2022 AHIP UNIT 5 ENROLLMENT GUIDANCE MA AND PART

2022 AHIP UNIT 5 ENROLLMENT GUIDANCE MA AND PART DQUESTION 1 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.Thisis 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. B.Thisis a good idea. Thislocks Mrs. Young into a plan and protects Agent Adams’ commission. c.Thisis a bad idea. Agents are generally prohibited from soliciting or accepting an enrollment form before the start of the AEP. d.Thisis a good idea. The plan will retain Mrs. Young’s application and process it when the AEP begins. Source: Part 5, Slide – Enrollment Periods - Annual Election Period and Slide – Enrollment Periods Annual Election Period, Timeframe for Submitting Enrollment Forms Question 2 Mrs. Reeves is newly eligible to enroll in a Medicare Advantage plan and her MA Initial Coverage Election Period (ICEP) has just begun. Which of the following can she not do during the ICEP? a.During her ICEP, she can make an enrollment choice and change that choice during her MA Open Enrollment Period (MA OEP) that follows her election. b.She can compare various MA plan options and select one to enroll in. c.She can enroll in a Medigap plan to supplement the benefits of the MA plan that she’s also enrolling in. d.She can choose to enroll in a MA-PD plan, provided that her Part D initial election period and MA ICEP occur at the same time. Source: Part 5, Enrollment Periods MA ICEP, continued. Question 3 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. If Mr. Block wantsto enroll in both a MA-PD and a stand-alone PDP, he may buy the extra coverage without any adverse effect. c. 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. d.If Mr. Block enrollsin 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. Source: Part 5, Slide – Beneficiary Acknowledgements when Enrolling. Question 4 Mr. Yoo’s employer hasrecently 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 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. Incorrect. The special election period (SEP) he would qualify for is because of an involuntary loss of creditable drug coverage. The SEP begins the month he was advised of the loss of coverage, and it ends 2 months after the loss of creditable coverage. The SEP does not mean that he’ll be able to purchase continued drug coverage from the insurer that the company had provided to its retirees. c.It meansthat he will have a one time opportunity to enroll in a Medigap policy with drug coverage. d.It meansthat he will be able to enroll in a state-funded pharmacy assistance program for retirees that will cover 80 percent of his drug costs. Source: Part 5, Slide – Typical SEPs – Involuntary Loss of Creditable Drug Coverage and Slide – Enrollment Periods – SEPs, Limitations begins in June and ends on September 1- two months after the loss of creditable coverage. c.Mr. Rockwell is eligible for a SEP due to hisinvoluntary loss of creditable drug coverage; the SEP Question 5 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 election periods (SEPs)? a.Mr. Rockwell is eligible for a SEP that beginsin June and ends three monthslater, during which he may enroll, disenroll, and reenroll in Part D plans, with his last selection considered binding. b.Mr. Rockwell must wait until the next annual election period (AEP) to sign up for Part D prescription drug coverage. d.Mr. Rockwell is eligible for a SEP that beginsthree months before the month in which he receives notice of loss of creditable coverage and ends three months after that month. Source: Part 5, Slide – Typical SEPs – Involuntary Loss of Creditable Drug Coverage. Question 6 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 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. b.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. 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 beneficiary moves outside of the service area. d.It is a period when beneficiaries who are newly eligible for Medicare may make their first choice of a Medicare prescription drug plan. Source: Part 5, Slide - Enrollment Periods - SEPs and Slide - Enrollment Periods - SEPs, continued. Question 7 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 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. b.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.She should wait until the new year to disenroll from Original Medicare and select an MA plan between January 1 and March 31. d.She could immediately enroll in MA plan based on the one-time special election period available to those 70 and younger. Source: Part 5, Slide – Enrollment Periods - MA Initial Coverage Election Period (ICEP) and Slide Enrollment Periods- Annual Election Period. Question 8 Mr. and Mrs. Nunez attended one of yoursales 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.You should sign the form for Mrs. Nunez yourself,since she informed you, asthe plan’srepresentative, that she wanted to enroll. b.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. c.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. d.Legalspouses can sign enrollment formsfor one another under federal law. You may enroll both Mr. and Mrs. Nunez, as long as her husband signs on her behalf. Source: Part 5, Slide – Who May Complete the Enrollment Form? Question 9 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 specializesin 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 there is a special needs plan (SNP) in Mr. Wendt’s area thatspecializes in caring for individuals with diabetes, he may enroll in the SNP at any time under a special election period (SEP) d.Because of the severity of his condition, Mr. Wendt must remain enrolled in Original Medicare and also enroll in a Medigap plan to supplement his additional medical needs. Source: Part 5, Slide – Typical SEPs -Severe or Disabling Chronic Conditions Question 10 A client wants to give you an enrollment application on October 1 before 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 sendsthe form directly to the plan, the plan will process the enrollment on the day the Annual Election Period begins. b.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. c.You must send it to the plan for immediate processing, although the enrollment will not become effective until January 1. 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. Source: Part 5, Slide -Enrollment Periods: Annual Election Period, Timeframe for Submitting Enrollment Forms Question 11 Mr. White has Medicare Parts A and B with a Part D plan. Last year, he received a notice that his plan sponsor identified him as a “potential at-risk” beneficiary. This month, he started receiving assistance from Medicaid. He wants to find a different Part D plan that’s more suitable to his current prescription drug needs. He believes he’s entitled to a SEP since he is now a dual eligible. Is he able to change to a different Part D plan during a SEP for dual eligible individuals? a.No. Individuals identified by the plan sponsor as “potential at-risk” must wait 2 years to switch plans, after which time the designation is lifted. b.Yes. “Potential at-risk” designations are just a warning. Only “at-risk” beneficiaries are prohibited from using this SEP while the designation is in place. c.Yes. The “potential at-risk” designation only impactsthe services he may receive from the Part D plan he enrolls, but it doesn’t affect his ability to change plans during this SEP. Incorrect.: Once an individual is identified by the plan sponsor as a “potential at-risk” or “at-risk” beneficiary and the plan sponsor has sent written notice to the individual, he or she cannot use this SEP to change plans while this designation is in place. d.No. Once he isidentified by the plan sponsor as a “potential at-risk” beneficiary, he cannot use the dual eligible SEP to change plans while this designation is in place. Source: Part 5, Slide – Typical SEPs – Beneficiaries who are dual eligible or who have LIS eligibility; and Slide – Typical SEPs – Beneficiaries who are dual eligible or who have LIS eligibility, limitations for at-risk and potential at-risk beneficiaries Question 12 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 thisinformation aslong 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 correctionsto information a beneficiary has provided. Review of enrollment forms is the sole responsibility of the plan sponsor. d.You may correct the information, butshe will need to write a briefstatement indicating she authorized you to make the change. Source: Part 5, Slide – Who May Complete the Enrollment Form? Marketing Representative Participation. 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 his employer-sponsored coverage to elect a Medicare Advantage or Part D plan within 2 months of his disenrollment. d.Mr. Chen can disenroll from the employer-sponsored plan and his only option is to choose a Medigap plan. Source: Part 5, Slide Other Common SEPs. Question 14 Mr. Garrett hasjust entered his MA Initial Coverage Election Period (ICEP). What action could you help him take during this time? a.He will have one opportunity to enroll in a Medicare Advantage plan. b.He will have a nine month period during which he may enroll in as many Medicare Advantage plans as he chooses, with the last enrollment being the effective one. c.If he has a disability, he must enroll in Original Fee-for-Service Medicare during the MA Initial Coverage Election Period. d.He may change or drop MA plans, but may not drop drug coverage. Source: Module 5, Slide - Enrollment Periods: MA Initial Coverage Election Period (ICEP) and Slide – Enrollment Periods MAICEP, continued Question 15 Mr. Robertsis enrolled in an MA plan. He recently suffered complicationsfollowing hip replacement surgery. As a result, he hasspent 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.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. Incorrect. An institutionalized individual, such as Mr. Roberts, does not have to return to Original Medicare within two months of discharge. He may make a Medicare Advantage enrollment request or at his option return to Original Medicare and enroll in Part D. b.His open enrollment period as an institutionalized individual will continue for two months after the month he moves out of the facility. c.His open enrollment period as an institutionalized individual will continue for 12 months following his date of discharge. d.Mr. Roberts hastwo 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. Source: Part 5, MA Open Enrollment Period for Institutionalized (OEPI) Individuals Part D SEP for Institutionalized Individuals. Question 16 Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-income subsidy. How does that affect his ability to enroll or disenroll in a Part D plan? a.He can enroll in a different plan or disenroll from his current plan during the next Annual Election Period. b.He qualifies for a special election period and can enroll in or disenroll from a Part D plan once during that period. c.He can apply the subsidy amount to his existing plan immediately, but he cannot enroll in a different plan. d.He can only enroll in or disenroll from an MA-PD plan. Incorrect. He is not restricted only to enrolling in or disenrolling from a MA-PD plan. He is also eligible to enroll in or disenroll from a Part D plan. Source: Part 5, Slide -Typical SEPs – Beneficiaries who are dual eligible or who have LIS eligibility, and Slide - Typical SEPs - Change in Medicaid or LIS Status. Question 17 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.She should wait for at least six monthsinto the plan year to be sure that she really wants to make the change. If she still wants to do so, she can make any sort of change she likes at that point. b.Her daughtershould come in November. c.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. d.Her daughter should come sometime between January 1 and March 31. Source: Part 5, Slide -Enrollment Periods: Annual Election Period. Question 18 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 records 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 can initiate a 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. c. You cannot, under any circumstances, ask Mrs. Midler any health-related questions. Incorrect. Marketing representatives may ask health screening questions during the completion of an enrollment request if they are necessary to determine eligibility to enroll in a SNP. d.You can only ask Mrs. Midler questions about conditionsthat affect eligibility,specifically, whethershe has one of the conditions that would qualify her for a special needs plan. Source: Part 5, Slide - Enrollment Discrimination Prohibitions. Question 19 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? 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 make one a.He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may only enroll in an MA-PD plan. c.He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may only add standalone Medicare prescription drug coverage. d.He must first enroll in a Medicare Part D plan, before enrolling in a Medicare Advantage plan. Source: Part 5,Slide - Enrollment Periods: Part D Initial Enrollment Period (IEP). Question 20 Mrs. Margolis contacts you in August because she will become eligible for Medicare for the first time in November. She would like to meet and discuss plan choices with you. What advice should you give her? a.Tell her to wait until October to discuss plan choices with you so that you can share plan benefits for the current year as well as any changes for the following year that may impact her choice b.Tell her you can meet with her immediately to discuss plan options for the following plan year only. c.Tell her that you should meet to discuss her plan choices as soon as possible so she has more time to weigh her options for the current and following plan years before her enrollment would become effective in November. d.Tell her you are not permitted to meet with her until after she becomes eligible for Medicare in November. Source: Module 5, Slide – Enrollment Periods – Annual Election Period, Timeframes for Submitting Enrollment Forms, continued and Slide – Timeframesfor Submitting Enrollment Forms, continued.