AHIP PRACTICE EXAM 2022/2023(100% SCORE)
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 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. 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. 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 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.
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.
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.
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 Canadian pharmacy 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.
, Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra help
paying for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know
whether he might qualify. What should you tell him?(correct answer)The extra help is available to
beneficiaries whose income and assets do not exceed annual limits specified by the government.
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?(correct 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.
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 a decision?(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.
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. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D
Prescription Drug program and he is wondering if there is any other option he has for obtaining help
with his considerable drug costs. What should you tell him?(correct answer)He could check with the
manufacturers of his medications to see if they offer an assistance program to help people with limited
means to obtain the medications they need. Alternatively, he could check to see whether his state has a
pharmacy assistance program to help him with his expenses.
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?(correct 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 brand name drugs or coinsurance of 5%.
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 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. 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. 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 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.
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.
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.
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 Canadian pharmacy 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.
, Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra help
paying for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know
whether he might qualify. What should you tell him?(correct answer)The extra help is available to
beneficiaries whose income and assets do not exceed annual limits specified by the government.
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?(correct 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.
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 a decision?(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.
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. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D
Prescription Drug program and he is wondering if there is any other option he has for obtaining help
with his considerable drug costs. What should you tell him?(correct answer)He could check with the
manufacturers of his medications to see if they offer an assistance program to help people with limited
means to obtain the medications they need. Alternatively, he could check to see whether his state has a
pharmacy assistance program to help him with his expenses.
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?(correct 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 brand name drugs or coinsurance of 5%.
