AHIP Module 3 - nk nk nk
2025 nk
1.Mr. Jacob understands that there is a standard Medicare Part D prescrip
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tion drug benefit, he sees a wide range in what they charge for deductib
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les, premiums, and cost sharing. How can you explain this to him?
nk nk nk nk nk nk nk nk nk nk nk
a. The Part D standard model's importance is that it is the only type of pla
nk nk nk nk nk nk nk nk nk nk nk nk nk nk
n into which low-
nk nk nk
income beneficiaries can enroll and still receive any extra help for which
nk nk nk nk nk nk nk nk nk nk nk n
kthey may qualify. nk nk
b. Medicare Part D drug plans may have different benefit structures, but
nk nk nk nk nk nk nk nk nk nk nk
on average, they must all be at least as good as the standard model est
nk nk nk nk nk nk nk nk nk nk nk nk nk nk
ablished by the government. nk nk nk
c. The government allows Part D plans to adopt any benefit structure as l
nk nk nk nk nk nk nk nk nk nk nk nk
ong as the list of covered drugs meets their approval.
nk nk nk nk nk nk nk nk nk
d. The government bases its payments to Part D plans on the standard be
nk nk nk nk nk nk nk nk nk nk nk nk
nefit model. For Part D plans to receive the full government payment, th
nk nk nk nk nk nk nk nk nk nk nk nk
ey must offer the standard model,: b.Medicare Part D drug plans may ha
nk nk nk nk nk nk nk nk nk nk nk nk
ve different benefit structures, but on average, they must all be at lea
nk nk nk nk nk nk nk nk nk nk nk nk
st as good as the standard model established by the government.
nk nk nk nk nk nk nk nk nk nk
2.Mr. Bickford did not quite qualify for the extra help low-
nk nk nk nk nk nk nk nk nk nk
income subsidy under the Medicare Part D and he is wondering if there
nk nk nk nk nk nk nk nk nk nk nk nk nk
is any other option he has for obtaining help with his considerable drug
nk nk nk nk nk nk nk nk nk nk nk nk n
kcosts. What should you tell him?
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a.He should contact his neighbors and family members and let them know
nk nk nk nk nk nk nk nk nk nk nk n
kthat any contributions they make toward his drug expenses will be tax de
nk nk nk nk nk nk nk nk nk nk nk nk
ductible. b.The only option available is to reduce his income so that he
nk nk nk nk nk nk nk nk nk nk nk nk nk
can qualify for the Part D extra help or wait until next year to see if the
nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk
annual limits change. c.He could check with the manufacturers of his me
nk nk nk nk nk nk nk nk nk nk nk
dications to see if they offer an assistance program to help people with l
nk nk nk nk nk nk nk nk nk nk nk nk nk
imited means to obtain the medications they need. Alternatively, he could
nk nk nk nk nk nk nk nk nk nk
nkcheck to see whether his state has a pharmacy assistance program to he
nk nk nk nk nk nk nk nk nk nk nk nk
lp him with his expenses.: c.He could check with the manufacturers of
nk nk nk nk nk nk nk nk nk nk nk nk
his medications to see if they offer an assistance program to help pe
nk nk nk nk nk nk nk nk nk nk nk nk
ople with limited means to obtain the medications they need.
nk nk nk nk nk nk nk nk nk
Alternatively, he could check to see whether his state has a pharmac nk nk nk nk nk nk nk nk nk nk nk
y assistance program to help him with his expenses.
nk nk nk nk nk nk nk nk
3.Mr. Carlini has heard that Medicare prescription drug plans are only off
nk nk nk nk nk nk nk nk nk nk nk
ered through private companies under a program known as (MA),He likes
nk nk nk nk nk nk nk nk nk nk
nkOriginal Medicare and does not want to sign up for an MA product, but
nk nk nk nk nk nk nk nk nk nk nk nk nk nk
he also wants prescription drug coverage. What should you tell him?
nk nk nk nk nk nk nk nk nk nk
a. Mr. Carlini can keep Original Medicare, but if he does not sign up for a
nk nk nk nk nk nk nk nk nk nk nk nk nk nk
1nk/
nk17
, AHIP Module 3 -
nk nk nk
2025
nk
n MA plan that includes RX coverage, he will only be able to obtain prescr
nk nk nk nk nk nk nk nk nk nk nk nk nk nk
iption drug coverage through a Medigap plan.
nk nk nk nk nk nk
2nk/
nk17
, AHIP Module 3 - nk nk nk
2025 nk
b. Mr. Carlini can obtain drug coverage through the fallback plans, which
nk nk nk nk nk nk nk nk nk nk n
kare designed to provide an alternative to privately sponsored MA. plans
nk nk nk nk nk nk nk nk nk nk
c. To obtain RX coverage, Mr. Carlini must enroll in an MA plan. The pla
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n will cover his Part A and Part B services, as well as provide him with
nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk
the desired prescription drug coverage.
nk nk nk nk
d. He can stay with Original Medicare and also enroll in an RX plan throu
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gh a private company that has contracted with the gove: d.He can stay
nk nk nk nk nk nk nk nk nk nk nk nk nk
with Original Medicare and also enroll in an RX plan through a privat
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e company that has con-
nk nk nk nk
tracted with the government to provide only such drug coverage to el
nk nk nk nk nk nk nk nk nk nk nk nk
igible Medicare beneficiaries. nk nk
4.Mr. and Mrs. Vaughn both take a specialized multivitamin RX each day.
nk nk nk nk nk nk nk nk nk nk nk
Mr. Vaughn takes a RX to help to regrow his hair. They are anxious to
nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk
have their Medicare prescription drug plan cover these drug needs. What
nk nk nk nk nk nk nk nk nk nk nk
should you tell them? nk nk nk
a. Medicare prescription drug plans are not permitted to cover the prescrip
nk nk nk nk nk nk nk nk nk nk
tion medications the Vaughns are interested in under Part D coverage, h
nk nk nk nk nk nk nk nk nk nk nk
owever, plans may cover them as supplemental benefits and the Vaughn
nk nk nk nk nk nk nk nk nk nk
s could look into that possibility
nk nk nk nk nk
b. Medicare prescription drug plans are permitted to cover vitamins, but
nk nk nk nk nk nk nk nk nk nk
not drugs for cosmetic purposes.
nk nk nk nk
c. The vitamins the Vaughns are taking will be covered under Part D bec
nk nk nk nk nk nk nk nk nk nk nk nk
ause their physician suggested they should take vitamins, but the hair l
nk nk nk nk nk nk nk nk nk nk nk
oss med- ication cannot be covered.
nk nk nk nk nk
d. Mr. Vaughn's hair growth medication would only be covered under Pa
nk nk nk nk nk nk nk nk nk nk
rt D if his balding resulted from an illness or was a side effect of a tre
nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk
atment
such as chemothera: a.Medicare prescription drug plans are not permitt
nk nk nk nk nk nk nk nk nk
ed to cover the prescription medications the Vaughns are interested i
nk nk nk nk nk nk nk nk nk nk
n under Part D coverage, however, plans may cover them as supple
nk nk nk nk nk nk nk nk nk nk nk
mental benefits and the Vaughns could look into that possibility
nk nk nk nk nk nk nk nk nk
5.What types of tools can Medicare Part D prescription drug plans use
nk nk nk nk nk nk nk nk nk nk nk nk
that affect the way their enrollees can access medications?
nk nk nk nk nk nk nk nk
a. Part D plans may use varying co-
nk nk nk nk nk nk
payments, but they are required to cover all prescription medications o
nk nk nk nk nk nk nk nk nk nk
n the market.
nk nk
b. The Federal government establishes a set formulary, or list of covered dr
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ugs, each year that the Part D plans must use. Beneficiaries should cons
nk nk nk nk nk nk nk nk nk nk nk nk
ult the government's list before deciding whether they wish to enroll in a
nk nk nk nk nk nk nk nk nk nk nk nk nk
3nk/
nk17
2025 nk
1.Mr. Jacob understands that there is a standard Medicare Part D prescrip
nk nk nk nk nk nk nk nk nk nk nk
tion drug benefit, he sees a wide range in what they charge for deductib
nk nk nk nk nk nk nk nk nk nk nk nk nk
les, premiums, and cost sharing. How can you explain this to him?
nk nk nk nk nk nk nk nk nk nk nk
a. The Part D standard model's importance is that it is the only type of pla
nk nk nk nk nk nk nk nk nk nk nk nk nk nk
n into which low-
nk nk nk
income beneficiaries can enroll and still receive any extra help for which
nk nk nk nk nk nk nk nk nk nk nk n
kthey may qualify. nk nk
b. Medicare Part D drug plans may have different benefit structures, but
nk nk nk nk nk nk nk nk nk nk nk
on average, they must all be at least as good as the standard model est
nk nk nk nk nk nk nk nk nk nk nk nk nk nk
ablished by the government. nk nk nk
c. The government allows Part D plans to adopt any benefit structure as l
nk nk nk nk nk nk nk nk nk nk nk nk
ong as the list of covered drugs meets their approval.
nk nk nk nk nk nk nk nk nk
d. The government bases its payments to Part D plans on the standard be
nk nk nk nk nk nk nk nk nk nk nk nk
nefit model. For Part D plans to receive the full government payment, th
nk nk nk nk nk nk nk nk nk nk nk nk
ey must offer the standard model,: b.Medicare Part D drug plans may ha
nk nk nk nk nk nk nk nk nk nk nk nk
ve different benefit structures, but on average, they must all be at lea
nk nk nk nk nk nk nk nk nk nk nk nk
st as good as the standard model established by the government.
nk nk nk nk nk nk nk nk nk nk
2.Mr. Bickford did not quite qualify for the extra help low-
nk nk nk nk nk nk nk nk nk nk
income subsidy under the Medicare Part D and he is wondering if there
nk nk nk nk nk nk nk nk nk nk nk nk nk
is any other option he has for obtaining help with his considerable drug
nk nk nk nk nk nk nk nk nk nk nk nk n
kcosts. What should you tell him?
nk nk nk nk nk
a.He should contact his neighbors and family members and let them know
nk nk nk nk nk nk nk nk nk nk nk n
kthat any contributions they make toward his drug expenses will be tax de
nk nk nk nk nk nk nk nk nk nk nk nk
ductible. b.The only option available is to reduce his income so that he
nk nk nk nk nk nk nk nk nk nk nk nk nk
can qualify for the Part D extra help or wait until next year to see if the
nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk
annual limits change. c.He could check with the manufacturers of his me
nk nk nk nk nk nk nk nk nk nk nk
dications to see if they offer an assistance program to help people with l
nk nk nk nk nk nk nk nk nk nk nk nk nk
imited means to obtain the medications they need. Alternatively, he could
nk nk nk nk nk nk nk nk nk nk
nkcheck to see whether his state has a pharmacy assistance program to he
nk nk nk nk nk nk nk nk nk nk nk nk
lp him with his expenses.: c.He could check with the manufacturers of
nk nk nk nk nk nk nk nk nk nk nk nk
his medications to see if they offer an assistance program to help pe
nk nk nk nk nk nk nk nk nk nk nk nk
ople with limited means to obtain the medications they need.
nk nk nk nk nk nk nk nk nk
Alternatively, he could check to see whether his state has a pharmac nk nk nk nk nk nk nk nk nk nk nk
y assistance program to help him with his expenses.
nk nk nk nk nk nk nk nk
3.Mr. Carlini has heard that Medicare prescription drug plans are only off
nk nk nk nk nk nk nk nk nk nk nk
ered through private companies under a program known as (MA),He likes
nk nk nk nk nk nk nk nk nk nk
nkOriginal Medicare and does not want to sign up for an MA product, but
nk nk nk nk nk nk nk nk nk nk nk nk nk nk
he also wants prescription drug coverage. What should you tell him?
nk nk nk nk nk nk nk nk nk nk
a. Mr. Carlini can keep Original Medicare, but if he does not sign up for a
nk nk nk nk nk nk nk nk nk nk nk nk nk nk
1nk/
nk17
, AHIP Module 3 -
nk nk nk
2025
nk
n MA plan that includes RX coverage, he will only be able to obtain prescr
nk nk nk nk nk nk nk nk nk nk nk nk nk nk
iption drug coverage through a Medigap plan.
nk nk nk nk nk nk
2nk/
nk17
, AHIP Module 3 - nk nk nk
2025 nk
b. Mr. Carlini can obtain drug coverage through the fallback plans, which
nk nk nk nk nk nk nk nk nk nk n
kare designed to provide an alternative to privately sponsored MA. plans
nk nk nk nk nk nk nk nk nk nk
c. To obtain RX coverage, Mr. Carlini must enroll in an MA plan. The pla
nk nk nk nk nk nk nk nk nk nk nk nk nk
n will cover his Part A and Part B services, as well as provide him with
nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk
the desired prescription drug coverage.
nk nk nk nk
d. He can stay with Original Medicare and also enroll in an RX plan throu
nk nk nk nk nk nk nk nk nk nk nk nk nk
gh a private company that has contracted with the gove: d.He can stay
nk nk nk nk nk nk nk nk nk nk nk nk nk
with Original Medicare and also enroll in an RX plan through a privat
nk nk nk nk nk nk nk nk nk nk nk nk
e company that has con-
nk nk nk nk
tracted with the government to provide only such drug coverage to el
nk nk nk nk nk nk nk nk nk nk nk nk
igible Medicare beneficiaries. nk nk
4.Mr. and Mrs. Vaughn both take a specialized multivitamin RX each day.
nk nk nk nk nk nk nk nk nk nk nk
Mr. Vaughn takes a RX to help to regrow his hair. They are anxious to
nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk
have their Medicare prescription drug plan cover these drug needs. What
nk nk nk nk nk nk nk nk nk nk nk
should you tell them? nk nk nk
a. Medicare prescription drug plans are not permitted to cover the prescrip
nk nk nk nk nk nk nk nk nk nk
tion medications the Vaughns are interested in under Part D coverage, h
nk nk nk nk nk nk nk nk nk nk nk
owever, plans may cover them as supplemental benefits and the Vaughn
nk nk nk nk nk nk nk nk nk nk
s could look into that possibility
nk nk nk nk nk
b. Medicare prescription drug plans are permitted to cover vitamins, but
nk nk nk nk nk nk nk nk nk nk
not drugs for cosmetic purposes.
nk nk nk nk
c. The vitamins the Vaughns are taking will be covered under Part D bec
nk nk nk nk nk nk nk nk nk nk nk nk
ause their physician suggested they should take vitamins, but the hair l
nk nk nk nk nk nk nk nk nk nk nk
oss med- ication cannot be covered.
nk nk nk nk nk
d. Mr. Vaughn's hair growth medication would only be covered under Pa
nk nk nk nk nk nk nk nk nk nk
rt D if his balding resulted from an illness or was a side effect of a tre
nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk nk
atment
such as chemothera: a.Medicare prescription drug plans are not permitt
nk nk nk nk nk nk nk nk nk
ed to cover the prescription medications the Vaughns are interested i
nk nk nk nk nk nk nk nk nk nk
n under Part D coverage, however, plans may cover them as supple
nk nk nk nk nk nk nk nk nk nk nk
mental benefits and the Vaughns could look into that possibility
nk nk nk nk nk nk nk nk nk
5.What types of tools can Medicare Part D prescription drug plans use
nk nk nk nk nk nk nk nk nk nk nk nk
that affect the way their enrollees can access medications?
nk nk nk nk nk nk nk nk
a. Part D plans may use varying co-
nk nk nk nk nk nk
payments, but they are required to cover all prescription medications o
nk nk nk nk nk nk nk nk nk nk
n the market.
nk nk
b. The Federal government establishes a set formulary, or list of covered dr
nk nk nk nk nk nk nk nk nk nk nk
ugs, each year that the Part D plans must use. Beneficiaries should cons
nk nk nk nk nk nk nk nk nk nk nk nk
ult the government's list before deciding whether they wish to enroll in a
nk nk nk nk nk nk nk nk nk nk nk nk nk
3nk/
nk17
