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AHIP MODULE 3 ACTUAL 2025/2026
QUESTIONS AND 100% CORRECT
ANSWERS
Mr. Carlini has heard that Medicare prescription drug plans are only offered
through private companies under a program known as Medicare Advantage (MA),
not by the government. He likes Original Medicare and does not want to sign up
for an MA product, but he also wants prescription drug coverage. What should
you tell him? - (ANSWER)b. Mr. Carlini can stay with Original Medicare and also
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. Correct
Mrs. Mulcahy 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? - (ANSWER)a.
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 Mrs. Mulcahy is entitled to Part A, she
does not need to enroll under Part B before enrolling in a prescription drug plan.
Correct
Mrs. Lopez is enrolled in a Medicare Advantage cost plan. 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)b. If a Part D benefit is offered through her plan
she may choose in enroll in that plan or a standalone PDP. Correct
Which of the following statements about Medicare Part D are correct?
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I. Part D plans must enroll any eligible beneficiary who applies regardless of health
status except in limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network
but may choose to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only
obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan. - (ANSWER)b. I, II, and III only Correct
All plans must cover at least the standard Part D coverage or its actuarial
equivalent. What costs would a beneficiary incur for prescription drugs in 2019
under the standard coverage? - (ANSWER)c. Standard Part D coverage would
require payment of an annual deductible, 25% cost-sharing up to the coverage
gap, a portion of costs for both generics and brand-name drugs in the coverage
gap, and co-pays or co-insurance after the coverage gap. Correct
Mrs. Andrews was preparing a budget for next year because she takes quite a few
prescription drugs, she will reach the coverage gap, and wants to be sure she has
enough money set aside for those months. She received assistance calculating her
projected expenses from her daughter who is a pharmacist, but she doesn't think
the calculations are correct because her out-of-pocket expenses would be lower
than last year. She calls to ask if you can help. What might you tell her? -
(ANSWER)a. It would not be unusual for her costs to be a bit less because the
Bipartisan Budget Act of 2018 moved up the date for closing the so-called "donut
hole" for brand name drugs to 2019. Correct
AHIP MODULE 3 ACTUAL 2025/2026
QUESTIONS AND 100% CORRECT
ANSWERS
Mr. Carlini has heard that Medicare prescription drug plans are only offered
through private companies under a program known as Medicare Advantage (MA),
not by the government. He likes Original Medicare and does not want to sign up
for an MA product, but he also wants prescription drug coverage. What should
you tell him? - (ANSWER)b. Mr. Carlini can stay with Original Medicare and also
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. Correct
Mrs. Mulcahy 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? - (ANSWER)a.
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 Mrs. Mulcahy is entitled to Part A, she
does not need to enroll under Part B before enrolling in a prescription drug plan.
Correct
Mrs. Lopez is enrolled in a Medicare Advantage cost plan. 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)b. If a Part D benefit is offered through her plan
she may choose in enroll in that plan or a standalone PDP. Correct
Which of the following statements about Medicare Part D are correct?
, 2
I. Part D plans must enroll any eligible beneficiary who applies regardless of health
status except in limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network
but may choose to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only
obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan. - (ANSWER)b. I, II, and III only Correct
All plans must cover at least the standard Part D coverage or its actuarial
equivalent. What costs would a beneficiary incur for prescription drugs in 2019
under the standard coverage? - (ANSWER)c. Standard Part D coverage would
require payment of an annual deductible, 25% cost-sharing up to the coverage
gap, a portion of costs for both generics and brand-name drugs in the coverage
gap, and co-pays or co-insurance after the coverage gap. Correct
Mrs. Andrews was preparing a budget for next year because she takes quite a few
prescription drugs, she will reach the coverage gap, and wants to be sure she has
enough money set aside for those months. She received assistance calculating her
projected expenses from her daughter who is a pharmacist, but she doesn't think
the calculations are correct because her out-of-pocket expenses would be lower
than last year. She calls to ask if you can help. What might you tell her? -
(ANSWER)a. It would not be unusual for her costs to be a bit less because the
Bipartisan Budget Act of 2018 moved up the date for closing the so-called "donut
hole" for brand name drugs to 2019. Correct
