Ahip 2025 Module 3
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? - ANS 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.
Mr. Rice is 68, actively working, and has coverage for medical services and medications through his
employer's group health plan. He is entitled to premium free Part A and thinking of enrolling in Part B
and switching to an MA-PD because he is paying a very large part of his group coverage premium, and it
does not provide coverage for a number of his medications. Which of the following is NOT a
consideration when making the change? - ANS Mr. Rice's retiree plan is required to take him back if,
within 63 days of having voluntarily quit the employer's plan, he decides that he prefers it to his
Medicare Part D plan.
Mrs. Hernandez is one of your clients. She has read that there is a new program that may help her
manage prescription drug costs. What do you tell her about the Medicare Prescription Payment Plan? -
ANS Part D enrollees can opt into the Medicare Prescription Payment Plan at the beginning of the plan
year or any point during the year.
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? - ANS If a Part D benefit is offered through her
plan she may choose to enroll in that plan or a standalone PDP.
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors
called TrOOP. She asks you to explain it. What do you say? - ANS TrOOP stands for true out-of-pocket
costs that count toward the Medicare Part D catastrophic limit and include not only expenses paid by a
beneficiary but also in some instances amounts paid by or through qualified State Pharmaceutical
Assistance Programs.
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
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? - ANS 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.
Mr. Rice is 68, actively working, and has coverage for medical services and medications through his
employer's group health plan. He is entitled to premium free Part A and thinking of enrolling in Part B
and switching to an MA-PD because he is paying a very large part of his group coverage premium, and it
does not provide coverage for a number of his medications. Which of the following is NOT a
consideration when making the change? - ANS Mr. Rice's retiree plan is required to take him back if,
within 63 days of having voluntarily quit the employer's plan, he decides that he prefers it to his
Medicare Part D plan.
Mrs. Hernandez is one of your clients. She has read that there is a new program that may help her
manage prescription drug costs. What do you tell her about the Medicare Prescription Payment Plan? -
ANS Part D enrollees can opt into the Medicare Prescription Payment Plan at the beginning of the plan
year or any point during the year.
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? - ANS If a Part D benefit is offered through her
plan she may choose to enroll in that plan or a standalone PDP.
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors
called TrOOP. She asks you to explain it. What do you say? - ANS TrOOP stands for true out-of-pocket
costs that count toward the Medicare Part D catastrophic limit and include not only expenses paid by a
beneficiary but also in some instances amounts paid by or through qualified State Pharmaceutical
Assistance Programs.
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
