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?
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?
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?
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%.
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?
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?
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?
Answer: If a Part D benefit is offered through her plan she may choose to
enroll in that plan or a standalone PDP.
,Question 6 (continued).
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.
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?
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?
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?
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?
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?
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?
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?
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?
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?
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%.
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?
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?
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?
Answer: If a Part D benefit is offered through her plan she may choose to
enroll in that plan or a standalone PDP.
,Question 6 (continued).
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.
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?
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?
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?
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?
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?
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?
