2024 AHIP Module 5
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? -
ANS-You must tell him you are not permitted to take the form. If he sends the form
directly to the plan, the plan will process the enrollment on the day the Annual
Election Period begins.
\Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area
that has suffered from major flooding that has been declared a major disaster by
both the Federal government and her state. As a result of dealing with the flooding
issues and being evacuated from her home, Edna missed her chance to enroll in MA
during her Initial Coverage Election Period. Felix lives in an area with a Medicare
Advantage plan with a 4-star rating that he would like to join. George dropped his
Medigap policy six months ago when he first enrolled in a Medicare Advantage plan.
He now wants to return to Original Medicare. Harriet has recently developed
diabetes and would like to enroll in a Medicare Advantage plan that focuses on care
for those with that disease. Which, if any, of these individuals would qualify for a
special election period (SEP)? - ANS-Edna would qualify for a SEP because
government officials have declared a major disaster for her area and she did not
enroll in MA during her ICEP due to the emergency. George would qualify for an
SEP because he enrolled in Medicare Advantage (MA) plan for the first time and
would now like to return to Original Medicare within the first 12 months of his
enrollment. Harriet would also qualify for a SEP to enroll in a C-SNP because she
has developed a chronic condition. Felix would not qualify for a SEP since he seeks
to enroll in a 4-star not a 5-star MA plan.
\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? - ANS-Mary
may make an unlimited number of MA enrollment requests and may disenroll from
her current MA plan.
\Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What
action could you help him take during this time? - ANS-He will have one opportunity
to enroll in a Medicare Advantage plan.
\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? - ANS-He qualifies for a special election period and can enroll in or disenroll
from a Part D plan once during that period.
\Mr. Roberts is enrolled in an MA plan. He recently suffered complications following
hip replacement surgery. As a result, he has spent the last three months in
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? -
ANS-You must tell him you are not permitted to take the form. If he sends the form
directly to the plan, the plan will process the enrollment on the day the Annual
Election Period begins.
\Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area
that has suffered from major flooding that has been declared a major disaster by
both the Federal government and her state. As a result of dealing with the flooding
issues and being evacuated from her home, Edna missed her chance to enroll in MA
during her Initial Coverage Election Period. Felix lives in an area with a Medicare
Advantage plan with a 4-star rating that he would like to join. George dropped his
Medigap policy six months ago when he first enrolled in a Medicare Advantage plan.
He now wants to return to Original Medicare. Harriet has recently developed
diabetes and would like to enroll in a Medicare Advantage plan that focuses on care
for those with that disease. Which, if any, of these individuals would qualify for a
special election period (SEP)? - ANS-Edna would qualify for a SEP because
government officials have declared a major disaster for her area and she did not
enroll in MA during her ICEP due to the emergency. George would qualify for an
SEP because he enrolled in Medicare Advantage (MA) plan for the first time and
would now like to return to Original Medicare within the first 12 months of his
enrollment. Harriet would also qualify for a SEP to enroll in a C-SNP because she
has developed a chronic condition. Felix would not qualify for a SEP since he seeks
to enroll in a 4-star not a 5-star MA plan.
\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? - ANS-Mary
may make an unlimited number of MA enrollment requests and may disenroll from
her current MA plan.
\Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What
action could you help him take during this time? - ANS-He will have one opportunity
to enroll in a Medicare Advantage plan.
\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? - ANS-He qualifies for a special election period and can enroll in or disenroll
from a Part D plan once during that period.
\Mr. Roberts is enrolled in an MA plan. He recently suffered complications following
hip replacement surgery. As a result, he has spent the last three months in
