AHIP Module 5

AHIP Module 5 Private Fee-for-Service (PFFS) Plan Eligibility To determine Mr. Kelly's eligibility for a PFFS plan, what questions would you ask? Answer: I would ask if Mr. Kelly is enrolled in Part A and Part B and if he lives in the PFFS plan's service area. Annual Election Period What should Mrs. Kumar tell her daughter to do during the Annual Election Period? Answer: Her daughter should come in November. Part D Initial Enrollment Period Can Ms. Claggett enroll in a Part D plan now? Answer: No, she cannot use the Part D Initial Enrollment Period since she's not eligible for Part B yet. Prohibited Activity What would be considered prohibited activity by Willard? Answer: Implying that only seniors can enroll in a Medicare Advantage plan when meeting with Mr. Hernandez, who is 58 but qualifies for Medicare due to disability. Medicare Prescription Drug Coverage Is Mrs. Walters eligible for a Medicare prescription drug plan? Answer: Yes, Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. Appeals Process What can you offer to help Mr. Barker with his concerns about his MA-PD coverage? Answer: You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. PFFS MA Coverage How does Mr. Wilcox's move to another service area impact his PFFS MA coverage? Answer: Lexington can allow for Mr. Wilcox's continued enrollment for up to 12 months whether or not he is in a visitor/traveler (V/T) program. Special Enrollment Period What can you tell Mr. Garcia about his SEP?