AHIP Module 3: Mr. Carlini has heard that Medicare prescription drug plans are only offered through
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AHIP Module 3
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 prescript...
AHIP Module 3
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? -
✔✔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? - ✔✔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? - ✔✔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.
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. - ✔✔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? - ✔✔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? - ✔✔d. 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
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? - ✔✔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? - ✔✔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? - ✔✔c. Part D plans do not have to cover all
medications. As a result, their formularies, or lists of covered drugs, will vary from plan
to plan. In addition, they can use cost containment techniques such as tiered co-
payments and prior authorization. Correct
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? -
✔✔a. 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. Correct
Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr.
Vaughn takes a prescription for helping to regrow his hair. They are anxious to have
their Medicare prescription drug plan cover these drug needs. What should you tell
them? - ✔✔b. Medicare prescription drug plans are not permitted to cover the
prescription medications the Vaughns are interested in under Part D coverage,
however, plans may cover them as supplemental benefits and the Vaughn's could look
into that possibility. Correct
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
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