AHIP Mod 3 Exam Questions With Correct
Answers
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 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.
2. 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.
3. 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.
4. 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 advise her? - ANS ✔ - She may fill prescriptions for covered drugs at non-network
pharmacies, but likely at a higher cost than paid at an in-network pharmacy.
5. 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|Page
Answers
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 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.
2. 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.
3. 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.
4. 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 advise her? - ANS ✔ - She may fill prescriptions for covered drugs at non-network
pharmacies, but likely at a higher cost than paid at an in-network pharmacy.
5. 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|Page
