Module 5 - Enrollment Guidance: Medicare Advantage and Part D Plans Review Questions Flashcards
Mrs. Kumar would like her daughter, who lives in another state, to meet with you during the Annual Election Period to help her complete her enrollment in a Part D plan. She asked you when she should have her daughter plan to visit. What could you tell her?
Her daughter should come in November.
the Medicare Annual Enrollment Period (AEP), also known as the Annual Election Period or Fall Open Enrollment Period, occurs each year from October 15 to December 7. This is the time when changes can be made to Medicare Part C and Part D plans for the upcoming year. So, November falls within this period and would be an appropriate time for Mrs. Kumar’s daughter to visit and help with the enrollment in a Part D plan.
A client wants to give you an enrollment application on October 1 before the beginning of the Annual Election Period 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 Annual Election Period begins.
This is because the Annual Election Period is the specific time period during which individuals can enroll in a health insurance plan. Submitting the form before this period may lead to complications or delays in processing. It’s important to follow the correct procedures to ensure a smooth enrollment process.
Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could you help him take during this time?
He will have one opportunity to enroll in a Medicare Advantage plan.
During the MA Initial Coverage Election Period (ICEP), Mr. Garrett is permitted to make one enrollment choice. Once the enrollment is effective, the ICEP is used. However, individuals choosing a MA plan during their ICEP have a MA-OEP following their election through the last day of the 3rd month of entitlement.
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.
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?
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.
This period is not for new beneficiaries to enroll in Medicare Part A, Part B, or Part D2. It’s only for beneficiaries who already have a Medicare Advantage plan and want to make a change12. So, Ms. Gonzales, who is currently on Original Medicare (Parts A and B) and Part D, would not be eligible to use this period to switch to a Medicare Advantage plan.
Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period. In mid-January of the following year, she wants to switch back to Original Medicare and enroll in a stand-alone prescription drug plan. What should you tell her?
During the MA Open Enrollment Period, from January 1 – March 31, she may disenroll from the MA-PD plan into Original Medicare and also may add a stand-alone prescription drug plan.
During the Medicare Advantage Open Enrollment Period (MA OEP), which runs from January 1 to March 31, individuals who are already enrolled in a Medicare Advantage plan as of January 1 can make a one-time election to switch to another Medicare Advantage plan or return to Original Medicare. If they choose to return to Original Medicare, they can also add a stand-alone Medicare Part D plan. So, Mrs. Goodman can disenroll from her MA-PD plan and switch back to Original Medicare, and she can also enroll in a stand-alone prescription drug plan during this period.
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.
This SEP allows him to make changes to his Medicare Advantage and Medicare drug coverage when certain events happen in his life, like if he loses other coverage1.
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.
The Medicare Part D SEP is unavailable for dual-eligible or LIS-eligible beneficiaries if their current PDP labels them as “at-risk” or “potentially at-risk” for substance abuse1. This means they could not change plans or disenroll from the plan while this designation is in place.
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.”
This statement is prohibited. It could be seen as steering the customer into a particular plan, which is not allowed3. It also makes an assumption about the customer’s health status and how it would affect their plan choice, which could be misleading.
You are visiting with Mr. Tully and his daughter at her request. He has advanced Alzheimer’s and is incapable of understanding the implications of choosing a Medicare Advantage or prescription drug plan. Can his daughter fill out the enrollment form and sign it for him?
Mr. Tully’s daughter can do so only, if she is authorized under state law as a court-appointed legal guardian, has a durable power of attorney for health care decisions, or is authorized under state surrogate consent laws to make health decisions.
This is because Medicare guidelines stipulate that a person can only make healthcare decisions on behalf of another individual if they are legally authorized to do so. This could be through being a court-appointed legal guardian, having a durable power of attorney for health care decisions, or being authorized under state surrogate consent laws.
When Myra first became eligible for Medicare, she enrolled in Original Medicare (Parts A and B). She is now 67 and will turn 68 on July 1. She would now like to enroll in a Medicare Advantage (MA) plan and approaches you about her options. What advice would you give her?
She should remain in Original Medicare until the annual election period running from October 15 to December 7, during which she can select an MA plan.
This is because the Medicare Advantage and Prescription Drug Plan annual election period, also known as the Open Enrollment Period, takes place each year from October 15 through December 712. During this period, Myra can make changes to her coverage, including switching from Original Medicare to a Medicare Advantage Plan 3. Any changes made during this period will start on January 1 of the next year. It’s important to note that Myra must live in the service area of the plan she wants to join.
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.
Mary’s admission to a rehabilitation hospital makes her eligible for an Open Enrollment Period for Institutionalized Individuals (OEPI). OEPI-eligible individuals can make unlimited MA enrollment requests, enroll in a Part D plan, as well as return to Original Medicare.
During this period, OEPI-eligible individuals can make unlimited MA enrollment requests, enroll in a Part D plan, as well as return to Original Medicare. Therefore, the correct answer would be:
Mary may make unlimited MA enrollment requests and may disenroll from her current MA plan.
Mrs. Reeves is newly eligible to enroll in a Medicare Advantage plan and her MA Initial Coverage Election Period (ICEP) has just begun. Which of the following can she not do during the ICEP?
She can enroll in a Medigap plan to supplement the benefits of the MA plan that she’s also enrolling in.
This is because, according to Medicare rules, you cannot have a Medigap policy and a Medicare Advantage Plan at the same time. Medigap policies are designed to supplement Original Medicare, not Medicare Advantage Plans. If Mrs. Reeves is enrolling in a Medicare Advantage plan during her Initial Coverage Election Period (ICEP), she cannot also enroll in a Medigap plan to supplement the benefits of the MA plan.
You have come to Mrs. Midler’s home for a sales presentation. At the beginning of the presentation, Mrs. Midler tells you that she has a copy of her medical records 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. What should you do?
You can only ask Mrs. Midler questions about conditions that affect eligibility, specifically, whether she has one of the conditions that would qualify her for a special needs plan.
Marketing representatives may ask health screening questions during the completion of an enrollment request if they are necessary to determine eligibility to enroll in a SNP.
Therefore, the correct answer would be: You can only ask Mrs. Midler questions about conditions that affect eligibility, specifically, whether she has one of the conditions that would qualify her for a special needs plan.
Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area that has suffered from major flooding that has been declared a major disaster by both the Federal government and her state. As a result of dealing with the flooding issues and being evacuated from her home, Edna missed her chance to enroll in MA during her Initial Coverage Election Period. Felix lives in an area with a Medicare Advantage plan with a 4-star rating that he would like to join. George dropped his Medigap policy six months ago when he first enrolled in a Medicare Advantage plan. He now wants to return to Original Medicare. Harriet has recently developed diabetes and would like to enroll in a Medicare Advantage plan that focuses on care for those with that disease. Which, if any, of these individuals would qualify for a special election period (SEP)?
Edna would qualify for a SEP because government officials have declared a major disaster for her area and she did not enroll in MA during her ICEP due to the emergency. George would qualify for an SEP because he enrolled in Medicare Advantage (MA) plan for the first time and would now like to return to Original Medicare within the first 12 months of his enrollment. Harriet would also qualify for a SEP to enroll in a C-SNP because she has developed a chronic condition. Felix would not qualify for a SEP since he seeks to enroll in a 4-star not a 5-star MA plan.
Edna: She would qualify for a SEP because government officials have declared a major disaster for her area and she did not enroll in MA during her Initial Coverage Election Period (ICEP) due to the emergency1.
George: He would not qualify for an SEP based on the information provided. While there are SEPs for certain situations, dropping a Medigap policy to enroll in a Medicare Advantage plan and then wanting to return to Original Medicare is not listed as a qualifying event2.
Harriet: She would qualify for a SEP if the Medicare Advantage plan she wishes to enroll in is a Chronic Special Needs Plan (C-SNP). These plans are designed to provide targeted care to individuals with specific severe or disabling chronic conditions2.
Felix: He would not qualify for an SEP just because a 4-star plan is available in his geographic area. The star rating of a plan does not trigger a SEP2.
