AHIP Module 3 QUESTIONS AND ANSWERS
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. She asks you to explain it. What do you say? Correct Answer: d. TrOOP stands for true out-of-pocket expenses that count toward the Medicare Part D...
has heard about a medicare concept from one of her neighbors cal
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AHIP 2020-2021 Module 3 QUESTIONS AND ANSWERS
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her
neighbors called TrOOP. She asks you to explain it. What do you say? Correct Answer: d.
TrOOP stands for true out-of-pocket expenses that count toward the Medicare Part D
catastrophic limit and include not only expenses paid by a beneficiary but also in some instances
drug manufacturer discounts.
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? Correct Answer: c. 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.
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. She currently does not have creditable coverage. What could you tell
her about the implications of such a decision? Correct Answer: a. If she does not sign up for a
Medicare prescription drug plan as soon as she is eligible to do so, and 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.
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.
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. Correct Answer: a. I, II, and III only
Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. She 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? Correct Answer: a. 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.
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? Correct Answer: d. Mr. Zachow has a right to request
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