AHIP 2025/2026 MODULE 3 SOLVED
QS & AS
Which of the following statements about Medicare Part D are correct? Answer - I, II,
and III only
-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.
Mr. Schultz 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. Schultz has lost his employer group coverage within the last
two weeks. How would you advise him? Answer - 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.
Mrs. Fiore is a retired federal worker with coverage under a Federal Employee
Health Benefits (FEHB) plan that includes creditable drug coverage. She is ready to
turn 65 and become Medicare eligible for the first time. What issues might she
consider about whether to enroll in a Medicare prescription drug plan? Answer - She
could compare the coverage to see if the Medicare Part D plan offers better benefits
and coverage than the FEHB plan for the specific medications she needs and
whether any additional benefits are worth the Part D premium costs on top of her
FEHB contribution.
Mrs. Fields wants to know whether applying for the Part D low income subsidy will be
worth the time to fill out the paperwork. What could you tell her? Answer - The Part D
low income subsidy could substantially lower her overall costs. She can apply by
contacting her state Medicaid office, or calling the Social Security Administration.
Mrs. Walters is entitled to Part A and has medical coverage without drug coverage
through an employer retiree plan. She is not enrolled in Part B. Since the employer
plan does not cover prescription drugs, she wants to enroll in a Medicare prescription
drug plan. Will she be able to? Answer - Yes. Mrs. Walters must be entitled to Part A
or enrolled in Part B to be eligible for coverage under the Medicare prescription drug
program.