AHIP latest Final Exam Practice
Questions 2023/2024 .
Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. In
addition to drugs on his plan's formulary he takes several other medications. These
include a prescription drug not 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?
- ANSWER None of the costs of Mr. Wingate's other medications would currently count
toward TrOOP but he may wish to ask his plan for an exception to cover the prescription
not on its formulary.
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 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.
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
Questions 2023/2024 .
Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. In
addition to drugs on his plan's formulary he takes several other medications. These
include a prescription drug not 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?
- ANSWER None of the costs of Mr. Wingate's other medications would currently count
toward TrOOP but he may wish to ask his plan for an exception to cover the prescription
not on its formulary.
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 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.
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
