AHIP 2024 Module 5 - Enrollment Guidance Medicare Advantage and Part D Plans
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Course
AHIP 2024 Module 5 - Enrollment Guidance Medicare
Institution
AHIP 2024 Module 5 - Enrollment Guidance Medicare
AHIP 2024 Module 5 - Enrollment Guidance Medicare Advantage
and Part D Plans
Medicare Prescription Drug Plan Eligibility
Mrs. Walters is entitled to Part A, has medical coverage without drug coverage through an employer
retiree plan, and wants to enroll in a Medicare prescription drug plan....
AHIP 2024 Module 5 - Enrollment Guidance Medicare Advantage
and Part D Plans
Medicare Prescription Drug Plan Eligibility
Mrs. Walters is entitled to Part A, has medical coverage without drug coverage through an employer
retiree plan, and wants to enroll in a Medicare prescription drug plan. Can she do so? Yes, she must be
entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug
program.
Medicare Advantage Enrollment
Mr. Sanchez is entitled to Part A, has coverage through an employer plan, and wants to enroll in a
Medicare Advantage plan. What will he have to do? He will have to enroll in Part B.
Private Fee-for-Service (PFFS) Plan Eligibility
To determine whether Mr. Kelly is eligible for a Private fee-for-service (PFFS) plan, what questions
would you need to ask? You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he
lives in the PFFS plan's service area.
Private Fee-for-Service (PFFS) Plan Enrollment
Mr. Gonzalez is entitled to Part A, but has not yet enrolled in Part B and wants to enroll in a Private Fee-
for-Service (PFFS) plan. What will he have to do? He will have to enroll in Part B prior to enrolling in the
PFFS plan.
Medicare Advantage and Prescription Drug Plans
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and
also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this?
If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage
or a Medical Savings Account, Mrs. Berkowitz can do this.
,Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for-Service (PFFS) plan. All
types of PFFS plans are available in her area. Which options could Mrs. Roberts consider before selecting
a PFFS plan?
Choose one answer.
a. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part
D prescription drug coverage, a PFFS plan offering only medical benefits, or a PFFS plan in combination
with a stand-alone prescription drug plan.
b. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part
D prescription drug coverage, a PFFS plan offering only medical benefits, or PFFS Medigap Supplemental
Insurance plan.
c. A PFFS plan offering only medical benefits or a PFFS Medigap Supplemental Insurance plan.
d. A stand-alone prescription drug plan in combination with a PFFS plan or a PFFS Medigap
Supplemental Insurance plan. ✔️a. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that
combines medical benefits and Part D prescription drug coverage, a PFFS plan offering only medical
benefits, or a PFFS plan in combination with a stand-alone prescription drug plan.
Which of the following individuals is most likely to be eligible to enroll in a Medicare Advantage or Part
D Plan?
Choose one answer.
a. Helena, an overseas college student who has overstayed her visa.
b. Jose, a grandfather who was granted asylum and has worked in the United States for many years.
c. Betsy, a grandmother from overseas who has overstayed her visa.
d. Guy, who has illegally crossed the Canadian border ✔️b. Jose, a grandfather who was granted
asylum and has worked in the United States for many years.
Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you to come to their home
to clear up a few questions. During the presentation, Mrs. Nunez feels tired and tells you that her
husband can finish things up. She goes to bed. At the end of your discussion, Mr. Nunez says that he
wants to enroll both himself and his wife. What should you do?
Choose one answer.
, a. You should sign the form for Mrs. Nunez yourself, since she informed you, as the plan's
representative, that she wanted to enroll.
b. You can countersign Mrs. Nunez' application, along with her husband, indicating that she approved
this choice verbally. This witness signature is sufficient to make the enrollment valid.
c. As long as she is able to do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will have to
wake up to sign her form or do so at another time.
d. Legal spouses can sign enrollment forms for one anoth ✔️c. As long as she is able to do so, only Mrs.
Nunez can sign her enrollment form. Mrs. Nunez will have to wake up to sign her form or do so at
another time.
You are visiting with Mr. Tully and his daughter at her request. He has advanced Alzheimer's and is
incapable of understanding the implications of choosing a Medicare Advantage or prescription drug
plan. Can his daughter fill out the enrollment form and sign it for him?
Choose one answer.
a. Mr. Tully's daughter can do so because she is an immediate family member who has taken
responsibility for her father's care.
b. A signature is not necessary since Mr. Tully is not physically or mentally capable of filling out and
signing the form.
c. Mr. Tully's daughter can do so only, if she is authorized under state law as a court-appointed legal
guardian, has durable power of attorney for health care decisions, or is authorized under state surrogate
consent laws to make health decisions.
d. If the enrollment form is countersigned by one of Mr. Tully's treating physicians, she can sign it for
him. ✔️c. Mr. Tully's daughter can do so only, if she is authorized under state law as a court-appointed
legal guardian, has durable power of attorney for health care decisions, or is authorized under state
surrogate consent laws to make health decisions.
You are meeting with Ms. Berlin and she has completed an enrollment form for a MA-PD plan you
represent. You notice that her handwriting is illegible and as a result, the spelling of her street looks
incorrect. She asks you to fill in the corrected street name. What should you do?
Choose one answer.
a. You may correct the information since it was a simple mistake. You do not need to do anything
further to the application form.
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