AHIP 2022 Module 3
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? - ANSWERPart D plans must
cover at least the Part D standard benefits or its actuarial equivalent. They are not required to offer the
standard plan.
Question text
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? - ANSWERIn general, he
must select a single Part D premium payment mechanism that will be used throughout the year.
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. - ANSWERBeneficiaries enrolled in an MA-PPO may not obtain Part D benefits through a
standalone PDP or through their plan. They must obtain them through their plan by enrolling in an MA-
PD.
, Mrs. Mulcahy, 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? - ANSWERMrs. Mulcahy can enroll in Part D because she is entitled to Part A. The
rules for Part D are different from those that apply to eligibility for Medicare Advantage (Part C).
Individuals entitled to Part A and/or enrolled in Part B are eligible to enroll in Part D. In contrast, to
enroll in an MA plan an individual must be eligible for Part A and enrolled in Part B.
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? - ANSWERTo avoid a
late enrollment penalty, Mr. Hutchinson must have "creditable" coverage. If he does not, he must enroll
in Medicare Part D during his initial eligibility period to avoid a late enrollment penalty.
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? - ANSWERIf a Part D benefit is offered through
her plan she may choose to enroll in that plan or a standalone PDP.
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? -
ANSWERNone 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. Shultz 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. Shultz has lost his employer group
coverage within the last two weeks. How would you advise him? - ANSWERMr. Schultz should enroll in a
Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty.
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
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? - ANSWERPart D plans must
cover at least the Part D standard benefits or its actuarial equivalent. They are not required to offer the
standard plan.
Question text
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? - ANSWERIn general, he
must select a single Part D premium payment mechanism that will be used throughout the year.
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. - ANSWERBeneficiaries enrolled in an MA-PPO may not obtain Part D benefits through a
standalone PDP or through their plan. They must obtain them through their plan by enrolling in an MA-
PD.
, Mrs. Mulcahy, 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? - ANSWERMrs. Mulcahy can enroll in Part D because she is entitled to Part A. The
rules for Part D are different from those that apply to eligibility for Medicare Advantage (Part C).
Individuals entitled to Part A and/or enrolled in Part B are eligible to enroll in Part D. In contrast, to
enroll in an MA plan an individual must be eligible for Part A and enrolled in Part B.
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? - ANSWERTo avoid a
late enrollment penalty, Mr. Hutchinson must have "creditable" coverage. If he does not, he must enroll
in Medicare Part D during his initial eligibility period to avoid a late enrollment penalty.
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? - ANSWERIf a Part D benefit is offered through
her plan she may choose to enroll in that plan or a standalone PDP.
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? -
ANSWERNone 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. Shultz 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. Shultz has lost his employer group
coverage within the last two weeks. How would you advise him? - ANSWERMr. Schultz should enroll in a
Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty.
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
