AHIP Medicare Part D Prescription Drug Plans

Question 1

Medicare Part D prescription drug coverage is provided through:

Accepted Answer

Private insurers approved by CMS

Answer

Part D coverage is delivered by private insurance companies that are approved and contracted with CMS.

Question 2

What is a formulary in a Medicare Part D plan?

Accepted Answer

A list of covered prescription drugs

Answer

A formulary is the list of prescription drugs covered by a Part D plan, typically organized into cost-sharing tiers.

Question 3

What is the Part D late enrollment penalty based on?

Accepted Answer

1% of the national base beneficiary premium for each full month without creditable coverage

Answer

The Part D late enrollment penalty is 1% of the national base beneficiary premium multiplied by the number of full months without creditable drug coverage.

Question 4

The 'coverage gap' (donut hole) in Medicare Part D refers to:

Accepted Answer

A temporary limit on drug coverage after total drug costs reach a threshold

Answer

The coverage gap is a temporary limit on drug coverage after total drug costs (plan + member) reach a defined threshold, during which the member pays a higher cost-share.

Question 5

What is 'catastrophic coverage' in Medicare Part D?

Accepted Answer

Coverage that begins after very high out-of-pocket drug costs are met

Answer

Catastrophic coverage kicks in after a beneficiary's out-of-pocket drug spending reaches the catastrophic threshold, significantly reducing their cost-sharing.

AHIP - America's Health Insurance Plans Practice Test

AHIP - America's Health Insurance Plans Practice Test

AHIP Medicare Part D Prescription Drug Plans