AHIP Module 5
1. 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 toenroll in a Part D plan. She knows that there is
such a thing as the "Part D InitialEnrollment Period" (IEP) and has concluded that, since she has
never enrolledin such a plan before, she should be eligible to enroll under this period. What
should you tell her about how the Part D Initial Enrollment Period applies to hersituation?
Answer: Ms. Claggett has had two IEPs and missed them both.The first occurredthree months
before and three months after the month when she was first entitled toPart 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.
2. 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 in a MA-PD plan. What enrollment rules would apply in this case?
Answer: He can make as many enrollment changes as helikes during the Annual Election
Period and the last choice made before the end ofthe period will be the effective one as of
January 1.He can make as many enrollmentchanges as he likes during the Annual Election
Period and the last choice made before the end of the period will be the effective one as of
January 1.
3. Mr. Anderson is a very organized individual and has filled out and broughtto you an
enrollment form on October 10 for a new plan available on January1 next year. He is currently
enrolled in Original Medicare. What should you do?
Answer: Tell Mr. Anderson that you cannot accept any enrollment forms until the annual
election period begins.
4. Mrs. Schmidt is moving and a friend told her she might qualify for a "specialelection period"
to enroll in a new Medicare Advantage plan. She contacted you to ask what a special election
period is. What could you tell her?
Answer: It is a single period from January 1 - March 31, created by statute, when any
Medicare beneficiary who has moved out of the area of their Medicare Advantage or Part D
plan can add, drop, or change their Medicare prescription drug coverage.
5. Mr. Yoo's employer has recently dropped comprehensive creditable pre- scription drug
coverage that was offered to company retirees. The company told Mr. Yoo that, because he
was affected by this change, he would qualify for a special election period. Mr. Yoo contacted
you to find out more about what this means.What can you tell him?
Answer: It means that he qualifies for a one-timeopportunity to enroll in an MA-PD or Part D
prescription drug plan.
, 6. Ms. Thomas has worked for many years and is turning 68 in June. She is eligible for
Medicare Part A and did not enroll for Part B when first eligible because she has insurance
through her employer - Coffee Brew, Inc. She alsodid not enroll in Part D because she had
creditable coverage. She would like toretire in June and enroll in a Medicare Advantage plan. She
has been informedthat her group coverage will end on her retirement effective date. How
wouldyou advise Ms. Thomas?
Answer: Ms. Thomas can enroll in Part B without a late penaltyat any time she is still
covered by her employer group and 8 months after her last month of employer group coverage
without a penalty. However, because she wantsto enroll in a MA plan after retirement, she
should make sure her Part B coverage is effective in time to use the Medicare Advantage/Part
D special election period forindividuals changing from employer group coverage to enroll in a
MA plan or MA-PD.The SEP begins while she has employer group coverage and will last until 2
monthsafter the month after the month her employer coverage ends. If she wants Part D
coverage she should enroll in an MA-PD or a PDP (depending on how she decidesto receive
her Part A and B benefits) during this time.
7. Ms. Lee is enrolled in an MA-PD plan but will be moving out of the plan's
service area next month. She is worried that she will not be able to enroll in another plan
available in her new residence until the Annual Election Period.What should you tell her?
Answer: She is eligible for a special election period (SEP) that begins either the month
before her permanent move, if the plan is notified in advance, or the month she provides
notice of the move, and this period typically lasts an additional two months.
8. 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 toenroll in a Medicare Advantage
(MA) plan as soon as possible.What could youtell her?
Answer: She may enroll in an MA plan beginning three months immediately beforeher first
entitlement to both Medicare Part A and Part B.
9. Mr. Liu turns 65 on June 19. He has never previously qualified for Medicareso his first
Medicare eligibility date will be June 1. Mr. Liu's ICEP and Part D IEP begin on March 1 and
end on September 30. He wants prescription drug coverage with his Part A and Part B
benefits. What advice can you provide him?
Answer: He can enroll in a MA-PD as long as he enrolls in Part B and is entitled to Part A.
10. Mrs. Young is currently enrolled in Original Medicare (Parts A and B), but she has been
working with Agent Neil Adams in the selection of a Medicare Advantage (MA) plan. It is
mid-September, and Mrs. Young is going on vacation. Agent Adams is considering suggesting
that he and Mrs. Young completethe application together before she leaves. He will then
submit the paper application before the start of the annual enrollment period (AEP).What would
you say If you were advising Agent Adams?
Answer: This is a bad idea. Agents are generally prohibited from soliciting or accepting an
enrollment form before the startof the AEP.
11. Mr. Block is currently enrolled in a Medicare Advantage plan that includesdrug
coverage.He found a stand-alone Medicare prescription drug plan in hisarea that offers better
coverage than that available through his MA-PD plan and in addition, has a low premium. It
1. 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 toenroll in a Part D plan. She knows that there is
such a thing as the "Part D InitialEnrollment Period" (IEP) and has concluded that, since she has
never enrolledin such a plan before, she should be eligible to enroll under this period. What
should you tell her about how the Part D Initial Enrollment Period applies to hersituation?
Answer: Ms. Claggett has had two IEPs and missed them both.The first occurredthree months
before and three months after the month when she was first entitled toPart 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.
2. 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 in a MA-PD plan. What enrollment rules would apply in this case?
Answer: He can make as many enrollment changes as helikes during the Annual Election
Period and the last choice made before the end ofthe period will be the effective one as of
January 1.He can make as many enrollmentchanges as he likes during the Annual Election
Period and the last choice made before the end of the period will be the effective one as of
January 1.
3. Mr. Anderson is a very organized individual and has filled out and broughtto you an
enrollment form on October 10 for a new plan available on January1 next year. He is currently
enrolled in Original Medicare. What should you do?
Answer: Tell Mr. Anderson that you cannot accept any enrollment forms until the annual
election period begins.
4. Mrs. Schmidt is moving and a friend told her she might qualify for a "specialelection period"
to enroll in a new Medicare Advantage plan. She contacted you to ask what a special election
period is. What could you tell her?
Answer: It is a single period from January 1 - March 31, created by statute, when any
Medicare beneficiary who has moved out of the area of their Medicare Advantage or Part D
plan can add, drop, or change their Medicare prescription drug coverage.
5. Mr. Yoo's employer has recently dropped comprehensive creditable pre- scription drug
coverage that was offered to company retirees. The company told Mr. Yoo that, because he
was affected by this change, he would qualify for a special election period. Mr. Yoo contacted
you to find out more about what this means.What can you tell him?
Answer: It means that he qualifies for a one-timeopportunity to enroll in an MA-PD or Part D
prescription drug plan.
, 6. Ms. Thomas has worked for many years and is turning 68 in June. She is eligible for
Medicare Part A and did not enroll for Part B when first eligible because she has insurance
through her employer - Coffee Brew, Inc. She alsodid not enroll in Part D because she had
creditable coverage. She would like toretire in June and enroll in a Medicare Advantage plan. She
has been informedthat her group coverage will end on her retirement effective date. How
wouldyou advise Ms. Thomas?
Answer: Ms. Thomas can enroll in Part B without a late penaltyat any time she is still
covered by her employer group and 8 months after her last month of employer group coverage
without a penalty. However, because she wantsto enroll in a MA plan after retirement, she
should make sure her Part B coverage is effective in time to use the Medicare Advantage/Part
D special election period forindividuals changing from employer group coverage to enroll in a
MA plan or MA-PD.The SEP begins while she has employer group coverage and will last until 2
monthsafter the month after the month her employer coverage ends. If she wants Part D
coverage she should enroll in an MA-PD or a PDP (depending on how she decidesto receive
her Part A and B benefits) during this time.
7. Ms. Lee is enrolled in an MA-PD plan but will be moving out of the plan's
service area next month. She is worried that she will not be able to enroll in another plan
available in her new residence until the Annual Election Period.What should you tell her?
Answer: She is eligible for a special election period (SEP) that begins either the month
before her permanent move, if the plan is notified in advance, or the month she provides
notice of the move, and this period typically lasts an additional two months.
8. 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 toenroll in a Medicare Advantage
(MA) plan as soon as possible.What could youtell her?
Answer: She may enroll in an MA plan beginning three months immediately beforeher first
entitlement to both Medicare Part A and Part B.
9. Mr. Liu turns 65 on June 19. He has never previously qualified for Medicareso his first
Medicare eligibility date will be June 1. Mr. Liu's ICEP and Part D IEP begin on March 1 and
end on September 30. He wants prescription drug coverage with his Part A and Part B
benefits. What advice can you provide him?
Answer: He can enroll in a MA-PD as long as he enrolls in Part B and is entitled to Part A.
10. Mrs. Young is currently enrolled in Original Medicare (Parts A and B), but she has been
working with Agent Neil Adams in the selection of a Medicare Advantage (MA) plan. It is
mid-September, and Mrs. Young is going on vacation. Agent Adams is considering suggesting
that he and Mrs. Young completethe application together before she leaves. He will then
submit the paper application before the start of the annual enrollment period (AEP).What would
you say If you were advising Agent Adams?
Answer: This is a bad idea. Agents are generally prohibited from soliciting or accepting an
enrollment form before the startof the AEP.
11. Mr. Block is currently enrolled in a Medicare Advantage plan that includesdrug
coverage.He found a stand-alone Medicare prescription drug plan in hisarea that offers better
coverage than that available through his MA-PD plan and in addition, has a low premium. It
