AHIP 2025 MODULE 3 QUESTIONS WITH
VERIFIED ANSWERS (ALREADY
GRADED A+)
Mr. Zachow has a condition for which three drugs are available. He has tried two but had an allergic react
ion to them. Only the third drug works for him and it is not on his Part D plan's formulary. What could yo
u tell him to do? - correct 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 empl
oyer's group health plan. He is entitled to premium free Part A and thinking of enrolling in Part B and swi
tchingYto an MA-
PD because he is paying a very large part of his group coverage premium, and it does not provide coverag
e for a number of his medications. Which of the following is NOT a consideration when making the chang
e? -Ycorrect answer-
Mr. Rice's retiree plan is required to take him back if, within 63 days of having voluntarily quit the employ
er'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 manag
e prescription drug costs. What do you tell her about the Medicare Prescription Payment Plan? -
correct answer-
Part D enrollees can opt into the Medicare Prescription Payment Plan at the beginning of the plan year or
any point duringYthe 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 PartYD p
rescription drug plan (PDP). What should you tell her? - correct answer-
If a Part D benefit isYoffered 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 calle
d TrOOP. She asks you to explain it. What do you say? - correct answer-TrOOP stands for true out-of-
pocket costs that count toward the Medicare Part D catastrophic limit and include not only expenses pai
d by a beneficiary but also in some instances amounts paid by or through qualified State Pharmaceutical
Assistance Programs.
VERIFIED ANSWERS (ALREADY
GRADED A+)
Mr. Zachow has a condition for which three drugs are available. He has tried two but had an allergic react
ion to them. Only the third drug works for him and it is not on his Part D plan's formulary. What could yo
u tell him to do? - correct 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 empl
oyer's group health plan. He is entitled to premium free Part A and thinking of enrolling in Part B and swi
tchingYto an MA-
PD because he is paying a very large part of his group coverage premium, and it does not provide coverag
e for a number of his medications. Which of the following is NOT a consideration when making the chang
e? -Ycorrect answer-
Mr. Rice's retiree plan is required to take him back if, within 63 days of having voluntarily quit the employ
er'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 manag
e prescription drug costs. What do you tell her about the Medicare Prescription Payment Plan? -
correct answer-
Part D enrollees can opt into the Medicare Prescription Payment Plan at the beginning of the plan year or
any point duringYthe 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 PartYD p
rescription drug plan (PDP). What should you tell her? - correct answer-
If a Part D benefit isYoffered 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 calle
d TrOOP. She asks you to explain it. What do you say? - correct answer-TrOOP stands for true out-of-
pocket costs that count toward the Medicare Part D catastrophic limit and include not only expenses pai
d by a beneficiary but also in some instances amounts paid by or through qualified State Pharmaceutical
Assistance Programs.
