AHIP Module 3 Exam 2024
Mrs. Allen has a rare condition for which two different brand name drugs are the only available
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? - Correct Answer-a. Medicare prescription drug plans are required to
cover drugs in each therapeutic category. She should be able to enroll in a Medicare prescription drug
plan that covers the medications she needs. Correct
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-b. 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. Correct
Mrs. Lopez is enrolled in a Medicare Advantage cost plan. 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-a. If a Part D benefit is offered
through her plan she may choose in enroll in that plan or a standalone PDP. Correct
Which of the following statements about Medicare 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. - Correct Answer-b. I, II, and III only Correct
All plans must cover at least the standard Part D coverage or its actuarial equivalent. What costs would a
beneficiary incur for prescription drugs in 2019 under the standard coverage? - Correct Answer-c.
Standard Part D coverage would require payment of an annual deductible, 25% cost-sharing up to the
coverage gap, a portion of costs for both generics and brand-name drugs in the coverage gap, and co-
pays or co-insurance after the coverage gap. Correct
Mrs. Andrews was preparing a budget for next year because she takes quite a few prescription drugs, she
will reach the coverage gap, and wants 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? - Correct Answer-d. It would not be unusual
for her costs to be a bit less because the Bipartisan Budget Act of 2018 moved up the date for closing the
so-called "donut hole" for brand name drugs to 2019. Correct
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? - Correct Answer-a. 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. Correct
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 her prescriptions that she has lost. How would you
advise her? - Correct Answer-d. She may fill prescriptions for covered drugs at non-network
pharmacies, but likely at a higher cost than paid at an in-network pharmacy. Correct
Mrs. Allen has a rare condition for which two different brand name drugs are the only available
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? - Correct Answer-a. Medicare prescription drug plans are required to
cover drugs in each therapeutic category. She should be able to enroll in a Medicare prescription drug
plan that covers the medications she needs. Correct
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-b. 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. Correct
Mrs. Lopez is enrolled in a Medicare Advantage cost plan. 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-a. If a Part D benefit is offered
through her plan she may choose in enroll in that plan or a standalone PDP. Correct
Which of the following statements about Medicare 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. - Correct Answer-b. I, II, and III only Correct
All plans must cover at least the standard Part D coverage or its actuarial equivalent. What costs would a
beneficiary incur for prescription drugs in 2019 under the standard coverage? - Correct Answer-c.
Standard Part D coverage would require payment of an annual deductible, 25% cost-sharing up to the
coverage gap, a portion of costs for both generics and brand-name drugs in the coverage gap, and co-
pays or co-insurance after the coverage gap. Correct
Mrs. Andrews was preparing a budget for next year because she takes quite a few prescription drugs, she
will reach the coverage gap, and wants 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? - Correct Answer-d. It would not be unusual
for her costs to be a bit less because the Bipartisan Budget Act of 2018 moved up the date for closing the
so-called "donut hole" for brand name drugs to 2019. Correct
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? - Correct Answer-a. 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. Correct
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 her prescriptions that she has lost. How would you
advise her? - Correct Answer-d. She may fill prescriptions for covered drugs at non-network
pharmacies, but likely at a higher cost than paid at an in-network pharmacy. Correct
