AHIP Practice Exam

What eligibility criteria must Mrs. Radford meet to enroll in Medicare Advantage?

1. Must be receiving Medicaid

2. Must be entitled to Part A and enrolled in Part B

3. Must have completed a health assessment

4. Must wait for a special enrollment period

The correct answer is: Must be entitled to Part A and enrolled in Part B

To enroll in Medicare Advantage, one of the primary eligibility criteria is that individuals must be entitled to Medicare Part A and enrolled in Medicare Part B. Medicare Advantage plans, also known as Medicare Part C, are designed to provide an alternative way to receive Medicare benefits through private insurance companies that contract with Medicare. Being entitled to Part A means that a person has qualified for hospital insurance, typically based on having worked and paid Medicare taxes. Enrollment in Part B is also necessary, which covers outpatient care, preventive services, and some home health care. Without both Parts A and B, an individual cannot enroll in a Medicare Advantage plan. Other options listed do not reflect essential eligibility requirements for Medicare Advantage enrollment. For instance, while being eligible for Medicaid might provide additional benefits in some Medicare plans, it is not a prerequisite for enrolling in Medicare Advantage. Similarly, completing a health assessment may be a part of the enrollment process for some plans, but it is not a universal eligibility criterion. Lastly, while a special enrollment period may allow individuals to enroll at certain times outside the standard enrollment frame due to specific circumstances, it does not set a foundational eligibility requirement for all enrollees.