AHIP CERTIFICATION EXAM SET 2 UPDATED
ACTUAL QUESTIONS AND CORRECT ANSWERS
⩥ 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?
Answer: 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.
⩥ 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? Answer: 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.
⩥ All plans must cover at least the standard Part D coverage or its
actuarial equivalent. Which of the following statements best describes
some of the costs a beneficiary would incur for prescription drugs under
the standard coverage? Answer: Standard Part D coverage would require
payment of an annual deductible, and once past the catastrophic
coverage threshold, the beneficiary pays whichever is greater of either
,the co-pays for generic and brand name drugs or coinsurance of
5%.fMci
⩥ Mrs. McIntire is enrolled in her state's Medicaid plan and has just
become eligible for Medicare as well. What can she expect will happen
to her drug coverage? Answer: Unless she chooses a Medicare Part D
prescription drug plan on her own, she will be automatically enrolled in
one available in her area.
⩥ Mrs. Quinn has just turned 65, is in excellent health and has a
relatively high income. She uses 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? Answer: 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.
⩥ Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She
has recently lost creditable 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? Answer: If a
Part D benefit is offered through her plan she may choose to enroll in
that plan or a standalone PDP.
, ⩥ Mr. Carlini has heard that Medicare prescription drug plans are only
offered through private companies under a program known as Medicare
Advantage (MA), not by the government. He likes 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? Answer: Mr.
Carlini can stay with Original Medicare and also enroll in a Medicare
prescription drug plan through a private company that has contracted
with the government to provide only such drug coverage to eligible
Medicare beneficiaries.
⩥ 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.
⩥ 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
⩥ Mr. and Mrs. Vaughn both take a specialized multivitamin
prescription each day. Mr. Vaughn takes a prescription for helping to
ACTUAL QUESTIONS AND CORRECT ANSWERS
⩥ 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?
Answer: 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.
⩥ 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? Answer: 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.
⩥ All plans must cover at least the standard Part D coverage or its
actuarial equivalent. Which of the following statements best describes
some of the costs a beneficiary would incur for prescription drugs under
the standard coverage? Answer: Standard Part D coverage would require
payment of an annual deductible, and once past the catastrophic
coverage threshold, the beneficiary pays whichever is greater of either
,the co-pays for generic and brand name drugs or coinsurance of
5%.fMci
⩥ Mrs. McIntire is enrolled in her state's Medicaid plan and has just
become eligible for Medicare as well. What can she expect will happen
to her drug coverage? Answer: Unless she chooses a Medicare Part D
prescription drug plan on her own, she will be automatically enrolled in
one available in her area.
⩥ Mrs. Quinn has just turned 65, is in excellent health and has a
relatively high income. She uses 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? Answer: 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.
⩥ Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She
has recently lost creditable 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? Answer: If a
Part D benefit is offered through her plan she may choose to enroll in
that plan or a standalone PDP.
, ⩥ Mr. Carlini has heard that Medicare prescription drug plans are only
offered through private companies under a program known as Medicare
Advantage (MA), not by the government. He likes 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? Answer: Mr.
Carlini can stay with Original Medicare and also enroll in a Medicare
prescription drug plan through a private company that has contracted
with the government to provide only such drug coverage to eligible
Medicare beneficiaries.
⩥ 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.
⩥ 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
⩥ Mr. and Mrs. Vaughn both take a specialized multivitamin
prescription each day. Mr. Vaughn takes a prescription for helping to
