AHIP 2025 MODULE 3 WITH CORRECT
SOLUTIONS
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? - ANSWER-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.
Mr. Rice is 68, actively working, and has coverage for medical services and medications
through his employer's group health plan. He is entitled to premium free Part A and
thinking of enrolling in Part B and switching to an MA-PD because he is paying a very
large part of his group coverage premium, and it does not provide coverage for a
number of his medications. Which of the following is NOT a consideration when making
the change? - ANSWER-Mr. Rice's retiree plan is required to take him back if, within 63
days of having voluntarily quit the employer's plan, he decides that he prefers it to his
Medicare Part D plan.
Mrs. Hernandez is one of your clients. She has read that there is a new program that
may help her manage prescription drug costs. What do you tell her about the Medicare
Prescription Payment Plan? - ANSWER-Part D enrollees can opt into the Medicare
Prescription Payment Plan at the beginning of the plan year or any point during the
year.
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? - ANSWER-If a Part D benefit is offered through her plan she may choose
to enroll in that plan or a standalone PDP.
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of
her neighbors called TrOOP. She asks you to explain it. What do you say? - ANSWER-
TrOOP stands for true out-of-pocket costs that count toward the Medicare Part D
catastrophic limit and include not only expenses paid by a beneficiary but also in some
instances amounts paid by or through qualified State Pharmaceutical Assistance
Programs.
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? - ANSWER-She may fill prescriptions for covered
drugs at non-network pharmacies, but likely at a higher cost than paid at an in-network
pharmacy.
SOLUTIONS
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? - ANSWER-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.
Mr. Rice is 68, actively working, and has coverage for medical services and medications
through his employer's group health plan. He is entitled to premium free Part A and
thinking of enrolling in Part B and switching to an MA-PD because he is paying a very
large part of his group coverage premium, and it does not provide coverage for a
number of his medications. Which of the following is NOT a consideration when making
the change? - ANSWER-Mr. Rice's retiree plan is required to take him back if, within 63
days of having voluntarily quit the employer's plan, he decides that he prefers it to his
Medicare Part D plan.
Mrs. Hernandez is one of your clients. She has read that there is a new program that
may help her manage prescription drug costs. What do you tell her about the Medicare
Prescription Payment Plan? - ANSWER-Part D enrollees can opt into the Medicare
Prescription Payment Plan at the beginning of the plan year or any point during the
year.
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? - ANSWER-If a Part D benefit is offered through her plan she may choose
to enroll in that plan or a standalone PDP.
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of
her neighbors called TrOOP. She asks you to explain it. What do you say? - ANSWER-
TrOOP stands for true out-of-pocket costs that count toward the Medicare Part D
catastrophic limit and include not only expenses paid by a beneficiary but also in some
instances amounts paid by or through qualified State Pharmaceutical Assistance
Programs.
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? - ANSWER-She may fill prescriptions for covered
drugs at non-network pharmacies, but likely at a higher cost than paid at an in-network
pharmacy.
