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AHIP STUDY GUIDE QUESTIONS
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1. Mr. Zachow has a condition for which three drugs are available. He has tried two but had an
allergic reaction to them. Only the third drug works for him and it is not on his Part D plan’s
formulary. What could you tell him to do?
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.
2. Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug
coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what
circumstances can she do this?
If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug
coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this.
3. 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.
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IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a
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standalone PDP or through their plan.
I, II, and III only
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4. Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. She uses
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no medications and sees no reason to spend money on a Medicare prescription drug plan if she
does not need the coverage. She currently does not have creditable coverage. What could you
tell her about the implications of such a decision?
If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so,
and if she does sign up at a later date, her premium will be permanently increased by 1% of the
national average premium for every month that she was not covered.
5. Mr. Hutchinson has drug coverage through his former employer’s retiree plan. He is concerned
about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but
does not want to purchase extra coverage that he will not need. What should you tell him?
If the drug coverage he has is not expected to pay, on average, at least as much as Medicare’s
standard Part D coverage expects to pay, then he will need to enroll in Medicare Part D during
his initial eligibility period to avoid the late enrollment penalty.
6. 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
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AHIP STUDY GUIDE QUESTIONS
ie
ird Module 3
uB
Ed
1. Mr. Zachow has a condition for which three drugs are available. He has tried two but had an
allergic reaction to them. Only the third drug works for him and it is not on his Part D plan’s
formulary. What could you tell him to do?
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.
2. Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug
coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what
circumstances can she do this?
If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug
coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this.
3. 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.
e
ie
IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a
di
ird
standalone PDP or through their plan.
I, II, and III only
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4. Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. She uses
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no medications and sees no reason to spend money on a Medicare prescription drug plan if she
does not need the coverage. She currently does not have creditable coverage. What could you
tell her about the implications of such a decision?
If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so,
and if she does sign up at a later date, her premium will be permanently increased by 1% of the
national average premium for every month that she was not covered.
5. Mr. Hutchinson has drug coverage through his former employer’s retiree plan. He is concerned
about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but
does not want to purchase extra coverage that he will not need. What should you tell him?
If the drug coverage he has is not expected to pay, on average, at least as much as Medicare’s
standard Part D coverage expects to pay, then he will need to enroll in Medicare Part D during
his initial eligibility period to avoid the late enrollment penalty.
6. 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
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