AHIP TRAINING MODULE 5 updated 2022 with complete solution

You are meeting with Mrs. BERLIN and she has completed an enrollment form for a MA-PD plan you represent. You notice that her handwriting is illegible and as a result, the spelling of her street looks incorrect. She asks you to fill in the corrected street name. What should you do? You MAY correct this information as long as you add your initials and date next to the correction. BLOCK is currently enrolled in a MA plan that includes drug coverage. He found a stand-alone Medicare Rx plan in his area that offers better coverage than that available through his MA-PD plan and in addition has a low premium. It won't cost him much more and, because he has the means to do so, he wishes to enroll in the stand-alone Rx plan in addition to his MA-PD plan. If Mr. Block enrolls in the stand-alone Medicare Rx plan, he will be dis-enrolled from the MA plan. You are doing a sales presentation for Mrs. PECK. You know that the 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." PROHIBITED STATEMENT You have come to Mrs. BROWN's home for a sales presentation. At the beginning of the presentation, Mrs. Brown tells you that she has a copy of her medical record available because she thinks this will help you understand her needs. She suggests that you will know which questions to ask her about her health status in order to best assist her in selecting a plan. You can only ask Mrs. Brown questions about conditions that affect eligibility, specifically, whether she has end stage renal disease or one of the conditions that would qualify her for a special needs plan. GRANT has just entered his MA ICEP. What action could you help him take during this time? He will have one opportunity to enroll in a MA plan. KENNY is six months away from turning 65. She wants to know what she will have to do to enroll in a MA plan as soon as possible. What could you tell her? She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and B. 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. He is currently in the Part D IEP and, during this time, he may make one Part D enrollment choice, including enrollment in a stand-alone Part D plan or a MA-PD plan. CLAGGETT is 66 years old. She has been covered under both Parts A and B of Original Medicare for the last six years due to her disability, has never been enrolled in a MA or 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 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 IEP applies to her situation? It 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. FORD enrolled in a MA only plan in mid November. 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? He can make as many enrollment changes as he likes during the AEP and the last choice made prior to the end of the period will be the effective one as of January 1. 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. What should you do? Tell Mr. Anderson that you CAN'T accept any enrollment forms until the AEP begins. A client wants to give you an enrollment application prior to the beginning of the AEP because he is leaving on vacation for two weeks and does not want to forget about turning it in. What should you tell him? You must tell him you are NOT permitted to take the form. If he sends the form directly to the plan, the plan will process the enrollment on the day the AEP begins. GOODMAN enrolled in an MA-PD plan during the AEP. In mid-January of the following year, she wants to switch back to Original Medicare and enroll in a stand-alone Rx plan. During the MA Disenrollment period, from January 1-February 14, she may dis-enroll from the MA PD plan into Original Medicare and also may add a stand-alone Rx plan. GARDNER is currently enrolled in an MA-PD plan. However, she wants to disenroll from the MA-PD plan and instead enroll in a Part D only plan and go back to Original Medicare. According to Medicare's enrollment guidelines, when could she do this? She may make such a change during the AEP that runs from Oct. 15 to Dec. 7th, or during the MA Disenrollment period that runs from January 1 to February 14 of each year. SCHMIDT is moving and a friend told her she might qualify for a SEP to enroll in a new MA plan. She contacted you to ask what a Special Election Period is. It is a time period, outside of the AEP, when a Medicare beneficiary can select a new or different MA and/or Part D Rx plan. Typically the SEP is beneficiary specific and results from events, such as when the beneficiary moves outside of the service area. GRACE was told he qualifies for a SEP, but he lost the paper that explains what he could do during the SEP. If the SEP is for MA coverage, he will have one opportunity to change his MA coverage.