AHIP Module 5 Test Questions and Answers
Mrs. Walters is entitled to Part A and has medical prescription drug coverage, a PFFS plan offering only
coverage without drug coverage through an medical benefits, or a PFFS plan in combination with
employer retiree plan. She is not enrolled in Part B. a stand-alone prescription drug plan.
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 - Which of the following individuals is most likely to be
Yes. Mrs. Walters must be entitled to Part A or eligible to enroll in a Medicare Advantage or Part D
enrolled in Part B to be eligible for coverage under plan? - ANSWER -Jose, a grandfather who was
the Medicare Prescription drug program granted aslum and has worked in the US for many
years.
Mr. Sanchez is entitled to Part A, but has not enrolled
in Part B because he has coverage through an Mr. Garrett has just entered his MA initial Coverage
employer plan. If he wants to enroll in a Medicare Election Period (ICEP). What action could you help
Advantage plan, what will he have to do? - him take during this time? - ANSWER -He will
ANSWER -He will have to enroll in Part B have one opportunity to enroll in a Medicare
Advantage Plan.
Mr. Kelly wants to know whether he is eligible to sign
up for a Private fee-for-service (PFFS) plan. What Mrs. Kendrick is six months away from turing 65. She
questions would you need to ask to determine his wants to know what she will have to do to enroll in a
eligibility? - ANSWER -You would need to ask MA plan as soon as possible. What could you tell
Mr. Kelly if he is enrolled in Part A and Part B and if her? - ANSWER -She may enroll in an MA plan
he lives in the PFFS plan's service area. beginning in 3 months immediately before her first
entitlement to both Medicare Part A and Part B.
Mr. Gonzalez is entitled to Part A, but has not yet
enrolled in Part B. If he wants to enroll in a Medicare Mr. Ziegler is turning 65 next month and has asked
Advantage (MA) plan, what will he have to do? - you what he can do, and when he must do it, with
ANSWER -He will have to enroll in Part B prior respect to enrolling in Part D. What could you tell
to enrolling in a MA plan. him? - ANSWER -He is currently in the Part D
initial Enrollment Period (IEP) and, during this time,
he may make one Part D enrollment choice, including
Mrs. Berkowitz wants to enroll in a Medicare enrollment in a Stand-alone Part D plan or an MA-PD
Advantage plan that does not include drug coverage plan.
and also enroll in a stand-alone Medicare
prescription drug plan. Under what circumstances
can she do this? - ANSWER -If the Medicare Ms. Claggett is sixty-six (66) years old. She has been
Advantage plan is a Private Fee-for-Service (PFFS) covered under both Parts A and B of Original
plan that does not offer drug coverage or a Medical Medicare for the last six years due to her disability,
Savings Account, Mrs. Berkowitz has never been enrolled in a Medicare Advantage or
a Part D plan before. She wants to enroll in a Part D
plan. She knows that there is such a thing as the
Mrs. Roberts has Original Medicare and would like to "Part D Initial Enrollment Period" and has concluded
enroll in a Private Fee-for-Service (PFFS) plan. All that, since she has never enrolled in such a plan
types of PFFS plans are available in her area. Which before, she should be eligible to enroll under this
options could Mrs. Roberts consider before selecting period. What should you tell her about how the Part D
a PFFS plan? - ANSWER -A Medicare Initial Enrollment Period applies to her situation? -
Advantage Prescription Drug (MA-PD) PFFS plan ANSWER -It occurs three months before and
that combines medical benefits and Part D three months after the month when a beneficiary
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, AHIP Module 5 Test Questions and Answers
meets the eligibility requirements for Part B, so she You must tell him you are not permitted to take the
will not be able to use it as a justification for enrolling form. If he sends the form directly to the plan, the
in a Part D plan now. plan will process the enrollment on the day the
Annual Election Period begins.
When Myra first became eligible for Medicare, she
enrolled in Original Medicare (Parts A and B). She is Mrs. Goodman enrolled in an MA-PD plan during the
now 67 and will turn 68 on July 1. She would now like Annual Election Period. In mid-January of the
to enroll in a Medicare Advantage (MA) plan and following year, she wants to switch back to Original
approaches you about her options. What advice Medicare and enroll in a stand-alone prescription
would you give her? - ANSWER -She should drug plan. What should you tell her? -
remain in Original Medicare until the annual election ANSWER -During the MA Open Enrollment
period running from October 15th to December 7th, Period, from January 1- March 31, she may only
during which she can select an MA plan. disenroll form a MA or MA-PD plan into Original
Medicare and also may add a stand-alone
prescription drug plan
Mr. Ford enrolled in an MA-only plan in mid
November. On December 1, he calls you up and
says that he has changed his mind and would like to Mrs. Young is currently enrolled in Original Medicare
enroll into an MA-PD plan. What enrollment rules (Parts A and B), but she has been working with Agent
would apply in this case? - ANSWER -He can Neil Adams in the selection of a Medicare Advantage
make as many enrollment changes as he likes during (MA) plan. It is mid-September, and Mrs. Young is
the Annual Election Period and the last choice made going on vacation. Agent Adams is considering
prior to the end of the period will be the effective one suggesting that he and Mrs. Young complete the
as of January 1... application together before she leaves. He will then
submit the paper application prior the start of the
annual enrollment period (AEP). What would you say
Mrs. Kumar would like her daughter, who lives in If you were advising Agent Adams? -
another state, to meet with you during the Annual ANSWER -This is a bad idea. Agents are
Election Period to help her complete her enrollment generally prohibited from soliciting or accepting an
in a Part D plan. She asked you when she should enrollment form prior to the start of the AEP
have her daughter plan to visit. What could you tell
her? - ANSWER -Her Daughter should come in
November. Ms. Gonzales decided to remain in Original Medicare
(Parts A and B) and Part D during the Annual
Enrollment Period (AEP). At the beginning of
Mr. Anderson is a very organized individual and has January, her neighbor told her about the Medicare
filled out and brought to you an enrollment form on Advantage (MA) plan he selected. He also told her
October 10th for a new plan available January 1 next there was an open enrollment period that she might
year. He is currently enrolled in Original Medicare. be able to use to enroll in a MA plan. Ms. Gonzales
What should you do? - ANSWER -Tell Mr. comes to you for advice shortly after speaking to her
Anderson that you cannot accept any enrollment neighbor. What should you tell her? -
forms until the annual election period begins. ANSWER -There is a MA Open enrollment
period that takes place between January 1 and March
31, but Ms. Gonzales cannot use it because eligibility
A client wants to give you an enrollment application to use the OEP is available only to MA enrollees.
on October 1 prior to the beginning of the Annual
Election Period because he is leaving on vacation for
two weeks and does not want to forget about turning Mrs. Schmidt is moving and a friend told her she
it in. What should you tell him? - ANSWER - might qualify for a "Special Election Period" to enroll
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Mrs. Walters is entitled to Part A and has medical prescription drug coverage, a PFFS plan offering only
coverage without drug coverage through an medical benefits, or a PFFS plan in combination with
employer retiree plan. She is not enrolled in Part B. a stand-alone prescription drug plan.
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 - Which of the following individuals is most likely to be
Yes. Mrs. Walters must be entitled to Part A or eligible to enroll in a Medicare Advantage or Part D
enrolled in Part B to be eligible for coverage under plan? - ANSWER -Jose, a grandfather who was
the Medicare Prescription drug program granted aslum and has worked in the US for many
years.
Mr. Sanchez is entitled to Part A, but has not enrolled
in Part B because he has coverage through an Mr. Garrett has just entered his MA initial Coverage
employer plan. If he wants to enroll in a Medicare Election Period (ICEP). What action could you help
Advantage plan, what will he have to do? - him take during this time? - ANSWER -He will
ANSWER -He will have to enroll in Part B have one opportunity to enroll in a Medicare
Advantage Plan.
Mr. Kelly wants to know whether he is eligible to sign
up for a Private fee-for-service (PFFS) plan. What Mrs. Kendrick is six months away from turing 65. She
questions would you need to ask to determine his wants to know what she will have to do to enroll in a
eligibility? - ANSWER -You would need to ask MA plan as soon as possible. What could you tell
Mr. Kelly if he is enrolled in Part A and Part B and if her? - ANSWER -She may enroll in an MA plan
he lives in the PFFS plan's service area. beginning in 3 months immediately before her first
entitlement to both Medicare Part A and Part B.
Mr. Gonzalez is entitled to Part A, but has not yet
enrolled in Part B. If he wants to enroll in a Medicare Mr. Ziegler is turning 65 next month and has asked
Advantage (MA) plan, what will he have to do? - you what he can do, and when he must do it, with
ANSWER -He will have to enroll in Part B prior respect to enrolling in Part D. What could you tell
to enrolling in a MA plan. him? - ANSWER -He is currently in the Part D
initial Enrollment Period (IEP) and, during this time,
he may make one Part D enrollment choice, including
Mrs. Berkowitz wants to enroll in a Medicare enrollment in a Stand-alone Part D plan or an MA-PD
Advantage plan that does not include drug coverage plan.
and also enroll in a stand-alone Medicare
prescription drug plan. Under what circumstances
can she do this? - ANSWER -If the Medicare Ms. Claggett is sixty-six (66) years old. She has been
Advantage plan is a Private Fee-for-Service (PFFS) covered under both Parts A and B of Original
plan that does not offer drug coverage or a Medical Medicare for the last six years due to her disability,
Savings Account, Mrs. Berkowitz has never been enrolled in a Medicare Advantage or
a Part D plan before. She wants to enroll in a Part D
plan. She knows that there is such a thing as the
Mrs. Roberts has Original Medicare and would like to "Part D Initial Enrollment Period" and has concluded
enroll in a Private Fee-for-Service (PFFS) plan. All that, since she has never enrolled in such a plan
types of PFFS plans are available in her area. Which before, she should be eligible to enroll under this
options could Mrs. Roberts consider before selecting period. What should you tell her about how the Part D
a PFFS plan? - ANSWER -A Medicare Initial Enrollment Period applies to her situation? -
Advantage Prescription Drug (MA-PD) PFFS plan ANSWER -It occurs three months before and
that combines medical benefits and Part D three months after the month when a beneficiary
1/7
, AHIP Module 5 Test Questions and Answers
meets the eligibility requirements for Part B, so she You must tell him you are not permitted to take the
will not be able to use it as a justification for enrolling form. If he sends the form directly to the plan, the
in a Part D plan now. plan will process the enrollment on the day the
Annual Election Period begins.
When Myra first became eligible for Medicare, she
enrolled in Original Medicare (Parts A and B). She is Mrs. Goodman enrolled in an MA-PD plan during the
now 67 and will turn 68 on July 1. She would now like Annual Election Period. In mid-January of the
to enroll in a Medicare Advantage (MA) plan and following year, she wants to switch back to Original
approaches you about her options. What advice Medicare and enroll in a stand-alone prescription
would you give her? - ANSWER -She should drug plan. What should you tell her? -
remain in Original Medicare until the annual election ANSWER -During the MA Open Enrollment
period running from October 15th to December 7th, Period, from January 1- March 31, she may only
during which she can select an MA plan. disenroll form a MA or MA-PD plan into Original
Medicare and also may add a stand-alone
prescription drug plan
Mr. Ford enrolled in an MA-only plan in mid
November. On December 1, he calls you up and
says that he has changed his mind and would like to Mrs. Young is currently enrolled in Original Medicare
enroll into an MA-PD plan. What enrollment rules (Parts A and B), but she has been working with Agent
would apply in this case? - ANSWER -He can Neil Adams in the selection of a Medicare Advantage
make as many enrollment changes as he likes during (MA) plan. It is mid-September, and Mrs. Young is
the Annual Election Period and the last choice made going on vacation. Agent Adams is considering
prior to the end of the period will be the effective one suggesting that he and Mrs. Young complete the
as of January 1... application together before she leaves. He will then
submit the paper application prior the start of the
annual enrollment period (AEP). What would you say
Mrs. Kumar would like her daughter, who lives in If you were advising Agent Adams? -
another state, to meet with you during the Annual ANSWER -This is a bad idea. Agents are
Election Period to help her complete her enrollment generally prohibited from soliciting or accepting an
in a Part D plan. She asked you when she should enrollment form prior to the start of the AEP
have her daughter plan to visit. What could you tell
her? - ANSWER -Her Daughter should come in
November. Ms. Gonzales decided to remain in Original Medicare
(Parts A and B) and Part D during the Annual
Enrollment Period (AEP). At the beginning of
Mr. Anderson is a very organized individual and has January, her neighbor told her about the Medicare
filled out and brought to you an enrollment form on Advantage (MA) plan he selected. He also told her
October 10th for a new plan available January 1 next there was an open enrollment period that she might
year. He is currently enrolled in Original Medicare. be able to use to enroll in a MA plan. Ms. Gonzales
What should you do? - ANSWER -Tell Mr. comes to you for advice shortly after speaking to her
Anderson that you cannot accept any enrollment neighbor. What should you tell her? -
forms until the annual election period begins. ANSWER -There is a MA Open enrollment
period that takes place between January 1 and March
31, but Ms. Gonzales cannot use it because eligibility
A client wants to give you an enrollment application to use the OEP is available only to MA enrollees.
on October 1 prior to the beginning of the Annual
Election Period because he is leaving on vacation for
two weeks and does not want to forget about turning Mrs. Schmidt is moving and a friend told her she
it in. What should you tell him? - ANSWER - might qualify for a "Special Election Period" to enroll
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