AHIP CERTIFICATION EXAM MODULE 3
2022/2023(COMPLETE QUESTIONS AND ANSWERS)
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 answers)b. 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. Correct
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? (correct answers)a. Everyone 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. Correct
Mrs. Lopez is enrolled in a Medicare Advantage cost plan. 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 answers)b. If a Part D benefit is offered
through her plan she may choose in enroll in that plan or a standalone PDP. Correct
Which of the following statements about Medicare Part D are correct?
I. Part D plans must enroll any eligible beneficiary who applies regardless of health status except in
limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to
have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits
through a standalone PDP.
IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a standalone PDP or through
their plan. (correct answers)b. I, II, and III only Correct
, All plans must cover at least the standard Part D coverage or its actuarial equivalent. What costs would a
beneficiary incur for prescription drugs in 2019 under the standard coverage? (correct answers)c.
Standard Part D coverage would require payment of an annual deductible of $435, 25% cost-sharing
between $435 and $4,020, and once through the catastrophic coverage threshold, the beneficiary pays
either co-pays for generic and brand name drugs or co-insurance of 5%, whichever is greater.
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 answers)b. 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. Correct
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? (correct answers)b. 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. Correct
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 either one of
them. What should you tell her? (correct answers)c. 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. Correct
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 her prescriptions that she has lost. How would you
advise her? (correct answers)d. She may fill prescriptions for covered drugs at non-network pharmacies,
but likely at a higher cost than paid at an in-network pharmacy. Correct
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
2022/2023(COMPLETE QUESTIONS AND ANSWERS)
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 answers)b. 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. Correct
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? (correct answers)a. Everyone 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. Correct
Mrs. Lopez is enrolled in a Medicare Advantage cost plan. 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 answers)b. If a Part D benefit is offered
through her plan she may choose in enroll in that plan or a standalone PDP. Correct
Which of the following statements about Medicare Part D are correct?
I. Part D plans must enroll any eligible beneficiary who applies regardless of health status except in
limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to
have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits
through a standalone PDP.
IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a standalone PDP or through
their plan. (correct answers)b. I, II, and III only Correct
, All plans must cover at least the standard Part D coverage or its actuarial equivalent. What costs would a
beneficiary incur for prescription drugs in 2019 under the standard coverage? (correct answers)c.
Standard Part D coverage would require payment of an annual deductible of $435, 25% cost-sharing
between $435 and $4,020, and once through the catastrophic coverage threshold, the beneficiary pays
either co-pays for generic and brand name drugs or co-insurance of 5%, whichever is greater.
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 answers)b. 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. Correct
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? (correct answers)b. 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. Correct
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 either one of
them. What should you tell her? (correct answers)c. 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. Correct
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 her prescriptions that she has lost. How would you
advise her? (correct answers)d. She may fill prescriptions for covered drugs at non-network pharmacies,
but likely at a higher cost than paid at an in-network pharmacy. Correct
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
