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AHIP MODULE 3 ACTUAL 2025/2026 150 QUESTIONS AND 100% CORRECT ANSWERS
ALREADY GRADED A+
1.
Medicare Part D coverage helps beneficiaries pay for prescription drugs through private
plans approved by Medicare.
Which type of plan offers only prescription drug coverage and can be added to Original
Medicare?
Correct Answer: Stand-alone Prescription Drug Plan (PDP)
2.
What is the primary purpose of Medicare Part D?
It is designed to help lower the cost of prescription drugs and protect beneficiaries
from high out-of-pocket expenses.
Correct Answer: To provide prescription drug coverage through approved private plans
3.
To enroll in a Medicare Part D plan, a person must first be entitled to Medicare Part A
and/or enrolled in Part B.
Which of the following is also required?
Correct Answer: They must live in the plan’s service area
4.
When is the Initial Enrollment Period for Part D?
It begins three months before the person’s Medicare eligibility month, includes the
eligibility month, and continues three months after.
Correct Answer: A 7-month period surrounding Medicare eligibility
5.
Beneficiaries who do not enroll in Medicare Part D when first eligible and lack
creditable coverage may face a financial consequence.
What is this consequence called?
Correct Answer: Late Enrollment Penalty (LEP)
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6.
What is “creditable prescription drug coverage” under Medicare rules?
It refers to coverage that is expected to pay, on average, as much as the standard
Medicare Part D plan.
Correct Answer: Coverage that is at least as good as Medicare’s standard Part D benefit
7.
Which of the following is not typically covered by Medicare Part D?
Part D does not pay for drugs for cosmetic purposes, weight loss, or over-the-counter
medications.
Correct Answer: Drugs for cosmetic or weight-loss purposes
8.
What is the standard Part D deductible for most plans in 2025 (approximate)?
This amount is the beneficiary’s responsibility before plan coverage begins.
Correct Answer: $545 (standard deductible in 2025)
9.
Which coverage stage comes after the initial coverage limit is reached in Part D?
During this phase, beneficiaries may pay a higher share of drug costs until they reach
catastrophic coverage.
Correct Answer: Coverage gap (donut hole)
10.
In the catastrophic coverage stage, beneficiaries pay significantly lower costs for
covered drugs.
What percentage of drug costs do they typically pay in this stage?
Correct Answer: About 5% of the drug cost or a small copay
11.
What is the Annual Enrollment Period (AEP) for Medicare Part D?
During this time, beneficiaries can enroll in, switch, or drop Part D plans for the
upcoming year.
Correct Answer: October 15 to December 7 each year
12.
If a beneficiary enrolls in a Part D plan during AEP, when does their new coverage
begin?
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This ensures no gap between plan years.
Correct Answer: January 1 of the following year
13.
Special Enrollment Periods (SEPs) allow beneficiaries to change Part D plans outside the
regular enrollment windows.
Which event typically qualifies for a SEP?
Correct Answer: Moving out of a plan’s service area
14.
Low-Income Subsidy (LIS), also called Extra Help, assists eligible beneficiaries with their
Part D costs.
Which costs does LIS help reduce?
Correct Answer: Premiums, deductibles, and cost-sharing amounts
15.
Which federal agency oversees the regulation and administration of Medicare Part D
plans?
It ensures plans meet federal standards and consumer protections.
Correct Answer: Centers for Medicare & Medicaid Services (CMS)
16.
Part D plans must use a formulary, which is a list of covered drugs.
How must these formularies be structured to meet Medicare requirements?
Correct Answer: They must include drugs in each therapeutic category and class
17.
What is a tiered formulary in Medicare Part D plans?
It affects how much beneficiaries pay for different categories of drugs.
Correct Answer: A structure where drugs are grouped by cost levels, with lower tiers
costing less
18.
If a drug is not on a plan’s formulary, what option does a beneficiary have to seek
coverage?
They may formally request coverage through a specific process.
Correct Answer: File a formulary exception request
19.
Part D plans must provide transition coverage for new members taking drugs not on
their formulary.
AHIP MODULE 3 ACTUAL 2025/2026 150 QUESTIONS AND 100% CORRECT ANSWERS
ALREADY GRADED A+
1.
Medicare Part D coverage helps beneficiaries pay for prescription drugs through private
plans approved by Medicare.
Which type of plan offers only prescription drug coverage and can be added to Original
Medicare?
Correct Answer: Stand-alone Prescription Drug Plan (PDP)
2.
What is the primary purpose of Medicare Part D?
It is designed to help lower the cost of prescription drugs and protect beneficiaries
from high out-of-pocket expenses.
Correct Answer: To provide prescription drug coverage through approved private plans
3.
To enroll in a Medicare Part D plan, a person must first be entitled to Medicare Part A
and/or enrolled in Part B.
Which of the following is also required?
Correct Answer: They must live in the plan’s service area
4.
When is the Initial Enrollment Period for Part D?
It begins three months before the person’s Medicare eligibility month, includes the
eligibility month, and continues three months after.
Correct Answer: A 7-month period surrounding Medicare eligibility
5.
Beneficiaries who do not enroll in Medicare Part D when first eligible and lack
creditable coverage may face a financial consequence.
What is this consequence called?
Correct Answer: Late Enrollment Penalty (LEP)
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6.
What is “creditable prescription drug coverage” under Medicare rules?
It refers to coverage that is expected to pay, on average, as much as the standard
Medicare Part D plan.
Correct Answer: Coverage that is at least as good as Medicare’s standard Part D benefit
7.
Which of the following is not typically covered by Medicare Part D?
Part D does not pay for drugs for cosmetic purposes, weight loss, or over-the-counter
medications.
Correct Answer: Drugs for cosmetic or weight-loss purposes
8.
What is the standard Part D deductible for most plans in 2025 (approximate)?
This amount is the beneficiary’s responsibility before plan coverage begins.
Correct Answer: $545 (standard deductible in 2025)
9.
Which coverage stage comes after the initial coverage limit is reached in Part D?
During this phase, beneficiaries may pay a higher share of drug costs until they reach
catastrophic coverage.
Correct Answer: Coverage gap (donut hole)
10.
In the catastrophic coverage stage, beneficiaries pay significantly lower costs for
covered drugs.
What percentage of drug costs do they typically pay in this stage?
Correct Answer: About 5% of the drug cost or a small copay
11.
What is the Annual Enrollment Period (AEP) for Medicare Part D?
During this time, beneficiaries can enroll in, switch, or drop Part D plans for the
upcoming year.
Correct Answer: October 15 to December 7 each year
12.
If a beneficiary enrolls in a Part D plan during AEP, when does their new coverage
begin?
, 3|Page
This ensures no gap between plan years.
Correct Answer: January 1 of the following year
13.
Special Enrollment Periods (SEPs) allow beneficiaries to change Part D plans outside the
regular enrollment windows.
Which event typically qualifies for a SEP?
Correct Answer: Moving out of a plan’s service area
14.
Low-Income Subsidy (LIS), also called Extra Help, assists eligible beneficiaries with their
Part D costs.
Which costs does LIS help reduce?
Correct Answer: Premiums, deductibles, and cost-sharing amounts
15.
Which federal agency oversees the regulation and administration of Medicare Part D
plans?
It ensures plans meet federal standards and consumer protections.
Correct Answer: Centers for Medicare & Medicaid Services (CMS)
16.
Part D plans must use a formulary, which is a list of covered drugs.
How must these formularies be structured to meet Medicare requirements?
Correct Answer: They must include drugs in each therapeutic category and class
17.
What is a tiered formulary in Medicare Part D plans?
It affects how much beneficiaries pay for different categories of drugs.
Correct Answer: A structure where drugs are grouped by cost levels, with lower tiers
costing less
18.
If a drug is not on a plan’s formulary, what option does a beneficiary have to seek
coverage?
They may formally request coverage through a specific process.
Correct Answer: File a formulary exception request
19.
Part D plans must provide transition coverage for new members taking drugs not on
their formulary.
