(Updated) AHIP Module 3 with Completed Answers
— 100% Correct
Introduction
This document provides 80 accurate, updated multiple-choice questions for AHIP
Module 3, focusing on Medicare Part D prescription drug plans and related regu-
lations for the 2025/2026 certification cycle. Each question includes four answer
options, the correct answer, and a brief explanation. The content is designed to
comply with Medicare guidelines and reflects recent updates, such as the Infla-
tion Reduction Act’s impact on Part D.
Multiple-Choice Questions
Question 1: Mr. Carlini has heard that Medicare prescription drug plans are only of-
fered through private companies under a program known as Medicare Ad-
vantage (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?
a. Medicare prescription drug plans are only available through Medicare
Advantage.
b. Mr. Carlini can stay with Original Medicare and also enroll in a Medi-
care prescription drug plan through a private company that has con-
tracted with the government to provide only such drug coverage to
eligible Medicare beneficiaries.
c. Prescription drug coverage is not available with Original Medicare.
d. He must enroll in a Medicare Advantage plan to get prescription drug
coverage.
Answer: b. Mr. Carlini can stay with Original Medicare and also enroll in a
Medicare prescription drug plan through a private company that has con-
tracted with the government to provide only such drug coverage to eligible
Medicare beneficiaries.
Explanation: Medicare Part D plans are stand-alone prescription drug plans
offered by private companies approved by Medicare, not limited to MA
plans. Beneficiaries with Original Medicare can enroll in these plans.[](https://www.stuvi
us/doc/7379635/ahip-module-3-updated-exam-questions-and-correct-answers)
Question 2: 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?
a. She must enroll in Part B to be eligible for a Part D plan.
b. Only individuals enrolled in both Part A and Part B are eligible for Part
D.
1
, c. An individual who is entitled to Part A or enrolled under Part B is eli-
gible to enroll in a Medicare prescription drug plan.
d. She needs to enroll in a Medicare Advantage plan first.
Answer: c. An individual who is entitled to Part A or enrolled under Part
B is eligible to enroll in a Medicare prescription drug plan.
Explanation: Eligibility for Part D requires entitlement to Part A or en-
rollment in Part B, not both. Mrs. Mulcahy’s entitlement to Part A qualifies
her.[](https://www.stuvia.com/en-us/doc/6502142/ahip-module-3-exam-questions-
with-complete-answers)
Question 3: Mrs. Edwards is enrolled in a Medicare Advantage plan that includes pre-
scription drug coverage. She is traveling and wishes to fill two prescrip-
tions she has lost. How would you advise her?
a. She cannot fill prescriptions outside her plan’s service area.
b. She may fill prescriptions for covered drugs at non-network pharma-
cies, but likely at a higher cost than at an in-network pharmacy.
c. She must return to her home state to fill prescriptions.
d. Non-network pharmacies will not fill Medicare prescriptions.
Answer: b. She may fill prescriptions for covered drugs at non-network
pharmacies, but likely at a higher cost than at an in-network pharmacy.
Explanation: Medicare Advantage plans with Part D coverage allow ben-
eficiaries to use non-network pharmacies, but out-of-network fills typically
have higher cost-sharing.[](https://www.stuvia.com/en-us/doc/6171944/ahip-
module-3-questions-en-answersgraded-a)
Question 4: Mr. Jacob understands that there is a standard Medicare Part D prescription
drug benefit, but when he looks at plans in his area, he sees a wide range
in deductibles, premiums, and cost-sharing. How can you explain this?
a. Part D plans must follow a standard benefit structure with no varia-
tions.
b. Medicare Part D drug plans may have different benefit structures, but
on average, they must be at least as good as the standard model estab-
lished by the government.
c. Plans can charge whatever they want without government oversight.
d. Variations are due to state-specific regulations only.
Answer: b. Medicare Part D drug plans may have different benefit struc-
tures, but on average, they must be at least as good as the standard model
established by the government.
Explanation: Part D plans must meet or exceed the actuarial value of the
standard benefit model, but they can vary in premiums, deductibles, and
cost-sharing.[](https://www.stuvia.com/en-us/doc/7379635/ahip-module-3-updated-
exam-questions-and-correct-answers)
2
, Question 5: What types of tools can Medicare Part D prescription drug plans use that
affect how enrollees access medications?
a. Part D plans must cover all medications without restrictions.
b. Part D plans do not have to cover all medications. Their formularies,
or lists of covered drugs, vary, and they can use cost containment tech-
niques such as tiered co-payments and prior authorization.
c. Part D plans can only use prior authorization.
d. Part D plans cannot use formularies.
Answer: b. Part D plans do not have to cover all medications. Their for-
mularies, or lists of covered drugs, vary, and they can use cost containment
techniques such as tiered co-payments and prior authorization.
Explanation: Part D plans use formularies and cost containment tools like
tiered co-payments, step therapy, and prior authorization to manage access
and costs.[](https://www.stuvia.com/en-us/doc/6171944/ahip-module-3-questions-
en-answersgraded-a)
Question 6: Mrs. Fiore is a retired federal worker with coverage under a Federal Em-
ployee Health Benefits (FEHB) plan that includes creditable drug coverage.
She is turning 65 and becoming Medicare-eligible. What issues should she
consider about enrolling in a Medicare Part D plan?
a. She cannot enroll in Part D if she keeps her FEHB plan.
b. She should compare the Part D plan’s coverage to her FEHB plan to
see if it offers better benefits for her medications and if the premium
is worth the cost.
c. Part D enrollment is mandatory for FEHB plan holders.
d. FEHB plans automatically include Part D coverage.
Answer: b. She should compare the Part D plan’s coverage to her FEHB
plan to see if it offers better benefits for her medications and if the pre-
mium is worth the cost.
Explanation: Mrs. Fiore should evaluate whether a Part D plan provides
better coverage or cost savings compared to her FEHB plan’s creditable
coverage.[](https://www.stuvia.com/en-us/doc/7379635/ahip-module-3-updated-
exam-questions-and-correct-answers)
Question 7: Mr. McCarthy, a Medicare beneficiary with diabetes, is considering enroll-
ment in a Medicare Advantage Prescription Drug (MA-PD) plan. He asks if
his insulin costs will be covered. What should you tell him?
a. Insulin is not covered by MA-PD plans.
b. Insulin is covered under Part D benefits in an MA-PD plan, subject to
the plan’s formulary and cost-sharing rules.
c. Insulin is only covered under Original Medicare.
d. MA-PD plans cover insulin at no cost to the beneficiary.
3
— 100% Correct
Introduction
This document provides 80 accurate, updated multiple-choice questions for AHIP
Module 3, focusing on Medicare Part D prescription drug plans and related regu-
lations for the 2025/2026 certification cycle. Each question includes four answer
options, the correct answer, and a brief explanation. The content is designed to
comply with Medicare guidelines and reflects recent updates, such as the Infla-
tion Reduction Act’s impact on Part D.
Multiple-Choice Questions
Question 1: Mr. Carlini has heard that Medicare prescription drug plans are only of-
fered through private companies under a program known as Medicare Ad-
vantage (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?
a. Medicare prescription drug plans are only available through Medicare
Advantage.
b. Mr. Carlini can stay with Original Medicare and also enroll in a Medi-
care prescription drug plan through a private company that has con-
tracted with the government to provide only such drug coverage to
eligible Medicare beneficiaries.
c. Prescription drug coverage is not available with Original Medicare.
d. He must enroll in a Medicare Advantage plan to get prescription drug
coverage.
Answer: b. Mr. Carlini can stay with Original Medicare and also enroll in a
Medicare prescription drug plan through a private company that has con-
tracted with the government to provide only such drug coverage to eligible
Medicare beneficiaries.
Explanation: Medicare Part D plans are stand-alone prescription drug plans
offered by private companies approved by Medicare, not limited to MA
plans. Beneficiaries with Original Medicare can enroll in these plans.[](https://www.stuvi
us/doc/7379635/ahip-module-3-updated-exam-questions-and-correct-answers)
Question 2: 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?
a. She must enroll in Part B to be eligible for a Part D plan.
b. Only individuals enrolled in both Part A and Part B are eligible for Part
D.
1
, c. An individual who is entitled to Part A or enrolled under Part B is eli-
gible to enroll in a Medicare prescription drug plan.
d. She needs to enroll in a Medicare Advantage plan first.
Answer: c. An individual who is entitled to Part A or enrolled under Part
B is eligible to enroll in a Medicare prescription drug plan.
Explanation: Eligibility for Part D requires entitlement to Part A or en-
rollment in Part B, not both. Mrs. Mulcahy’s entitlement to Part A qualifies
her.[](https://www.stuvia.com/en-us/doc/6502142/ahip-module-3-exam-questions-
with-complete-answers)
Question 3: Mrs. Edwards is enrolled in a Medicare Advantage plan that includes pre-
scription drug coverage. She is traveling and wishes to fill two prescrip-
tions she has lost. How would you advise her?
a. She cannot fill prescriptions outside her plan’s service area.
b. She may fill prescriptions for covered drugs at non-network pharma-
cies, but likely at a higher cost than at an in-network pharmacy.
c. She must return to her home state to fill prescriptions.
d. Non-network pharmacies will not fill Medicare prescriptions.
Answer: b. She may fill prescriptions for covered drugs at non-network
pharmacies, but likely at a higher cost than at an in-network pharmacy.
Explanation: Medicare Advantage plans with Part D coverage allow ben-
eficiaries to use non-network pharmacies, but out-of-network fills typically
have higher cost-sharing.[](https://www.stuvia.com/en-us/doc/6171944/ahip-
module-3-questions-en-answersgraded-a)
Question 4: Mr. Jacob understands that there is a standard Medicare Part D prescription
drug benefit, but when he looks at plans in his area, he sees a wide range
in deductibles, premiums, and cost-sharing. How can you explain this?
a. Part D plans must follow a standard benefit structure with no varia-
tions.
b. Medicare Part D drug plans may have different benefit structures, but
on average, they must be at least as good as the standard model estab-
lished by the government.
c. Plans can charge whatever they want without government oversight.
d. Variations are due to state-specific regulations only.
Answer: b. Medicare Part D drug plans may have different benefit struc-
tures, but on average, they must be at least as good as the standard model
established by the government.
Explanation: Part D plans must meet or exceed the actuarial value of the
standard benefit model, but they can vary in premiums, deductibles, and
cost-sharing.[](https://www.stuvia.com/en-us/doc/7379635/ahip-module-3-updated-
exam-questions-and-correct-answers)
2
, Question 5: What types of tools can Medicare Part D prescription drug plans use that
affect how enrollees access medications?
a. Part D plans must cover all medications without restrictions.
b. Part D plans do not have to cover all medications. Their formularies,
or lists of covered drugs, vary, and they can use cost containment tech-
niques such as tiered co-payments and prior authorization.
c. Part D plans can only use prior authorization.
d. Part D plans cannot use formularies.
Answer: b. Part D plans do not have to cover all medications. Their for-
mularies, or lists of covered drugs, vary, and they can use cost containment
techniques such as tiered co-payments and prior authorization.
Explanation: Part D plans use formularies and cost containment tools like
tiered co-payments, step therapy, and prior authorization to manage access
and costs.[](https://www.stuvia.com/en-us/doc/6171944/ahip-module-3-questions-
en-answersgraded-a)
Question 6: Mrs. Fiore is a retired federal worker with coverage under a Federal Em-
ployee Health Benefits (FEHB) plan that includes creditable drug coverage.
She is turning 65 and becoming Medicare-eligible. What issues should she
consider about enrolling in a Medicare Part D plan?
a. She cannot enroll in Part D if she keeps her FEHB plan.
b. She should compare the Part D plan’s coverage to her FEHB plan to
see if it offers better benefits for her medications and if the premium
is worth the cost.
c. Part D enrollment is mandatory for FEHB plan holders.
d. FEHB plans automatically include Part D coverage.
Answer: b. She should compare the Part D plan’s coverage to her FEHB
plan to see if it offers better benefits for her medications and if the pre-
mium is worth the cost.
Explanation: Mrs. Fiore should evaluate whether a Part D plan provides
better coverage or cost savings compared to her FEHB plan’s creditable
coverage.[](https://www.stuvia.com/en-us/doc/7379635/ahip-module-3-updated-
exam-questions-and-correct-answers)
Question 7: Mr. McCarthy, a Medicare beneficiary with diabetes, is considering enroll-
ment in a Medicare Advantage Prescription Drug (MA-PD) plan. He asks if
his insulin costs will be covered. What should you tell him?
a. Insulin is not covered by MA-PD plans.
b. Insulin is covered under Part D benefits in an MA-PD plan, subject to
the plan’s formulary and cost-sharing rules.
c. Insulin is only covered under Original Medicare.
d. MA-PD plans cover insulin at no cost to the beneficiary.
3
