AHIP Module 3
1. Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollmentin a Medicare
prescription drug plan because, although she is entitled to PartA, she is not enrolled under
Medicare Part B. What should you tell her?
Answer: An individual 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, shedoes
not need to enroll under Part B before enrolling in a prescription drug plan.
2. Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is
concerned about the Part D premium penalty if he does not enrollin a Medicare prescription
drug plan, but does not want to purchase extra coverage that he will not need. What should you
tell him?
Answer: If the drug coveragehe has is not expected to pay, on average, at least as much as
Medicare's standardPart D coverage expects to pay, then he will need to enroll in Medicare Part
D duringhis initial eligibility period to avoid the late enrollment penalty.
3. Mr.Torres has a small savings account. He would like to pay for his monthlyPart D premiums
with an automatic monthly withdrawal from his savings account until it is exhausted, and then
have his premiums withheld from his Social Security check. What should you tell him?
Answer: In general, he must select a single Part D premium payment mechanism that will be
used throughout the year.
4. Mr. Wingate 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 count toward TrOOP should he
ever reach the Part D catastrophic limit.What shouldyou say.
Answer: None of the costs of Mr. Wingate's other medications would currently
count toward TrOOP but he may wish to ask his plan for an exception to cover theprescription,
not on its formulary.
5. Mr. Hildalgo complains to you that because he takes multiple expensivedrugs, 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?
1. Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollmentin a Medicare
prescription drug plan because, although she is entitled to PartA, she is not enrolled under
Medicare Part B. What should you tell her?
Answer: An individual 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, shedoes
not need to enroll under Part B before enrolling in a prescription drug plan.
2. Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is
concerned about the Part D premium penalty if he does not enrollin a Medicare prescription
drug plan, but does not want to purchase extra coverage that he will not need. What should you
tell him?
Answer: If the drug coveragehe has is not expected to pay, on average, at least as much as
Medicare's standardPart D coverage expects to pay, then he will need to enroll in Medicare Part
D duringhis initial eligibility period to avoid the late enrollment penalty.
3. Mr.Torres has a small savings account. He would like to pay for his monthlyPart D premiums
with an automatic monthly withdrawal from his savings account until it is exhausted, and then
have his premiums withheld from his Social Security check. What should you tell him?
Answer: In general, he must select a single Part D premium payment mechanism that will be
used throughout the year.
4. Mr. Wingate 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 count toward TrOOP should he
ever reach the Part D catastrophic limit.What shouldyou say.
Answer: None of the costs of Mr. Wingate's other medications would currently
count toward TrOOP but he may wish to ask his plan for an exception to cover theprescription,
not on its formulary.
5. Mr. Hildalgo complains to you that because he takes multiple expensivedrugs, 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?
