Module 3 Final Review
Review of attempt 1
Started on Saturday, May 1, 2021, 12:56 PM
Complete
d on
Saturday, May 1, 2021, 01:20 PM
Time
taken
24
... [Show More] mins 21 secs
Marks 19/20
Grade 95 out of a maximum of 100 (95%)
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Question
1
Marks: 1
Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of
your clients. In addition to drugs on his plan’s formulary he takes several
other medications. These include a prescription drug not on his plan’s
formulary, over-the-counter medications for colds and allergies, vitamins,
and drugs from an Internet-based Canadian pharmacy to promote hair
growth and reduce joint swelling. His neighbor recently told him about a
concept called TrOOP and he asks you if any of his other medications
could count toward TrOOP should he ever reach the Part D catastrophic
limit. What should you say?
Choose one answer.
Correct: None of the costs of Mr.
Wingate’s other medications would
currently count toward TrOOP but
he may wish to ask his plan for an
exception to cover the prescription
not on its formulary. If he receives
an exception under which the plan
covers the drug, it could count
toward TrOOP.
a. The cost of the prescription
drugs that are not on his plan’s
formulary as well as the cost of
the drug(s) to reduce joint
swelling from the Canadian
pharmacy will count toward
TrOOP but the other
medications in question will not
count toward TrOOP.
b. None of the costs of Mr.
Wingate’s other medications
would currently count toward
TrOOP but he may wish to ask
his plan for an exception to
cover the prescription not on
its formulary.
Source: Module 3, Slide – True Out-of-Pocket Counts? (TrOOP): What
Counts, Slide - True Out-of-Pocket Costs (TrOOP): What is Excluded?
Correct
Marks for this submission: 1/1.
Question
2
Marks: 1
Mr. Shapiro gets by on a very small amount of fixed income. He has
heard there may be extra help paying for Part D prescription drugs for
Medicare beneficiaries with limited income. He wants to know whether
he might qualify. What should you tell him?
Choose one answer.
d. The cost of the prescription
drug that is not on his plan’s
formulary will count toward
TrOOP but the other
medications in question will not
count toward TrOOP.
c. The cost of all medications
bought within the United
States not covered by his plan
would count toward TrOOP.
The cost of the Canadian
bought medications would not
count toward TrOOP.
a. The extra help is available
only to Medicare
beneficiaries who are
enrolled in Medicaid. He
should apply for coverage
under his state’s Medicaid
program to access the extra
help with his drug costs.
Source: Module 3, Slide - Help for Individuals with Limited Income and
Limited Resources and Slide - Encourage Individuals with Limited
Income/Resources to Apply to the State Medicaid Office
Correct
Marks for this submission: 1/1.
Question
3
Marks: 1
Correct: If a beneficiary has limited
income and resources, they may
qualify for a low-income subsidy (LIS)
to cover all or part of the Part D plan
premium and cost-sharing.
Beneficiary income may not exceed
150 percent of the Federal Poverty
Level (FPL). Assets may not exceed
a limited amount also specified by the
government.
c. He must apply for the
extra help at the same time
he applies for enrollment in a
Part D plan. If he missed this
opportunity, he will not be
able to apply for the extra
help again until the next
annual enrollment period.
b. The government pays a
per-beneficiary dollar
amount to the Medicare Part
D prescription drug plans, to
offset premiums for their lowincome
enrollees in
accordance with the plan’s
set criteria. Mr. Shapiro
should check with his plan to
see if he qualifies.
d. The extra help is available
to beneficiaries whose
income and assets do not
exceed annual limits
specified by the government.
Mrs. Quinn has just turned 65, is in excellent health and has a relatively
high income. She uses no medications and sees no reason to spend
money on a Medicare prescription drug plan if she does not need the
coverage. She currently does not have creditable coverage. What could
you tell her about the implications of such a decision?
Choose one answer.
Incorrect: The premium
penalty exists as long as
the enrollee has Part D
coverage, and the
premium penalty amount
is 1% of the national
average premium for
each month the individual
does not have Part D
coverage.
d. If she does not sign up for a Medicare
prescription drug plan, she will incur no
penalty, as long as she can demonstrate
that she was in good health and did not
take any medications.
a. If she does not sign up for a Medicare
prescription drug plan as soon as she is
eligible to do so, and if she does sign up
at a later date, she will have to pay a
one-time penalty equal to 10% of the
annual premium amount.
b. If she does not sign up for a Medicare
prescription drug plan as soon as she is
eligible to do so, and if she does sign up
at a later date, she will be required to
pay a higher premium during the first
year that she is enrolled in the Medicare
prescription drug program. After that
point, her premium will return to the
normal amount.
c. If she does not sign up for a Medicare
prescription drug plan as soon as she is
eligible to do so, and if she does sign up
at a later date, her premium will be
permanently increased by 1% of the
national average premium for every
month that she was not covered.
Source: Module 3, Slide -Part D Late Enrollment Penalty, Slide – Part D
Late Enrollment Penalty Examples
Incorrect
Marks for this submission: 0/1.
Question
4
Marks: 1
Mr. Shultz 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. Shultz has
lost his employer group coverage within the last two weeks. How would
you advise him?
Choose one answer.
Correct: Mr. Schultz should
enroll in a Part D plan, or
otherwise obtain creditable drug
coverage, before he has a 63-
day break in order to avoid a
premium penalty.
d. 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.
a. Mr. Schultz should immediately
enroll in a Part D plan but he can
expect to pay a premium penalty
because he failed to enroll when
first eligible.
c. Mr. Schultz should seek to
continue employer group coverage
through COBRA because it is
likely to have superior benefits at a
more reasonable price.
b. Mr. Schultz can wait up to 180
days after the loss of his creditable
employer group coverage before
enrolling in a Part D plan without
worrying payment a premium
penalty.
Source: Module 3, Slide – Employer Coverage of Drugs, Slide –
Employer/Union Coverage of Drugs, continued
Correct
Marks for this submission: 1/1.
Question
5 [Show Less]