AHIP Module 5 Complete Solutions

AHIP Module 5 Complete Solutions Medicare Advantage (MA) Enrollment Can Mary Samuels change her MA plan due to a change in residence? Yes, she can make an unlimited number of MA enrollment requests during the Special Election Period (SEP) due to a change of residence. Can an individual qualify for a SEP for MA and Part D due to a change of residence? Yes, options II, III, and IV qualify for a SEP. Annual Enrollment Period (AEP) Can Mr. Anderson enroll in a new plan on October 10 that begins January 1 next year? No, you cannot accept any enrollment forms until the AEP begins. Special Enrollment Period (SEP) Can Ms. Gonzales use the Open Enrollment Period (OEP) to enroll in a Medicare Advantage plan? No, OEP is only available to MA enrollees, not Original Medicare beneficiaries. Can Mr. Tully's daughter fill out his enrollment form for him? No, she needs authorization 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. Medicare Advantage and Part D Enrollment Can Mrs. Berkowitz enroll in a Medicare Advantage plan without drug coverage and also enroll in a stand-alone Part D plan? Yes, 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. Eligibility Can Mr. Kelly sign up for a Private Fee-for-Service (PFFS) plan? Yes, if he is entitled to Part A, enrolled in Part B, and lives in the PFFS plan's service area. Can Mrs. Pierce enroll in a Medicare Cost plan that offers Part D prescription drug coverage? No, enrollment in Cost plans offering Part D coverage is available only during enrollment periods under the Part D program. Special Enrollment Period (SEP) What can Mr. Garcia do during his SEP if he lost the paper explaining what he could do during the SEP? He will generally have one opportunity to change his MA coverage. Can Ms. Lee enroll in another Medicare Advantage plan when she moves out of her current plan's service area? She is eligible for a Special Election Period that begins either the month before her permanent move or the month she provides notice of the move. Initial Enrollment Period (IEP) Can Ms. Claggett enroll in a Part D plan during the IEP? No, the IEP occurs three months before and three months after the month when a beneficiary meets the eligibility requirements for Part B, so she will not be able to use it as a justification for enrolling in a Part D plan now. Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period (AEP). On December 1, he calls you up and says that he has changed his mind and would like to enroll into a MA PD plan. What enrollment rules would apply in this case? ️d. He can make as many enrollment changes as he likes during the Annual Election Period and the last choice made prior to the end of the period will be the effective one as of January 1. Mrs. Kendrick is in good health, has worked for many years and is six months away from turning 65. She wants to know what she will have to do to enroll in a Medicare Advantage (MA) plan as soon as possible. What could you tell her? ️a. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. 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. ️b. "If you're not in very good health, you will probably do better with a different product." Mrs. Ridgeway enrolled in Original Medicare and Medigap coverage following her retirements several years ago. Four months ago, Mrs. Ridgeway dropped her Medigap policy to enroll in a Medicare Advantage (MA) plan for the first time. Unfortunately, Mrs. Ridgeway has found that many of her providers are not in the MA plan's network. She has come to you for advice? What should you tell her? ️b. She qualifies for a special enrollment period (SEP) that will allow her to make a one-time election to return to Original Medicare and she also has a guaranteed eligibility period to rejoin her Medigap 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? ️a. Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. 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. Mrs. Schneider has Original Medicare Parts A and B and has just qualified for her state's Medicaid program, so the state is now paying her Part B premium and she is considered a dual eligible. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan? ️c. Yes. Qualifying for this state program gives Mrs. Schneider access to a Special Enrollment Period that allows her to make changes to her MA and/or Part D enrollment during the first 9 months of each calendar year. 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? ️a. Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan. Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. In setting up the enrollment site, which of the following must Phiona consider? I. If a legal representative is completing an electronic enrollment request, he or she must first upload proof of his or her authority. II. All data elements required to complete an enrollment request must be captured