AHIP Module 3 Questions and Answers Graded A+
One of your clients, Lauren Nichols, has heard about Part D benefits through a standalone PDP or through
a Medicare concept from one of her neighbors called their plan. - ANSWER -a. I, II, and III only
TrOOP. She asks you to explain it. What do you say?
- ANSWER -d. TrOOP stands for true out-of-
pocket expenses that count toward the Medicare Part Mrs. Roswell is a new Medicare beneficiary who has
D catastrophic limit and include not only expenses just retired from retail work. She is interested in
paid by a beneficiary but also in some instances drug selecting a Medicare Part D prescription drug plan.
manufacturer discounts. 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
Mrs. Allen has a rare condition for which two different make an abrupt change to new drugs that would be
brand name drugs are the only available treatment. covered and asks what she should do. What should
She is concerned that since no generic prescription you tell her? - ANSWER -a. Every Part D drug
drug is available and these drugs are very high cost, plan is required to cover a single one-month fill of her
she will not be able to find a Medicare Part D existing medications sometime during a 90-day
prescription drug plan that covers either one of them. transition period.
What should you tell her? - ANSWER -c.
Medicare prescription drug plans are required to
cover drugs in each therapeutic category. She should Mr. Zachow has a condition for which three drugs are
be able to enroll in a Medicare prescription drug plan available. He has tried two but had an allergic
that covers the medications she needs. 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 -d. Mr.
Mrs. Quinn has just turned 65, is in excellent health Zachow has a right to request a formulary exception
and has a relatively high income. She uses no to obtain coverage for his Part D drug. He or his
medications and sees no reason to spend money on physician could obtain the standardized request form
a Medicare prescription drug plan if she does not on the plan's website, fill it out, and submit it to his
need the coverage. She currently does not have plan.
creditable coverage. What could you tell her about
the implications of such a decision? -
ANSWER -a. If she does not sign up for a Mr. Bickford did not quite qualify for the extra help
Medicare prescription drug plan as soon as she is low-income subsidy under the Medicare Part D
eligible to do so, and if she does sign up at a later Prescription Drug program and he is wondering if
date, her premium will be permanently increased by there is any other option he has for obtaining help
1% of the national average premium for every month with his considerable drug costs. What should you tell
that she was not covered. him? - ANSWER -b. He could check with the
manufacturers of his medications to see if they offer
an assistance program to help people with limited
Which of the following statements about Medicare means to obtain the medications they need.
Part D are correct? Alternatively, he could check to see whether his state
I. Part D plans must enroll any eligible beneficiary has a pharmacy assistance program to help him with
who applies regardless of health status except in his expenses.
limited circumstances.
II. Private fee-for-service (PFFS) plans are not
required to use a pharmacy network but may choose Ms. Edwards is enrolled in a Medicare Advantage
to have one. plan that includes prescription drug plan (PDP)
III. Beneficiaries enrolled in a MA-Medical Savings coverage. She is traveling and wishes to fill two of the
Account (MSA) plan may only obtain Part D benefits prescriptions that she has lost. How would you advise
through a standalone PDP. her? - ANSWER -b. She may fill prescriptions
IV. Beneficiaries enrolled in a MA-PPO may obtain for covered drugs at non-network pharmacies, but
1/3
One of your clients, Lauren Nichols, has heard about Part D benefits through a standalone PDP or through
a Medicare concept from one of her neighbors called their plan. - ANSWER -a. I, II, and III only
TrOOP. She asks you to explain it. What do you say?
- ANSWER -d. TrOOP stands for true out-of-
pocket expenses that count toward the Medicare Part Mrs. Roswell is a new Medicare beneficiary who has
D catastrophic limit and include not only expenses just retired from retail work. She is interested in
paid by a beneficiary but also in some instances drug selecting a Medicare Part D prescription drug plan.
manufacturer discounts. 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
Mrs. Allen has a rare condition for which two different make an abrupt change to new drugs that would be
brand name drugs are the only available treatment. covered and asks what she should do. What should
She is concerned that since no generic prescription you tell her? - ANSWER -a. Every Part D drug
drug is available and these drugs are very high cost, plan is required to cover a single one-month fill of her
she will not be able to find a Medicare Part D existing medications sometime during a 90-day
prescription drug plan that covers either one of them. transition period.
What should you tell her? - ANSWER -c.
Medicare prescription drug plans are required to
cover drugs in each therapeutic category. She should Mr. Zachow has a condition for which three drugs are
be able to enroll in a Medicare prescription drug plan available. He has tried two but had an allergic
that covers the medications she needs. 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 -d. Mr.
Mrs. Quinn has just turned 65, is in excellent health Zachow has a right to request a formulary exception
and has a relatively high income. She uses no to obtain coverage for his Part D drug. He or his
medications and sees no reason to spend money on physician could obtain the standardized request form
a Medicare prescription drug plan if she does not on the plan's website, fill it out, and submit it to his
need the coverage. She currently does not have plan.
creditable coverage. What could you tell her about
the implications of such a decision? -
ANSWER -a. If she does not sign up for a Mr. Bickford did not quite qualify for the extra help
Medicare prescription drug plan as soon as she is low-income subsidy under the Medicare Part D
eligible to do so, and if she does sign up at a later Prescription Drug program and he is wondering if
date, her premium will be permanently increased by there is any other option he has for obtaining help
1% of the national average premium for every month with his considerable drug costs. What should you tell
that she was not covered. him? - ANSWER -b. He could check with the
manufacturers of his medications to see if they offer
an assistance program to help people with limited
Which of the following statements about Medicare means to obtain the medications they need.
Part D are correct? Alternatively, he could check to see whether his state
I. Part D plans must enroll any eligible beneficiary has a pharmacy assistance program to help him with
who applies regardless of health status except in his expenses.
limited circumstances.
II. Private fee-for-service (PFFS) plans are not
required to use a pharmacy network but may choose Ms. Edwards is enrolled in a Medicare Advantage
to have one. plan that includes prescription drug plan (PDP)
III. Beneficiaries enrolled in a MA-Medical Savings coverage. She is traveling and wishes to fill two of the
Account (MSA) plan may only obtain Part D benefits prescriptions that she has lost. How would you advise
through a standalone PDP. her? - ANSWER -b. She may fill prescriptions
IV. Beneficiaries enrolled in a MA-PPO may obtain for covered drugs at non-network pharmacies, but
1/3
