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UNDERSTANDING MEDICARE ENROLLMENT: KEY
SCENARIOS & SOLUTIONS/ AHIP FINAL
EXAMINATION TEST BANK 2024 | 3 VERSIONS WITH 50
QUESTIONS EACH/EADY GRADED /BRAND NEW 2024-
2025
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? - RIGHT
ANS:>>>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.
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? - RIGHT ANS:>>>Ms.
Claggett has had two IEPs and missed them both. The first occurred three months before and
three months after the month when she was first entitled to Part A OR enrolled in Part B.
Because she was eligible for Medicare before age 65, Ms. Claggett had a second IEP based on
turning age 65, which has also expired.
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? - RIGHT ANS:>>>Mary may make an unlimited number of MA enrollment
requests and may disenroll from her current MA plan.
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? - RIGHT ANS:>>>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.
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 into a MA-PD plan. What enrollment rules would apply in this case? - RIGHT
ANS:>>>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.
Which of the following individuals is most likely to be eligible to enroll in a Medicare
Advantage (MA) or Part D Plan? - RIGHT ANS:>>>Jose, a grandfather who was granted
asylum and has worked in the United States for many years.
Which of the following individuals are likely to qualify for a special enrollment 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. - RIGHT ANS:>>>II, III, and IV only
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? - RIGHT
ANS:>>>You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if
he lives in the PFFS plan's service area.
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 and she is considered a dual
eligible. Will gaining eligibility for this program affect her ability to enroll in a Medicare
Advantage or Medicare Prescription Drug plan? - RIGHT ANS:>>>Yes. Qualifying for this
state program gives Mrs. Schneider access to a Special Enrollment Period that allows her to
make changes to her MA and/or Part D enrollment during the first 9 months of each calendar
year.
,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 mechanism must advise each individual at the beginning of the process that he or she is
completing an actual enrollment request.
IV. The mechanism must capture an accurate time and date stamp at the time the applicant enters
the online site. - RIGHT ANS:>>>II and III only
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? - RIGHT ANS:>>>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.
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? - RIGHT ANS:>>>She may enroll in an MA plan
beginning three months immediately before her first entitlement to both Medicare Part A and
Part B.
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)? - RIGHT ANS:>>>Mr.
Rockwell is eligible for a SEP due to his involuntary loss of creditable drug coverage; the SEP
begins in June and ends on September 1- two months after the loss of creditable coverage.
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? - RIGHT ANS:>>>Mr. Chen can disenroll from his
, employer-sponsored coverage to elect a Medicare Advantage or Part D plan within 2 months of
his disenrollment.
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? - RIGHT
ANS:>>>Her daughter should come in November.
Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could
you help him take during this time? - RIGHT ANS:>>>He will have one opportunity to enroll in
a Medicare Advantage plan.
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? - RIGHT ANS:>>>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.
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? - RIGHT ANS:>>>This is a bad idea. Agents are generally
prohibited from soliciting or accepting an enrollment form before the start of the AEP.
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? - RIGHT
ANS:>>>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.
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? - RIGHT
ANS:>>>He qualifies for a special election period and can enroll in or disenroll from a Part D
plan once during that period.
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