2018 AHIP
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.
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through acupuncture. She is concerned about whether or not Medicare will
cover these items and services. What should you tell her? - Medicare does not cover
acupuncture, or, in general, glasses or dentures.
Which statement best describes PACE plans? - It includes comprehensive medical and
social service delivery systems using an interdisciplinary team approach in an adult day
health center, supplemented by in-home and referral services.
Mr. Shultz 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. Shultz has lost his employer group coverage. How would you advise
him? - Mr. Schultz should enroll in a Part D plan before he has a 63-day break in
coverage in order to avoid a premium penalty.
For which of the following individuals would a Cost Plan be most appropriate? - Ms.
Baker who is enrolled in Medicare Part B and is willing to continue paying Part B
premiums plus any plan premiums.
Mrs. Berkowitz 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? - If the Medicare Advantage plan is a Private Fee-for-
Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account,
Mrs. Berkowitz can do this.
Ms. Goldstein is required by the plan she represents to obtain enrollment forms that
have carbon copies in the back. She gives one to the beneficiary, sends another to the
plan and retains the third. What should she do with her copies of the enrollment forms?
- She should make every effort to safeguard the beneficiary information on those
enrollment forms.
Mr. Lopez takes several high cost prescription drugs. He would like to enroll in a
standalone Part D prescription drug plan that is available in his area. In what type of
Medicare Health Plan can he enroll? - Private Fee-for-Service (PFFS) plan that does
not include drug coverage.
, Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug
coverage. He found a stand-alone Medicare prescription drug plan in his area that offers
better coverage than that available through his MA-PD plan and in addition has a low
premium. It won't cost him much more and, because he has the means to do so, he
wishes to enroll in the stand-alone prescription drug plan in addition to his MA-PD plan.
What should you tell him? - If Mr. Block enrolls in the stand-alone Medicare prescription
drug plan, he will be disenrolled from the Medicare Advantage plan.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full
time, and paid taxes during that entire period. She is concerned that she will not qualify
for coverage under part A because she was not born in the United States. What should
you tell her? - Most individuals who are citizens and over age 65 are covered under Part
A by virtue of having paid Medicare taxes while working, though some may be covered
as a result of paying monthly premiums.
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? - If a Part D benefit is offered through her plan she must enroll in this plan.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare? What could you tell him? - Part A, which
covers hospital, skilled nursing facility, hospice and home health services and Part B,
which covers professional services such as those provided by a doctor are covered
under Original Medicare.
Mrs. Wellington is enrolled in Parts A and B of Original Medicare. A friend recently told
her that there is an excellent Medicare Advantage (MA) plan with a five-star rating
serving her area. On January 15 she comes to you for advice as to what options, if any,
she has. What should you say regarding special enrollment periods (SEPs)? - Mrs.
Wellington is eligible for a SEP that may be used once until November 30 to enroll in the
five-star plan.
Mr. Shapiro gets by on a very small fixed income. He has heard there may be extra help
paying for Part D prescription drugs for Medicare beneficiaries with limited income. He
wants to know whether he might qualify. What should you tell him? - The extra help is
available to beneficiaries whose income and assets do not exceed annual limits
specified by the government.
A client wants to give you an enrollment application on October 1 prior to the beginning
of the Annual Election Period because he is leaving on vacation for two weeks and does
not want to forget about turning it in. What should you tell him? - You must tell him you
are not permitted to take the form. If he sends the form directly to the plan, the plan will
process the enrollment on the day the Annual Election Period begins.
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.
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through acupuncture. She is concerned about whether or not Medicare will
cover these items and services. What should you tell her? - Medicare does not cover
acupuncture, or, in general, glasses or dentures.
Which statement best describes PACE plans? - It includes comprehensive medical and
social service delivery systems using an interdisciplinary team approach in an adult day
health center, supplemented by in-home and referral services.
Mr. Shultz 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. Shultz has lost his employer group coverage. How would you advise
him? - Mr. Schultz should enroll in a Part D plan before he has a 63-day break in
coverage in order to avoid a premium penalty.
For which of the following individuals would a Cost Plan be most appropriate? - Ms.
Baker who is enrolled in Medicare Part B and is willing to continue paying Part B
premiums plus any plan premiums.
Mrs. Berkowitz 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? - If the Medicare Advantage plan is a Private Fee-for-
Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account,
Mrs. Berkowitz can do this.
Ms. Goldstein is required by the plan she represents to obtain enrollment forms that
have carbon copies in the back. She gives one to the beneficiary, sends another to the
plan and retains the third. What should she do with her copies of the enrollment forms?
- She should make every effort to safeguard the beneficiary information on those
enrollment forms.
Mr. Lopez takes several high cost prescription drugs. He would like to enroll in a
standalone Part D prescription drug plan that is available in his area. In what type of
Medicare Health Plan can he enroll? - Private Fee-for-Service (PFFS) plan that does
not include drug coverage.
, Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug
coverage. He found a stand-alone Medicare prescription drug plan in his area that offers
better coverage than that available through his MA-PD plan and in addition has a low
premium. It won't cost him much more and, because he has the means to do so, he
wishes to enroll in the stand-alone prescription drug plan in addition to his MA-PD plan.
What should you tell him? - If Mr. Block enrolls in the stand-alone Medicare prescription
drug plan, he will be disenrolled from the Medicare Advantage plan.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full
time, and paid taxes during that entire period. She is concerned that she will not qualify
for coverage under part A because she was not born in the United States. What should
you tell her? - Most individuals who are citizens and over age 65 are covered under Part
A by virtue of having paid Medicare taxes while working, though some may be covered
as a result of paying monthly premiums.
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? - If a Part D benefit is offered through her plan she must enroll in this plan.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare? What could you tell him? - Part A, which
covers hospital, skilled nursing facility, hospice and home health services and Part B,
which covers professional services such as those provided by a doctor are covered
under Original Medicare.
Mrs. Wellington is enrolled in Parts A and B of Original Medicare. A friend recently told
her that there is an excellent Medicare Advantage (MA) plan with a five-star rating
serving her area. On January 15 she comes to you for advice as to what options, if any,
she has. What should you say regarding special enrollment periods (SEPs)? - Mrs.
Wellington is eligible for a SEP that may be used once until November 30 to enroll in the
five-star plan.
Mr. Shapiro gets by on a very small fixed income. He has heard there may be extra help
paying for Part D prescription drugs for Medicare beneficiaries with limited income. He
wants to know whether he might qualify. What should you tell him? - The extra help is
available to beneficiaries whose income and assets do not exceed annual limits
specified by the government.
A client wants to give you an enrollment application on October 1 prior to the beginning
of the Annual Election Period because he is leaving on vacation for two weeks and does
not want to forget about turning it in. What should you tell him? - You must tell him you
are not permitted to take the form. If he sends the form directly to the plan, the plan will
process the enrollment on the day the Annual Election Period begins.
