AHIP
What impact, if any, have recent regulatory changes had on Medigap plans?
The Part B deductible is no longer covered for individuals newly eligible for
Medicare starting January 1, 2020.
Mrs. Schmidt is moving and a friend told her she might qualify for a "special
election period" to enroll in a new Medicare Advantage plan. She contacted
you to ask what a special election period is. What could you tell her?
It is a single period from January 1 - March 31, created by statute, when any
Medicare beneficiary who has moved out of the area of their Medicare
Advantage or Part D plan can add, drop, or change their Medicare
prescription drug coverage.
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 (SEP) 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.
Mrs. Tanner is enrolled in a Medicare Advantage HMO that offers a point of
service option. This allows Mrs. Tanner to do which of the following?
Mrs. Tanner can go to non-plan doctors for certain services without receiving
prior approval.
, Scot Fitzwilliam is a Medicare beneficiary who currently takes several
prescription drugs daily. He does not suffer, however, from diabetes. He is
currently considering enrolling in the PDP you represent. Mr. Fitzwilliam
enjoys a comfortable income and therefore is unlikely to qualify for a low-
income subsidy. He is careful with his money and asks you about his likely
out-of-pocket costs under a standard benefits PDP plan. What do you say?
Mr. Fitzwilliam is likely to be responsible for a deductible of $590 (PY 2025)
after which he will be responsible for 25 percent of his prescription drug
costs during the initial coverage phase - that is, between the deductible and
the initial coverage limit of $2,000 (PY 2025).
Richard is a licensed agent who represents Spartan Health Plan and its
Medicare Advantage (MA) plans. Richard has several clients who have
recently come to him for help who are in their initial coverage election period
(ICEP) and are interested in enrolling in one of Spartan Health Plan's MA
plans. Alice will soon turn 65 and retire. Alice has coverage through Spartan
Health Plan offered by her employer. Bob had health coverage through
Spartan but dropped the coverage when he retired early to travel overseas.
Bob, who has just turned age 65, is now back in the United States. Charlotte,
who will turn 65 next month, has coverage through Athena Health plan - a
company Richard also represents. Who qualifies for the opt-in simplified
enrollment mechanism?
Alice and Charlotte because each of them currently have health coverage
and is in their initial coverage election period (ICEP).
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare
prescription drug plan you represent and simply give you a check to cover
his premiums for the entire year. What should you tell him?
He will need to mail in his payment with his enrollment form.
What impact, if any, have recent regulatory changes had on Medigap plans?
The Part B deductible is no longer covered for individuals newly eligible for
Medicare starting January 1, 2020.
Mrs. Schmidt is moving and a friend told her she might qualify for a "special
election period" to enroll in a new Medicare Advantage plan. She contacted
you to ask what a special election period is. What could you tell her?
It is a single period from January 1 - March 31, created by statute, when any
Medicare beneficiary who has moved out of the area of their Medicare
Advantage or Part D plan can add, drop, or change their Medicare
prescription drug coverage.
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 (SEP) 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.
Mrs. Tanner is enrolled in a Medicare Advantage HMO that offers a point of
service option. This allows Mrs. Tanner to do which of the following?
Mrs. Tanner can go to non-plan doctors for certain services without receiving
prior approval.
, Scot Fitzwilliam is a Medicare beneficiary who currently takes several
prescription drugs daily. He does not suffer, however, from diabetes. He is
currently considering enrolling in the PDP you represent. Mr. Fitzwilliam
enjoys a comfortable income and therefore is unlikely to qualify for a low-
income subsidy. He is careful with his money and asks you about his likely
out-of-pocket costs under a standard benefits PDP plan. What do you say?
Mr. Fitzwilliam is likely to be responsible for a deductible of $590 (PY 2025)
after which he will be responsible for 25 percent of his prescription drug
costs during the initial coverage phase - that is, between the deductible and
the initial coverage limit of $2,000 (PY 2025).
Richard is a licensed agent who represents Spartan Health Plan and its
Medicare Advantage (MA) plans. Richard has several clients who have
recently come to him for help who are in their initial coverage election period
(ICEP) and are interested in enrolling in one of Spartan Health Plan's MA
plans. Alice will soon turn 65 and retire. Alice has coverage through Spartan
Health Plan offered by her employer. Bob had health coverage through
Spartan but dropped the coverage when he retired early to travel overseas.
Bob, who has just turned age 65, is now back in the United States. Charlotte,
who will turn 65 next month, has coverage through Athena Health plan - a
company Richard also represents. Who qualifies for the opt-in simplified
enrollment mechanism?
Alice and Charlotte because each of them currently have health coverage
and is in their initial coverage election period (ICEP).
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare
prescription drug plan you represent and simply give you a check to cover
his premiums for the entire year. What should you tell him?
He will need to mail in his payment with his enrollment form.
