.
UNDERSTANDING MEDICARE ENROLLMENT: KEY fy fy fy
fy SCENARIOS & SOLUTIONS/ AHIP FINAL EXAMINATION fy fy fy fy fy
TEST BANK | 3 VERSIONS WITH 50 QUESTIONS fy fy fy fy fy fy fy fy
EACH/EADY GRADED /BRAND NEW 2025 fy fy fy fy fy
Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Annual Enrollment Period (AEP). At the beginning of January, her neighbor told her about the
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Medicare Advantage (MA) plan he selected. He also told her there was an open enrollment period
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
that she might be able to use to enroll in a MA plan. Ms. Gonzales comes to you for advice shortly
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
after speaking to her neighbor. What should you tell her? - RIGHT ANS:>>>There is a MA Open
fy fy fy fy fy fy fy fy fy fy fy f y fy fy fy fy fy
Enrollment Period (OEP) that takes place between January 1 and March 31, but Ms. Gonzales
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
cannot use it because eligibility to use the OEP is available only to MA enrollees.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Ms. Claggett is sixty-six (66) years old. She has been covered under Original Medicare for the last
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
six years due to her disability and has never been enrolled in a Medicare Advantage or a Part D plan
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
before. She wants to enroll in a Part D plan. She knows that there is such a thing as the "Part D
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Initial Enrollment Period" (IEP) and has concluded that, since she has never enrolled in such a plan
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
before, she should be eligible to enroll under this period. What should you tell her about how the
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Part D Initial Enrollment Period applies to her situation? - RIGHT ANS:>>>Ms. Claggett has had
fy fy fy fy fy fy fy fy fy fy f y fy fy fy fy
two IEPs and missed them both. The first occurred three months before and three months after the
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
month when she was first entitled to Part A OR enrolled in Part B. Because she was eligible for
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Medicare before age 65, Ms. Claggett had a second IEP based on turning age 65, which has also
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
expired.
fy
Mary Samuels recently suffered a stroke while visiting her daughter and grandchildren. As a result,
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Mary has been admitted to a rehabilitation hospital where she is expected to reside for several
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
months. The rehabilitation hospital is located outside the geographic area served by her current
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Medicare Advantage (MA) plan. What options are available to Mary regarding her health plan
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
coverage? - RIGHT ANS:>>>Mary may make an unlimited number of MA enrollment requests
fy fy f y fy fy fy fy fy fy fy fy fy fy
and may disenroll from her current MA plan.
fy fy fy fy fy fy fy fy
Mrs. Pierce would like to enroll in a Medicare Cost plan that offers Part D prescription drug
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
coverage. She comes to you for advice about when she can enroll in a plan you have previously
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
discussed. What should you tell her? - RIGHT ANS:>>>Enrollment in Cost plans offering
fy fy fy fy fy fy fy f y fy fy fy fy fy
,Part D coverage is available only during enrollment periods under the Part D program, and Cost plans
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
must accept enrollments during these periods.
fy fy fy fy fy fy
Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period (AEP).
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
On December 1, he calls you up and says that he has changed his mind and would like to enroll into a
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
MA-PD plan. What enrollment rules would apply in this case? - RIGHT ANS:>>>He can make
fy fy fy fy fy fy fy fy fy fy fy f y fy fy fy
as many enrollment changes as he likes during the Annual Election Period and the last choice
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
made prior to the end of the period will be the effective one as of January 1.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Which of the following individuals is most likely to be eligible to enroll in a Medicare Advantage
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
(MA) or Part D Plan? - RIGHT ANS:>>>Jose, a grandfather who was granted asylum and has
fy fy fy fy fy fy f y fy fy fy fy fy fy fy fy fy
worked in the United States for many years.
fy fy fy fy fy fy fy fy
Which of the following individuals are likely to qualify for a special enrollment period (SEP) for
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
either a MA and/or Part D due to a change of residence?
fy fy fy fy fy fy fy fy fy fy fy fy
I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
existing plan's service area.II. Fiona (enrolled in MA and Part D) moves cross-country to an area
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
outside her existing plan's service area.III. Gilbert moves into a plan service area where there is
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
now a Part D plan available to him from a service area where no Part D plan was available.IV.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Henry makes a permanent move to a new state providing him with new MA and Part D options. -
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
RIGHT ANS:>>>II, III, and IV only
f y fy fy fy fy fy
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS)
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
plan. What questions would you need to ask to determine his eligibility? - RIGHT ANS:>>>You
fy fy fy fy fy fy fy fy fy fy fy fy fy f y fy
would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
plan's service area.
fy fy fy
Mrs. Schneider has Original Medicare Parts A and B and has just qualified for her state's Medicaid
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
program, so the state is now paying her Part B premium and she is considered a dual eligible. Will
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Medicare Prescription Drug plan? - RIGHT ANS:>>>Yes. Qualifying for this state program
fy fy fy fy fy f y fy fy fy fy fy fy
gives Mrs. Schneider access to a Special Enrollment Period that allows her to make changes to her
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
MA and/or Part D enrollment during the first 9 months of each calendar year.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
,Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. In setting up
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
the enrollment site, which of the following must Phiona consider?
fy fy fy fy fy fy fy fy fy fy
I. If a legal representative is completing an electronic enrollment request, he or she must first
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
upload proof of his or her authority.
fy fy fy fy fy fy fy
II. All data elements required to complete an enrollment request must be captured.
fy fy fy fy fy fy fy fy fy fy fy
III. The mechanism must advise each individual at the beginning of the process that he or she is
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
completing an actual enrollment request.
fy fy fy fy fy
IV. The mechanism must capture an accurate time and date stamp at the time the applicant enters the
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
online site. - RIGHT ANS:>>>II and III only
fy fy fy f y fy fy fy fy
Mrs. Ridgeway enrolled in Original Medicare and Medigap coverage following her retirements
fy fy fy fy fy fy fy fy fy fy fy
several years ago. Four months ago, Mrs. Ridgeway dropped her Medigap policy to enroll in a
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Medicare Advantage (MA) plan for the first time. Unfortunately, Mrs. Ridgeway has found that
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
many of her providers are not in the MA plan's network. She has come to you for advice? What
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
should you tell her? - RIGHT ANS:>>>She qualifies for a special enrollment period (SEP) that will
fy fy fy fy fy f y fy fy fy fy fy fy fy fy fy fy
allow her to make a one-time election to return to Original Medicare and she also has a guaranteed
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
eligibility period to rejoin her Medigap plan.
fy fy fy fy fy fy fy
Mrs. Kendrick is in good health, has worked for many years and is six months away from turning
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
65. She wants to know what she will have to do to enroll in a Medicare Advantage (MA) plan as soon
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
as possible. What could you tell her? - RIGHT ANS:>>>She may enroll in an MA plan beginning
fy fy fy fy fy fy fy fy f y fy fy fy fy fy fy fy fy
three months immediately before her first entitlement to both Medicare Part A and Part B.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work and is
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
covered by an employer health plan, he has not enrolled in Part B or Part D. He receives a notice on
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
June 1 that his employer is cutting back on prescription drug benefits and that as of July 1 his
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
coverage will no longer be creditable. He has come to you for advice. What advice would you give
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Mr. Rockwell about special election periods (SEPs)? - RIGHT ANS:>>>Mr.
fy fy fy fy fy fy fy fy f y fy
Rockwell is eligible for a SEP due to his involuntary loss of creditable drug coverage; the SEP begins
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
in June and ends on September 1- two months after the loss of creditable coverage.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He would like to
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
know his options since he has decided to drop his retiree coverage and is eligible for Medicare.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
What should you tell him? - RIGHT ANS:>>>Mr. Chen can disenroll from his
fy fy fy fy fy fy f y fy fy fy fy fy fy
, employer-sponsored coverage to elect a Medicare Advantage or Part D plan within 2 months of his fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
disenrollment.
fy
Mrs. Kumar would like her daughter, who lives in another state, to meet with you during the Annual
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Election Period to help her complete her enrollment in a Part D plan. She asked you when she
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
should have her daughter plan to visit. What could you tell her? - RIGHT ANS:>>>Her daughter
fy fy fy fy fy fy fy fy fy fy fy fy fy f y fy fy
should come in November.
fy fy fy fy
Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could you
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
help him take during this time? - RIGHT ANS:>>>He will have one opportunity to enroll in a
fy fy fy fy fy fy fy f y fy fy fy fy fy fy fy fy fy
Medicare Advantage plan.
fy fy fy
Mrs. Margolis contacts you in August because she will become eligible for Medicare for the first
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
time in November. She would like to meet and discuss plan choices with you. What advice should
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
you give her? - RIGHT ANS:>>>Tell her to wait until October to discuss plan choices with you
fy fy fy fy f y fy fy fy fy fy fy fy fy fy fy fy fy
so that you can share plan benefits for the current year as well as any changes for the following year
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
that may impact her choice.
fy fy fy fy fy
Mrs. Young is currently enrolled in Original Medicare (Parts A and B), but she has been working
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
with Agent Neil Adams in the selection of a Medicare Advantage (MA) plan. It is mid- September,
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
and Mrs. Young is going on vacation. Agent Adams is considering suggesting that he and Mrs.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Young complete the application together before she leaves. He will then submit the paper
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
application before the start of the annual enrollment period (AEP). What would you say If you
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
were advising Agent Adams? - RIGHT ANS:>>>This is a bad idea. Agents are generally
fy fy fy fy fy f y fy fy fy fy fy fy fy fy
prohibited from soliciting or accepting an enrollment form before the start of the AEP.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you to come to their
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
home to clear up a few questions. During the presentation, Mrs. Nunez feels tired and tells you that
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
her husband can finish things up. She goes to bed. At the end of your discussion, Mr. Nunez says
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
that he wants to enroll both himself and his wife. What should you do? - RIGHT ANS:>>>As
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy f y fy
long as she can do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will have to
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
wake up to sign her form or do so at another time.
fy fy fy fy fy fy fy fy fy fy fy fy
Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-income subsidy.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
How does that affect his ability to enroll or disenroll in a Part D plan? - RIGHT ANS:>>>He
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy f y fy
qualifies for a special election period and can enroll in or disenroll from a Part D plan once during
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
that period.
fy fy
UNDERSTANDING MEDICARE ENROLLMENT: KEY fy fy fy
fy SCENARIOS & SOLUTIONS/ AHIP FINAL EXAMINATION fy fy fy fy fy
TEST BANK | 3 VERSIONS WITH 50 QUESTIONS fy fy fy fy fy fy fy fy
EACH/EADY GRADED /BRAND NEW 2025 fy fy fy fy fy
Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Annual Enrollment Period (AEP). At the beginning of January, her neighbor told her about the
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Medicare Advantage (MA) plan he selected. He also told her there was an open enrollment period
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
that she might be able to use to enroll in a MA plan. Ms. Gonzales comes to you for advice shortly
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
after speaking to her neighbor. What should you tell her? - RIGHT ANS:>>>There is a MA Open
fy fy fy fy fy fy fy fy fy fy fy f y fy fy fy fy fy
Enrollment Period (OEP) that takes place between January 1 and March 31, but Ms. Gonzales
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
cannot use it because eligibility to use the OEP is available only to MA enrollees.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Ms. Claggett is sixty-six (66) years old. She has been covered under Original Medicare for the last
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
six years due to her disability and has never been enrolled in a Medicare Advantage or a Part D plan
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
before. She wants to enroll in a Part D plan. She knows that there is such a thing as the "Part D
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Initial Enrollment Period" (IEP) and has concluded that, since she has never enrolled in such a plan
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
before, she should be eligible to enroll under this period. What should you tell her about how the
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Part D Initial Enrollment Period applies to her situation? - RIGHT ANS:>>>Ms. Claggett has had
fy fy fy fy fy fy fy fy fy fy f y fy fy fy fy
two IEPs and missed them both. The first occurred three months before and three months after the
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
month when she was first entitled to Part A OR enrolled in Part B. Because she was eligible for
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Medicare before age 65, Ms. Claggett had a second IEP based on turning age 65, which has also
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
expired.
fy
Mary Samuels recently suffered a stroke while visiting her daughter and grandchildren. As a result,
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Mary has been admitted to a rehabilitation hospital where she is expected to reside for several
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
months. The rehabilitation hospital is located outside the geographic area served by her current
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Medicare Advantage (MA) plan. What options are available to Mary regarding her health plan
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
coverage? - RIGHT ANS:>>>Mary may make an unlimited number of MA enrollment requests
fy fy f y fy fy fy fy fy fy fy fy fy fy
and may disenroll from her current MA plan.
fy fy fy fy fy fy fy fy
Mrs. Pierce would like to enroll in a Medicare Cost plan that offers Part D prescription drug
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
coverage. She comes to you for advice about when she can enroll in a plan you have previously
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
discussed. What should you tell her? - RIGHT ANS:>>>Enrollment in Cost plans offering
fy fy fy fy fy fy fy f y fy fy fy fy fy
,Part D coverage is available only during enrollment periods under the Part D program, and Cost plans
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
must accept enrollments during these periods.
fy fy fy fy fy fy
Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period (AEP).
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
On December 1, he calls you up and says that he has changed his mind and would like to enroll into a
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
MA-PD plan. What enrollment rules would apply in this case? - RIGHT ANS:>>>He can make
fy fy fy fy fy fy fy fy fy fy fy f y fy fy fy
as many enrollment changes as he likes during the Annual Election Period and the last choice
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
made prior to the end of the period will be the effective one as of January 1.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Which of the following individuals is most likely to be eligible to enroll in a Medicare Advantage
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
(MA) or Part D Plan? - RIGHT ANS:>>>Jose, a grandfather who was granted asylum and has
fy fy fy fy fy fy f y fy fy fy fy fy fy fy fy fy
worked in the United States for many years.
fy fy fy fy fy fy fy fy
Which of the following individuals are likely to qualify for a special enrollment period (SEP) for
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
either a MA and/or Part D due to a change of residence?
fy fy fy fy fy fy fy fy fy fy fy fy
I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
existing plan's service area.II. Fiona (enrolled in MA and Part D) moves cross-country to an area
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
outside her existing plan's service area.III. Gilbert moves into a plan service area where there is
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
now a Part D plan available to him from a service area where no Part D plan was available.IV.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Henry makes a permanent move to a new state providing him with new MA and Part D options. -
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
RIGHT ANS:>>>II, III, and IV only
f y fy fy fy fy fy
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS)
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
plan. What questions would you need to ask to determine his eligibility? - RIGHT ANS:>>>You
fy fy fy fy fy fy fy fy fy fy fy fy fy f y fy
would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
plan's service area.
fy fy fy
Mrs. Schneider has Original Medicare Parts A and B and has just qualified for her state's Medicaid
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
program, so the state is now paying her Part B premium and she is considered a dual eligible. Will
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Medicare Prescription Drug plan? - RIGHT ANS:>>>Yes. Qualifying for this state program
fy fy fy fy fy f y fy fy fy fy fy fy
gives Mrs. Schneider access to a Special Enrollment Period that allows her to make changes to her
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
MA and/or Part D enrollment during the first 9 months of each calendar year.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
,Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. In setting up
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
the enrollment site, which of the following must Phiona consider?
fy fy fy fy fy fy fy fy fy fy
I. If a legal representative is completing an electronic enrollment request, he or she must first
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
upload proof of his or her authority.
fy fy fy fy fy fy fy
II. All data elements required to complete an enrollment request must be captured.
fy fy fy fy fy fy fy fy fy fy fy
III. The mechanism must advise each individual at the beginning of the process that he or she is
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
completing an actual enrollment request.
fy fy fy fy fy
IV. The mechanism must capture an accurate time and date stamp at the time the applicant enters the
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
online site. - RIGHT ANS:>>>II and III only
fy fy fy f y fy fy fy fy
Mrs. Ridgeway enrolled in Original Medicare and Medigap coverage following her retirements
fy fy fy fy fy fy fy fy fy fy fy
several years ago. Four months ago, Mrs. Ridgeway dropped her Medigap policy to enroll in a
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Medicare Advantage (MA) plan for the first time. Unfortunately, Mrs. Ridgeway has found that
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
many of her providers are not in the MA plan's network. She has come to you for advice? What
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
should you tell her? - RIGHT ANS:>>>She qualifies for a special enrollment period (SEP) that will
fy fy fy fy fy f y fy fy fy fy fy fy fy fy fy fy
allow her to make a one-time election to return to Original Medicare and she also has a guaranteed
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
eligibility period to rejoin her Medigap plan.
fy fy fy fy fy fy fy
Mrs. Kendrick is in good health, has worked for many years and is six months away from turning
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
65. She wants to know what she will have to do to enroll in a Medicare Advantage (MA) plan as soon
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
as possible. What could you tell her? - RIGHT ANS:>>>She may enroll in an MA plan beginning
fy fy fy fy fy fy fy fy f y fy fy fy fy fy fy fy fy
three months immediately before her first entitlement to both Medicare Part A and Part B.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work and is
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
covered by an employer health plan, he has not enrolled in Part B or Part D. He receives a notice on
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
June 1 that his employer is cutting back on prescription drug benefits and that as of July 1 his
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
coverage will no longer be creditable. He has come to you for advice. What advice would you give
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Mr. Rockwell about special election periods (SEPs)? - RIGHT ANS:>>>Mr.
fy fy fy fy fy fy fy fy f y fy
Rockwell is eligible for a SEP due to his involuntary loss of creditable drug coverage; the SEP begins
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
in June and ends on September 1- two months after the loss of creditable coverage.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He would like to
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
know his options since he has decided to drop his retiree coverage and is eligible for Medicare.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
What should you tell him? - RIGHT ANS:>>>Mr. Chen can disenroll from his
fy fy fy fy fy fy f y fy fy fy fy fy fy
, employer-sponsored coverage to elect a Medicare Advantage or Part D plan within 2 months of his fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
disenrollment.
fy
Mrs. Kumar would like her daughter, who lives in another state, to meet with you during the Annual
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Election Period to help her complete her enrollment in a Part D plan. She asked you when she
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
should have her daughter plan to visit. What could you tell her? - RIGHT ANS:>>>Her daughter
fy fy fy fy fy fy fy fy fy fy fy fy fy f y fy fy
should come in November.
fy fy fy fy
Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could you
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
help him take during this time? - RIGHT ANS:>>>He will have one opportunity to enroll in a
fy fy fy fy fy fy fy f y fy fy fy fy fy fy fy fy fy
Medicare Advantage plan.
fy fy fy
Mrs. Margolis contacts you in August because she will become eligible for Medicare for the first
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
time in November. She would like to meet and discuss plan choices with you. What advice should
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
you give her? - RIGHT ANS:>>>Tell her to wait until October to discuss plan choices with you
fy fy fy fy f y fy fy fy fy fy fy fy fy fy fy fy fy
so that you can share plan benefits for the current year as well as any changes for the following year
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
that may impact her choice.
fy fy fy fy fy
Mrs. Young is currently enrolled in Original Medicare (Parts A and B), but she has been working
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
with Agent Neil Adams in the selection of a Medicare Advantage (MA) plan. It is mid- September,
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
and Mrs. Young is going on vacation. Agent Adams is considering suggesting that he and Mrs.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Young complete the application together before she leaves. He will then submit the paper
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
application before the start of the annual enrollment period (AEP). What would you say If you
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
were advising Agent Adams? - RIGHT ANS:>>>This is a bad idea. Agents are generally
fy fy fy fy fy f y fy fy fy fy fy fy fy fy
prohibited from soliciting or accepting an enrollment form before the start of the AEP.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy
Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you to come to their
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
home to clear up a few questions. During the presentation, Mrs. Nunez feels tired and tells you that
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
her husband can finish things up. She goes to bed. At the end of your discussion, Mr. Nunez says
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
that he wants to enroll both himself and his wife. What should you do? - RIGHT ANS:>>>As
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy f y fy
long as she can do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will have to
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
wake up to sign her form or do so at another time.
fy fy fy fy fy fy fy fy fy fy fy fy
Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-income subsidy.
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
How does that affect his ability to enroll or disenroll in a Part D plan? - RIGHT ANS:>>>He
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy f y fy
qualifies for a special election period and can enroll in or disenroll from a Part D plan once during
fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy fy
that period.
fy fy
