BAHIP 2024 MODULE 5 QUESTIONS AND
ANSWERS 100% VERIFIED
Mr. White has Medicare Parts A and B with a Part D plan. Last year, he received a notice that his plan
sponsor identified him as a
"potential at-risk" beneficiary. This month, he started receiving assistance from Medicaid. He wants to
find a different Part D plan that's
more suitable to his current prescription drug needs. He believes he's entitled to a SEP since he is now a
dual eligible. Is he able to change
to a different Part D plan during a SEP for dual eligible individuals? - No. Once he is identified by the plan
sponsor as a "potential at-risk" beneficiary, he cannot use the dual eligible SEP to change plans while this
designation is in place.
Mr. Ziegler is turning 65 next month and has asked you what he can do, and when he must do it, with
respect to enrolling in Part D. What
could you tell him? - He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he
may make one Part D enrollment choice, including enrollment in a stand-alone Part D plan or an MA-PD
plan.
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)? - 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. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-income subsidy. How
does that affect his ability to enroll
or disenroll in a Part D plan? - He qualifies for a special election period and can enroll in or disenroll from
a Part D plan once during that period.
Mrs. Margolis contacts you in August because she will become eligible for Medicare for the first time in
November. She would like to meet
, and discuss plan choices with you. What advice should you give her? - Tell her to wait until October to
discuss plan choices with you so that you can share plan benefits for the current year as well as any
changes for the following year that may impact her choice.
Torie Jones is a new marketing representative. Torie asks you for advice as to what topics must be
discussed with a Medicare beneficiary
prior to enrollment in a Medicare Advantage (MA-PD) plan. What should you say? - Torie, there are many
required questions and topics regarding beneficiary needs to be discussed prior to enrollment in an MA
plan. These include information regarding primary care providers and specialists whether they are in the
plan network, whether or not a beneficiary's current prescriptions are covered as well as premiums,
benefits, and costs of health care services.
Mrs. Parker likes to handle most of her business matters through telephone calls. She currently is
enrolled in Original Medicare Parts A
and B but has heard about a Medicare Advantage plan offered by Senior Health from a neighbor. Mrs.
Parker asks you whether she can
enroll in Senior Health's MA plan over the telephone. What can you tell her? - II and III only
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. - "If you're
not in very good health, you will probably do better with a different product."
Mr. Roberts is enrolled in an MA plan. He recently suffered complications following hip replacement
surgery. As a result, he has spent the
last three months in Resthaven, a skilled nursing facility. Mr. Roberts is about to be discharged. What
advice would you give him regarding
his health coverage options? - His open enrollment period as an institutionalized individual will continue
for two months after the month he moves out of the facility.
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? - Mary may make an unlimited number of MA enrollment
requests and may disenroll from her current MA plan.
Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the Annual
Enrollment Period (AEP). At the
ANSWERS 100% VERIFIED
Mr. White has Medicare Parts A and B with a Part D plan. Last year, he received a notice that his plan
sponsor identified him as a
"potential at-risk" beneficiary. This month, he started receiving assistance from Medicaid. He wants to
find a different Part D plan that's
more suitable to his current prescription drug needs. He believes he's entitled to a SEP since he is now a
dual eligible. Is he able to change
to a different Part D plan during a SEP for dual eligible individuals? - No. Once he is identified by the plan
sponsor as a "potential at-risk" beneficiary, he cannot use the dual eligible SEP to change plans while this
designation is in place.
Mr. Ziegler is turning 65 next month and has asked you what he can do, and when he must do it, with
respect to enrolling in Part D. What
could you tell him? - He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he
may make one Part D enrollment choice, including enrollment in a stand-alone Part D plan or an MA-PD
plan.
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)? - 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. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-income subsidy. How
does that affect his ability to enroll
or disenroll in a Part D plan? - He qualifies for a special election period and can enroll in or disenroll from
a Part D plan once during that period.
Mrs. Margolis contacts you in August because she will become eligible for Medicare for the first time in
November. She would like to meet
, and discuss plan choices with you. What advice should you give her? - Tell her to wait until October to
discuss plan choices with you so that you can share plan benefits for the current year as well as any
changes for the following year that may impact her choice.
Torie Jones is a new marketing representative. Torie asks you for advice as to what topics must be
discussed with a Medicare beneficiary
prior to enrollment in a Medicare Advantage (MA-PD) plan. What should you say? - Torie, there are many
required questions and topics regarding beneficiary needs to be discussed prior to enrollment in an MA
plan. These include information regarding primary care providers and specialists whether they are in the
plan network, whether or not a beneficiary's current prescriptions are covered as well as premiums,
benefits, and costs of health care services.
Mrs. Parker likes to handle most of her business matters through telephone calls. She currently is
enrolled in Original Medicare Parts A
and B but has heard about a Medicare Advantage plan offered by Senior Health from a neighbor. Mrs.
Parker asks you whether she can
enroll in Senior Health's MA plan over the telephone. What can you tell her? - II and III only
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. - "If you're
not in very good health, you will probably do better with a different product."
Mr. Roberts is enrolled in an MA plan. He recently suffered complications following hip replacement
surgery. As a result, he has spent the
last three months in Resthaven, a skilled nursing facility. Mr. Roberts is about to be discharged. What
advice would you give him regarding
his health coverage options? - His open enrollment period as an institutionalized individual will continue
for two months after the month he moves out of the facility.
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? - Mary may make an unlimited number of MA enrollment
requests and may disenroll from her current MA plan.
Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the Annual
Enrollment Period (AEP). At the
