AHIP Certification - Part 5
Medicare Prescription Drug Plan Eligibility
Mrs. Walters 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...
AHIP Certification - Part 5
Medicare Prescription Drug Plan Eligibility
Mrs. Walters 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.
PFFS Plan Options
,Mrs. Roberts has Original Medicare and wants to enroll in a Private Fee-for-Service (PFFS) plan. Which
options could she consider before selecting a PFFS plan? Mrs. Roberts could consider a PFFS plan
offering only medical benefits, a PFFS Medigap Supplemental Insurance plan, or a combination of both.
c. 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.
d. A stand-alone prescription drug plan in combination with a PFFS plan or a PFFS Medigap
Supplemental Insurance plan.
c ✔️Which of the following individuals is most likely to be eligible to enroll in a Medicare Advantage or
Part D Plan?
a. Betsy, a grandmother from overseas who has overstayed her visa.
b. Helena, an overseas college student who has overstayed her visa.
c. Jose, a grandfather who was granted asylum and has worked in the United States for many years.
d. Guy, who has illegally crossed the Canadian border
d ✔️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?
a. Legal spouses can sign enrollment forms for one another under federal law. You may enroll both Mr.
and Mrs. Nunez, as long as her husband signs on her behalf
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. You should sign the form for Mrs. Nunez yourself, since she informed you, as the plan's
representative, that she wanted to enroll.
d. 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.
, b ✔️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?
a. If the enrollment form is countersigned by one of Mr. Tully's treating physicians, she can sign it for
him.
b. 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.
c. A signature is not necessary since Mr. Tully is not physically or mentally capable of filling out and
signing the form.
d. Mr. Tully's daughter can do so because she is an immediate family member who has taken
responsibility for her father's care.
a ✔️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?
a. You may correct this information as long as you add your initials and date next to the correction
b. You may correct the information since it was a simple mistake. You do not need to do anything
further to the application form.
c. Under no circumstances may you make corrections to information a beneficiary has provided. Review
of enrollment forms is the sole responsibility of the plan sponsor.
d. You may correct the information, but she will need to write a brief statement indicating she
authorized you to make the change.
a ✔️Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of
BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. In setting up the
enrollment site, which of the following must Phiona consider?
I. If a legal representative is completing an electronic enrollment request, he or she must first upload
proof of his or her authority.
II. All data elements required to complete an enrollment request must be captured.
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