AHIP Module 3 - vb vb vb
2025 vb
1.Mr. Jacob understands that there is a standard Medicare Part D prescrip
vb vb vb vb vb vb vb vb vb vb vb
tion drug benefit, he sees a wide range in what they charge for deductib
vb vb vb vb vb vb vb vb vb vb vb vb vb
les, premiums, and cost sharing. How can you explain this to him?
vb vb vb vb vb vb vb vb vb vb vb
a. The Part D standard model's importance is that it is the only type of pla
vb vb vb vb vb vb vb vb vb vb vb vb vb vb
n into which low-
vb vb vb
income beneficiaries can enroll and still receive any extra help for which
vb vb vb vb vb vb vb vb vb vb vb v
bthey may qualify. vb vb
b. Medicare Part D drug plans may have different benefit structures, but
vb vb vb vb vb vb vb vb vb vb vb
on average, they must all be at least as good as the standard model est
vb vb vb vb vb vb vb vb vb vb vb vb vb vb
ablished by the government. vb vb vb
c. The government allows Part D plans to adopt any benefit structure as l
vb vb vb vb vb vb vb vb vb vb vb vb
ong as the list of covered drugs meets their approval.
vb vb vb vb vb vb vb vb vb
d. The government bases its payments to Part D plans on the standard be
vb vb vb vb vb vb vb vb vb vb vb vb
nefit model. For Part D plans to receive the full government payment, th
vb vb vb vb vb vb vb vb vb vb vb vb
ey must offer the standard model,: b.Medicare Part D drug plans may ha
vb vb vb vb vb vb vb vb vb vb vb vb
ve different benefit structures, but on average, they must all be at le
vb vb vb vb vb vb vb vb vb vb vb vb
ast as good as the standard model established by the government.
vb vb vb vb vb vb vb vb vb vb
2.Mr. Bickford did not quite qualify for the extra help low-
vb vb vb vb vb vb vb vb vb vb
income subsidy under the Medicare Part D and he is wondering if there
vb vb vb vb vb vb vb vb vb vb vb vb vb
is any other option he has for obtaining help with his considerable drug
vb vb vb vb vb vb vb vb vb vb vb vb v
bcosts. What should you tell him?
vb vb vb vb vb
a.He should contact his neighbors and family members and let them know
vb vb vb vb vb vb vb vb vb vb vb v
bthat any contributions they make toward his drug expenses will be tax de
vb vb vb vb vb vb vb vb vb vb vb vb
ductible. b.The only option available is to reduce his income so that he
vb vb vb vb vb vb vb vb vb vb vb vb vb
can qualify for the Part D extra help or wait until next year to see if the
vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb
annual limits change. c.He could check with the manufacturers of his me
vb vb vb vb vb vb vb vb vb vb vb
dications to see if they offer an assistance program to help people with l
vb vb vb vb vb vb vb vb vb vb vb vb vb
imited means to obtain the medications they need. Alternatively, he could
vb vb vb vb vb vb vb vb vb vb
vbcheck to see whether his state has a pharmacy assistance program to he
vb vb vb vb vb vb vb vb vb vb vb vb
lp him with his expenses.: c.He could check with the manufacturers of
vb vb vb vb vb vb vb vb vb vb vb vb
his medications to see if they offer an assistance program to help pe
vb vb vb vb vb vb vb vb vb vb vb vb
ople with limited means to obtain the medications they need.
vb vb vb vb vb vb vb vb vb
Alternatively, he could check to see whether his state has a pharmac vb vb vb vb vb vb vb vb vb vb vb
y assistance program to help him with his expenses.
vb vb vb vb vb vb vb vb
3.Mr. Carlini has heard that Medicare prescription drug plans are only off
vb vb vb vb vb vb vb vb vb vb vb
ered through private companies under a program known as (MA),He likes
vb vb vb vb vb vb vb vb vb vb
vbOriginal Medicare and does not want to sign up for an MA product, but
vb vb vb vb vb vb vb vb vb vb vb vb vb vb
he also wants prescription drug coverage. What should you tell him?
vb vb vb vb vb vb vb vb vb vb
a. Mr. Carlini can keep Original Medicare, but if he does not sign up for a
vb vb vb vb vb vb vb vb vb vb vb vb vb vb
1vb/
vb17
, AHIP Module 3 -
vb vb vb
2025
vb
n MA plan that includes RX coverage, he will only be able to obtain prescr
vb vb vb vb vb vb vb vb vb vb vb vb vb vb
iption drug coverage through a Medigap plan.
vb vb vb vb vb vb
2vb/
vb17
, AHIP Module 3 - vb vb vb
2025 vb
b. Mr. Carlini can obtain drug coverage through the fallback plans, which
vb vb vb vb vb vb vb vb vb vb v
bare designed to provide an alternative to privately sponsored MA. plans
vb vb vb vb vb vb vb vb vb vb
c. To obtain RX coverage, Mr. Carlini must enroll in an MA plan. The pla
vb vb vb vb vb vb vb vb vb vb vb vb vb
n will cover his Part A and Part B services, as well as provide him with
vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb
the desired prescription drug coverage.
vb vb vb vb
d. He can stay with Original Medicare and also enroll in an RX plan throu
vb vb vb vb vb vb vb vb vb vb vb vb vb
gh a private company that has contracted with the gove: d.He can stay
vb vb vb vb vb vb vb vb vb vb vb vb vb
with Original Medicare and also enroll in an RX plan through a privat
vb vb vb vb vb vb vb vb vb vb vb vb
e company that has con-
vb vb vb vb
tracted with the government to provide only such drug coverage to el
vb vb vb vb vb vb vb vb vb vb vb vb
igible Medicare beneficiaries. vb vb
4.Mr. and Mrs. Vaughn both take a specialized multivitamin RX each day.
vb vb vb vb vb vb vb vb vb vb vb
Mr. Vaughn takes a RX to help to regrow his hair. They are anxious to
vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb
have their Medicare prescription drug plan cover these drug needs. What
vb vb vb vb vb vb vb vb vb vb vb
should you tell them? vb vb vb
a. Medicare prescription drug plans are not permitted to cover the prescrip
vb vb vb vb vb vb vb vb vb vb
tion medications the Vaughns are interested in under Part D coverage, h
vb vb vb vb vb vb vb vb vb vb vb
owever, plans may cover them as supplemental benefits and the Vaughn
vb vb vb vb vb vb vb vb vb vb
s could look into that possibility
vb vb vb vb vb
b. Medicare prescription drug plans are permitted to cover vitamins, but
vb vb vb vb vb vb vb vb vb vb
not drugs for cosmetic purposes.
vb vb vb vb
c. The vitamins the Vaughns are taking will be covered under Part D bec
vb vb vb vb vb vb vb vb vb vb vb vb
ause their physician suggested they should take vitamins, but the hair l
vb vb vb vb vb vb vb vb vb vb vb
oss med- ication cannot be covered.
vb vb vb vb vb
d. Mr. Vaughn's hair growth medication would only be covered under Pa
vb vb vb vb vb vb vb vb vb vb
rt D if his balding resulted from an illness or was a side effect of a tre
vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb
atment
such as chemothera: a.Medicare prescription drug plans are not permitt
vb vb vb vb vb vb vb vb vb
ed to cover the prescription medications the Vaughns are interested i
vb vb vb vb vb vb vb vb vb vb
n under Part D coverage, however, plans may cover them as supple
vb vb vb vb vb vb vb vb vb vb vb
mental benefits and the Vaughns could look into that possibility
vb vb vb vb vb vb vb vb vb
5.What types of tools can Medicare Part D prescription drug plans use
vb vb vb vb vb vb vb vb vb vb vb vb
that affect the way their enrollees can access medications?
vb vb vb vb vb vb vb vb
a. Part D plans may use varying co-
vb vb vb vb vb vb
payments, but they are required to cover all prescription medications o
vb vb vb vb vb vb vb vb vb vb
n the market.
vb vb
b. The Federal government establishes a set formulary, or list of covered dr
vb vb vb vb vb vb vb vb vb vb vb
ugs, each year that the Part D plans must use. Beneficiaries should cons
vb vb vb vb vb vb vb vb vb vb vb vb
ult the government's list before deciding whether they wish to enroll in a
vb vb vb vb vb vb vb vb vb vb vb vb vb
3vb/
vb17
2025 vb
1.Mr. Jacob understands that there is a standard Medicare Part D prescrip
vb vb vb vb vb vb vb vb vb vb vb
tion drug benefit, he sees a wide range in what they charge for deductib
vb vb vb vb vb vb vb vb vb vb vb vb vb
les, premiums, and cost sharing. How can you explain this to him?
vb vb vb vb vb vb vb vb vb vb vb
a. The Part D standard model's importance is that it is the only type of pla
vb vb vb vb vb vb vb vb vb vb vb vb vb vb
n into which low-
vb vb vb
income beneficiaries can enroll and still receive any extra help for which
vb vb vb vb vb vb vb vb vb vb vb v
bthey may qualify. vb vb
b. Medicare Part D drug plans may have different benefit structures, but
vb vb vb vb vb vb vb vb vb vb vb
on average, they must all be at least as good as the standard model est
vb vb vb vb vb vb vb vb vb vb vb vb vb vb
ablished by the government. vb vb vb
c. The government allows Part D plans to adopt any benefit structure as l
vb vb vb vb vb vb vb vb vb vb vb vb
ong as the list of covered drugs meets their approval.
vb vb vb vb vb vb vb vb vb
d. The government bases its payments to Part D plans on the standard be
vb vb vb vb vb vb vb vb vb vb vb vb
nefit model. For Part D plans to receive the full government payment, th
vb vb vb vb vb vb vb vb vb vb vb vb
ey must offer the standard model,: b.Medicare Part D drug plans may ha
vb vb vb vb vb vb vb vb vb vb vb vb
ve different benefit structures, but on average, they must all be at le
vb vb vb vb vb vb vb vb vb vb vb vb
ast as good as the standard model established by the government.
vb vb vb vb vb vb vb vb vb vb
2.Mr. Bickford did not quite qualify for the extra help low-
vb vb vb vb vb vb vb vb vb vb
income subsidy under the Medicare Part D and he is wondering if there
vb vb vb vb vb vb vb vb vb vb vb vb vb
is any other option he has for obtaining help with his considerable drug
vb vb vb vb vb vb vb vb vb vb vb vb v
bcosts. What should you tell him?
vb vb vb vb vb
a.He should contact his neighbors and family members and let them know
vb vb vb vb vb vb vb vb vb vb vb v
bthat any contributions they make toward his drug expenses will be tax de
vb vb vb vb vb vb vb vb vb vb vb vb
ductible. b.The only option available is to reduce his income so that he
vb vb vb vb vb vb vb vb vb vb vb vb vb
can qualify for the Part D extra help or wait until next year to see if the
vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb
annual limits change. c.He could check with the manufacturers of his me
vb vb vb vb vb vb vb vb vb vb vb
dications to see if they offer an assistance program to help people with l
vb vb vb vb vb vb vb vb vb vb vb vb vb
imited means to obtain the medications they need. Alternatively, he could
vb vb vb vb vb vb vb vb vb vb
vbcheck to see whether his state has a pharmacy assistance program to he
vb vb vb vb vb vb vb vb vb vb vb vb
lp him with his expenses.: c.He could check with the manufacturers of
vb vb vb vb vb vb vb vb vb vb vb vb
his medications to see if they offer an assistance program to help pe
vb vb vb vb vb vb vb vb vb vb vb vb
ople with limited means to obtain the medications they need.
vb vb vb vb vb vb vb vb vb
Alternatively, he could check to see whether his state has a pharmac vb vb vb vb vb vb vb vb vb vb vb
y assistance program to help him with his expenses.
vb vb vb vb vb vb vb vb
3.Mr. Carlini has heard that Medicare prescription drug plans are only off
vb vb vb vb vb vb vb vb vb vb vb
ered through private companies under a program known as (MA),He likes
vb vb vb vb vb vb vb vb vb vb
vbOriginal Medicare and does not want to sign up for an MA product, but
vb vb vb vb vb vb vb vb vb vb vb vb vb vb
he also wants prescription drug coverage. What should you tell him?
vb vb vb vb vb vb vb vb vb vb
a. Mr. Carlini can keep Original Medicare, but if he does not sign up for a
vb vb vb vb vb vb vb vb vb vb vb vb vb vb
1vb/
vb17
, AHIP Module 3 -
vb vb vb
2025
vb
n MA plan that includes RX coverage, he will only be able to obtain prescr
vb vb vb vb vb vb vb vb vb vb vb vb vb vb
iption drug coverage through a Medigap plan.
vb vb vb vb vb vb
2vb/
vb17
, AHIP Module 3 - vb vb vb
2025 vb
b. Mr. Carlini can obtain drug coverage through the fallback plans, which
vb vb vb vb vb vb vb vb vb vb v
bare designed to provide an alternative to privately sponsored MA. plans
vb vb vb vb vb vb vb vb vb vb
c. To obtain RX coverage, Mr. Carlini must enroll in an MA plan. The pla
vb vb vb vb vb vb vb vb vb vb vb vb vb
n will cover his Part A and Part B services, as well as provide him with
vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb
the desired prescription drug coverage.
vb vb vb vb
d. He can stay with Original Medicare and also enroll in an RX plan throu
vb vb vb vb vb vb vb vb vb vb vb vb vb
gh a private company that has contracted with the gove: d.He can stay
vb vb vb vb vb vb vb vb vb vb vb vb vb
with Original Medicare and also enroll in an RX plan through a privat
vb vb vb vb vb vb vb vb vb vb vb vb
e company that has con-
vb vb vb vb
tracted with the government to provide only such drug coverage to el
vb vb vb vb vb vb vb vb vb vb vb vb
igible Medicare beneficiaries. vb vb
4.Mr. and Mrs. Vaughn both take a specialized multivitamin RX each day.
vb vb vb vb vb vb vb vb vb vb vb
Mr. Vaughn takes a RX to help to regrow his hair. They are anxious to
vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb
have their Medicare prescription drug plan cover these drug needs. What
vb vb vb vb vb vb vb vb vb vb vb
should you tell them? vb vb vb
a. Medicare prescription drug plans are not permitted to cover the prescrip
vb vb vb vb vb vb vb vb vb vb
tion medications the Vaughns are interested in under Part D coverage, h
vb vb vb vb vb vb vb vb vb vb vb
owever, plans may cover them as supplemental benefits and the Vaughn
vb vb vb vb vb vb vb vb vb vb
s could look into that possibility
vb vb vb vb vb
b. Medicare prescription drug plans are permitted to cover vitamins, but
vb vb vb vb vb vb vb vb vb vb
not drugs for cosmetic purposes.
vb vb vb vb
c. The vitamins the Vaughns are taking will be covered under Part D bec
vb vb vb vb vb vb vb vb vb vb vb vb
ause their physician suggested they should take vitamins, but the hair l
vb vb vb vb vb vb vb vb vb vb vb
oss med- ication cannot be covered.
vb vb vb vb vb
d. Mr. Vaughn's hair growth medication would only be covered under Pa
vb vb vb vb vb vb vb vb vb vb
rt D if his balding resulted from an illness or was a side effect of a tre
vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb vb
atment
such as chemothera: a.Medicare prescription drug plans are not permitt
vb vb vb vb vb vb vb vb vb
ed to cover the prescription medications the Vaughns are interested i
vb vb vb vb vb vb vb vb vb vb
n under Part D coverage, however, plans may cover them as supple
vb vb vb vb vb vb vb vb vb vb vb
mental benefits and the Vaughns could look into that possibility
vb vb vb vb vb vb vb vb vb
5.What types of tools can Medicare Part D prescription drug plans use
vb vb vb vb vb vb vb vb vb vb vb vb
that affect the way their enrollees can access medications?
vb vb vb vb vb vb vb vb
a. Part D plans may use varying co-
vb vb vb vb vb vb
payments, but they are required to cover all prescription medications o
vb vb vb vb vb vb vb vb vb vb
n the market.
vb vb
b. The Federal government establishes a set formulary, or list of covered dr
vb vb vb vb vb vb vb vb vb vb vb
ugs, each year that the Part D plans must use. Beneficiaries should cons
vb vb vb vb vb vb vb vb vb vb vb vb
ult the government's list before deciding whether they wish to enroll in a
vb vb vb vb vb vb vb vb vb vb vb vb vb
3vb/
vb17
