Social Science Business Insurance
AHIP Module 3 Questions Verified and Provided with A+ Graded
Answers Latest Updated 2026
Mr. Carlini has heard that Medicare prescription b. Mr. Carlini can stay with Original Medicare and also enroll in a
drug plans are only offered through private Medicare prescription drug plan through a private company that has
companies under a program known as Medicare contracted with the government to provide only such drug coverage to
Advantage (MA), not by the government. He likes eligible Medicare beneficiaries. Correct
Original Medicare and does not want to sign up
for an MA product, but he also wants prescription
drug coverage. What should you tell him?
Mrs. Mulcahy is concerned that she may not d. Everyone who is entitled to Part A or enrolled under Part B is eligible
qualify for enrollment in a Medicare prescription to enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy
drug plan because, although she is entitled to Part is entitled to Part A, she does not need to enroll under Part B
A, she is not enrolled under Medicare Part B. What before
should you tell her? enrolling in a prescription drug plan. Correct
Mrs. Lopez is enrolled in a Medicare Advantage a. If a Part D benefit is offered through her plan she may choose in
cost plan. She has recently lost creditable enroll in that plan or a standalone PDP. Correct
coverage previously available through her
husband's employer. She is interested in enrolling
in a Medicare Part D prescription drug plan (PDP).
What should you tell her?
Which of the following statements about Medicare b. I, II, and III only Correct
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.
IV. Beneficiaries enrolled in a MA-PPO may obtain
Part D benefits through a standalone PDP or
through their plan.
All plans must cover at least the standard Part D c. Standard Part D coverage would require payment of an annual
coverage or its actuarial equivalent. What costs deductible, 25% cost-sharing up to the coverage gap, a portion of costs
would a beneficiary incur for prescription drugs in for both generics and brand-name drugs in the coverage gap, and
2019 under the standard coverage? co-pays or co-insurance after the coverage gap. Correct
, Mrs. Andrews was preparing a budget for next d. It would not be unusual for her costs to be a bit less because the
year because she takes quite a few prescription Bipartisan Budget Act of 2018 moved up the date for closing the
drugs, she will reach the coverage gap, and wants so-called "donut hole" for brand name drugs to 2019. Correct
to be sure she has enough money set aside for
those months. She received assistance calculating
her projected expenses from her daughter who
is a pharmacist, but she doesn't think the
calculations are correct because her out-of-
pocket expenses would be lower than last
year. She calls to ask if you can help. What
might you tell her?
Mr. Jacob understands that there is a standard a. Medicare Part D drug plans may have different benefit structures,
Medicare Part D prescription drug benefit, but but on average, they must all be at least as good as the standard
when he looks at information on various plans model established by the government. Correct
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?
Ms. Edwards is enrolled in a Medicare d. She may fill prescriptions for covered drugs at non-network
Advantage plan that includes prescription drug pharmacies, but likely at a higher cost than paid at an in-network
plan (PDP) coverage. She is traveling and wishes pharmacy. Correct
to fill two of her prescriptions that she has lost.
How would you advise her?
What types of tools can Medicare Part D c. Part D plans do not have to cover all medications. As a result, their
prescription drug plans use that affect the way formularies, or lists of covered drugs, will vary from plan to plan.
their enrollees can access medications? In addition, they can use cost containment techniques such as tiered
co-payments and prior authorization. Correct
Mrs. Allen has a rare condition for which two a. Medicare prescription drug plans are required to cover drugs in each
different brand name drugs are the only therapeutic category. She should be able to enroll in a Medicare
available prescription drug plan that covers the medications she needs. Correct
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?
Mr. and Mrs. Vaughn both take a specialized b. 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. Correct
prescription drug plan cover these drug needs.
What should you tell them?
Under what conditions can a Medicare a. When a formulary change is in response to a drug's removal from the
prescription drug plan reduce its coverage for a market. Correct
given drug during the first 60 days of the year?
AHIP Module 3 Questions Verified and Provided with A+ Graded
Answers Latest Updated 2026
Mr. Carlini has heard that Medicare prescription b. Mr. Carlini can stay with Original Medicare and also enroll in a
drug plans are only offered through private Medicare prescription drug plan through a private company that has
companies under a program known as Medicare contracted with the government to provide only such drug coverage to
Advantage (MA), not by the government. He likes eligible Medicare beneficiaries. Correct
Original Medicare and does not want to sign up
for an MA product, but he also wants prescription
drug coverage. What should you tell him?
Mrs. Mulcahy is concerned that she may not d. Everyone who is entitled to Part A or enrolled under Part B is eligible
qualify for enrollment in a Medicare prescription to enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy
drug plan because, although she is entitled to Part is entitled to Part A, she does not need to enroll under Part B
A, she is not enrolled under Medicare Part B. What before
should you tell her? enrolling in a prescription drug plan. Correct
Mrs. Lopez is enrolled in a Medicare Advantage a. If a Part D benefit is offered through her plan she may choose in
cost plan. She has recently lost creditable enroll in that plan or a standalone PDP. Correct
coverage previously available through her
husband's employer. She is interested in enrolling
in a Medicare Part D prescription drug plan (PDP).
What should you tell her?
Which of the following statements about Medicare b. I, II, and III only Correct
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.
IV. Beneficiaries enrolled in a MA-PPO may obtain
Part D benefits through a standalone PDP or
through their plan.
All plans must cover at least the standard Part D c. Standard Part D coverage would require payment of an annual
coverage or its actuarial equivalent. What costs deductible, 25% cost-sharing up to the coverage gap, a portion of costs
would a beneficiary incur for prescription drugs in for both generics and brand-name drugs in the coverage gap, and
2019 under the standard coverage? co-pays or co-insurance after the coverage gap. Correct
, Mrs. Andrews was preparing a budget for next d. It would not be unusual for her costs to be a bit less because the
year because she takes quite a few prescription Bipartisan Budget Act of 2018 moved up the date for closing the
drugs, she will reach the coverage gap, and wants so-called "donut hole" for brand name drugs to 2019. Correct
to be sure she has enough money set aside for
those months. She received assistance calculating
her projected expenses from her daughter who
is a pharmacist, but she doesn't think the
calculations are correct because her out-of-
pocket expenses would be lower than last
year. She calls to ask if you can help. What
might you tell her?
Mr. Jacob understands that there is a standard a. Medicare Part D drug plans may have different benefit structures,
Medicare Part D prescription drug benefit, but but on average, they must all be at least as good as the standard
when he looks at information on various plans model established by the government. Correct
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?
Ms. Edwards is enrolled in a Medicare d. She may fill prescriptions for covered drugs at non-network
Advantage plan that includes prescription drug pharmacies, but likely at a higher cost than paid at an in-network
plan (PDP) coverage. She is traveling and wishes pharmacy. Correct
to fill two of her prescriptions that she has lost.
How would you advise her?
What types of tools can Medicare Part D c. Part D plans do not have to cover all medications. As a result, their
prescription drug plans use that affect the way formularies, or lists of covered drugs, will vary from plan to plan.
their enrollees can access medications? In addition, they can use cost containment techniques such as tiered
co-payments and prior authorization. Correct
Mrs. Allen has a rare condition for which two a. Medicare prescription drug plans are required to cover drugs in each
different brand name drugs are the only therapeutic category. She should be able to enroll in a Medicare
available prescription drug plan that covers the medications she needs. Correct
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?
Mr. and Mrs. Vaughn both take a specialized b. 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. Correct
prescription drug plan cover these drug needs.
What should you tell them?
Under what conditions can a Medicare a. When a formulary change is in response to a drug's removal from the
prescription drug plan reduce its coverage for a market. Correct
given drug during the first 60 days of the year?
