AHIP Module 3
By ExamNavigator
- / 2
AHIP Module 3
- 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?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. Rice is 68, actively working, and has coverage for medical services and medications
through his employer's group health plan. He is entitled to premium free Part A and thinking of enrolling in Part B and switching to an MA-PD because he is paying a very large part of his group coverage premium, and it does not provide coverage for a number of his medications.Which of the following is NOT a consideration when making the change?Answer: Mr. Rice's retiree plan is required to take him back if, within 63 days of having voluntarily quit the employer's plan, he decides that he prefers it to his Medicare Part D plan.
- Mrs. Hernandez is one of your clients. She has read that there is a new program that may
help her manage prescription drug costs. What do you tell her about the Medicare Prescription Payment Plan?Answer: Part D enrollees can opt into the Medicare Prescription Payment Plan at the beginning of the plan year or any point during the year.
- 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?Answer: If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP.
- One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her
neighbors called TrOOP. She asks you to explain it. What do you say?Answer: TrOOP stands for true out-of-pocket costs that count toward the Medicare Part D catastrophic limit and include not only expenses paid by a beneficiary but also in some instances amounts paid by or through qualified State Pharmaceutical Assistance Programs.
- Ms. Edwards is enrolled in a Medicare Advantage plan that includes pre- scription drug
plan (PDP) coverage. She is traveling and wishes to fill two of the prescriptions that she has lost. How would you advise her?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. Roswell is a new Medicare beneficiary who has just retired from retail work. She is
- / 2
interested in selecting a Medicare Part D prescription drug plan. She takes several medications and is concerned that she has not been able to identify a plan that covers all of her medications. She does not want to