AHIP Module 3
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? - ANS-c. Standard Part D coverage would require payment of
an annual deductible, 25% cost-sharing up to the coverage gap, a portion of costs
for both generics and brand-name drugs in the coverage gap, and co-pays or
co-insurance after the coverage gap. Correct
\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? - ANS-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. 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? - ANS-a. He could check with the manufacturers of his medications to see if
they offer an assistance program to help people with limited means 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. Correct
\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? -
ANS-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
\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? - ANS-b. 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. 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? - ANS-a. 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
\Mr. Katz reached the Part D coverage gap in August last year. His prescriptions
have not changed, he is keeping the same Part D plan and the benefits,
cost-sharing, and coverage of his drugs are all the same as last year. He asked what
to expect for this year about his out-of-pocket costs. What could you tell him? -
ANS-d. Because he reached the coverage gap last year, he will probably reach it
again this year close to the same time. Correct
\Mr. Rice has coverage for medical services and medications through his employer's
retiree plan. He is considering switching to a Medicare prescription drug plan
because his retiree plan does not cover two important medications. What should he
consider before making a change? - ANS-c. If Mr. Rice drops his drug coverage
through the retiree plan, he may not be able to get it back and he also may lose his
medical health coverage. Correct
\Mr. Shapiro gets by on a very small 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? -
ANS-b. The extra help is available to beneficiaries whose income and assets do not
exceed annual limits specified by the government. Correct
\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. How would
you advise him? - ANS-b. Mr. Schultz should enroll in a Part D plan before he has a
63-day break in coverage in order to avoid a premium penalty. Correct
\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? - ANS-c. In general, he must select a single Part D
premium payment mechanism that will be used throughout the year. Correct
\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? - ANS-a. 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. 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? - ANS-a. 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
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? - ANS-c. Standard Part D coverage would require payment of
an annual deductible, 25% cost-sharing up to the coverage gap, a portion of costs
for both generics and brand-name drugs in the coverage gap, and co-pays or
co-insurance after the coverage gap. Correct
\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? - ANS-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. 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? - ANS-a. He could check with the manufacturers of his medications to see if
they offer an assistance program to help people with limited means 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. Correct
\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? -
ANS-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
\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? - ANS-b. 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. 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? - ANS-a. 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
\Mr. Katz reached the Part D coverage gap in August last year. His prescriptions
have not changed, he is keeping the same Part D plan and the benefits,
cost-sharing, and coverage of his drugs are all the same as last year. He asked what
to expect for this year about his out-of-pocket costs. What could you tell him? -
ANS-d. Because he reached the coverage gap last year, he will probably reach it
again this year close to the same time. Correct
\Mr. Rice has coverage for medical services and medications through his employer's
retiree plan. He is considering switching to a Medicare prescription drug plan
because his retiree plan does not cover two important medications. What should he
consider before making a change? - ANS-c. If Mr. Rice drops his drug coverage
through the retiree plan, he may not be able to get it back and he also may lose his
medical health coverage. Correct
\Mr. Shapiro gets by on a very small 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? -
ANS-b. The extra help is available to beneficiaries whose income and assets do not
exceed annual limits specified by the government. Correct
\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. How would
you advise him? - ANS-b. Mr. Schultz should enroll in a Part D plan before he has a
63-day break in coverage in order to avoid a premium penalty. Correct
\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? - ANS-c. In general, he must select a single Part D
premium payment mechanism that will be used throughout the year. Correct
\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? - ANS-a. 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. 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? - ANS-a. 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
