Health Care > AHIP > AHIP 2022 Module 3 QUESTIONS AND ANSWERS (All)

AHIP 2022 Module 3 QUESTIONS AND ANSWERS

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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: Part 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? Correct Answer: In 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. Correct Answer: Beneficiaries 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? Correct Answer: Mrs. 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? Correct Answer: To 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? Correct Answer: If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP.

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