2022 OVERVIEW of MEDICARE PROGRAM BASICS: CHOICE, ELIGIBILTY, AND BENEFITS
ENROLLMENT GUIDANCE MEDICARE ADVANTAGE AND PART D PLANS
PART 5
1. 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. Mr. Tully’s daughter can do so only, if she is authorized under state law as a court-appointed legal
guardian, has a durable power of attorney for health care decisions, or is authorized under state
surrogate consent laws to make health decisions. Correct
b. Mr. Tully’s daughter can do so because she is an immediate family member who has taken
responsibility for her father’s care. Incorrect
c. A signature is not necessary since Mr. Tully is not physically or mentally capable of filling out and
signing the form. Incorrect
d. If the enrollment form is countersigned by one of Mr. Tully’s treating physicians, she can sign it for
him. Incorrect
2. 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. Correct
b. She should call the doctor’s office to complain since the plan cannot do anything about the doctor’s
schedule. Incorrect
c. She must write to the plan and wait for a response and then she could file a grievance if she is still
dissatisfied. Incorrect
d. She should not expect to get in to see her doctor any more quickly since she is a Medicare patient.
Incorrect
3. 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. You cannot, under any circumstances, ask Mrs. Midler any health-related questions. Incorrect
,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. Incorrect
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.
Correct
d. 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. Incorrect
4. 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 the information since it was a simple mistake. You do not need to do anything further
to the application form. Incorrect
b. 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. Incorrect
c. You may correct the information, but she will need to write a brief statement indicating she authorized
you to make the change. Incorrect
d. You may correct this information as long as you add your initials and date next to the correction
Correct
5. 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. A $20 gift certificate thanking her for enrolling. Incorrect
b. Evidence of plan membership, information on how to obtain services, and the effective date of
coverage. Correct
c. 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. Incorrect
d. 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. Incorrect
6. Mr. Garcia was told he qualifies for a Special Enrollment 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 will generally have one opportunity to change his MA coverage.
Correct
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. Incorrect
, c. He may only use the SEP to disenroll from his MA plan and return to Original Medicare. Incorrect
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. Incorrect
7. 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 Incorrect
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. Incorrect
c. You should sign the form for Mrs. Nunez yourself, since she informed you, as the plan’s representative,
that she wanted to enroll. Incorrect
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. Correct
8. 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 must remain enrolled in the Medicare Cost plan until the next AEP. Incorrect
b. Mrs. Valentino can call Medicare, request to be disenrolled from the Cost plan, and enroll in Original
Medicare. Incorrect
c. Mrs. Valentino qualifies for a special enrollment period, which will allow her to immediately enroll in a
MA-PD plan of her choice. Incorrect
d. Mrs. Valentino can submit a written request to Medicare to be disenrolled from the Cost plan and
enroll in Original Medicare. Correct
9. 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. The SNP would select her primary care provider (PCP) but she could file a grievance within 90 days if
the PCP proved incapable. Incorrect
b. 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.
Correct
ENROLLMENT GUIDANCE MEDICARE ADVANTAGE AND PART D PLANS
PART 5
1. 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. Mr. Tully’s daughter can do so only, if she is authorized under state law as a court-appointed legal
guardian, has a durable power of attorney for health care decisions, or is authorized under state
surrogate consent laws to make health decisions. Correct
b. Mr. Tully’s daughter can do so because she is an immediate family member who has taken
responsibility for her father’s care. Incorrect
c. A signature is not necessary since Mr. Tully is not physically or mentally capable of filling out and
signing the form. Incorrect
d. If the enrollment form is countersigned by one of Mr. Tully’s treating physicians, she can sign it for
him. Incorrect
2. 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. Correct
b. She should call the doctor’s office to complain since the plan cannot do anything about the doctor’s
schedule. Incorrect
c. She must write to the plan and wait for a response and then she could file a grievance if she is still
dissatisfied. Incorrect
d. She should not expect to get in to see her doctor any more quickly since she is a Medicare patient.
Incorrect
3. 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. You cannot, under any circumstances, ask Mrs. Midler any health-related questions. Incorrect
,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. Incorrect
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.
Correct
d. 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. Incorrect
4. 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 the information since it was a simple mistake. You do not need to do anything further
to the application form. Incorrect
b. 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. Incorrect
c. You may correct the information, but she will need to write a brief statement indicating she authorized
you to make the change. Incorrect
d. You may correct this information as long as you add your initials and date next to the correction
Correct
5. 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. A $20 gift certificate thanking her for enrolling. Incorrect
b. Evidence of plan membership, information on how to obtain services, and the effective date of
coverage. Correct
c. 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. Incorrect
d. 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. Incorrect
6. Mr. Garcia was told he qualifies for a Special Enrollment 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 will generally have one opportunity to change his MA coverage.
Correct
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. Incorrect
, c. He may only use the SEP to disenroll from his MA plan and return to Original Medicare. Incorrect
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. Incorrect
7. 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 Incorrect
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. Incorrect
c. You should sign the form for Mrs. Nunez yourself, since she informed you, as the plan’s representative,
that she wanted to enroll. Incorrect
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. Correct
8. 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 must remain enrolled in the Medicare Cost plan until the next AEP. Incorrect
b. Mrs. Valentino can call Medicare, request to be disenrolled from the Cost plan, and enroll in Original
Medicare. Incorrect
c. Mrs. Valentino qualifies for a special enrollment period, which will allow her to immediately enroll in a
MA-PD plan of her choice. Incorrect
d. Mrs. Valentino can submit a written request to Medicare to be disenrolled from the Cost plan and
enroll in Original Medicare. Correct
9. 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. The SNP would select her primary care provider (PCP) but she could file a grievance within 90 days if
the PCP proved incapable. Incorrect
b. 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.
Correct
