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AHIP 2020 Questions & Answers


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Guest guest georgia
On 7/22/2019 at 12:48 PM, Guest David said:

All three are treated as independent agents under CMS compensation rules

question 17

anwser will be A

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Guest Test Taker

Susan,

You can save the whole test with your choices before you submit by doing a control P (for print) and save it as a PDF document.

 

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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

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Guest She has an SEP
18 hours ago, Guest Susan M. said:

This is why this one is correct:  

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:  B is wrong because you can't accept applications for AEP prior to October 15th.  D is wrong because you cannot ask for her health history.  C is wrong because it is not her initial enrollment / SEP.  Her initial enrollment ICEP would have been when she turned 65.  She only qualifies for a regular SEP.  We don't know what month she is contacting the agent, so it's hard to tell whether or not the agent can take an application from her.  if she was meeting the agent in June, he could accept an application form (30 days prior to loss of coverage and up to 2 months after loss of coverage).  But since that information is not present, A is the best answer.  A is technically correct.

Answer: C is the correct answer because she is retiring she is also leaving her employer coverage. That IS her SEP. She has the month of her loss and 2 months after to enroll in whatever plan she wants. (medicare.gov - " Ileft coverage from my employer or union (including COBRA coverage).What can I do?Join a Medicare Advantage Plan or Medicare Prescription Drug Plan. When? Your chance to join lasts for 2 full months after the month your coverage ends.

 

18 hours ago, Guest Susan M. said:

Question 19Agent 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?

We don't have the 4 answer options here.  Potential answers:  He can provide snacks and gifts totalling 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.  

 

 

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Guest She has an SEP
18 hours ago, Guest Susan M. said:

This is why this one is correct:  

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:  B is wrong because you can't accept applications for AEP prior to October 15th.  D is wrong because you cannot ask for her health history.  C is wrong because it is not her initial enrollment / SEP.  Her initial enrollment ICEP would have been when she turned 65.  She only qualifies for a regular SEP.  We don't know what month she is contacting the agent, so it's hard to tell whether or not the agent can take an application from her.  if she was meeting the agent in June, he could accept an application form (30 days prior to loss of coverage and up to 2 months after loss of coverage).  But since that information is not present, A is the best answer.  A is technically correct.

Answer: C is the correct answer because she is retiring she is also leaving her employer coverage. That IS her SEP. She has the month of her loss and 2 months after to enroll in whatever plan she wants. (medicare.gov - " Ileft coverage from my employer or union (including COBRA coverage).What can I do?Join a Medicare Advantage Plan or Medicare Prescription Drug Plan. When? Your chance to join lasts for 2 full months after the month your coverage ends.

 

Quote

Question 19Agent 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?

We don't have the 4 answer options here.  Potential answers:  He can provide snacks and gifts totalling 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.  

 

 

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Guest She has an SEP
15 hours ago, Guest CONFUSED said:

HI, THE FOLLOWING QUESTION IS VERY CONFUSING OR I JUST DONT UNDERSTAND. SO IF A BENEFICIARY HAS ANY LEVEL OF MEDICAID & MEDICARE AND DECIDES TO APPLY FOR A MA-PPO PLAN AND GOES  OUT OF NETWORK TO A DOCTOR THAT ONLY ACCEPTS MEDICARE, THE DOCTOR STILL IS ONLY ALLOWED TO COLLECT FROM MEDICAID ? EVEN HE DOES NOT ACCEPTS MEDICAID?

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?

Choose one answer.

 

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 plus 15 percent balance billing.

 
 

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

 
 

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

 

The correct answer is B. If you look up on medicare.gov it explains that the doctor can bill medicare first and then 15% charge for medicaid. (https://www.aarp.org/content/dam/aarp/ppi/2017-01/medicare-limits-on-balance-billing-and-private-contracting-ppi.pdf  -  Nonparticipating providers who accept Medicare. A small proportion of physicians—about 4 percent—accept Medicare but are “nonparticipating providers.”3 These providers are allowed to balance-bill patients, but by law the amount they balance-bill cannot exceed 15 percent of the Medicare-approved payment amount for nonparticipating physicians for each service.)

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17 hours ago, Guest She has an SEP said:

The correct answer is B. If you look up on medicare.gov it explains that the doctor can bill medicare first and then 15% charge for medicaid. (https://www.aarp.org/content/dam/aarp/ppi/2017-01/medicare-limits-on-balance-billing-and-private-contracting-ppi.pdf  -  Nonparticipating providers who accept Medicare. A small proportion of physicians—about 4 percent—accept Medicare but are “nonparticipating providers.”3 These providers are allowed to balance-bill patients, but by law the amount they balance-bill cannot exceed 15 percent of the Medicare-approved payment amount for nonparticipating physicians for each service.)

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. 

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Guest Judy V
On 7/25/2019 at 6:45 PM, Guest CONFUSED said:

HI, THE FOLLOWING QUESTION IS VERY CONFUSING OR I JUST DONT UNDERSTAND. SO IF A BENEFICIARY HAS ANY LEVEL OF MEDICAID & MEDICARE AND DECIDES TO APPLY FOR A MA-PPO PLAN AND GOES  OUT OF NETWORK TO A DOCTOR THAT ONLY ACCEPTS MEDICARE, THE DOCTOR STILL IS ONLY ALLOWED TO COLLECT FROM MEDICAID ? EVEN HE DOES NOT ACCEPTS MEDICAID?

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?

Choose one answer.

 

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 plus 15 percent balance billing.

 
 

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

 
 

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

 

The answer to this question is C. The doctor may only collect from Mr Rivera the cost sharing allowable under the state's Medicaid program. Module 2 slide 38

 

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Guest Judy V

 

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?

Has anyone come across this question and if so can u post the choices.

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Guest Judy Vega
7 hours ago, Guest Judy V said:

 

 

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?

Has anyone come across this question and if so can u post the choices.

Here are the choices:

 

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).

 

I answered - c. Alice because she will not have a break between her non-Medicare and Medicare coverage through
Spartan Health Plan.

I got 98% on my Ahip test but don't know the wrong once. I will forward to David my questions and answers later.

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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.

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Guest LOUISE CUTLER

I WISH THERE WAS A WAY TO SEE WHAT QUESTIONS WHERE RIGHT AND WHICH WERE WRONG? THIS THE FIRST TIME I AM TAKING THE TEST AND THE FIRST ATTEMPT WAS A 76 AND THEN 80. I HAVE BEEN GOING OVER THIS ALL DAY. TAKING THE MODULES AND GOING OVER MY PREVIOUS TESTS BUT I AM NOT SURE WHAT IS RIGHT OR WRONG.

 

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Guest LOUISE CUTLER
On 7/25/2019 at 4:45 PM, Guest CONFUSED said:

HI, THE FOLLOWING QUESTION IS VERY CONFUSING OR I JUST DONT UNDERSTAND. SO IF A BENEFICIARY HAS ANY LEVEL OF MEDICAID & MEDICARE AND DECIDES TO APPLY FOR A MA-PPO PLAN AND GOES  OUT OF NETWORK TO A DOCTOR THAT ONLY ACCEPTS MEDICARE, THE DOCTOR STILL IS ONLY ALLOWED TO COLLECT FROM MEDICAID ? EVEN HE DOES NOT ACCEPTS MEDICAID?

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?

Choose one answer.

 

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 plus 15 percent balance billing.

 
 

c. The doctor may only collect from Mr. Rivera the cost sharing allowable under the state’s Medicaid program. THIS IS THE ANSWER. 

 

 
 

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

 

 

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Guest LOUISE CUTLER
On 7/25/2019 at 4:45 PM, Guest CONFUSED said:

HI, THE FOLLOWING QUESTION IS VERY CONFUSING OR I JUST DONT UNDERSTAND. SO IF A BENEFICIARY HAS ANY LEVEL OF MEDICAID & MEDICARE AND DECIDES TO APPLY FOR A MA-PPO PLAN AND GOES  OUT OF NETWORK TO A DOCTOR THAT ONLY ACCEPTS MEDICARE, THE DOCTOR STILL IS ONLY ALLOWED TO COLLECT FROM MEDICAID ? EVEN HE DOES NOT ACCEPTS MEDICAID?

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?

Choose one answer.

 

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 plus 15 percent balance billing.

 
 

c. The doctor may only collect from Mr. Rivera the cost sharing allowable under the state’s Medicaid program. THIS IS THE ANSWER. 

 

 
 

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

 

 

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Guest edward m

Can someone clarify this question from page one in module four it's listed:

Question: 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?

Answer: You may go ahead and call them.

and TEST 3

looks like similar question but the answer is different and don't see it as an option also

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

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Guest Edward M

TEST 3 Question 46 Has 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

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

test 1&2 has a different answer

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

not sure if this is the one that was missed on test 3 but i'm just trying to get the right one

 

 

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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. 

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On 7/22/2019 at 11:07 AM, Guest Question 45 said:

What is the answer to Q45 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?

So what is the correct answer????? A or D

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  • 2 months later...

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.

 

 

 

 
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