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