2025 AHIP Module 5

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 wants to enroll in both a MA-PD and a stand-alone PDP, he may buy the extra coverage without any adverse effect. d. If Mr. Block enrolls in a stand-alone Medicare prescription drug

a

Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't sufficiently cover his prescription drug needs. He is interested in changing plans during the upcoming MA Open Enrollment Period. What are his options during the MA OEP? a. He can switch to a MA-PD plan. b. He can only switch to Original Medicare with a PDP. c. He can only switch to another MA plan. d. He can change to Original Medicare with a PDP. But if he later finds a better MA-PD plan he likes, he can switch to that as long as the change is before the end of the MA OEP.

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 in an MA-PD or Part D prescription drug plan. b. It means that he will have a one time opportunity to enroll in 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 in a state-funded pharmacy assistance program for retirees that will cover 80 percent of his drug costs.

a

Ms. Thomas has worked for many years and is turning 68 in June. She is eligible for Medicare Part A and did not enroll for Part B when first eligible because she has insurance through her employer - Coffee Brew, Inc. She also did not enroll in Part D because she had creditable coverage. She would like to retire in June and enroll in a Medicare Advantage plan. She has been informed that her group coverage will end on her retirement effective date. How would you advise Ms. Thomas? a. Ms. Thomas can enroll in Part B without a late penalty at any time she is still covered by her employer group and 8 months after her last month of employer group coverage without a penalty. However, because she wants to enroll in a MA plan after retirement, she should make sure her Part B coverage is effective in time to use the Medicare Advantage/Part D special election period for individuals changing from employer group coverage to enro

a

Which of the following individuals are likely to qualify for a special election period (SEP) for either a MA and/or 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 to a new state providing him with new MA and Part D options. a. II, III, and IV only. b. II and III only. c. I, II, III and IV. d. I and II only.

a

Which of the following individuals has enrolled in a plan based on a fixed enrollment period? a. Ben enrolls in a Medicare Advantage plan during the Medicare Advantage Open Enrollment Period (MA OEP). b. Josephine enrolls in Original Medicare when she first becomes eligible for Medicare. c. Lucy enrolls in a Medicare Advantage plan after moving into a skilled nursing facility institution. d. Jorge enrolls in a Medicare Advantage plan during a special election period after special circumstances arose.

a

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 on January 1 next year. He is currently enrolled in Original Medicare. What should you do? a. Accept the form and wait until the Annual Election Period begins to send it to the plan for processing. b. Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. c. Tell Mr. Anderson that you cannot accept an enrollment form for coverage to begin on January 1 of next year before December 15. d. Accept the form and immediately send it to the plan for processing.

b

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. If the SEP is for MA coverage, he may make as many changes to his MA enrollment as he wants and the last choice made before the end of the SEP period will be the effective one. b. If the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage. c. If the SEP is for MA coverage, he may only use the SEP to disenroll from his MA plan and return to Original Medicare. d. 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.

b

Mrs. Kendrick is in good health, has worked for many years, and 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 must first enroll in a Medicare Part D plan, before enrolling in a Medicare Advantage plan. b. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. c. 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. d. 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.

b

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 certain MA plans 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. 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. 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

c

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 should sign the form for Mrs. Nunez yourself, since she informed you, as the plan's representative, that she wanted to enroll. c. As long as she can 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. d. You can countersign Mrs. Nunez's application, along with her husband, indicating that she approved this choice v

c

Mrs. Pierce would like to enroll in a Medicare Cost plan that offers Part D prescription drug coverage. She comes to you for advice about when she can enroll in a plan you have previously discussed. What should you tell her? a. Enrollment in Cost plans offering Part D coverage is generally available only 30 days per year, because of the more generous benefits of these plans. b. Enrollment in Cost plans offering Part D coverage is generally available year-round, so she can immediately enroll and have prescription drug coverage. c. Enrollment in Cost plans offering Part D coverage is available only during enrollment periods under the Part D program, and Cost plans must accept enrollments during these periods. d. Enrollment in Cost plans offering Part D prescription drug coverage is not necessary because Cost plans offer more generous Part B benefits.

c

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 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 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 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 bene

c

Ms. Claggett is sixty-six (66) years old. She has been covered under Original Medicare for the last six years due to her disability and 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" (IEP) 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. Ms. Claggett has had two IEPs and missed them both. The f

c

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 will have to wait until the next Annual Election Period to be able to enroll in a plan available in her new location. 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 Postal Service with a notification that the resident has moved. So, she should be sure to notify the Postal Service immediately. c. She is eligible for a special election period (SEP) 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

c

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 his employer-sponsored coverage to elect a Medicare Advantage or Part D plan, but he must wait until the next Annual Election Period. b. Mr. Chen must convert his current coverage to employer-sponsored retiree coverage and wait one year before enrolling in a MA or Part D plan. c. Mr. Chen can disenroll from the employer-sponsored plan and his only option is to choose a Medigap plan. d. Mr. Chen can disenroll from his employer-sponsored coverage to elect a Medicare Advantage or Part D plan within 2 months of his disenrollment.

d

Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period (AEP). On December 1, he calls you up and says that he has changed his mind and would like to enroll in a MA-PD plan. What enrollment rules would apply in this case? a. He must return to Original Medicare but must then enroll in a Part D plan if he wants prescription drug coverage through Medicare. b. He should wait for at least six months into the plan year to be sure that he wants to make the change. If he still wants to do so, he can make any sort of change he likes at that point. c. He can only make a single enrollment change during the Annual Election Period, so he will not be able to change his enrollment. d. He can make as many enrollment changes as he likes during the Annual Election Period and the last choice made before the end of the period will be the effective one as of January 1.

d

Mr. Liu turns 65 on June 19. He has never previously qualified for Medicare so his first Medicare eligibility date will be June 1. Mr. Liu's ICEP and Part D IEP begin on March 1 and end on September 30. He wants prescription drug coverage with his Part A and Part B benefits. What advice can you provide him? a. He can enroll in a MA plan now, but he will have to wait until the next Annual Election Period to obtain prescription drug coverage. b. He must wait until the next Annual Election Period to enroll in a MA-PD plan. c. Since this is his first time qualifying for Medicare, he will have to enroll in Original Medicare with a Part D plan this year and change his enrollment to a MA-PD plan next year. d. He can enroll in a MA-PD as long as he enrolls in Part B and is entitled to Part A.

d

Mrs. Ridgeway enrolled in Original Medicare and Medigap coverage following her retirement 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 qualifies for a special election 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. b. She must wait until the next MA Open Enrollment Period (OEP) during which she can elect to return to Original Medicare. 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 election period (SEP) that will allow her to make a one

d

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 before the start of the annual enrollment period (AEP). What would you say If you were advising Agent Adams? a. This is a good idea. The plan will retain Mrs. Young's application and process it when the AEP begins. b. 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. This is a good idea. This locks Mrs. Young into a plan and protects Agent Adams' commission. d. This is a bad idea. Agents are generally prohibited from soliciting

d