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2024 AHIP CERTIFICATION MOD 3 EXAM WITH CORRECT ANSWERS
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AHIP CERTIFICATION MOD 3 EXAM WITH CORRECT ANSWERS
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AHIP CERTIFICATION MOD 3 EXAMWITH CORRECT ANSWERS
Drug plans for HMO or PPO can be obtained by: - CORRECT-ANSWERSOnly
through their HMO or PPO
How can Medicaid beneficiaries obtain a drug plan? - CORRECT-
ANSWERSOnly through Medicaid
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? - CORRECT-ANSWERSMr. 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
Note:
Mr. Carlini can stay in Original Medicare and obtain prescription drug benefits
through a stand-alone Part D plan. He does not have to enroll in a MA plan.
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? - CORRECT-ANSWERSMedicare
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.
Note:
Even if Mr. Vaughn's balding was the result of illness or a side effect of
chemotherapy, by law Part D plans are not permitted to provide coverage for
cosmetic purposes.
Mr. Hutchinson has drug coverage through his former employer's retiree
plan. He is concerned about the Part D premium penalty if he does not enroll
in a Medicare prescription drug plan, but does not want to purchase extra
coverage that he will not need. What should you tell him? - CORRECT-
ANSWERSIf the drug coverage he has is not expected to pay, on average, at
least as much as Medicare's standard Part D coverage expects to pay, then
, he will need to enroll in Medicare Part D during his initial eligibility period to
avoid the late enrollment penalty.
Note:
A penalty will be incurred if the employer coverage is not "creditable."
Prescription drug coverage is "creditable" if on average it equals at least as
much as Medicare's standard Part D coverage expects to pay.
All plans must cover at least the standard Part D coverage or its actuarial
equivalent. Which of the following statements best describes some of the
costs a beneficiary would incur for prescription drugs under the standard
coverage? - CORRECT-ANSWERSStandard Part D coverage would require
payment of an annual deductible, and once past the catastrophic coverage
threshold, the beneficiary pays whichever is greater of either the co-pays for
generic and brand name drugs or coinsurance of 5%
Note:
Standard Part D coverage does require payment of an annual deductible.
However, once catastrophic coverage begins the beneficiary pays either co-
pays for generic and brand name drugs or co-insurance of 5%, whichever is
greater. The plan does NOT pay 100% of all costs.
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? -
CORRECT-ANSWERSAn individual 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.
Note:
Mrs. Mulcahy can enroll in Part D because she is entitled to Part A. The rules
for Part D are different from those that apply to eligibility for Medicare
Advantage (Part C). Individuals entitled to Part A and/or enrolled in Part B are
eligible to enroll in Part D. In contrast, to enroll in an MA plan an individual
must be eligible for Part A and enrolled in Part B.
Part D Plan Types - CORRECT-ANSWERS-Stand Alone Prescription Drug Plans
(PDP)
-Medicare Advantage Prescription Drug (MA-PD)
-Cost PD Plans
-PACE Plans: Medicare/Medicaid plans
Who can enroll in stand alone Part D? - CORRECT-ANSWERS-MA-MSA
-PFFS
-Cost Plans
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