AHIP 2025 MODULE 3 QUESTIONS WITH
VERIFIED ANSWERS (ALREADY
GRADED A+)
Mr. Zachow has a condition for which three drugs are available. He has tried two but had an allergic react
ion to them. Only the third drug works for him and it is not on his Part D plan's formulary. What could yo
u tell him to do? - correct 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 empl
oyer's group health plan. He is entitled to premium free Part A and thinking of enrolling in Part B and swi
tchingYto an MA-
PD because he is paying a very large part of his group coverage premium, and it does not provide coverag
e for a number of his medications. Which of the following is NOT a consideration when making the chang
e? -Ycorrect answer-
Mr. Rice's retiree plan is required to take him back if, within 63 days of having voluntarily quit the employ
er'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 manag
e prescription drug costs. What do you tell her about the Medicare Prescription Payment Plan? -
correct answer-
Part D enrollees can opt into the Medicare Prescription Payment Plan at the beginning of the plan year or
any point duringYthe 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 PartYD p
rescription drug plan (PDP). What should you tell her? - correct answer-
If a Part D benefit isYoffered 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 calle
d TrOOP. She asks you to explain it. What do you say? - correct answer-TrOOP stands for true out-of-
pocket costs that count toward the Medicare Part D catastrophic limit and include not only expenses pai
d by a beneficiary but also in some instances amounts paid by or through qualified State Pharmaceutical
Assistance Programs.
, Ms. LEdwards Lis Lenrolled Lin La LMedicare LAdvantage Lplan Lthat Lincludes Lprescription Ldrug Lplan L(PDP)
Lcoverag
e. LShe Lis Ltraveling Land Lwishes Lto Lfill Ltwo Lof Lthe Lprescriptions Lthat Lshe Lhas Llost. LHow Lwould Lyou
Ladvise Lher?
- Lcorrect Lanswer-She Lmay Lfill Lprescriptions Lfor Lcovered Ldrugs Lat Lnon-
network Lpharmacies, Lbut Llikely Lat La Lhigher Lcost Lthan Lpaid Lat Lan Lin-network Lpharmacy.
Mrs. LRoswell Lis La Lnew LMedicare Lbeneficiary Lwho Lhas Ljust Lretired Lfrom Lretail Lwork. LShe Lis
Linterested Lin Lsele Lcting La LMedicare LPart LD Lprescription Ldrug Lplan. LShe Ltakes Lseveral Lmedications
Land Lis Lconcerned Lthat Lshe Lh Las Lnot Lbeen Lable Lto Lidentify La Lplan Lthat Lcovers Lall Lof Lher
Lmedications. LShe Ldoes Lnot Lwant Lto Lmake Lan Labru LptYchange Lto Lnew Ldrugs Lthat Lwould Lbe
Lcovered Land Lasks Lwhat Lshe Lshould Ldo. LWhat Lshould Lyou Ltell Lher? L- Lcorrect Lanswer-Every LPart LD
Ldrug Lplan Lis Lrequired Lto Lcover La Lsingle Lone-
month Lfill Lof Lher LexistingYmedications Lsometime Lduring La L90-day Ltransition Lperiod.
Mr. LJacob Lunderstands Lthat Lthere Lis La Lstandard LMedicare LPart LD Lprescription Ldrug Lbenefit, Lbut
Lwhen Lhe Llo Loks Lat Linformation Lon Lvarious Lplans Lavailable Lin Lhis Larea, Lhe Lsees La Lwide Lrange Lin
Lwhat Lthey Lcharge Lfor Lde Lductibles, Lpremiums, Land Lcost Lsharing. LHow Lcan Lyou Lexplain Lthis Lto
Lhim? L- Lcorrect Lanswer-
Medicare LPart LD Ldrug Lplans Lmay Lhave Ldifferent Lbenefit Lstructures, Lbut Lon Laverage, Lthey Lmust Lall
Lbe Lat Llea Lst Las Lgood Las Lthe Lstandard Lmodel Lestablished Lby Lthe Lgovernment.
WhatYtypes Lof Ltools Lcan LMedicare LPart LD Lprescription Ldrug Lplans Luse Lthat Laffect Lthe Lway Ltheir
Lenrollees Lc Lan Laccess Lmedications? L- Lcorrect Lanswer-
Part LD Lplans Ldo Lnot Lhave Lto Lcover Lall Lmedications. LAs La Lresult, Ltheir Lformularies, Lor Llists Lof
Lcovered Ldrugs, Lwill Lvary Lfrom Lplan Lto Lplan. LIn Laddition, Lthey Lcan Luse Lcost Lcontainment
Ltechniques Lsuch Las Ltiered Lco- Lpayments Land Lstep Ltherapy.
Mr. Land LMrs. LVaughn Lboth Ltake La Lspecialized Lmultivitamin Lprescription Leach Lday. LMr. LVaughn
Ltakes La Lpres Lcription Lto Lhelp Lto Lregrow Lhis Lhair. LThey Lare Lanxious Lto Lhave Ltheir LMedicare
Lprescription Ldrug Lplan Lcover Lt Lhese Ldrug Lneeds. LWhat Lshould Lyou Ltell Lthem? L- Lcorrect Lanswer-
Medicare Lprescription Ldrug Lplans Lare Lnot Lpermitted Lto Lcover Lthe Lprescription Lmedications Lthe
LVaughns Lar Le Linterested Lin Lunder LPart LD Lcoverage, Lhowever, Lplans Lmay Lcover Lthem Las
Lsupplemental Lbenefits Land Lthe LVaughns Lcould Llook Linto Lthat Lpossibility.
Mr. LCarlini LhasYheard Lthat LMedicare Lprescription LdrugYplans Lare Lonly Loffered Lthrough Lprivate
Lcompanies Lu Lnder La Lprogram Lknown Las LMedicare LAdvantage L(MA), Lnot Lby Lthe Lgovernment. LHe
Llikes LOriginal LMedicare Land Ldoes Lnot Lwant Lto Lsign Lup Lfor Lan LMA Lproduct, Lbut Lhe Lalso Lwants
Lprescription LdrugYcoverage. LWhat Lsho Luld Lyou Ltell Lhim? L- Lcorrect Lanswer-
Mr. LCarlini Lcan Lstay Lwith LOriginal LMedicare Land Lalso Lenroll Lin La LMedicare Lprescription Ldrug Lplan
Lthrough La Lprivate Lcompany Lthat Lhas Lcontracted Lwith Lthe Lgovernment Lto Lprovide Lonly Lsuch Ldrug
Lcoverage Lto Leligible LMedicare Lbeneficiaries.
VERIFIED ANSWERS (ALREADY
GRADED A+)
Mr. Zachow has a condition for which three drugs are available. He has tried two but had an allergic react
ion to them. Only the third drug works for him and it is not on his Part D plan's formulary. What could yo
u tell him to do? - correct 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 empl
oyer's group health plan. He is entitled to premium free Part A and thinking of enrolling in Part B and swi
tchingYto an MA-
PD because he is paying a very large part of his group coverage premium, and it does not provide coverag
e for a number of his medications. Which of the following is NOT a consideration when making the chang
e? -Ycorrect answer-
Mr. Rice's retiree plan is required to take him back if, within 63 days of having voluntarily quit the employ
er'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 manag
e prescription drug costs. What do you tell her about the Medicare Prescription Payment Plan? -
correct answer-
Part D enrollees can opt into the Medicare Prescription Payment Plan at the beginning of the plan year or
any point duringYthe 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 PartYD p
rescription drug plan (PDP). What should you tell her? - correct answer-
If a Part D benefit isYoffered 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 calle
d TrOOP. She asks you to explain it. What do you say? - correct answer-TrOOP stands for true out-of-
pocket costs that count toward the Medicare Part D catastrophic limit and include not only expenses pai
d by a beneficiary but also in some instances amounts paid by or through qualified State Pharmaceutical
Assistance Programs.
, Ms. LEdwards Lis Lenrolled Lin La LMedicare LAdvantage Lplan Lthat Lincludes Lprescription Ldrug Lplan L(PDP)
Lcoverag
e. LShe Lis Ltraveling Land Lwishes Lto Lfill Ltwo Lof Lthe Lprescriptions Lthat Lshe Lhas Llost. LHow Lwould Lyou
Ladvise Lher?
- Lcorrect Lanswer-She Lmay Lfill Lprescriptions Lfor Lcovered Ldrugs Lat Lnon-
network Lpharmacies, Lbut Llikely Lat La Lhigher Lcost Lthan Lpaid Lat Lan Lin-network Lpharmacy.
Mrs. LRoswell Lis La Lnew LMedicare Lbeneficiary Lwho Lhas Ljust Lretired Lfrom Lretail Lwork. LShe Lis
Linterested Lin Lsele Lcting La LMedicare LPart LD Lprescription Ldrug Lplan. LShe Ltakes Lseveral Lmedications
Land Lis Lconcerned Lthat Lshe Lh Las Lnot Lbeen Lable Lto Lidentify La Lplan Lthat Lcovers Lall Lof Lher
Lmedications. LShe Ldoes Lnot Lwant Lto Lmake Lan Labru LptYchange Lto Lnew Ldrugs Lthat Lwould Lbe
Lcovered Land Lasks Lwhat Lshe Lshould Ldo. LWhat Lshould Lyou Ltell Lher? L- Lcorrect Lanswer-Every LPart LD
Ldrug Lplan Lis Lrequired Lto Lcover La Lsingle Lone-
month Lfill Lof Lher LexistingYmedications Lsometime Lduring La L90-day Ltransition Lperiod.
Mr. LJacob Lunderstands Lthat Lthere Lis La Lstandard LMedicare LPart LD Lprescription Ldrug Lbenefit, Lbut
Lwhen Lhe Llo Loks Lat Linformation Lon Lvarious Lplans Lavailable Lin Lhis Larea, Lhe Lsees La Lwide Lrange Lin
Lwhat Lthey Lcharge Lfor Lde Lductibles, Lpremiums, Land Lcost Lsharing. LHow Lcan Lyou Lexplain Lthis Lto
Lhim? L- Lcorrect Lanswer-
Medicare LPart LD Ldrug Lplans Lmay Lhave Ldifferent Lbenefit Lstructures, Lbut Lon Laverage, Lthey Lmust Lall
Lbe Lat Llea Lst Las Lgood Las Lthe Lstandard Lmodel Lestablished Lby Lthe Lgovernment.
WhatYtypes Lof Ltools Lcan LMedicare LPart LD Lprescription Ldrug Lplans Luse Lthat Laffect Lthe Lway Ltheir
Lenrollees Lc Lan Laccess Lmedications? L- Lcorrect Lanswer-
Part LD Lplans Ldo Lnot Lhave Lto Lcover Lall Lmedications. LAs La Lresult, Ltheir Lformularies, Lor Llists Lof
Lcovered Ldrugs, Lwill Lvary Lfrom Lplan Lto Lplan. LIn Laddition, Lthey Lcan Luse Lcost Lcontainment
Ltechniques Lsuch Las Ltiered Lco- Lpayments Land Lstep Ltherapy.
Mr. Land LMrs. LVaughn Lboth Ltake La Lspecialized Lmultivitamin Lprescription Leach Lday. LMr. LVaughn
Ltakes La Lpres Lcription Lto Lhelp Lto Lregrow Lhis Lhair. LThey Lare Lanxious Lto Lhave Ltheir LMedicare
Lprescription Ldrug Lplan Lcover Lt Lhese Ldrug Lneeds. LWhat Lshould Lyou Ltell Lthem? L- Lcorrect Lanswer-
Medicare Lprescription Ldrug Lplans Lare Lnot Lpermitted Lto Lcover Lthe Lprescription Lmedications Lthe
LVaughns Lar Le Linterested Lin Lunder LPart LD Lcoverage, Lhowever, Lplans Lmay Lcover Lthem Las
Lsupplemental Lbenefits Land Lthe LVaughns Lcould Llook Linto Lthat Lpossibility.
Mr. LCarlini LhasYheard Lthat LMedicare Lprescription LdrugYplans Lare Lonly Loffered Lthrough Lprivate
Lcompanies Lu Lnder La Lprogram Lknown Las LMedicare LAdvantage L(MA), Lnot Lby Lthe Lgovernment. LHe
Llikes LOriginal LMedicare Land Ldoes Lnot Lwant Lto Lsign Lup Lfor Lan LMA Lproduct, Lbut Lhe Lalso Lwants
Lprescription LdrugYcoverage. LWhat Lsho Luld Lyou Ltell Lhim? L- Lcorrect Lanswer-
Mr. LCarlini Lcan Lstay Lwith LOriginal LMedicare Land Lalso Lenroll Lin La LMedicare Lprescription Ldrug Lplan
Lthrough La Lprivate Lcompany Lthat Lhas Lcontracted Lwith Lthe Lgovernment Lto Lprovide Lonly Lsuch Ldrug
Lcoverage Lto Leligible LMedicare Lbeneficiaries.
