Social Science Business Insurance
AHIP – 3 Questions Verified and Provided with A+ Graded
Answers Latest Updated 2026
Mrs. Mulcahy, age 65, is concerned that she may An individual who is entitled to Part A or enrolled under Part B is eligible
not qualify for enrollment in a Medicare to enroll in a Medicare prescription drug plan. As long as Mrs.
Mulcahy prescription drug plan because, although she is is entitled to Part A, she does not need to enroll under
Part B before
enrolling in a prescription drug plan.
entitled to Part A, she is not enrolled under
Medicare Part B. What should you tell her?
3 multiple choice options
Which of the following statements about Medicare I, II, and III only
Part D are correct?
3 multiple choice options
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.
One of your clients, Lauren Nichols, has heard TrOOP stands for true out-of-pocket expenses that count toward
the about a Medicare concept from one of her Medicare Part D catastrophic limit and include not only expenses paid
neighbors called TrOOP. She asks you to explain it. by a beneficiary but also in some instances drug manufacturer
What do you say? discounts.
3 multiple choice options
Mr. Zachow has a condition for which three drugs Mr. Zachow has a right to request a formulary exception to
obtain are available. He has tried two but had an allergic coverage for his Part D drug. He or his physician could obtain
the
reaction to them. Only the third drug works for him standardized request form on the plan's website, fill it out, and submit
it and it is not on his Part D plan's formulary. What to his plan.
could you tell him to do?
3 multiple choice options
Mrs. Walters is entitled to Part A and has medical Yes. Mrs. Walters must be entitled to Part A and/or enrolled in Part B
to coverage without drug coverage through an be eligible for coverage under the Medicare prescription drug
employer retiree plan. She is not enrolled in Part B. program.
the employer plan does not cover
Since 3 multiple choice options
prescription drugs, she wants to enroll in a
Medicare prescription drug plan. Will she be able
to?
Mrs. Roswell is a new Medicare beneficiary who Every Part D drug plan is required to cover a single one-month fill of her
has just retired from retail work. She is interested in existing medications sometime during a 90-day transition period.
a Medicare Part D prescription drug
selecting 3 multiple choice options
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?
, Mrs. Allen has a rare condition for which two Medicare prescription drug plans are required to cover drugs in each
different brand name drugs are the only available therapeutic category. She should be able to enroll in a Medicare
treatment. She is concerned that since no generic prescription drug plan that covers the medications she needs.
drug is available and these drugs are
prescription 3 multiple choice options
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?
Mr. and Mrs. Vaughn both take a specialized Medicare prescription drug plans are not permitted to cover the
multivitamin prescription each day. Mr. Vaughn prescription medications the Vaughns are interested in under Part D
takes a prescription for helping to regrow his hair. coverage, however, plans may cover them as supplemental benefits
and They are anxious to have their Medicare the Vaughn's could look into that possibility.
drug plan cover these drug needs.
prescription 3 multiple choice options
What should you tell them?
What types of tools can Medicare Part D Part D plans do not have to cover all medications. As a result,
their prescription drug plans use that affect the wayformularies, or lists of covered drugs, will vary from plan to plan.
In
their enrollees can access medications? addition, they can use cost containment techniques such as tiered co-
payments and prior authorization.
3 multiple choice options
Mrs. Fields wants to know whether applying for the The Part D low-income subsidy could substantially lower her
overall Part D low-income subsidy will be worth the time costs. She can apply by contacting her state Medicaid
office or calling to fill out the paperwork. What could you tell her? the Social Security Administration.
3 multiple choice options
Mr. Schultz was still working when he first qualified Mr. Schultz should enroll in a Part D plan before he has a 63-day
break for Medicare. At that time, he had employer group in coverage in order to avoid a premium penalty.
that was creditable. During his initial Part
coverage 3 multiple choice options
D eligibility period, he decided not to enroll
because he was satisfied with his drug coverage. It
is now a year later and Mr. Schultz has lost his
employer group coverage within the last two
weeks. How would you advise him?
Mr. Wingate is a newly enrolled Medicare Part D None of the costs of Mr. Wingate's other medications would
currently beneficiary and one of your clients. In addition to count toward TrOOP but he may wish to ask his plan for an
exception to drugs on his plan's formulary he takes several other cover the prescription not on its formulary.
medications. These include a prescription drug not 3 multiple choice options
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?
All plans must cover at least the standard Part D Standard Part D coverage would require payment of an annual
coverage or its actuarial equivalent. Which of the deductible, and once past the catastrophic coverage threshold, the
following statements best describes some of the beneficiary pays whichever is greater of either the co-pays for
generic costs a beneficiary would incur for prescription and brand name drugs or coinsurance of 5%.
under the standard coverage?
drugs 3 multiple choice options
Mrs. Fiore is a retired federal worker with coverage She could compare the coverage to see if the Medicare Part D plan
under a Federal Employee Health Benefits (FEHB) offers better benefits and coverage than the FEHB plan for the specific
plan that includes creditable drug coverage. She is medications she needs and whether any additional benefits are
AHIP – 3 Questions Verified and Provided with A+ Graded
Answers Latest Updated 2026
Mrs. Mulcahy, age 65, is concerned that she may An individual who is entitled to Part A or enrolled under Part B is eligible
not qualify for enrollment in a Medicare to enroll in a Medicare prescription drug plan. As long as Mrs.
Mulcahy prescription drug plan because, although she is is entitled to Part A, she does not need to enroll under
Part B before
enrolling in a prescription drug plan.
entitled to Part A, she is not enrolled under
Medicare Part B. What should you tell her?
3 multiple choice options
Which of the following statements about Medicare I, II, and III only
Part D are correct?
3 multiple choice options
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.
One of your clients, Lauren Nichols, has heard TrOOP stands for true out-of-pocket expenses that count toward
the about a Medicare concept from one of her Medicare Part D catastrophic limit and include not only expenses paid
neighbors called TrOOP. She asks you to explain it. by a beneficiary but also in some instances drug manufacturer
What do you say? discounts.
3 multiple choice options
Mr. Zachow has a condition for which three drugs Mr. Zachow has a right to request a formulary exception to
obtain are available. He has tried two but had an allergic coverage for his Part D drug. He or his physician could obtain
the
reaction to them. Only the third drug works for him standardized request form on the plan's website, fill it out, and submit
it and it is not on his Part D plan's formulary. What to his plan.
could you tell him to do?
3 multiple choice options
Mrs. Walters is entitled to Part A and has medical Yes. Mrs. Walters must be entitled to Part A and/or enrolled in Part B
to coverage without drug coverage through an be eligible for coverage under the Medicare prescription drug
employer retiree plan. She is not enrolled in Part B. program.
the employer plan does not cover
Since 3 multiple choice options
prescription drugs, she wants to enroll in a
Medicare prescription drug plan. Will she be able
to?
Mrs. Roswell is a new Medicare beneficiary who Every Part D drug plan is required to cover a single one-month fill of her
has just retired from retail work. She is interested in existing medications sometime during a 90-day transition period.
a Medicare Part D prescription drug
selecting 3 multiple choice options
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?
, Mrs. Allen has a rare condition for which two Medicare prescription drug plans are required to cover drugs in each
different brand name drugs are the only available therapeutic category. She should be able to enroll in a Medicare
treatment. She is concerned that since no generic prescription drug plan that covers the medications she needs.
drug is available and these drugs are
prescription 3 multiple choice options
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?
Mr. and Mrs. Vaughn both take a specialized Medicare prescription drug plans are not permitted to cover the
multivitamin prescription each day. Mr. Vaughn prescription medications the Vaughns are interested in under Part D
takes a prescription for helping to regrow his hair. coverage, however, plans may cover them as supplemental benefits
and They are anxious to have their Medicare the Vaughn's could look into that possibility.
drug plan cover these drug needs.
prescription 3 multiple choice options
What should you tell them?
What types of tools can Medicare Part D Part D plans do not have to cover all medications. As a result,
their prescription drug plans use that affect the wayformularies, or lists of covered drugs, will vary from plan to plan.
In
their enrollees can access medications? addition, they can use cost containment techniques such as tiered co-
payments and prior authorization.
3 multiple choice options
Mrs. Fields wants to know whether applying for the The Part D low-income subsidy could substantially lower her
overall Part D low-income subsidy will be worth the time costs. She can apply by contacting her state Medicaid
office or calling to fill out the paperwork. What could you tell her? the Social Security Administration.
3 multiple choice options
Mr. Schultz was still working when he first qualified Mr. Schultz should enroll in a Part D plan before he has a 63-day
break for Medicare. At that time, he had employer group in coverage in order to avoid a premium penalty.
that was creditable. During his initial Part
coverage 3 multiple choice options
D eligibility period, he decided not to enroll
because he was satisfied with his drug coverage. It
is now a year later and Mr. Schultz has lost his
employer group coverage within the last two
weeks. How would you advise him?
Mr. Wingate is a newly enrolled Medicare Part D None of the costs of Mr. Wingate's other medications would
currently beneficiary and one of your clients. In addition to count toward TrOOP but he may wish to ask his plan for an
exception to drugs on his plan's formulary he takes several other cover the prescription not on its formulary.
medications. These include a prescription drug not 3 multiple choice options
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?
All plans must cover at least the standard Part D Standard Part D coverage would require payment of an annual
coverage or its actuarial equivalent. Which of the deductible, and once past the catastrophic coverage threshold, the
following statements best describes some of the beneficiary pays whichever is greater of either the co-pays for
generic costs a beneficiary would incur for prescription and brand name drugs or coinsurance of 5%.
under the standard coverage?
drugs 3 multiple choice options
Mrs. Fiore is a retired federal worker with coverage She could compare the coverage to see if the Medicare Part D plan
under a Federal Employee Health Benefits (FEHB) offers better benefits and coverage than the FEHB plan for the specific
plan that includes creditable drug coverage. She is medications she needs and whether any additional benefits are
