. 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 Medicare Pa...
AHIP Module 3 QUESTIONS &
ANSWERS(GRADED A)
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 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.
What type of tools scan Medicare Part D prescription drug plans use that affect the way their enrollees
can access medications - ANSWER 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.
Mrs. Edwards is enrolled in a Medicare advantage plan that includes prescription drug plan coverage.
She is traveling and wishes to fill two of the prescriptions that she has lost. How would you advise her? -
ANSWER She may fill prescriptions for covered drugs at non-network pharmacies. But likely at a higher
cost than paid at an in-network pharmacy.
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? - ANSWER An 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.
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? - ANSWER 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.
Which of the following statements about Medicare Part D are correct? - ANSWER I, II and III only
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