AHIP – 5 Questions and Answers with
Complete Solutions
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?
If the SEP is for MA coverage, he will generally have one opportunity to change his MA
coverage.
3 MULTIPLE CHOICE OPTIONS
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?
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.
3 MULTIPLE CHOICE OPTIONS
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?
During the MA Open Enrollment 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.
3 MULTIPLE CHOICE OPTIONS
,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?
If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug
coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this.
3 MULTIPLE CHOICE OPTIONS
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?
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.
3 MULTIPLE CHOICE OPTIONS
You are doing a sales presentation for Mrs. Pearson. You know that Medicare marketing
guidelines prohibit certain types of statements. Apply those guidelines to the following
statements and identify which would be prohibited.
"If you're not in very good health, you will probably do better with a different product."
3 MULTIPLE CHOICE OPTIONS
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?
, Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period
begins.
3 MULTIPLE CHOICE OPTIONS
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?
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.
3 MULTIPLE CHOICE OPTIONS
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?
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.
3 MULTIPLE CHOICE OPTIONS
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
Complete Solutions
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?
If the SEP is for MA coverage, he will generally have one opportunity to change his MA
coverage.
3 MULTIPLE CHOICE OPTIONS
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?
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.
3 MULTIPLE CHOICE OPTIONS
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?
During the MA Open Enrollment 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.
3 MULTIPLE CHOICE OPTIONS
,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?
If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug
coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this.
3 MULTIPLE CHOICE OPTIONS
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?
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.
3 MULTIPLE CHOICE OPTIONS
You are doing a sales presentation for Mrs. Pearson. You know that Medicare marketing
guidelines prohibit certain types of statements. Apply those guidelines to the following
statements and identify which would be prohibited.
"If you're not in very good health, you will probably do better with a different product."
3 MULTIPLE CHOICE OPTIONS
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?
, Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period
begins.
3 MULTIPLE CHOICE OPTIONS
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?
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.
3 MULTIPLE CHOICE OPTIONS
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?
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.
3 MULTIPLE CHOICE OPTIONS
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
