Jump to content
Insurance Agent Forum by NAAIP

NAAIP Admin

Administrators
  • Posts

    281
  • Joined

  • Last visited

Everything posted by NAAIP Admin

  1. the there is a med quote engine was updated a long time ago. you are able to edit out the name of the carrier to show major company #1, etc. because the quote engine is good at collecting info. We did build a medicare quoter that only collects client info.. no rates.. that is very good.. You can access it on quote engine positions in your back office.. to make life and hide the engine. I believe we will be hiding all med sup quote engines on all site and making the quoter live. The Final expense quoter is only collecting client info.. so it is good... I call quote engine when it gives rates and quoter when just collects client info.. we dont have a final expense quote engine.. Here is link to all our iframe quote engines/quoters https://www.naaip.org/quote-engine-agent-websites
  2. Hello {agent}, Website News: I did a switch. If the term life quote engine was sitting at the top of your site and Final Expense quoter was at the bottom, then they are now reversed. The FEX is at the top. You can edit back at Quote Engine Position. The mission statement of NAAIP has become to provide full-time employment for agents to sell Final Expense and Mortgage Protection insurance. We have a great system and you might as well join in. Incentive-based marketing works. I will give you a free luxury vacation if you set up your NAAIP site well and make one sale for either of our favored carriers. Between these 2 carriers, you have 6 different Final Expense Policies. Recruiter Level Commissions are listed on the linked pages. We offer advanced commissions for those that need up-front cash. We are not playing games. Congrats to Emma Pinkston who edited her website with my help to highlight a free vacation to Orlando or Las Vegas for booking an appointment. Emma is a notary public and also helps her neighbors with their "Last Will & Testament." Emma and I are working on her Facebook Advertisements. Filled out forms for 3 and 4 dollars is the way to go. Holler If you want to put this video on your website: https://www.youtube.com/watch?v=SJI5gnDIQpw - I am here to help you. You can use my account to offer your clients free luxury vacations. Unbelievable. I joined MarketingBoost.com right before their price increased to $197/month. These great ideas and discussions occur on my Facebook Group. A few days ago, I had to change the FB group address because of a technical issue. Please join. The 6 day per week conference call is going on for up to two hours. There is demand for my new-found technique offering a game-changing good deal for agents selling Final Expense. Next call is in 20 minutes. Conference Call: Monday to Thursday Noon & Weekdays 2pm Eastern Time Dial 1(888)532-9320 Regulations regarding incentives as per Florida below. Agents should check the regulations for their state. Per F.S. 626.9541 Unfair methods of competition and unfair or deceptive acts or practices defined. (m) Advertising and promotional gifts and charitable contributions permitted.— 1. The provisions of paragraph (f), paragraph (g), or paragraph (h) do not prohibit a licensed insurer or its agent from: a. Giving to insureds, prospective insureds, or others any article of merchandise, goods, wares, store gift cards, gift certificates, event tickets, anti-fraud or loss mitigation services, or other items having a total value of $100 or less per insured or prospective insured in any calendar year. b. Making charitable contributions, as defined in s. 170(c) of the Internal Revenue Code, on behalf of insureds or prospective insureds, of up to $100 per insured or prospective insured in any calendar year.
  3. this is a one that says no MLM.. just direct $34 lead for postcards 26.3% closing rate on postcards average 700-800 dollars a sale with 6 carriers..85 percent aa, rna, prosperity for gi and aig also has starts at 105% at core.. and 115% with primary carriers 110 and 120..8,000 in a month three months in a row 115 and 125 15k three months in a row 120 and 130 20k three months in a row aig is 60% average agent sells GI 4% of the time should have 3000 usd to invest in leads 300 dollars for class.. but he can get it for 80 usd. 4 and half weeks for direct mail to come back to you. average agent is spending for 20 leads per weeks - minimum lead order is 15 leads a week. top agents are buying 40 leads per weeks every morning at 9am they have training call... for about half hour advances are 9 months.. 16 hour course to be trained... relationship with builder aged leads from 50cents to 28 usd, facebook leads are 20 usd
  4. We discuss Promocodes on daily conference call At the footer of www.naaip.org I have a link to https://www.webce.com/naaip - I believe very shortly I will be coming up with a better discount. This one is 10% check the footer of www.naaip.org under sales tools when you are ready to order or ask at our 6 day per week conference. Conference Call: Monday to Thursday Noon & Weekends 2pm ET Dial (888)532-9320 - No Pin needed
  5. Hello Agent, Subject Line: Free Vacation from NAAIP - Orlando, Las Vegas, Cancun, etc. 49 Cities/Resorts Available Christmas is Coming Early! I will incentivize you to do your job. To earn six figures. I will give you a free vacation. You have a choice of 50 cities and resorts worldwide. From 3 nights/4 days in Orlando or Las Vegas to 8 days /7 nights in Bangkok or Bali. Typically, a 4 or 5 star resort/hotel in which you only pay taxes/resort fees that average $25 per night. I joined MarketingBoost.com right before their price increased to $197/month. I am allowed to send out unlimited vacations, unlimited $100, $200 or $300 hotel/car rental savings cards and unlimited vouchers that includes 55,000 local and chain restaurants with discounts of up to 50% off from Dining Advantage. Click on marketingboost above and tell me where you want to go. The location has to be at least 100 miles from your residence and 30 days from the booking. I can only give you one free vacation per year. If you want to have these incentives in your arsenal, please join with the link above which is NAAIP's affiliate link. Please be aware of state regulations as to specific dollar amount of incentives that your state allows. I have seen insurance agents use incentives to set appointments and encourage referrals. An insurance agent must be aware of state laws which prohibit incentivizing the actual purchase of a policy. Here is what I need you to do. (I can help you with each point) 1. Set up your NAAIP website properly on your domain name. 2. Properly understand "Moving up Google" by watching the 13-minute video on this page https://www.naaip.org/buy-domain 3. Set up your website in with Google Local and Maps (then Bing Places). 4. Join my Facebook Group & Like my Facebook Page - Give 5 stars and make a nice comment. 5. Subscribe to my YouTube Channel and make at least one comment - You can access by clicking on any NAAIP video. 6. Refer at least one agent to sign up to NAAIP website - tell me his/her name. 7. I need you to register for Dental Plans and link it up properly to your NAAIP website. If you want to delete it afterwards that is fine. You should be aware that NAAIP websites are very good for products that have click to buy. 8. Be cognizant that offering prospects a Free Will is a "Winner." Consider being a Notary Public and carrying a portable printer in your car. 9. Be cognizant that Facebook Leads are huge. Especially using incentive-based marketing - I can help you set up/run the account if you work with NAAIP. 10. Be cognizant that postcard marketing is huge. Sometimes it is best to just knock on the door, explaining that you sent the postcard already. 11. Be cognizant of the tremendous resources at www.naaip.org/lead-services. Tell me how much time you were on this page. NAAIP is working hot and heavy for United Home Life and Oxford Life. NAAIP's mission statement is to get agents selling these two carriers. United Home Life has a tremendous product line that includes five different Whole Life/FEX policies (up to 150k), Term till 300k and accident that can get to 200k. More Website News: You can now put the FEX Quote form at the top of your site. Check out your back office and the two new buttons Quote Widgets and Quote Engine Positions. Soon enough NAAIP will have a "Free Will" at the bottom of all sites and be able to be white labeled for recruiters. Patience, my dear. NAAIP is aiming to be a dominant player in the insurance. I need your help. Please join our 6-day per week conference call, and we will figure out together how to make this work. Conference Call: Monday to Thursday & Weekends 2pm ET Dial (888)532-9320 - No Pin needed Regulations regarding incentives as per Florida below. Agents should check the regulations for their state. Per F.S. 626.9541 Unfair methods of competition and unfair or deceptive acts or practices defined. (m) Advertising and promotional gifts and charitable contributions permitted.— 1. The provisions of paragraph (f), paragraph (g), or paragraph (h) do not prohibit a licensed insurer or its agent from: a. Giving to insureds, prospective insureds, or others any article of merchandise, goods, wares, store gift cards, gift certificates, event tickets, anti-fraud or loss mitigation services, or other items having a total value of $100 or less per insured or prospective insured in any calendar year. b. Making charitable contributions, as defined in s. 170(c) of the Internal Revenue Code, on behalf of insureds or prospective insureds, of up to $100 per insured or prospective insured in any calendar year.
  6. NAAIP was recently tasked with making a Final Expense Carrier America's #1 Final Expense/Whole Life/Mortgage Term carrier. It will be a relatively easy job for us to accomplish. Here are the bullet points: 5 different FEX/Whole Life products. Preferred, 2 Standards, Graded and GI. The Preferred FEX is called Provider Whole Life and offers from 10k to 150k in whole life and is not shown on fexquotes so you may not have known about these super-competitive rates. No E&O required. All forms, quote engines, applications are online with password protection. Use password USA to access. Over the phone selling made easy. UHL FEX, Term and accident can be sold by phone. UHL's term life combined with accident is perfect for mortgage protection. Commission levels: ask us. NAAIP's mission statement is to recruit and train agents to sell FEX's product line. I encourage agents to put our final expense quoters at the top of your NAAIP website - example site. These changes can be made in your back office via "quote engine position", "Header image(big)", and "Pop-over in header image." It would be a good idea to change the content to include information on the product that you are selling by editing "Content Management." I have beefed up our page https://www.naaip.org/sell-final-expense-by-phone and https://www.naaip.org/lead-services with more great information and resources. I will walk you through the exact steps that you must do to make a sale a day for United Home Life. FEX products are simple - No invasive testing. A few yes/no questions to determine eligibility. I have a feeling that UHL is the perfect fit for NAAIP agents. Soon enough, NAAIP will have a "Free Will" at the bottom of all sites and be able to be white labeled for recruiters. Patience, my dear. Join NAAIP's Facebook Group - FEX carrier recruited us because they were impressed. Having lots of agents in our Facebook Group helps. I need everyone who reads this email to join NAAIP's group. It is a great resource to interact with our agent services and other NAAIP users. Facebook is Huge! New Conference Call Times. Monday to Thursday Noon & Weekends 2pm ET - I am dropping Friday and Adding Saturday at 2pm. Bring a friend, even a non-licensed person, to join. The training that will be provided on the conference call will cause any normal person to earn a decent living. More news: The Brokerage Company that NAAIP was referring agents is not happy with the type of agent that we have been sending. The brokerage company is adamant that NAAIP should not refer them new agents that earn less than 100k per year. I have to respect their wishes.
  7. for new agents - the 3 main carriers rna 100 - no height and weight and voice signature - jet term, spwl uhl 102.5 - full suite of products - low rates - seemless eapp - now for 300k aa 105 - for term and ul products - mortgage protection.. easy UL.. lower rates, more db - goes to 300k then americo is 120 - high commissions.. - mortgage protection... for me annuity athene, national life group/ameritas iul transamerica - paper apps/complicated - for unhealthy moo - moo is tough underwriting.. .. has good GUL - ton of products Our Final Expense carriers are: Americo = 120% (E&O Required) Mutual of Omaha = 110% (E&O Required) American Amicable = 105% Royal Neighbors (RNA) = 100% Transamerica = 115% United Home Life (UHL) = 102.5%
  8. Subject Line: {$name}: It's All About the Benjamins w/ NAAIP "It's All About the Benjamins" is slang for making money. A Benjamin is a $100 dollar bill. My job is to some how, some way figure out the way to get NAAIP to 20, 30 and then 40 and 50,000 users. To make NAAIP synonymous with high quality free-forever websites, quoters and sky high compensation if agents sell through us as the up-line. Currently, NAAIP is sitting at 10,674 registered users. Your job as a licensed insurance agent is to make a sale a day or a few sales a week. To be consistently earning 6 figures per year. NAAIP technology is always improving but this latest improvement is a winner. Our programmers made https://www.naaip.org/quote-engine-agent-websites. Additional iFrame html quote engine widgets for FEX, health, medicare, homeowners, renters, boat, motorcycle, condo, business and more. We placed these quoters at the bottom of all sites. Agents can place the individual quoters on non-NAAIP sites using the codes from the link above. There is another day or two for the programmer to work to make the quoters for NAAIP sites more editable, etc. In the meantime, great programming work is sitting at the bottom of your NAAIP site. Perfect programming and thousands of agents relying on our brain-power will help NAAIP get to 50,000 agents. I am all-in in helping agents succeed. Leads (getting in front of prospects) are so important for agents. I am constantly updating https://www.naaip.org/lead-services. NAAIP is part of an incredible incentive-based marketing programming. Free vacations, free restaurants. I have the ability to give away a free 4 day/3 night vacation in Orlando, Las Vegas, Cancun and dozens of other locations. I will be using these gifts to incentive you to Signup to NAAIP. Properly host your NAAIP site on your own domain. Do proper steps to move up Google, Google Local/Maps, etc. Sell insurance with NAAIP as the up-line. Incredibly high commissions, especially with with my favorite, FEX/Annuity/SPWL carrier. Join us at a conference call for details. Remove the adverts on your site by selling/referring or paying a measly 99 cents per month. Agents can use incentive-based marketing to boost business. You have to be aware of department of insurance regulations that forbid you from incentivizing the purchase of an insurance policy. Yet, incentivizing the filling out of a lead forms and meeting the agent seems to be OK as long as you don't demand that one must make a purchase in order to get the free vacation/restaurant. As well, incentivizing referrals from your existing clients is OK. Imagine showing your appreciation to your existing client base by giving them a free vacation after they refer you to their friends. Amazing. If you decide to join this incentive based marketing program it would be $41/month. Click here. NAAIP is a partner/affiliate. Click our link which is also located on our lead-services page. Lots of good resources in the incentive-based marketing back office. Facebook lead help in particular. In the future, if you decide not to pay the $41/month you can have NAAIP send the free vacation/restaurant link to your people. I would love that you know this program well so that you can explain the program and have use of the resources in the incentive-based marketing's back office. I figured out that Facebook and Facebook Groups is HUGE. Join NAAIP's Facebook Group -NAAIP's Facebook Group We placed advertisements on - after 25 hits, to hide the ads you can sell through NAAIP, or refer others to do so. The alternative is to input your credit card/paypal for 99 cents first month and 9.99 afterwards. Thank you for giving me the opportunity to help you earn more money. Sincerely,
  9. John Hancock announced Oct. 3 it is expanding its Apple Watch program to include the new Apple Watch Series 5. Beginning this fall, customers can earn the watch through the John Hancock Vitality Program for just $25, simply by being more active. The newest version of the watch features an always-on retina display, an updated compass, and international emergency calling, as well as hard fall and electrical heart sensors. Brooks Tingle, president and CEO of John Hancock Insurance, said the announcement further cements the company’s commitment to motivate and inspire customers to both protect their financial futures and live longer, healthier lives. “The Apple Watch has been an extremely popular and effective component of our program as customers who use it report increased motivation and physical activity, the bottom line in what we’re trying to do with our insurance,” Tingle said. “Healthier lives are not only good for our customers and their families, but good for our business and society as a whole.” In a recent survey of John Hancock Vitality members with Apple Watch, 84% said they are motivated to exercise by their Apple Watch and 90% wear an Apple Watch seven days a week. Furthermore, a RAND Europestudy of over 400,000 people, the world’s largest behavior tech study based on verified data, concluded that those who participated in Vitality’s Global Apple Watch programs averaged a 34% sustained increase in physical activity compared to participants without an Apple Watch. With the John Hancock Vitality Apple Watch program, policyholders can choose the Series 5 (40mm) or Series 3 (38mm), pay a $25 initial fee (plus tax), and get started. They can also customize their watch with features like cellular or a larger face size for a one-time upgrade fee. Whether they like to walk, run, bike or swim, it’s easy for participants to share their activities and earn points that go toward monthly payments for their watch over a two-year period. John Hancock Vitality members are able to fully fund their watch by meeting monthly physical activity targets. The John Hancock Vitality Program first launched in 2015. Through the program, customers can earn savings of up to 15%* on premiums and rewards for the everyday things they do to stay healthy, like exercising, eating well and getting regular checkups, including $600 in annual savings on healthy food purchases. As an extension of John Hancock Vitality, the Company first introduced the Apple Watch program in 2016, offering policyholders the opportunity to earn an Apple Watch to support their physical activity goals and earn points.
  10. Hello , A huge part of selling financial products is coming across as a professional. Let's Do It! You're NAAIP is part of a list that is a.) not properly hosted or b.) has advertisements on their website. Not good. For the longest time, I have been encouraging agents buy a domain and do proper hosting. Buying a domain from Godaddy using a coupon code is $5 for the first year and then $10 per year for the next two years. Afterwards it would be $18. I would recommend that you change over to Cloudflare at $8 per year instead of paying the $18. NAAIP websites are free forever, but we place advertisements on your site after 25 hits. You have the option to sell through us at the highest commissions levels in the industry or refer to us and the adverts will disappear. You can even sell through us years later and I will refund whatever payments you have made. In any case, the payments to hide the adverts are tiny. First month with a promo code is 99 cents and afterwards $9.99. Here is the plan. I can take care of everything. a.) Join the conference call and I will walk you through what must be done. It is described here anyways. https://www.naaip.org/buy-domain with relevant videos. I will give you the 99 cent promo code during the conference call. The other alternative is to give me your credit card/paypal info. 1. I will hide the advertisements on your site that appear after 25 hits. I will not use the promo code. It will be $9.99/month from the start. Obviously, if you sell via NAAIP and input sales in your NAAIP back office the adverts/payments would not be an issue. 2. I will open a GoDaddy account for you and make a 3 year domain purchase. I will choose the domain from the list on https://www.naaip.org/buy-domain - We will be on sms/text message contact for you to confirm that you like the domain. Then I will purchase the domain in your account for 3 years. 3. I will properly host your website via DNS IP address in your GoDaddy and NAAIP back office. This is a 2 step process that takes 3 minutes. I will do this for you. Hopefully, when your site is properly hosted you will spend the 13 minutes to learn how to move your site up Google, Google maps, Google local, etc. I am making a link to that YouTube video on this email. As my Daddy told me when I was a kid. Don't be Stupid! lol. Seriously, this is so easy and so important for you to impress others that you are a top-level professional. Let's do it. As you know we placed advertisements on - after 25 hits, to hide the ads you can sell through NAAIP, or refer others to do so. The alternative is to input your credit card/paypal for 99 cents first month and 9.99 afterwards. Thank you for giving me the opportunity to help you earn more money
  11. Live Daily Coaching Calls. I’ll teach a lesson on sales training, lead generation, or review an agent’s sales call, all with the goal of increasing your sales and marketing skill, so that you’ll get better results selling insurance. Learn Multiple Insurance Sales And Marketing Systems. In addition to my final expense sales and marketing system, you can now learn how to sell Medicare Supplements to folks turning 65 and older, in addition to learning how to sell and market for mortgage protection business, annuities, and critical illness insurance. This is great training for new agents looking to specialize in a market and wanting to know the best options, and for experienced agents looking for a product change. FREE Access To Term, Universal Life, Final Expense, Medicare and Annuity quote engines at footer of https://www.naaip.org. Learn How To Generate Insurance Leads Organically on YouTube and Through Google Search. Discover How To Create Your Own Facebook Ads And Eliminate The Lead Generation Middle Man.
  12. Aetna offers a variety of Aetna Medicare Advantage plan types. Which plan type requires a person to use only network providers? (Excluding emergency or urgently needed services) Choose one answer. a. PDP plan b. HMO plan c. PPO plan d. ESRD plan Correct. Correct Marks for this submission: 5/5. Question2 Marks: 5 Which plan type allows members to see preferred doctors in network, doctors out of network and does not require referrals to a specialist? Choose one answer. a. PDP plan b. Cost plan c. PPO plan d. HMO plan Correct. Correct Marks for this submission: 5/5. Question3 Marks: 5 Most Aetna Medicare Advantage plans are integrated with prescription drug coverage, so they are called MAPD plans. Answer: True False Correct. Correct Marks for this submission: 5/5. Question4 Marks: 5 Aetna case management consists of registered nurses, social workers, behavioral health professionals and pharmacists who help members navigate the health care system and access services. Answer: True False Correct. Correct Marks for this submission: 5/5. Question5 Marks: 5 Aetna Medicare Advantage HMO and PPO plans have no out-of-pocket maximum. Answer: True False Correct. Correct Marks for this submission: 5/5. Question6 Marks: 5 Aetna Medicare Advantage HMO and PPO plans cover routine preventive care including an annual wellness visit, screening mammograms, and prostate cancer screenings. Answer: True False Correct. Correct Marks for this submission: 5/5. Question7 Marks: 5 A member’s cost share at a preferred pharmacy will usually be lower than cost share at a standard pharmacy. Answer: True False Correct. Correct Marks for this submission: 5/5. Question8 Marks: 5 All MAPD plans have a prescription drug component. Answer: True False Correct. Correct Marks for this submission: 5/5. Question9 Marks: 5 Which of the following are true? Choose one answer. a. The Aetna Medicare PPO plans provide access to services from doctors in the PPO network at a lower out-of-pocket cost. b. In the Aetna Medicare Open Access HMO plan, members can go to any Aetna Medicare Plan HMO network doctor they choose for covered services without a PCP referral as long as the doctor is a contracted HMO doctor. c. All of the Medicare Advantage plans include free monthly fitness club memberships to any facility participating within the SilverSneakers network. d. All of the above. Correct. Correct Marks for this submission: 5/5. Question10 Marks: 5 You can find a quick list of tools for Aetna Medicare plans on www.aetnamedicare.com/brokers which includes information about plans, medications, and doctors. Answer: True False Correct. Correct Marks for this submission: 5/5. Question11 Marks: 5 What is a Dual eligible Special Needs Plan (D-SNP)? Choose one answer. a. A type of Medicare Advantage Prescription Drug (MAPD) plan designed to provide targeted care and services to individuals with specific needs b. A MA plan that tailors benefits, provider choices and drug formularies to meet specific needs of the groups they serve c. A MA plan for those who are eligible for Medicare and Medicaid. d. A MA plan required to contract with a state Medicaid agency e. All of the above Correct. Correct Marks for this submission: 5/5. Question12 Marks: 5 Low Income Subsidy (LIS) is a Medicare financial assistance program that helps to reduce prescription drug costs. Answer: True False Correct. Correct Marks for this submission: 5/5. Question13 Marks: 5 The difference between LIS and the Medicare Savings Program (MSP) is LIS helps reduce prescription drug costs and MSP helps with Medicare plan premiums, deductibles and copayments/coinsurance with medical services. Answer: True False Correct. Correct Marks for this submission: 5/5. Question14 Marks: 5 Which of the following is true for Low Income Subsidy: Choose one answer. a. Beneficiaries pay no more than $3.60 for a covered generic and $8.95 for each brand name drug b. There is no coverage gap c. There is no Late Enrollment Penalty d. All of the above Correct. Correct Marks for this submission: 5/5. Question15 Marks: 5 A full dual eligible means an individual has Medicare, but is only eligible for assistance with Medicare premiums and sometimes cost share through the Medicare Saving Program. Answer: True False Correct. Correct Marks for this submission: 5/5. Question16 Marks: 5 LIS Medicare drug plan premium and deductible costs are based on income level. Answer: True False Correct. Correct Marks for this submission: 5/5. Question17 Marks: 5 Full benefit duals meet state Medicaid eligibility requirements and are entitled to receive the Medicaid services they need. Answer: True False Correct. Correct Marks for this submission: 5/5. Question18 Marks: 5 One of Aetna’s Model of Care goals is to improve use of preventive health services. Answer: True False Correct. Correct Marks for this submission: 5/5. Question19 Marks: 5 Which are attributes of the Aetna’s Model of Care: Choose one answer. a. An Interdisciplinary Care Team approach b. Clinical Programs to improve health and well-being c. Transition of Care Program d. A and B e. All of the above Correct. Correct Marks for this submission: 5/5. Question20 Marks: 5 The Aetna DSNP care manager and care team provide a single point-of-contact to help coordinate all Medicare and Medicaid covered care and services that the member needs. Answer: True False Correct.
  13. when can consumers eligible for unitedhealthcare sco plan enroll if the consumer has both medicaid and medicare? answer: once per quarter during and during aep while determining if carl is eligible for the UHC sco plan, anne learns that carl does not pay copayments when he goes to the pharmacy. what that may indicate. answer. carl may be enrrolled in pace. if that is confirmed carl should not enroll. uhc sco is a fully integrated dual eligible fide (fide)snp offered in MA. the plan covers remibursed under medicare and masshealth, the ma state medicaid program. the uhc sco plan also provides specialized geriatric elder support services and respite care for families and caregivers in addition to providing the medicare and medicaid benefits. medicaid in ma is called masshealth is combination medicaid and state childrens health inssurance plan (schip) in one program. to be eligible for masshealth, must live in ma, have low to medium income and meet certain financial eligibilty requirements. masshealth offers six coverage types of individuals, families and people with disablities. masshealth standard masshealth common health masshealth careplus masshealth family assistance masshealth premium assistance masshealth limited only individuals enrolled in masshealth standard who also meet the eligibility requirements maybe enrolled in uhc sco Pace is the program for the all-inclusive care for the elderly progrram covered by medicare and masshealth. in some areas it is referred b to as the elder service plan (esp) special consideration should be given prior to enrolling a pace covered person in SCO. pace offers coordinated care provided by health providers, additional covered services (meal delivery) and case management. the purpose of a sco is to keep members as independant as possible, whether they live in the commnity or in an institution. to achieve this goal, the plan offers benefits in addition to those covered by Original medicare and medicaid alone. as a fully integrated plan, members receive all their medicaid and medicare benefits through UHC. sco plans are like health maintenance organizations hmo. and require each member to select and use an in-network pcp primary care physician. community service - adult day care, housekeeping, home delivered meals, transporrtantion, are covercovered if guidelines are met other benefits and services, drugs - no copayments or out of pocket costs for covered drugs and for over the counter medications orded by the primary physician (unlike masshealth only coverage) dental- routine exams, cleanings, fillings, dentures, implants, and more in addition to masshealth. vision, annual eyeglasses and hearing benefits. transportation to all medical benefits hospice at in network hospice providers for masshealth standard recipients without medicare(original medicare still covers hospice for those with medicare) masshealth - medicaid -standard sco members must be enrolled in masshealth... most will be covered by medicare, but it is not required for enrollment in uhc sco. cms granted permission to the state executive office for health and human services eohhc to require that medicaid only individuals be included in the sco eligible eligible population. sco plans contracted with MA are required to provide the same benefits to the medicaid only members as medicare and medicare covered members. care management team is responsible for care planning and service coordination of all medicare and masshealth standard covered services. a health risk assessment tool is used to assess the level of each member's health care within 30 days of becoming a member. all members assessed at least twice a year, with more frail members being assessed more frequently. care management proactively works to coordinate care and service as a seamless model of care. this is a fundamental aspect of the UHC sco and is also a key selling point. uhc sco care management provides recomendations for timely, medically necessary covered health care services in an appropriate setting. uhc sco care management focuses on primary and preventative care. care managers share servics and care plan information with the member's Pcp. in addition. the uhc sco clinical team has a healthcare service coordinator to help assist members get on boarded onto the plan and obtain preventative services they may need , such as flu and pneumonia vaccines. uhc sco care management provides access to telephonic support 27/7. members are able to call toll free to reach health care professionals to ask questions and discuss concerns about their health care. uhc sco care management seeks to optimize a members health and well being by helping the member obtain the medical and home/communitiy based services they need. such as personal care assistance, home health and adult day health. to enroll in uhc sco plan, what level of medicaid must the consumer have. answer enrolled in masshealth standard. what is NOT a component of care management? providing community services is not specifically a function of care management. the other choices were. eligibility to uhc sco plan. - prefacing. best practice to not be intrusive ,, asking in a nice way personal questions. .. ask for approval to continue. is the consumer 65 or older? is the consumer enrolled in masshealth standard does the consumer live in the plans service area does the consumer have esrd does the consumer only have masshealth and live in a hospice that is outside the plans netowkr. does the consumer qualify for masshealth standard through frail elder waiver - few consumers must have a valid election period to enroll or disenroll in uhc sco plan. medicare and medicade can enroll during the Medicare initial enrollment period - iep - and the annual election period aep, the medicare advantage open enrollment period oep and available special election period sep. consumer with medicare and medicaid can use the sep for dual/lis maintainting once per calendar quarter from january till september medicaid only consumer are not restricted by cms election rules and can enroll/disenroll monthly. the plans effective date depends on the election period used by the consumer. when sep/lis maintaining is used the plan effective date is the first day of the month following the receipt of the enrollment application. the date the agent signs the enrollment application is considered the reciept date. pace stands for program for all inclusive care for the elderly pace is unique benefit under medicare and medicaid that focuses on frail seniors who meet the states standards for nursing home care. it features comprehensiv medical and social services at an adult day health center. - in home and or in patient facility. for most participants , the comprehensive care allows them to remain in their home while receiving care, rather than be institutionalized. a team of doctors, nurses and other health care professionals assess a participants needs, develops care plans and delivers all services under one integrated plan. PACE is available in states like MA that have offered to it through their medicaid program. pace and other sco plans. when consider enrolling consumers in uhc sco, be sure to determin whether the consumer is enrolled in pace. unless their is a compelling reason, it is generally nor appropriate to enroll pace members in uhc sco. these members are very frail and moving to sco may require changing providers. these maybe the reason to change to sco.... that the pace member moved out of the pace service area. that the member does want to stay with her pcp and wants to use a pcp with uhc sco netork. there are numerous pace sites in MA. see online. there are six uhc sco plans in ma.if consumer is not happy with providers may change, but ussually not by seeing the insurance card one is able to know if with plan already. if consumer states that pays no copayment for drugs then agent must seek confirmation that not with pace or sco. if on adult day care - then cross reference the pace centers. which is comparible to benefits of sco. marketing.. be complient... agent must take and pass the events basic module. take the module to present the plan. only enroll if good for consumer.. signed and dated by agent, review medicare card for accuracy.. provider directory for their area, pharmacy formulary will be mailed in welcome kit. if want provider directory for additional area they may request and it will be mailed at no cost. agents should use online directory and formulary.. and encourage members to contact customer service or online to confirm up to date provider status. agents should look up online the doctor status... jarvis,uhc toolkit, uhc sco promo materials, phd, jarvis wrap, search tools, uhc toolkit,, additional sales tools be knowledgable about medicaid eligibility requirements and masshealth benefits, scope of appt review current health coverage, verify if have masshealth standard. look up consumers providers, pcp, if in network. must be willing to change pcp if not in network. explain how to access doctors. confirm understanding of plan. explain, review the sco enrollment guide. explain costs, details. pcp name. enrollment guide to rules about enrollment, cancelation, disenrollment ... consumer may cancel before effective date.... cancelations in writing .,. and effective till end of month.. effective till ineligilbe .. they are in service area and in masshealth standard. venues to sell should be accessable to wheelchair.. and public transportation.. if inquire about eligibility refer to eohhc] agents must make available to uhc sco, upon request, all schedules of selling and activity to sell. consumers should have upon request.. relevant info.. agents use approved materail,,,access used by uhc sco materials.... distribute that material by mail promo material if less than 15 dollars no incentives to enroll or refer.. no door to door, or unsolicited contacts..must only use approved scripts, etc. select with group of individual might qualify for medicaid? certain person and famililies with low income requirement of masshealth? live in MA which is the following compenents of uhc sco plan is considered its foundation care management which 2 are true about uhc sco care management program? a health risk assessment tool is used to assess the level of each member's health care care management team is responsible for care planning and service coordination of all medicare and masshealth standard covered services. when will johns coverage begin - only medicaid- if sign up nov 10th? december 1 and use current year app.. which of the question could you ask the consumer to determin if they have pace or another sco plan? do you currently pay copays for drugs. requirements of uhc sco plan. resident of service area. which of the following about esrd. and uhc sco? may not enroll in plan unless has uhc or the ma plan that they have has terminated. what is best describe pace and why no good to enroll them in sco plan.. it is an optional benefit under medicaid and medicare that focuses on frail seniors who meet their states standards for nursing home care. pace features comprehensive care that allows members to remain in their homes while recieving care. enrolling in a sco plan would change their providers and care approach. mr javitz saw his pcp is not in sco network.. and not willing to change his pcp. what should agent do. agent should not enroll him. health risk assessment .. statement is true. it is used by the care management team to determine the members level of healthcare needs. when presenting sco plan to consumer these 2 things agent must do look up provideers in online directory confirm if doctors are in network. explain that the doctor status can change the advise consumer to call the plan or look online to confirm before see dr. coverage guidelines do not typically cover in community services? pet grooming if medicaid only which is true regarding enrollment in uhc sco/ enrollment can occur year round with continueous enrollment. what is the reason to enroll a pace member in a uhc sco? participant moves out of pace area.
  14. Final Exam - Attempt 2 - one wrong answer - not sure which one - From Sally of Bangor - very trusted Question1 Marks: 1 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? Choose one answer. a. Lexington can allow for Mr. Wilcox’s continued enrollment for up to 12 months whether or not he is in a visitor/traveler (V/T) program. Question2 Marks: 1 A client wants to give you an enrollment application on October 1 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? Choose one answer. c. You must tell him you are not permitted to take the form. If he sends the form directly to the plan, the plan will process the enrollment on the day the Annual Election Period begins. Question3 Marks: 1 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? Choose one answer. b. The Medicare Advantage plan received a 5-star rating in customer service and care coordination with an overall performance rating of 4-stars. Question4 Marks: 1 Mr. Lopez takes several high-cost prescription drugs. He would like to enroll in a standalone Part D prescription drug plan that is available in his area. In what type of Medicare Health Plan can he enroll? Choose one answer. c. Private Fee-for-Service (PFFS) plan that does not include drug coverage. Question5 Marks: 1 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? Choose one answer. b. Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and Lou Gehrig’s disease so she will be eligible for Medicare. Question6 Marks: 1 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? Choose one answer. b. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. Question7 Marks: 1 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 as his current HMO plan requires him to do. What should you tell him? Choose one answer. a. 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. Question8 Marks: 1 Mr. Chen has heard about a 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? Choose one answer. c. Under the Medicare Advantage program, a MSA plan involves the combination of a high deductible health plan and a 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. Question9 Marks: 1 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? Choose one answer. c. Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey’s entire lifetime. Question10 Marks: 1 Able, Baker, and Charles are engaged in the marketing to and 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 organization (FMO). Mr. Charles is an independent agent paid for his work by a third-party marketing organization (TMO). How do the CMS compensation rules apply to these three agents? Choose one answer. c. All three are treated as independent agents under CMS compensation rules. Question11 Marks: 1 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? Choose one answer. 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. Question12 Marks: 1 Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him? Choose one answer. c. He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Question13 Marks: 1 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? Choose one answer. b. 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. Question14 Marks: 1 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? Choose one answer. c. A meal cannot be provided, but light snacks would be permitted. Question15 Marks: 1 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? Choose one answer. d. 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. Question16 Marks: 1 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? Choose one answer. 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. Question17 Marks: 1 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 disenrolled from the stand-alone prescription drug plan? Choose one answer. d. 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 Question18 Marks: 1 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. What should you do? Choose one answer. d. You may go ahead and call them. Question19 Marks: 1 Mr. Jenkins is interested in enrolling in a Medicare cost plan and has sought your advice. What would you tell him? Choose one answer. d. 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. Question20 Marks: 1 Mrs. Chou likes a PFFS plan available in her area that does not include drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What should you tell her? Choose one answer. a. She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. Question21 Marks: 1 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? Choose one answer. 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 for drugs on the plan's formulary purchased at a plan's participating pharmacy. In some instances, amounts not directly paid by the enrollee (like manufacturer discounts) count toward TrOOP. Question22 Marks: 1 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? Choose one answer. c. He can wait until October and send them information about the plans he represents. Question23 Marks: 1 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? Choose one answer. d. Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received the MSN in the mail. Question24 Marks: 1 Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What should you tell him? Choose one answer. a. 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. Question25 Marks: 1 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? Choose one answer. c. 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. Question26 Marks: 1 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? Choose one answer. c. D-SNP Question27 Marks: 1 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? Choose one answer. 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 Question28 Marks: 1 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? Choose one answer. c. The plan may withhold commission, require retraining, report the misconduct to a state department of insurance or terminate the contract. Question29 Marks: 1 Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. 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? Choose one answer. d. If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. Question30 Marks: 1 This year you decide 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? Choose one answer. b. 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. Question31 Marks: 1 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? Choose one answer. b. Formularies must be developed with input from pharmacists, doctors, and other experts. Question32 Marks: 1 Ms. Hernandez has marketed several different types of insurance products in her home state and has typically sought approval of 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? Choose one answer. a. 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. Question33 Marks: 1 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? Choose one answer. a. 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. Question34 Marks: 1 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? Choose one answer. a. 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. Question35 Marks: 1 Ms. Gardner is currently enrolled in an MA-PD plan. However, she wants to disenroll 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? Choose one answer. c. She may make such a change during the Annual Election Period that runs from Oct. 15 to December 7, or during the MA Open Enrollment Period which takes place from January 1- March 31 of each year (beginning in 2019). Question36 Marks: 1 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? Choose one answer. d. 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 her for a special enrollment period. Question37 Marks: 1 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? Choose one answer. c. Melanie must remain trained, tested, licensed, and appointed, regardless of whether she is actively selling MA products. Question38 Marks: 1 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? Choose one answer. d. Plans are required to cover out-of-network emergency care. Question39 Marks: 1 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? Choose one answer. a. The neighbors may not provide a meal, but light snacks would be permitted. Question40 Marks: 1 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 options, if any, she has. What should you say regarding special enrollment periods (SEPs)? Choose one answer. d. Mrs. Wellington is eligible for a SEP that may be used once until November 30 to enroll in the five-star plan. Question41 Marks: 1 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? Choose one answer. d. 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. Question42 Marks: 1 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? Choose one answer. d. 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. Question43 Marks: 1 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? Choose one answer. c. 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. Question44 Marks: 1 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? Choose one answer. a. 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. Question45 Marks: 1 Mrs. Schneider 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 and she is considered a dual eligible. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan? Choose one answer. a. Yes. Qualifying for this state program gives Mrs. Schneider access to a Special Enrollment Period that allows her to make changes to her MA and/or Part D enrollment during the first 9 months of each calendar year beginning in 2019. Question46 Marks: 1 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? Choose one answer. b. Due to his participation in the workforce he will not have to pay premiums for Part A but he will pay higher premiums for Part B and Part D due to the amount of his income. Question47 Marks: 1 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? Choose one answer. b. Yes. All SNPs are required to provide Part D coverage for prescription drugs. Question48 Marks: 1 Who is most likely to be eligible to enroll in a Part D prescription drug plan? Choose one answer. b. Ms. Davis who recently turned age 65 and is eligible for Part A and has just enrolled in Part B. . Question49 Marks: 1 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? Choose one answer. b. You may correct this information as long as you add your initials and date next to the correction . Question50 Marks: 1 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? Choose one answer. c. 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.
  15. at the top right of www.naaip.org it states Login.. as well at the bottom of your site.. in very small it has button member login
  16. Hello Agent, For the longest time I have been shouting from the rooftop that agents should: 1. Seek out the highest possible commissions. 2. Figure out a lead system that works and then cut out the middleman/vendor. Let's talk leads. Here, I created a page that could be considered the Wikipedia of insurance agent lead generation. I am constantly adding more information and links. Join our daily conference call for an in-depth discussion on this topic. I have learned the following vis-à-vis insurance agent leads. 1. Direct mail postcards and now Facebook leads are the primary lead source for a very high percentage of agents. 2. The postcard companies will sell you 1,000 postcards for $450-$500. Obviously, if postcards are a major part of your business you should print them yourself and send from the local post office. 3. Facebook leads are much more complicated to set up for many agents. Facebook lead vendors are selling each FB lead from $20 to $25. Doing it yourself will have Facebook leads be between $4 and $8. This is a huge savings. 4. To drum up business for our favorite FEX and Annuity Carrier which is Oxford Life - I will personally set up your Facebook account for you with your credit card. At a certain point, I will hand over the account back to you with instructions to press On to Activate the leads and Off and Deactivate. Very simple. In order for me to be intimately involved in your business, I need you to sell Oxford Life. Last month's newsletter explained why Oxford Life is my favorite carrier, notwithstanding super-high compensation. I expect to be overloaded with work setting up Facebook advertising accounts for NAAIP/Oxford Life agents. Join our daily conference call for detailed discussion and sell lots of Oxford Life policies so I can put you at the top of the list. It should be noted that I put back the 5 links of iPipeline at the footer of NAAIP.org and this email. Many of the other 75 carriers that we contract agents for at the absolute highest commission are accessible via those 5 iPipeline links. Please register and be familiar with iPipeline.
  17. Test 2 and 3 are 100% accurate. I do know that all three are guided by CMS compensation rules in the same manner..
  18. Edward, Test 2 is 100% accurate while Test 1 has one wrong answer and one that I am not sure about. I assume test 2 answer is right. As well, test 3 has one wrong answer. Please comment.. before I make the changes by editing the results. You found the one wrong answer on TEST 3. Congratulations. I will edit the test and now write the that Test 3 is 100% accurate. Can you review test 1 and answer that one debatable question and find the other wrong answer.
  19. AHIP TEST 3 2020 Judy from Nevada was kind enough to give us her 50 questions on her AHIP Test. Judy got one answer out of 50. Let’s find that one wrong answer for her. Hi David, Attached is my Ahip test for you to review and shared in the forum, i got only 98%, don't know which is the wrong answer. Best wishes, Judy We found the one wrong answer - It was question 46. I edited your answer and now the answers showing are 100% correct. David Question 1. 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 applications. b. Alice and Bob because each of them has had coverage through Spartan Health Plan. c. Alice because she will not have a break between her non-Medicare and Medicare coverage through Spartan Health Plan. d. Alice and Charlotte because each of them currently have health coverage and is in their initial coverage election period (ICEP). Answer: C. Alice because she will not have a break between her non-Medicare and Medicare coverage through Spartan Health Plan. Question 2. Ms. Bushman has two homes in different states and is concerned about restrictions on where she can get her medications. What should you tell her? a. Part D prescription drug plans are restricted to local service areas. She will have to use mail order to fill all of her prescriptions. b. Part D prescription drug plans use networks of pharmacies within their service areas. She could look for a plan that maintains a network in both states. c. Part D prescription drug plans generally contract with every pharmacy in the country, so she should be able to obtain her drugs in both states with no problem. Answer: B. Part D prescription drug plans use networks of pharmacies within their service areas. She could look for a plan that maintains a network in both states. Question 3. Mrs. Reynolds just signed up for a Medicare Advantage 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 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. b. Coverage always begins on the first of July, or the first of January after a beneficiary enrolls, whichever comes first. c. Typically, coverage is effective on the date that the beneficiary completes the application form, so her coverage will be in place before 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. Answer: 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. Question 4: 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. 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. b. 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. c. Since SNPs don’t cover prescription drugs Mr. Sinclair should consider a different option. d. SNPs are essentially the same as Original Medicare and are not likely to have a noticeable impact on how Mr. Sinclair receives his care. Answer: a. 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 Question 5. 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 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. b. 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. c. Winthrop Brokerage must submit the advertisement to CMS for prior approval because it is considered general audience marketing. d. Winthrop Brokerage must submit the advertisement to CMS for prior approval because it meets the definition of marketing material. Answer: b. 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. Question 6. 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 options, if any, she has. What should you say regarding special enrollment periods (SEPs)? a. Mrs. Wellington must first enroll in a standalone PDP before she is eligible for a SEP to enroll in the MA five-star plan. b. Mrs. Wellington can enroll in the five-star plan in the following October, when the next annual enrollment period (AEP) begins – not before. c. Mrs. Wellington is eligible for a SEP that may be used once until November 30 to enroll in the five-star plan. d. 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. Answer: c. Mrs. Wellington is eligible for a SEP that may be used once until November 30 to enroll in the five-star plan. Question 7. 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 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 problems. b. 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. c. Step therapy involves slow changes in the dosages of a given drug in order to discover the correct amount. d. Step therapy involves taking somewhat larger doses but skipping every other day, resulting in lower overall consumption of the drug. Answer: b. 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. Question 8. 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. 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. 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. 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. Answer: d. 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. Question 9. 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 a MA-PD plan. What enrollment rules would apply in this case? a. 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. b. He can return to Original Medicare, but must then enroll in a Medicare Part D plan. c. He can make as many enrollment changes as he likes during the Annual Election Period and the last choice made prior to the end of the period will be the effective one as of January 1. d. He can only make a single enrollment change during the Annual Election Period, so he will not be able to change his enrollment. Answer: c. He can make as many enrollment changes as he likes during the Annual Election Period and the last choice made prior to the end of the period will be the effective one as of January 1. Question 10. This year you decide 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 do not need to take an annual test, but you must not provide potential enrollees with more than light snacks at presentations 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 can make unsolicited contacts but you cannot cross-sell other products. d. 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. Answer: d. 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. Question 11. 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. You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. c. You may offer meals to existing enrollees of the plan(s) you represent, but potential enrollees may not have a meal. d. There is no limitation on meals. You may continue to provide your Thanksgiving style meal, to any individual, in any manner you see fit. Answer: b. You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. Question 12. Mr. Chen has heard about a 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, the MSA is funded by money he sets aside each year. If he does not use it all on IRS allowable health care expenditures then he will lose the money the following year. b. Under the Medicare Advantage program, the MSA plan is a form of prescription drug coverage. c. Under the Medicare Advantage program, the MSA is only an account to help him pay for IRS-allowed health expenditures he may have. It does not involve health insurance of any kind. d. Under the Medicare Advantage program, a MSA plan involves the combination of a high deductible health plan and a 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. Answer: d. Under the Medicare Advantage program, a MSA plan involves the combination of a high deductible health plan and a 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. Question 13. Mr. Lopez takes several high-cost prescription drugs. He would like to enroll in a standalone 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-POS plan that does not include drug coverage. b. Medicare Advantage (MA) PPO that does not include drug coverage. c. Medicare Advantage (MA) HMO that does not include drug coverage. d. Private Fee-for-Service (PFFS) plan that does not include drug coverage. Answer: d. Private Fee-for-Service (PFFS) plan that does not include drug coverage Question 14. You have decided to focus on doing in-home presentations 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 to an individual’s house to provide presentations 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. 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. d. 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. Answer: d. 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. Question 15. 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 wrong and that only agents employed by the plans are exempt from training and testing requirements. d. You could tell her she is right and ask if you could get a contract with the TMO too. Answer: 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. Question 16. Mr. Shapiro gets by on a very small amount of 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 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. 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 to beneficiaries whose income and assets do not exceed annual limits specified by the government. Answer: d. The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. Question 17. 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. All costs not covered by Medicare are covered by some Medigap plans. b. 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. c. Medigap plans are not sold by private companies and are a government insurance product. d. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. Answer d. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. Question 18. 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 may enroll in a Medicare Advantage plan, but only if they are willing to pay an extra premium to do so. b. Individuals with end-stage renal disease can only enroll in a Medicare Advantage plan after they have been on dialysis for 12 months. c. Individuals with end-stage renal disease can enroll in any Medicare Advantage plan that they choose without paying an extra premium. d. 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. Answer: d. 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. Question 19. 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 for 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. Answer: will be b. I, III, and IV only Question 20. 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? a. PFFS plans primarily cover drugs that Original FFS Medicare does not cover. b. Original Medicare and PFFS plans are essentially the same thing. c. PFFS plans are a type of Medicare Advantage plan offered by private companies. d. PFFS is a form of supplemental coverage that fills in the gaps where Original Medicare leaves off. Answer: c. PFFS plans are a type of Medicare Advantage plan offered by private companies. Question 21. 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 government allows Part D plans to adopt any benefit structure as long as the list of covered drugs meets their approval. b. 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. c. 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. 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. Answer: 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. Question 22. 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 refers 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 later. 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 is only to allow him to visit in-network specialists without a referral. He will have no coverage if he goes out-of-network. d. 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. Answer: 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. Question 23. 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) program in which his friend is enrolled. What should you tell him? a. To be eligible for a MTM program, a Medicare beneficiary must suffer from at least one chronic disease, such as asthma, and be likely to incur considerable drug costs. b. A MTM program is an excellent choice for someone taking very few prescription drugs such as Mr. Chan. c. A MTM program is available to all Medicare Part D enrollees who seek help in selecting the prescription drugs most appropriate to their needs. d. 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. Answer: d. 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. Question 24. 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 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. b. Ms. Lopez no longer needs to be concerned about state licensure since she is marketing an MA product subject to federal rules. c. 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. d. 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. Answer: d. 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. Question 25. 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 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. d. 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 A Answer: c. 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. Question 26. 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? 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. All individuals who are citizens and over age 65 will be covered under Part A. 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. Most individuals who are citizens and over age 65 and wish to be covered under Part A must enroll in a Medicare Health Plan. 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. Question 27. 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 not be able to enroll in Part D unless he decides to also enroll in a Medicare Advantage plan. B. He will incur a one-time financial penalty equal to 30 percent of the annual Part D premium. C. He will avoid any financial penalty or late enrollment fee under the grandfathering provisions of Medicare Part D. D. He will incur a late enrollment penalty. Answer: d. He will incur a late enrollment penalty. Question 28. Willard works as a representative focused on the senior marketplace. What would be considered prohibited activity by Willard? a. Asking health questions to determine whether Mr. Ryan would be eligible to enroll in an SNP because he has a chronic condition. 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. 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. Answer: c. 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. Question 29: 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? a. Medicaid will cover his cost-sharing, regardless of from which physician or hospital he receives his Medicare-covered services. b. He should know that Medicaid will pay cost sharing only for services provided by Medicaid participating providers. c. Medicaid will no longer pay any cost sharing once he is eligible for Medicare, so he will need to rely only on Medicare providers. d. For Medicaid beneficiaries, Medicare reduces its cost-sharing amounts to match those charged by the state Medicaid program so there will be no change in his cost-sharing amounts. Answer: b. He should know that Medicaid will pay cost sharing only for services provided by Medicaid participating providers. Question 30. 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. Nothing may be provided to eat or drink during the sales presentation. b. Any meal is allowed, as long as it is valued at less than $15. 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. Answer: d. A meal cannot be provided, but light snacks would be permitted. Question 31. 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. 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. b. 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. c. All beneficiaries enrolled in an MSA pay a plan premium in addition to their Part B premium. d. For enrollees in an MSA, after the annual deductible is met, the MSA plan generally pays 75% of covered services. Answer: a. 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. Question 32. 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. D-SNP b. I-SNP c. C-SNP d. FIDE-SNP Answer: c. C-SNP Question 33. 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. Regular CMS and renewal compensation rules apply to the PDP enrollment, 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. c. This situation is considered a “dual enrollment,” and CMS compensation rules are applied to the two plans at once and independently of each other. 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. Regular initial year enrollment rules apply to the PDP. Answer: c. This situation is considered a “dual enrollment,” and CMS compensation rules are applied to the two plans at once and independently of each other. Question 34. 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. Answer: c. Agent Lopez’s entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. Question 35. 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. She currently does not have creditable coverage. What could you tell her about the implications of such a decision? a. a. 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. 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 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. 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. Answer: 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. Question 36. 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 all identity cards are being phased out in favor of a new electronic identity system developed by the Social Security Administration. b. 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. c. 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. d. The card she received is valid, the change has been made to protect Medicare beneficiaries from identity theft, and she should now destroy her old card. Answer d. The card she received is valid, the change has been made to protect Medicare beneficiaries from identity theft, and she should now destroy her old card. Question 37. 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 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. b. Mrs. Disraeli would have substantial restrictions on obtaining emergency care and must use network facilities or be responsible for most emergency care costs. c. The SNP would select her primary care provider (PCP) but she could file a grievance within 90 days if the PCP proved incapable. d. 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. Answer: a. 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. Question 38. 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. 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. b. She will have to pay the monthly Part A premium in order to obtain the coverage. c. 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. d. She will have to obtain a job and work enough years to qualify for Medicare Part A. Answer: a. 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. Question 39. 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 not responsible for enforcing compliance with applicable law and guidance. This job belongs solely to the Medicare agency. d. 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. Answer: d. 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. Question 40. 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 but will be automatically covered by Original Medicare and a standalone Part D prescription drug plan. b. 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. 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. Answer: 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. Question 41. 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 the next steps in the enrollment process? a. 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. 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 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. 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. Answer: 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. Question 42. 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. 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. b. 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. c. CMS generally issues plan ratings in January of each year, and plan sponsors must update the rating information available to enrollees within 30 days. d. 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. Answer: a. 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. Question 43. 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 from Mr. Rivera the cost sharing allowable under the state’s Medicaid program. b. The doctor may only collect the amount allowable under Medicare plus 25 percent balance billing. c. The doctor may only collect the amount allowable under Medicare plus 15 percent balance billing. d. The doctor may only collect the amount allowable under Medicare Advantage (MA) PPO plan cost sharing for non-QMB enrollees. Answer: a. The doctor may only collect from Mr. Rivera the cost sharing allowable under the state’s Medicaid program. Question 44. 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? 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. Answer: c. Medicare does not cover acupuncture, or, in general, glasses or dentures. Question 45. 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. 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 c. In general, he must select a single Part D premium payment mechanism that will be used throughout the year. d. 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. Answer: c. In general, he must select a single Part D premium payment mechanism that will be used throughout the year. Question 46. Mrs. Tanner is enrolled in a 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 knowing that cost sharing will generally be the same as with network providers. b. Mrs. Tanner can go to non-plan doctors for certain services without receiving prior approval. c. Mrs. Tanner can go to non-plan doctors without receiving prior approval for all services. d. Mr. Tanner can go to non-network doctors without worrying about a cap on the amount of out-of-network services she may receive. Answer: b. Mrs. Tanner can go to non-plan doctors for certain services without receiving prior approval. Question 47. 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 could immediately disenroll from the Part D plan and select a new Part D plan that covers the drug that works for him. b. 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. 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 will need to enroll in a Special Needs Plan to obtain coverage for his medication. Answer: b. 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. Question 48. 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. Melanie must remain trained, tested, licensed, and appointed, regardless of whether she is actively selling MA products. b. Melanie will need to do nothing to continue receiving renewal fees since the initial sale was made when she met all requirements. c. All that she needs to do is meet state licensure requirements moving forward. d. All that she needs to do is avoid being terminated for cause. Answer: a. Melanie must remain trained, tested, licensed, and appointed, regardless of whether she is actively selling MA products. Question 49: Mr. Jenkins is interested in enrolling in a Medicare cost plan and has sought your advice. What would you tell him? a. Costs plans are required to be open to enrollment year-round, so he should select a date when he would like coverage to begin. b. 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. c. 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 enrollments during the annual enrollment period. d. All cost plans (like other types of MA plans) are required to be open for enrollment during the MA annual election period. Answer: b. 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. Question 50. 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. 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. b. Yes, he can execute the enrollment for her. He can do so because he is an immediate family member. No power of attorney is necessary. c. No, he cannot execute the enrollment for her. Only Ms. Duarte can sign the form, regardless of her mental capacities. d. Yes, he can execute the enrollment for her. A financial power of attorney is sufficient. Answer: a. 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.
  20. Question: 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 Medicare covered services. How much may the doctor collect from Mr. Rivera? Answer: The doctor may only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid program. this is from the modules as well. this answer is C correct c. The doctor may only collect from Mr. Rivera the cost sharing allowable under the state’s Medicaid program.
  21. the 2nd test is now 100% correct - The first test we still have 1 question we are not sure of and a second question that I cannot find.. Please email me your test in pdf format or any format so I can format and post online. My email is david@naaip.org
  22. Agent Gary from Florida - TEST 2 sent me his AHIP 2020 Test Questions and Answers. Attached is my AHIP Final Exam – I got a 98% on it the first time. Realize that I have been doing these AHIP exams since 2010 and Medicare is my primary business. I am surprised I got any wrong. Not sure which answer is incorrect. Sincerely, Agent Gary (I believe that I found the wrong answer - please comment) - Patty and Susan found the wrong answer - all 50 questions are now answered correctly. Question 1. 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, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. b. She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan. c. She can enroll in the PPO and purchase drug coverage through a Medigap plan. d. 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. Answer: a. She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. Question 2. 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? a. Medicaid will cover his cost-sharing, regardless of from which physician or hospital he receives his Medicare-covered services. b. He should know that Medicaid will pay cost sharing only for services provided by Medicaid participating providers. c. For Medicaid beneficiaries, Medicare reduces its cost-sharing amounts to match those charged by the state Medicaid program so there will be no change in his cost-sharing amounts. d. Medicaid will no longer pay any cost sharing once he is eligible for Medicare, so he will need to rely only on Medicare providers Answer: b. He should know that Medicaid will pay cost sharing only for services provided by Medicaid participating providers. Question 3. You have decided to focus on doing in-home presentations to market the Medicare Advantage (MA) plans you represent. Before you conduct such sales presentations, what must you do? a. 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. b. There is no special action that you must take. If they choose, you may go to an individual’s house to provide presentations and offer assistance with enrolling in a plan. c. You must first contact the Medicare agency to ensure that the individual is actually a Medicare beneficiary. 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. Answer: a. 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. Question 4. 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 25 percent balance billing. b. The doctor may only collect the amount allowable under Medicare Advantage (MA) PPO plan cost sharing for non-QMB enrollees. c. The doctor may only collect the amount allowable under Medicare plus 15 percent balance billing. d. The doctor may only collect from Mr. Rivera the cost sharing allowable under the state’s Medicaid program. Answer d. The doctor may only collect from Mr. Rivera the cost sharing allowable under the state’s Medicaid program. B 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. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields' long-term care costs. b. Medicare will cover an unlimited number of days in a skilled-nursing facility, as long as a physician certifies that such care is needed. c. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered because Medicare does not provide such a benefit. d. Medicare will cover Mrs. Shields' 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 Answer d. Medicare will cover Mrs. Shields' 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. Question 6. 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. Plans may not participate in advertising such an event. All advertising must be done by community organizations. c. 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. d. You must only ensure that the advertisement is factually accurate. Answer: a. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. Question 7. 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. A signature is not necessary since Mr. Tully is not physically or mentally capable of filling out and signing the form. b. Mr. Tully’s daughter can do so because she is an immediate family member who has taken responsibility for her father’s care. c. Mr. Tully’s daughter can do so only, if she is authorized under state law as a court-appointed legal guardian, has a durable power of attorney for health care decisions, or is authorized under state surrogate consent laws to make health decisions. d. If the enrollment form is countersigned by one of Mr. Tully’s treating physicians, she can sign it for him. Answer: c. a. Mr. Tully’s daughter can do so only, if she is authorized under state law as a court-appointed legal guardian, has a durable power of attorney for health care decisions, or is authorized under state surrogate consent laws to make health decisions. Question 8. 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? a. All individuals who are citizens and over age 65 will be covered under Part A. b. Most individuals who are citizens and over age 65 and are covered under Part A must pay a monthly premium for that coverage. c. Most individuals who are citizens and over age 65 and wish to be covered under Part A must enroll in a Medicare Health Plan. d. 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. Answer: d. 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. Question 9. 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? a. He will need to mail in his payment with his enrollment form. b. You can take his first payment, but after that, he will need to make arrangements to send his monthly premium payment to the plan. c. This is perfectly acceptable. You will be happy to forward his payment to the plan. 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. Answer: 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 Question 10. 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 expect to receive. How would you reply? a. She should expect to receive Evidence of Coverage (EOC) within 21 days of confirmation of enrollment. b. She should expect to receive hard copies of both the provider and pharmacy directories automatically within 30 days of confirmation of enrollment. c. She should expect to receive a hard copy of the provider directory in and a separate notice describing where she can find monthly periodic updates online and how to request hardcopies. d. 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. Answer: d. 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. Question 11. 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. 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. b. A PFFS plan is one of the 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. 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. Answer: b. a. A PFFS plan is one of the various types of Medicare Advantage plans offered by private entities and she may enroll in one if it is available in her area. Question 12. 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 ambulance services. b. Original Medicare covers orthopedic shoes. c. Original Medicare covers cosmetic surgery. d. Original Medicare covers routine foot care. Answer: a. Original Medicare covers ambulance services. Question 13. 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 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. b. 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. c. Ms. Lopez no longer needs to be concerned about state licensure since she is marketing an MA product subject to federal rules. d. 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. Answer: a. 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. Question 14. 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 Advantage plan? a. 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. b. If a provider accepts her Medicare Advantage 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. c. State Medicaid programs do not coordinate any of their coverage with Medicare Advantage plans. d. She can enroll in any type of Medicare Advantage (MA) plan except an MA Medical Savings Account (MSA) plan. Answer: d. She can enroll in any type of Medicare Advantage (MA) plan except an MA Medical Savings Account (MSA) plan. Question 15 explained by Susan Question 15. 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 you are happy to meet with her once this year’s open enrollment begins on October 15th. b. 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 15th. c. 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 her for a special enrollment period. d. 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. Answer: a. Tell Julia that you are happy to meet with her once this year’s open enrollment begins on October 15th. Question 16. 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. Mileage reimbursement IV. Referral fees Answer: d. I, II, and IV only Question 17. 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 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 coinsurance of 5%, whichever is greater. b. Standard Part D coverage would require payment of fixed per-prescription co-payments and 75% of the costs in the coverage gap. c. Standard Part D coverage would require payment of only fixed per-prescription co-payments. 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. Answer: 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. Question 18. 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. No. This action is permissible. Handing out enrollment forms, on the other hand, would not be permissible. c. Yes. When an event has been advertised as “educational,” discussing plan-specific premiums is impermissible. d. No. Attendees expect some “puffery” at any event on a product in which they may be potentially interested. Answer: c. Yes. When an event has been advertised as “educational,” discussing plan-specific premiums is impermissible. Question 19: 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? Answer: the agent did not give me this answer. We don't have the 4 answer options here. Potential answers from Susan: He can provide snacks and gifts totaling less than $15 per person. He can provide reply cards so that potential enrollees can provide authorization for the agent to contact them. He can provide information as to star ratings, as long as he isn't misleading in his star rating statements. Question 20. 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 as his current HMO plan requires him to do. What should you tell him? a. 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. 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. He may receive services from any physician, regardless of whether or not that physician participates in the plan or Original Medicare. d. If he enrolls in the PFFS plan, he can go to any doctor anywhere as long as the doctor accepts Original Medicare. Answer: 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. Question 21. 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 by a consortium of health plans. c. Plans must use a single, standard formulary developed by the Federal government to keep costs down and quality high for beneficiaries. d. 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. Answer: a. Formularies must be developed with input from pharmacists, doctors, and other experts. Question 22. 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. A meal cannot be provided, but light snacks would be permitted. b. 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. c. Nothing may be provided to eat or drink during the sales presentation. d. Any meal is allowed, as long as it is valued at less than $15. Answer: a. A meal cannot be provided, but light snacks would be permitted. Question 23. 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 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. b. 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. c. 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. 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. Answer: a. 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. Question 24. Ms. Hernandez has marketed several different types of insurance products in her home state and has typically sought approval of 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. Materials need only be reviewed and approved by the company(s) she represents. b. States 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. 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. Answer: 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. Question 25. 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? a. Lexington must disenroll Mr. Wilcox after 12 weeks unless he can provide proof that he is simply visiting on a temporary basis. b. Lexington can offer an extended visitor/traveler (V/T) benefit to Mr. Wilcox for up to 15 months. c. Lexington can allow for Mr. Wilcox’s continued enrollment for up to 12 months whether or not he is in a visitor/traveler (V/T) program. d. Lexington must disenroll Mr. Wilcox after 6 months unless he can provide proof that he is simply visiting on a temporary basis Answer: c. Lexington can allow for Mr. Wilcox’s continued enrollment for up to 12 months whether or not he is in a visitor/traveler (V/T) program. Question 26: 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. Mrs. Wilson will be contacted by you within one week for a follow-up appointment to handle the verification process. 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. 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. d. Mrs. Wilson will be contacted by the plan sponsor within 15 calendar days of receipt of the enrollment request. Answer: d. Mrs. Wilson will be contacted by the plan sponsor within 15 calendar days of receipt of the enrollment request. Question 27. 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 enrollment in Part D, so he can go ahead and enroll in a Part D prescription drug plan. b. He will have to enroll in Part B before he can enroll in a Part D prescription drug plan. c. 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. 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. Answer: 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. Question 28. Mrs. Walters 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. No. Mrs. Walters will have to enroll in Part B in order to qualify for enrollment into 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. 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. d. Yes. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. d. Yes. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. Question 29. If you are to be in compliance with Medicare’s guidance regarding educational events, which of the following would be acceptable activities? a. You may discuss plan specific premiums and benefits. b. You may have a stack of enrollment forms on the table in your booth but may only pass them out to individuals who request one. c. You may ask passers-by to provide you with their names, addresses and phone numbers so that you could contact them later with information about the plan(s) you represent. d. You may distribute business cards to individuals who request information on how to contact you for further details on the plan(s) you represent. Answer: d. You may distribute business cards to individuals who request information on how to contact you for further details on the plan(s) you represent. Question 30. 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 the beneficiary the same costsharing as Original Medicare as long as she sends the claim to Medicare and not the plan. b. 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. c. 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. d. 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. Answer: c. 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. Question 31. Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for Medicare & Medicaid Services’ communication and Marketing Guidelines to ensure he is compliant for which type of products? a. Medicare Advantage (MA) and Prescription Drug (PDP) plans b. Private long-term care policies for Medicare beneficiaries c. Section 1332 waiver plans d. Medigap plans. Answer: a. Medicare Advantage (MA) and Prescription Drug (PDP) plans Question 32. 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. Hospice services are currently only offered under a limited demonstration project. Whether they will eventually become available nationally depends on the outcomes of the demonstration. c. Medicare does not cover hospice services. Hospice services are only available through state Medicaid programs, if the state offers such coverage. d. The Federal government facilitates competition between hospice programs to lower the price of their services for Medicare beneficiaries, but does not offer coverage for hospice services through the Medicare program. Answer: a. Medicare covers hospice services and they will be available for her. Question 33. 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 continue obtaining these services as a Medicare beneficiary. What should you tell him about annual check-ups? a. Medicare will cover only a one-time “Welcome to Medicare” wellness visit. b. Medicare will cover an annual wellness visit, even if he has no illnesses or injuries. 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. Answer: b. Medicare will cover an annual wellness visit, even if he has no illnesses or injuries. Question 34. Mr. Lopez takes several high-cost prescription drugs. He would like to enroll in a standalone 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-POS plan that does not include drug coverage. b. Medicare Advantage (MA) HMO that does not include drug coverage. c. Private Fee-for-Service (PFFS) plan that does not include drug coverage. d. Medicare Advantage (MA) PPO that does not include drug coverage. Answer: c. Private Fee-for-Service (PFFS) plan that does not include drug coverage. Question 35. 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. 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. 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. CMS generally issues plan ratings in January of each year, and plan sponsors must update the rating information available to enrollees within 30 days. d. 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. Answer: a. 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. Question 36. 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 options, if any, she has. What should you say regarding special enrollment periods (SEPs)? a. 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. b. Mrs. Wellington must first enroll in a standalone PDP before she is eligible for a SEP to enroll in the MA five-star plan. c. Mrs. Wellington is eligible for a SEP that may be used once until November 30 to enroll in the five-star plan. d. Mrs. Wellington can enroll in the five-star plan in the following October, when the next annual enrollment period (AEP) begins – not before. Answer: c. Mrs. Wellington is eligible for a SEP that may be used once until November 30 to enroll in the five-star plan. Question 37. Mr. Gonzalez is entitled to Part A, but has not yet enrolled in Part B. If he wants to enroll in a Medicare Advantage (MA) plan, what will he have to do? a. He will have to drop Part A and then will be eligible to enroll in a MA plan. b. He will have to enroll in a Medicare prescription drug plan prior to enrolling in a MA plan. c. He will need to do nothing. His entitlement to Part A makes him eligible to enroll in any Medicare Advantage plan. d. He will have to enroll in Part B prior to enrolling in a MA plan. Answer: d. He will have to enroll in Part B prior to enrolling in a MA plan. Question 38. Ms. Bushman has two homes in different states and is concerned about restrictions on where she can get her medications. What should you tell her? a. Part D prescription drug plans generally contract with every pharmacy in the country, so she should be able to obtain her drugs in both states with no problem. b. Part D prescription drug plans focus almost entirely on mail order with fairly limited access to retail pharmacies, so as long as she orders all of her medications through the mail, she will be fine. c. Part D prescription drug plans use networks of pharmacies within their service areas. She could look for a plan that maintains a network in both states. d. Part D prescription drug plans are restricted to local service areas. She will have to use mail order to fill all of her prescriptions. Answer: c. Part D prescription drug plans use networks of pharmacies within their service areas. She could look for a plan that maintains a network in both states. Question 39. 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 otheroption he has for obtaining help with his considerable drug costs. What should you tell him? a. 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. b. He should look into the possibility of purchasing his medications through the internet from off-shore pharmacies. c. He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means to 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. d. 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. Answer: c. He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means to 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. Question 40. Ms. Gardner is currently enrolled in an MA-PD plan. However, she wants to disenroll 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? a. She may only make such a change during her “initial coverage election period,” which occurred when she first became entitled to Medicare. b. She may do it only during the MA Disenrollment Period, which runs from January 1 to February 14 of each year. c. Any time that she is dissatisfied with the plan’s network coverage or customer service she may make such a change. d. She may make such a change during the Annual Election Period that runs from Oct. 15 to December 7, or during the MA Open Enrollment Period which takes place from January 1- March 31 of each year (beginning in 2019). Answer: d. She may make such a change during the Annual Election Period that runs from Oct. 15 to December 7, or during the MA Open Enrollment Period which takes place from January 1- March 31 of each year (beginning in 2019). This question below was corrected by Susan and Patty- The correct answer is A and all 50 questions on this test are now correct. Question 41. 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 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. 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. Part B will cover her dental and vision needs. d. She should disenroll if she does not want to pay the monthly premiums. There is no disadvantage in doing so. Answer: a. 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. Question 42: 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. The VA will not offer drug coverage to Mrs. Fiore once she qualifies for the Medicare Part D program. b. 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. c. Costs under the VA are significantly higher than those under a Medicare Part D plan. d. 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. Answer: d. 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. Question 43. 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. 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. b. 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. c. 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. d. PFFS plans are the same as Medicare supplement plans and he may obtain care from any provider in the U.S. Answer: c. 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. Question 44. Mr. Jenkins is interested in enrolling in a Medicare cost plan and has sought your advice. What would you tell him? a. All cost plans (like other types of MA plans) are required to be open for enrollment during the MA annual election period. b. Costs plans are required to be open to enrollment year-round, so he should select a date when he would like coverage to begin. c. 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 enrollments during the annual enrollment period. d. 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. Answer: d. 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. Question 45. Mrs. Tanner is enrolled in a 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 knowing that cost sharing will generally be the same as with network providers. b. Mrs. Tanner can go to non-plan doctors without receiving prior approval for all services. c. Mrs. Tanner can go to non-plan doctors for certain services without receiving prior approval. d. Mr. Tanner can go to non-network doctors without worrying about a cap on the amount of out-of-network services she may receive. Answer: c. Mrs. Tanner can go to non-plan doctors for certain services without receiving prior approval. Question 46. Who is most likely to be eligible to enroll in a Part D prescription drug plan? a. Mr. Charles, an undocumented immigrant, entered the country illegally. b. Ms. Davis who recently turned age 65 and is eligible for Part A and has just enrolled in Part B. c. Ms. Bradley is currently living abroad for a multi-year job assignment. d. Ms. Adams, a healthy early retiree who has just begun to collect Social Security at age 62. Answer: b. Ms. Davis who recently turned age 65 and is eligible for Part A and has just enrolled in Part B. Question 47. 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 nogap in coverage. What can you tell her? a. 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. b. She may only enroll in Part B during the general enrollment period whether she is retired or not. c. 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. d. She must wait at least 30 days after her employment terminates before she may enroll in Medicare Part B Answer: c. 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. Question 48. 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 an annual basis and consists of an enrollee's out-of-pocket deductible plus any amounts paid on behalf of an enrollee by Medicaid. 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 deductible, 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 for drugs on the plan's formulary purchased at a plan's participating pharmacy. In some instances, amounts not directly paid by the enrollee (like manufacturer discounts) count toward TrOOP. d. 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 Answer: 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 for drugs on the plan's formulary purchased at a plan's participating pharmacy. In some instances, amounts not directly paid by the enrollee (like manufacturer discounts) count toward TrOOP. Question 49. 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? a. PFFS is a form of supplemental coverage that fills in the gaps where Original Medicare leaves off. b. PFFS plans primarily cover drugs that Original FFS Medicare does not cover. c. Original Medicare and PFFS plans are essentially the same thing. d. PFFS plans are a type of Medicare Advantage plan offered by private companies. Answer: d. PFFS plans are a type of Medicare Advantage plan offered by private companies. Question 50. 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 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. b. 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. c. 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. d. She is unlikely to qualify for a SEP but will be automatically covered by Original Medicare and a standalone Part D prescription drug plan. Answer: c. 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.
  23. Susan M, Thank you - I edited the answers on my test to take into account your corrections. One question you are not sure and I am not sure as well. While another question is identified. Of the 50 questions here - 48 are definitely correct. Another agent sent me his test with answers - He claims to only have gotten one wrong - I will post shortly - please review that test.
  24. 43 looks good. They are married and told the government they are married. joint returns or joint filing separately. She is good. No need for pay for part A.
  25. United Healthcare is the only one that accept’s it on the 4th 5th or 6th attempts. But instead of paying it twice they could just take the UHC cert instead of taking AHIP.
×
×
  • Create New...