AHIP FINAL – EXAMINATION
COMPLETE QUESTIONS AND DETAILED SOLUTIONS
LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: 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.
Question 2: 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.
Question 3: Mr. and Mrs. Vaughn both take a specialized
multivitamin prescription each day. Mr. Vaughn takes a
prescription for helping to regrow his hair. They are anxious to
have their Medicare prescription drug plan cover these drug needs.
What should you tell them?
,Answer:
Medicare prescription drug plans are not permitted to cover the
prescription medications the Vaughns are interested in under Part D
coverage, however, plans may cover them as supplemental benefits and
the Vaughn's could look into that possibility.
Question 4: 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.
Question 5: Mrs. Mulcahy is concerned that she may not qualify for
enrollment in a Medicare prescription drug plan because, although
she is entitled to Part A, she is not enrolled under Medicare Part B.
What should you tell her?
Answer:
An individual who is entitled to Part A or enrolled under Part B is eligible
to enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is
entitled to Part A, she does not need to enroll under Part B before
enrolling in a prescription drug plan. 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.
Question 6: 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
Question 7: Mr. Shapiro gets by on a very small amount of fixed
income. He has heard there may be extra help paying for Part D
prescription drugs for Medicare beneficiaries with limited income.
He wants to know whether he might qualify. What should you tell
him?
Answer:
The extra help is available to beneficiaries whose income and assets do
not exceed annual limits specified by the government. Mr. Shultz was
still working when he first qualified for Medicare. At that time, he had
employer group coverage that was creditable. During his initial Part D
eligibility period, he decided not to enroll because he was satisfied with
his drug coverage. It is now a year later and Mr. Shultz has lost his
employer group coverage within the last
Question 8: two weeks. How would you advise him?
Answer:
, Mr. Schultz should enroll in a Part D plan before he has a 63-day break
in coverage in order to avoid a premium penalty.
Question 9: 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?
Answer:
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.
Question 10: Mr. Jacob understands that there is a standard
Medicare Part D prescription drug benefit, but when he looks at
information on various plans available in his area, he sees a wide
range in what they charge for deductibles, premiums, and cost
sharing. How can you explain this to him?
Answer:
Medicare Part D drug plans may have different benefit structures, but on
average, they must all be at least as good as the standard model
established by the government.
Question 11: 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,
COMPLETE QUESTIONS AND DETAILED SOLUTIONS
LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: 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.
Question 2: 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.
Question 3: Mr. and Mrs. Vaughn both take a specialized
multivitamin prescription each day. Mr. Vaughn takes a
prescription for helping to regrow his hair. They are anxious to
have their Medicare prescription drug plan cover these drug needs.
What should you tell them?
,Answer:
Medicare prescription drug plans are not permitted to cover the
prescription medications the Vaughns are interested in under Part D
coverage, however, plans may cover them as supplemental benefits and
the Vaughn's could look into that possibility.
Question 4: 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.
Question 5: Mrs. Mulcahy is concerned that she may not qualify for
enrollment in a Medicare prescription drug plan because, although
she is entitled to Part A, she is not enrolled under Medicare Part B.
What should you tell her?
Answer:
An individual who is entitled to Part A or enrolled under Part B is eligible
to enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is
entitled to Part A, she does not need to enroll under Part B before
enrolling in a prescription drug plan. 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.
Question 6: 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
Question 7: Mr. Shapiro gets by on a very small amount of fixed
income. He has heard there may be extra help paying for Part D
prescription drugs for Medicare beneficiaries with limited income.
He wants to know whether he might qualify. What should you tell
him?
Answer:
The extra help is available to beneficiaries whose income and assets do
not exceed annual limits specified by the government. Mr. Shultz was
still working when he first qualified for Medicare. At that time, he had
employer group coverage that was creditable. During his initial Part D
eligibility period, he decided not to enroll because he was satisfied with
his drug coverage. It is now a year later and Mr. Shultz has lost his
employer group coverage within the last
Question 8: two weeks. How would you advise him?
Answer:
, Mr. Schultz should enroll in a Part D plan before he has a 63-day break
in coverage in order to avoid a premium penalty.
Question 9: 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?
Answer:
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.
Question 10: Mr. Jacob understands that there is a standard
Medicare Part D prescription drug benefit, but when he looks at
information on various plans available in his area, he sees a wide
range in what they charge for deductibles, premiums, and cost
sharing. How can you explain this to him?
Answer:
Medicare Part D drug plans may have different benefit structures, but on
average, they must all be at least as good as the standard model
established by the government.
Question 11: 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,
