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AHIP (America’s Health Insurance Plans) Newest
2025 Final Exam Test Bank featuring 500
accurate and verified questions covering
Medicare Advantage, Medicare Part D, fraud,
waste, and abuse (FWA), enrollment procedures,
compliance guidelines, and ethic
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
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her? - ....ANSWER ....✔✔ d. 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 ....✔✔ a. 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?
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.
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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 ....✔✔ d. It would not be unusual for her
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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
Mr. Jacob understands that there is a standard
Medicare Part D prescription drug benefit, but when he
looks at information on various plans available in his
area, he sees a wide range in what they charge for
deductibles, premiums and cost sharing. How can you
explain this to him? - ....ANSWER ....✔✔ a. Medicare
Part D drug plans may have different benefit structures,
but on average, they must all be at least as good as the
standard model established by the government. Correct
Ms. Edwards is enrolled in a Medicare Advantage plan
that includes prescription drug plan (PDP) coverage. She
is traveling and wishes to fill two of her prescriptions
that she has lost. How would you advise her? -
....ANSWER ....✔✔ d. She may fill prescriptions for
covered drugs at non-network pharmacies, but likely at
a higher cost than paid at an in-network pharmacy.
Correct
What types of tools can Medicare Part D prescription
drug plans use that affect the way their enrollees can
access medications? - ....ANSWER ....✔✔ c. Part D
plans do not have to cover all medications. As a result,
AHIP (America’s Health Insurance Plans) Newest
2025 Final Exam Test Bank featuring 500
accurate and verified questions covering
Medicare Advantage, Medicare Part D, fraud,
waste, and abuse (FWA), enrollment procedures,
compliance guidelines, and ethic
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
,2|Page
her? - ....ANSWER ....✔✔ d. 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 ....✔✔ a. 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?
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.
,3|Page
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 ....✔✔ d. It would not be unusual for her
, 4|Page
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
Mr. Jacob understands that there is a standard
Medicare Part D prescription drug benefit, but when he
looks at information on various plans available in his
area, he sees a wide range in what they charge for
deductibles, premiums and cost sharing. How can you
explain this to him? - ....ANSWER ....✔✔ a. Medicare
Part D drug plans may have different benefit structures,
but on average, they must all be at least as good as the
standard model established by the government. Correct
Ms. Edwards is enrolled in a Medicare Advantage plan
that includes prescription drug plan (PDP) coverage. She
is traveling and wishes to fill two of her prescriptions
that she has lost. How would you advise her? -
....ANSWER ....✔✔ d. She may fill prescriptions for
covered drugs at non-network pharmacies, but likely at
a higher cost than paid at an in-network pharmacy.
Correct
What types of tools can Medicare Part D prescription
drug plans use that affect the way their enrollees can
access medications? - ....ANSWER ....✔✔ c. Part D
plans do not have to cover all medications. As a result,
