AHIP Module 3 Exam with Questions and Correct Answers 2025.

AHIP Module 3 Exam with Questions and
Correct Answers 2025




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 ,ANSWER-b. ,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. ,Correct


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? ,- ,CORRECT ,ANSWER-d.
,Everyone ,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.
,Correct


Mrs. ,Lopez ,is ,enrolled ,in ,a ,Medicare ,Advantage ,cost ,plan. ,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 ,ANSWER-a. ,If ,a ,Part ,D ,benefit ,is ,offered ,through
,her ,plan ,she ,may ,choose ,in ,enroll ,in ,that ,plan ,or ,a ,standalone ,PDP. ,Correct


Which ,of ,the ,following ,statements ,about ,Medicare ,Part ,D ,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 ,a ,MA-Medical ,Savings ,Account ,(MSA) ,plan ,may ,only
,obtain ,Part ,D ,benefits ,through ,a ,standalone ,PDP.
IV. ,Beneficiaries ,enrolled ,in ,a ,MA-PPO ,may ,obtain ,Part ,D ,benefits ,through ,a
,standalone ,PDP ,or ,through ,their ,plan. ,- ,CORRECT ,ANSWER-b. ,I, ,II, ,and ,III ,only
,Correct


All ,plans ,must ,cover ,at ,least ,the ,standard ,Part ,D ,coverage ,or ,its ,actuarial ,equivalent.
,What ,costs ,would ,a ,beneficiary ,incur ,for ,prescription ,drugs ,in ,2019 ,under ,the
,standard ,coverage? ,- ,CORRECT ,ANSWER-c. ,Standard ,Part ,D ,coverage ,would
,require ,payment ,of ,an ,annual ,deductible, ,25% ,cost-sharing ,up ,to ,the ,coverage ,gap,
,a ,portion ,of ,costs ,for ,both ,generics ,and ,brand-name ,drugs ,in ,the ,coverage ,gap, ,and
,co-pays ,or ,co-insurance ,after ,the ,coverage ,gap. ,Correct


Mrs. ,Andrews ,was ,preparing ,a ,budget ,for ,next ,year ,because ,she ,takes ,quite ,a ,few
,prescription ,drugs, ,she ,will ,reach ,the ,coverage ,gap, ,and ,wants ,to ,be ,sure ,she ,has
,enough ,money ,set ,aside ,for ,those ,months. ,She ,received ,assistance ,calculating ,her
,projected ,expenses ,from ,her ,daughter ,who ,is ,a ,pharmacist, ,but ,she ,doesn't ,think ,the
,calculations ,are ,correct ,because ,her ,out-of-pocket ,expenses ,would ,be ,lower ,than ,last
,year. ,She ,calls ,to ,ask ,if ,you ,can ,help. ,What ,might ,you ,tell ,her? ,- ,CORRECT
,ANSWER-d. ,It ,would ,not ,be ,unusual ,for ,her ,costs ,to ,be ,a ,bit ,less ,because ,the
,Bipartisan ,Budget ,Act ,of ,2018 ,moved ,up ,the ,date ,for ,closing ,the ,so-called ,"donut
,hole" ,for ,brand ,name ,drugs ,to ,2019. ,Correct


Mr. ,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? ,- ,CORRECT ,ANSWER-a. ,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. ,Correct


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 ,her ,prescriptions ,that
,she ,has ,lost. ,How ,would ,you ,advise ,her? ,- ,CORRECT ,ANSWER-d. ,She ,may ,fill
,prescriptions ,for ,covered ,drugs ,at ,non-network ,pharmacies, ,but ,likely ,at ,a ,higher ,cost
,than ,paid ,at ,an ,in-network ,pharmacy. ,Correct


What ,types ,of ,tools ,can ,Medicare ,Part ,D ,prescription ,drug ,plans ,use ,that ,affect ,the
,way ,their ,enrollees ,can ,access ,medications? ,- ,CORRECT ,ANSWER-c. ,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. ,Correct


Mrs. ,Allen ,has ,a ,rare ,condition ,for ,which ,two ,different ,brand ,name ,drugs ,are ,the ,only
,available ,treatment. ,She ,is ,concerned ,that ,since ,no ,generic ,prescription ,drug ,is
,available ,and ,these ,drugs ,are ,very ,high ,cost, ,she ,will ,not ,be ,able ,to ,find ,a ,Medicare
,Part ,D ,prescription ,drug ,plan ,that ,covers ,either ,one ,of ,them. ,What ,should ,you ,tell