Ahip Healthcare 101 Section Medicare Module 2 Latest Updated 2024
Module
Question1
Marks: 1
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 pla...
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?
Choose one answer.
a. He will need to enroll in a Medicare prescription drug plan upon becoming eligible for
the program in order to avoid a premium penalty. To reduce his expenses, he should
look for a plan with a zero premium.
b. If 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.
c. As long as he has any sort of employer coverage, regardless of the level of coverage,
he will incur no penalty if he does not enroll in a Part D plan when first eligible.
d. He should drop the employer coverage and enroll in a Medicare prescription drug
plan. Employer plans are almost always more costly for beneficiaries and most do not
cover the same range of drugs available from a Medicare prescription drug plan.
Correct
Marks for this submission: 1/1.
,Question2
Marks: 1
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?
Choose one answer.
a. Medicare prescription drug plans are required to include only a certain percentage of brand
name drugs among those they cover. It may be possible that plans available in her area have
opted not to include in their formularies the brand name drugs she needs. She may need to
pay for this particular medication out of pocket.
b. When medication costs exceed a certain threshold amount, which rises each year, a
Medicare prescription drug plan is permitted to exclude coverage for all but the least
expensive of the medications in a given category. Mrs. Allen will need to encourage her
physician to prescribe the least expensive of the two alternatives.
c. Medicare prescription drug plans are allowed to restrict their coverage to generic drugs.
She will need to pay for her brand name medications out of pocket.
d. 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
Marks for this submission: 1/1.
Question3
Marks: 1
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
the prescriptions that she has lost. How would you advise her?
Choose one answer.
, a. She may fill one prescription out-of-network per year and it will be fully covered. Her
second prescription will require her to pay the full cost out-of-pocket.
b. She should wait to fill her prescriptions until she is back home since only her local
pharmacy is likely to be in her plan’s network.
c. She may fill both prescriptions and they will be fully covered at in-network pricing due to
the fact that she is traveling.
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
Marks for this submission: 1/1.
Question4
Marks: 1
Which of the following steps may a Part D sponsor adopt for beneficiaries who are at risk of misusing or abusing frequently abused drugs?
Identifying at risk individuals by using criteria that includes the number of opioid prescriptions the beneficiary has and the number of prescribers who
have written those prescriptions.
Locking an at-risk beneficiary into one pharmacy.
Locking an at-risk beneficiary into one prescriber.
Increasing deductibles and copays for at-risk beneficiaries.
Choose one answer.
a. I only
b. I, II, III, and IV
c. I, II and III only
d. I and II only
Correct
, Marks for this submission: 1/1.
Question5
Marks: 1
Mr. Rice has coverage for medical services and medications through his employer’s retiree plan. He is considering switching to a Medicare
prescription drug plan because his retiree plan does not cover two important medications. What should he consider before making a change?
Choose one answer.
a. If his drug coverage through the retiree plan is “creditable” he should not switch, even
though it is possible to do so.
b. Mr. Rice’s retiree plan is required to take him back if, within 63 days of having
voluntarily quit the employer’s plan, he decides that he prefers it to his Medicare Part D
plan.
c. If Mr. Rice drops his drug coverage through the retiree plan, he may not be able to get
it back and he also may lose his medical health coverage.
d. Mr. Rice can only receive his prescription drug coverage through a Medicare
Advantage prescription drug plan so he should drop his employer coverage.
Correct
Marks for this submission: 1/1.
Question6
Marks: 1
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?
Choose one answer.
a. Mr. Zachow will have to wait until the Annual Election Period when he can switch Part D plans. In the
meantime, he will have to pay for his drug out of pocket.
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