AHIP EXAM Modules 1-5 (Latest 2026 /
2027 Updates) Questions & Answers 100%
Correct {Grade A}
Mr. and Mrs. Cole both take a specialized multivitamin prescription each day. Mr. Cole
takes a prescription to help regrow his hair. They are anxious to have their Medicare
prescription drug plan cover these drug needs. What should you tell them? - correct
answer Medicare prescription drug plans are not permitted to cover the prescription
medications the Coles are interested in under Part D coverage, however, plans may
cover them as supplemental benefits and the Coles could look into that possibility.
Ms. Ramos 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? - correct answer She may fill prescriptions
for covered drugs at non-network pharmacies, but likely at a higher cost than paid at
an in-network pharmacy.
Mr. Chen was still working when he first qualified for Medicare. At that time, he had
employer group coverage that was creditable. During his initial Part D eligibility period,
,he decided not to enroll because he was satisfied with his drug coverage. It is now a
year later and Mr. Chen has lost his employer group coverage within the last two
weeks. How would you advise him? - correct answer Mr. Chen should enroll in a Part
D plan before he has a 63-day break in coverage in order to avoid a premium penalty.
Mrs. Kelly wants to enroll in a Medicare Advantage plan that does not include drug
coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what
circumstances can she do this? - correct answer If the Medicare Advantage plan is a
Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical
Savings Account plan, Mrs. Kelly can do this.
John Cohen is a Medicare beneficiary who suffers from diabetes. Mr. Cohen is
considering enrollment in an MA-PD plan that you represent. He asks you whether his
insulin costs will be covered. What should you say? - correct answer Mr. Cohen's
insulin costs for a one-month supply cannot be more than $35 in any coverage phase.
Mrs. Strickland is a new Medicare beneficiary who has just retired from retail work.
She is interested in selecting a Medicare Part D prescription drug plan. She takes
,several 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? -
correct answer 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.
What types of tools can Medicare Part D prescription drug plans use that affect the
way their enrollees can access medications? - correct answer Part D plans do not
have to cover all medications. As a 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 step therapy.
Which of the following statements about Medicare Part D is/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 an MA-Medical Savings Account (MSA) plan may only
obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in an MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan. - correct answer I, II, and III only
Mrs. Sharma has Original Medicare and would like to enroll in a Private Fee-for-
Service (PFFS) plan. All types of PFFS plans are available in her area. Which options
could Mrs. Sharma consider before selecting a PFFS plan? - correct answer A
Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical
benefits and Part D prescription drug coverage, a PFFS plan offering only medical
benefits, or a PFFS plan in combination with a stand-alone prescription drug plan.
Mr. Aguilar is a newly enrolled Medicare Part D beneficiary and one of your clients. In
addition to drugs on his plan's formulary, he takes several other medications. These
include a prescription drug not on his plan's formulary, over-the-counter medications
for colds and allergies, vitamins, and drugs from an Internet-based Canadian
pharmacy to promote hair growth and reduce joint swelling. His neighbor recently told
him about a concept called TrOOP and he asks you if any of his other medications could
2027 Updates) Questions & Answers 100%
Correct {Grade A}
Mr. and Mrs. Cole both take a specialized multivitamin prescription each day. Mr. Cole
takes a prescription to help regrow his hair. They are anxious to have their Medicare
prescription drug plan cover these drug needs. What should you tell them? - correct
answer Medicare prescription drug plans are not permitted to cover the prescription
medications the Coles are interested in under Part D coverage, however, plans may
cover them as supplemental benefits and the Coles could look into that possibility.
Ms. Ramos 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? - correct answer She may fill prescriptions
for covered drugs at non-network pharmacies, but likely at a higher cost than paid at
an in-network pharmacy.
Mr. Chen was still working when he first qualified for Medicare. At that time, he had
employer group coverage that was creditable. During his initial Part D eligibility period,
,he decided not to enroll because he was satisfied with his drug coverage. It is now a
year later and Mr. Chen has lost his employer group coverage within the last two
weeks. How would you advise him? - correct answer Mr. Chen should enroll in a Part
D plan before he has a 63-day break in coverage in order to avoid a premium penalty.
Mrs. Kelly wants to enroll in a Medicare Advantage plan that does not include drug
coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what
circumstances can she do this? - correct answer If the Medicare Advantage plan is a
Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical
Savings Account plan, Mrs. Kelly can do this.
John Cohen is a Medicare beneficiary who suffers from diabetes. Mr. Cohen is
considering enrollment in an MA-PD plan that you represent. He asks you whether his
insulin costs will be covered. What should you say? - correct answer Mr. Cohen's
insulin costs for a one-month supply cannot be more than $35 in any coverage phase.
Mrs. Strickland is a new Medicare beneficiary who has just retired from retail work.
She is interested in selecting a Medicare Part D prescription drug plan. She takes
,several 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? -
correct answer 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.
What types of tools can Medicare Part D prescription drug plans use that affect the
way their enrollees can access medications? - correct answer Part D plans do not
have to cover all medications. As a 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 step therapy.
Which of the following statements about Medicare Part D is/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 an MA-Medical Savings Account (MSA) plan may only
obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in an MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan. - correct answer I, II, and III only
Mrs. Sharma has Original Medicare and would like to enroll in a Private Fee-for-
Service (PFFS) plan. All types of PFFS plans are available in her area. Which options
could Mrs. Sharma consider before selecting a PFFS plan? - correct answer A
Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical
benefits and Part D prescription drug coverage, a PFFS plan offering only medical
benefits, or a PFFS plan in combination with a stand-alone prescription drug plan.
Mr. Aguilar is a newly enrolled Medicare Part D beneficiary and one of your clients. In
addition to drugs on his plan's formulary, he takes several other medications. These
include a prescription drug not on his plan's formulary, over-the-counter medications
for colds and allergies, vitamins, and drugs from an Internet-based Canadian
pharmacy to promote hair growth and reduce joint swelling. His neighbor recently told
him about a concept called TrOOP and he asks you if any of his other medications could
