AHIP 2024 Module 3 Verified Answers

AHIP 2024 Module 3 Verified Answers Question 1: When selecting a Medicare Part D plan, Mrs. Roswell is concerned about finding a plan that covers all her medications. What should she know? Answer: Every Part D drug plan is required to cover a single one-month fill of her existing medications sometime during a 90-day transition period. Question 2: Mr. Rice is considering enrolling in Medicare Part B and switching to an MA-PD plan due to his large out-of-pocket expenses for his group health plan. What should he consider? Answer: He should weigh the pros and cons of switching to an MA-PD plan, including whether his retiree plan will take him back if he changes his mind. Question 3: Mrs. Edwards is traveling and needs to refill her prescriptions. What should she know about filling prescriptions outside of her network? Answer: She may fill prescriptions at non-network pharmacies, but likely at a higher cost than at an in network pharmacy. Question 4: Which of the following statements about Medicare Part D are correct? A) Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. B) Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. C) Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP. D) Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a standalone PDP or through their plan. Correct answers: A, B, and C Question 5: Mrs. Fiore is considering enrolling in a Medicare Part D plan despite having creditable drug coverage through her FEHB plan. What should she consider? Answer: She should compare the coverage to see if the Medicare Part D plan offers better benefits and coverage than the FEHB plan for her specific medications and whether any additional benefits are worth the Part D premium costs on top of her FEHB contribution. Question 6: What does TrOOP stand for, and how does it work? Answer: TrOOP stands for true out-of-pocket expenses that count toward the Medicare Part D catastrophic limit, including not only expenses paid by the beneficiary but also in some instances drug manufacturer discounts. Question 7: Mr. Wingate has other medications not covered by his Part D plan. Can any of these costs count toward TrOOP? Answer: None of his 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. Question 8: Mr. Zachow has a condition for which three drugs are available, but he has tried two and had an allergic reaction. What can he do?