AHIP 2025 MODULE 3 EXAM
QUESTIONS AND ANSWERS
Mr. Zachow has a condition for which three drugs are available. He has tried two but
had an allergic reaction to them. Only the third drug works for him and it is not on his
Part D plan's formulary. What could you tell him to do? - Answer- Mr. Zachow has a
right to request a formulary exception to obtain coverage for his Part D drug. He or
his physician could obtain the standardized request form on the plan's website, fill it
out, and submit it to his plan.
Mr. Rice is 68, actively working, and has coverage for medical services and
medications through his employer's group health plan. He is entitled to premium free
Part A and thinking of enrolling in Part B and switching to an MA-PD because he is
paying a very large part of his group coverage premium, and it does not provide
coverage for a number of his medications. Which of the following is NOT a
consideration when making the change? - Answer- Mr. Rice's retiree plan is required
to take him back if, within 63 days of having voluntarily quit the employer's plan, he
decides that he prefers it to his Medicare Part D plan.
Mrs. Hernandez is one of your clients. She has read that there is a new program that
may help her manage prescription drug costs. What do you tell her about the
Medicare Prescription Payment Plan? - Answer- Part D enrollees can opt into the
Medicare Prescription Payment Plan at the beginning of the plan year or any point
during the year.
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. 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? - Answer- If a Part D benefit is offered through her plan she may
choose to enroll in that plan or a standalone PDP.
One of your clients, Lauren Nichols, has heard about a Medicare concept from one
of her neighbors called TrOOP. She asks you to explain it. What do you say? -
Answer- TrOOP stands for true out-of-pocket costs that count toward the Medicare
Part D catastrophic limit and include not only expenses paid by a beneficiary but also
in some instances amounts paid by or through qualified State Pharmaceutical
Assistance Programs.
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? - 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.
Mrs. Roswell 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
QUESTIONS AND ANSWERS
Mr. Zachow has a condition for which three drugs are available. He has tried two but
had an allergic reaction to them. Only the third drug works for him and it is not on his
Part D plan's formulary. What could you tell him to do? - Answer- Mr. Zachow has a
right to request a formulary exception to obtain coverage for his Part D drug. He or
his physician could obtain the standardized request form on the plan's website, fill it
out, and submit it to his plan.
Mr. Rice is 68, actively working, and has coverage for medical services and
medications through his employer's group health plan. He is entitled to premium free
Part A and thinking of enrolling in Part B and switching to an MA-PD because he is
paying a very large part of his group coverage premium, and it does not provide
coverage for a number of his medications. Which of the following is NOT a
consideration when making the change? - Answer- Mr. Rice's retiree plan is required
to take him back if, within 63 days of having voluntarily quit the employer's plan, he
decides that he prefers it to his Medicare Part D plan.
Mrs. Hernandez is one of your clients. She has read that there is a new program that
may help her manage prescription drug costs. What do you tell her about the
Medicare Prescription Payment Plan? - Answer- Part D enrollees can opt into the
Medicare Prescription Payment Plan at the beginning of the plan year or any point
during the year.
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. 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? - Answer- If a Part D benefit is offered through her plan she may
choose to enroll in that plan or a standalone PDP.
One of your clients, Lauren Nichols, has heard about a Medicare concept from one
of her neighbors called TrOOP. She asks you to explain it. What do you say? -
Answer- TrOOP stands for true out-of-pocket costs that count toward the Medicare
Part D catastrophic limit and include not only expenses paid by a beneficiary but also
in some instances amounts paid by or through qualified State Pharmaceutical
Assistance Programs.
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? - 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.
Mrs. Roswell 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
