2027 AHIP MEDICARE TRAINING
EXAM – QUESTIONS WITH CORRECT
VERIFIED ANSWERS (A+ MATERIAL)
1
,Which of the following statements about Medicare Part D is/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 an MA-Medical Savings Account (MSA) plan may only
obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in an MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan. ANSWER > I, II, and III only
Mr. Aguilar 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?
Question 2Answer ANSWER > None of the costs of Mr. Aguilar'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.
2
, What types of tools can Medicare Part D prescription drug plans use that affect the way
their enrollees can access medications? ANSWER > Part D plans do not have to cover
all medications. As a result, their formularies, or lists of covered drugs, will vary from
plan to plan. In addition, they can use cost containment techniques such as tiered co-
payments and step therapy.
Mrs. Esmeralda Avila is a Medicare beneficiary enrolled in a MA-PD plan you represent.
Her neighbor recently suffered from a painful case of shingles. Mrs. Avila hopes to avoid
such an illness through vaccination. She asks you whether the cost of the shingles
vaccination will be covered under the plan you represent. What should you say?
ANSWER > Yes, there is no cost sharing for the shingles vaccine even in the deductible
phase of her prescription drug plan because it is an adult vaccine recommended by the
Advisory Committee on Immunization Practices (AICP)
Mrs. Sharma has Original Medicare and would like to enroll in a Private Fee-for-Service
(PFFS) plan. All types of PFFS plans are available in her area. Which options could
Mrs. Sharma consider before selecting a PFFS plan? ANSWER > A Medicare
Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and
Part D prescription drug coverage, a PFFS plan offering only medical benefits, or a
PFFS plan in combination with a stand-alone prescription drug plan.
Mrs. Nguyen 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.
Mrs. Wood, age 65, 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. Wood is entitled to Part A, she does not need to enroll under
Part B before enrolling in a prescription drug plan.
3
EXAM – QUESTIONS WITH CORRECT
VERIFIED ANSWERS (A+ MATERIAL)
1
,Which of the following statements about Medicare Part D is/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 an MA-Medical Savings Account (MSA) plan may only
obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in an MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan. ANSWER > I, II, and III only
Mr. Aguilar 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?
Question 2Answer ANSWER > None of the costs of Mr. Aguilar'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.
2
, What types of tools can Medicare Part D prescription drug plans use that affect the way
their enrollees can access medications? ANSWER > Part D plans do not have to cover
all medications. As a result, their formularies, or lists of covered drugs, will vary from
plan to plan. In addition, they can use cost containment techniques such as tiered co-
payments and step therapy.
Mrs. Esmeralda Avila is a Medicare beneficiary enrolled in a MA-PD plan you represent.
Her neighbor recently suffered from a painful case of shingles. Mrs. Avila hopes to avoid
such an illness through vaccination. She asks you whether the cost of the shingles
vaccination will be covered under the plan you represent. What should you say?
ANSWER > Yes, there is no cost sharing for the shingles vaccine even in the deductible
phase of her prescription drug plan because it is an adult vaccine recommended by the
Advisory Committee on Immunization Practices (AICP)
Mrs. Sharma has Original Medicare and would like to enroll in a Private Fee-for-Service
(PFFS) plan. All types of PFFS plans are available in her area. Which options could
Mrs. Sharma consider before selecting a PFFS plan? ANSWER > A Medicare
Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and
Part D prescription drug coverage, a PFFS plan offering only medical benefits, or a
PFFS plan in combination with a stand-alone prescription drug plan.
Mrs. Nguyen 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.
Mrs. Wood, age 65, 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. Wood is entitled to Part A, she does not need to enroll under
Part B before enrolling in a prescription drug plan.
3
