.
UNDERSTANDING MEDICARE ENROLLMENT: KEY
SCENARIOS & SOLUTIONS/ AHIP FINAL
EXAMINATION TEST BANK 2024 | 3 VERSIONS WITH
50 QUESTIONS EACH/EADY GRADED /BRAND NEW
2026-2027
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? - RIGHT ANS:>>>There 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 unde r this period. What should you tell her about how the Part D
Initia l Enrollment Period applies to her situation? - RIGHT ANS:>>>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.
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 g eographic area served by her current Medicare Advantage (MA) plan.
What options are available to Mary regarding her health plan coverage? - RIGHT
ANS:>>>Mary 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? - RIGHT ANS:>>>Enrollment 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.
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? - RIGHT ANS:>>>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.
Which of the following individuals is most likely to be eligible to enroll in a Medicare
Advantage (MA) or Part D Plan? - RIGHT ANS:>>>Jose, a grandfather who was granted
asylum and has worked in the United States for many years .
Which of the following individuals are likely to qualify for a special enrollment period
(SEP) for either a MA and/or Part D due to a change of residence?
I. Edward (enrolled in MA and Part D) moves to a new home within the same
neighborhood in his existing plan's service area.II. Fiona (enrolled in MA and Part D)
moves cross - country to an area outside her existing plan's service area.III . Gilbert
moves into a plan service area where there is now a Part D plan available to him
from a service area where no Part D plan was available.IV. Henry makes a
permanent move to a new state providing him with new MA and Part D options. -
RIGHT ANS:>>>II, III, and IV only
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee - for - service
(PFFS) plan. What questions would you need to ask to determine his eligibility? -
RIGHT ANS:>>>You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in
Part B, and if he lives in the PFFS plan's service area.
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? - RIGHT
ANS:>>>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 t he first 9 months of each calendar year.
, 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.
III. The mechanism must advise each individual at the beginning of the process that
he or she is completing an actual enrollment request.
IV. The mechanism must capture an accurate time and date stamp at the time the
applicant enters the online site. - RIGHT ANS:>>>II and III only
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.
Ridg eway 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? - RIGHT ANS:>>>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.
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? - RIGHT ANS:>>>She may enroll in
an MA plan beginning three months immediately before her first entitlement to both
Medicare Part A and Part B.
Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work
and is covered by an employer health plan, he has not enrolled in Part B or Part D. He
receives a notice on June 1 that his employer is cutting back on prescription drug
benefits and that as of July 1 his coverage will no longer be creditable. He has come to
you for advice. What advice would you give Mr. Rockwell about special election periods
(SEPs)? - RIGHT ANS:>>>Mr.
Rockwell is eligible for a SEP due to his involuntary loss of creditable drug coverage;
the SEP begins in June and ends on September 1 - two months after the loss of
creditable coverage.
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He
UNDERSTANDING MEDICARE ENROLLMENT: KEY
SCENARIOS & SOLUTIONS/ AHIP FINAL
EXAMINATION TEST BANK 2024 | 3 VERSIONS WITH
50 QUESTIONS EACH/EADY GRADED /BRAND NEW
2026-2027
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? - RIGHT ANS:>>>There 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 unde r this period. What should you tell her about how the Part D
Initia l Enrollment Period applies to her situation? - RIGHT ANS:>>>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.
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 g eographic area served by her current Medicare Advantage (MA) plan.
What options are available to Mary regarding her health plan coverage? - RIGHT
ANS:>>>Mary 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? - RIGHT ANS:>>>Enrollment 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.
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? - RIGHT ANS:>>>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.
Which of the following individuals is most likely to be eligible to enroll in a Medicare
Advantage (MA) or Part D Plan? - RIGHT ANS:>>>Jose, a grandfather who was granted
asylum and has worked in the United States for many years .
Which of the following individuals are likely to qualify for a special enrollment period
(SEP) for either a MA and/or Part D due to a change of residence?
I. Edward (enrolled in MA and Part D) moves to a new home within the same
neighborhood in his existing plan's service area.II. Fiona (enrolled in MA and Part D)
moves cross - country to an area outside her existing plan's service area.III . Gilbert
moves into a plan service area where there is now a Part D plan available to him
from a service area where no Part D plan was available.IV. Henry makes a
permanent move to a new state providing him with new MA and Part D options. -
RIGHT ANS:>>>II, III, and IV only
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee - for - service
(PFFS) plan. What questions would you need to ask to determine his eligibility? -
RIGHT ANS:>>>You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in
Part B, and if he lives in the PFFS plan's service area.
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? - RIGHT
ANS:>>>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 t he first 9 months of each calendar year.
, 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.
III. The mechanism must advise each individual at the beginning of the process that
he or she is completing an actual enrollment request.
IV. The mechanism must capture an accurate time and date stamp at the time the
applicant enters the online site. - RIGHT ANS:>>>II and III only
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.
Ridg eway 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? - RIGHT ANS:>>>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.
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? - RIGHT ANS:>>>She may enroll in
an MA plan beginning three months immediately before her first entitlement to both
Medicare Part A and Part B.
Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work
and is covered by an employer health plan, he has not enrolled in Part B or Part D. He
receives a notice on June 1 that his employer is cutting back on prescription drug
benefits and that as of July 1 his coverage will no longer be creditable. He has come to
you for advice. What advice would you give Mr. Rockwell about special election periods
(SEPs)? - RIGHT ANS:>>>Mr.
Rockwell is eligible for a SEP due to his involuntary loss of creditable drug coverage;
the SEP begins in June and ends on September 1 - two months after the loss of
creditable coverage.
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He
