AHIP NONDISCRIMINATION FINAL STUDY
GUIDE 2026 COMPLETE SOLVED
QUESTIONS 100% CORRECT
◉Mr. Sinclair has diabetes and heart trouble and is generally
satisfied with the care he has received under Original Medicare, but
he would like to know more about Medicare Advantage Special
Needs Plans (SNPs). What could you tell him? Answer: SNPs have
special programs for enrollees with chronic conditions, like Mr.
Sinclair, and they provide prescription drug coverage that could be
very helpful as well.
◉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? Answer: Standard
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
brandname drugs or coinsurance of 5%.
◉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? 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?
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? 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? 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?
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?
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
GUIDE 2026 COMPLETE SOLVED
QUESTIONS 100% CORRECT
◉Mr. Sinclair has diabetes and heart trouble and is generally
satisfied with the care he has received under Original Medicare, but
he would like to know more about Medicare Advantage Special
Needs Plans (SNPs). What could you tell him? Answer: SNPs have
special programs for enrollees with chronic conditions, like Mr.
Sinclair, and they provide prescription drug coverage that could be
very helpful as well.
◉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? Answer: Standard
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
brandname drugs or coinsurance of 5%.
◉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? 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?
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? 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? 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?
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?
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
