AHIP Examination Test Question Answers Part-II

 

AHIP Examination Preparation Answer Question

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(100 Question Answer)

Q101-Mrs. Grant uses several very expensive drugs and anticipates that she will enter catastrophic coverage at some point during the year. To help her determine when she is likely to qualify for catastrophic coverage, she asked which expenses count toward the out-of-pocket limit that qualifies her for catastrophic coverage. Which one of the following would count?

a. Prescription drugs she purchases on her own that are not on her Part D plan’s formulary.

b. Prescription drugs she purchases when in the Part D coverage gap.

c. Prescription drugs she purchases on her vacation to Canada. 

d. Non-prescription, over-the-counter medications she purchases.

Q102-Mr. Shapiro gets by on a very small fixed income. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know whether he might qualify. What should you tell him?

a. The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government.

b. He must apply for the extra help at the same time he applies for enrollment in a Part D plan. If he missed this opportunity, he will not be able to apply for the extra help again until the next annual enrollment period. 

c. The government pays a per-beneficiary dollar amount to the Medicare Part D prescription drug plans, to offset premiums for their low-income enrollees in accordance with the plan’s set criteria. Mr. Shapiro should check with his plan to see if he qualifies. 

d. The extra help is available only to Medicare beneficiaries who are enrolled in Medicaid. He should apply for coverage under his state’s Medicaid program to access the extra help with his drug costs.

Q103-Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the time to fill out the paperwork. What could you tell her?

a. Those who qualify for the Part D low income subsidy pay nothing for any of their medications. She should definitely apply if she believes there is any chance of her qualifying. 

b. The Part D low income subsidy is designed for Medicare beneficiaries who also qualify for Medicaid. If she does not qualify for Medicaid, she would likely not qualify for the extra help and therefore should not take the time to apply

c. The Part D low income subsidy could substantially lower her overall costs. She can apply by contacting her state Medicaid office, or calling the Social Security Administration.

d. The Part D low income subsidy will not help her once she reaches the coverage gap, so she need not take the time to apply.

Q104-Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. What should you tell him?

a. He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means obtain the medications they need. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses.

b. He should look into the possibility of purchasing his medications through the internet from off-shore pharmacies. 

c. He should contact his neighbors and family members and let them know that any contributions they make toward his drug expenses will be tax deductible. 

d. The only option available is to reduce his income so that he can qualify for the Part D extra help or wait until next year to see if the annual limits change.

Q105-Mrs. Fiore was in the Army for 35 years and is now retired. She has drug coverage through the VA. What issues might she consider with regard to whether to enroll in a Medicare prescription drug plan?

a. Costs under the VA are significantly higher than those under a Medicare Part D plan. 

b. The VA will not offer drug coverage to Mrs. Fiore once she qualifies for the Medicare Part D program

c. She could compare the coverage to see if the Medicare Part D plan offers better benefits and coverage than the VA for the specific medications she needs and whether any additional benefits are worth the Part D premium costs.

d. The VA does not offer creditable coverage and Mrs. Fiore may incur a Part D premium penalty if she enrolls in a Medicare prescription drug plan at some point after her initial eligibility date.

Q106-Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to purchase extra coverage that he will not need. What should you tell him?

a. As long as he has any sort of employer coverage, regardless of the level of coverage, he will incur no penalty if he does not enroll in a Part D plan when first eligible.

b. If the drug coverage he has is not expected to pay, on average, at least as much as Medicare's standard Part D coverage expects to pay, then he will need to enroll in Medicare Part D during his initial eligibility period to avoid the late enrollment penalty.

c. He will need to enroll in a Medicare prescription drug plan upon becoming eligible for the program in order to avoid a premium penalty. To reduce his expenses, he should look for a plan with a zero premium. 

d. He should drop the employer coverage and enroll in a Medicare prescription drug plan. Employer plans are almost always more costly for beneficiaries and most do not cover the same range of drugs available from a Medicare prescription drug plan.

Q107-Mr. Rice has coverage for medical services and medications through his employer's retiree plan. He is considering switching to a Medicare prescription drug plan because his retiree plan does not cover two important medications. What should he consider before making a change?

a. Mr. Rice can only receive his prescription drug coverage through a Medicare Advantage prescription drug plan so he should drop his employer coverage.

b. If Mr. Rice drops his drug coverage through the retiree plan, he may not be able to get it back and he also may lose his medical health coverage.

c. If his drug coverage through the retiree plan is “creditable” he should not switch, even though it is possible to do so. 

d. Mr. Rice’s retiree plan is required to take him back if, within 63 days of having voluntarily quit the employer’s plan, he decides that he prefers it to his Medicare Part D plan.

Q108-Mr. Shultz was still working when he first qualified for Medicare. At that time, he had employer group coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. It is now a year later and Mr. Shultz has lost his employer group coverage. How would you advise him?

a. Mr. Schultz can wait up to 180 days after the loss of his creditable employer group coverage before enrolling in a Part D plan without worrying payment a premium penalty. 

b. Mr. Schultz should seek to continue employer group coverage through COBRA because it is likely to have superior benefits at a more reasonable price. 

c. Mr. Schultz should immediately enroll in a Part D plan but he can expect to pay a premium penalty because he failed to enroll when first eligible.

d. Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty.

Q109-Mrs. McIntire is enrolled in her state's Medicaid plan and has just become eligible for Medicare as well. What can she expect will happen with respect to her drug coverage?

a. Medicaid will cover all drugs not covered under the Medicare Part D prescription drug plan into which Mrs. McIntire is enrolled.

b. Unless she chooses a Medicare Part D prescription drug plan on her own, she will be automatically enrolled in one available in her area.

c. She can change Medicare Part D prescription drug plans only during the annual election period. 

d. She will continue to obtain her drug coverage through Medicaid.

Q110-Mr. Moy’s wife has a Medicare Advantage Plan, but he wants to understand what coverage Medicare supplemental insurance provides since his health care needs are different from his wife’s needs. What could you tell Mr. Moy?

a. Medicare Supplemental Insurance would cover his long-term care services.

b. Medicare Supplemental Insurance would cover his dental, vision and hearing services only.

c. Mr. Moy that Medicare Supplemental Insurance would help cover his Part A and Part B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover.

d. Medicare Supplemental Insurance would cover all of his IRS approved health care expenditures not covered under Original Fee-for-Service (FFS) Medicare.

Q111-Mrs. Pierce would like to enroll in a Medicare Cost Plan that offer Part D prescription drug coverage. She comes to you for advice about when she can enroll in plan you have previously discussed. What should you tell her?

a. Enrollment in Cost plan offering Part D coverage is generally available year-round, so she can immediately enroll and have prescription drug coverage.

b. Enrollment in Cost plan offering Part D coverage is available only during enrollment period under the Part D program, and cost plan must accept enrollments during these periods.

c. Enrollment in Cost plan offering Part D coverage is generally available only 30 days per year, because of the more generous benefits of these plans.

d. Enrollment in Cost plan offering Part D coverage is not necessary because Cost plans offer more generous Part B benefits.

Q112- Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a PPO that does not include drug coverage. What should you tell her about obtaining drug coverage?

a. She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan.

b. She can enroll in the PPO and purchase drug coverage through a Medigap plan.
c. She can enroll in the PPO and if she decides that she wants drug coverage, she will be able to drop her PPO at any time in favor of a Medicare Advantage plan that includes such drug coverage.

d. She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan.

Medicare Advantage HMO or PPO may only obtain Part D benefits through their plan. They may not enroll in a standalone PDP. (Employer group plan enrollees may have additional choices.)

(Answer: Answered by smarazazaidi

Ms. Gibson should be informed that that all business plans for enrollees may have extra options for her. She ought to likewise be informed that individuals with Medicare Advantage PPO or Medicare Advantage HMO can just get the Part D benefits with her arrangement. She won't most likely select/pursue an independent PDP.  

Further Explanation:  Drug coverage:

Medicare Advantage Plan or other Medicare wellbeing plan that offers Medicare physician endorsed medicate inclusion. You get the majority of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) inclusion, and physician recommended tranquilize inclusion (Part D), through these plans.  

Doctor prescribed Drug coverage:  

Professionally prescribed Drug Coverage. Medical coverage or plan that helps pay for physician recommended medications and prescriptions. All Marketplace plans spread professionally prescribed medications.  

Drugs covered by insurance:

Not all wellbeing plans spread all drugs, and on the off chance that you need a medication that is not secured, it can cost you a great deal of cash. To maintain a strategic distance from those costs, you have to take a gander at the rundown of physician endorsed medications secured by your medical coverage plan. This rundown is known as a model.  

PPO:  

A favored supplier association (PPO) is a therapeutic consideration plan in which restorative experts and offices give administrations to bought in customers at diminished rates. PPO medicinal and social insurance suppliers are called favored suppliers.  

PPO work:  

PPOs work in the accompanying ways: You pay part; the PPO pays part. A PPO uses cost-sharing to help hold costs under tight restraints. When you see the specialist or use social insurance administrations, you pay for part of the expense of those administrations yourself as deductibles, coinsurance, and copayments.

Subject: Health          Level: High School

Keywords: Drug coverage, doctor prescribed Drug coverage, Drugs covered by insurance, PPO, PPO work. Read more on Brainly.com - https://brainly.com/question/13009409#readmore)

Q113-Mr. Wong is a single individual. He has a successful business career and is now able to retire with a comfortable income. Mr. Wong's taxable income is in excess of $80,000. Mr. Wong has health coverage through his employer but will sign-up for Medicare Part A, Part B and Part D when he leaves the workforce. How would you advise him as he budgets for Medicare premiums?

a.Due to his participation in the workforce he will not have to pay premiums for Part A and he will pay the lowest monthly premium rates for Part B and Part D.

b. Due to his participation in the workforce he will not have to pay premiums for Part A and he will pay the higher monthly premium rates for Part B and Part D due to the amount of his income.

c. Due to the provisions of MACRA, his Part B and D coverage will be combined and covered through a low-cost Medigap policy to supplement his Part A coverage.

d. Due to his participation in the workforce he will not have to pay premiums for Part A and will pay reduced premium  for Part B and Part D.

Q114- Mr. Wong is a single individual. He has had a successful business career and is now able to retire with a comfortable income. Mr. Wong's taxable income is in excess of $100,000. Mr. Wong has health coverage through his employer but will sign-up Medicare Part A, Part B and Part D when he leaves the workforce. How would you advise him as he budgets for Medicare premiums?

a.Due to his participation in the workforce he will not have to pay premiums for Part A and he will pay the lowest monthly premium rates for Part B and Part D.

b. Due to his participation in the workforce he will not have to pay premiums for Part A and he will pay the higher monthly premium rates for Part B and Part D due to the amount of his income.

c. Due to the provisions of MACRA, his Part B and D coverage will be combined and covered through a low-cost Medigap policy to supplement his Part A coverage.

d. Due to his participation in the workforce he will not have to pay premiums for Part A and will pay reduced premium  for Part B and Part D.

(Basically, here are the things I would tell Mr. Wong :

- Since he's participating in the workforce, He does not have to spend a single penny for the medicare part A.  So he can  pretty much focus his budget on the medicare part B and part D.

- According to the federal, workers with higher than $85,000 income need to pay higher premiums for part B and D. Nothing Mr. Wong can really for this higher payment. (since's he is considered middle to upperclass earner).

But, he can adjust his part B and Part D plan with private insurance to cater specifically for the type of treatment that he wants. (so he does not have to pay for all type of specialists/drugs and reduce the overall cost))

(Answer:macra provisions      Explanation:new change)

Q115- Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low income subsidy. Where might he turn for help w/ his prescription drug costs?

He may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program

 

Q116- PINTOK is interested in joining a MA-PD plan and wants advice on which type would allow him to select or change his personal PCP.

He has a right to select or change his PCP from within the plan's network w/o interference.

Q117- FERA is selling his home to move into a retirement facility new his daughter in a neighboring state. he has a stand-alone Rx plan and has learned it is not available where he is moving. He doesn't know what he should do.

Because he is moving outside of the service area, the plan must automatically disenroll him. He will have a SEP to select a new plan

Q118- MURPHY has been very ill and has been in the hospital multiple times this year. She is concerned that her expenses have reached the max out of pocket costs and now her SNP will disenroll her.

There is NO limit on the expenses a plan can incur on behalf of any one beneficiary and a plan sponsor may NOT end a member's enrollment just because of high costs, so she should not be concerned.

Q119- BROWN wants to enroll in a MA plan that does NOT include drug coverage and also enroll in a stand-alone Medicare Rx plan. Under what circumstances can she do this?

If the MA plan is a PFFS plan that does NOT offer drug coverage or a MSA, Mrs. Brown can do this. 

Q120-Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for Medicare & Medicaid Services' Marketing Guidelines to ensure he is compliant for which type of products?

a. Long-Term Care policies for Medicare beneficiaries 

b. Section 1332 waiver plans.

c. Medicare Advantage (MA) and Prescription Drug (PDP) plans.

d. Medigap plans

Q121-Another agent working for your agency claims that because you are not employed by the Medicare Advantage plans that you represent, you are not subject to the same requirements as the plans themselves. How should you respond to such a statement?

a. Your coworker is not correct. Marketing on behalf of a plan is considered marketing by the plan and requires that all contracted and employed agents comply with all Medicare marketing rules.

b. Your coworker is correct. You may use any marketing techniques that do not involve providing misinformation to potential enrollees. 

c. Your coworker is correct because employed agents have to follow a stricter set of rules than do independent agents, such as yourself. 

d. Your coworker is correct. You are subject only to requirements issued by your state department of insurance.

Source: Medicare Marketing Rules:Plan Marketing Representatives

Q122-You work for a company that has marketed Medigap products for many years. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. What do you need to do with your materials before using them for marketing purposes?

a. You do not need to get CMS approval of the materials, so long as the materials are not misleading or materially inaccurate. 

b. You need to include a statement that the plans you are marketing are approved by the Centers for Medicare & Medicaid Services and the Department of Health and Human Services. 

c. Only scripts and marketing practices must be approved by CMS, so you do not need to do anything further with your marketing materials, as long as you make them available to anyone who attends the marketing event

d. You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate. 

(Marketing materials include any MA, MA-PD, section 1876 cost, or PDP plan or plan sponsor informational materials targeted to Medicare beneficiaries which:
▪ Promote the plan sponsor or any plan offered by the plan sponsor;
▪ Inform Medicare beneficiaries that they may enroll, or remain enrolled in a plan offered by the plan sponsor;
▪ Explain the benefits of enrollment or rules that apply to enrollees; or
▪ Explain how Medicare services are covered under the plan, including conditions that apply to such coverage.
General audience materials such as brochures, direct mail, newspapers, magazines, television, radio, billboards, yellow pages or the Internet.
▪ Marketing representative scripts or outlines for telemarketing, enrollment or other presentations.
▪ Presentation materials such as slides and charts.
▪ Promotional materials such as brochures or leaflets, including materials for circulation by physicians, other providers, or third parties.
▪ Enrollee communications including rules; agreements; handbooks; contractual changes; changes in providers, premiums, or benefits; plan procedures; and wallet card instructions to enrollees.
▪ Social media (e.g., Facebook, Twitter, YouTube, etc.) posts that meet the definition of marketing materials, specifically those that contain plan-specific benefits, premiums, cost-sharing, or Star Ratings.)

Q123-Which of the following is a correct statement about state laws as they pertain to marketing representatives?

a. State licensure laws are pre-empted and do not apply to marketing representatives marketing MA and Part D plans 

b. Plan sponsors can use any marketing representative, as long as they are licensed in at least one state. 

c. Plans must contract only with marketing representatives who reside in the state where they intend to work.

d. Medicare health plans must comply with requests for information from state insurance departments investigating complaints about a marketing representative. (Plans are responsible for ensuring compliance with Medicare rules by their marketing representatives. Plan marketing representatives include:
▪ individuals employed by a plan and
▪ individuals or entities under contract to the plan through a direct or downstream contract
▪ This would include brokers and agents (contracting directly with the plan or through an agency or other entity), third party marketing organizations (TMOs) such as a field marketing organizations (FMOs), general agents (GAs), or other marketing contractors).)

Q124-You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. You have completed the required training for each plan, but you did not achieve a passing score on the tests that came after the training. What can you do in this situation?

a. Your name will be registered with the Medicare agency by the plans you are seeking to represent and you will be unable to contract with any Medicare Advantage or Part D plan.

b. You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score, although you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing.

c. You will have to repeat the tests in three months, but may begin enrolling beneficiaries while you are waiting. 

d. You will have to attend one of several remedial training events sponsored by the Medicare agency before being allowed to retake the test.

Q125-Your colleague works at a third party marketing organization (TMO) and she said she did not need to take the Medicare training for brokers and agents or pass a test to market Medicare plans since her contract is with the TMO, not the plans that have the products she sells. What could you say to her?

a. You could tell her she is wrong, and that only agents selling employer/union group plans are permitted an exemption from testing, but some employer/union group plans may require testing to promote agent compliance with CMS marketing requirements.

b. You could tell her she was right, but new rules will require her to take the training and pass the test at least every other year. 

c. You could tell her she is right and ask if you could get a contract with the TMO too. 

d. You could tell her she is wrong and that only agents employed by the plans are exempt from training and testing requirements

Q126-Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a website marketing the MA plans with which it has contracts. Agent Armstrong follows up with individuals who request more information about ABC MA plans via the website and tries to persuade them to enroll in ABC plans. What statement best describes the marketing and compliance rules that apply to Agent Armstrong?

a. Agent Armstrong needs to be licensed and appointed only in his state of residence. 

b. Agent Armstrong needs to be licensed and appointed only in the state where ABC Health Plan is headquartered. 

c. Agent Armstrong needs to be licensed and appointed only in the state where XYZ Agency is headquartered.

d. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located.

(Employed or independent agents/brokers must be state-licensed and follow all state appointment regulations in order to sell Medicare Advantage plans)

Q127-You are mailing invitations to new Medicare beneficiaries for a marketing event. You want an idea of how many people to expect, so you would like to request RSVPs. What should you keep in mind?

a. You are not permitted to request RSVPs, so you will need to find a different way to estimate how many people are coming. 

b. You may not require RSVPs, but when people arrive, you may require completion of contact information on a sign-up sheet. 

c. You may require RSVPs and an e-mail address so you can follow up in the event of a cancellation.

d. You may request RSVPs, but you are not permitted to require contact information.

Source: Medicare Marketing Rules: Marketing or Sales Events, continued

Q128-Agent Antonio is preparing for a presentation on Medicare and Medicare Advantage before a local senior citizen civic group where he hopes to enroll some attendees. Which of the following steps should he take in order to be in compliance with Medicare marketing rules?

a. Antonio should include a statement that due to the venue limitations accommodations for persons with special needs will not be available. b. Antonio should indicate that in order to attend the meeting, an e-mail address must be provided on the RSVP card.

c. Antonio should include on the invitation a statement that a salesperson will be present with information and applications.

d. Antonio should include on the invitation that food will be served and alcoholic beverages will be available free of charge

Q129-You have set up an appointment for an in-home sales presentation with Mrs. Fernandez, who expressed interest in the Medicare plans you represent. In preparation for the sales presentation, what must you do?

a. Prior to arriving at her home, request approval from CMS to use special materials that you developed to explain the plan benefits instead of the plan’s materials, which you think are confusing. 

b. Seven days prior to the appointment, you must notify the company(s) you represent regarding which products you will be presenting, so they can report the nature of your meeting to the Medicare agency. 

c. At the time you arrive for the appointment, let her know which products you will be going over

d. Prior to conducting the presentation, obtain, and document having obtained her permission to visit, along with her interest in the specific products you will present. (During individual appointments, marketing representatives may:
▪ Distribute plan materials such as an enrollment kit or marketing materials. ▪ Provide educational information.
▪ Provide and collect enrollment forms. During individual appointments, marketing representatives may not:
▪ Discuss plan options that were not agreed to in the Scope of Appointment.
▪ Market non-health care related products. ▪ Ask for referrals.
Solicit/accept an enrollment request for a January 1st effective date prior to the start of the Annual Election Period on October 15 unless the beneficiary is entitled to another enrollment period (for example, an initial enrollment period or special enrollment period) Personal/Individual marketing appointments are defined by the
intimacy of the appointments' location or format and typically take place in person at the beneficiary's home or a venue such as a library or coffee shop or via telephone call. All individual appointments
▪ Are considered sales/marketing events; ▪ Must meet sales/marketing event requirements;
▪ Must follow scope of appointment requirements (See following slides))

Q130-Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. She agreed to sign a scope of appointment form and meet with you October 15. During the appointment, what are you permitted to do?

a. You may leave enrollment kits for several MA plans and offer to discuss a Medigap and Part D prescription drug plan she might like. 

b. You may leave an enrollment kit and discuss a new life insurance product she might like

c. You may provide her with the required enrollment materials and take her completed enrollment application.

d. You may take her completed enrollment application and ask her to provide names of any of her friends who may be interested in enrolling.

Q131-While making an appointment to discuss Medicare Advantage (MA) and Part D plans with a potential enrollee, you are asked to describe other types of insurance products that your client might wish to purchase. What additional types of insurance can you present during the MA and Part D marketing appointment?

a. You can present only health care related lines of business, but must obtain the beneficiary's permission to do so before the presentation occurs and document that you have obtained that permission.

b. You can present any line of business you represent as long as you obtain the beneficiary’s permission first. 

c. You cannot present any line of business other than MA or Part D during such a presentation, regardless of whether or not it is health care related. 

d. You can present only end of life and life insurance lines of business.

Source: Required Practices: Scope of Appointment, and Required Practices: Marketing Activities

Q132-A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. Before engaging in such a discussion, what should you do?

a. You do not have to do anything. You may proceed with the discussion and enroll the individual, if she so desires. 

b. You must set an appointment for another time, at least 48 hours from the point when she walked into your office

c. You must have her sign a scope of appointment form, indicating which products she wishes to discuss. You may then proceed with the discussion.

d. Prior to speaking with the individual, you must inquire as to her eligibility for MA and Part D plans and then complete a scope of appointment form for the plans for which she is eligible.

Q133-You are meeting with Mrs. Hall in her home. On her scope of appointment form she asked to discuss Medicare Advantage plans. During the meeting, she asks to discuss a stand-alone prescription drug plan. She is leaving the next day to visit her family for a week in another state, so it is important to her to make a decision before she leaves. What must happen before that additional discussion can take place?

a. Since Mrs. Hall specifically asked that you discuss the stand-alone Part D plan, you may do so, as long as she signs a new scope of appointment form first, indicating that she wants to discuss the Part D plan.

b. You must make a telephone call from a location outside Mrs. Hall’s home to ensure that the discussion of the prescription drug plan can take place. 

c. Since Mrs. Hall is leaving the state, you can immediately present her with information on the prescription drug plan, so she can make a decision before it is too late. 

d. You must refer Mrs. Hall to another agent in order for her to be able to engage in such a discussion.

Q134-Which of the following statements best describes how business reply cards (BRCs) may be employed in the marketing of Medicare Advantage products?

a. A BRC may be used to document a beneficiary's scope of appointment agreement provided it has been submitted to CMS for approval and includes a statement informing the beneficiary that a salesperson may call.

b. Since they are a common marketing technique, agents can simply send them to lists of prospects. 

c. Since they are a common marketing technique, plan sponsors simply need to have them approved by their internal compliance departments. 

d. A BRC may be used to document a beneficiary’s scope of appointment agreement provided it has been submitted to CMS for approval.

Q135-Ordinarily, you obtain referrals from a third-party that initiates contact with potential clients and usually sets up appointments for you. How would the guidelines for marketing Medicare Advantage and Part D plans apply to this practice?

a. Third parties may only make initial contact with a beneficiary if they first obtain certification from the Medicare agency as an approved marketing entity and are licensed under applicable state law. 

b. This is an acceptable practice, as long as the third party clearly states, during a call that it is calling on behalf of a Medicare Advantage or Part D plan, or the plan’s marketing representative

c. Third parties may not make unsolicited calls, visits, or emails to Medicare beneficiaries in order to set up such appointments, or for any other reason related to the marketing of Medicare Advantage or Part D plans.

d. Third parties may make initial calls to a potential client, but they must then pass the name and phone number on to you and it will be your responsibility to set up the sales appointment and obtain a completed scope of appointment form.

Q136-You market many different types of insurance and ordinarily you spend time each evening calling potential clients. To be in compliance with requirements for marketing Medicare Advantage and Part D plans, what must you do about contacting potential clients to market those plans?

a. Because the Medicare health plans are important federal programs for beneficiaries, federal law regarding the "Do Not Call" registry is waived so you will be able to call and enroll beneficiaries over the telephone. 

b. You only need to comply with requirements of federal and state “Do Not Call” registries

c. You will have to avoid calling any potential client, unless he or she initiates contact with you and specifically asks that you give him or her a call.

d. As long as you market only health-related products, you can make an initial call to any beneficiary, but then must honor "do not call again" requests.

Q137-Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. What should you tell her?

a. Marketing representatives may only use internet pop-up ads providing plan-specific information that have been approved by CMS when soliciting prospects through electronic means of communication. 

b. While unsolicited contacts may be made through print media such as direct mail, marketing representatives may not initiate electronic contact. 

c. Marketing representatives may initiate electronic contact through e-mail and as long as an e-mail is opened marketing representatives may also follow-up with unsolicited telephone calls.

d. Marketing representatives may initiate electronic contact through e-mail but the subject line must say "marketing" and an opt-out process must be provided.

Q138-Winthrop Brokerage wishes to place an advertisement in the local newspaper that says: "We offer Medicare Advantage plans offered by AB Health and Top Choice Health. Contact us if you would like to learn more." Which of the following best describes the obligation(s) of Winthrop Brokerage regarding the advertisement?

a. Winthrop Brokerage must submit the advertisement to CMS for prior approval because it is considered general audience marketing. 

b. Winthrop Brokerage does not need to submit the advertisement to CMS for prior approval and may also include in the advertisement information about the plans’ benefit structures and star rankings

c. Winthrop Brokerage does not need to submit the advertisement to CMS for prior approval because it does not include information about the plans' benefit structures, cost sharing, or information about measures or ranking standards.

d. Winthrop Brokerage must submit the advertisement to CMS for prior approval because it meets the definition of marketing material

Q139-ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' protected health information to market non-health related products such as life insurance and annuities. To do so it must obtain authorization from the enrollees. Which statement best describes the authorization process?

a. The request for authorization may include a brief synopsis of non-health related content. 

b. Once a plan sends out a written request for consent, a beneficiary can authorize consent by simply failing to reply within 21 days. 

c. It is not necessary for ABC to obtain an authorization to simply explain pending state or federal legislation, since there is no anticipation of selling a non-health related product in these circumstances.

d. Authorization may be obtained by directing a beneficiary to a website to provide consent. As long as the website include a mechanism for an electronic signature that is valid under applicable law.

Q140-During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a 5-star rating in customer service and care coordination, and received an overall plan performance rating of a 4-star, which of the following would be the correct statement to say to her?

a. The Medicare Advantage plan received a 5-star rating in customer service and care coordination with an overall performance rating of 4-stars.

b. This Medicare Advantage plan is a 5-star rated plan due to its high rating in customer service. 

c. The Medicare Advantage plan received the best star rating in customer service and care coordination. 

d. The Medicare Advantage plan is a top rated plan.

Source: Required Practices: Plan Ratings, continued

Q141-Mr. Valesquez asked if the Private Fee-for-Service plan you have discussed is like Original Medicare or a Medigap supplement plan. What should you say about a Private Fee-for-Service (PFFS) plan to explain it to Mr. Valesquez?

a. It is the same as Original Medicare, but offered by a private company. 

b. It is like a Medicare supplement or Medigap plan.

c. It is not Original Medicare and it works differently than a Medicare supplement plan.

d. It is a type of Medicare Advantage plan that allows you to go to any doctor anywhere.

Q142-Ajax Agency is targeting potential enrollees for MSA plans. Which of the following statements best describes the rules that apply to the MSA materials it distributes?

a. The materials must make clear that beneficiaries are automatically enrolled in a prescription drug plan as part of the MSA

b. The materials must make clear that Medicare MSA plans do not cover prescription drugs and that beneficiaries can join a separate Part D prescription drug plan.

c. The materials must make clear that those who enroll must make monthly deposits into the custodial savings account associated with plan.

d. The materials must make clear that money in the MSA custodial account can be used for all medical expenses and both Medicare-covered and non-covered expenses count toward the beneficiary’s deductible.

Q143-During a sales presentation, your client asks you whether the Medicare agency recommends that she sign up for your plan or stay in Original Medicare. What should you tell her?

a. Tell her that Medicare recommends that beneficiaries enroll in a Medicare Advantage plan because it will serve her better than Original Medicare

b. Tell her that the Medicare agency does not endorse or recommend any plan.

c. Tell her that, because you represent a Medicare health plan, you therefore work for Medicare, and the information you offer her is a good basis of any decision she makes. 

d. Tell her that Medicare or CMS (the Medicare agency) has approved and endorsed the plan.

Source: Prohibited Practices: Marketing Activities, continued

Q144-By contacting plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefit package. What should you do to make sure your clients know about these pieces of information?

a. You have clear evidence that your plan is the best and can say so to your clients. 

b. To obtain information about another plan’s benefits, you must refer clients to those other plans, because you may not provide comparative information, regardless of the source, to demonstrate any differences among the plans. 

c. You may create a chart that lists each plan in the beneficiary’s service area along with the benefits of the plan you represent, compared to those of the other available plans.

d. You may present comparative information that has been created and approved by the Medicare agency (CMS), such as a print-out from the Medicare plan comparison website.

(You may make comparisons between plans if you can support them by studies or statistical data and such comparisons are factually based.)

Q145- When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan?

a. You may provide gifts or prizes to all potential enrollees during an event that do not exceed $15 in retail value.
b. You may provide any gift to induce enrollment, as long as its retail value does not exceed $25 in value.
c. You may provide cash promotions or giveaways as long they are offered to everyone, whether they are a Medicare beneficiary or the general public.
d. You may give enrollees post-enrollment gifts to compensate them for their time.

 

Q146-Ordinarily, you provide clients who purchase various types of insurance products from you with a gift when they enroll and you let them know that they will receive it after their enrollment is complete. When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan?

a. You may provide any gift to induce enrollment, as long as its retail value does not exceed $15 in value. 

b. You may give enrollees post-enrollment gifts to compensate them for their time. 

c. You may provide cash promotions or giveaways as long they are offered to everyone, whether they are a Medicare beneficiary or the general public.

d. You may not provide any gift or prize as an inducement to enroll. 

(Marketing representatives may offer gifts to potential enrollees if they attend a marketing presentation as long as the gifts are of nominal value and provided regardless of enrollment and without discrimination.
▪ Gifts are of nominal value if an individual item is worth $15 or less (based on retail purchase price of the item);
▪ When more than one gift is offered, the combined value of all items must not exceed $15;
▪ Gifts must not be in the form of cash or other monetary reward, even if their worth is less than $15. Cash gifts include charitable contributions on behalf of an attendee and those gift certificates or gift cards that can be readily converted to cash.
▪ There is an exception where state law requires that the gift certificate or gift card must be convertible to cash and the cash value is no more than $2.00.
▪ If the gift is one large one that is enjoyed by all attending an event, the total cost must be $15 or less when divided by the estimated attendance. Anticipated attendance may be used, but must be based on venue size, response rate, or advertisement circulation. Plan sponsors must include a disclaimer on all marketing materials
promoting a prize or drawing or any promise of a free gift that there is no obligation to enroll in the plan.Plan sponsors must track and document promotional activities and items given to current enrollees during the year. Plan sponsors and their marketing representatives may not willfully structure pre-enrollment activities with the intent to give people more than $75 per year.)

Q147-One of your colleagues argues that it is better to focus your time and energy exclusively in neighborhoods with single family homes. He further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. How should you respond?

a. This is not a discriminatory activity since this is merely a widely recommended sales practice.

b. This could be considered discriminatory activity and a prohibited practice.

c. This could be considered discriminatory activity, but it is not a prohibited practice. 

d. This is not a discriminatory activity since it is based on the incomes of likely prospects and not based on race or gender.

Q148-Agent Harriet Walker has recently begun marketing Medicare Advantage and related products aimed at meeting the needs of senior citizens. Client Mildred Jones has expressed interest in a Medicare Advantage plan. It is now the beginning of September. If you were in Agent Walker's position, what would you do?

a. Inquire whether the client qualifies for a special enrollment period, and if not, solicit an enrollment application once the annual open enrollment election period begins on October 15th.

b. Solicit and complete the enrollment application in September and wait until the open enrollment date to submit it so that the client does not purchase a plan through another agent. 

c. Tell the client that she should also consider non-health products (such as cash value life insurance) to meet some of her health needs and offer to submit a life insurance application to see if client Jones is insurable. 

d. Tell the client that she cannot speak to her until after open enrollment begins on January 1st of the following year.

Q149-Mr. Murphy is an agent. A neighbor invited him to discuss the Medicare Advantage (MA) and Part D plans he sells at the regular Tuesday brunch the neighbors have for senior citizens. What should Mr. Murphy tell his neighbor about the kinds of food that can be provided to potential enrollees who attend the sales presentation?

a. The neighbors may not provide anything to either eat or drink during the sales presentation. 

b. Any type of meal or food is allowed, as long as it is available to the general public and not just to those who are eligible to enroll in the plans

c. The neighbors may not provide a meal, but light snacks would be permitted.

d. Any meal is allowed, as long as it is valued at less than $15.

Source: Prohibited Practices: Inducements and Light Snacks versus Prohibited Meals.

Q150- You have had a good meeting with Mr. Claggett and he has selected a Medicare Advantage plan. He would like you to help him complete the enrollment application because he wants to make sure he gets into the right plan. You offer to help, but you tell him that you cannot do which of the following?

If enrollment is completed during a face-to-face interview, the plan representative should use the individual's Medicare card to verify the spelling of the name, sex, Medicare number; and Part A and Part B effective dates.

(?? Help him fill out any portion of the enrollment form OR Help him correct any information on the enrollment form if he makes a mistake. (you can correct the mistake but put your initials beside it))

Q151-Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled a marketing event and expects about 40 people to attend. He has hired a magician at a cost of $200 to entertain attendees. Can he do this in a way that complies with guidance from the Medicare agency?

a. He cannot do this because the total value of the gift exceeds the maximum $15 retail gift value. 

b. He can do this because the ads for the event are distributed both to enrollees and non-enrollees, so no restrictions apply

c. He can do this, because the estimated number of attendees is based on the venue size and response rate and the value of the gift does not exceed $15.

d. He can do this because the gift is not a cash gift and is not readily converted to cash.

Q152-You will be holding a sales event in the near future, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation?

a. Gifts of nominal retail value ($15 or less)

b. Gift cards or gift certificates of $15 or less that can be readily converted to cash.

c. Two or more gifts whose combined value does not exceed $15. 

d. Gifts worth more than $15 but based on anticipated attendance will not exceed $15 per attendee.

Source: Promotional Activities: Nominal Gifts.

Q153-You are scheduled to give a sales presentation at a local senior center. At the beginning of the presentation, which of the following must you do?

Clearly state that no obligation exists to enroll if a gift or prize is being provided.

b. Make sure that those present provide leads. 

c. Explain, in your own words, how the plan you represent compares to other companies’ plans. 

d. Determine whether the beneficiaries present are healthy enough for the plan.

Q154-Ordinarily, you ask your clients for referrals to people they think would benefit from the products you offer. When selling Medicare Advantage or Part D products, how might you solicit referrals?

a. You may call current MA and Part D enrollees to solicit referrals and offer thank you gifts of less than $15 for each referral received. 

b. You may send an e-mail to all current plan members who have given permission to email them asking for the names, e-mail addresses, and phone numbers of referrals. 

c. You may enter referring individuals in a drawing for substantial prizes as long as they are not told in advance of the drawing the value of the prize.

d. You may solicit referrals from current MA and Part D enrollees and provide one thank you gift per member per year of up to $15, based on retail purchase price for the item, although you may not inform enrollees of the availability of the gift in your letter soliciting referrals.

Q155-When soliciting referrals from current members of an MA or Part D plan, what may you do?

a. You may request names and mailing addresses.

b. You may offer gifts or prizes worth $15 or less in retail value to obtain referrals. 

c. You may request names and phone numbers. 

d. You may offer gifts and prizes worth $15 or less in retail value for each individual on the list of referrals who chooses to enroll.

Q156-Several agents you work with are planning sales events in your area. One plans on giving door prizes worth $5, refreshments valued at $8 per anticipated attendee, and coupon books with discounts worth $10. Since no gift or prize exceeds the $15 limit he believes his plan is acceptable. What should you tell them?

a. Gifts and prizes are not permitted under the Marketing Guidelines promulgated by the Medicare agency 

b. Only a single prize or give away can be made at any one event, regardless of its value 

c. He is correct. He can offer multiple prizes or give-aways at a single event, as long as no one item has a retail value that exceeds $15

d. He can give away more than one gift during a single event, but the aggregate retail value cannot exceed $15.

Q157-You have approached a hospital administrator about marketing in her facility. The administrator is uncomfortable with the suggestion. How could you address her concerns?

a. Tell her that Medicare guidelines allow you to conduct marketing activities anywhere in the facility, so long as the affected providers agree to that event. 

b. Tell her that if a plan obtains permission from CMS for a marketing event in a provider facility, the event may go forward, regardless of where it occurs in the facility. 

c. Tell her that Medicare guidelines only allow you to conduct marketing activities in areas of the facility where individuals are waiting to receive health care services, but not in places where they would be receiving health care such as an examining room.

d. Tell her that Medicare guidelines allow you to conduct marketing activities in common areas of a provider's facility.

Q158-You would like to market an MA plan at a neighborhood pharmacy. What should you keep in mind to comply with the marketing requirements for MA plans?

a. You must set up your table and make marketing presentations only in common areas, but you may accept enrollment applications anywhere in the pharmacy. 

b. You must set up your table, make marketing presentations, and accept enrollment applications near the pharmacy counter where people wait for their prescriptions. 

c. You may not market in a pharmacy if you are not a pharmacist or do not have the pharmacist’s permission.

d. You must set up your table, make marketing presentations, and accept enrollment applications only in common areas outside of where the patient waits for services from the pharmacist.

(Marketing representatives may:
Engage in marketing activities (i.e., conduct sales presentations and distribute and accept enrollment applications) in common areas of health care settings, for example:
At a hospital or nursing home - in a cafeteria, community or recreational room, or conference room;At a retail pharmacy, in areas away from the pharmacy counter.Marketing representatives must NOT:Engage in marketing activities in areas where patients receive health care services, for example:
In the area where a beneficiary waits for health care or pharmacy services, exam rooms, dialysis center treatment areas, or hospital patient rooms.Marketing that is prohibited in health care settings is prohibited during and outside of normal business hours.)

Q159-Your friend's mother just moved to an assisted living facility and he asked if you could present a program for the residents about the MA-PD plans you market. What could you tell him?

a. You appreciate the opportunity and would ask the facility to provide enrollment applications for the MA-PD plans you represent. 

b. You appreciate the opportunity and would just need to complete scope of appointment forms on behalf of all the residents who would like to attend

c. You appreciate the opportunity and would be happy to schedule an appointment with anyone at their request.

d. You appreciate the opportunity and will ask the facility to provide a plan brochure and enrollment application in every resident’s room prior to the meeting to promote interest in the event.

Q160-ABC is a long-term care facility provider. What steps may it take to inform residents of the Medicare options available to them?

a. ABC may set up appointment on their behalf with knowledgeable agents. 

b. ABC may display posters about Medicare in their rooms. 

c. Since they are likely to be frail or suffer mental incapacity, ABC may choose plan coverages on their behalf.

d. ABC may provide residents that meet the I-SNP criteria an explanatory brochure, reply card, and phone number for additional information for each I-SNP with which it contracts.

(An institutionalized beneficiary has a continuous open enrollment period (OEPI) for purposes of changing enrollment in Medicare Advantage plans; this period does not end until two months after the month the beneficiary moves out of the institution. Medicare-Medicaid beneficiaries have a continuous special enrollment period that permits them to enroll in a MA, MAPD, PDP, or MMP (in applicable states and subject to state-specific eligibility rules) during any month. As previously noted this enrollment is only valid when executed by the beneficiary/legal representative or as State law allows. The Medicare Managed Care Manual Chapter 2 has a full description of the relevant special enrollment periods)

Q161-You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. The hospital administration expresses some hesitation about allowing marketing in a health care facility. What should you tell them?

a. So long as the hospital or its physician staff don’t object, marketing anywhere in the hospital is an acceptable practice. 

b. As long as the marketing activities are conducted in a way that does not target healthy beneficiaries, it does not matter where in the hospital these activities are carried out.

c. Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving or waiting to receive health care and as long as the hospital displays materials for all plans that provide them to the hospital.

d. Marketing in health care facilities is an acceptable practice, regardless of where it takes place.

Q162-Plan sponsors may undertake the following marketing activities with current Medicare Advantage plan members?

a. Market non-health related products, such as life insurance, to current members without the need to consider HIPAA Privacy Rules. 

b. Market non-Medicare health-related products, such as financial planning, to current members as permitted by HIPAA Privacy Rules. 

c. Market contact information lists of current member to third-party vendors of ancillary health products as permitted by HIPAA Privacy Rules.

d. Market non-Medicare health-related products, such as dental insurance, to current members as permitted by HIPAA Privacy Rules. (Marketing materials include any MA, MA-PD, section 1876 cost, or PDP plan or plan sponsor informational materials targeted to Medicare beneficiaries which:
▪ Promote the plan sponsor or any plan offered by the plan sponsor;
▪ Inform Medicare beneficiaries that they may enroll, or remain enrolled in a plan offered by the plan sponsor;
▪ Explain the benefits of enrollment or rules that apply to enrollees; or
▪ Explain how Medicare services are covered under the plan, including conditions that apply to such coverage.)

Q163- You have been providing a pre-Thanksgiving meal during sales presentations in November for many years and your clients look forward to attending this annual event. When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals?

a. As long as the meal is paid for by another person or entity, you are permitted to invite your clients and their friends to partake of the meal at your sales presentation. 

b. There is no limitation on meals. You may continue to provide your Thanksgiving style meal, to any individual, in any manner you see fit. 

c. You may offer meals to existing enrollees of the plan(s) you represent, but potential enrollees may not have a meal.

d. You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. 

(Marketing representatives should contact plan sponsor regarding the appropriateness of the food products provided and must ensure that items provided could not be reasonably considered a meal and/or that multiple items are not being "bundled" and provided as if a meal.
Examples of foods that may be considered "light snacks" include:
▪ Fruit and raw vegetables ▪ Pastries and muffins ▪ Cookies or other small bite-size dessert items
▪ Crackers ▪ Cheese ▪ Chips ▪ Yogurt ▪ Nuts)

Q164-Next week you will be participating in your first "educational event" for prospective enrollees. In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage?

a. You should plan to answer questions and accept enrollment forms. 

b. You should plan to conduct sales presentations, but must not accept enrollment forms. 

c. You should plan to conduct sales presentations and accept enrollment forms

d. You should plan to ensure that the educational event is a social event, and must not conduct a sales presentation or distribute or accept enrollment forms at the event. 

(An agent attends a community-sponsored health fair, and hands out plan-specific benefits information including premium and/or copayment amounts;
▪ An agent participates in a health fair and hands out enrollment forms;
▪ An agent hands out only educational materials but gives a brief presentation that mentions plan-specific premiums and/or copayment amounts;
▪ An agent distributes business cards to attendees and asks them to call him about getting the best Medicare coverage representatives may NOT:
▪ Conduct sales presentations;
▪ Discuss or distribute plan-specific premiums, benefits, or materials including provider and pharmacy directories;
▪ Distribute or collect enrollment applications; ▪ Collect names/addresses of potential enrollees;
▪ Distribute or display business reply cards, scope of appointment forms, or sign up sheets;
▪ Attach business cards or plan/agent contact information to educational materials (business cards free of marketing information may be provided upon beneficiary request);
▪ Ask participants if they want information about a specific plan or limited
number of plans;
▪ Set up personal sales appointments or get permission for an outbound call to the beneficiary; or
▪ Distribute or make available marketing materials.)

Q165-If you are to be in compliance with Medicare's guidance regarding educational events, which of the following would be acceptable activities?

You may distribute business cards to individuals who request information on how to contact you for further details on the plan(s) you represent.

Q166-You are working with a number of plans and community organizations to sponsor an educational event. When putting together advertisements for this event, what should you do?

a. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event.

b. You must only ensure that the advertisement is factually accurate. 

c. Plans may not participate in advertising such an event. All advertising must be done by the community organizations. 

d. You must state in the advertisement that it will be an educational event and that the education will consist of specific information about the participating plans.

Q167-You plan to participate in an educational event sponsored by a large regional health care system. One of your colleagues suggests that you do a presentation on one of the Medicare Health plans you market, and modify it to include information about preventive screening tests showcased at the event. How should you respond to your colleague's suggestion?

a. As long as your sales presentation includes information that is about healthy living or clinically effective screening exams, you could talk about the Medicare plans in your presentation.

b. You should tell your colleague no because participation in an educational event may not include a sales presentation.

c. Whether or not a sales presentation is allowed at this educational event is entirely up to the sponsor of the event. 

d. You should tell your colleague no, because marketing representatives are not permitted to participate, in any way, in an educational event.

Q168-Agent Mary Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings distributes materials that are solely educational in nature. However, she gives a brief presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that has been advertised as educational?

a. Yes. Whether or not an event has been advertised as “educational” or a “sales presentation,” discussing plan-specific information is impermissible.

b. Yes. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible.

c. No. This action is permissible. Handing out enrollment forms, on the other hand, would not be permissible. 

d. No. Attendees expect some “puffery” at any event on a product in which they may be potentially interested.

Q169-Another agent you know has engaged in misconduct that has been verified by the plan she represented. What sort of penalty might the plan impose on this individual?

a. Plans do not impose penalties. Instead, the Medicare agency has specific authority to fine such individuals for each violation. 

b. Plans must immediately terminate their contracts with such individuals

c. The plan may withhold commission, require retraining, report the misconduct to a state department of insurance or terminate the contract.

d. Her name will be reported to a publicly accessible database and could be advertised in local newspapers.

Q170-BestCare Health Plan has received a request from a state insurance department in connection with the investigation of several marketing representatives licensed by the state who sell Medicare Advantage plans. What action(s) should BestCare take in response?

a. Immediately terminate all the agents involved as a precaution against potential legal liability. 

b. Immediately meet with the marketing representatives and suggest they obtain licensing in another jurisdiction. 

c. Under Federal privacy statutes, BestCare is not obligated to provide information about marketing representatives to the state and should refuse to do so.

d. Cooperate with the state and supply requested information.

(Agent Armstrong is an independent agent under contract with MarketCo, a third party marketing organization. MarketCo has a contract with BestChoice health plan, a Medicare Advantage organization, to offer marketing services through its contracted agents and agencies. Agent Armstrong returns calls to individuals who call
MarketCo in response to its mailers promoting BestChoice health plan. Agent Armstrong is a marketing representative of BestChoice. Thus, he is obligated to comply with all marketing requirements, including those regarding using only approved call scripts.)

Q171-Mr. Lynn, an agent for Acme Insurance, Inc. thinks that, since state laws are preempted with regard to the marketing of Medicare health plans, he doesn't have much to worry about. What might you, as his colleague, advise him concerning the type of scrutiny he will be under?

a. The state sets most requirements for marketing Medicare health plans, but each plan has different policies that he must adhere to. b. The Medicare agency conducts only complaint-based oversight and he can market the products he represents as he sees fit, as long as he does so in a manner that would be considered ethical by a reasonable lay person

c. Organizations sponsoring Medicare health plans are responsible for the behavior of their contracted representatives and will be conducting monitoring activities to ensure compliance with all applicable Federal law and guidance and plan policies. Furthermore, state agent licensure laws are not preempted and he must abide by their requirements.

d. Organizations sponsoring Medicare health plans are not responsible for enforcing compliance with applicable law and guidance. This job belongs solely to the Medicare agency.

Q172-Medicare health plans establish provisions in marketing representative contracts to ensure compliance with applicable laws and policies. If non-compliance occurs, CMS can penalize a plan in which of the following ways?

a. CMS requires plan sponsors to publish in local newspapers the names and misdeeds of the marketing representatives who have not complied with the terms of their contracts, so that potential clients can know whom to avoid.

b. CMS requires plan sponsors to create and complete a corrective action plan and may terminate a sponsor's contract.

c. CMS requires the dismissal of senior plan management. 

d. CMS cannot penalize the plan sponsor for marketing representative non-compliance. That is the role of the state.

Q173-Monica is an agent focused on serving seniors eligible for Medicare. As she reviews her records, she is trying to determine which of the following items are considered compensation. What do you tell her?
I.Commissions          II.Bonuses     III.Mileager eimbursement          IV. Referral fees

a. I and II only                 b. I, II, and IV only.               c. I, II, III, and IV       d. I, II and III only

Source: Marketing Representative Compensation: Compensation Defined

Q174-Alice is a marketing representative employed by a health plan. Betty is a captive agent of a health plan who markets to multiple plans and sponsors. Carl is a captive agent who markets to only one plan/sponsor. Denise is an independent agent who markets to different types of groups. Edward is an independent agent who markets only to employer and union groups. CMS marketing representative compensation rules generally apply to:

a. Betty and Denise, but not Alice (the employee) or Carl or Edward (to whom exceptions apply).

b. All of these people. 

c. Denise and Edward (the independent agents), but not Alice (the employee) or Betty or Carl (the captive agents). 

d. All of these people except Alice, the employee.

Q175-Wendy Park becomes eligible for Medicare for the first time in July. With the help of Agent James Chan, she enrolls in FeelBetter Medicare Advantage plan with an effective date of July 1st. Which statement best describes how Agent Chan may be compensated under CMS rules?

a. FeelBetter will pay Agent Chan initial year compensation for the 12 months of July through July. Renewal amount will be paid thereafter if Ms. Park remains enrolled. 

b. FeelBetter will pay Agent Chan initial year compensation for the period July 1 through October 15th -(the date open enrollment begins). If Ms. Park remains enrolled in the plan, renewal amounts will be paid. 

c. FeelBetter will pay Agent Chan a bonus equal to three months initial year compensation since he has successfully enrolled Ms. Park in a MA plan when she is both first eligible and a younger, and likely healthier, enrollee.

d. FeelBetter will pay Agent Chan initial year compensation for the months July through December. Renewal amounts will be paid starting in January if Ms. Park remains enrolled the following year.

(Agents/brokers must be licensed in the State in which they do business, annually complete training and pass a test on their knowledge of Medicare and health and prescription drug plans, and follow all Medicare marketing rules. Agents/brokers are subject to rigorous oversight by their contracted health or drug plans and face the risk of loss of licensure with their State and termination with their contracted health or drug plans if they don't comply with strict rules related to selling to and enrolling Medicare beneficiaries in Medicare plans.)

Q176-Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the Annual Open Enrollment Period. Ralph's effective enrollment date is January 1st. Ralph disenrolls on February 12th because he did not understand that the plan did not cover services furnished by several of his longtime providers. Which of the following statements best describes the impact of Ralph's action upon Agent Lopez's compensation?

a. Agent Lopez’s compensation is not impacted because Ralph’s disenrollment occurred more than 30 days after the effective date of coverage. 

b. Agent Lopez is entitled to a pro rata amount of the compensation earned including the full amount for the month of February.

c. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment.

d. Agent Lopez’s compensation is not impacted because Ralph’s disenrollment occurred after the Annual Open Enrollment Period.

Q177-Agent Higgins helps Mrs. O'Malley to enroll in AB Medicare Advantage (MA) plan during the Annual Open Enrollment Period. Mrs. O'Malley's effective enrollment date is January 1st. Subsequently, Mrs. O'Malley disenrolls on February 12th following a move outside the plan's service area. What impact will this have on Agent Higgins compensation?

a. AB MA plan must recoup a pro rata amount of Agent Higgins’ compensation and pay him only for the month of January.

b. AB MA plan does not have to recoup Agent Higgins' compensation because she has moved away from its service area.

c. Agent Higgins entire compensation must be recouped because Mrs. O’Malley has disenrolled within 3 months of enrollment. 

d. AB MA plan must recoup a pro rata amount of Agent Higgins’ compensation if Mrs. O’Malley subsequently enrolls in Original Medicare and Part D

Q178- You are completing a PFFS plan sale to Mr. West(SCHMIDT) who is new to Medicare, and as you are finishing up, what should you tell him about next steps in the enrollment process?

You need to get Mr. Schmidt's phone number and include it on the enrollment form because the plan must call him after you leave to ensure that he understood the nature of the PFFS plan he selected and to verify his intent to enroll

Q179-You have come to Mrs. Midler’s

You

Q180-Mr. Wilcox has been enrolled in lexington PFFS Medicare Advantage Health Plan (Lexington) for several years. Recently, Mr. Wilcox decided to spend time with his children who live in another state that is not in Lexington’s service area. In the future, he may relocate near his children permanently. How does this move to another service area impact his PFFS MA coverage?

Lexington can allow Mr. Wilcox continued enrollment for upto 12 months wether or not he is a visitor/traveler (v/T) program. 

Q181- Madeline Martinez was widowed several years ago. Her husband worked for many years and contributed into the Medicare system. He also left a substantial estate which provides Madeline w/ an annual income of approx. $130,000. Madeline, who has only worked part-time for the last 3 years, will soon turn age 65 and hopes to enroll in Original Medicare. She comes to you for advice. What should you tell her?

You should tell Madeline that she will be able to enroll in Medicare Part A w/out paying monthly premiums due to her husband's long work record & participation in the Medicare system. You should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest rate due to her substantial income

Q182-Mrs. Sanchez lives in a state located near Canada. She has recently become eligible for Medicare and is considering enrollment in Part D prescription drug coverage. One of her friends has told her that she needs to be aware of something called TrOOP. What should you tell her when she asks you about TrOOP?

a. TrOOP is calculated on a cumulative basis and consists of the sum of an enrollee’s out-of-pocket deductibles from the date of his or her enrollment in Part D plus outlays for over-the-counter drugs.

b. TrOOP are out-of-pocket costs that count toward the annual out-of-pocket threshold to move into catastrophic coverage and generally include, in addition to the annual dedutible, costs for drugs not on the Part D plan’s formulary and drugs purchased outside the United States.

c. TrOOP are out-of-pocket costs that count toward the annual out-of-pocket threshold to move into catastrophic coverage and generally include the annual deductible(s) and costs from drugs on teh plan's formulary purchased at a plans' participating pharmacy. In some instances, amounts not directly paid by the enrollee (like manufacturers discounts) count toward TrOOP.

d. TrOOP is calculated on an annual basis and consists of an enrollee’s out-of-pocket deductible plus any amounts paid on behalf of an enrollee by Medicaid.

Q183-If a beneficiary is enrolled in a stand-alone prescription drug plan and wants to keep that plan, what type of Medicare health plan could the individual also enroll in, without being automatically dis-enrolled from the stand-alone prescription drug plan?

a. The beneficiary could only stay in a stand-alone prescription drug plan if he or she has original fee-for service Medicare.

b. The beneficiary could enroll in a private fee-for-service (PFFS) plan that does not include prescription drug coverage; an 1876 Cost Plan; or a Medicare Medical Savings Account (MSA) plan.

b. The beneficiary could only choose an 1876 Cost Plan.

d. The beneficiary could only choose a Medicare Medical Service Saving Account (MSA) plan. 

 

Q184- BUSHMAN has two homes in different states and is concerned about restrictions on where she can get her medications.

?? Part D Rx plan use networks of pharmacies within their service areas. She could look for a plan that maintains a network in both states

Q185- Anita Magri will turn 65 in August 2020. Anita intends to enroll in Original Medicare Part A & B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's older neighbor Mel had told her about Medigap Part F plan in which he is enrolled. It not only provides foreign travel emergency benefits, but also covers his Medicare Part B deductible. Anita comes to you for advice. What should you tell her?

You are sorry to disappoint her but a Medigap Part F plan is no longer available to those who turn 65 after Jan. 1, 2020. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible

 

Q186- Mr. Singh would like drug coverage, but does not want to be enrolled in a Medicare Advantage plan. What should you tell him?

Mr. Singh can enroll in a stand alone prescription drug plan & continue to be covered for Part A & B services through Original Fee-for-Service Medicare

 

Q187-Mrs. Walters(WEISS) is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to?

a. Yes. Mrs. Walters(WEISS) must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program.

b. Yes, but Mrs. Walters must drop the employer coverage prior to enrolling in a Medicare prescription drug plan. 

c. No. Mrs. Walters will have to enroll in Part B in order to qualify for enrollment into the Medicare prescription drug program. 

d. No. As long as her employer offers coverage that is equivalent to that available through Medicare, Mrs. Walters cannot enroll in a Medicare prescription drug plan.

Q188-Mr. Sanchez(SAUNDERS) is entitled to Part A, but has not enrolled in Part B because he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do?

a. He will have to enroll in Part B.

b. He will not need to do anything. His entitlement to Part A makes him eligible to enroll in any Medicare Advantage plan. 

c. He must wait until the next Annual Election Period, at which time he can enroll in a Medicare Advantage plan. 

d. As long as his employer offers coverage that is equivalent to Medicare’s, he cannot enroll in Part B.

Q189-Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS) plan. What questions would you need to ask to determine his eligibility?

a. You would need to ask Mr. Kelly if he is enrolled in Part A and Part D and if he needs drug coverage. 

b. You would need to ask Mr. Kelly if he is enrolled in Part A and Part B, if he is healthy, and how often he expects to visit a doctor.

c. You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PFFS plan's service area.

d. You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if his doctor will accept the terms and conditions of payment of the PFFS plan.

Q190-Mr. Gonzalez is entitled to Part A, but has not yet enrolled in Part B. If he wants to enroll in a Private Fee-for-Service (PFFS) plan, what will he have to do?

a. He will need to do nothing. His entitlement to Part A makes him eligible to enroll in any Medicare Advantage plan. 

b. He will have to drop Part A and then will be eligible to enroll in a PFFS plan. 

c. He will have to enroll in a Medicare prescription drug plan prior to enrolling in a PFFS plan.

d. He will have to enroll in Part B prior to enrolling in the PFFS plan. (PFFS options available to beneficiaries may include:
Enrolling in a PFFS plan offering only Medicare A/B benefits and not obtaining Part D coverage;
Enrolling in a PFFS plan that combines Medicare A/B and Part D prescription drug benefits (MAPD
plan); or Enrolling in a PFFS plan offering Medicare A/B benefits and enrolling in a stand-alone Part D
prescription drug plan (PDP). Individuals enrolled in a PFFS plan receive their Medicare benefits through the plan. PFFS is not the same as Original Medicare. PFFS is not a Medicare supplement, Medigap, or a
Medicare Select policy)

Q191-Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this?

a. Mrs. Berkowitz can apply for any Medicare Advantage plan and, if it offers drug coverage, ask to have that element of the coverage eliminated, after which she can enroll in a stand-alone Medicare prescription drug plan in her service area. 

b. Mrs. Berkowitz can enroll in any Medicare Advantage plan, regardless of whether it offers drug coverage, and enroll in any stand-alone Medicare prescription drug plan.

c. If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account, Mrs. Berkowitz can do this.

d. This is not a possibility. If Mrs. Berkowitz wants health coverage and drug coverage through a plan, she must purchase an MA-PD plan.

Q192-Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for-Service (PFFS) plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts consider before selecting a PFFS plan?

a. A PFFS plan offering only medical benefits or a PFFS Medigap Supplemental Insurance plan. 

b. A stand-alone prescription drug plan in combination with a PFFS plan or a PFFS Medigap Supplemental Insurance plan. 

c. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D prescription drug coverage, a PFFS plan offering only medical benefits, or PFFS Medigap Supplemental Insurance plan.

d. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D prescription drug coverage, a PFFS plan offering only medical benefits, or a PFFS plan in combination with a stand-alone prescription drug plan.

Q193-Which of the following individuals is most likely to be eligible to enroll in a Medicare Advantage or Part D Plan?

a. Guy, who has illegally crossed the Canadian border 

b. Betsy, a grandmother from overseas who has overstayed her visa

c. Jose, a grandfather who was granted asylum and has worked in the United States for many years.

. d. Helena, an overseas college student who has overstayed her visa.

Q194-Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you to come to their home to clear up a few questions. During the presentation, Mrs. Nunez feels tired and tells you that her husband can finish things up. She goes to bed. At the end of your discussion, Mr. Nunez says that he wants to enroll both himself and his wife. What should you do?

a. As long as she is able to do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will have to wake up to sign her form or do so at another time.

b. Legal spouses can sign enrollment forms for one another under federal law. You may enroll both Mr. and Mrs. Nunez, as long as her husband signs on her behalf 

c. You can countersign Mrs. Nunez’ application, along with her husband, indicating that she approved this choice verbally. This witness signature is sufficient to make the enrollment valid. 

d. You should sign the form for Mrs. Nunez yourself, since she informed you, as the plan’s representative, that she wanted to enroll.

Q195-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?

a. Mr. Tully’s daughter can do so because she is an immediate family member who has taken responsibility for her father’s care.

b. Mr. Tully's daughter can do so only, if she is authorized under state law as a court-appointed legal guardian, has durable power of attorney for health care decisions, or is authorized under state surrogate consent laws to make health decisions.

c. If the enrollment form is countersigned by one of Mr. Tully’s treating physicians, she can sign it for him. 

d. A signature is not necessary since Mr. Tully is not physically or mentally capable of filling out and signing the form.

Q196-You are meeting with Ms. 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?

a. You may correct the information, but she will need to write a brief statement indicating she authorized you to make the change.

b. You may correct this information as long as you add your initials and date next to the correction.

c. You may correct the information since it was a simple mistake. You do not need to do anything further to the application form. 

d. Under no circumstances may you make corrections to information a beneficiary has provided. Review of enrollment forms is the sole responsibility of the plan sponsor.

Q197-Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. In setting up the enrollment site, which of the following must Phiona consider?
I. If a legal representative is completing an electronic enrollment request, he or she must first upload proof of his or her authority.
II. All data elements required to complete an enrollment request must be captured.
III. The process must include a clear and distinct step that requires the applicant to activate an "Enroll Now" or "I Agree" type of button or tool.
IV. The mechanism must capture an accurate time and date stamp at the time the applicant enters the online site.

a. I and II only                    b. II and III only        c. I, II, III, and IV                 d. II, III, and IV only.

(Enrollment via the internet:
CMS offers an on-line enrollment center through www.medicare.gov
• Individuals can also enroll through:
www.ssa.gov/medicare/apply.html
• CMS on-line enrollment is disabled for MA and Part D plans with a low performer icon (LPI), which means the plan received less than 3 stars for three consecutive years. MA and Part D plans may offer CMS-approved online enrollment on the plan sponsor's website. MA organizations may develop and offer electronic enrollment mechanisms made available via an electronic device or secure internet website. A number of requirements apply to electronic enrollment mechanisms, including, but not limited to: Plan Sponsors must submit all materials, web pages, and images (e.g. screen shots) related to the electronic enrollment process for CMS approval.Individuals must be provided with all required pre-enrollment information (see module 4).The mechanism must comply with CMS' data security policies. Each individual must be advised at the beginning of the electronic enrollment process that he or she is completing an enrollment request.)

Q198-Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug coverage. He found a stand-alone Medicare prescription drug 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 prescription drug plan in addition to his MA-PD plan. What should you tell him?

a. If Mr. Block wants to enroll in both a MA-PD and a stand-alone PDP, he may buy the extra coverage without any adverse effect. 

b. If Mr. Block enrolls in a stand-alone Medicare prescription drug plan, he can request that his Medicare Advantage plan remove the drug benefit from the package they offer and reduce his premium accordingly 

c. Mr. Block will have to wait until the annual election period, beginning October 15, and then he can add the stand-alone coverage to the MA-PD.

d. If Mr. Block enrolls in the stand-alone Medicare prescription drug plan, he will be dis-enrolled from the Medicare Advantage plan. 

(Individuals' eligibility to enroll in a stand-alone PDP depends on how they receive their medical benefits. If enrolled in a Medicare coordinated care plan (HMO/PPO) or a PFFS plan that includes Part D drug coverage, the beneficiary may not be enrolled in a stand-alone PDP. Enrollment in a stand-alone PDP will result in automatic disenrollment from a Medicare coordinated care or PFFS plan that includes Part D coverage. Enrollees may be enrolled in a stand-alone PDP only if they are enrolled in:
Original fee-for-service Medicare; Private Fee-for-Service (PFFS) plan without Part D drug coverage;
Medical Savings Account (MSA) plan; or 1876 Cost plan.)

Q199-You are doing a sales presentation for Mrs. Pearson/ 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.

a. “A Private Fee-for-Service plan is not the same as a Medigap supplemental policy.” 

b. “How are you this morning, Mrs. Pearson?” 

c. “Are you interested in a Medicare supplement plan or a Medicare health plan?”

d. "If you're not in very good health, you will probably do better with a different product." 

(Marketing representatives cannot say:
▪ The government wants you to join a Medicare health plan because it helps them.
▪ I am certified by Medicare to sell this plan. ▪ If your doctor accepts Medicare, she accepts this plan.
▪ There are no limits on services. ▪ We cover all drugs without restrictions.
▪ If you don't like this plan, you can stop paying your premium and return to original Medicare anytime.
▪ It is better to choose a different company if you are sick.
▪ (Name of plan) is the best Medicare plan you can buy.
▪ Medicare Advantage plans are the same as Medigap plans.
▪ You should opt out of MMP enrollment because everyone knows you will get a higher quality care through a Medicare Advantage plan.)

Q200-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 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. What should you do?

a. If she brings up the topic of her health, you can ask Mrs. Midler as many questions as she is willing to answer, so you can determine which plan is most suitable for her health needs. 

b. You can initiate detailed discussion of all of Mrs. Midler's health conditions only to better understand her situation and to advise her to choose a different plan if she is experiencing significant health problems.

c. You can only ask Mrs. Midler 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.

d. You cannot, under any circumstances, ask Mrs. Midler any health-related questions.

Also See AHIP Examination Test Question Answers Part-III