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SilverScript 2019 Certification Answers
AHIP2019 posted a topic in Insurance Agent ForumAgents need to act in a manner consistent with the SilverScript Code of Conduct. The SilverScript Code of Conduct is available for viewing/download via the SilverScript Agent Portal’s Reference Material tab. true The date the agent receives the application is the official Application Date. CMS does not consider the date the member signed/completed the application. true The SilverScript Choice PDP formulary is NOT the same as the SilverScript Plus PDP and SilverScript Allure PDP formulary in 2019. true Agents MUST communicate the pricing tool disclaimer to prospects and clients. The disclaimers for SilverScript's Drug Lookup & Pricing tool appear at bottom of the pricing tool pages. true Your client will never receive a letter from SilverScript requesting proof of Creditable Coverage if you or your client have already submitted proof of creditable coverage with the enrollment application. false In 2019, SilverScript Choice PDP only utilizes a standard pharmacy network. There are no preferred pharmacies. false SilverScript will NOT perform data entry on behalf of the agent. true Plan performance summary ratings are issued in October and reflect the previous plan contract year. Enrollment kits fulfilled prior to November will reflect the previous year's star rating. SilverScript will insert the updated star ratings sheet into the enrollment kits once the new ratings are released. SilverScript will post an announcement on the SilverScript Agent Portal when new Star Ratings are released. You should download the updated star ratings sheet from the SilverScript Agent Portal, print copies of the updated document and replace the form that is in the kits you have in your office supply to ensure you distributed current information to your prospects. true Plan sponsors may engage in discriminatory practices. false The pricing tools on Medicare, SilverScript, and most third-party websites reflect retail and mail network pricing. A pharmacy can also participate in a long term care (LTC) network. The costs displayed on most pricing tools will typically be different than what your clients in a long term care facility will be charged. Be certain to inform your clients that your estimates are based on retail and/or mail pharmacies and not LTC pharmacies. true CMS has eliminated the requirement to obtain a scope of appointment. false If a member is assessed a Part D Income Related Monthly Adjustment Amount (Part D-IRMAA), the member will be notified by the Social Security Administration. Part D-IRMAA is not paid to SilverScript. true Mail service is not available for any SilverScript PDP. false SilverScript PDPs will be supported by two plan-specific pharmacy networks in 2019. true The SilverScript Plus PDP offers extra gap coverage for Tier 1 and Tier 2 medications. true The SilverScript Choice retail pharmacy network is identical to the SilverScript Plus/Allure retail pharmacy network. false the member will pay whichever is lower the tiered copay or Silverscript negotiated price. true SilverScript Insurance Company is a CVS Health company. true SilverScript members can pay the monthly plan premium (including any late enrollment penalty) by mail, automatic bank draft withdrawal, automatic deduction from monthly Railroad Retirement Board check, automatic deduction from Social Security benefit check, or credit card. true The SilverScript Agent Portal functionality allows agents to view enrollment status and enrollment reports. true
AHIP2019 posted a topic in Insurance Agent ForumFor 2020 AHIP We did a much better job - We posted Questions and Answers of all 5 Modules in the order asked and We posted 2020 AHIP Questions and Answers. I got a 6 wrong answers / 88%/ so I have to take the test again. - If a reader to can help me find the 6 wrong answers it would be appreciated. As well, Join www.naaip.org - and our Medicare Advantage Free Mailer program and Walmart/CVS Retail Selling opportunity Ms. Goldstein is required by the plan she represents to obtain enrollment forms that have carbon copies in the back. She gives one to the beneficiary, sends another to the plan and retains the third. What should she do with her copies of the enrollment forms? - this is answered by me .. but not sure if correct.. Choose one answer. a. There are no specific requirements to which she is subject with regard to safekeeping the information. b. She should make every effort to safeguard the beneficiary information on those enrollment forms. c. She should retain them for six years and then throw them in the garbage, as is, without shredding them. d. She should retain them until she is informed by the plan that they have been successfully processed and then she can throw them in the garbage, as is, without shredding them. Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be a correct description? Choose one answer. a. Medicare Advantage is a health insurance program operated jointly by the states with the Federal government. b. Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies. c. Medicare Advantage is designed to pick up where Original Medicare leaves off, covering those health care services that would not normally be covered by Original Medicare. d. Medicare Advantage is a new name for the Original Medicare program. 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. a. All that she needs to do is meet state licensure requirements moving forward. b. Melanie must remain trained, tested, licensed, and appointed, regardless of whether she is actively selling MA products. c. Melanie need do nothing to continue receiving renewal fees since the initial sale was made when she met all requirements. d. All that she needs to do is avoid being terminated for cause. Question4 By contacting plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefit package. What should you do to make sure your clients know about these pieces of information? Choose one answer. a. You may make comparisons between plans if you can support them by studies or statistical data and such comparisons are factually based. b. You may create a chart that lists each plan in the beneficiary’s service area along with the benefits of the plan you represent, compared to those of the other available plans. c. You have clear evidence that your plan is the best and can say so to your clients. d. To obtain information about another plan’s benefits, you must refer clients to those other plans, because you may not provide comparative information, regardless of the source, to demonstrate any differences among the plans. Question5 Marks: 1 Ms. Gates is dually eligible for Medicare and Medicaid. She is very concerned about being locked into a specific Medicare prescription drug plan for the entire year. What should you tell her? Choose one answer. a. Individuals who are enrolled in Medicaid can change their Part D plans throughout the year, so if she is not satisfied with her prescription drug plan, she can change to a different Part D plan. b. She need not enroll in a Medicare prescription drug plan, but can continue receiving drug coverage through her state’s Medicaid program. c. The one-year lock in is a fundamental aspect of the plan design and cannot be avoided. d. If she is dissatisfied, she can request a one-time opportunity to change. Question6 Marks: 1 Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. What should you tell her? Choose one answer. a. While unsolicited contacts may be made through print media such as direct mail, marketing representatives may not initiate electronic contact. b. Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. c. Marketing representatives may initiate electronic contact through e-mail and as long as an e-mail is opened marketing representatives may also follow-up with unsolicited telephone calls. d. Marketing representatives may only use internet pop-up ads providing plan-specific information that have been approved by CMS when soliciting prospects through electronic means of communication. Question7 Marks: 1 Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this? Choose one answer. a. Mrs. Berkowitz can apply for any Medicare Advantage plan and, if it offers drug coverage, ask to have that element of the coverage eliminated, after which she can enroll in a stand-alone Medicare prescription drug plan in her service area. b. Mrs. Berkowitz can enroll in any Medicare Advantage plan, regardless of whether it offers drug coverage, and enroll in any stand-alone Medicare prescription drug plan. c. If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account, Mrs. Berkowitz can do this. d. This is not a possibility. If Mrs. Berkowitz wants health coverage and drug coverage through a plan, she must purchase an MA-PD plan. Question8 Marks: 1 BestCare Health Plan has received a request from a state insurance department in connection with the investigation of several marketing representatives licensed by the state who sell Medicare Advantage plans. What action(s) should BestCare take in response? Choose one answer. a. Immediately terminate all the agents involved as a precaution against potential legal liability. b. Immediately meet with the marketing representatives and suggest they obtain licensing in another jurisdiction. c. Cooperate with the state and supply requested information. d. Under Federal privacy statutes, BestCare is not obligated to provide information about marketing representatives to the state and should refuse to do so. Question9 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. a. The Medicare Advantage plan is a top rated plan. b. The Medicare Advantage plan received a 5-star rating in customer service and care coordination with an overall performance rating of 4-stars. c. The Medicare Advantage plan received the best star rating in customer service and care coordination. d. This Medicare Advantage plan is a 5-star rated plan due to its high rating in customer service. Question10 Marks: 1 Agent Higgins helps Mrs. O'Malley to enroll in AB Medicare Advantage (MA) plan during the Annual Open Enrollment Period. Mrs. O'Malley's effective enrollment date is January 1st. Subsequently, Mrs. O'Malley disenrolls on February 12th following a move outside the plan's service area. What impact will this have on Agent Higgins compensation? Choose one answer. a. AB MA plan must recoup a pro rata amount of Agent Higgins’ compensation and pay him only for the month of January. b. AB MA plan must recoup a pro rata amount of Agent Higgins’ compensation if Mrs. O’Malley subsequently enrolls in Original Medicare and Part D c. Agent Higgins entire compensation must be recouped because Mrs. O’Malley has disenrolled within 3 months of enrollment. d. AB MA plan does not have to recoup Agent Higgins’ compensation because she has moved away from its service area. Question11 Marks: 1 Mrs. Kelly, age 65, is entitled to Part A, but has not yet enrolled in Part B. She is considering enrollment in a Medicare health plan (Part C). What should you advise her to do before she will be able to enroll into a Medicare health plan? Choose one answer. a. In order to join a Medicare health plan, she must be enrolled in Parts A, B and D. b. To enroll in a Medicare health plan, she need only be entitled to Part A, so she does not need to take any further steps. c. Since she is age 65 she may enroll in any Medicare health plan, regardless of whether she is entitled to Part A or Part B coverage. d. In order to join a Medicare health plan, she also must enroll in Part B. Question12 Marks: 1 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? Choose one answer. a. She should expect to receive hard copies of both the provider and pharmacy directories automatically within 30 days of confirmation of enrollment. b. She should expect to receive Evidence of Coverage (EOC) within 21 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. Question13 Marks: 1 You market many different types of insurance and ordinarily you spend time each evening calling potential clients. To be in compliance with requirements for marketing Medicare Advantage and Part D plans, what must you do about contacting potential clients to market those plans? Choose one answer. a. As long as you market only health-related products, you can make an initial call to any beneficiary, but then must honor "do not call again" requests. b. You only need to comply with requirements of federal and state “Do Not Call” registries. c. You will have to avoid calling any potential client, unless he or she initiates contact with you and specifically asks that you give him or her a call. d. Because the Medicare health plans are important federal programs for beneficiaries, federal law regarding the "Do Not Call" registry is waived so you will be able to call and enroll beneficiaries over the telephone. Question14 Marks: 1 Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her? Choose one answer. a. Mrs. Radford must apply to the Medicare Advantage plan, which will include a medical review, prior to being accepted and enrolled. b. Even if Mrs. Radford has end stage renal disease, she will be able to enroll in any Medicare Advantage plan in her service area. c. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. d. Mrs. Radford can enroll in any Medicare Advantage plan that operates within the United States. Question15 Marks: 1 Alice is a marketing representative employed by a health plan. Betty is a captive agent of a health plan who markets to multiple plans and sponsors. Carl is a captive agent who markets to only one plan/sponsor. Denise is an independent agent who markets to different types of groups. Edward is an independent agent who markets only to employer and union groups. CMS marketing representative compensation rules generally apply to: Choose one answer. a. All of these people except Alice, the employee. b. All of these people. c. Denise and Edward (the independent agents), but not Alice (the employee) or Betty or Carl (the captive agents). d. Betty and Denise, but not Alice (the employee) or Carl or Edward (to whom exceptions apply). Question16 Marks: 1 Mrs. Young is currently enrolled in Original Medicare (Parts A and B), but she has been working with Agent Neil Adams in the selection of a Medicare Advantage (MA) plan. It is mid-September, and Mrs. Young is going on vacation. Agent Adams is considering suggesting that he and Mrs. Young complete the application together before she leaves. He will then submit the paper application prior the start of the annual enrollment period (AEP). What would you say If you were advising Agent Adams? Choose one answer. a. This is a bad idea. Agents are generally prohibited from soliciting or accepting an enrollment form prior to the start of the AEP. b. This is a good idea. The plan will retain Mrs. Young’s application and process it when the AEP begins. c. This is a good idea. This locks Mrs. Young into a plan and protects Agent Adams’ commission. d. This is a bad idea. Mrs. Young should complete an online application now so that Agent Adams will be given immediate credit for his work once the AEP begins. Question17 Marks: 1 Ms. Claggett is sixty-six (66) years old. She has been covered under both Parts A and B of Original Medicare for the last six years due to her disability, has never been enrolled in a Medicare Advantage or a Part D plan before. She wants to enroll in a Part D plan. She knows that there is such a thing as the “Part D Initial Enrollment Period” and has concluded that, since she has never enrolled in such a plan before, she should be eligible to enroll under this period. What should you tell her about how the Part D Initial Enrollment Period applies to her situation? Choose one answer. a. It occurs from October 15 to December 7of each year, so she will have to wait until that point to utilize that particular enrollment period. b. The Part D Initial Enrollment Period occurs only when a beneficiary turns 62, so it cannot be used as the justification for allowing her to enroll at this point. c. It occurs three months before and three months after the month when a beneficiary meets the eligibility requirements for Part B, so she will not be able to use it as a justification for enrolling in a Part D plan now. d. It occurs from January 1 to February 14 of each year, so she will have to wait until that point to utilize that particular enrollment period. Question18 Marks: 1 Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her? Choose one answer. a. Part D covers long-term care services and she shouldn’t worry because there has been no change in coverage. b. Part D covers physician and non-physician practitioner services and the deductible has not changed this year, but the physician charges may go up. c. Part D covers hospital and home health services and the cost sharing has changed this year. d. Part D covers prescription drugs and she should look at her premiums, formulary, and cost sharing among other factors to see if they have changed. Question19 Marks: 1 Plan sponsors may undertake the following marketing activities with current Medicare Advantage plan members? Choose one answer. a. Market non-Medicare health-related products, such as financial planning, to current members as permitted by HIPAA Privacy Rules. b. Market non-Medicare health-related products, such as dental insurance, to current members as permitted by HIPAA Privacy Rules. c. Market non-health related products, such as life insurance, to current members without the need to consider HIPAA Privacy Rules. d. Market contact information lists of current member to third-party vendors of ancillary health products as permitted by HIPAA Privacy Rules. Question20 Marks: 1 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? Choose one answer. 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 meets the definition of marketing material. d. Winthrop Brokerage must submit the advertisement to CMS for prior approval because it is considered general audience marketing. Question21 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. a. You must send it to the plan for immediate processing, although the enrollment will not become effective until January 1. b. You must tell him you are not permitted to take the form and if he sends it to the plan, the application will be rejected and he will need to fill out another form and submit it after the Annual Election Period begins. 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. d. You must accept the application, but hold it until the annual election period begins, after which you must send it to the plan for processing. Question22 Marks: 1 Mr. Katz reached the Part D coverage gap in August last year. His prescriptions have not changed, he is keeping the same Part D plan and the benefits, cost-sharing, and coverage of his drugs are all the same as last year. He asked what to expect for this year about his out-of-pocket costs. What could you tell him? Choose one answer. a. Because he reached the coverage gap last year, he will not have to go through it again this year. b. Because he reached the coverage gap last year, he will probably reach it again this year close to the same time. c. Because he reached the coverage gap in August last year, he probably will reach it much earlier this year. d. Because he reached the coverage gap in August last year, he probably won’t reach it until much later this year. Question23 Marks: 1 Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for-Service (PFFS) plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts consider before selecting a PFFS plan? Choose one answer. a. A PFFS plan offering only medical benefits or a PFFS Medigap Supplemental Insurance plan. b. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D prescription drug coverage, a PFFS plan offering only medical benefits, or PFFS Medigap Supplemental Insurance plan. c. A stand-alone prescription drug plan in combination with a PFFS plan or a PFFS Medigap Supplemental Insurance plan. d. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D prescription drug coverage, a PFFS plan offering only medical benefits, or a PFFS plan in combination with a stand-alone prescription drug plan. Question24 Marks: 1 All plans must cover at least the standard Part D coverage or its actuarial equivalent. What costs would a beneficiary incur for prescription drugs in 2019 under the standard coverage? Choose one answer. a. Standard Part D coverage would require payment of an annual deductible, 25% cost-sharing up to the coverage gap, a portion of costs for both generics and brand-name drugs in the coverage gap, and co-pays or co-insurance after the coverage gap. b. Standard Part D coverage would require payment of only fixed per-prescription co-payments. c. Standard Part D coverage would require payment of an annual deductible, 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. d. Standard Part D coverage would require payment of fixed per-prescription co-payments and 75% of the costs in the coverage gap. Question25 Marks: 1 When Myra first became eligible for Medicare, she enrolled in Original Medicare (Parts A and B). She is now 67 and will turn 68 on July 1. She would now like to enroll in a Medicare Advantage (MA) plan and approaches you about her options. What advice would you give her? Choose one answer. a. She should remain in Original Medicare until the annual election period running from October 15 to December 7, during which she can select an MA plan. b. She could enroll in an MA plan during the period including the three months before, the month of, and up to three months after turning 68. c. She could immediately enroll in MA plan based on the one-time special enrollment period available to those 70 and younger. d. She should wait until the new year to disenroll from Original Medicare and select an MA plan between January 1 and March 31. Question26 Marks: 1 Mr. Alonso receives some help paying for his two generic prescription drugs from his employer’s retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. What should you tell him? Choose one answer. a. He generally would pay only a monthly premium. Medicare covers all other costs. b. He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. c. He generally would pay only a per-prescription co-payment. Medicare covers all other costs. d. He generally would pay only a monthly premium and deductible. Medicare covers all other costs. Question27 Marks: 1 Mrs. Andrews was preparing a budget for next year because she takes quite a few prescription drugs, she will reach the coverage gap, and wants to be sure she has enough money set aside for those months. She received assistance calculating her projected expenses from her daughter who is a pharmacist, but she doesn’t think the calculations are correct because her out-of-pocket expenses would be lower than last year. She calls to ask if you can help. What might you tell her? Choose one answer. a. It would not be unusual for her costs to be a bit less because the Bipartisan Budget Act of 2018 moved up the date for closing the so-called “donut hole” for brand name drugs to 2019. b. It would not be unusual for her costs to be substantially less because a new requirement will result in generic drugs being automatically substituted for brand name drugs in the coverage gap. c. There is likely an error because she will be paying 86 percent of the cost of generic drugs in the coverage gap in 2019. d. There is likely an error in the calculations because prescription drug costs continue to rise, so her costs will probably be much higher next year. Question28 Marks: 1 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? Choose one answer. a. Section 1332 waiver plans. b. Medicare Advantage (MA) and Prescription Drug (PDP) plans c. Medigap plans d. Long-Term Care policies for Medicare beneficiaries Question29 Marks: 1 Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a website marketing the MA plans with which it has contracts. Agent Armstrong follows up with individuals who request more information about ABC MA plans via the website and tries to persuade them to enroll in ABC plans. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? Choose one answer. a. Agent Armstrong needs to be licensed and appointed only in his state of residence. b. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. c. Agent Armstrong needs to be licensed and appointed only in the state where ABC Health Plan is headquartered. d. Agent Armstrong needs to be licensed and appointed only in the state where XYZ Agency is headquartered. Question30 Marks: 1 Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. What should you tell him? Choose one answer. a. Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Health Plan. b. Part D prescription drug coverage can only be obtained by enrollment into a Medicare Health Plan that also covers Part A and Part B services. c. Mr. Singh must leave Original Medicare to receive drug coverage. d. 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. Question31 Marks: 1 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? Choose one answer. a. Original Medicare covers ambulance services. b. Original Medicare covers cosmetic surgery. c. Original Medicare covers orthopedic shoes. d. Original Medicare covers routine foot care. Question32 Marks: 1 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? Choose one 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. b. She should disenroll if she does not want to pay the monthly premiums. There is no disadvantage to doing so. c. Part B will cover her dental and vision needs. d. 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. Question33 Marks: 1 Mr. Denton is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? Choose one answer. a. He may not sign-up for Medicare until he reaches age 62, the date he first becomes eligible for Social Security benefits. b. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. c. He may sign-up for Medicare at any time and coverage usually begins immediately. d. He may sign-up for Medicare at any time however coverage usually begins on the sixth month after dialysis treatments start. Question34 Marks: 1 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? Choose one answer. a. Typically, coverage is effective on the date that the beneficiary completes the application form, so her coverage will be in place before she leaves. b. 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. c. Coverage always begins on the first of July, or the first of January after a beneficiary enrolls, whichever comes first. d. 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. Question35 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. a. The premiums differ because some plans intend to market to sicker beneficiaries and have set their premiums to reflect expected greater costs. b. All drug plans must offer exactly the same coverage model. The difference in premium is a result of the differing financial estimates of the companies offering the plans. c. 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. d. Medicare permits plans that have the highest quality services to reduce their premiums below the standard amount in order to increase their market share. This accounts for the variation in premium amounts. Question36 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. 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, 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. d. 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. Question37 Marks: 1 Which of the following individuals are likely to qualify for a special enrollment period (SEP) for both MA and Part D due to a change of residence? I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area. II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service area. III. Gilbert moves into a plan service area where there is now a Part D plan available to him from a service area where no Part D plan was available. IV. Henry makes a permanent move providing him with new MA and Part D options. Choose one answer. a. II, III, and IV only b. II and III only c. I, II, III and IV d. I and II only Question38 Marks: 1 You will be holding a sales event in the near future, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation? Choose one answer. a. Two or more gifts whose combined value does not exceed $15. b. Gift cards or gift certificates of $15 or less that can be readily converted to cash. c. Gifts of nominal retail value ($15 or less) d. Gifts worth more than $15 but based on anticipated attendance will not exceed $15 per attendee. Question39 Marks: 1 Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group health plan that includes drug coverage with nominal copays. He heard about a neighbor’s MA-PD plan that you represent and because he takes numerous prescription drugs, he is considering signing up for it. What should you tell him? Choose one answer. a. Generally, employers prefer retirees to enroll in a stand-alone PDP, so he should consider that instead of the MA-PD. b. Beneficiaries should check with their employer or union group benefits administrator before changing plans to avoid losing coverage they want to keep. c. Generally, employers prefer retirees to have both the retiree group plan and the MA-PD plan to fill in the gaps, but he would be better off with just the MA-PD plan. d. When possible, it is always the best option to have both the employer’s plan and the MA-PD, so he would have no out-of-pocket expenses. Question40 Marks: 1 Under what conditions can a Medicare prescription drug plan reduce its coverage for a given drug during the first 60 days of the year? Choose one answer. a. Under no conditions can a Medicare Part D prescription drug plan reduce its coverage for a given drug at any point during the year. b. When a formulary change is in response to a drug’s removal from the market. c. When the Part D plan can demonstrate to CMS that no enrollee has accessed the medication in the past six months, generally the plan can remove the drug from its formulary within the first 60 days of the year. d. If the Medicare prescription drug plan can show that reducing coverage early in the year will result in savings for the Part D plan and the Medicare program, generally the plan may make such a change. Question41 Marks: 1 Mrs. Walters is enrolled in her state’s Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare Health Plan? Choose one answer. 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. She can enroll in any type of Medicare Advantage (MA) plan except an MA Medical Savings Account (MSA) plan. c. State Medicaid programs do not coordinate any of their coverage with Medicare Health Plans. d. If a provider accepts her Medicare Health Plan coverage, that provider is legally obligated to also accept her Medicaid coverage, so she does not need to worry about finding providers who participate in both Medicare and Medicaid. Question42 Marks: 1 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? Choose one answer. a. He will avoid any financial penalty or late enrollment fee under the grandfathering provisions of Medicare Part D. b. He will not be able to enroll in Part D unless he decides to also enroll in a Medicare Advantage plan. c. He will incur a one-time financial penalty equal to 30 percent of the annual Part D premium. d. He will incur a late enrollment penalty. Question43 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. a. You would need to ask Mr. Kelly if he is enrolled in Part A and Part B, if he is healthy, and how often he expects to visit a doctor. b. You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PFFS plan’s service area. c. You would need to ask Mr. Kelly if he is enrolled in Part A and Part D and if he needs drug coverage. 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 Question44 Marks: 1 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? Choose one answer. 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. Question45 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. 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 can enroll in the five-star plan in the following October, when the next annual enrollment period (AEP) begins – not before. c. Mrs. Wellington must first enroll in a standalone PDP before she is eligible for a SEP to enroll in the MA five-star plan. d. Mrs. Wellington is eligible for a SEP that may be used once until November 30 to enroll in the five-star plan. Question46 Marks: 1 Mrs. Park is an elderly retiree. She has a low, fixed income. What could you tell Mrs. Park that might be of assistance? Choose one answer. a. She can apply to the Medicare agency for lower premiums and cost-sharing. b. She should not sign up for a Medigap or Medicare Advantage plan. c. She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help with Medicare costs for which she is responsible. d. She should only seek help from private organizations to cover her Medicare costs. Question47 Marks: 1 Mr. Shultz was still working when he first qualified for Medicare. At that time, he had employer group coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. It is now a year later and Mr. Shultz has lost his employer group coverage. How would you advise him? Choose one answer. a. Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty. b. Mr. Schultz should immediately enroll in a Part D plan but he can expect to pay a premium penalty because he failed to enroll when first eligible. c. Mr. Schultz should seek to continue employer group coverage through COBRA because it is likely to have superior benefits at a more reasonable price. d. Mr. Schultz can wait up to 180 days after the loss of his creditable employer group coverage before enrolling in a Part D plan without worrying payment a premium penalty. Question48 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. b. The neighbors may not provide anything to either eat or drink during the sales presentation. c. Any meal is allowed, as long as it is valued at less than $15. d. Any type of meal or food is allowed, as long as it is available to the general public and not just to those who are eligible to enroll in the plans. Question49 Marks: 1 Your friend’s mother just moved to an assisted living facility and he asked if you could present a program for the residents about the MA-PD plans you market. What could you tell him? Choose one answer. a. You appreciate the opportunity and would be happy to schedule an appointment with anyone at their request. b. You appreciate the opportunity and would ask the facility to provide enrollment applications for the MA-PD plans you represent. c. You appreciate the opportunity and would just need to complete scope of appointment forms on behalf of all the residents who would like to attend. d. You appreciate the opportunity and will ask the facility to provide a plan brochure and enrollment application in every resident’s room prior to the meeting to promote interest in the event. Question50 Marks: 1 Mrs. Pierce would like to enroll in a Medicare Cost plan that offers Part D prescription drug coverage. She comes to you for advice about when she can enroll in a plan you have previously discussed. What should you tell her? Choose one answer. a. Enrollment in Cost plans offering Part D coverage is available only during enrollment periods under the Part D program, and Cost plans must accept enrollments during these periods. b. Enrollment in Cost plans offering Part D prescription drug coverage is not necessary because Cost plans offer more generous Part B benefits. c. Enrollment in Cost plans offering Part D coverage is generally available year-round, so she can immediately enroll and have prescription drug coverage. d. Enrollment in Cost plans offering Part D coverage is generally available only 30 days per year, because of the more generous benefits of these plans.