Ahip 2025 Module 3
1. Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr.
Vaughn takes a prescription to help to regrow his hair. They are anxious to have their
Medicare prescription drug plan cover these drug needs. What should you tell them?
>ANS>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 Vaughns could look into that possibility.
2. 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? >ANS>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.
3. 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? >ANS>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.
4. Mr. Hildalgo complains to you that because he takes multiple expensive drugs, he has
trouble paying his cost sharing for his prescription drugs, particularly at the beginning of
the year during the deductible phase. He is happy with his plan and does not want to
change. However, he said he had heard about a new program called the Medicare
Prescription Payment Plan and asked whether it might help. What do you tell him?
>ANS>The Medicare Prescription Payment Plan helps spread out beneficiary
cost-sharing payments but does not decrease the total amount owed.
5. Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is
concerned about the Part D premium penalty if he does not enroll in a Medicare
prescription drug plan, but does not want to purchase extra coverage that he will not
need. What should you tell him? >ANS>If the drug coverage he has is not expected to
pay, on average, at least as much as Medicare's standard Part D coverage expects to
pay, then he will need to enroll in Medicare Part D during his initial eligibility period to
avoid the late enrollment penalty.
6. 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? >ANS>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.
1. Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr.
Vaughn takes a prescription to help to regrow his hair. They are anxious to have their
Medicare prescription drug plan cover these drug needs. What should you tell them?
>ANS>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 Vaughns could look into that possibility.
2. 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? >ANS>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.
3. 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? >ANS>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.
4. Mr. Hildalgo complains to you that because he takes multiple expensive drugs, he has
trouble paying his cost sharing for his prescription drugs, particularly at the beginning of
the year during the deductible phase. He is happy with his plan and does not want to
change. However, he said he had heard about a new program called the Medicare
Prescription Payment Plan and asked whether it might help. What do you tell him?
>ANS>The Medicare Prescription Payment Plan helps spread out beneficiary
cost-sharing payments but does not decrease the total amount owed.
5. Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is
concerned about the Part D premium penalty if he does not enroll in a Medicare
prescription drug plan, but does not want to purchase extra coverage that he will not
need. What should you tell him? >ANS>If the drug coverage he has is not expected to
pay, on average, at least as much as Medicare's standard Part D coverage expects to
pay, then he will need to enroll in Medicare Part D during his initial eligibility period to
avoid the late enrollment penalty.
6. 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? >ANS>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.
