AHIP Module 3 Question and Answers V2 (2022/2023) 100% Correct Answers

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CARLINI has heard that Medicare Rx plans are only offered through private companies under a program known as MA, NOT by the government. He likes Original Medicare and does NOT want to sign up for an ... MA product, but he also wants Rx coverage. (Medicare Part D Rx coverage, basics, eligibility) Correct Answer: Mr. Carlini can stay with Original Medicare and ALSO enroll in a Medicare Rx plan through a private company that has contracted with the government to provide only such drug coverage to eligible Medicare beneficiaries. MULCAHY is concerned that she may not qualify for enrollment in a Medicare Rx plan because, although she is entitled to Part A, she is not enrolled under Medicare Part B. What should you tell her? (Medicare Part D Rx coverage, basics, eligibility) Correct Answer: Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare Rx plan. As long as Mrs. Mulcahy is entitled to Part A, she DOESN'T need to enroll under Part B before enrolling in a Rx plan. ALL plans must cover at least the standard Part D coverage or its actuarial equivalent. What costs would a beneficiary incur for Rx drugs in 2016 under the standard coverage? (Medicare Part D Rx coverage, basics, eligibility) Correct Answer: 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 generic and brand name drugs in the coverage gap, and co-pays or co-insurance after the coverage gap. ANDREWS is preparing a budget for next year because she takes quite a few Rx's, she will reach the coverage gap, and wants to be sure she has enough money set aside for those months. She received assistance calculating her projected expenses from her daughter who is a pharmacist, but she doesn't think the calculations are correct because her out of pocket expenses would be lower than last year. (Medicare Part D Rx coverage, basics, eligibility) Correct Answer: It would NOT be unusual for her costs to be a bit less because each year until 2020, an enrollee's share of the drug costs in the coverage gap are less. JACOB understands that there is a standard Medicare Part D Rx 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? (Medicare Part D Rx coverage, basics, eligibility) Correct Answer: 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. What types of tools can Medicare Part D Rx plan use that affect the way their enrollees can access medications? (Part D management tools; covered drugs/formulary) Correct Answer: Part D plans do NOT have to cover all medications. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. In addition, they can use cost containment techniques such as tiered co-payments and prior authorizations. [Show More]

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