AHIP Examination Test Question Answers Part-III

 

AHIP Examination Preparation Answer Question

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(100 Question Answer)

Q201-Willard works as a representative focused on the senior marketplace. What would be considered prohibited activity by Willard?.

a. Discouraging Mrs. Johnson from enrolling in a Medicare Advantage plan that does not service her area.

b. Implying that only seniors can enroll in a Medicare Advantage plan when meeting with Mr. Hernandez, who is 58 but qualifies for Medicare because she is disabled.

c. Asking health questions to determine whether Mr. Ryan would be eligible to enroll in an SNP because he has a chronic condition. 

d. Setting an appointment with Mrs. McLaughlin without first asking about her financial health to determine whether she can afford a plan offering Willard the best commission.

Q202-Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could you help him take during this time?

a. If he has a disability, he may enroll in Original Fee-for-Service Medicare during the MA Initial Coverage Election Period. 

b. He may change or drop MA plans, but may not drop drug coverage. 

c. He will have a three-month period during which he may enroll in as many Medicare Advantage plans as he chooses, with the last enrollment being the effective one.

d. He will have one opportunity to enroll in a Medicare Advantage plan

Q203-Mrs. Kendrick/KENNY is six months away from turning 65. She wants to know what she will have to do to enroll in a Medicare Advantage (MA) plan as soon as possible. What could you tell her?

a. MA plans are only available to those who have been enrolled in a Medigap plan for at least six months. Therefore, before enrolling in an MA plan, she must first use a Medigap plan to supplement her Original Medicare coverage. 

b. She must first enroll in a Medicare Part D plan, before enrolling in a Medicare Advantage plan. 

c. She must have previously been enrolled in Original Fee-for-Service Medicare for at least one year before she may enroll in an MA plan

d. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B.

Q204-Mr. Ziegler is turning 65 next month and has asked you what he can do, and when he must do it, with respect to enrolling in Part D. What could you tell him?

a. He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may enroll in a Medigap plan that includes creditable coverage for prescription drugs. 

b. He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may only enroll in an MA-PD plan. 

c. He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may only add stand-alone Medicare prescription drug coverage.

d. He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may make one Part D enrollment choice, including enrollment in a stand-alone Part D plan or an MA-PD plan.

Q205-Ms. Claggett is sixty-six (66) years old. She has been covered under both Parts A and B of Original Medicare for the last six years due to her disability, has never been enrolled in a Medicare Advantage or a Part D plan before. She wants to enroll in a Part D plan. She knows that there is such a thing as the "Part D Initial Enrollment Period" and has concluded that, since she has never enrolled in such a plan before, she should be eligible to enroll under this period. What should you tell her about how the Part D Initial Enrollment Period applies to her situation?

a. It occurs three months before and three months after the month when a beneficiary meets the eligibility requirements for Part B, so she will not be able to use it as a justification for enrolling in a Part D plan now.

b. The Part D Initial Enrollment Period occurs only when a beneficiary turns 62, so it cannot be used as the justification for allowing her to enroll at this point. 

c. It occurs from October 15 to December 7of each year, so she will have to wait until that point to utilize that particular enrollment period. 

d. It occurs from January 1 to February 14 of each year, so she will have to wait until that point to utilize that particular enrollment period.

Q206-When Myra first became eligible for Medicare, she enrolled in Original Medicare (Parts A and B). She is now 67 and will turn 68 on July 1. She would now like to enroll in a Medicare Advantage (MA) plan and approaches you about her options. What advice would you give her?

a. She should wait until the new year to disenroll from Original Medicare and select an MA plan between January 1 and March 31.

b. She should remain in Original Medicare until the annual election period running from October 15 to December 7, during which she can select an MA plan.

c. She could immediately enroll in MA plan based on the one-time special enrollment period available to those 70 and younger. 

d. She could enroll in an MA plan during the period including the three months before, the month of, and up to three months after turning 68.

Q207-Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period. On December 1, he calls you up and says that he has changed his mind and would like to enroll into an MA-PD plan. What enrollment rules would apply in this case?

a. He can only make a single enrollment change during the Annual Election Period, so he will not be able to change his enrollment. 

b. He can return to Original Medicare, but must then enroll into a Medicare Part D plan. 

c. He should wait for at least six months into the plan year to be sure that he really wants to make the change. If he still wants to do so, he can make any sort of change he likes at that point.

d. He can make as many enrollment changes as he likes during the Annual Election Period (AEP) and the last choice made prior to the end of the period will be the effective one as of January 1.

Q208-Mrs. Kumar would like her daughter, who lives in another state, to meet with you during the Annual Election Period to help her complete her enrollment in a Part D plan. She asked you when she should have her daughter plan to visit. What could you tell her?

a. Her daughter should come sometime between January 1 and March 31. 

b. Her daughter should come during the three-month period that begins on the first day of her birthday month and runs for three full months.

c. Her daughter should come by September 1.

d. Her daughter should come in November.

Q209-Mr. Anderson is a very organized individual and has filled out and brought to you an enrollment form on October 10 for a new plan available January 1 next year. He is currently enrolled in Original Medicare. What should you do?

a. Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period (AEP)  begins.

b. Accept the form and immediately send it in to the plan for processing. 

c. Accept the form and wait until the Annual Election Period begins to send it to the plan for processing. 

d. Tell Mr. Anderson that you cannot accept an enrollment form for coverage to begin on January 1 of next year prior to December 15.

Q210-A client wants to give you an enrollment application on October 1st prior to the beginning of the Annual Election Period because he is leaving on vacation for two weeks and does not want to forget about turning it in. What should you tell him?

a. You must tell him you are not permitted to take the form. If he sends the form directly to the plan, the plan will process the enrollment on the day the Annual Election Period (AEP) begins.

b. You must send it to the plan for immediate processing, although the enrollment will not become effective until January 1. 

c. You must accept the application, but hold it until the annual election period begins, after which you must send it to the plan for processing. 

d. You must tell him you are not permitted to take the form and if he sends it to the plan, the application will be rejected and he will need to fill out another form and submit it after the Annual Election Period begins.

Q211-Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period(AEP). In mid-January of the following year, she wants to switch back to Original Medicare and enroll in a stand-alone prescription drug(Rx) plan. What should you tell her?

a. During the MA Disenrollment Period, from January 1 – March 31, she may only add or drop Part D coverage, so she cannot switch back to Original Medicare. 

b. During the MA Disenrollment Period, from January 1 – March 31, she may drop a MA or MA-PD plan and go back to Original Medicare, but she may only enroll in a stand-alone prescription drug plan if she also purchases a Medigap policy. 

c. During the MA Disenrollment Period, from January 1 – March 31, she may only dis-enroll from a MA or MA-PD plan, but cannot enroll in a stand-alone Part D plan.

d. During the MA Open Enrollment Period, from January 1 - March 31, she may dis-enroll from the MA-PD plan into Original Medicare and also may add a stand-alone prescription drug(Rx) plan.

(Annual election period (October 15 - December 7) Medicare Advantage Disenrollment Period (January 1 - February 14) Beneficiaries may only enroll in or change plans at certain fixed times each year or under certain limited special circumstances. If the application does not include information supporting a permissible election period, plans must contact the beneficiary to decide if enrollment is permissible.MA and Part D Enrollment periods are: MA Initial Coverage Election Period (ICEP)Part D Initial Enrollment Period (IEP)MA and Part D Annual Election Period (AEP)MA and Part D Special Enrollment Periods (SEP)Open Enrollment Period for Institutionalized Individuals (OEPI)MA 45-Day Disenrollment Period (MADP))

Q212-Mrs. Young is currently enrolled in Original Medicare (Parts A and B), but she has been working with Agent Neil Adams in the selection of a Medicare Advantage (MA) plan. It is mid-September, and Mrs. Young is going on vacation. Agent Adams is considering suggesting that he and Mrs. Young complete the application together before she leaves. He will then submit the paper application prior the start of the annual enrollment period (AEP). What would you say If you were advising Agent Adams?

a. This is a bad idea. Agents are generally prohibited from soliciting or accepting an enrollment form prior to the start of the AEP.

b. This is a bad idea. Mrs. Young should complete an online application now so that Agent Adams will be given immediate credit for his work once the AEP begins. 

c. This is a good idea. This locks Mrs. Young into a plan and protects Agent Adams’ commission. 

d. This is a good idea. The plan will retain Mrs. Young’s application and process it when the AEP begins.

Q213-Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the Annual Enrollment Period (AEP). At the beginning of January, her neighbor told her about the Medicare Advantage (MA) plan he selected. He also told her there was an open enrollment period that she might be able to use to enroll in a MA plan. Ms. Gonzales comes to you for advice shortly after speaking to her neighbor. What should you tell her?

a. There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31, but Ms. Gonzales cannot use it because eligibility to use the OEP is available only to MA enrollees.

b. There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31 and Ms. Gonzales can use it to change from Original Medicare and Part D only to a MA plan that includes prescription drug coverage. 

c. There is a MA Disenrollment Period that takes place between January 1 and February 14 but since Ms. Gonzales enrolled in Original Medicare and Part D during the AEP this would not apply to her. 

d. There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31 and Ms. Gonzales can use it to change from Original Medicare and Part D to a MA or MA-PD plan

Q214-Mrs. Schmidt is moving and a friend told her she might qualify for a "Special Election Period (SEP)" to enroll in a new Medicare Advantage plan. She contacted you to ask what a Special Election Period is. What could you tell her?

a. It is a time period when only Medicare beneficiaries who have moved out of the area and are dually eligible for Medicaid may add, drop, or change their prescription drug coverage. 

b. It is a time period when beneficiaries who are newly eligible for Medicare may make their first choice of a Medicare prescription drug plan.

c. It is a single time period from January 1 – March 31, created by statute, when any Medicare beneficiary who has moved out of the area of their Medicare Advantage or Part D plan can add, drop, or change their Medicare prescription drug coverage.

d. It is a time period, outside of the Annual Election Period (AEP), when a Medicare beneficiary can select a new or different Medicare Advantage and/or Part D prescription drug plan. Typically the Special Election Period is beneficiary specific and results from events, such as when the beneficiary moves outside of the service area.

( Who is eligible for a SEP based on change of residence? MA and Part D enrollees who move out of their existing plan's service area, or who have new options available to them as a result of a permanent move.
Beneficiaries who have moved into a plan service area from a location where there was no Part D plan available (e.g. overseas) qualify for an SEP just for Part D election purposes MA eligible and Part D eligible beneficiaries who experience certain qualifying events are allowed an SEP Timeframes for SEPs are variable, however, most begin on the first day of the month in which the qualifying event occurs and last for a total of three months. The SEP ends when the individual utilizes their SEP to make an allowed change, or the time period expires, whichever comes first. Where appropriate, SEPs allowing changes to MA coverage are coordinated with those allowing changes in Part D coverage.)

Q215-Mr. Garcia (GRACE) was told he qualifies for a Special Election Period (SEP), but he lost the paper that explains what he could do during the SEP. What can you tell him?

a. If the SEP is for MA coverage, he may make as many changes to his MSA enrollment as he wants and the last choice made before the end of the SEP period will be the effective one. 

b. He may only use the SEP to disenroll from his MA plan and return to Original Medicare. 

c. If the SEP is for Part D coverage, he may only drop, but not add or change, his Part D coverage one time before the SEP expires.

d. If the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage.

Q216-Mr. Wendt suffers from diabetes which has gotten progressively worse during the last year. He is currently enrolled in Original Medicare (Parts A and B) and a Part D prescription drug plan and did not enroll in a Medicare Advantage (MA) plan during the last annual open enrollment period (AEP) which has just closed. Mr. Wendt has heard that there are certain MA plans that might provide him with more specialized coverage for his diabetes and wants to know if he must wait until the next annual open enrollment period (AEP) before enrolling in such a plan. What should you tell him?

a. If there is a special needs plan (SNP) in Mr. Wendt’s area that specializes in caring for individuals with diabetes, he may enroll in the SNP during the MA Open Enrollment Period which takes place between January 1 and March 31. 

b. As long as there is a special needs plan (SNP) specializing in diabetes within 500 miles of Mr. Wendt’s residence, he can enroll in the SNP at any time under a special enrollment period (SEP). 

c. Mr. Wendt must wait until the next annual open enrollment period (AEP) before he can enroll in a special needs plan (SNP).

d. If there is a special needs plan (SNP) in Mr. Wendt's area that specializes in caring for individuals with diabetes, he may enroll in the SNP at any time under a special enrollment period (SEP).

Q217-Which of the following individuals are likely to qualify for a special enrollment period (SEP) for both MA and Part D due to a change of residence?

I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area.

II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service area.

III. Gilbert moves into a plan service area where there is now a Part D plan available to him from a service area where no Part D plan was available.

IV. Henry makes a permanent move providing him with new MA and Part D options.

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

Q218-Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work and is covered by an employer health plan, he has not enrolled in Part B or Part D. He receives a notice on June 1 that his employer is cutting back on prescription drug benefits and that as of July 1 his coverage will no longer be creditable. He has come to you for advice. What advice would you give Mr. Rockwell about special enrollment periods (SEPs)?

a. Mr. Rockwell is eligible for a SEP that begins in June and ends three months later, during which he may enroll, disenroll, and reenroll in Part D plans, with his last selection considered binding. 

b. Mr. Rockwell is eligible for a SEP that begins three months before the month in which he receives notice of loss of creditable coverage and ends three months after that month. 

c. Mr. Rockwell must wait until the next annual election period (AEP) to sign up for Part D prescription drug coverage.

d. Mr. Rockwell is eligible for a SEP due to his involuntary loss of creditable drug coverage; the SEP begins in June and ends September 1 - two months after the loss of creditable coverage.

Q219-Ms. Lee is enrolled in an MA-PD plan, but will be moving out of the plan's service area next month. She is worried that she will not be able to enroll in another plan available in her new residence until the Annual Election Period. What should you tell her?

a. She will be able to enroll in a new plan, because she qualifies for a Special Election Period that begins 30 days after a plan’s written communications are returned by the United States Post Office with notification that the resident has moved. So, she should be sure to notify the Post Office immediately. 

b. She may continue to keep her existing plan, because all Medicare health plans are required to provide coverage to anyone, no matter where they live. 

c. She will have to wait until the next Annual Election Period to be able to enroll in a plan available in her new location

d. She is eligible for a Special Election Period(SEP) that begins either the month before her permanent move, if the plan is notified in advance, or the month she provides notice of the move, and this period typically lasts an additional two months.

(For MA and Part D plans the individual must Permanently reside in the service area of the plan. Submit a complete enrollment request (a legal representative may complete the enrollment request for the individual) Be fully informed of and agree to abide by the plan rules provided during the enrollment request. Be a U.S. citizen or lawfully present in the United States on or before the enrollment effective date. (CMS makes this determination)

Q220-Mr. Yoo's employer has recently dropped comprehensive creditable prescription drug coverage that was offered to company retirees. The company told Mr. Yoo that, because he was affected by this change, he would qualify for a Special Election Period. Mr. Yoo contacted you to find out more about what this means. What can you tell him?

a. It means that he will be able to purchase continued drug coverage from the insurer that had provided it to the company retirees, but that he will not have to pay the entire premium himself. 

b. It means that he will be able to enroll into a state-funded pharmacy assistance program for retirees that will cover 80 percent of his drug costs. 

c. It means that he qualifies for a one-time opportunity to enroll into an MA-PD or Part D prescription drug plan.

d. It means that he will have a one time opportunity to enroll into a Medigap policy with drug coverage.

Q221-Mrs. Schneider(STEELEY) has Original Medicare Parts A and B and has just qualified for her state's Medicaid program, so the state is now paying her Part B premium. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug(Rx) plan?

a. Yes. Individuals who enroll into any portion of their state Medicaid program cannot participate in either MA or Part D. 

b. Yes. Mrs. Schneider has a Special Enrollment Period during which she can make a single change to her MA enrollment only. 

c. No. Mrs. Schneider must wait until the Annual Election Period to make any changes in her enrollment in an MA or Part D plan.

d. Yes. Qualifying for this state program gives Mrs. Schneider access to a Special Election Period that allows her to make changes to her MA and/or Part D enrollment at any time.

Q222-If Mr. Johannsen(JOHNSON) gains the Part D low-income subsidy, how does that affect his ability to enroll or disenroll in a Part D plan?

a. He can apply the subsidy amount to his existing plan immediately, but he cannot enroll in a different plan. 

b. He can only enroll into or disenroll from an MA-PD plan. 

c. The subsidy will become effective next year when he can enroll in a different plan or disenroll from his current plan during the next Annual Election Period.

d. He can enroll in or dis-enroll from a Part D plan at any time and the subsidy will apply to the plan he chooses. 

(Who is eligible for a SEP based on gaining eligibility for Part D LIS? Non-dual beneficiaries who qualify for LIS but do not receive Medicaid benefits. When does the SEP take place? Begins on the month the individual becomes eligible for LIS. Continues as long as he or she is eligible for LIS.
What can beneficiaries do during the SEP? Enroll in or disenroll from a PDP or MA-PD plan at any time Who is eligible for a SEP based on loss of eligibility for Part D LIS?
(1) Beneficiaries who lose their LIS eligibility because they are no longer deemed eligible for the following calendar year.
(2) Beneficiaries who lose their LIS eligibility during the year outside of the annual redetermination process.When does the SEP take place?
Group 1: January 1 - March 31
Group 2: Begins the month beneficiaries are notified and continues for two months.
What can be done during the SEP?
Enroll in or disenroll from a PDP or MA-PD plan.
Example: Ms. Perry is awarded LIS. CMS facilitates her enrollment into a PDP, effective October 1st. She decides she
would rather be enrolled in another PDP or an MA-PD plan and submits a request in November. She does so using this SEP and her enrollment is effective December 1st.)

Q223-Mrs. Ridgeway enrolled in Original Medicare and Medigap coverage following her retirements several years ago. Four months ago, Mrs. Ridgeway dropped her Medigap policy to enroll in a Medicare Advantage (MA) plan for the first time. Unfortunately, Mrs. Ridgeway has found that many of her providers are not in the MA plan's network. She has come to you for advice? What should you tell her?

a. She qualifies for a special enrollment period (SEP) that will allow her to make a one-time election to return to Original Medicare, but she may or may not qualify to rejoin her Medigap plan based on medical underwriting. 

b. She must wait until the next MA Open Enrollment Period (OEP) during which she can elect to return to Original Medicare.

c. She qualifies for a special enrollment period (SEP) that will allow her to make a one-time election to return to Original Medicare and she also has a guaranteed eligibility period to rejoin her Medigap plan.

d. She must wait until the next Annual Election Period (AEP) during which she may select another MA plan.

Q224-Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He would like to know his options since he has decided to drop his retiree coverage and is eligible for Medicare. What should you tell him?

a. Mr. Chen must convert his current coverage to employer-sponsored retiree coverage and wait one year before enrolling in an MA or Part D plan. He must ensure he has no gap in coverage. 

b. Mr. Chen can disenroll from his employer-sponsored coverage to elect a Medicare Advantage or Part D plan within 2 months of his disenrollment, but he should revaluate if he really wants to drop his employer coverage.

c. Mr. Chen can disenroll from the employer-sponsored plan and his only option is to choose a Medigap plan. 

d. Mr. Chen can disenroll from his employer-sponsored coverage to elect a Medicare Advantage or Part D plan, but must wait until the next Annual Election Period.

Q225-Mary Samuels recently suffered a stroke while visiting her daughter and grandchildren. As a result, Mary has been admitted to a rehabilitation hospital where she is expected to reside for several months. The rehabilitation hospital is located outside the geographic area served by her current Medicare Advantage (MA) plan. What options are available to Mary regarding her health plan coverage?

a. Mary may make one change to either Original Medicare or another MA under the special enrollment period available to institutionalized individuals.

b. Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan.

c. Mary may enroll in another MA plan coupled with a Medigap plan under the special enrollment period available to institutionalized individuals. 

d. Mary’s only option in this situation is to return to Original Medicare

Q226-Mr. Roberts is enrolled in an MA plan. He recently suffered complications following hip replacement surgery. As a result, he has spent the last three months in Resthaven, a skilled nursing facility. Mr. Roberts is about to be discharged. What advice would you give him regarding his health coverage options?

a. His open enrollment period as an institutionalized individual will continue for 12 months following his date of discharge. 

b. Mr. Roberts has two months following his discharge to continue under his current MA plan before he must return to Original Medicare for the remainder to the calendar year.

c. His open enrollment period as an institutionalized individual will continue for two months after the month he moves out of the facility.

d. Mr. Roberts must return to Original Medicare within two months of discharge, but he may continue to enroll and disenroll in Part D for 12 months following discharge.

Q227-Mrs. Lenard is enrolled in a Medicare Cost plan. Recently the cost plan announced its intention to end its cost contract and transition to a Medicare Advantage (MA) Mrs. Lenard received a letter indicating that unless she chooses another plan or opts out she will be automatically enrolled in the new Medicare Advantage plan operated by an organization affiliated with her cost plan. What does this mean?

a. The Cost plan has been non-renewed in her area and Mrs. Lenard has been automatically enrolled in Original Medicare (Parts A and B). 

b. The Cost plan has been non-renewed in her area and Mrs. Lenard must make a plan choice or she will be automatically enrolled in Original Medicare (Parts and B) and a Part D plan. 

c. Mrs. Lenard must take immediate action if she wants to continue receiving Medicare.

d. If Mrs. Lenard wants to enroll in a Medicare Advantage plan affiliated with her cost plan effective January 1, she should do nothing and she will be automatically enrolled. If she does not want to enroll in that MA plan, she should choose another plan or otherwise opt out of the automatic enrollment.

Q228-You are completing a PFFS plan sale to Mr. West who is new to Medicare and prefers to be contacted by telephone. As you are finishing up, what should you tell him about next steps in the enrollment process?

a. You need to ask Mr. West a few final questions to ensure he understands the nature of the plan and really wants to enroll. You also should tell Mr. Schmidt that after you leave, he should not answer any questions about his enrollment in the plan because it could result in a disenrollment. 

b. You should not include Mr. West’s phone number on the enrollment form in case he is on the “Do Not Call” registry. 

c. You need to get Mr. West’s phone number and include it on the enrollment form because the PFFS plan will contact him once the organization receives the enrollment form and will ask about the quality of your service. You should not discuss the phone call with Mr. West to avoid influencing his answers.

d. You need to get Mr. West'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.

Q229-Mrs. Johnson calls to tell you she has not received her new plan ID card yet, but she needs to see a doctor. What can she expect to receive from the plan after the plan has received her enrollment form?

a. She will not receive anything from the plan until her ID card arrives, so she should not expect the plan to cover her medical needs until then. 

b. A $20 gift certificate thanking her for enrolling.

c. Evidence of plan membership, information on how to obtain services, and the effective date of coverage.

d. A solicitation for friends who might be interested in enrolling in the plan, with a postcard for her to list their names, addresses, and phone numbers.

Q230-Mrs. Reynolds(AUSTIN) just signed up for a Medicare Advantage(MA) plan on the second of the month. She is leaving for vacation in two weeks and wants to know if her new coverage will start before she leaves. What should you tell her?

a. Typically, coverage is effective on the date that the beneficiary completes the application form, so her coverage will be in place before she leaves. 

b. Coverage always begins on the first of July, or the first of January after a beneficiary enrolls, whichever comes first. 

c. Typically her coverage would begin 30 days after she submits the application form, so she should not expect the coverage to begin until after she leaves.

d. Typically her coverage would begin on the first day of the next month, so she should not expect her coverage to begin before she leaves.

(Initial Coverage Election Period (ICEP). The ICEP begins three months immediately before the individual's first entitlement to both Medicare Part A and Part B and ends on the later of:
The last day of the month preceding entitlement to both Part A and Part B, or;The last day of the individual's Part B initial enrollment period.The initial enrollment period for Part B is the seven (7)month period that begins 3 months before the month an individual meets the eligibility requirements for Part B, and ends 3 months after the month of eligibility.)

Q231-You meet with Mrs. Wilson to complete her enrollment in a Medicare Advantage plan. You tell her that there will be an enrollment verification process to confirm that she is enrolled in the plan that she requested and understands the plan features and rules. What should Mrs. Wilson expect regarding the verification process?

a. You will contact Mrs. Wilson within 10 calendar days to set up a joint call with the plan’s home office to verify that she has enrolled in a plan of her choice and understands its features and rules. 

b. Your assistant will contact Mrs. Wilson within seven calendar days to set up a joint call with the plan’s home office to verify that she has enrolled in a plan of her choice and understands its features and rules.

c. Mrs. Wilson will be contacted by the plan sponsor within 15 calendar days of receipt of the enrollment request.

d. Mrs. Wilson will be contacted by you within one week for a follow-up appointment to handle the verification process.

Q232-Mrs. Burton is in an MA-PD plan and was disappointed in the service she received from her primary care physician because she was told she would have to wait five weeks to get an appointment when she was feeling ill. She called you to ask what she could do so she wouldn't continue to have to put up with such poor access to care. What could you tell her?

a. She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment.

b. She should call the doctor’s office to complain since the plan cannot do anything about the doctor’s schedule. 

c. She should not expect to get in to see her doctor any more quickly since she is a Medicare patient. 

d. She must write to the plan and wait for a response and then she could file a grievance if she is still dissatisfied.

Q233-Mr. Barker had surgery recently and expected that he would have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included a number of services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him?

a. You could suggest he call the doctor who performed the surgery to complain about the costs and ask for a discount on the charges.

b. You can offer to review the plans appeal process to help him ask the plan to review the coverage decision.

c. You could remind him that he cannot do anything until the next Annual Election Period when he will have an opportunity to change plans. 

d. You could reassure him that such charges are typical, but if he needs assistance in paying, he should apply to the state.

Q234-Mrs. Disraeli is enrolled in Original Medicare (Parts A and B) and a standalone Part D prescription drug plan. She has recently developed diabetes and has suffered from heart disease for several years. She has also recently learned that her area is served by a SNP for individuals suffering from such a combination of chronic diseases (C-SNP). Mrs. Disraeli is concerned however, that she will have few rights or protections if she enrolls in a C-SNP. How would you respond?

a. Enrollees, while able to select their primary care provider (PCP), do have substantial restrictions and financial responsibilities regarding emergency care whether obtained at in-network or out-of-network facilities.

b. Enrollees in SNPs must have access to provider networks that include enough doctors, specialists, and hospitals to provide all covered services necessary to meet enrollee needs within reasonable travel time.

c. Mrs. Disraeli would have substantial restrictions on obtaining emergency care and must use network facilities or be responsible for most emergency care costs. 

d. The SNP would select her primary care provider (PCP) but she could file a grievance within 90 days if the PCP proved incapable.

Q235-Ms. O'Donnell learned about a new MA-PD plan that her neighbor suggested and that you represent. She plans to switch from her old MA HMO plan to the new MA-PD plan during the Annual Election Period. However, she wants to make sure she does not end up paying premiums for two plans. What can you tell her?

a. It is illegal for a marketing representative to sell her an MA-PD plan before she completes a voluntary disenrollment form and you can offer to help her do so before you assist with the new enrollment, but these must be during two separate appointments

b. She only needs to enroll in the new MA-PD plan and she will automatically be disenrolled from her old MA plan.

c. She must wait until the MA Disenrollment Period and then she will be able to disenroll from the MA-HMO and select the MAPD plan 

d. She will need to complete a disenrollment form the month before she wants to submit her application for the new plan to ensure she does not end up with two plans.

Q236-Mr. Fitzgerald is selling his home to permanently move into a retirement facility near his daughter in a neighboring state. He has a stand-alone prescription drug plan, and has learned it is not available where he is moving. He doesn't know what he should do. What can you tell him?

a. Since he is moving before the Annual Election Period, he will need to continue using the prescription drug plan, but should get his prescriptions filled through the plan’s mail order service.

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

c. Since he is moving before the Annual Election Period, he should request an exception to continue using the plan for several more months until the AEP when he can enroll in a new plan. 

d. He can keep his plan indefinitely because prescription drug plan’s must be available to all beneficiary’s regardless of where they live.

Q237-Mr. Robinson was quite ill recently and forgot to pay his monthly premium for his MA-PD plan. He is worried that he will lose his coverage now when he needs it the most. He is certain his plan will disenroll him because that is what happened to a friend of his in a similar type of plan. What can you tell Mr. Robinson about his situation?

a. Plan sponsors must disenroll members who do not pay their premiums, but they have the discretion to make exceptions for certain members, so he should ask for an exception for this special circumstance.

b. Plan sponsors have the option to disenroll members who do not pay their premiums, but they must first provide each member with a grace period of not less than 2 months.

c. Plan sponsors have the option to disenroll members, but if they choose to do so, they must act immediately and cannot permit a grace period. d. Plan sponsors must disenroll members who do not pay their premiums, but he will have a special enrollment period to sign up for a different MA-PD plan. ( , III, and IV only.)

Q238-Mrs. Valentino is currently enrolled in a Medicare Cost plan. This plan is no longer meeting her needs, but it is now mid-year and past the annual election period (AEP). What would you say to Mrs. Valentino regarding her options?

a. Mrs. Valentino can submit a written request to Medicare to be disenrolled from the Cost plan and enroll in Original Medicare.

b. Mrs. Valentino must remain enrolled in the Medicare Cost plan until the next AEP. 

c. Mrs. Valentino can call Medicare, request to be disenrolled from the Cost plan, and enroll in Original Medicare. 

d. Mrs. Valentino qualifies for a special enrollment period, which will allow her to immediately enroll in a MA-PD plan of her choice.

Q239-From the following answer choices, choose the description of the ethical principle that best corresponds to the term Beneficence:

A. Health plans and their providers are obligated not to harm their members

B. Health plans and their providers should treat each member in a manner that respects the member's goals and values, and they also have a duty to promote the good of the members as a group

C. Health plans and their providers should allocate resources in a way that fairly distributes

benefits and burdens among the members

D. Health plans and their providers have a duty to respect the right of their members to make decisions about the course of their lives

Q240-Dr. Julia Phram is a cardiologist under contract to Holcomb HMO, Inc., a typical closed- panel plan. The following statements are about this situation. Select the answer choice containing the correct statement:

A. All members of Holcomb HMO must select Dr. Phram as their primary care physician (PCP).

B. Any physician who meets Holcomb's standards of care is eligible to contract with Holcomb HMO as a provider.

C. Dr. Phram is either an employee of Holcomb HMO or belongs to a group of physicians that has contracted with Holcomb HMO

D. Holcomb HMO plan members may self-refer to Dr. Phram at full benefits without first obtaining a referral from their PCPs.

Q241-By offering a comprehensive set of healthcare benefits to its members, an HMO ensures that its members obtain quality, cost-effective, and appropriate medical care. Ways that an HMO provides comprehensive care include:

A. coordinating care across a variety of benefits

B. emphasizing preventive care by covering many preventive services either in full or with a small copayment

C. offering its members access to wellness programs

D. All of the above

Q242-As part of its quality management program, the Lyric Health Plan regularly compares its practices and services with those of its most successful competitor. When Lyric concludes that its competitor's practices or services are better than its own, Lyric im:

A. Benchmarking.

B. Standard of care.

C. An adverse event.

D. Case-mix adjustment.

Q243-In response to the demand for a method of assessing outcomes, accrediting organizations and other government and commercial groups have developed quantitative measures of quality that consumers, purchasers, regulators, and others can use to compare health:

A. quality standards

B. accreditation decisions

C. standards of care

D. performance measures

Q244-In 1999, the United States Congress passed the Financial Services Modernization Act, referred to as the Gramm-Leach-Bliley (GLB) Act. The primary provisions included under the GLB Act require financial institutions, including health plans, to take several:

A. Notify customers of any sharing of non-public personal financial information with nonaffiliated third parties.

B. Prohibit customers from having the opportunity to 'opt-out' of sharing non-public

personal financial information.

C. Disclose to affiliates, but not to third parties, their privacy policies regarding the sharing of nonpublic personal financial information.

D. Agree not to disclose personally identifiable financial information or personally identifiable health information.

Q245-Ed Murray is a claims analyst for a managed care plan that provides a higher level of benefits for services received in-network than for services received out-of-network. Whenever Mr. Murray receives a health claim from a plan member, he reviews the claim:

A. A, B, C, and D                                  B. A and C only

C. A, B, and D only                               D. B, C, and D only

Q246-If left unresolved, member complaints about the actions or decisions made by a health plan or its providers can lead to formal appeals. One procedure health plans can use to address formal appeals is to submit the original decision and any supporting info:

A. A Level One appeal, and the member has the right to a further appeal

B. A Level Two appeal, and the reviewer's decision is final and binding

C. An independent external appeal, and the member has the right to a further appeal

D. Arbitration, and the reviewer's decision is final and binding

Q247-Health plans require utilization review for all services administered by its participating physicians:

A. True           B. False

Q248- Qa15- HMOs typically employ several techniques to manage provider utilization and member utilization of medical services. One technique that an HMO uses to manage member utilization is:

A. the use of physician practice guidelines                              B. capitation

C. the requirement of copayments for office visits                  D. risk pools

 

Q249-Health plans can organize under a not-for-profit form or a for-profit form. One true statement regarding not-for-profit health plans is that these organizations typically:

A. are exempt from review by the Internal Revenue Service (IRS)

B. are organized as stock companies for greater flexibility in raising capital

C. rely on income from operations for the large cash outlays needed to fund long-term projects and expansion

D. engage in lobbying or political activities in order to maintain their tax-exempt status

Q250-Mr. Denton (Davis) is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him?

a. He may sign-up for Medicare at any time however coverage usually begins on the sixth month after dialysis treatments start

He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start.

c. He may not sign-up for Medicare until he reaches age 62, the date he first becomes eligible for Social Security benefits. 

d. He may sign-up for Medicare at any time and coverage usually begins immediately.

Q251-Mrs. Kelly, age 65, is entitled to Part A, but has not yet enrolled in Part B. She is considering enrollment in a Medicare health plan (Part C). What should you advise her to do before she will be able to enroll into a Medicare health plan?

a. To enroll in a Medicare health plan, she need only be entitled to Part A, so she does not need to take any further steps. 

b. In order to join a Medicare health plan, she must be enrolled in Parts A, B and D. 

c. Since she is age 65 she may enroll in any Medicare health plan, regardless of whether she is entitled to Part A or Part B coverage.

d. In order to join a Medicare health plan, she also must enroll in Part B.

Q252-Mrs. Park is an elderly retiree. She has a low, fixed income. What could you tell Mrs. Park that might be of assistance?

a. She should not sign up for a Medigap or Medicare Advantage plan

b. She should contact her state Medicaid agency to see if she qualified for one of several programs that can help with Medicare costs for which she is responsible.

c. She can apply to the Medicare agency for lower premiums and cost-sharing. 

d. She should only seek help from private organizations to cover her Medicare costs.

Q253-Ms. Levi is considering enrollment in a Medicare Advantage HMO plan offered in her area. Ms. Levi often travels to visit relatives and is concerned that she may need emergency care outside of her plan's service area. What should you tell her about coverage of emergency care?

a. Plans are required to cover out-of-network emergency care only if she has the ambulance driver or ER doctor call her plan for approval prior to receiving emergency services.

b. Plans are required to cover at least 20% of the cost of out-of-network emergency care.

C. Plans are required to cover at charges for in-network emergency care, but coverage of out-of-network emergency care is not required. 

d. Plans are required to cover out-of-network emergency.

(Cover the following services even when provided by non-network providers:
• emergency services; • out-of-area urgently needed services; and • out-of-area renal dialysis.
Have access to doctors, specialists and hospitals:
Get emergency care when and where they need it. CMS may offer services through non-network providers at the in-network enrollee cost-sharing level.)

 

Q254- Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries?

Beneficiaries under Original Medicare have no cost-sharing for most preventive services which inc. immunizations such as annual flu shots

Q255-Mrs. Gunner thought she was enrolling in a stand-alone PDP, but when she received her plan materials, she found out she was enrolled in a Private Fee for Service (PFFS) plan with drug coverage. She called her marketing representative for help. What should the marketing representative tell her?

If she believes she received misleading information, she must contact Medicare and, if she qualifies for a Special Enrollment Period(SEP), she can select a new option, which could include a different MA plan, a PDP, or Original Medicare

Q256-Mr. Cole has been a Medicaid beneficiary for some time, and recently qualified for Medicare as well. He is concerned about changes in his cost-sharing. What should you tell him?

He should know that Medicaid will pay cost sharing only for services provided by Medicaid participating providers.

Q257-Mr. Jenkins is interested in enrolling in a Medicare cost plan and has sought your advise. What would you tell him?

a. Cost plans are required to be open to enrollment at least 30 days per year, and many are open for enrollment all year. So open enrollment will be dependent on the plan he chooses.

b. Cost plans that offer an optional supplemental Part D benefit are required to be open to enrollment at least 90 days per year in addition to accepting Part D enrolments during the annual election period.

c. Al cost plans (like other types of MA plans) are required to be open for enrollment during the MA annual election period.

d. Costs plans are required to be open to enrollment year-round, so he should select a date when he would like coverage to begin.

Q258-Ms. Gates is dually eligible for Medicare and Medicaid. She is very concerned about being locked into a specific Medicare Prescription drug plan for the entire year. What should you tell her?

a. She need not enroll in a Medicare Prescription Drug Plan, but can continue receiving drug coverage through her state’s Medicaid program.

b. Individuals who are enrolled in Medicaid can change their Part D plans throughout the year, so if she is not satisfied with her prescription drug plan, she can change to a different part D plan.

c. If she dissatisfied, she can request a one-time opportunity to change.

d. The one-year lock in is a fundamental aspect of the plan design and cannot be avoided.

Q259-Mr. Nguyen understands that Medicare prescription drug plans can use a formulary, or list of covered drugs, He is suspicious about how plans establish these formularies. What should you tell him?

a. Formularies must be developed with input from pharmacists, doctors, and other experts.

b. Formularies are developed purely on the basis of drug costs and include the least expensive drugs to keep costs down for beneficiaries and the Medicare program.

c. Formularies are developed by a consortium of health plans.

d. Plans must use a single, standard formulary developed by the Federal government to keep costs down and quality high for beneficiaries.

Q260-What type of tools scan Medicare Part D prescription drug plans use that affect the way their enrollees can access medications

Part D plans do not have to cover all medications. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. In addition, they can use cost containment techniques such as tiered co-payments and prior authorization.

Q261- Qa17- Emily Brown works for Integral Health Plan and represents the company as a board member for the board of directors. Which best describes Emily's position?

A. Community Representative

B. Inside Director                 C. Outside Director                   D. None of these

Q262-Mr. Olsen is concerned that a Medicdare Advantage plan will not cover the same range of services that would be covered under Original fee-for-service Medicare. What should you tell him?

a. Medicare advantage plans are required to cover services mandated under health care reform and applicable state law, which may differ from the Original Medicare package of benefits.

b. . Medicare advantage plans are required to create a benefits package that results in roughly equivalent costs and may exclude coverage for some items and services that are covered under Part A and/or Part B of Original Medicare.

c. Though their cost sharing may differ from Original Medicare's, Medicare Advantage plans are required to cover all services covered by original Medicare.

d. Medicare Advantage plans differ from Original Medicare in that they are required to cover any service ordered by a physician.

Q263-Agent Hillary Baxter has recently become licensed and appointed to sell Medicare Advantage (MA) plans. She intends to reach out to members of her community who might be interested in such products. How would you advise Agent Baxter as to what steps would be permissible for her to undertake?

Agent Baxter should consider a direct mail campaign targeted throughout her community using CMS approved materials

Q264-Able, Baker and Charles are engaged in the marketing to an enrollment of beneficiaries into Medicare health plans. Mr. Able is an independent agent paid directly by a health plan. Ms. Baker is an independent agent paid through a field marketing organizations(FMO). Mr. Charles in an independent agent paid for his work by a third-party marketing organizations (TMO). How do the CMS compensation rules apply to these three agents?

Baker and Charles are subject to CMS compensation rules because they are paid by third parties. Able is not because she is paid directly by a health plan.

Q265-Who is eligible to enroll in a Part D prescription drug plan?

Mrs. Davis is eligible for Part A and has just enrolled in Part B

Q266-Agent Roderick enrolls retiree Mrs. Martinez in a medical savings account (MSA) Medicare Health plan. The MSA plan does not offer prescription drug coverage, so Agent Roderick also enrolls Mrs. Martinez in a standalone prescription drug plan (PDP). What CMS compensation rules apply to this situation?

a. When an MSA Medicare Health Plan is combined with a PDP, initial and renewal year(s) compensation is paid only for the MSA enrollment in order to recompense CMS for contributions made to the enrollee’s MSA account.

b. This situation is considered a "dual enrollment" and CMS compensation rules are applied to the two plans at once and independently of each other.

c. Regular CMS and renewal compensation rules apply to the PDP enrolment, but compensation is limited to $100 for the MSA health plan enrollment in order to recompense CMS  for contributions made to the enrollee’s MSA account.

d. MSA Medicare health plans are subject to special rules limiting initial year compensation to 50 percent of the fair market value (FMV) published annually by CMS. Regula initial year enrollment rules apply to the PDP. 

Q267-Mrs. Tanner is enrolled ina Medicare Advantage HMO that offers a point of service option. This allows Mrs. Tanner to do which of the following?

a. Mrs. Tanner can go to non-plan doctors for certain services without receiving prior approval.

b. Mrs. Tanner can go to non-network doctors without worrying about a cap on the amount of out-of-network services she may receive.

c. Mrs. Tanner can go to non-plan doctors without receiving prior approval for all services.

d. Mrs. Tanner can go to non-plan doctors knowing that cost sharing will generally be the same as with network providers.

Q268-Mrs. Wellington is enrolled in Parts A and B of Original Medicare. A friend recently told her that there is an excellent Medicare Advantage (MA) plan with a five-star rating serving her area. On January 15 she comes to you for advice as to what option, if any, she has. What should you say regarding special enrollment periods (SEPs)?

a. Mrs. Wellington can enroll in the five-star plan in the following October, when the next annual enrollment period (AEP) begins-not before.

b. Mrs. Wellington is eligible for a SEP that may be used once until November 30 to enroll in the five- star plan.

c. Mrs. Wellington is eligible for a two-month SEP that began on January 1, so she should act quickly if she wishes to enroll in the MA five-star plan.

d. Mrs. Wellington must first enroll in a stand-alone PDP before she is eligible for a SEP to enroll in the MA five-star plan.

Q269-Mr. Chen has heard about Medical Savings Account (MSA), but wants to know if it is just about saving money, or if he will get insurance coverage for his health care expenditures as well. What should you tell him?

a. Under the Medicare Advantage program, a MSA plan involves the combination of high deductible health plan and savings account for health expenses. Medicare will make contributions to this savings account to help him pay his health care expenses while in the deductible.

b. Under the Medicare Advantage program, the MSA is only an account to help him pay for IRS-allowed health expenditures he may have. If does not involve health insurance of any kind.

c. Under the Medicare Advantage program, the MSA plan is a form of prescription drug coverage.

d. Under the Medicare Advantage program, the MSA is funded by money he sets aside each year. If he does not use it all on IRSallowable health care expenditures then he will los the money the following year.

Q270-Mrs. Redding requested that you call her to discuss a Part D plan she is interested in learning about to determine if she wants to enroll, However, she is concerned about identity theft and does not want ot give you her Social Security number. What should you tell her?

When you call her, you should indicate that she is not required to provide any information to you, and failure to do so will not affect her membership in the plan.

Q271-Mrs. Gardner is currently enrolled in a MA-PD plan. However, she wants to dis-enroll from the MA-PD plan and instead enroll in a Part D only plan and go back to Original Medicare. According to Medicare's enrollment guidelines, when could she do this?

Any time that she is dissatisfied with the plan’s network coverage or customer service she may make such a change.

b. She may do it only during the MA Disenrollment Period, which runs from January 1 to Februay 14 of each year.

c. She may only make such a change during her “initial coverage election period.” Which occurred when she first became entitled to Medicare.

d. She may make such a change during the Annual Election Period(AEP) that runs from Oct. 15 to December 7, or during the MA Dis enrollment period that runs from January 1 to February 14 each year 

(or during the MA Open Enrollment Period which takes place from January 1 to March 31 of each year (beginning in 2019))

Q272-Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage (MA) and Part D plans that Agent Smith sells at the regular Tuesday brunch the neighbors have for senior citizens. What should Agent Tom Smith tell Mr. Moreno about the kinds of food that can be provided to potential enrollees who attend the sales presentation?

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

b. Nothing may be provided to eat or drink during the sales presentation.

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

d.A meal cannot be provided, but light snacks would be permitted. 

(A meal CAN'T be provided, but light snacks would be permitted. 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)

Q273- Medicaid program, sothe state is now paying her Part B premium and she is considered a dual eligible.Will gaining eligibility for thisprogram affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan?

b. No. Mrs. Schneider must wait until the Annual Election Period to make any changesin her enrollment in an MA or Part D plan.

c. Yes. Qualifying for this state program gives Mrs. Schneider access to a SpecialEnrollment Period that allows her to make changes to her MA and/or Part Denrollment during the first 9 months of each calendar year beginning in 2019.

d. Yes. Individuals who enroll into any portion of their state Medicaid program cannotparticipate in either MA or Part D.

e

Q274-Ms. Lewis understands that Medicare prescription drug plans may use various methods to control the use of specific drugs. She has heard about a technique called "step therapy" and is wondering if you can explain what that is. What should you tell her?

a. Step therapy involves using one or more lower priced drugs before trying a more expensive drug when all are used to treat the same condition.

b. Step therapy involves slow changes in the dosages of a given drug in order to discover the correct amount.

c. Step therapy involves taking somewhat larger doses but skipping every other day, resulting in lower overall consumption of the drug.

d. Step therapy refers to incentives plans can provide to enrollees to engage in regular walking in order to reduce their need for medications treating heart and cholesterol. 

Q275-During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a type of Medicare health plan known as Private Fee-For-Service (PFFS). She wants to know if this would be available to her. What should you tell her about PFFS plans?

a. A PFFS plan is exactly the same as Original Medicare, only offered by a private entity and she may enroll in one if it is available in her area.

b. A PFFS plan is one of various types of Medicare Advantage plans offered by private entities and she may enroll in one if it is available in her area.

c. A PFFS plan is a type of Medicare Supplement plan and she may enroll in one if it is available in her area.

d. PFFS plans are designed to cover only prescription drugs and if that is the type of coverage she wants, she may enroll in one if it is available in her area.

Q276-Mr. Polanski likes the cost of an HMO plan available in his area, but would like to be able to visit one or two doctors who aren't participating providers. He wants to know if the Point of Service (POS) option available with some HMOs will be of any help in this situation. What should you tell him?

a. The POS option refer to a method of processing claims in real time so that Mr. Polanski will be able to finalize his bill at the point of service with the provider, rather than waiting for the plan to mail him statements several weeks. It does not have anything to do with his ability to access out-of-network providers.

b. The POS option might be a good solution for him as it will allow him to visit out-of-network providers, generally without prior approval. However, he should be aware that it is likely he will have to pay higher cost-sharing for services from out-of-network providers.

c. The POS option will allow him to visit out-of-network providers and generally the plan must provide the same level of cost sharing as if he went to in-network providers.

d. The POS option will allow him to visit in-network specialists without a referral. He will have no coverage if he goes out-of-network.

Q277-  Melissa Meadows is a marketing representative for Best Care which has recently introduce a Medicare Advanrage plan offeing comprehensive dental benefits for $15 per month. Best care has not submitted any potencial posts to CMS for approval. Melissa would like to use the power of social media to reach potential prospects. what advice would you give her? 

Answer: The best advice that I would give her if her contract agreement permit her to do so is to tell her to post a tweet on her social media account by stating that Best Care offers great and different array of Medicare Advantage benefit packages. One might be of benefit for you. You can call me to find out more either through my phone number , email or by sending me a message.

Explanation:

Based on the information given about Melissa Meadows who is a marketing representative for Best Care which has Medicare Advantage plan offering comprehensive dental benefits for tha amount $15 per month, in which we were told that she would like to use the power of social media to reach potential prospects which might be interested in the Medicare Advantage plan the best advice I would give her if her contract agreement permit her to do so is to tell her to post a tweet on her social media account by stating that Best Care offers great and different array of Medicare Advantage benefit packages. One might be of benefit for you. You can call me to find out more either through my phone number , email or by sending me a message.

 

https://brainly.com/question/13085492?exp=10-3

The federal medical assistance program that pays for the health care of individuals with low incomes and individuals who are physically disabled or blind is...A) medigapB) workers' compensation C) Medicaid D) Medicare

See answers (1)

michalalee4747

Asked 11/14/2019

Mark was severely injured while on vacation and expects to be unable to work for at least 12 months. Because of his injury, he should expect to be eligible for disability income from Multiple Choice A) Social Security. B) Medicaid. C) A public income insurance program. D) Worker's compensation. E) Medicare.

Q278-Agent Willis had several clients who disenrolled from the plans he represents during the AEP to try new Medicare Advantage plans, Agent Willis believes that the choices they made are not ideal for them and would like to get their business back during the Medicare Advantage Open Enrollment Period (MA-OEP). What can agent Willis do?

a. He can send them information about the MA-OEP along with a flyr on the plans he represents.

b . He can e-mail them in January and ask them to let him know if they are not happy with their new plans.

c. He can wait until October and send them information about the plans he represents.

d. He can call them to let them know that if they do not like their new plans, they can change back during the MA-OEP.

Q279-Mr. James has end-stage renal disease (ESRD). He has been covered under Original Medicare but would like to know if he can enroll in a Medicare Advantage plan. What should you tell him?

a. Individuals with end-stage renal disease can only enroll in a Medicare Advantage plan after they have been on dialysis for 12 months.

b. Individuals with end-stage renal disease may enroll in a Medicare Advantage plan, but only if they are willing to pay an extra premium to do so.

c. He will not be able to enroll in a Medicare Advantage plan because he has end-stage renal disease unless a special needs plan for beneficiaries with ESRD is available in his service area.

d. Individuals with end-stage renal disease can enroll in any Medicare Advantage plan that they choose without paying an extra premium.

Q280-Mr. Perry is entitled to Medicare Part A but has not yet enrolled in Part B, even though he is 69 years old. He would like to enroll in a Medicare Part D prescription drug plan but is concerned that he will have to sign up for Part B as well in order to qualify for enrollment in a Part D plan. What should you tell him?

a. He need not be entitled to Part A or enrolled in Part B to be eligible for the Part D prescription drug benefit. He must only be aged 65 to qualify for enrollement in Part D, so he can go ahead and enroll in a Part D prescription drug plan.

b. He does not have to enroll in Part B but, must pay a penalty for his failure to do so when he first turned 65. After that, he can enroll in a Part D prescription drug plan.

c. He will have to enroll in Part B before he can enroll in a Part D prescription drug plan.

d. He is eligible for the Part D prescription drug benefit because he is entitled to Part A and he does not have to be enrolled in Part B

Q281-Agent Chan is conducting a sales presentation on senior issues where he hopes to enroll some attendees in the Medicare Advantage (MA) plans he represents. What action(s) may Agent Chan take during the event?

a. Discuss plan specific information such as premiums and benefits.

b. Coduct free health screenings as part of the event.

c. Sell personal information obtained as part of a raffle to a third-party marketer.

d. Indicate that in order participate attendees must provide their contact information.

Q282-Eleanor takes several high-cost prescription drugs. She would like to enroll in a standalone Part D prescription drug plan that is available in her area. In what type of Medicare Health Plan can she enroll in she also wishes to enroll in the standalone Part D plan?

a. A MA PPO plan that offers drug coverage if she chooses not to enroll in it.

b. A cost Plan only if it does not offer drug coverage.

c. A Cost Plan that does not offer drug coverage or a Cost Plan that does offer drug coverage if she chooses not to enroll in it.

d. A MA PPO plan only if it does not offer drug coverage.

Q283-Last year Agent Melanie Meyers marketed and enrolled several clients in Medicare Advantage (MA) health plans. This year she has decided to focus on non-MA products. What advice would you give Melanie if she wishes to continue to receive renewal fees?

a. Malanie will need to do nothing to continue receiving renewal fees since the initial sale was made when she met all requirements.

b. Melanie must remain trained, tested, licensed, and appointed, regardless of whether she is actively selling MA products.

c. All that she needs to do is avoid being terminated for cause.

d. All that she needs to do is meet state licensure requirements moving forward.

Q284-Mrs. Wu was primarily a homemaker and employed in jobs that provided taxable income only sporadically. Her husband worked full-time throughout his long career. She has heard that to qualify for Medicare Part A she has to have worked and paid Medicare taxes for a sufficient time. What should you tell her?

a. Because her husband paid Medicare taxes, and she rarely did, she will have to pay Part A premiums but will do so at a reduced rate.

b. Since her husband paid Medicare taxes during the entire time he was working, she will automatically qualify for Medicare Part A without having to pay any premiums.

c. She will have to pay the montly Part A premium in order to obtain the coverage.

d. She will have to obtain a job and work enough years to qualify for Medicare Part A.

Q285-Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare prescription drug plan you represent and simply give you a check to cover his premiums for the entire year. What should you tell him?

You can take his first payment, but after that, he will need to make arrangements to send his monthly premium payment to the plan.

b. This is perfectly acceptable. You will be happy to forward his payment to the plan.

c. He will need to mail in his payment with his enrllment form.

d.Enrollees should pay using automatic withdrawal from a bank account or credit or debit card, direct monthly billing from the plan, or deductions from their Social Security check.

(Part D enrollees have three options for paying their Part D premium.
(1) Automatic electronic monthly mechanism, such as withdrawal from their checking or savings bank account or automatic deduction from their credit or debit card;
(2) Direct monthly billing from the plan; or
(3) Automatic deduction from their monthly Social Security Administration (SSA) benefit check.
• Typically it takes 2-3 months for SSA withholding to begin or end.
• When withholding begins, it will be for the 2-3 months of premiums owed.
• If a beneficiary is considering this option, he/she should call the plan first.
Generally the beneficiary must stay with the premium payment option for the entire year.)

Q286-Who is most likely to be eligible to enrolled in a Part D prescription drug plan?

a. Ms. Bradly is currently living aboard for a multi-year job aasignment.

b. Ms. Davis who recently turned age 65 and is eligible for Part A and has just enrolled in Part B.

c. Mr. Charles, an undocumented immigrant, entered the country illegally.

d. Ms. Adams, a healthy early retiree who has just begun to collect Social Security at age 62.

Q287-Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through acupuncture. She is concerned about whether or not Medicare will cover these items and services. What should you tell her?

Medicare does not cover acupuncture, or, in general, glasses or dentures.

Q288-Since 2004 Ms. Eisenberg has had a Medigap plan that provides some drug coverage. She has recently received a letter form her Medigap carrier informing her that her drug coverage is not "creditable". She wants to know what this means. What should you tell her?

a. The letter is to inform her that her Medigap plan coverage has determined by the Federal Government to be inadequate and the plan must therefore discontinue offering such coverage. Ms. Eisenberg will have to select a different Medigap plan if she wants drug coverage.

b. The letter is to inform her that her Medicare Part D prescription drug coverage is available, but there is no need for her to change her drug coverage since it is just as good as Part D coverage at a later date.

c. The letter is to inform her that her Medigap must be supplemented by purchasing coverage under a Part D plan. If she does do so within 63 days, she will not be able to Part D program, she will face a premium penalty if she enrolls in a Part D plan at a later date.

d. The letter is to inform her that the drug coverage offered through her Medigap plan does not offer drug coverage that is a least comparable to that provided under the Medicare Part D prescription drug program. If she does not have such creditable coverage during periods when she is first eligible for the Part D program, she will face a premium penalty if she enrolls in a Part D plan at a later date.

Q289-Mr. Jackson just turned 65. He has been seeing the same general practitioner for annual check-ups for the past 15 years, likes these yearly visits, and would like to continure obtaining these services as a Medicare beneficiary. What hsould you tell him about annual check-ups?

a. Medicare will cover an annual wellness visit, even if he has no illnesses or injuries.

b. Medicare will cover only a one-time “Welcome to Medicare” wellness visit.

c. He can have as many preventive physical exams as he feels that he needs. They will all be covered by Medicare.

d. Physical exams, in the absence of readily observable illness or injury, are never covered under any circumstances.

 

Q290-During an appointment scheduled to discuss a Medicare Advantage Prescription Drug plan (MA-PD), Mr. Peters asked his agent to describe a stand-alone prescription drug plan (Part D plan) that his neighbor told him about. What should his agent do?

a. Since Mr. Peters requested a description of the Part D plan, his agent must leave Part D plan brochure, but not an enrollment form, and would have to schedule another appointment after at least 48 hours have passed to discuss the Part D plan with Mr. Peters.

b. Since Mr. Peters requested a description of the Part D plan, his agent must have Mr. Peters sign a new scope of appointment form that includes Part D, and then the agent may discuss the Part D plan so Mr. Peters can compare plans and make an informed enrollment choice during the appointment.

c. Since Mr. Peters requested a description of the Part D plan, his agent must inform Mr. Peters that can only sign up for the MA-PD plan, and can not receive a brochure or any other information about Part D plan now bwcause he did not agree in advance to discuss that plan.

d. Since Mr. Peters requested a description of the Part D plan, his agent must discuss both the Part D and the MA-PD plans and return after at least 48 hours to complete the Part D plan enrollment from with Mr. Peters.

 

Q291-Mr. Landry is approaching his 65th birthday. He has signed up for Medicare Part A, but he did not enroll in Part B because he has employer-sponsored coverage and intends to keep working for several more years. But he is considering enrolling in Part D prescription drug coverage because he believes it is superior to his employer plan. How would you advise him?

a. Mr. Landry must enroll in Part B to enroll in Part D, but his initial enrollment period for Part B lapsed when he enrolled in Part A.

b. Mr. Landry must enroll in Part B to enroll in Part D, and he still has time to do so.

c. Mr. Landry must wait until the next annual open enrollment period because his initial enrollment period for Part D lapsed when he enrolled in Part D.

d. Mr. Landry is eligible for Part D since he has Part A, and his initial enrollment period (IEP) for Part D will continue for three months after his 65th birthday.

(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.)
MA MSA may only obtain Part D benefits through a standalone PDP.MA PFFS plan that offers Part D coverage may only obtain Part D benefits through that plan. If the PFFS plan does not offer Part D coverage, the beneficiary may enroll in a standalone PDP. Cost plan may obtain Part D benefit through their plan (if offered) or through a standalone PDP. Medicare-Medicaid plan may only receive Part D benefits through that plan. PACE plan may only receive Part D benefits through that plan.)

Q292-Which of the following statements is correct about the appeal and grievance processes?

I. Enrollees have a right to obtain a review (appeal) of certain decisions about prescription drug coverage.
II. The grievance process is used to reviews of coverage decisions on Plan benefits.
III. Plans must provide a link to the Medicare.gov website where an enrollee can enter a complaint.
IV. Enrollees have a right to file complaints (sometimes called grievances) about the quality of their care.

I, III, and IV only

Q293-You are doing a sales presentation for Ms. Duarte and her son. Ms. Duarte has some cognitive impairment and her son informs you that he has power of attorney to make financial decisions for her. Can he execute the enrollment for her?

a. Yes, he can execute the enrollment for her. He can do so because he is an immediate family member. No power of attotney is necessary.

b. No, he cannot execute the enrollment for her. He must have a legal authorization, under state law that explicitly allows him to make health care decisions for his mother.

c. No, he can not execute the enrollment for her. Only Ms. Duarte can sign the form

d. Yes, he can execute the enrollment for her. A financial power of attorney is sufficient.

Q294-Ms. Jensen has heard about "Original Fee-for-Service Medicare" and "Private Fee-for-Service" plans. She wants to know what the difference is, if any. What should you tell her?

PFFS plans are a type of Medicare Advantage plan offered by private companies.

Q295-Mr. Decaro has looked at Medicare prescription drug plans available in his area and noted a wide range in premiums. He thought that all the drug plans were required to offer the same standard benefits and would like you to explain why there is such a range in premiums. What should you tell him?

Medicare permits plans that have the highest quality services to reduce their premiums below the standard amount in order to increase their market share. This accounts for the variation in premium amounts.

b. The premiums differ because some some plans intend to market to sicker beneficiaries and have set their premium to reflect expected greater costs.

c. All drug plans must offer exactly the same coverage model. The difference in premium is a result of the differing financial estimates of the companies offering the plans.

d. Some prescription drug plans ay have higher operating costs and/or may offer enhanced coverage in return for an additional premium amount. He could look at plan designs to see if one of the enhanced plans would serve his needs better than a plan based on the standard design. 

(Some prescription drug plans may have higher operating costs and/or may offer enhanced coverage in return for an additional
premium amount. He could look at plan designs to see if one of the enhanced plans would serve his needs better than a plan based on the standard design.
Part D enrollees have three options for paying their Part D premium.
(1) Automatic electronic monthly mechanism, such as withdrawal from their checking or savings bank account or automatic deduction from their credit or debit card;
(2) Direct monthly billing from the plan; or
(3) Automatic deduction from their monthly Social Security Administration (SSA) benefit check.
• Typically it takes 2-3 months for SSA withholding to begin or end.
• When withholding begins, it will be for the 2-3 months of premiums owed.
• If a beneficiary is considering this option, he/she should call the plan first.
Generally the beneficiary must stay with the premium payment option for the entire year.)

Q296-Ms. Brooks has an aggressive cancer and would like to know if Medicare will cover hospice services in case she needs them. What should you tell her?

a. Medicare covers hospice services and they will be available for her.

b. The Federal Government facilitate competition between hospice programs to lower the price of their services for Medicare beneficiaries, but not offer coverage for hospice services through the Medicare program.

c. Medicare does not cover hospice services. Hospice services are only available through state Medicaid programs, if the state offers such coverage.

d. Hospice services are currently only offered under a limited demonstration project. Whether they will eventually become available nationa depends on the outcomes of the demonstration.

Q297-Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor recently confirmedf a diagnosis of end-stage renal disease (ESRD). What options does Mrs. Davenport have in regard to her MA plan during the next open enrollment season

a. She must immediately drop her ABC MA plan and enroll in Original Medicare.

b. She must immediately drop her ABC MA plan and enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area.

c. She must immediately drop her ABC MA plan unless the plan terminates.

d. She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for individual suffering from ESRD if one is available in her area.

Q298-Ms. Stuart has heard about a special needs plan (SNP) that one of her friends is enrolled in and is interested in that product. She wants to be sure she also has coverage for prescription drugs. Would she be able to obtain drug coverage if she enrolled in the SNP?

a. Yes, but only if she qualifies for Part D prescription drug coverage under her state Medicaid program.

b. No, Medicare beneficiaries who enroll in an SNP must always obtain their drug coverage through a stand-alone Part D Medicare prescription drug plan that they sign up for independent of their enrollment in the SNP.

c. Yes. All SNPs are required to provide Part D coverage for prescription drugs.

d. Maybe. Some SNPs offer Part D coverage for prescription drug and some do not.

Q299-Julia Harris is turning 66 in July, at which time she will retire. She has contacted your office and requested a meeting so that she can learn about Medicare and the products you represent. How should you respond?

a. Tell Julia that she must first complete a questionnaire providing her health history so that you can recommend an appropriate product before submitting an enrollment application, since she qualifies for a special enrollment period.

b. Tell Julia that you will meet with her to explain Medicare and should she be interested you can accept and submit an enrollment request, since this is an initial enrollment qualifying he for a special enrollment period.

c. Tell Julia that you are happy to meet with her once this year’s open enrollment begins on October 15^th.

d. Tell Julia that you will meet with her at a time of her convenience within the next week, when you can accept a completed enrollment application to be submitted after October 15^th.

Q300-Mr. Chan is one of your clients and in excellent health. He is enrolled in a Medicare prescription drug plan that you represent. He recently heard about a Medication Therapy Management (MTM) prgram in which his friend is enrolled. What should you tell him?

a. A MTM program is available to all Medicare Part D enrollees who seek help in selecting the prescription drugs most appropriate to their needs.

b. To be eligible for a MTM program, a Medicare beneficiary must have multiple chronic diseases, be taking multiple Part D prescription drugs, and likely to incur considerable drug costs.

c. To be eligible for a MTM program, a Medicare beneficiary must have multiple chronic diseases, be taking multiple Part D prescription drugs, and likely to incur considerable drug costs.

d. A MTM program is an excellent choice for someone taking very few prescription drugs such as Mr. Chan.

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