AHIP Exam Test Complete

 

Q1-Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will have considerable income when she retires. She is concerned that her income will make it impossible for her to qualify for Medicare. What could you tell her to address her concern?

a. Medicare is a program for people who have incomes and assets below specific limits, so you will have to find out her exact financial situation before telling her whether she can obtain Medicare coverage.

b. Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, end stage renal disease or Lou Gehrig's disease, so she will be eligible for Medicare.

c. Medicare is a program for people of all ages with specific mental health disabilities. Since she is in excellent health, she would not qualify, but should instead look into her state’s Medicaid program if she wants further coverage.

d. Eligibility for Medicare is based on whether or not a person has ever been employed by the federal government. If she or her husband were ever employed by the federal government, she can enroll in Medicare

Source: Medicare Program Basics

Q2-Ms. Goldstein is required by the plan she represents to obtain enrollment forms that have carbon copies in the back. She gives one to the beneficiary, sends another to the plan and retains the third. What should she do with her copies of the enrollment forms?

a. She should make every effort to safeguard the beneficiary information on those enrollment forms.

b. She should retain them for six years and then throw them in the garbage, as is, without shredding them.

c. There is no specific requirements to which she is subject with regard to safekeeping the information.

d. She should retain them until she is informed by the plan that they have been successfully processed and then she can throw them in the garbage, as is, without shredding them.

 

Q3-Mr. Lopez takes several high-cost prescription drugs. He would like to enroll in a stand-alone Part D prescription drug plan that is available in his area. In what type of Medicare Health Plan can he enroll?

a. Medicare Advantage (MA) HMO that does not include drug coverage.

b Private Fee-for-Service (PFFS) plan that does not include drug coverage.

c. Medicare Advantage (MA) PPO that does not include drug coverage.

d. Medicare Advantage (MA) HMO-POS plan that does not include drug coverage.

Q4-Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few weeks. She concerned about having prescription drug coverage. Which of the following statements provides the best advice?

Prescription drug coverage can be obtained by enrolling in a Medicare Advantage plan that includes Part D coverage.

Q6-Mr. Meoni'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.Meoni?

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.

Q7-Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxes during that entire period. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. What should you tell her? 

Choose one answer.
a. Most individuals who are citizens and over age 65 are covered under Part A by virtue of having paid Medicare taxes while working, though some may be covered as a result of paying monthly premiums.
b. Most individuals who are citizens and over age 65 and wish to be covered under Part A must enroll in a Medicare Health Plan.
c. Most individuals who are citizens and over age 65 and are covered under Part A must pay a monthly premium for that coverage.
d. All individuals who are citizens and over age 65 will be covered under Part A.

Q8-Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. He is wondering whether he can obtain coverage under Medicare. What should you tell him?

a. He became eligible for Medicare when his disability eligibility determination was first made. 

b. Individuals who become eligible for such disability payments only have to wait 12 months before they can apply for coverage under Medicare. 

c. Individuals receiving such disability payments from the Social Security Administration continue to receive those payments, but only become eligible for Medicare upon reaching age 65.

d. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.

Q9-Mr. Davis is 49 years old and has been receiving disability benefits from the Social Security Administration for 12 months. Can you sell him a Medicare Advantage or Part D Prescription Drug policy?

No, he cannot purchase a Medicare Advantage or Part D policy because he has not received Social Security or Railroad Retirement disability benefits for 24 months.

Q10-Ms. Henderson believes that she will qualify for Medicare coverage when she turns 65, without paying any premiums, because she has been working for 40 years and paying Medicare taxes. What should you tell her?

a. She is correct because she will be covered under Part A, without paying premiums and she has worked for 40 years so she will not have to pay Part B premiums.

b. She is correct that she will not have to pay a premium because State programs cover the cost of Part B premiums for all Medicare beneficiaries.

c. In order to obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.

d. Medicare beneficiaries only pay a Part B premium if they are enrolled in a Medicare Health Plan.

Q11-Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. He has heard that there is a premium penalty for those who did not sign up for Part B when first eligible and wants to know how much he will have to pay. What should you tell him?

a. Mr. Diaz will pay a penalty, which will be a flat amount each year, paid during the first month of coverage. 

b. The penalty will be a permanent 10% increase in his Part B premium for every 12 month period that passed during which he could have enrolled and did not.

c. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.

d. During the first year he is covered under Part B, his premiums will be 10% higher than they otherwise would be, after which point they will return to normal.

Q12-Mrs. Peňa is 66 years old, has coverage under an employer plan and will retire next year. She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell her?

a. She may enroll at any time while she is covered under her employer plan, but she will have a special eight month enrollment period that differs from the standard general enrollment period, during which she may enroll in Medicare Part B.

b. She must wait at least 30 days after her employment terminates before she may enroll in Medicare Part B.

c. She may only enroll in Part B during the general enrollment period whether she is retired or not. 

d. She may not enroll in Part B while covered under an employer group health plan and must wait until the standard general enrollment period after she retires.

Q13-Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is considering enrollment in a Medicare health plan. What should you advise her to do before she will be able to enroll into a Medicare health plan?

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

Q14-Mrs. Park has a low, fixed income. What could you tell her that might be of assistance?

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

Q15-Mr. Yu has limited income and resources so you have encouraged him to see if he qualifies for some type of financial assistance. Mr. Yu is not sure it is worth the trouble to apply and wants to know what the assistance could do for him if he qualifies. What could you tell him?

He might qualify for help with Part D prescription drug costs and help paying Part A and/or Part B premiums, deductibles, and/or cost sharing.

Q16- Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. He wants to understand the health care costs he might be exposed to under Medicare if he were to require hospitalization as a result of an illness. In general terms, what could you tell him about his costs for inpatient hospital services under Original Medicare?

a. Under Original Medicare, the inpatient hospital co-payment is a flat per-day amount that remains the same throughout the first 60 days of a beneficiary’s stay. After day 60 the amount gradually increases until day 90. After 90 days he would pay the full amount of all costs. 

b. Under Original Medicare, if the inpatient hospital service is provided by a participating Medicare provider, the co-payment is waived. Co-payments are only charged when a beneficiary opts to receive care from a nonparticipating provider. 

c. Under Original Medicare, the inpatient hospital co-payment is a percentage of allowed charges. The percentage increases after 60 days and again after 90 days.

d. Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-day amount through day 90. After day 90, he would pay a daily amount up to 60 days over his lifetime, after which he would be responsible for all costs

Q17- Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treated for that condition. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility?

a. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered because Medicare does not provide such a benefit.

b. Medicare will cover Mrs. Schmidt's skilled nursing services provided during the first 20 days of her stay, after which she would have a coinsurance until she has been in the facility for 100 days.

 

(Skilled nursing and rehabilitative care only after a three day hospital stay, up to 100 days in a benefit period (as defined by Medicare). In 2017, beneficiaries pay $164.50 coinsurance for days 21-100 each benefit period.Inpatient psychiatric care (up to 190 lifetime days) Part A does not cover custodial or long-term care Cost-sharing may differ for enrollees of Medicare)

c. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields' long-term care costs. 

d. Medicare will cover an unlimited number of days in a skilled-nursing facility, as long as a physician certifies that such care is needed.

Q18- Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay that Medicare will cover?

a. Medicare inpatient psychiatric coverage is limited to the same number of days covered for typical inpatient stays

b. Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.

c. Inpatient psychiatric services are not covered under Original

Medicare.

d. Medicare will cover, at its allowable amount, as many stays as are needed throughout Mr. Rainey’s life, as long as no single stay exceeds 190 days.

Source: Medicare Part A Benefits, Continued

 

Q19- Mrs. Quinn has just turned 65 and received a letter informing her that she has been automatically enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn?

c. Part B primarily covers physician services. She will be paying a monthly premium and, with the exception of many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an annual deductible.

Q20- Mr. Buck has several family members who died from different cancers. He wants to know if Medicare covers cancer screening. What should you tell him?

a. Medicare covers treatments for existing disease, injury and malformed limbs or body parts. As such, it does not cover any screening tests and these must be paid for by the beneficiary out of pocket. 

b. Medicare covers some screening tests that must be performed within the first year after enrollment. Beyond that point expenses for screening tests are the responsibility of the beneficiary.

c. Medicare covers periodic performance of a range of screening tests that are meant to provide early detection of disease. Mr. Buck will need to check specific tests before obtaining them to see if they will be covered. (Preventive & screening services)

d. Medicare covers all screening tests that have been approved by the FDA on a frequency determined by the treating physician.

Q21- Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are met? What could you tell her?

a. Original Medicare covers routine foot care. 

b. Original Medicare covers orthopedic shoes.

c. Original Medicare covers ambulance services.

d. Original Medicare covers cosmetic surgery.

Q22-Mrs. Wolf 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?

a. Medicare covers 50% of the cost of these three services.

b. Medicare covers glasses, but not dentures or acupuncture.

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

d. Medicare covers 80% of the cost of these three services.

 

Q23- Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the health plan may, at some time in the future, reduce his benefits below what is available in Original Medicare. What should you tell him about his concern?

a. Medicare health plans have the option of deciding, each year, what services they will cover. He is correct that the health plan could eliminate some benefits covered by Medicare and he should think carefully before enrolling in a Medicare health plan.

b. He should not be concerned because Medicare health plans must cover all IRS-approved health care expenses, which means that all of them provide substantially greater benefits than are available under Medicare Part A and Part B.

c. Medicare health plans must cover all benefits available under Medicare Part A and Part B. Many also cover Part D prescription drugs.

d. Medicare health plans offer a menu of benefits, from which he may choose, so if he ever wants to increase his coverage, he need only contact the plan and select other options.

Source: Different Ways to Get Medicare, continued

Q24-Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? What could you tell him?

a. Part C, which always covers dental and vision services, is covered under Original Medicare. 

b. Part D, which covers prescription drug services, is covered under Original Medicare. 

c. Part A, which covers long term custodial care services, is covered under Original Medicare

d. Part A, which covers hospital, skilled nursing facility, hospice and home health services and Part B, which covers professional services such as those provided by a doctor are covered under Original Medicare.

( Medicare health plans must cover all benefits available under Medicare Part A and Part B. Many also cover Part D prescription drugs.)

Source: Different Ways to Get Medicare

Q25- 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 with his prescription drug costs?

a. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program.

b. Mr. Wu may still qualify for help in paying for Part D costs through the local Office of the Aging. 

c. Mr. Wu has no alternative but to liquidate his remaining assets and apply for coverage through his state’s Medicaid program. 

d. Mr. Wu may still qualify for help in paying for Part D costs through the Federal Pharmaceutical Assistance Program.

Q26-Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefit package of a Medicare Health Plan before she starts looking at specific plans. What could you tell her?

a. Medicare Health Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental services and must include a maximum out-of-pocket limit on Part A and Part B services.

b. All Medicare Health Plans offer cost-sharing that is lower than Original Medicare for all Part A and Part B covered services, but the maximum out-of-pocket limit is higher than in Original Medicare. 

c. Medicare Health Plans are not permitted to offer any benefits beyond those available under the Original Medicare program and must have the same maximum out-of-pocket limit on Part A and Part B services as FFS Medicare. 

d. Medicare Health Plans do not necessarily have to cover all of the Original Medicare Part A and Part B services, but must include a maximum out-of-pocket limit. Source: Part C Medicare Health Plans

Source: Part C Medicare Health Plans

Q27- Anita Magri will turn age 65 in August 2020. Anita intends to enroll in Original Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's older neighbor Mel has told her about the 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?

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

Q28- If Dr. Elizabeth Brennan does not contract with the PFFS plan, but accepts the plan's terms and conditions for payment, how will she be paid?

Ans: Generally, the PFFS plan will pay Dr. Brennan directly the same amount Original Medicare would pay her.

Q29-Mrs. Quinn has recently turned 66 and decided after many years of work to begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn?

a. Part B will cover her dental and vision needs. 

b. She will need to pay no premiums for Part B as she qualifies for premium free coverage due to the number of quarters she has worked. 

c. She should disenroll if she does not want to pay the monthly premiums. There is no disadvantage to doing so.

d. Part B primarily covers physician services. She will be paying a monthly premium and, with the exception of many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an annual deductible.

Q30-Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. She is attracted by the idea of maintaining control over a Medical Savings Account (MSA), but is not sure if the plan associated with the account will fit her needs. What specific piece of information about a Medicare MSA plan would it be important for her to know, prior to enrolling in such a plan?

a. MSA enrollees may only receive covered health care services from a limited panel of network providers because otherwise some providers may charge more than Original Medicare rates. 

b. All beneficiaries enrolled in an MSA pay a plan premium in addition to their Part B premium. 

c. For enrollees in an MSA, after the annual deductible is met, the MSA plan generally pays 75% of covered services.

d.  All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be obtained by also enrolling in a separate prescription drug plan.

Q31- You have come to Mrs. BROWN's home for a sales presentation. At the beginning of the presentation, Mrs. Brown tells you that she has a copy of her medical record available because she thinks this will help you understand her needs. She suggests that you will know which questions to ask her about her health status in order to best assist her in selecting a plan.

You can only ask Mrs. Brown questions about conditions that affect eligibility, specifically, whether she has end stage renal disease or one of the conditions that would qualify her for a special needs plan.

Q32-Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. What can you tell her about Medigap as an option to address this concern?

a. If Mrs. Paterson applies during the Medigap open enrollment period, she will have to undergo a medical review to determine if she has a pre-existing condition that would increase the premium for a Medigap policy. 

b. Medigap plans are not sold by private companies and are a government insurance product.

c.  Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services.

d. All costs not covered by Medicare are covered by some Medigap plans.

Q33- Mr. Rivera has QMB-Plus eligibility and is thus covered by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) plan. Later in the year, Mr. Rivera needs dentures, a service only covered under Medicaid. What action would you recommend he take in order to have this cost covered?

Ans: He should go to a Medicaid provider or obtain the services through a Medicaid manage care plan if he is enrolled in one. (has QMB-Plus eligibility. She has decided to enroll in a Medicare Advantage plan.
Ms. Jones can receive all Medicare covered services through her Medicare Advantage plan cost sharing. However, in order to receive coverage of services that are only covered under
Medicaid, for example, dentures, she must go to a Medicaid provider or obtain the services through a
Medicaid managed care plan if she is enrolled in one Categories of dual eligible beneficiaries and out-of pocket costs that must be paid by Medicaid:
QMB Plus - Medicare Part A and Part B premiums; cost sharing for Part A & Part B benefits; Full Medicaid benefits.When a dual eligible individual enrolls in an MA plan, if the individual has coverage for Part A and B
cost sharing, they will not have to pay more than the cost sharing that would apply under Medicaid.
This rule applies to all types of Medicare Advantage plans, including dual eligible SNPs.
Dual eligible beneficiaries may enroll in any type of MA plan except an MA MSA. Some MA plans, known as dual eligible Special Needs Plans, are tailored to dual eligible individuals, depending on the category (see prior slide) to which they belong.)

Q34- Mrs. Chou likes a PFFS plan available in her area that does not offer drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What should you tell her?

a. She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.

b. She could enroll in the PFFS plan and a Medigap plan that offer drug coverage, but not in a stand-alone Medicare prescription drug plan.

c. If she wants drug coverage and a PFFS plan, she could only enroll in a PFFS plan that includes Medicare prescription drug coverage.

d. She could enroll in a PFFS plan, but nit in a stand-alone drug plan.

Q35- Mrs. Lopez is enrolled in a Medicare Advantage cost plan. She has recently lost creditable coverage previously available through her husband's employer. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). What should you tell her?

a. If a Part D benefit is offered through her plan she may choose in enroll in that plan or a standalone PDP.

b. Mrs. Lopez must first seek COBRA benefits under her husband’s plan before she can apply for Part D coverage. 

c. If a Part D benefit is offered through her plan she must enroll in this plan. 

d. Mrs. Lopez must enroll in either a HMO or PPO Medicare Advantage plan in order to obtain Part D coverage.

Q36- All plans must cover at least the standard Part D coverage or its actuarial equivalent. What costs would a beneficiary incur for prescription drugs in 2018 under the standard coverage?

Ans. Standard Part D coverage would require payment of an annual deductible, 25% cost-sharing up to the coverage gap, a portion of costs for both generics and brand-name drugs in the coverage gap, and co-pays or co-insurance after the coverage gap.

Q37- GRANT has just entered his MA ICEP. What action could you help him take during this time?

He will have one opportunity to enroll in a MA plan.

Q38- Under what conditions can a Medicare prescription drug plan reduce its coverage for a given drug mid-way through the year?

Ans When a new generic drug for the same condition becomes available or when the FDA or manufacturer withdraws the drug from the market, a brand name drug can be replaced.

Q39- Mr. Jenkins 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?

Ans If Mr. Jenkins 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.

Q40-Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. What should you tell him?

a. Mr. Singh must leave Original Medicare to receive drug coverage.

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

c. Part D prescription drug coverage can only be obtained by enrollment into a Medicare Health Plan that also covers Part A and Part B services. 

d. Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Health Plan.

Q41-Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. What should you tell him?

a. He generally would pay only a monthly premium. Medicare covers all other costs. 

b. He generally would pay only a monthly premium and deductible. Medicare covers all other costs.

c. He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing.

d. He generally would pay only a per-prescription co-payment. Medicare covers all other costs.

Q42-Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her?

a. Part D covers long-term care services and she shouldn’t worry because there has been no change in coverage. 

b. Part D covers physician and non-physician practitioner services and the deductible has not changed this year, but the physician charges may go up. 

c. Part D covers hospital and home health services and the cost sharing has changed this year.

d. Part D covers prescription drugs and she should look at her premiums, formulary, and cost sharing among other factors to see if they have changed.

Q43- While marketing Medicare Advantage and Part D plans, you collected a large number of scope of appointment forms from your clients, wherein they indicated their interest in specific products and their wish for you to provide information on those products in their homes. What should you do with those forms?

The scope of appointment forms must be retained for a period of ten (10) years.

Q44-Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug coverage. She would like to keep the coverage she has, but replace her existing Medigap plan with one that provides drug coverage. What should you tell her?

a. Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug plan.

b. Mrs. Gonzalez should purchase a K or L Medigap plan. 

c. Medigap is a replacement for Original Medicare and she has been paying for double coverage. She should simply drop her Medigap policy. 

d. Mrs. Gonzalez can purchase a Medigap plan that covers drugs, but it likely won’t offer coverage that is equivalent to that provided under Part D.

Q45-Mr. Kelly has substantial financial means. He enrolled in Original Medicare and purchased a Medigap policy many years ago that offered prescription drug coverage. The prescription drug coverage has not been comparable to that offered by Medicare Part D for several years and despite notification, Mr. Kelly took no action. Which of the following statements best describes what will occur if Mr. Kelly now decides to enroll in Medicare Part D?

a. He will incur a late enrollment penalty.

b. He will not be able to enroll in Part D unless he decides to also enroll in a Medicare Advantage plan. 

c. He will avoid any financial penalty or late enrollment fee under the grandfathering provisions of Medicare Part D. 

d. He will incur a one-time financial penalty equal to 30 percent of the annual Part D premium.

Q46-Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. What should you tell him?

a. Medigap plans that cover costs not paid for by a MA plan are available only in Massachusetts, Minnesota, and Wisconsin.

b. It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original Medicare.

c. Medigap plans are a form of Medicare Advantage, so purchasing both would be redundant coverage. 

d. Medigap policies designed to cover costs not paid for by a MA plan can be purchased, but only if the MA plan’s design is considered to be the “defined standard benefit.”

Q47-What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) have upon Medigap plans?

a. MACRA provides funding to help individuals age 59 and above enroll in Medigap plans. 

b. The Part A deductible is no longer covered under Medigap plans for all enrollees staring January 1, 2020. 

c. The Part A deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020.

d. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020.

(The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020.The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will make changes to Medigap plans effective 2020. Specifically, for individuals newly eligible to Medicare, the Part B deductible cannot be covered. Therefore, Plans C and F will no longer be an option for newly eligible individuals starting January 1, 2020. However, individuals who already have Plans C and F will be able to keep their current versions of the plans and individuals eligible for Medicare prior to January 1, 2020, can purchase the current version of Plans C and F on or after January 1, 2020)

Q48-Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about what type of plan designs are available through this program. What should you tell him about the types of health plans that are available through the Medicare Advantage program?

a. They are Medigap Supplemental plans that fill in the gaps not covered by Medicare. 

b. They are long-term care plans for people with Medicare. 

c. They are major medical policies, but are only for low-income beneficiaries with Medicare.

d. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.

Q49-Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be a correct description?

a. Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies.

b. Medicare Advantage is a new name for the Original Medicare program. 

c. Medicare Advantage is a health insurance program operated jointly by the states with the Federal government. 

d. Medicare Advantage is designed to pick up where Original Medicare leaves off, covering those health care services that would not normally be covered by Original Medicare.

Q50-Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her?

a. Mrs. Radford can enroll in any Medicare Advantage plan that operates within the United States

b. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.

c. Mrs. Radford must apply to the Medicare Advantage plan, which will include a medical review, prior to being accepted and enrolled. 

d. Even if Mrs. Radford has end stage renal disease, she will be able to enroll in any Medicare Advantage plan in her service area.

Q51- Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn?

Part B primarily covers physician services. She will be paying a monthly premium and, with the exception of many preventive and screening tests, generally will have 20% coinsurance for these services, in addition to an annual deductible.

 

Q52-Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs. Billings 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 a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. 

b. She must remain enrolled in her ABC MA plan unless the plan terminates.

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

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

Q53-Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to be most appropriate for him?

a. E-SNP         b. D-SNP        c.C-SNP            d. I-SNP

Q54-Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him?

a. Mr. Kumar will be able to obtain routine care outside of the plan’s service area, but will pay a higher co-payment (except in an emergency).

b. In most Medicare Advantage HMOs, Mr. Kumar must obtain his services only from providers who have a contractual relationship with the plan (except in an emergency or where care is unavailable within the network).

c. In Medicare Advantage HMO plans, services provided by primary care physicians are covered at 100%, but those of specialists are covered at 80%. 

d. With any Medicare Advantage HMO, Mr. Kumar will be able to see any provider he likes, so long as that provider participates in Original Medicare.

Q55-Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care. What should you tell her?

a. In general, Mrs. Ramos will need a referral to see specialists. 

b. Mrs. Ramos should be aware that generally plan providers can decide, on a case-by-case basis, whether they will treat her. 

c. In general, Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but will have to pay the difference between the plan’s allowed amount and the provider’s usual and customary charge.

d. Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a provider who/that is not part of the PPO network.

(Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally will be charged a lower co-payment if she goes to one of the plan's preferred providers. Preferred Provider Organizations (PPOs), local and regional; PPO enrollees generally may get care from any provider in the U.S. who accepts Medicare, but will pay less if they go to one of the "preferred" providers in the PPO's network. PPOs must have a maximum limit on member out-of pocket costs for network providers of not greater than $6,700 per year and an aggregate limit on network and non-network costs of $10,000. Enrollees do not need a referral to see an out-of-network provider, but may be encouraged to contact the plan to be sure the service is medically necessary and will be covered. Regional PPOs are PPOs that serve an entire region, made up of one or more states.)

Q56-Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). What could you tell him?

a. Since SNPs don’t cover prescription drugs Mr. Sinclair should consider a different option. 

b. SNPs are essentially the same as Original Medicare and are not likely to have a noticeable impact on how Mr. Sinclair receives his care. 

c. SNPs offer care from any doctor or hospital Mr. Sinclair would like to use and his costs will always be lower than in Original Medicare.

d. SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as well.

Q57-Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. What should you tell him?

a. SNPs only serve individuals in long-term care facilities, so he cannot enroll. 

b. SNPs only serve individuals eligible for both Medicaid and Medicare, so he cannot enroll.

c. SNPs limit enrollment to certain sub-populations of beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP.

d. SNPs do not provide Part D prescription drug coverage, so if he does enroll, he should be aware that he will not have coverage for any medications he may need now or in the future.

Q58-Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know if he must use doctors in a network like his current HMO plan requires him to do. What should you tell him?

a. He may receive services from any physician, regardless of whether or not that physician participates in the plan or Original Medicare.

b. He may receive health care services from any doctor allowed to bill Medicare, as long as he shows the doctor the plan's identification card and the doctor agrees to accept the PFFS plan's payment terms and conditions, which could include balance billing.

c. If he enrolls in the PFFS plan and shows his card to a doctor who participates in Original Medicare, then that doctor is required to accept the plan’s terms and conditions, which could include balance billing. 

d. If he enrolls in the PFFS plan, he can go to any doctor anywhere as long as the doctor accepts Original Medicare.

Q59-Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-Service (PFFS) plan. As part of that discussion, what should you be sure to tell her?

a. PFFS plans may choose to offer Part D benefits but are not required to do so.

b. If she uses non-network providers, she would not be permitted to obtain care outside of her plan’s service area. 

c. PFFS plans are not permitted to provide any benefits beyond what is covered under Original Medicare. 

d. If she uses non-network providers, her cost sharing would be the same under a PFFS plan as it would be under Original Medicare.

Q60-Mr. McTaggert notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know what makes them different from an HMO or a PPO. What should you tell him?

a. PFFS plans are the same as Medicare supplement plans and he may obtain care from any provider in the U.S.

b. Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts Original Medicare, as long as the provider has a reasonable opportunity to access the plan's terms and conditions and agrees to accept them.

c. If a PFFS enrollee shows his/her card when obtaining services from a provider who participates in Original Medicare, then that provider is required to accept the plan’s terms and conditions. 

d. If offered, beneficiaries can select a stand-alone Part D prescription drug plan (PDP) with an HMO or a PPO, but not with a PFFS plan.

Q61-Dr. Elizabeth Brennan does not contract with the PFFS plan but accepts the plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge?

a. Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan's terms and condition of payment which may include balance billing up to 15 percent of the Medicare rate.

b. Dr. Brennan can charge Mary no more than the cost sharing specified in the PFFS plan’s terms and conditions of payment which may include balance billing up to 25 percent of the Medicare rate. 

c. Dr. Brennan can charge the beneficiary the same cost sharing as Original Medicare as long as she sends the claim to Medicare and not the plan. 

d. Dr. Brennan can charge Mary Rodgers more than the cost sharing specified in the PFFS plan’s terms and conditions as long as she treats all beneficiaries the same.

Q62- You have received an advertisement from a vendor who says they can provide you with an extensive list of publicly available e-mail addresses for individuals who are Medicare beneficiaries. In addition, one of your Medicare Advantage clients offered to share her e-mail address book with you so you could contact her Medicare-eligible friends. In considering these sources of leads, what rules must you be sure to abide by?

You may send an e-mail to a beneficiary about Medicare Advantage plan information if the beneficiary a

Q63-Which of the following statement is correct about Medicare Savings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits .
III. An individual who is eligible for health care benefits through the Veteran's Administration may enroll in an MSA.
IV. Non-network providers must accept the same amount that Original Medicare would pay them as payment in full.

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

Q64-Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan, but does not want to be limited in terms of where he obtains his care. What should you tell him about how a Medicare Cost Plan might fit his needs?

a. Cost plans do not offer optional supplemental benefits, but they also do not maintain networks of providers, so he can obtain services from any provider he wishes to see and the cost-sharing will be the same.

b. Cost plan enrollees can choose to receive Medicare covered services under the plan's benefits by going to plan network providers and paying plan cost sharing, or may receive services from non-network providers and pay cost-sharing due under Original Medicare.

c. Cost plans do not offer Part D prescription drug coverage as an optional benefit, so regardless of which Cost plan he enrolls in, he will need to ensure that he obtains drug coverage in some other way. 

d. Cost plan enrollees must receive all their covered services from network providers.

Q65-For which of the following individuals would a Cost Plan be most appropriate?

a. Mr. Charles who is enrolled Medicare Part A but does not want to enroll in Part B. 

b. Ms. Darwin who is enrolled in Medicare Parts A and B who also is enrolled in a Medicare Supplement (Medigap) and is unwilling to pay any additional plan premiums. 

c. Mr. Able who has retiree health insurance but relatively modest prescription drug benefits.

d. Ms. Baker who is enrolled in Medicare Part B and is willing to continue paying Part B premiums plus any plan premiums.

Q66-Which statement best describes PACE plans?

a. It is an all-inclusive publicly sponsored Medicaid plan for the elderly.

b. It allows enrollees to choose whether to receive Medicare service by going to plan network providers and paying plan cost-sharing, or receiving services from non-network providers and paying cost-sharing due under Original Medicare. 

c. It is an all-inclusive Medicare plan widely available throughout the United States.

d. It includes comprehensive medical and social service delivery systems using an interdisciplinary team approach in an adult day health center, supplemented by in-home and referral services.

 

Q67-Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group health plan that includes drug coverage with nominal copays. He heard about a neighbor's MA-PD plan that you represent and because he takes numerous prescription drugs, he is considering signing up for it. What should you tell him?

a. Generally, employers prefer retirees to have both the retiree group plan and the MA-PD plan to fill in the gaps, but he would be better off with just the MA-PD plan. 

b. Generally, employers prefer retirees to enroll in a stand-alone PDP, so he should consider that instead of the MA-PD. 

c. When possible, it is always the best option to have both the employer’s plan and the MA-PD, so he would have no out-ofpocket expenses.

d. Beneficiaries should check with their employer or union group benefits administrator before changing plans to avoid losing coverage they want to keep.

Q68-Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare Health Plan?

a. If a provider accepts her Medicare Health Plan coverage, that provider is legally obligated to also accept her Medicaid coverage, so she does not need to worry about finding providers who participate in both Medicare and Medicaid. 

b. State Medicaid programs do not coordinate any of their coverage with Medicare Health Plans

c. She can enroll in any type of Medicare Advantage (MA) plan except an MA Medical Savings Account (MSA) plan.

d. She can submit any bills she has for co-payments under Medicare to the state’s Medicaid program and they will always be fully covered.

Q69-Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access to services since she receives some assistance for her health care costs from the State.
What should you tell her?

a. Medicaid will cover all of her PFFS out-of-pocket costs and Medicaid providers will accept amounts paid by the PFFS plan as payment in full. 

b. If Mrs. Andrews joins a PFFS plan, the State will not cover any of her medical expenses because she will be using only Medicare providers.

c. Medicaid may provide additional benefits, but Medicaid will coordinate benefits only with Medicaid participating providers.

d. Medicaid beneficiaries are not eligible for enrollment into a PFFS plan. They must obtain their care through their state’s Medicaid program.

Q70-Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he sees an out-of-network doctor to receive a Medicare covered service. How much may the doctor collect from Mr. Rivera?

a. The doctor may only collect the amount allowable under Medicare plus 15 percent balance billing.

b. The doctor may only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid program.

c. The doctor may only collect the amount allowable under Medicare Advantage (MA) PPO plan cost sharing for non-QMB enrollees. 

d. The doctor may only collect the amount allowable under Medicare plus 25 percent balance billing.

Q71-Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does not include drug coverage and intends to obtain his drug coverage through a stand-alone Medicare prescription drug plan. What should you tell him about this situation?

a. He cannot enroll in a stand-alone prescription drug plan because you do not represent such a plan. 

b. He could enroll in the MA-only plan and purchase a Medigap plan with drug coverage

c. He could enroll in one of the MA plans that include prescription drug coverage or a Medigap plan and a stand-alone prescription drug plan, but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan.

d. He could enroll in the MA-only PPO plan and a stand-alone Medicare prescription drug plan.

Q72- Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. How would you respond?

Answer: Juan is likely to be eligible for Medicare once he turns 65 and if he enrolls Medicare would become the primary payor of his healthcare claims and Smallcap does not have to continue to offer him coverage comparable to those under age 65 under its employer sponsored health plan.

Explanation: The common requirements to qualify for Medicare are:

1.   US citizen or permanent resident for at least 5 years.

2.   Currently receiving social security benefits or qualified to receive them in the future

3.   Your spouse is employed by the government and he/she has paid Medicare payroll taxes.

Apparently "J"uan Perez complies with them since he is a US citizen and has been contributing to Medicare for more than 20 years. Therefore, he should be eligible for it and Medicare would become his primary healthcare insurer. After Juan is enrolled in Medicare, his employer will no longer be required to provide sponsored health coverage.

Q73- Agent Mark Andrews would like to employ technology to facilitate the growth of his Medicare Advantage (MA) practice. What step(s) would you recommend that Mark take?

Purchase Internet pop-up ads providing plan-specific information that have been reviewed and approved by CMS.

(Plans/Part D Sponsors must submit to CMS social media (e.g.,Facebook, Twitter, YouTube, LinkedIn, Scan Code, or QR Code)posts that meet the definition of marketing materials, specifically those that contain plan-specific benefits, premiums, cost-sharing,or Star Ratings. Social media posts are subject to marketing requirements, such as those related to testimonials. Generally disclaimers are not required unless a communication written for social media has the potential to be disseminated via other mediums, such as youtube.Plans/Part D Sponsors must not include content on social/electronic media that discusses plan-specific benefits, premiums, cost-sharing, or Star Ratings for products offered in the next contract year prior to October 1.)

Q74-Mrs. Mclntire is enrolled in her state’s medicad plan and has just become elegible for medicare aswel what can she expect will happen with respect to her drug coverage?

Unless she chooses a medicare part d prescription drug plan on her own , she will be automatically enrolled in one available in her area

Q75- Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal diease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him?

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

Q76- Mrs. Quinn recently turned 66 and decided after __________ Social Security benefits. Shortly thereafter, Mrs. Quinn received a letter informing her she has been automatically enrolled in Medicare Part B. She wants to understand what this means. What should you tell her?

Part B primarily covers physician services. She will be paying a monthly premium &, with the exception of many preventive and screening tests, generally will have 20% coinsurance for these services, in addition to an annual deductible

 

Q77- Mr. Carter(CHARLES), who is enrolled in a stand-alone Part D plan, receives the Part D low-income subsidy and just received a letter from the Social Security Administration(SSA) informing him that he will no longer qualify for the subsidy? He is wondering if he can switch to a lower cost Part D plan. What should you tell him?

He qualifies for a SEP which begins the month he was notified of his loss and continues for two more months. This SEP allows him one opportunity to enroll into another PDP or an MA-PD.

(Medicaid: help with health care costs. Medicare Savings Program: help paying for the Medicare Part B premium and, in some cases, deductibles and coinsurance. Part D low-income subsidy: help paying for prescription drug coverage. The State Medicaid office will check eligibility for this and other programs such as the Medicare Savings Program. Persons interested in Part D help only may call the Social Security Administration (SSA) at 1-800-772-1213 or apply online at www.ssa.gov/prescriptionhelp.
Supplemental Security Income (SSI) benefits: help with cash for basic needs. You also may apply through SSA.)

Q78- Mrs. Lenard is enrolled in a Medicare Cost plan. Recently the cost plan has transitioned to a Medicare Advantage (MA) contract, and Mrs. Lenard has been told that she has been subject to "deemed enrollment." What does this mean?

Some cost plans transitioning to MA contracts will have "deemed" or facilitated enrollment. That is,
unless a cost plan enrollee opts out, he/she will be automatically enrolled in an MA plan offered by the same organization.Individuals subject to deemed enrollment will be notified by CMS and the plan and given the opportunity to choose another option.

Q79- You have decided to focus on doing in-home presentation to market the Medicare Advantage (MA) plans you represent. Before you conduct such sales presentations, what must you do?

a. There is no special action that you must take. If they choose, you may go an individual’s house to provide presentation and offer assistance with enrolling in a plan.

b. You must first contact the Medicare agency to ensure that the individual is actually a Medicare beneficiary.

c. You must receive an invitation from the beneficiary and document the specific types of products the beneficiary wants to discuss prior to making an in-home presentation.

d. A proper introduction at the door that includes a disclaimer regarding your relationship with the plan you represent is the only required action you must take, prior to entering the beneficiary’s home.

Q80- This year you have decided to focus your efforts on marketing to employer group plans. One employer provides you with a list of their retirees and asks you to contact them to explain the characteristics of the plan they have selected.

a. You may only contact the retirees after the employer has notified them that they will be receiving a call. 

b. You may not make any unsolicited contact with Medicare beneficiaries. The employer will have to tell its retirees to call you. 

c. You may call them, but must record every call.

d. You may go ahead and call them.

Source: Marketing to Employer/Union Groups

Q81- This year you decided to focus your efforts on marketing to employer and union groups. Which of the following statements best describes what you can and cannot do in order to stay in compliance?

a. You are not required to submit communication and marketing materials specific only to those employer plans to CMS at the time of use, but CMS may request and review copies if employee complaints occur.

b. You do not need to complete a scope of appointment, but CMS can ask you to reconstruct one if there is a subsequent employee complaint.

c. You are not required to submit copies of disseminated materials to CMS at the time of use, but CMS may request and review copies if employee complains occur.

d. You do not need to take an annual test, but you must not provide potential enrollees with more than light snaks at presentation.

Q82- Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. inaddition to drugs in his plan's formulary he takes several other medications. these include a prescription drug noton his plan's formulary, over-the-counter medications for colds and allergies, vitamins, and drugs from an internet-based Canadian pharmacy to promota hair growth and reduce joint swelling. His nieghbor recently told him about a concept called TrOOP should he ever reach the Part D catastrophic limit. What should you say:

None of the costs of Mr. Wingate's other medications would currently count toward TrOOP but he may wish to ask his plan for an exception to cover the prescription not on its formulary.

Q83- Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA), not by the government. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. What should you tell him?

a. Mr. Carlini can keep Original Medicare, but if he does not sign up for an MA plan that includes prescription drug coverage, he will only be able to obtain prescription drug coverage through a Medigap plan. 

b. In order to obtain prescription drug coverage, Mr. Carlini must enroll in an MA plan. The plan will cover his Part A and Part B services, as well as provide him with the desired prescription drug coverage.

c. Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan through a private company that has contracted with the government to provide only such drug coverage to eligible Medicare beneficiaries.

d. Mr. Carlini can obtain drug coverage through the Federal government’s fallback plans, which are designed to provide an alternative to privately sponsored Medicare Advantage plans.

Q84- Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare prescription drug plan because, although she is entitled to Part A, she is not enrolled under Medicare Part B. What should you tell her?

a. Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she does not need to enroll under Part B before enrolling in a prescription drug plan.

b. As long as Mrs. Mulcahy is 65, eligibility for a Medicare prescription drug plan is not dependent on entitlement to Part A or enrollment under Part B, so she should not be concerned. 

c. To qualify for enrollment into a Medicare prescription drug plan, Mrs. Mulcahy must be entitled to Part A and enrolled under Part B. She should contact her local Social Security office and make arrangements to enroll in Part B prior to selecting a prescription drug plan. 

d. Like all Medicare beneficiaries, Mrs. Mulcahy will be automatically enrolled into a Medicare prescription drug plan when she turns 65. She will have a six month window during which she can select a plan other than the one into which she has been automatically enrolled.

Q85-All plans must cover at least the standard Part D coverage or its actuarial equivalent. What costs would a beneficiary incur for prescription drugs in 2020 under the standard coverage?

a. Standard Part D coverage would require payment of fixed per-prescription co-payments and 75% of the costs in the coverage gap. 

b. Standard Part D coverage would require payment of only fixed per-prescription co-payments

c. Standard Part D coverage would require payment of an annual deductible of $435, 25% cost-sharing between $435 and $4,020, and once through the catastrophic coverage threshold the beneficiary pays either  co-pays for generic and brand name drugs or co-insurance of 5%, whichever is greater.

d. Standard Part D coverage would require payment of an annual deductible, fixed per-prescription co-payments, 35% of the costs in the coverage gap, and once catastrophic coverage begins, the plan covers 100% of all costs.

Q86- Which of the following statements about Medicare Part D are correct?
I. Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a standalone PDP or through their plan.

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

Q87-All plans must cover at least the standard Part D coverage or its actuarial equivalent. What costs would a beneficiary incur for prescription drugs in 2019 under the standard coverage?

a. Standard Part D coverage would require payment of fixed per-prescription co-payments and 75% of the costs in the coverage gap. 

b. Standard Part D coverage would require payment of only fixed per-prescription co-payments

c. Standard Part D coverage would require payment of an annual deductible, 25% cost-sharing up to the coverage gap, a portion of costs for both generics and brand-name drugs in the coverage gap, and co-pays or co-insurance after the coverage gap.

d. There is likely an error because she will be paying 86 percent of the cost of generic drugs in the coverage gap in 2019

Miguel Sanchez is a relatively new agent who has come to you for advice as to what he can do during the Medicare Advantage Open Enrollment Period (MA-OEP). What advice should you give Miguel?

During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings

 

Q88-Mrs. Andrews was preparing a budget for next year because she takes quite a few prescription drugs, she will reach the coverage gap, and wants to be sure she has enough money set aside for those months. She received assistance calculating her projected expenses from her daughter who is a pharmacist, but she doesn't think the calculations are correct because her out-of-pocket expenses would be lower than last year. She calls to ask if you can help. What might you tell her?

It would not be unusual for her costs to be a bit less because the Bipartisan Budget Act of 2018 moved up the date for closing the so-called "donut hole" for brand name drugs to 2019.

Q89-Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he looks at information on various plans available in his area, he sees a wide range in what they charge for deductibles, premiums and cost sharing. How can you explain this to him?

a. The Part D standard model’s importance is that it is the only type of plan into which low-income beneficiaries can enroll and still receive any extra help for which they may qualify. 

b. The government allows Part D plans to adopt any benefit structure as long as the list of covered drugs meets their approval. 

c. The government bases its payments to Part D plans on the standard benefit model. For Part D plans to receive the full government payment, they must offer the standard model, however, they can take a risk and revise their benefit structure to attract more beneficiaries. 

d. Medicare Part D drug plans may have different benefit structures, but on average, they must all be at least as good as the standard model established by the government.

Q90-Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. She is traveling and wishes to fill two of her prescriptions that she has lost. How would you advise her?

a. She may fill both prescriptions and they will be fully covered at in-network pricing due the fact that she is traveling. 

b. She may fill one prescription out-of-network per year and it will be fully covered. Her second prescription will require her to pay the full cost out-of-pocket. 

c. She should wait to fill her prescriptions until she is back home since only her local pharmacy is likely to be in her plan’s network.

d. She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an in-network pharmacy.

Q91-What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications?

a. Part D plans may use varying co-payments for brand name and generic drugs, but they may not restrict access through prior authorization. 

b. The Federal government establishes a set formulary, or list of covered drugs, each year that the Part D plans must use. Beneficiaries should consult the government’s list prior to deciding whether they wish to enroll in a Part D plan during that year. 

c. Part D plans may use varying co-payments, but they are required to cover all prescription medications on the market.

d. 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.

Q92-Mrs. Allen has a rare condition for which two different brand name drugs are the only available treatment. She is concerned that since no generic prescription drug is available and these drugs are very high cost, she will not be able to find a Medicare Part D prescription drug plan that covers either one of them. What should you tell her?

a. Medicare prescription drug plans are allowed to restrict their coverage to generic drugs. She will need to pay for her brand name medications out of pocket.

b. Medicare prescription drug plans are required to cover drugs in each therapeutic category. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs.

c. Medicare prescription drug plans are required to include only a certain percentage of brand name drugs among those they cover. It may be possible that plans available in her area have opted not to include in their formularies the brand name drugs she needs. She may need to pay for this particular medication out of pocket. 

d. When medication costs exceed a certain threshold amount, which rises each year, a Medicare prescription drug plan is permitted to exclude coverage for all but the least expensive of the medications in a given category. Mrs. Allen will need to encourage her physician to prescribe the least expensive of the two alternatives.

Q93-Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr. Vaughn takes a prescription for helping to regrow his hair. They are anxious to have their Medicare prescription drug plan cover these drug needs. What should you tell them?

a. Medicare prescription drug plans are not permitted to cover the prescription medications the Vaughns are interested in under Part D coverage, however, plans may cover them as supplemental benefits and the Vaughn's could look into that possibility.

b. Mr. Vaughn’s hair growth medication would only be covered under Part D if his balding resulted from an illness or was a side effect of a treatment such as chemotherapy. 

c. Medicare prescription drug plans are permitted to cover vitamins, but not drugs for cosmetic purposes. 

d. The vitamins the Vaughns are taking will be covered under Part D, because their physician suggested they should take vitamins, but the hair loss medication cannot be covered.

Q94-Under what conditions can a Medicare prescription drug plan reduce its coverage for a given drug during the first 60 days of the year?

a. If the Medicare prescription drug plan can show that reducing coverage early in the year will result in savings for the Part D plan and the Medicare program, generally the plan may make such a change. 

b. When the Part D plan can demonstrate to CMS that no enrollee has accessed the medication in the past six months, generally the plan can remove the drug from its formulary within the first 60 days of the year. 

c. Under no conditions can a Medicare Part D prescription drug plan reduce its coverage for a given drug at any point during the year.

d. When a formulary change is in response to a drug's removal from the market.

Q95-Which of the following steps may a Part D sponsor adopt for beneficiaries who are at risk of misusing or abusing frequently abused drugs?
I. Identifying at risk individuals by using criteria that includes the number of opioid prescriptions the beneficiary has and the number of prescribers who have written those prescriptions.
II. Locking an at-risk beneficiary into one pharmacy.
III. Locking an at-risk beneficiary into one prescriber.
IV. Increasing deductibles and copays for at-risk beneficiaries.

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

Q96-Mrs. Roswell is a new Medicare beneficiary and is interested in selecting a Medicare Part D prescription drug plan. She takes a number of medications and is concerned that she has not been able to identify a plan that covers all of her medications. She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. What should you tell her?

a. There is no possibility of obtaining coverage for her existing medications once coverage under the Medicare Part D plan begins. She will need to have her physician help her select a new drug that is covered. 

b. She should use any existing prescription drug coverage to get as large a supply of her existing drugs as possible, and then pick new drugs that are covered under her Medicare plan’s formulary. 

c. The Medicare Part D drug plan is required to offer her coverage of the exact same drugs that she is currently stabilized on, so she does not need to be concerned about transitioning to any new medications.

d. Every Part D drug plan is required to cover a single one-month fill of her existing medications sometime during a 90 day transition period.

Q97-Mr. Zachow has a condition for which three drugs are available. He has tried two, but had an allergic reaction to them. Only the third drug works for him and it is not on his Part D plan's formulary. What could you tell him to do?

a. Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his plan.

b. Mr. Zachow will need to enroll in a Special Needs Plan to obtain coverage for his medication. 

c. Mr. Zachow will have to wait until the Annual Election Period when he can switch Part D plans. In the meantime, he will have to pay for his drug out of pocket. 

d. Mr. Zachow could immediately disenroll from the Part D plan and select a new Part D plan that covers the drug that works for him.

Q98-Mrs. Quinn has just turned 65, is in excellent health, and has a relatively high income. She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. What could you tell her about the implications of such a decision?

a. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, if she does sign up at a later date, she will be required to pay a higher premium during the first year that she is enrolled in the Medicare prescription drug program. After that point, her premium will return to the normal amount. 

b. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, if she does sign up at a later date, she will have to pay a one-time penalty equal to 10% of the annual premium amount. 

c. If she does not sign up for a Medicare prescription drug plan, she will incur no penalty, as long as she can demonstrate that she was in good health and did not take any medications.

d. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, if she does sign up at a later date, her premium will be permanently increased by 1% of the national average premium for every month that she was not covered. 

(If you do not have a Medicare Advantage plan that includes Part D drug coverage, you must sign up for it separately. You should sign up for Medicare Part D at the same time that you enroll in Part B.Do not delay even if you do not take any prescription drugs regularly right now. If you wait until later to sign up, you will be charged extra on your premium for every month that you waited. The amount of the premium penalty changes every year.)

Q99-Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his savings account until it is exhausted, and then have his premiums withheld from his Social Security check. What should you tell him?

a. As long as he fills out the paperwork to begin withholding from his Social Security check at least 63 days before such withholding should begin, he can change his method of Part D premium payment and withholding will begin the month after his savings account is exhausted. 

b. In general, to pay his Part D premium, he only can have automatic withdrawals made from a checking account, so he will need to transfer the funds prior to beginning such withdrawals. 

c. During 2017, many people experienced significant problems with deductions from their Social Security check for their Part D premium. As a result, this method of payment is no longer an option for Part D premium payments

d. In general, he must select a single Part D premium payment mechanism that will be used throughout the year.

Q100-Mr. Katz reached the Part D coverage gap in August last year. His prescriptions have not changed, he is keeping the same Part D plan and the benefits, cost-sharing, and coverage of his drugs are all the same as last year. He asked what to expect for this year about his out-of-pocket costs. What could you tell him?

a. Because he reached the coverage gap last year, he will probably reach it again this year close to the same time.

b. Because he reached the coverage gap last year, he will not have to go through it again this year. 

c. Because he reached the coverage gap in August last year, he probably will reach it much earlier this year. 

d. Because he reached the coverage gap in August last year, he probably won’t reach it until much later this year.

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.

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 introduced a Medicare Advantage plan offering comprehensive dental benefits for $15 per month. Best Care has not submitted any potential 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.

Q301-Alice is enrolled in a MA-PD plan. She makes a permanent move across the country and wonders what her options are for continuing MA-PD coverage. What would you say to her in regard to a special enrollment period (SEP)?

a. She is unlikely to qualify for a SEP and should remain on her current plan, relying on her current plan’s out-of-network benefits.

b. She is unlikely to qualify for a SEP but will be automatically covered by Original Medicare and a standalone Part D prescription drug plan.

c. She is likely to qualify for a SEP. She can choose an effective date of up to six months after the month in which the enrollment form is received by the new plan, but the effective date may not be earlier than 30 days prior to the date of her move.

d. She is likely to qualify for a SEP. She can choose an effective date of up to three months after the month in which the enrollment form is received by the new plan, but the effective date may not be earlier than the date of her permanent move.

Q302-Ms. Hernandez has marketed several different types of insurance products in her home state and has typically sought approval for her materials from her State Department of Insurance. What would you advise her regarding seeking such approval for materials she uses to market Medicare Advantage plans?

a. State often volunteer to review marketing materials on behalf of the Medicare agency. She should check with her Department of Insurance to see if such a review is available and would satisfy CMS requirements.

b. Materials need only be reviewed and approved by the company(s) she represents.

c. Materials for marketing Medicare health plans to individuals are subject to Medicare's uniform national requirements. They do not need to be reviewed by the state, but the company she represents must obtain approval from the Medicare agency (CMS) for any materials she uses.

d. Obtaining approval of her materials from the State Department of Insurance is a good practice and she should continue it with materials for the Medicare health plans she represents.

Q303-Richard is a licensed agent who represents Spartan Health Plan and its Medicare Advantage (MA) plans. Richard has several clients who have recently come to him for help who are in their initial coverage election period (ICEP) and are interested in enrolling in one of Spartan Health Plan's MA plans. Alice will soon turn 65 and retire. Alice has coverage through Spartan Health Plan offered by her employer. Bob had health coverage through Spartan but dropped the coverage when he retired early to travel overseas. Bob, who has just turned age 65, is now back in the United States. Charlotte, who will turn 65 next month, has coverage through Athena Health plan - a company Richard also represents. Who qualifies for the opt-in simplified enrollment mechanism?

a. Alice, Bob, and Charlotte because electronic health record interoperability will allow Richard to access any needed information for their application.

b. Alice and Charlotte because each of them currently have health coverage and is in their initial coverage election period (ICEP).

c. Alice and Bob because each of them has had coverage through Spartan Health Plan.

d. Alice because she will not have a break between her non-Medicare and Medicare coverage though Spartan Health Plan.

Q304-Mrs. Patterson is a new enrollee in the HealthBest Medicare Advantage (MA-PD) plan. She is new to this type of coverage and asks you what materials, if any, she should receive. How would you reply?

She should expect either the pharmacy directory in hard copy or a distinct and separate notice (in hard copy) describing where she can find the pharmacy directory online and how to request a hard copy.

Q305-Ms. Lopez is an independent agent under contract with MarketCo, a third-party marketing organization. MarketCo has a contract with BestCare health plan, a Medicare Advantage (MA) organization, to offer marketing services through its contracted agents and agencies. Ms. Lopez returns calls to individuals who contact MarketCo in response to its mailers promoting BestCare health plan. Which of the following best describes the responsibilities of Ms. Lopez?

a. Ms. Lopez no longer needs to be concerned about state licensure sine she is marketing an MA product subject to federal rules.

b. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to comply with CMS marketing requirements, including those regarding using only approved call scripts.

c. Ms. Lopez needs to maintain state licensure, but because she is working for a third-party marketing organization she is exempt from CMS training requirements that apply to BestCare captive agents.

d. Ms. Lopez is considered a marketing representative of BestCare but is exempt from the marketing rules regarding approved call scripts because she works directly for MarketCo.

Q306-Mr. Albert has heard about something called the Star Rating system for Medicare Advantage plans. He asks you to explain it to him since he is interested in enrolling in a plan that is newly available in his area. After you explain that it is the way for consumers to judge plan performance, what else would you say?

a. CMS generally issues plan rating in January of each year, and plan sponsors must update the rating information available to enrollees within 30 days.

b. Plans must provide Star Rating information as part of the Summary of Benefits package, but they may optionally choose to provide Star Rating information on their websites.

c. New plans and Part D sponsors must provide a projection of the Star Rating they will receive until they have been officially awarded an overall Star Rating by CMS.

d. New plans and Part D sponsors that do not have any Star Rating are not required to provide Star Rating information until the next contract year.

(Beneficiaries who live in the service area of a 5-star plan and are enrolled in an MA or PDP plan, or beginning in 2013, a Cost plan Beneficiaries who live in the service area of a 5-star plan, are enrolled in Original Medicare, and meet the eligibility requirements for Medicare Advantage or Part D plans. The SEP is available each year beginning on December 8 and may be used once through November 30 of the following year. For example, the SEP for calendar year 2018 can be used from December 8, 2017 through November 30, 2018. Disenroll from an MA plan, PDP or Cost plan or leave Original Medicare Enroll in a 5-star MA plan, PDP or Cost plan. Eligible individuals may enroll in a 5-star plan through 1-800-MEDICARE, Medicare.gov, or directly through the 5-star plan)

Q307-Mrs. Roberts has just received a new Medicare Identity card in the mail. She is concerned that it is a forgery since it does not have her Social Security number on it. What should you tell her?

a. The card is indeed a forgery since newly issued Medicare cards will have both a beneficiary’s Social Security number and date of birth imprinted on them. 

b. The card she received I valid, the change has been made to protect Medicare beneficiaries from identity theft, and she should now destroy her old card. 

c. The card is indeed a forgery since all identity cards are being phased-out in favor of a new electronic identity system developed by the Social Security Administration. 

d. The card she received is valid but she should keep her old card for at least two years and present it whenever she receives health care.

Source: New Medicare Identification Cards

Q308- One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. She asks you to explain it. What do you say

e.

Q309-Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims for services. What advice would you give her?

a. Mrs. Duarte has no right to appeal this determination since her claim has been partially paid.

b. Mrs. Duarte should file an appeal of this initial determination within 90 days of the date she received the MSN in the mail. If she still disagrees with Medicare Administrative Contractor’s (MAC’s) further decision she should request a reconsideration by a qualified independent party within 10 days.

c. Mrs. Duarte should request a reconsideration of the decision by a qualified independent party within 60 days of the date she received the MSN in the mail.

d. Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received the MSN in the mail

Q310-Any person who knowingly submits false claims to the Government is liable for five times the Governments damages caused by the violator plus a penalty.

False

Q311-These are examples of issues that should be reported to a Compliance Department: suspected Fraud, Waste, and Abuse (FWA): potential health privacy violation, and behavior/employee misconduct.

True

Q312-Bribes or kickbacks of any kind for services that are paid under a Federal health care program (which includes Medicare constitute fraud by the person making as well as the person receiving them.

True

Q313-Waste includes any misuse of resources such as the overuse of services, or other practices that, directly or indirectly, result in unnecessary costs to the Medicare Program

True

Q314-Ways to report potential Fraud, Waste, and Abuse (FWA) include:

All of the above

Q315-Once a corrective action plan is started, the corrective actions must be monitored annually to ensure they are effective.

True

Q316-Which are of potential discrimination is not generally covered by ACA Section 1557?

Employment

Q317-As a result of violations of ACA Section 1557 nondiscrimination rules,

a health plan may revoke an agent or broker's appointment with the health plan.

Q318-if a health plan violates ACA Section 1557 nondiscrimination protections, it may be:

Required to take corrective action and sometimes pay damages, and it may be sued by individuals.

Q319-Under ACA Section 1557, a health plan sold through a state exchange may, based on an individual's age,

Under ACA Section 1557, a health plan sold through a state exchange may, based on an individual's age,

Q320-ACA section 1557 rules for disability concern

Policies and procedures, physical access, and communication.

Q321-Under ACA Seciton 1557, a person

cannot be discriminated against based on her legal or illegal immigration status or ability to speak English

Q322- Qa1-In order to cover some of the gap between FFS Medicare coverage and the actual cost of services, beneficiaries often rely on Medicare supplements. Which of the following statements about Medicare supplements is correct?

A. The initial ten (A-J) Medigap policies offer a basic benefit package that includes coverage for Medicare Part A and Medicare Part B coinsurance.

B. Each insurance company selling Medigap must sell all the different Medigap policies.

C. Medicare SELECT is a Medicare supplement that uses a preferred provider organization (PPO) to supplement Medicare Part A coverage.

D. Medigap benefits vary by plan type (A through L), and are not uniform nationally.

Q323-Which of these actions is most likely to be permitted in dealing with a person with limited English proficiency?

Allowing a child to interpret in an emergency.

Q324- ACA Section 1557 differs from earlier legislation in providing broader protection against discrimination based on

Sex

Q325-Section 1557 of the Affordable Care Act applies to

All health programs and activities administered by or receiving federal financial assistance from HHS.

Q326-Which Medicare programs are covered by ACA Section 1557?

Parts A, C and D, but not B

Q327-Under ACA section 1557, prohibited actions involve

Eligibility, claims, and marketing.

Q328- Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare Parts A & B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years. However, the plan does not provide drug benefits. How would you advise Agent John Miller to proceed?

Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage