AHIP Module 3 – 100% Updated with
Verified Correct Answers
Question 1: 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 Orig-
inal 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 en-
roll in a Medicare prescription drug plan through a private com-
pany that has contracted with the government to provide only such
drug coverage to eligible Medicare beneficiaries.
Rationale: Medicare Part D plans are standalone prescription drug
plans offered by private companies approved by CMS, separate from
Medicare Advantage plans. Beneficiaries can enroll in Part D while
remaining in Original Medicare.
Question 2: Mrs. Mulcahy is concerned that she may not qualify for enrollment
in a Medicare prescription drug plan because, although she is en-
titled to Part A, she is not enrolled under Medicare Part B. What
should you tell her?
Answer: Everyone who is entitled to Part A or enrolled under Part
B is eligible to enroll in a Medicare prescription drug plan. As long
as Mrs. Mulcahy is entitled to Part A, she does not need to enroll
under Part B before enrolling in a prescription drug plan.
Rationale: Eligibility for Part D requires entitlement to Part A or
enrollment in Part B. Mrs. Mulcahy’s entitlement to Part A satisfies
this requirement.
Question 3: All plans must cover at least the standard Part D coverage or its
actuarial equivalent. What costs would a beneficiary incur for pre-
scription drugs in 2025 under the standard coverage?
Answer: Standard Part D coverage would require payment of an
annual deductible, 25% cost-sharing up to the coverage gap, a por-
tion of costs for both generics and brand-name drugs in the cover-
age gap, and co-pays or co-insurance after the coverage gap.
Rationale: The standard Part D benefit structure for 2025 includes
a deductible, initial coverage phase with 25% cost-sharing, a cov-
erage gap with reduced cost-sharing due to the Inflation Reduction
Act, and catastrophic coverage with minimal or no cost-sharing.
Question 4: What types of tools can Medicare Part D prescription drug plans
use that affect the way their enrollees can access medications?
Answer: Part D plans do not have to cover all medications. As a
1
, result, their formularies, or lists of covered drugs, will vary from
plan to plan. In addition, they can use cost containment techniques
such as tiered co-payments and prior authorization.
Rationale: Part D plans use formularies and cost containment tools
like tiered co-pays, prior authorization, and step therapy to manage
drug access and costs.
Question 5: 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 Part D plan.
What should you tell her?
Answer: Mrs. Lopez can enroll in a Part D plan because her Medi-
care Advantage cost plan does not offer prescription drug coverage,
allowing her to add a standalone Part D plan.
Rationale: Medicare Advantage cost plans typically do not include
Part D coverage, so beneficiaries can enroll in a standalone Part D
plan without disenrolling from the cost plan.
Question 6: Mr. Kelly has been informed that the Medicare Part D plan he was
enrolled in did not provide creditable coverage. Which of the fol-
lowing statements best describes what will occur if Mr. Kelly now
decides to enroll in Medicare Part D?
Answer: He will incur a late enrollment penalty.
Rationale: If a beneficiary does not maintain creditable prescrip-
tion drug coverage and enrolls in Part D after the initial enrollment
period, they face a late enrollment penalty based on the number of
months without coverage.
Question 7: Mrs. Allen has a stand-alone prescription drug plan and has learned
that there is an annual enrollment period during which she can
make changes to her plan. When is this period?
Answer: The Annual Enrollment Period (AEP) for Medicare Part D
is from October 15 to December 7 each year, with changes effective
January 1 of the following year.
Rationale: The AEP allows beneficiaries to enroll in, switch, or dis-
enroll from Part D plans, with coverage changes effective the fol-
lowing January 1.
Question 8: Mr. Johannsen is entitled to Medicare Part A and Part B. He has
decided to enroll in a Medicare Advantage plan for the first time
and wants to know what out-of-pocket costs he should expect. What
should you tell him?
Answer: He should expect to pay premiums, deductibles, copay-
ments, or coinsurance for services, which vary by plan, and poten-
tially higher costs for out-of-network services if he chooses a PPO
plan.
2
Verified Correct Answers
Question 1: 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 Orig-
inal 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 en-
roll in a Medicare prescription drug plan through a private com-
pany that has contracted with the government to provide only such
drug coverage to eligible Medicare beneficiaries.
Rationale: Medicare Part D plans are standalone prescription drug
plans offered by private companies approved by CMS, separate from
Medicare Advantage plans. Beneficiaries can enroll in Part D while
remaining in Original Medicare.
Question 2: Mrs. Mulcahy is concerned that she may not qualify for enrollment
in a Medicare prescription drug plan because, although she is en-
titled to Part A, she is not enrolled under Medicare Part B. What
should you tell her?
Answer: Everyone who is entitled to Part A or enrolled under Part
B is eligible to enroll in a Medicare prescription drug plan. As long
as Mrs. Mulcahy is entitled to Part A, she does not need to enroll
under Part B before enrolling in a prescription drug plan.
Rationale: Eligibility for Part D requires entitlement to Part A or
enrollment in Part B. Mrs. Mulcahy’s entitlement to Part A satisfies
this requirement.
Question 3: All plans must cover at least the standard Part D coverage or its
actuarial equivalent. What costs would a beneficiary incur for pre-
scription drugs in 2025 under the standard coverage?
Answer: Standard Part D coverage would require payment of an
annual deductible, 25% cost-sharing up to the coverage gap, a por-
tion of costs for both generics and brand-name drugs in the cover-
age gap, and co-pays or co-insurance after the coverage gap.
Rationale: The standard Part D benefit structure for 2025 includes
a deductible, initial coverage phase with 25% cost-sharing, a cov-
erage gap with reduced cost-sharing due to the Inflation Reduction
Act, and catastrophic coverage with minimal or no cost-sharing.
Question 4: What types of tools can Medicare Part D prescription drug plans
use that affect the way their enrollees can access medications?
Answer: Part D plans do not have to cover all medications. As a
1
, result, their formularies, or lists of covered drugs, will vary from
plan to plan. In addition, they can use cost containment techniques
such as tiered co-payments and prior authorization.
Rationale: Part D plans use formularies and cost containment tools
like tiered co-pays, prior authorization, and step therapy to manage
drug access and costs.
Question 5: 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 Part D plan.
What should you tell her?
Answer: Mrs. Lopez can enroll in a Part D plan because her Medi-
care Advantage cost plan does not offer prescription drug coverage,
allowing her to add a standalone Part D plan.
Rationale: Medicare Advantage cost plans typically do not include
Part D coverage, so beneficiaries can enroll in a standalone Part D
plan without disenrolling from the cost plan.
Question 6: Mr. Kelly has been informed that the Medicare Part D plan he was
enrolled in did not provide creditable coverage. Which of the fol-
lowing statements best describes what will occur if Mr. Kelly now
decides to enroll in Medicare Part D?
Answer: He will incur a late enrollment penalty.
Rationale: If a beneficiary does not maintain creditable prescrip-
tion drug coverage and enrolls in Part D after the initial enrollment
period, they face a late enrollment penalty based on the number of
months without coverage.
Question 7: Mrs. Allen has a stand-alone prescription drug plan and has learned
that there is an annual enrollment period during which she can
make changes to her plan. When is this period?
Answer: The Annual Enrollment Period (AEP) for Medicare Part D
is from October 15 to December 7 each year, with changes effective
January 1 of the following year.
Rationale: The AEP allows beneficiaries to enroll in, switch, or dis-
enroll from Part D plans, with coverage changes effective the fol-
lowing January 1.
Question 8: Mr. Johannsen is entitled to Medicare Part A and Part B. He has
decided to enroll in a Medicare Advantage plan for the first time
and wants to know what out-of-pocket costs he should expect. What
should you tell him?
Answer: He should expect to pay premiums, deductibles, copay-
ments, or coinsurance for services, which vary by plan, and poten-
tially higher costs for out-of-network services if he chooses a PPO
plan.
2
