AHIP Modules 1-5 LATEST NEW EXAM 2026
(COMPLIED FROM REAL EXAM) 100%
|SOLVED
Mrs. Castro 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 a
decision?
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.
Which of the following individuals is most likely to be eligible to enroll in a Part D
Plan?
Jose, a grandfather who was granted asylum and has worked in the United States for many
years.
Mrs. Esmeralda Avila is a Medicare beneficiary enrolled in a MA-PD plan you
represent. Her neighbor recently suffered from a painful case of shingles. Mrs. Avila
hopes to avoid such an illness through vaccination. She asks you whether the cost of
the shingles vaccination will be covered under the plan you represent. What should
you say?
Yes, there is no cost sharing for the shingles vaccine even in the deductible phase of her
prescription drug plan because it is an adult vaccine recommended by the Advisory
Committee on Immunization Practices (AICP).
Mrs. Russo is entitled to Part A and has medical coverage without drug coverage
through an employer retiree plan. She is not enrolled in Part B. Since the employer
plan does not cover prescription drugs, she wants to enroll in a Medicare
prescription drug plan. Will she be able to?
,Yes. Mrs. Russo must be entitled to Part A and/or enrolled in Part B to be eligible for
coverage under the Medicare prescription drug program.
Mrs. Willis has a rare condition for which two different brand name drugs are the
only available treatment. She is concerned that since no generic prescription drugs
are 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?
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.
Mrs. McFarren is enrolled in her state's Medicaid plan and has just become eligible
for Medicare as well. What can she expect will happen to her drug coverage?
Unless she chooses a Medicare Part D prescription drug plan on her own, she will be
automatically enrolled in one available in her area.
Mrs. Wood, age 65, 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?
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. Wood is entitled to Part A, she does not
need to enroll under Part B before enrolling in a prescription drug plan.
Mr. Sutton 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?
In general, he must select a single Part D premium payment mechanism that will be used
throughout the year.
, Mr. and Mrs. Cole both take a specialized multivitamin prescription each day. Mr.
Cole takes a prescription to help regrow his hair. They are anxious to have their
Medicare prescription drug plan cover these drug needs. What should you tell them?
Medicare prescription drug plans are not permitted to cover the prescription medications
the Coles are interested in under Part D coverage, however, plans may cover them as
supplemental benefits and the Coles could look into that possibility.
Ms. Ramos 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?
She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a
higher cost than paid at an in-network pharmacy.
Mr. Chen was still working when he first qualified for Medicare. At that time, he had
employer group coverage that was creditable. During his initial Part D eligibility
period, he decided not to enroll because he was satisfied with his drug coverage. It is
now a year later and Mr. Chen has lost his employer group coverage within the last
two weeks. How would you advise him?
Mr. Chen should enroll in a Part D plan before he has a 63-day break in coverage in order to
avoid a premium penalty.
Mrs. Kelly wants to enroll in a Medicare Advantage plan that does not include drug
coverage and also enroll in a stand-alone Medicare prescription drug plan. Under
what circumstances can she do this?
If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer
drug coverage or a Medical Savings Account plan, Mrs. Kelly can do this.
John Cohen is a Medicare beneficiary who suffers from diabetes. Mr. Cohen is
considering enrollment in an MA-PD plan that you represent. He asks you whether
his insulin costs will be covered. What should you say?
Mr. Cohen's insulin costs for a one-month supply cannot be more than $35 in any coverage
phase.
(COMPLIED FROM REAL EXAM) 100%
|SOLVED
Mrs. Castro 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 a
decision?
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.
Which of the following individuals is most likely to be eligible to enroll in a Part D
Plan?
Jose, a grandfather who was granted asylum and has worked in the United States for many
years.
Mrs. Esmeralda Avila is a Medicare beneficiary enrolled in a MA-PD plan you
represent. Her neighbor recently suffered from a painful case of shingles. Mrs. Avila
hopes to avoid such an illness through vaccination. She asks you whether the cost of
the shingles vaccination will be covered under the plan you represent. What should
you say?
Yes, there is no cost sharing for the shingles vaccine even in the deductible phase of her
prescription drug plan because it is an adult vaccine recommended by the Advisory
Committee on Immunization Practices (AICP).
Mrs. Russo is entitled to Part A and has medical coverage without drug coverage
through an employer retiree plan. She is not enrolled in Part B. Since the employer
plan does not cover prescription drugs, she wants to enroll in a Medicare
prescription drug plan. Will she be able to?
,Yes. Mrs. Russo must be entitled to Part A and/or enrolled in Part B to be eligible for
coverage under the Medicare prescription drug program.
Mrs. Willis has a rare condition for which two different brand name drugs are the
only available treatment. She is concerned that since no generic prescription drugs
are 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?
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.
Mrs. McFarren is enrolled in her state's Medicaid plan and has just become eligible
for Medicare as well. What can she expect will happen to her drug coverage?
Unless she chooses a Medicare Part D prescription drug plan on her own, she will be
automatically enrolled in one available in her area.
Mrs. Wood, age 65, 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?
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. Wood is entitled to Part A, she does not
need to enroll under Part B before enrolling in a prescription drug plan.
Mr. Sutton 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?
In general, he must select a single Part D premium payment mechanism that will be used
throughout the year.
, Mr. and Mrs. Cole both take a specialized multivitamin prescription each day. Mr.
Cole takes a prescription to help regrow his hair. They are anxious to have their
Medicare prescription drug plan cover these drug needs. What should you tell them?
Medicare prescription drug plans are not permitted to cover the prescription medications
the Coles are interested in under Part D coverage, however, plans may cover them as
supplemental benefits and the Coles could look into that possibility.
Ms. Ramos 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?
She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a
higher cost than paid at an in-network pharmacy.
Mr. Chen was still working when he first qualified for Medicare. At that time, he had
employer group coverage that was creditable. During his initial Part D eligibility
period, he decided not to enroll because he was satisfied with his drug coverage. It is
now a year later and Mr. Chen has lost his employer group coverage within the last
two weeks. How would you advise him?
Mr. Chen should enroll in a Part D plan before he has a 63-day break in coverage in order to
avoid a premium penalty.
Mrs. Kelly wants to enroll in a Medicare Advantage plan that does not include drug
coverage and also enroll in a stand-alone Medicare prescription drug plan. Under
what circumstances can she do this?
If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer
drug coverage or a Medical Savings Account plan, Mrs. Kelly can do this.
John Cohen is a Medicare beneficiary who suffers from diabetes. Mr. Cohen is
considering enrollment in an MA-PD plan that you represent. He asks you whether
his insulin costs will be covered. What should you say?
Mr. Cohen's insulin costs for a one-month supply cannot be more than $35 in any coverage
phase.
