AHIP MEDICARE TRAINING EXAM |
QUESTIONS AND VERIFIED ANSWERS
| RATED A+ | 2024/2025 GUIDE
Mr. Torres has a small savings account. He would like to pay for his
monthly Part D premiums with an automatic monthly withdrawal from his
savings account until it is exhausted, and then have his premiums
withheld from his Social Security check. What should you tell him?
- Correct Answer - In general, he must select a single Part D premium
payment mechanism that will be used throughout the year.
What types of tools can Medicare Part D prescription drug plans use that
affect the way their enrollees can access medications?
- Correct 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 costcontainment techniques such as
tiered copayments and prior authorization.
Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of
your clients. In addition to drugs on his plan's formulary he takes several
other medications. These include a prescription drug not on his plan's
formulary, over-the-counter medications for colds and allergies, vitamins,
and drugs from an Internet-based Canadianpharmacy to promote hair
growth and reduce joint swelling. His neighbor recently told him about a
,concept called TrOOP and he asks you if any of his other medications
could count toward TrOOP should he ever reach the Part D catastrophic
limit. What should you say?
- Correct Answer - None of the costs of Mr. Wingate's other medications
would currently count toward TrOOP but he may wish to ask his plan for
an exception to cover the prescription not on its formulary.
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 - 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.
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. 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?
- Correct Answer - If a Part D benefit is offered through her plan she
may choose to enroll in that plan or a standalone PDP.
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 Answer -
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.
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 - Mr. Zachow has a right to request a
formulary exception to obtain coverage for his Part D drug. He or his
physician could obtain the standardized request form on the plan's
website, fill it out, and submit it to his plan.
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 adecision? - Correct Answer -
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.
, 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? -
Correct 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.
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 - 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.
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 Answer -
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.
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
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