name tablets
are the handiest to be had treatment. She is involved that due to the fact no customary
prescription drug is available and those tablets are very excessive price, she will not be
capable of discover a Medicare Part D prescription drug plan that covers either one in every
of them. What must you tell her? - ANSa. Medicare prescription drug plans are required to
cover capsules in every therapeutic class. She ought to be capable of enroll in a Medicare
prescription drug plan that covers the medicines she wishes. Correct
Mr. And Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr. Vaughn
takes a prescription for assisting to regrow his hair. They are stressful to have their Medicare
prescription drug plan cowl these drug desires. What ought to you inform them? - ANSb.
Medicare prescription drug plans are not accepted to cover the prescription medications the
Vaughns are interested by under Part D insurance, however, plans may additionally cover
them as supplemental blessings and the Vaughn's should inspect that opportunity. Correct
Under what conditions can a Medicare prescription drug plan lessen its coverage for a given
drug at some stage in the first 60 days of the 12 months? - ANSa. When a formulary
exchange is in reaction to a drug's elimination from the market. Correct
Which of the following steps may a Part D sponsor adopt for beneficiaries who are prone to
misusing or abusing regularly abused capsules?
