2022 AHIP Final Exam Practice Questions
Questions from Premier Scholars Worldwide
Superior Questions with Expert Solutions Diverse
Questions with Correct Solutions
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? - -correct ans- -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.
Mrs. Berkowitz 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? - -correct ans- -If the Medicare Advantage plan is a Private
Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account
plan, Mrs. Berkowitz can do this.
Mr. Zachow has a condition for which three drugs are available. He has tried two but had an
allergic reaction to them. Only the third drug works for him and it is not on his Part D plan's
formulary. What could you tell him to do? - -correct ans- -Mr. Zachow has a right to request
a formulary exception to obtain coverage for his Part D drug. He or his physician could
obtain the standardized request form on the plan's website, fill it out, and submit it to his
plan.
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? - -correct ans- -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%.fMci
Mrs. McIntire is enrolled in her state's Medicaid plan and has just become eligible for
Medicare as well. What can she expect will happen to her drug coverage? - -correct ans- -
Unless she chooses a Medicare Part D prescription drug plan on her own, she will be
automatically enrolled in one available in her area.
Mrs. Quinn 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? - -correct ans- -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.
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently lost
creditable coverage previously available through her husband's employer. She is interested
in enrolling in a Medicare Part D prescription drug plan (PDP). What should you tell her? - -
correct ans- -If a Part D benefit is offered through her plan she may choose to enroll in that
plan or a standalone PDP.
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? - -correct ans- -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.
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? - -correct ans- -
, 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.
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? - -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
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? - -correct ans- -
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. 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? - -correct ans- -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.
Which of the following individuals is most likely to be eligible to enroll in a Part D Plan? - -
correct ans- -Jose, having been granted asylum, is legally present in the United States thus
meeting one of the criteria for Part D eligibility.
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 prior authorization. (not b)
Questions from Premier Scholars Worldwide
Superior Questions with Expert Solutions Diverse
Questions with Correct Solutions
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? - -correct ans- -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.
Mrs. Berkowitz 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? - -correct ans- -If the Medicare Advantage plan is a Private
Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account
plan, Mrs. Berkowitz can do this.
Mr. Zachow has a condition for which three drugs are available. He has tried two but had an
allergic reaction to them. Only the third drug works for him and it is not on his Part D plan's
formulary. What could you tell him to do? - -correct ans- -Mr. Zachow has a right to request
a formulary exception to obtain coverage for his Part D drug. He or his physician could
obtain the standardized request form on the plan's website, fill it out, and submit it to his
plan.
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? - -correct ans- -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%.fMci
Mrs. McIntire is enrolled in her state's Medicaid plan and has just become eligible for
Medicare as well. What can she expect will happen to her drug coverage? - -correct ans- -
Unless she chooses a Medicare Part D prescription drug plan on her own, she will be
automatically enrolled in one available in her area.
Mrs. Quinn 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? - -correct ans- -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.
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently lost
creditable coverage previously available through her husband's employer. She is interested
in enrolling in a Medicare Part D prescription drug plan (PDP). What should you tell her? - -
correct ans- -If a Part D benefit is offered through her plan she may choose to enroll in that
plan or a standalone PDP.
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? - -correct ans- -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.
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? - -correct ans- -
, 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.
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? - -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
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? - -correct ans- -
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. 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? - -correct ans- -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.
Which of the following individuals is most likely to be eligible to enroll in a Part D Plan? - -
correct ans- -Jose, having been granted asylum, is legally present in the United States thus
meeting one of the criteria for Part D eligibility.
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 prior authorization. (not b)
