2025 AHIP Module 3-Questions with Correct Answers/Verified
Mr. Shapiro gets by on a very small amount of 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.
Mrs. Allen has a rare condition for which two different brand name drugs are the only
available treatment. She is concerned that since no generic prescription drug is available
and these drugs are very high cost, she will not be able to find a Medicare Part D
prescription drug plan that covers either one of them. What should you tell her? -
✔✔Medicare prescription drug plans are required to cover drugs in each therapeutic
category. She should be able to enroll in a Medicare prescription drug plan that covers the
medications she needs.
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 should you say. - ✔✔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 the prescription, not on its formulary.
What types of tools can Medicare Part D prescription drug plans use that affect the way
their enrollees can access medications? - ✔✔Part D plans do not have to cover all
medications. As a result, their formularies, or lists of covered drugs, will vary from plan to
plan. In addition, they can use cost containment techniques such as tiered co-payments and
step therapy.
Mrs. Mulcahy, age 65, 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? - ✔✔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, she does not need to enroll under Part B before enrolling
in a prescription drug plan.
Mr. Shapiro gets by on a very small amount of 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.
Mrs. Allen has a rare condition for which two different brand name drugs are the only
available treatment. She is concerned that since no generic prescription drug is available
and these drugs are very high cost, she will not be able to find a Medicare Part D
prescription drug plan that covers either one of them. What should you tell her? -
✔✔Medicare prescription drug plans are required to cover drugs in each therapeutic
category. She should be able to enroll in a Medicare prescription drug plan that covers the
medications she needs.
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 should you say. - ✔✔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 the prescription, not on its formulary.
What types of tools can Medicare Part D prescription drug plans use that affect the way
their enrollees can access medications? - ✔✔Part D plans do not have to cover all
medications. As a result, their formularies, or lists of covered drugs, will vary from plan to
plan. In addition, they can use cost containment techniques such as tiered co-payments and
step therapy.
Mrs. Mulcahy, age 65, 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? - ✔✔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, she does not need to enroll under Part B before enrolling
in a prescription drug plan.
