AHIP 2023 MODULE 5
QUESTIONS AND ANSWERS A
GRADED
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? - correct answer-Evidence of plan membership,
information on how to obtain services, and the effective date of coverage.
Mr. Robinson was quite ill recently and forgot to pay his monthly premium for his MA-PD
plan. He is worried that he will lose his coverage now when he needs it the most. He is
certain his plan will disenroll him because that is what happened to a friend of his in a
similar type of plan. What can you tell Mr. Robinson about his situation? - correct
answer-Plan sponsors have the option to do nothing when a plan member does not pay
their premiums or disenroll the member after a grace period and notice.
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? - correct answer-Ms. 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.
Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't sufficiently cover
his prescription drug needs. He is interested in changing plans during the upcoming MA
Open Enrollment Period. What are his options during the MA OEP? - correct answer-He
can switch to a MA-PD plan.
, Which of the following individuals has enrolled in a plan based on a fixed enrollment
period? - correct answer-Ben, who enrolls in a Medicare Advantage plan during the
Medicare Advantage Open Enrollment Period (MA OEP).
Mrs. Jenkins is enrolled in both Part A and Part B of Medicare. She has recently also
become eligible for Medicaid and would like to enroll in a MA-PD plan. Since this is her
first experience with Medicare Advantage, she is concerned that she will be locked into
a plan and unable to make any coverage changes for at least a year if not longer. What
should you tell her? - correct answer-Since Mrs. Jenkins has Medicare Part A and Part
B and receives Medicaid, she has a special election period (SEP) that will allow her to
enroll or disenroll from an MA or MA-PD plan during the first 9 months of each calendar
year.
Mr. Wilcox has been enrolled in Lexington Private Fee-for-Service (PFFS) Medicare
Advantage Health Plan (Lexington) for several years. Recently, Mr. Wilcox decided to
spend time with his children who live in another state that is not in Lexington's service
area. In the future, he may relocate near his children permanently. How does this move
to another service area impact his PFFS MA coverage? - correct answer-Lexington can
allow for Mr. Wilcox's continued enrollment for up to 12 months whether or not he is in a
visitor/traveler (V/T) program since it is a PFFS plan.
Mr. Fitzgerald is selling his home to permanently move into a retirement facility near his
daughter in a neighboring state before the Annual Election Period. He has a stand-
alone prescription drug plan and has learned it is not available where he is moving. He
doesn't know what he should do. What can you tell him? - correct answer-Because he is
moving outside of the service area, the plan must automatically disenroll him. He will
have a special election period to select a new plan.
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? - correct answer-Tell Mr.
Anderson that you cannot accept any enrollment forms until the annual election period
begins.
Mr. Wendt suffers from diabetes which has gotten progressively worse during the last
year. He is currently enrolled in Original Medicare (Parts A and B) and a Part D
prescription drug plan and did not enroll in a Medicare Advantage (MA) plan during the
last annual open enrollment period (AEP) which has just closed. Mr. Wendt has heard
certain MA plans might provide him with more specialized coverage for his diabetes and
wants to know if he must wait until the next annual open enrollment period (AEP) before
enrolling in such a plan. What should you tell him? - correct answer-If there is a special
QUESTIONS AND ANSWERS A
GRADED
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? - correct answer-Evidence of plan membership,
information on how to obtain services, and the effective date of coverage.
Mr. Robinson was quite ill recently and forgot to pay his monthly premium for his MA-PD
plan. He is worried that he will lose his coverage now when he needs it the most. He is
certain his plan will disenroll him because that is what happened to a friend of his in a
similar type of plan. What can you tell Mr. Robinson about his situation? - correct
answer-Plan sponsors have the option to do nothing when a plan member does not pay
their premiums or disenroll the member after a grace period and notice.
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? - correct answer-Ms. 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.
Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't sufficiently cover
his prescription drug needs. He is interested in changing plans during the upcoming MA
Open Enrollment Period. What are his options during the MA OEP? - correct answer-He
can switch to a MA-PD plan.
, Which of the following individuals has enrolled in a plan based on a fixed enrollment
period? - correct answer-Ben, who enrolls in a Medicare Advantage plan during the
Medicare Advantage Open Enrollment Period (MA OEP).
Mrs. Jenkins is enrolled in both Part A and Part B of Medicare. She has recently also
become eligible for Medicaid and would like to enroll in a MA-PD plan. Since this is her
first experience with Medicare Advantage, she is concerned that she will be locked into
a plan and unable to make any coverage changes for at least a year if not longer. What
should you tell her? - correct answer-Since Mrs. Jenkins has Medicare Part A and Part
B and receives Medicaid, she has a special election period (SEP) that will allow her to
enroll or disenroll from an MA or MA-PD plan during the first 9 months of each calendar
year.
Mr. Wilcox has been enrolled in Lexington Private Fee-for-Service (PFFS) Medicare
Advantage Health Plan (Lexington) for several years. Recently, Mr. Wilcox decided to
spend time with his children who live in another state that is not in Lexington's service
area. In the future, he may relocate near his children permanently. How does this move
to another service area impact his PFFS MA coverage? - correct answer-Lexington can
allow for Mr. Wilcox's continued enrollment for up to 12 months whether or not he is in a
visitor/traveler (V/T) program since it is a PFFS plan.
Mr. Fitzgerald is selling his home to permanently move into a retirement facility near his
daughter in a neighboring state before the Annual Election Period. He has a stand-
alone prescription drug plan and has learned it is not available where he is moving. He
doesn't know what he should do. What can you tell him? - correct answer-Because he is
moving outside of the service area, the plan must automatically disenroll him. He will
have a special election period to select a new plan.
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? - correct answer-Tell Mr.
Anderson that you cannot accept any enrollment forms until the annual election period
begins.
Mr. Wendt suffers from diabetes which has gotten progressively worse during the last
year. He is currently enrolled in Original Medicare (Parts A and B) and a Part D
prescription drug plan and did not enroll in a Medicare Advantage (MA) plan during the
last annual open enrollment period (AEP) which has just closed. Mr. Wendt has heard
certain MA plans might provide him with more specialized coverage for his diabetes and
wants to know if he must wait until the next annual open enrollment period (AEP) before
enrolling in such a plan. What should you tell him? - correct answer-If there is a special
