AHIP Module 3 Already Rated A

AHIP Module 3 Already Rated A Question 1: Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA). What should you tell him? a. He can stay with Original Medicare and 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. b. He needs to enroll in a Medicare Advantage plan to get prescription drug coverage. c. He can only enroll in a Medicare prescription drug plan if he enrolls in a Medicare Advantage plan. Correct answer: a. He can stay with Original Medicare and 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. Question 2: Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare prescription drug plan because she is not enrolled under Part B. What should you tell her? a. She needs to enroll under Part B before enrolling in a prescription drug plan. b. 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 she is entitled to Part A, she does not need to enroll under Part B before enrolling in a prescription drug plan. c. She needs to wait until she turns 65 to enroll in a prescription drug plan. Correct answer: b. 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 she is entitled to Part A, she does not need to enroll under Part B before enrolling in a prescription drug plan. Under what conditions can a Medicare prescription drug plan reduce its coverage for a given drug during the first 60 days of the year? ️a. When a formulary change is in response to a drug's removal from the market. Correct Which of the following steps may a Part D sponsor adopt for beneficiaries who are at risk of misusing or abusing frequently abused drugs? I. Identifying at risk individuals by using criteria that includes the number of opioid prescriptions the beneficiary has and the number of prescribers who have written those prescriptions. II. Locking an at-risk beneficiary into one pharmacy. III. Locking an at-risk beneficiary into one prescriber. IV. Increasing deductibles and copays for at-risk beneficiaries ️c. I, II and III only Correct Mrs. Roswell is a new Medicare beneficiary and is interested in selecting a Medicare Part D prescription drug plan. She takes a number of medications and is concerned that she has not been able to identify a plan that covers all of her medications. She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. What should you tell her? ️c. Every Part D drug plan is required to cover a single one-month fill of her existing medications sometime during a 90 day transition period. Correct 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? ️a. 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. Correct Mrs. Quinn has just turned 65, is in excellent health, and has a relatively high income. She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. What could you tell her about the implications of such a decision? ️b. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, if she does sign up at a later date, her premium will be permanently increased by 1% of the national average premium for every month that she was not covered. Correct Mr. Torres has a small savings account. He would like to pay for his monthly Part 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? ️c. In general, he must select a single Part D premium payment mechanism that will be used throughout the year. Correct Mr. Katz reached the Part D coverage gap in August last year. His prescriptions have not changed, he is keeping the same Part D plan and the benefits, cost-sharing, and coverage of his drugs are all the same as last year. He asked what to expect for this year about his out-of-pocket costs. What could you tell him? ️d. Because he reached the coverage gap last year, he will probably reach it again this year close to the same time. Correct