AHIP MODULE 3 WITH COMPLETE
SOLUTIONS
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-b. 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.
Correct
Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare
prescription drug plan because, although she is entitled to Part A, she is not enrolled
under Medicare Part B. What should you tell her? - ANSWER-d. 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. 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? - 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. - 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? - 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? - 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? - 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? - 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
Which of the following steps may a Part D sponsor adopt for beneficiaries who are at
risk of misusing or abusing frequently abused drugs?
I. Identifying at risk individuals by using criteria that includes the number of opioid
prescriptions the beneficiary has and the number of prescribers who have written those
prescriptions.
II. Locking an at-risk beneficiary into one pharmacy.
III. Locking an at-risk beneficiary into one prescriber.
IV. Increasing deductibles and copays for at-risk beneficiaries - ANSWER-c. I, II and III
only Correct
Mrs. Roswell is a new Medicare beneficiary and is interested in selecting a Medicare
Part D prescription drug plan. She takes a number of medications and is concerned that
she has not been able to identify a plan that covers all of her medications. She does not
want to make an abrupt change to new drugs that would be covered and asks what she
should do. What should you tell her? - ANSWER-c. Every Part D drug plan is required
to cover a single one-month fill of her existing medications sometime during a 90 day
transition period. Correct
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
SOLUTIONS
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-b. 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.
Correct
Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare
prescription drug plan because, although she is entitled to Part A, she is not enrolled
under Medicare Part B. What should you tell her? - ANSWER-d. 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. 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? - 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. - 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? - 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? - 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? - 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? - 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
Which of the following steps may a Part D sponsor adopt for beneficiaries who are at
risk of misusing or abusing frequently abused drugs?
I. Identifying at risk individuals by using criteria that includes the number of opioid
prescriptions the beneficiary has and the number of prescribers who have written those
prescriptions.
II. Locking an at-risk beneficiary into one pharmacy.
III. Locking an at-risk beneficiary into one prescriber.
IV. Increasing deductibles and copays for at-risk beneficiaries - ANSWER-c. I, II and III
only Correct
Mrs. Roswell is a new Medicare beneficiary and is interested in selecting a Medicare
Part D prescription drug plan. She takes a number of medications and is concerned that
she has not been able to identify a plan that covers all of her medications. She does not
want to make an abrupt change to new drugs that would be covered and asks what she
should do. What should you tell her? - ANSWER-c. Every Part D drug plan is required
to cover a single one-month fill of her existing medications sometime during a 90 day
transition period. Correct
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
