AHIP MODULE 3 QUESTIONS AND
ANSWERS
m 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? - 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? - 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? - 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. - 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? - 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? - 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. mJacob munderstands mthat mthere mis ma mstandard mMedicare mPart mD mprescription mdrug mbenefit, mbut
mwhen mhe mlooks mat minformation mon mvarious mplans mavailable min mhis marea, mhe msees ma mwide mrange
min mwhat mthey mcharge mfor mdeductibles, mpremiums mand mcost msharing. mHow mcan myou mexplain mthis
mto mhim? m- ma. mMedicare mPart mD mdrug mplans mmay m have mdifferent mbenefit mstructures, mbut mon
maverage, mthey mmust mall mbe mat mleast mas mgood mas mthe mstandard mmodel mestablished mby mthe
mgovernment. mCorrect
Ms. mEdwards mis menrolled min ma mMedicare mAdvantage mplan mthat mincludes mprescription mdrug mplan
m(PDP) mcoverage. mShe mis mtraveling mand mwishes mto mfill mtwo mof mher mprescriptions mthat mshe mhas
mlost. mHow mwould myou madvise mher? m- md. mShe mmay mfill mprescriptions mfor mcovered mdrugs mat mnon-
network mpharmacies, mbut mlikely mat ma mhigher mcost mthan mpaid mat man min-network mpharmacy. mCorrect
What mtypes mof mtools mcan mMedicare mPart mD mprescription mdrug mplans muse mthat maffect mthe mway
mtheir menrollees mcan maccess mmedications? m- mc. mPart mD mplans mdo mnot mhave mto mcover mall
mmedications. mAs ma mresult, mtheir mformularies, mor mlists mof mcovered mdrugs, mwill mvary mfrom mplan mto
mplan. mIn maddition, mthey mcan muse mcost mcontainment mtechniques msuch mas mtiered mco-payments mand
mprior mauthorization. mCorrect
Mrs. mAllen mhas ma mrare mcondition mfor mwhich mtwo mdifferent mbrand mname mdrugs mare mthe monly
mavailable mtreatment. mShe mis mconcerned mthat msince mno mgeneric mprescription mdrug mis mavailable mand
mthese mdrugs mare mvery mhigh mcost, mshe mwill mnot mbe mable mto mfind ma mMedicare mPart mD mprescription
mdrug mplan mthat mcovers meither mone mof mthem. mWhat mshould myou mtell mher? m- ma. mMedicare
mprescription mdrug mplans mare mrequired mto mcover mdrugs min meach mtherapeutic mcategory. mShe mshould
mbe mable mto menroll min ma mMedicare mprescription mdrug mplan mthat mcovers mthe mmedications mshe
mneeds. mCorrect
Mr. mand mMrs. mVaughn mboth mtake ma mspecialized mmultivitamin mprescription meach mday. mMr. mVaughn
mtakes ma mprescription mfor mhelping mto mregrow mhis mhair. mThey mare manxious mto mhave mtheir mMedicare
mprescription mdrug mplan mcover mthese mdrug mneeds. mWhat mshould myou mtell mthem? m- mb. mMedicare
mprescription mdrug mplans mare mnot mpermitted mto mcover mthe mprescription mmedications mthe mVaughns
mare minterested min munder mPart mD mcoverage, mhowever, mplans mmay mcover mthem mas msupplemental
mbenefits mand mthe mVaughn's mcould mlook minto mthat mpossibility. mCorrect
Under mwhat mconditions mcan ma mMedicare mprescription mdrug mplan mreduce mits mcoverage mfor ma mgiven
mdrug mduring mthe mfirst m60 mdays mof mthe myear? m- ma. mWhen ma mformulary mchange mis min mresponse mto
ma mdrug's mremoval mfrom mthe mmarket. mCorrect
Which mof mthe mfollowing msteps mmay ma mPart mD msponsor madopt mfor mbeneficiaries mwho mare mat mrisk
mof mmisusing mor mabusing mfrequently mabused mdrugs?
ANSWERS
m 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? - 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? - 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? - 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. - 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? - 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? - 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. mJacob munderstands mthat mthere mis ma mstandard mMedicare mPart mD mprescription mdrug mbenefit, mbut
mwhen mhe mlooks mat minformation mon mvarious mplans mavailable min mhis marea, mhe msees ma mwide mrange
min mwhat mthey mcharge mfor mdeductibles, mpremiums mand mcost msharing. mHow mcan myou mexplain mthis
mto mhim? m- ma. mMedicare mPart mD mdrug mplans mmay m have mdifferent mbenefit mstructures, mbut mon
maverage, mthey mmust mall mbe mat mleast mas mgood mas mthe mstandard mmodel mestablished mby mthe
mgovernment. mCorrect
Ms. mEdwards mis menrolled min ma mMedicare mAdvantage mplan mthat mincludes mprescription mdrug mplan
m(PDP) mcoverage. mShe mis mtraveling mand mwishes mto mfill mtwo mof mher mprescriptions mthat mshe mhas
mlost. mHow mwould myou madvise mher? m- md. mShe mmay mfill mprescriptions mfor mcovered mdrugs mat mnon-
network mpharmacies, mbut mlikely mat ma mhigher mcost mthan mpaid mat man min-network mpharmacy. mCorrect
What mtypes mof mtools mcan mMedicare mPart mD mprescription mdrug mplans muse mthat maffect mthe mway
mtheir menrollees mcan maccess mmedications? m- mc. mPart mD mplans mdo mnot mhave mto mcover mall
mmedications. mAs ma mresult, mtheir mformularies, mor mlists mof mcovered mdrugs, mwill mvary mfrom mplan mto
mplan. mIn maddition, mthey mcan muse mcost mcontainment mtechniques msuch mas mtiered mco-payments mand
mprior mauthorization. mCorrect
Mrs. mAllen mhas ma mrare mcondition mfor mwhich mtwo mdifferent mbrand mname mdrugs mare mthe monly
mavailable mtreatment. mShe mis mconcerned mthat msince mno mgeneric mprescription mdrug mis mavailable mand
mthese mdrugs mare mvery mhigh mcost, mshe mwill mnot mbe mable mto mfind ma mMedicare mPart mD mprescription
mdrug mplan mthat mcovers meither mone mof mthem. mWhat mshould myou mtell mher? m- ma. mMedicare
mprescription mdrug mplans mare mrequired mto mcover mdrugs min meach mtherapeutic mcategory. mShe mshould
mbe mable mto menroll min ma mMedicare mprescription mdrug mplan mthat mcovers mthe mmedications mshe
mneeds. mCorrect
Mr. mand mMrs. mVaughn mboth mtake ma mspecialized mmultivitamin mprescription meach mday. mMr. mVaughn
mtakes ma mprescription mfor mhelping mto mregrow mhis mhair. mThey mare manxious mto mhave mtheir mMedicare
mprescription mdrug mplan mcover mthese mdrug mneeds. mWhat mshould myou mtell mthem? m- mb. mMedicare
mprescription mdrug mplans mare mnot mpermitted mto mcover mthe mprescription mmedications mthe mVaughns
mare minterested min munder mPart mD mcoverage, mhowever, mplans mmay mcover mthem mas msupplemental
mbenefits mand mthe mVaughn's mcould mlook minto mthat mpossibility. mCorrect
Under mwhat mconditions mcan ma mMedicare mprescription mdrug mplan mreduce mits mcoverage mfor ma mgiven
mdrug mduring mthe mfirst m60 mdays mof mthe myear? m- ma. mWhen ma mformulary mchange mis min mresponse mto
ma mdrug's mremoval mfrom mthe mmarket. mCorrect
Which mof mthe mfollowing msteps mmay ma mPart mD msponsor madopt mfor mbeneficiaries mwho mare mat mrisk
mof mmisusing mor mabusing mfrequently mabused mdrugs?
