AHIP 2025 Mod III| ALL QUESTIONS & CORRECT
ANSWERS
1. Mr. Torres has a small savings account. He would like to pay for his monthly
Part D premiums with an automatic monthly withdrawal from his savings
account until it is exhausted, and then have his premiums withheld from his
Social Security check. What should you tell him? ANS >> In general, he must
select a single Part D premium payment mechanism that will be used throughout
the year.
2. Mr. Bickford did not quite qualify for the extra help low-income subsidy
under the Medicare Part D Prescription Drug program and he is wondering
if there is any other option he has for obtaining help with his considerable
drug costs. What should you tell him? ANS >> He could check with the
manufacturers of his medications to see if they offer an assistance program to
help people with limited means to obtain the medications they need.
Alternatively, he could check to see whether his state has a pharmacy
assistance program to help him with his expenses.
3. 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? ANS >> 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.
4. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of
your clients. In addition to drugs on his plan's formulary, he takes several
other medications. These include a prescription drug not on his plan's for-
mulary, over-the-counter medications for colds and allergies, vitamins, and
drugs from an Internet-based Canadian pharmacy to promote hair growth
and reduce joint swelling. His neighbor recently told him about a concept
https://www.stuvia.com/user/Mboffin 1/7
, called TrOOP and he asks you if any of his other medications could count
toward TrOOP should he ever reach the Part D catastrophic limit. What should
you say. ANS >> None of the costs of Mr. Wingate's 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.
5. 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? ANS >> 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.
https://www.stuvia.com/user/Mboffin 2/7
ANSWERS
1. Mr. Torres has a small savings account. He would like to pay for his monthly
Part D premiums with an automatic monthly withdrawal from his savings
account until it is exhausted, and then have his premiums withheld from his
Social Security check. What should you tell him? ANS >> In general, he must
select a single Part D premium payment mechanism that will be used throughout
the year.
2. Mr. Bickford did not quite qualify for the extra help low-income subsidy
under the Medicare Part D Prescription Drug program and he is wondering
if there is any other option he has for obtaining help with his considerable
drug costs. What should you tell him? ANS >> He could check with the
manufacturers of his medications to see if they offer an assistance program to
help people with limited means to obtain the medications they need.
Alternatively, he could check to see whether his state has a pharmacy
assistance program to help him with his expenses.
3. 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? ANS >> 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.
4. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of
your clients. In addition to drugs on his plan's formulary, he takes several
other medications. These include a prescription drug not on his plan's for-
mulary, over-the-counter medications for colds and allergies, vitamins, and
drugs from an Internet-based Canadian pharmacy to promote hair growth
and reduce joint swelling. His neighbor recently told him about a concept
https://www.stuvia.com/user/Mboffin 1/7
, called TrOOP and he asks you if any of his other medications could count
toward TrOOP should he ever reach the Part D catastrophic limit. What should
you say. ANS >> None of the costs of Mr. Wingate's 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.
5. 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? ANS >> 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.
https://www.stuvia.com/user/Mboffin 2/7
