AHIP Certification - Part 5

a

Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug coverage. He found a stand-alone Medicare prescription drug plan in his area that offers better coverage than that available through his MA-PD plan and in addition has a low premium. It won't cost him much more and, because he has the means to do so, he wishes to enroll in the stand-alone prescription drug plan in addition to his MA-PD plan. What should you tell him? a. If Mr. Block enrolls in the stand-alone Medicare prescription drug plan, he will be disenrolled from the Medicare Advantage plan. b. Mr. Block will have to wait until the annual election period, beginning October 15, and then he can add the stand-alone coverage to the MA-PD. c. If Mr. Block enrolls in a stand-alone Medicare prescription drug plan, he can request that his Medicare Advantage plan remove the drug benefit from the package they offer and reduce his premium accordingly d. If Mr. Block wants to enroll in both a MA-PD and a stand-alone PDP, he may buy the extra coverage without any adverse effect.

c

Mr. Fitzgerald is selling his home to permanently move into a retirement facility near his daughter in a neighboring state. He has a stand-alone prescription drug plan, and has learned it is not available where he is moving. He doesn't know what he should do. What can you tell him? a. He can keep his plan indefinitely because prescription drug plan's must be available to all beneficiary's regardless of where they live. b. Since he is moving before the Annual Election Period, he will need to continue using the prescription drug plan, but should get his prescriptions filled through the plan's mail order service. c. Because he is moving outside of the service area, the plan must automatically disenroll him. He will have a special election period to select a new plan. d. Since he is moving before the Annual Election Period, he should request an exception to continue using the plan for several more months until the AEP when he can enroll in a new plan.

a

Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period. 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 would apply in this case? a. He can make as many enrollment changes as he likes during the Annual Election Period and the last choice made prior to the end of the period will be the effective one as of January 1. b. He can only make a single enrollment change during the Annual Election Period, so he will not be able to change his enrollment. c. He should wait for at least six months into the plan year to be sure that he really wants to make the change. If he still wants to do so, he can make any sort of change he likes at that point. d. He can return to Original Medicare, but must then enroll into a Medicare Part D plan.

c

Mr. Garcia was told he qualifies for a Special Election Period (SEP), but he lost the paper that explains what he could do during the SEP. What can you tell him? a. He may only use the SEP to disenroll from his MA plan and return to Original Medicare. b. If the SEP is for Part D coverage, he may only drop, but not add or change, his Part D coverage one time before the SEP expires. c. If the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage. d. If the SEP is for MA coverage, he may make as many changes to his MSA enrollment as he wants and the last choice made before the end of the SEP period will be the effective one.

b

Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could you help him take during this time? a a. If he has a disability, he may enroll in Original Fee-for-Service Medicare during the MA Initial Coverage Election Period. b. He will have one opportunity to enroll in a Medicare Advantage plan c. He may change or drop MA plans, but may not drop drug coverage. d. He will have a three-month period during which he may enroll in as many Medicare Advantage plans as he chooses, with the last enrollment being the effective one.

a

Mr. Gonzalez is entitled to Part A, but has not yet enrolled in Part B. If he wants to enroll in a Private Fee-for-Service (PFFS) plan, what will he have to do? a. He will have to enroll in Part B prior to enrolling in the PFFS plan. b. He will need to do nothing. His entitlement to Part A makes him eligible to enroll in any Medicare Advantage plan. c. He will have to drop Part A and then will be eligible to enroll in a PFFS plan. d. He will have to enroll in a Medicare prescription drug plan prior to enrolling in a PFFS plan.

b

Mr. Robinson was quite ill recently and forgot to pay his monthly premium for his MA-PD plan. He is worried that he will lose his coverage now when he needs it the most. He is certain his plan will disenroll him because that is what happened to a friend of his in a similar type of plan. What can you tell Mr. Robinson about his situation? a. Plan sponsors have the option to disenroll members, but if they choose to do so, they must act immediately and cannot permit a grace period. b. Plan sponsors have the option to disenroll members who do not pay their premiums, but they must first provide each member with a grace period of not less than 2 months. c. Plan sponsors must disenroll members who do not pay their premiums, but they have the discretion to make exceptions for certain members, so he should ask for an exception for this special circumstance. d. Plan sponsors must disenroll members who do not pay their premiums, but he will have a special enrollment period to sign up for a different MA-PD plan.

c

Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work and is covered by an employer health plan, he has not enrolled in Part B or Part D. He receives a notice on June 1 that his employer is cutting back on prescription drug benefits and that as of July 1 his coverage will no longer be creditable. He has come to you for advice. What advice would you give Mr. Rockwell about special enrollment periods (SEPs)? a. Mr. Rockwell must wait until the next annual election period (AEP) to sign up for Part D prescription drug coverage. b. Mr. Rockwell is eligible for a SEP that begins three months before the month in which he receives notice of loss of creditable coverage and ends three months after that month. c. Mr. Rockwell is eligible for a SEP due to his involuntary loss of creditable drug coverage; the SEP begins in June and ends September 1 - two months after the loss of creditable coverage. d. Mr. Rockwell is eligible for a SEP that begins in June and ends three months later, during which he may enroll, disenroll, and reenroll in Part D plans, with his last selection considered binding.

c

Mr. Wendt suffers from diabetes which has gotten progressively worse during the last year. He is currently enrolled in Original Medicare (Parts A and B) and a Part D prescription drug plan and did not enroll in a Medicare Advantage (MA) plan during the last annual open enrollment period (AEP) which has just closed. Mr. Wendt has heard that there are certain MA plans that might provide him with more specialized coverage for his diabetes and wants to know if he must wait until the next annual open enrollment period (AEP) before enrolling in such a plan. What should you tell him? a. As long as there is a special needs plan (SNP) specializing in diabetes within 500 miles of Mr. Wendt's residence, he can enroll in the SNP at any time under a special enrollment period (SEP). b. Mr. Wendt must wait until the next annual open enrollment period (AEP) before he can enroll in a special needs plan (SNP). c. If there is a special needs plan (SNP) in Mr. Wendt's area that specializes in caring for individuals with diabetes, he may enroll in the SNP at any time under a special enrollment period (SEP). d. If there is a special needs plan (SNP) in Mr. Wendt's area that specializes in caring for individuals with diabetes, he may enroll in the SNP during the MA Open Enrollment Period which takes place between January 1 and March 31.

a

Mr. Yoo's employer has recently dropped comprehensive creditable prescription drug coverage that was offered to company retirees. The company told Mr. Yoo that, because he was affected by this change, he would qualify for a Special Election Period. Mr. Yoo contacted you to find out more about what this means. What can you tell him? a. It means that he qualifies for a one-time opportunity to enroll into an MA-PD or Part D prescription drug plan. b. It means that he will have a one time opportunity to enroll into a Medigap policy with drug coverage. c. It means that he will be able to purchase continued drug coverage from the insurer that had provided it to the company retirees, but that he will not have to pay the entire premium himself. d. It means that he will be able to enroll into a state-funded pharmacy assistance program for retirees that will cover 80 percent of his drug costs.

a

Mr. Ziegler is turning 65 next month and has asked you what he can do, and when he must do it, with respect to enrolling in Part D. What could you tell him? a. He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may make one Part D enrollment choice, including enrollment in a stand-alone Part D plan or an MA-PD plan. b. He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may enroll in a Medigap plan that includes creditable coverage for prescription drugs. c. He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may only add stand-alone Medicare prescription drug coverage. d. He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may only enroll in an MA-PD plan.

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

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? a. Mrs. Berkowitz can apply for any Medicare Advantage plan and, if it offers drug coverage, ask to have that element of the coverage eliminated, after which she can enroll in a stand-alone Medicare prescription drug plan in her service area. b. 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. c. Mrs. Berkowitz can enroll in any Medicare Advantage plan, regardless of whether it offers drug coverage, and enroll in any stand-alone Medicare prescription drug plan. d. This is not a possibility. If Mrs. Berkowitz wants health coverage and drug coverage through a plan, she must purchase an MA-PD plan.

a

Mrs. Burton is in an MA-PD plan and was disappointed in the service she received from her primary care physician because she was told she would have to wait five weeks to get an appointment when she was feeling ill. She called you to ask what she could do so she wouldn't continue to have to put up with such poor access to care. What could you tell her? a. She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. b. She should not expect to get in to see her doctor any more quickly since she is a Medicare patient. c. She should call the doctor's office to complain since the plan cannot do anything about the doctor's schedule. d. She must write to the plan and wait for a response and then she could file a grievance if she is still dissatisfied.

a

Mrs. Disraeli is enrolled in Original Medicare (Parts A and B) and a standalone Part D prescription drug plan. She has recently developed diabetes and has suffered from heart disease for several years. She has also recently learned that her area is served by a SNP for individuals suffering from such a combination of chronic diseases (C-SNP). Mrs. Disraeli is concerned however, that she will have few rights or protections if she enrolls in a C-SNP. How would you respond? a. Enrollees in SNPs must have access to provider networks that include enough doctors, specialists, and hospitals to provide all covered services necessary to meet enrollee needs within reasonable travel time. b. Enrollees, while able to select their primary care provider (PCP), do have substantial restrictions and financial responsibilities regarding emergency care whether obtained at in-network or out-of-network facilities. c. The SNP would select her primary care provider (PCP) but she could file a grievance within 90 days if the PCP proved incapable. d. Mrs. Disraeli would have substantial restrictions on obtaining emergency care and must use network facilities or be responsible for most emergency care costs.

b

Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period. In mid-January of the following year, she wants to switch back to Original Medicare and enroll in a stand-alone prescription drug plan. What should you tell her? a. During the MA Disenrollment Period, from January 1 - March 31, she may drop a MA or MA-PD plan and go back to Original Medicare, but she may only enroll in a stand-alone prescription drug plan if she also purchases a Medigap policy. b. During the MA Disenrollment Period, from January 1 - March 31, she may disenroll from the MA-PD plan into Original Medicare and also may add a stand-alone prescription drug plan. c. During the MA Disenrollment Period, from January 1 - March 31, she may only disenroll from a MA or MA-PD plan, but cannot enroll in a stand-alone Part D plan. d. During the MA Disenrollment Period, from January 1 - March 31, she may only add or drop Part D coverage, so she cannot switch back to Original Medicare.

a

Mrs. Johnson calls to tell you she has not received her new plan ID card yet, but she needs to see a doctor. What can she expect to receive from the plan after the plan has received her enrollment form? a. Evidence of plan membership, information on how to obtain services, and the effective date of coverage. b. A solicitation for friends who might be interested in enrolling in the plan, with a postcard for her to list their names, addresses, and phone numbers. c. She will not receive anything from the plan until her ID card arrives, so she should not expect the plan to cover her medical needs until then. d. A $20 gift certificate thanking her for enrolling.

a

Mrs. Kendrick is six months away from turning 65. She wants to know what she will have to do to enroll in a Medicare Advantage (MA) plan as soon as possible. What could you tell her? a. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. b. She must have previously been enrolled in Original Fee-for-Service Medicare for at least one year before she may enroll in an MA plan. c. She must first enroll in a Medicare Part D plan, before enrolling in a Medicare Advantage plan. d. MA plans are only available to those who have been enrolled in a Medigap plan for at least six months. Therefore, before enrolling in an MA plan, she must first use a Medigap plan to supplement her Original Medicare coverage.

b

Mrs. Lenard is enrolled in a Medicare Cost plan. Recently the cost plan announced its intention to end its cost contract and transition to a Medicare Advantage (MA) Mrs. Lenard received a letter indicating that unless she chooses another plan or opts out she will be automatically enrolled in the new Medicare Advantage plan operated by an organization affiliated with her cost plan. What does this mean? a. The Cost plan has been non-renewed in her area and Mrs. Lenard must make a plan choice or she will be automatically enrolled in Original Medicare (Parts and B) and a Part D plan. b. If Mrs. Lenard wants to enroll in a Medicare Advantage plan affiliated with her cost plan effective January 1, she should do nothing and she will be automatically enrolled. If she does not want to enroll in that MA plan, she should choose another plan or otherwise opt out of the automatic enrollment. c. Mrs. Lenard must take immediate action if she wants to continue receiving Medicare. d. The Cost plan has been non-renewed in her area and Mrs. Lenard has been automatically enrolled in Original Medicare (Parts A and B).

d

Mrs. Ridgeway enrolled in Original Medicare and Medigap coverage following her retirements several years ago. Four months ago, Mrs. Ridgeway dropped her Medigap policy to enroll in a Medicare Advantage (MA) plan for the first time. Unfortunately, Mrs. Ridgeway has found that many of her providers are not in the MA plan's network. She has come to you for advice? What should you tell her? a. She must wait until the next MA Open Enrollment Period (OEP) during which she can elect to return to Original Medicare. b. She qualifies for a special enrollment period (SEP) that will allow her to make a one-time election to return to Original Medicare, but she may or may not qualify to rejoin her Medigap plan based on medical underwriting. c. She must wait until the next Annual Election Period (AEP) during which she may select another MA plan. d. She qualifies for a special enrollment period (SEP) that will allow her to make a one-time election to return to Original Medicare and she also has a guaranteed eligibility period to rejoin her Medigap plan.

b

Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for-Service (PFFS) plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts consider before selecting a PFFS plan? a. A PFFS plan offering only medical benefits or a PFFS Medigap Supplemental Insurance plan. b. 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 a PFFS plan in combination with a stand-alone prescription drug plan. 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.

d

Mrs. Schmidt is moving and a friend told her she might qualify for a "Special Election Period" to enroll in a new Medicare Advantage plan. She contacted you to ask what a Special Election Period is. What could you tell her? a. It is a time period when only Medicare beneficiaries who have moved out of the area and are dually eligible for Medicaid may add, drop, or change their prescription drug coverage. b. It is a single time period from January 1 - March 31, created by statute, when any Medicare beneficiary who has moved out of the area of their Medicare Advantage or Part D plan can add, drop, or change their Medicare prescription drug coverage. c. It is a time period when beneficiaries who are newly eligible for Medicare may make their first choice of a Medicare prescription drug plan. d. It is a time period, outside of the Annual Election Period, when a Medicare beneficiary can select a new or different Medicare Advantage and/or Part D prescription drug plan. Typically the Special Election Period is beneficiary specific and results from events, such as when the beneficiary moves outside of the service area.

a

Mrs. Schneider has Original Medicare Parts A and B and has just qualified for her state's Medicaid program, so the state is now paying her Part B premium. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan? a. Yes. Qualifying for this state program gives Mrs. Schneider access to a Special Election Period that allows her to make changes to her MA and/or Part D enrollment at any time. b. Yes. Individuals who enroll into any portion of their state Medicaid program cannot participate in either MA or Part D. c. No. Mrs. Schneider must wait until the Annual Election Period to make any changes in her enrollment in an MA or Part D plan. d. Yes. Mrs. Schneider has a Special Enrollment Period during which she can make a single change to her MA enrollment only.

b

Mrs. Valentino is currently enrolled in a Medicare Cost plan. This plan is no longer meeting her needs, but it is now mid-year and past the annual election period (AEP). What would you say to Mrs. Valentino regarding her options? a. Mrs. Valentino can call Medicare, request to be disenrolled from the Cost plan, and enroll in Original Medicare. b. Mrs. Valentino can submit a written request to Medicare to be disenrolled from the Cost plan and enroll in Original Medicare. c. Mrs. Valentino qualifies for a special enrollment period, which will allow her to immediately enroll in a MA-PD plan of her choice. d. Mrs. Valentino must remain enrolled in the Medicare Cost plan until the next AEP.

b

Mrs. Young is currently enrolled in Original Medicare (Parts A and B), but she has been working with Agent Neil Adams in the selection of a Medicare Advantage (MA) plan. It is mid-September, and Mrs. Young is going on vacation. Agent Adams is considering 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 annual enrollment period (AEP). What would you say If you were advising Agent Adams? a. This is a good idea. This locks Mrs. Young into a plan and protects Agent Adams' commission. b. This is a bad idea. Agents are generally prohibited from soliciting or accepting an enrollment form prior to the start of the AEP. c. This is a good idea. The plan will retain Mrs. Young's application and process it when the AEP begins. d. This is a bad idea. Mrs. Young should complete an online application now so that Agent Adams will be given immediate credit for his work once the AEP begins.

c

Ms. Claggett is sixty-six (66) years old. She has been covered under both Parts A and B of Original 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 plan. She knows that there is such a thing as the "Part D Initial Enrollment Period" and has concluded that, since she has never enrolled in such a plan before, she should be eligible to enroll under this period. What should you tell her about how the Part D Initial Enrollment Period applies to her situation? a. It occurs from January 1 to February 14 of each year, so she will have to wait until that point to utilize that particular enrollment period. b. The Part D Initial Enrollment Period occurs only when a beneficiary turns 62, so it cannot be used as the justification for allowing her to enroll at this point. c. It occurs three months before and three months after the month when a beneficiary meets the eligibility requirements for Part B, so she will not be able to use it as a justification for enrolling in a Part D plan now. d. It occurs from October 15 to December 7of each year, so she will have to wait until that point to utilize that particular enrollment period.

b

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 January, her neighbor told her about the Medicare Advantage (MA) plan he selected. He also told her there was an open enrollment period that she might be able to use to enroll in a MA plan. Ms. Gonzales comes to you for advice shortly after speaking to her neighbor. What should you tell her? a. There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31 and Ms. Gonzales can use it to change from Original Medicare and Part D only to a MA plan that includes prescription drug coverage. b. There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31, but Ms. Gonzales cannot use it because eligibility to use the OEP is available only to MA enrollees. c. There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31 and Ms. Gonzales can use it to change from Original Medicare and Part D to a MA or MA-PD plan. d. There is a MA Disenrollment Period that takes place between January 1 and February 14 but since Ms. Gonzales enrolled in Original Medicare and Part D during the AEP this would not apply to her.

d

Ms. Lee is enrolled in an MA-PD plan, but will be moving out of the plan's service area next month. She is worried that she will not be able to enroll in another plan available in her new residence until the Annual Election Period. What should you tell her? a. She may continue to keep her existing plan, because all Medicare health plans are required to provide coverage to anyone, no matter where they live. b. She will be able to enroll in a new plan, because she qualifies for a Special Election Period that begins 30 days after a plan's written communications are returned by the United States Post Office with notification that the resident has moved. So, she should be sure to notify the Post Office immediately. c. She will have to wait until the next Annual Election Period to be able to enroll in a plan available in her new location. d. She is eligible for a Special Election Period that begins either the month before her permanent move, if the plan is notified in advance, or the month she provides notice of the move, and this period typically lasts an additional two months.

c

Which of the following individuals are likely to qualify for a special enrollment period (SEP) for both MA and Part D due to a change of residence? I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area. II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service area. III. Gilbert moves into a plan service area where there is now a Part D plan available to him from a service area where no Part D plan was available. IV. Henry makes a permanent move providing him with new MA and Part D options. a. II and III only b. I, II, III and IV c. II, III, and IV only d. I and II only

a

You are completing a PFFS plan sale to Mr. West who is new to Medicare and prefers to be contacted by telephone. As you are finishing up, what should you tell him about next steps in the enrollment process? a. You need to get Mr. West's phone number and include it on the enrollment form because the plan must call him after you leave to ensure that he understood the nature of the PFFS plan he selected and to verify his intent to enroll. b. You need to get Mr. West's phone number and include it on the enrollment form because the PFFS plan will contact him once the organization receives the enrollment form and will ask about the quality of your service. You should not discuss the phone call with Mr. West to avoid influencing his answers. c. You need to ask Mr. West a few final questions to ensure he understands the nature of the plan and really wants to enroll. You also should tell Mr. Schmidt that after you leave, he should not answer any questions about his enrollment in the plan because it could result in a disenrollment. d. You should not include Mr. West's phone number on the enrollment form in case he is on the "Do Not Call" registry.

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.

c

You have come to Mrs. Midler's home for a sales presentation. At the beginning of the presentation, Mrs. Midler tells you that she has a copy of her medical record available because she thinks this will help you understand her needs. She suggests that you will know which questions to ask her about her health status in order to best assist her in selecting a plan. What should you do? a. If she brings up the topic of her health, you can ask Mrs. Midler as many questions as she is willing to answer, so you can determine which plan is most suitable for her health needs. b. You cannot, under any circumstances, ask Mrs. Midler any health-related questions. c. You can only ask Mrs. Midler questions about conditions that affect eligibility, specifically, whether she has end stage renal disease or one of the conditions that would qualify her for a special needs plan. d. You can initiate detailed discussion of all of Mrs. Midler's health conditions only to better understand her situation and to advise her to choose a different plan if she is experiencing significant health problems.

a

A client wants to give you an enrollment application 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 it in. What should you tell him? a. You must tell him you are not permitted to take the form. If he sends the form directly to the plan, the plan will process the enrollment on the day the Annual Election Period begins. b. You must send it to the plan for immediate processing, although the enrollment will not become effective until January 1. c. You must tell him you are not permitted to take the form and if he sends it to the plan, the application will be rejected and he will need to fill out another form and submit it after the Annual Election Period begins. d. You must accept the application, but hold it until the annual election period begins, after which you must send it to the plan for processing.

d

If Mr. Johannsen gains the Part D low-income subsidy, how does that affect his ability to enroll or disenroll in a Part D plan? a. The subsidy will become effective next year when he can enroll in a different plan or disenroll from his current plan during the next Annual Election Period. b. He can only enroll into or disenroll from an MA-PD plan. c. He can apply the subsidy amount to his existing plan immediately, but he cannot enroll in a different plan. d. He can enroll in or disenroll from a Part D plan at any time and the subsidy will apply to the plan he chooses.

a

Mary Samuels recently suffered a stroke while visiting her daughter and grandchildren. As a result, Mary has been admitted to a rehabilitation hospital where she is expected to reside for several months. The rehabilitation hospital is located outside the geographic area served by her current Medicare Advantage (MA) plan. What options are available to Mary regarding her health plan coverage? a. Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan. b. Mary's only option in this situation is to return to Original Medicare. c. Mary may make one change to either Original Medicare or another MA under the special enrollment period available to institutionalized individuals. d. Mary may enroll in another MA plan coupled with a Medigap plan under the special enrollment period available to institutionalized individuals.

d

Mr. Anderson is a very organized individual and has filled out and brought to you an enrollment form on October 10 for a new plan available January 1 next year. He is currently enrolled in Original Medicare. What should you do? Choose one answer. a. Accept the form and wait until the Annual Election Period begins to send it to the plan for processing. b. Accept the form and immediately send it in to the plan for processing. c. Tell Mr. Anderson that you cannot accept an enrollment form for coverage to begin on January 1 of next year prior to December 15. d. Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins.

d

Mr. Barker had surgery recently and expected that he would have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included a number of services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him? a. You could reassure him that such charges are typical, but if he needs assistance in paying, he should apply to the state. b. You could suggest he call the doctor who performed the surgery to complain about the costs and ask for a discount on the charges. c. You could remind him that he cannot do anything until the next Annual Election Period when he will have an opportunity to change plans. d. You can offer to review the plans appeal process to help him ask the plan to review the coverage decision.

b

Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He would like to know his options since he has decided to drop his retiree coverage and is eligible for Medicare. What should you tell him? a. Mr. Chen can disenroll from the employer-sponsored plan and his only option is to choose a Medigap plan. b. Mr. Chen can disenroll from his employer-sponsored coverage to elect a Medicare Advantage or Part D plan within 2 months of his disenrollment, but he should revaluate if he really wants to drop his employer coverage. c. Mr. Chen can disenroll from his employer-sponsored coverage to elect a Medicare Advantage or Part D plan, but must wait until the next Annual Election Period. d. Mr. Chen must convert his current coverage to employer-sponsored retiree coverage and wait one year before enrolling in an MA or Part D plan. He must ensure he has no gap in coverage.

c

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 eligibility? a. You would need to ask Mr. Kelly if he is enrolled in Part A and Part D and if he needs drug coverage. b. You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if his doctor will accept the terms and conditions of payment of the PFFS plan c. 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. d. You would need to ask Mr. Kelly if he is enrolled in Part A and Part B, if he is healthy, and how often he expects to visit a doctor.

d

Mr. Roberts is enrolled in an MA plan. He recently suffered complications following hip replacement surgery. As a result, he has spent the last three months in Resthaven, a skilled nursing facility. Mr. Roberts is about to be discharged. What advice would you give him regarding his health coverage options? a. His open enrollment period as an institutionalized individual will continue for 12 months following his date of discharge. b. Mr. Roberts has two months following his discharge to continue under his current MA plan before he must return to Original Medicare for the remainder to the calendar year. c. Mr. Roberts must return to Original Medicare within two months of discharge, but he may continue to enroll and disenroll in Part D for 12 months following discharge. d. His open enrollment period as an institutionalized individual will continue for two months after the month he moves out of the facility.

a

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 Advantage plan, what will he have to do? a. He will have to enroll in Part B. b. He will not need to do anything. His entitlement to Part A makes him eligible to enroll in any Medicare Advantage plan. c. He must wait until the next Annual Election Period, at which time he can enroll in a Medicare Advantage plan. d. As long as his employer offers coverage that is equivalent to Medicare's, he cannot enroll in Part B.

c

Mrs. Reynolds just signed up for a Medicare Advantage plan on the second of the month. She is leaving for vacation in two weeks and wants to know if her new coverage will start before she leaves. What should you tell her? a. Typically, coverage is effective on the date that the beneficiary completes the application form, so her coverage will be in place before she leaves. b. Coverage always begins on the first of July, or the first of January after a beneficiary enrolls, whichever comes first. c. Typically her coverage would begin on the first day of the next month, so she should not expect her coverage to begin before she leaves. d. Typically her coverage would begin 30 days after she submits the application form, so she should not expect the coverage to begin until after she leaves.

d

Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to? a. No. As long as her employer offers coverage that is equivalent to that available through Medicare, Mrs. Walters cannot enroll in a Medicare prescription drug plan. b. No. Mrs. Walters will have to enroll in Part B in order to qualify for enrollment into the Medicare prescription drug program. c. Yes, but Mrs. Walters must drop the employer coverage prior to enrolling in a Medicare prescription drug plan. d. 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.

b

Ms. O'Donnell learned about a new MA-PD plan that her neighbor suggested and that you represent. She plans to switch from her old MA HMO plan to the new MA-PD plan during the Annual Election Period. However, she wants to make sure she does not end up paying premiums for two plans. What can you tell her? a. She will need to complete a disenrollment form the month before she wants to submit her application for the new plan to ensure she does not end up with two plans. b. She only needs to enroll in the new MA-PD plan and she will automatically be disenrolled from her old MA plan. c. It is illegal for a marketing representative to sell her an MA-PD plan before she completes a voluntary disenrollment form and you can offer to help her do so before you assist with the new enrollment, but these must be during two separate appointments. d. She must wait until the MA Disenrollment Period and then she will be able to disenroll from the MA-HMO and select the MA-PD plan

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. III. The process must include a clear and distinct step that requires the applicant to activate an "Enroll Now" or "I Agree" type of button or tool. IV. The mechanism must capture an accurate time and date stamp at the time the applicant enters the online site. a. II and III only b. I and II only c. II, III, and IV only d. I, II, III, and IV

c

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 to enroll in a Medicare Advantage (MA) plan and approaches you about her options. What advice would you give her? a. She could immediately enroll in MA plan based on the one-time special enrollment period available to those 70 and younger. b. She should wait until the new year to disenroll from Original Medicare and select an MA plan between January 1 and March 31. c. She should remain in Original Medicare until the annual election period running from October 15 to December 7, during which she can select an MA plan. d. She could enroll in an MA plan during the period including the three months before, the month of, and up to three months after turning 68.

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

a

Willard works as a representative focused on the senior marketplace. What would be considered prohibited activity by Willard? a. Implying that only seniors can enroll in a Medicare Advantage plan when meeting with Mr. Hernandez, who is 58 but qualifies for Medicare because she is disabled. b. Discouraging Mrs. Johnson from enrolling in a Medicare Advantage plan that does not service her area. c. Setting an appointment with Mrs. McLaughlin without first asking about her financial health to determine whether she can afford a plan offering Willard the best commission. d. Asking health questions to determine whether Mr. Ryan would be eligible to enroll in an SNP because he has a chronic condition.

a

You are doing a sales presentation for Mrs. Pearson. You know that the Medicare marketing guidelines prohibit certain types of statements. Apply those guidelines to the following statements and identify which would be prohibited. a. "If you're not in very good health, you will probably do better with a different product." b. "Are you interested in a Medicare supplement plan or a Medicare health plan?" c. "How are you this morning, Mrs. Pearson?" d. "A Private Fee-for-Service plan is not the same as a Medigap supplemental policy."

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.

d

You meet with Mrs. Wilson to complete her enrollment in a Medicare Advantage plan. You tell her that there will be an enrollment verification process to confirm that she is enrolled in the plan that she requested and understands the plan features and rules. What should Mrs. Wilson expect regarding the verification process? a. You will contact Mrs. Wilson within 10 calendar days to set up a joint call with the plan's home office to verify that she has enrolled in a plan of her choice and understands its features and rules. b. Mrs. Wilson will be contacted by you within one week for a follow-up appointment to handle the verification process. c. Your assistant will contact Mrs. Wilson within seven calendar days to set up a joint call with the plan's home office to verify that she has enrolled in a plan of her choice and understands its features and rules. d. Mrs. Wilson will be contacted by the plan sponsor within 15 calendar days of receipt of the enrollment request.

b

Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a website marketing the MA plans with which it has contracts. Agent Armstrong follows up with individuals who request more information about ABC MA plans via the website and tries to persuade them to enroll in ABC plans. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? a. Agent Armstrong needs to be licensed and appointed only in the state where XYZ Agency is headquartered. b. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. c. Agent Armstrong needs to be licensed and appointed only in the state where ABC Health Plan is headquartered. d. Agent Armstrong needs to be licensed and appointed only in his state of residence.

c

Mrs. Kumar would like her daughter, who lives in another state, to meet with you during the Annual Election Period to help her complete her enrollment in a Part D plan. She asked you when she should have her daughter plan to visit. What could you tell her? a. Her daughter should come during the three-month period that begins on the first day of her birthday month and runs for three full months. b. Her daughter should come by September 1. c. Her daughter should come in November. d. Her daughter should come sometime between January 1 and March 31.