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AHIP MODULE 3 EXAM Q&A
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AHIP MODULE 3 EXAM Q&A
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AHIP MODULE 3 EXAM Q&AMr. 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
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? - Answer-Medicare prescription drug plans are not permitted to cover the
prescription medications the Vaughns are interested in under Part D coverage,
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