AHIP Final Test 2027 Questions and Answers (Latest Verified
Answers)
Question 1.
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?
Correct 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.
Question 2.
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?
Correct 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.
Question 3.
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?
Correct 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
Question 4.
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?
Correct 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.
Question 5.
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?
,Correct 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.
Question 6.
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?
Correct 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? - ✓✓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.
Question 7.
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?
Correct 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 8.
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?
Correct 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 9.
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?
Correct 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 10.
Mr. Schultz 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. Schultz has lost his employer group coverage within the last two
weeks. How would you advise him?
Correct 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 11.
Which of the following individuals is most likely to be eligible to enroll in a Part D Plan?
Correct Answer: Jose, having been granted asylum, is legally present in the
United States thus meeting one of the criteria for Part D eligibility.
Question 12.
What types of tools can Medicare Part D prescription drug plans use that affect the way
their enrollees can access medications?
Correct 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 prior authorization. (not b)
• 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? -✓✓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 13.
Mr. Torres has a small savings account. He would like to pay for his monthly Part D
premiums with an automatic monthly withdrawal from his savings account until it is
exhausted, and then have his premiums withheld from his Social Security check. What
should you tell him?
Correct Answer: In general, he must select a single Part D premium payment
mechanism that will be used throughout the year.
Answers)
Question 1.
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?
Correct 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.
Question 2.
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?
Correct 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.
Question 3.
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?
Correct 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
Question 4.
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?
Correct 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.
Question 5.
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?
,Correct 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.
Question 6.
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?
Correct 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? - ✓✓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.
Question 7.
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?
Correct 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 8.
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?
Correct 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 9.
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?
Correct 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 10.
Mr. Schultz 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. Schultz has lost his employer group coverage within the last two
weeks. How would you advise him?
Correct 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 11.
Which of the following individuals is most likely to be eligible to enroll in a Part D Plan?
Correct Answer: Jose, having been granted asylum, is legally present in the
United States thus meeting one of the criteria for Part D eligibility.
Question 12.
What types of tools can Medicare Part D prescription drug plans use that affect the way
their enrollees can access medications?
Correct 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 prior authorization. (not b)
• 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? -✓✓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 13.
Mr. Torres has a small savings account. He would like to pay for his monthly Part D
premiums with an automatic monthly withdrawal from his savings account until it is
exhausted, and then have his premiums withheld from his Social Security check. What
should you tell him?
Correct Answer: In general, he must select a single Part D premium payment
mechanism that will be used throughout the year.
