AHIP – 5 QUESTIONS WITH
ACCURATE ANSWERS
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? -
ANSWERSIf the SEP is for MA coverage, he will generally have one opportunity to
change his MA coverage.
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? - ANSWERSYes. Mrs. Walters must be entitled to Part A or
enrolled in Part B to be eligible for coverage under the Medicare prescription drug
program.
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? - ANSWERSDuring
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.
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? - ANSWERSIf 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.
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? -
ANSWERSShe 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.
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. - ANSWERS"If you're not
in very good health, you will probably do better with a different product."
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? - ANSWERSTell Mr.
, Anderson that you cannot accept any enrollment forms until the annual election period
begins.
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? - ANSWERSMr. 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.
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? - ANSWERSThere 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? - ANSWERSMs. 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? - ANSWERSMary 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? - ANSWERSEnrollment 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.
ACCURATE ANSWERS
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? -
ANSWERSIf the SEP is for MA coverage, he will generally have one opportunity to
change his MA coverage.
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? - ANSWERSYes. Mrs. Walters must be entitled to Part A or
enrolled in Part B to be eligible for coverage under the Medicare prescription drug
program.
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? - ANSWERSDuring
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.
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? - ANSWERSIf 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.
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? -
ANSWERSShe 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.
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. - ANSWERS"If you're not
in very good health, you will probably do better with a different product."
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? - ANSWERSTell Mr.
, Anderson that you cannot accept any enrollment forms until the annual election period
begins.
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? - ANSWERSMr. 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.
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? - ANSWERSThere 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? - ANSWERSMs. 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? - ANSWERSMary 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? - ANSWERSEnrollment 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.
