AHIP MODULE 3 | QUESTIONS AND VERIFIED 100%
CORRECT ANSWERS| LATEST UPDATE 2026/2027 |
GRADED A+
Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. She is
interested in selecting a Medicare Part D prescription drug plan. She takes a number of
medications and is concerned that she has not been able to identify a plan that covers all
of her medications. She does not want to make an abrupt change to new drugs that would
be covered and asks what she should do. What should you tell her?
- 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.
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.
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.
Which of the following statements about Medicare Part D are correct?
I. Part D plans must enroll any eligible beneficiary who applies regardless of health status
except in limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but
may choose to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only
obtain Part D benefits through a standalone PDP.
, IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a standalone
PDP or through their plan.
- ANSWER: I, II, and III only
Mrs. Allen has a rare condition for which two different brand name drugs are the only
available treatment. She is concerned that since no generic prescription drug is available
and these drugs are very high cost, she will not be able to find a Medicare Part D
prescription drug plan that covers either one of them. What should you tell her?
- ANSWER: Medicare prescription drug plans are required to cover drugs in each
therapeutic category. She should be able to enroll in a Medicare prescription drug plan
that covers the medications she needs.
Mrs. Fiore is a retired federal worker with coverage under a Federal Employee Health
Benefits (FEHB) plan that includes creditable drug coverage. She is ready to turn 65 and
become Medicare eligible for the first time. What issues might she consider about
whether to enroll in a Medicare prescription drug plan?
- ANSWER: She could compare the coverage to see if the Medicare Part D plan offers
better benefits and coverage than the FEHB plan for the specific medications she needs
and whether any additional benefits are worth the Part D premium costs on top of her
FEHB contribution.
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 expenses that count toward the
Medicare Part D catastrophic limit and include not only expenses paid by a beneficiary
but also in some instances drug manufacturer discounts.
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 formulary, 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 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?
- ANSWER: 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.
CORRECT ANSWERS| LATEST UPDATE 2026/2027 |
GRADED A+
Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. She is
interested in selecting a Medicare Part D prescription drug plan. She takes a number of
medications and is concerned that she has not been able to identify a plan that covers all
of her medications. She does not want to make an abrupt change to new drugs that would
be covered and asks what she should do. What should you tell her?
- 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.
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.
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.
Which of the following statements about Medicare Part D are correct?
I. Part D plans must enroll any eligible beneficiary who applies regardless of health status
except in limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but
may choose to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only
obtain Part D benefits through a standalone PDP.
, IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a standalone
PDP or through their plan.
- ANSWER: I, II, and III only
Mrs. Allen has a rare condition for which two different brand name drugs are the only
available treatment. She is concerned that since no generic prescription drug is available
and these drugs are very high cost, she will not be able to find a Medicare Part D
prescription drug plan that covers either one of them. What should you tell her?
- ANSWER: Medicare prescription drug plans are required to cover drugs in each
therapeutic category. She should be able to enroll in a Medicare prescription drug plan
that covers the medications she needs.
Mrs. Fiore is a retired federal worker with coverage under a Federal Employee Health
Benefits (FEHB) plan that includes creditable drug coverage. She is ready to turn 65 and
become Medicare eligible for the first time. What issues might she consider about
whether to enroll in a Medicare prescription drug plan?
- ANSWER: She could compare the coverage to see if the Medicare Part D plan offers
better benefits and coverage than the FEHB plan for the specific medications she needs
and whether any additional benefits are worth the Part D premium costs on top of her
FEHB contribution.
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 expenses that count toward the
Medicare Part D catastrophic limit and include not only expenses paid by a beneficiary
but also in some instances drug manufacturer discounts.
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 formulary, 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 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?
- ANSWER: 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.
