2018 AHIP, AHIP MEDICARE 2019, AHIP Testing 2018, AHIP questions, AHIP Module 1 Quiz 2, AHIP Module 2, AHIP Module 5, AHIP module 4, AHIP Testing 2018, AHIP Module 3, AHIP Testing 2018..., AHIP module 1, Ahip Module 3, 2018 *** AHIP****(NAMES), Ahip...

Which area of potential discrimination is not generally covered by ACA Section 1557?

Employment (with the exception of the provision of health insurance).

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?

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.

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?

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.

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

Every Part D drug plan is required to cover a 30 day supply of her existing medications sometime during a 90 day transition period

*MR. CASTILLO*, A NATURALIZED CITIZEN, PREVIOUSLY ENROLLED IN MEDICARE PART B BUT HAS RECENTLY STOPPED PAYING HIS PART B PREMIUM. HE WOULD LIKE TO ENROLL IN MEDICARE ADVANTAGE (MA) PLAN AND IS STILL COVERED BY PART A. WHAT SHOULD YOU TELL HIM?

HE IS NOT ELIGIBLE TO ENROLL IN A MEDICARE ADVANTAGE PLAN UNTIL HE RE-ENROLLS IN MEDICARE PART B

*MRS QUINN* HAS JUST TURNED 65 AND RECEIVED A LETTER INFORMING HER THAT SHE HAS BEEN AUTOMATICALLY ENROLLED IN MEDICARE PART B..............

PART B PRIMARILY COVERS PHYCICAN SERVIES. SHE WILL BE PAYING A MONTHLY............

Mr. Saunders is entitled to Part A, but has not enrolled in Part B because he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do?

He will have to enroll in Part B

Mr. Gonzalez is entitled to Part A, but has not yet enrolled in Part B. If he wants to enroll in a Private Fee-for-Service (PFFS) plan, what will he have to do?

He will have to enroll in Part B prior to enrolling in the PFFS plan.

Mr. Sanchez is entitled to Part A, but has not enrolled in Part B because he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do?

He will have to enroll in Part B.

Mr. Saunders is entitled to Part A, but has not enrolled in Part B because he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do?

He will have to enroll in Part B.

During a sales presentation, your client asks you whether the Medicare agency recommends that she sign up for your plan or stay in Original Medicare. What should you tell her?

Tell her that the Medicare agency does not endorse or recommend any plan.

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

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

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?

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

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?

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.

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

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

YOU ARE DOING A SALES PRESENTATION FOR *MRS. PEARSON* YOU KNOW THAT THE MEDICARE.

IF YOURE NOT IN VERY GOOD HEALTH YOU WILL PROBABLY DO BETTER WITH A DIFFERENT PRODUCT

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

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

Mr. Meoni's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs. What could you tell Mr.Meoni?

Medicare Supplemental Insurance would help cover his Part A and Part B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover

The Medicare agency requires all Medicare health plans that contract with marketing representatives to ensure that contracts address which of the following?

Medicare health plans must include in all marketing representative contracts requirements to abide by all guidance from the Federal agency overseeing Medicare and all applicable state laws.

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

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

b

Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for Medicare & Medicaid Services' Marketing Guidelines to ensure he is compliant for which type of products? a. Medigap plans b. Medicare Advantage (MA) and Prescription Drug (PDP) plans c. Section 1332 waiver plans. d. Long-Term Care policies for Medicare beneficiaries

Which Medicare programs are covered by ACA Section 1557?

Parts A, C, and D, but not B

ACA Section 1557 rules for disability concern

Policies and procedures, physical access, and communication

Roberta is a retiree who has just learned that she has purchased a Medicare Advantage (MA) plan from an unlicensed individual representing BestCare Health Plan. What are Roberta's options, if any?

Roberta may request to change plans upon receiving notification of the agent's unlicensed status.

*MRS. KENDRICK* IS SIX MONTHS AWAY FROM TURNING 65. SHE WANTS TO KNOW WHAT SHE WILL HAVE TO DO TO ENROLL IN MA PLAN........

SHE MAY ENROLL IN AN MA PLAN BEGINNING THREE MONTHS IMMEDIATELY BEFORE HER FIRST ENTITLEMENT TO BOTH PAR AND B

Mrs. Fiore was in the Army for 35 years and is now retired. She has drug coverage through the VA. What issues might she consider with regard to whether to enroll in a Medicare prescription drug plan?

She could compare the coverage to see if the Medicare Part D plan offers better benefits and coverage than the VA for the specific medications she needs and whether any additional benefits are worth the Part D premium costs

Mrs. Fiore was in the Army for 35 years and is now retired. She has drug coverage through the VA. What issues might she consider with regard to whether to enroll in a Medicare prescription drug plan?

She could compare the coverage to see if the Medicare Part D plan offers better benefits and coverage than the VA for the specific medications she needs and whether any additional benefits are worth the Part D premium costs.

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?

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

You are meeting with Mrs. Hall in her home. On her scope of appointment form she asked to discuss Medicare Advantage plans. During the meeting, she asks to discuss a stand-alone prescription drug plan. She is leaving the next day to visit her family for a week in another state, so it is important to her to make a decision before she leaves. What must happen before that additional discussion can take place?

Since Mrs. Hall specifically asked that you discuss the stand-alone Part D plan, you may do so, as long as she signs a new scope of appointment form first, indicating that she wants to discuss the Part D plan

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. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan?

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

When soliciting referrals from current members of an MA or Part D plan, what may you do?

You may request names and mailing addresses

You plan to participate in an educational event sponsored by a large regional health care system. One of your colleagues suggests that you do a presentation on one of the Medicare Health plans you market, and modify it to include information about preventive screening tests showcased at the event. How should you respond to your colleague's suggestion?

You should tell your colleague no because participation in an educational event may not include a sales presentation

You plan to participate in an educational event sponsored by a large regional health care system. One of your colleagues suggests that you do a presentation on one of the Medicare Health plans you market, and modify it to include information about preventive screening tests showcased at the event. How should you respond to your colleague's suggestion?

You should tell your colleague no because participation in an educational event may not include a sales presentation.

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

charge higher premiums

Under ACA Section 1557, prohibited actions involve

eligibility, claims, and marketing

SEVERAL AGENTS YOU WORK WITH ARE PLANNING SALES EVENTS IN YOR AREA. ONE PLANS ON GIVING DOOR PRIZES WORTH $5, REFRESHMENTS VALUED AT $8 PER ANTICIPATED ATTENDEE, AND COUPON BOOKS......

HE CAN GIVE AWAY MORE THAN ONE GIFT DURING A SINGLE EVENT, BUT THE AGGREGATE RETAIL VALUE CANNOT EXCEED $15

*MR. BICKFORD* DID NOT QUITE QUALIFY FOR THE EXTRA HELP LOW INCOME SUBSIDY UNDER THE MEDICARE PART D PRESCRIPTION DRUG PROGRAM

HE COULD CHECK WITH THE MANUFACTURERS OF HIS MEDICATIONS TO SEE IF THEY OFFER AN ASSISTANCE...........

*MR. CARTER* WHO IS ENROLLED IN A STAND ALONE PRESCRIPTION PART D PLAN RECIEVES THE PART D LOW INCOME SUDSIDY AND JUST.........

HE QUALIFIES FOR A SPECIAL ELECTION PERIOD WHICH BEGINS THE MONTH HE WAS NOTIFIED OF HIS LOSS AND CONTINUES FOR TWO MORE MONTHS. THIS SEP ALLOWS....

You are doing a sales presentation for Mrs. Pearson. You know that the Medicare marketing guidelines prohibit certain types of statements. Apply those guidelines to the following statements and identify which would be prohibited.

"If you're not in very good health, you will probably do better with a different product."

You are doing a sales presentation for Mrs. Peck. You know that the Medicare marketing guidelines prohibit certain types of statements. Apply those guidelines to the following statements and identify which would be prohibited.

"If you're not in very good health, you will probably do better with a different product."

Medicare Advantage

-Cover all Part A and Part B benefits; -Provide plan cost-sharing actuarially equivalent to cost sharing under Medicare Parts A and B, but may be different for specific services; and -Include an annual maximum out-of-pocket (MOOP) limit on total enrollee cost sharing (deductibles, coinsurance, and copayments) for Part A and Part B services. -Cover the following services even when provided by non-network providers: emergency services: out-of-area urgently needed services; and out-of-area renal dialysis

Part C Medicare health plans

-Cover all part A and B benefits; -Provide plan cost-sharing actuarially equivalent to cost sharing under Medicare part A and B, but may be different for specific services; and -Include an annual maximum out-of-pocket (moop) limit on total enrollee cost sharing (deductibles, coinsurance, and co-payment) for part A and B services. •original medicare does not have such a gap -Cover the following services even when provided by non-network providers: •Emergency services; •out-of-area (and in limited circumstances, in area) urgently needed services; and •out-of-area renal dialysis

New Medicare Identification cards

-Every medicare beneficiary receives a medical ID card -During the next year, medicare will stop using social security numbers for identification. For beneficiaries who already have their medicare identification card with there social security number, medicare will mail them new cards with medicare ID numbers.. mailing will begin April 2018 and be completed by April 2019 -The change is intended to help protect beneficiaries from identity theft. -After they received them, beneficiaries need to bring there new cards whenever they get care -Beneficiaries should also destroy there old cards when receiving new cards

Part C- Medicare Advantage Plans (Medicare Advantage plans must cover all part A and B services)

-HMO (some includes part D) -PPO (some includes part D) -Private fee-for-service plans (PFFS) (some offer part D but are not obligated) -Special needs plan SPN (all plans include part D) -Medical Savings Account plan (MSAs) (do not include part D) -employers or union group plans

Medicare Law

-Medicare statues are found under title xviii of the social security act: "Health insurance for the aged and disabled" Title xviii is split by topic into several subsections -part A. Hospital -part B. Medical -part C. medicare health plans, which must cover part A and B benefits -part D perscription drug coverage -part E. miscellaneous provisions, including Medigap coverage

Different ways to get medicare overview

-Original (part A and B) -Medicare Advantage plans (Medicare part c with or without Part D) -Medicare cost sharing plans -PACE Plans -Medicare-Medicaid plans -Medicare perscription drug plans (medicare part D) -medigap

Different ways to get Medicare, countinued

-other types of health plans •Medicare Cost Plans (some also include Part D) •PACE plans (includes Part D) Medicare-Medicaid Plans (includes part D)

to qualify for medicare you need to be

.65 or older .under 65 with certain disabilities .all who get disability benifits from social security or certain disability benifits from the railroad retirement for 24 months. . Individuals with Amyotrophic Lateral sclerosis (also known as lue garings disease

WHICH OF THE FOLLOWING STATEMENTS BEST DESCRIBES HOW BUSINESS REPLY CARDS (BRCS) MAY BE EMPLOYED IN THE MARKETING OF MEDICARE ADVANTAGE PRODUCTS?

A BRC MAY BE USED TO DOCUMENT A BENEFICIARY'S SCOPE OF APPOINTMENT AGREEMENT PROVIDED IT HAS BEEN SUBMITTED TO CMS FOR APPROVAL AND INCLUDES A STATEMENT FOLLOWING THE BENEFICIARY THAT A SALESPERSON MAY CALL.

Which of the following statements best describes how business reply cards (BRCs) may be employed in the marketing of Medicare Advantage products?

A BRC may be used to document a beneficiary's scope of appointment agreement provided it has been submitted to CMS for approval and includes a statement informing the beneficiary that a salesperson may call

Which of the following statements best describes how business reply cards (BRCs) may be employed in the marketing of Medicare Advantage products?

A BRC may be used to document a beneficiary's scope of appointment agreement provided it has been submitted to CMS for approval and includes a statement informing the beneficiary that a salesperson may call.

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

A Cost Plan only if it does not offer drug coverage.

*MR. HERNANDEZ* IS CONCERNED THAT IF HE SIGNS UP FOR A MEDICAR HEALTH PLAN, THE HEALTH PLAN MAY, AT SOME TIME IN THE FUTURE, REDUCE......

A MEDICARE HEALTH PLANS MUST COVER ALL BENEFITS AVAILABLE UNDER MEADICARE PART A AND PART B. MANY ALSO COVER PART D

Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for-Service (PFFS) plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts consider before selecting a PFFS plan?

A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D prescription drug coverage, a PFFS plan offering only medical benefits, or a PFFS plan in combination with a stand-alone prescription drug plan

Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for-Service (PFFS) plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts consider before selecting a PFFS plan?

A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D prescription drug coverage, a PFFS plan offering only medical benefits, or a PFFS plan in combination with a stand-alone prescription drug plan.

d

A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. Before engaging in such a discussion, what should you do? a. Prior to speaking with the individual, you must inquire as to her eligibility for MA and Part D plans and then complete a scope of appointment form for the plans for which she is eligible. b. You do not have to do anything. You may proceed with the discussion and enroll the individual, if she so desires. c. You must set an appointment for another time, at least 48 hours from the point when she walked into your office. d. You must have her sign a scope of appointment form, indicating which products she wishes to discuss. You may then proceed with the discussion.

*DURING A SALES PRESENTATION* IN MS. SULLIVAN'S HOME, SHE TELLS YOU THAT SHE HAS HEARD ABOUT A TYPE OF MEDICARE HEALTH PLAN KNOWN AS PRIVATE FEE FOR SERVIVES.............

A PFFS PLAN IS ONE OF VARIOUS TYPES OF MEDICARE ADVANTAGE PLANS OFFERED BY PRIVATE ENTITIES.............................

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

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

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

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

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

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

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

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

Agent Higgins helps Mrs. O'Malley to enroll in AB Medicare Advantage (MA) plan during the Annual Open Enrollment Period. Mrs. O'Malley's effective enrollment date is January 1st. Subsequently, Mrs. O'Malley disenrolls on February 12th following a move outside the plan's service area. What impact will this have on Agent Higgins compensation?

AB MA plan does not have to recoup Agent Higgins' compensation because she has moved away from its service area.

ABC IS A LONG-TERM CARE FACILITY PROVIDER. WHAT STEPS MAY IT TAKE TO INFORM RESIDENTS OF THE MEDICARE OPTIONS AVAILABLE TO THEM?

ABC MAY PROIVDE RESIDENTS THAT MEET THE I-SNP CRITERIA AN EXPLANATORY BROCHURE, REPLY CARD, AND PHONE NUMBER FOR ADDITIONAL INFORMATION FOR EACH I-SNP.......

b

ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' protected health information to market non-health related products such as life insurance and annuities. To do so it must obtain authorization from the enrollees. Which statement best describes the authorization process? a. The request for authorization may include a brief synopsis of non-health related content. b. Authorization may be obtained by directing a beneficiary to a website to provide consent. c. Once a plan sends out a written request for consent, a beneficiary can authorize consent by simply failing to reply within 21 days. d. It is not necessary for ABC to obtain an authorization to simply explain pending state or federal legislation, since there is no anticipation of selling a non-health related product in these circumstances.

c

ABC is a long-term care facility provider. What steps may it take to inform residents of the Medicare options available to them? a. ABC may display posters about Medicare in their rooms. b. Since they are likely to be frail or suffer mental incapacity, ABC may choose plan coverages on their behalf. c. ABC may provide residents that meet the I-SNP criteria an explanatory brochure, reply card, and phone number for additional information for each I-SNP with which it contracts. d. ABC may set up appointment on their behalf with knowledgeable agents.

ABC is a long-term care facility provider. What steps may it take to inform residents of the Medicare options available to them?

ABC may provide residents that meet the I-SNP criteria an explanatory brochure, reply card, and phone number for additional information for each I-SNP with which it contracts

ABC is a long-term care facility provider. What steps may it take to inform residents of the Medicare options available to them?

ABC may provide residents that meet the I-SNP criteria an explanatory brochure, reply card, and phone number for additional information for each I-SNP with which it contracts.

AGENT *ARMSTRONG* IS EMPLOYED BY XYZ AGENCY, WHICH IS UNDER CONTRACT WITH ABC HEALTH PLAN, A MEDICARE ADVANTAGE (MA) PLAN THAT OFFER PLANS IN MULTIPLE STATES. XYZ AGENCY MAINTAINS A INDIVIDUALS WHO REQUEST MORE INFORMATION ABOUT ABC..........

AGENT ARMSTRONG NEEDS TO BE LICENSED AND APPOINTED IN EVERY STATE IN WHICH BENEFICIARIES TO WHOM HE MARKETS ABC MA PLANS ARE LOCATED.

ABC HEALTH PLAN HAS JUST LEARNED THAT SEVERAL INDIVIDUALS MARKETING THEIR MEDICARE ADVANTAGE PLANS IN A STATE ARE UNLICENSED. WHAT ACTIONS MUST ABC........

AMONG OTHERS STEPS, ABC MUST TERMINATE THESE INDIVIDUALS AND REPORT TO BOTH STATE AND CMS INCIDENCES OF SUBMISSION OF APPLICATION...........

AGENT *ANTONIO* IS PREPARING FOR A PRESENTATION ON MEDICARE AND MEDICARE ADVANTAGE BEFORE A LOCAL SENIOR CITIZEN CIVIC GROUP WHERE HE HELPS TO ENROLL SOME ATTENDEES. WHICH OF THE FOLLOWING STEPS SHOULD HE TAKE IN OREDER TO BE IN COMPLIANCE WITH MARKETING RULES?

ANTONIO SHOULD INCLUDE ON THE INVITATION A STATEMENT THAT A SALESPERSON WILL BE PRESENT WITH INFORMATION AND APPLICATIONS.

ABC IS A MEDICARE ADVANTAGE (MA) PLAN SPONSOR. IT WOULD LIKE TO USE ITS ENROLLEES' PROTECTED HEALTH INFORMATION TO MARKET NON-HEALTH RELATED PRODUCTS SUCH AS LIFE INSURANCE AND ANNUITIES.......

AUTHORIZATION MAY BE OBTAINED BY DIRECTING A BENEFICIARY TO A WEBSITE TO PROVIDE CONSENT.

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

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

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

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

d

Agent Antonio is preparing for a presentation on Medicare and Medicare Advantage before a local senior citizen civic group where he hopes to enroll some attendees. Which of the following steps should he take in order to be in compliance with Medicare marketing rules? a. Antonio should include a statement that due to the venue limitations accommodations for persons with special needs will not be available. b. Antonio should include on the invitation that food will be served and alcoholic beverages will be available free of charge. c. Antonio should indicate that in order to attend the meeting, an e-mail address must be provided on the RSVP card. d. Antonio should include on the invitation a statement that a salesperson will be present with information and applications.

d

Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. What should you tell her? a. Marketing representatives may only use internet pop-up ads providing plan-specific information that have been approved by CMS when soliciting prospects through electronic means of communication. b. Marketing representatives may initiate electronic contact through e-mail and as long as an e-mail is opened marketing representatives may also follow-up with unsolicited telephone calls. c. While unsolicited contacts may be made through print media such as direct mail, marketing representatives may not initiate electronic contact. d. Marketing representatives may initiate electronic contact through e-mail but the subject line must say "marketing" and an opt-out process must be provided.

d

Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a website marketing the MA plans with which it has contracts. Agent Armstrong follows up with individuals who request more information about ABC MA plans via the website and tries to persuade them to enroll in ABC plans. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? a. Agent Armstrong needs to be licensed and appointed only in his state of residence. b. Agent Armstrong needs to be licensed and appointed only in the state where ABC Health Plan is headquartered. c. Agent Armstrong needs to be licensed and appointed only in the state where XYZ Agency is headquartered. d. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located.

Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a website marketing the MA plans with which it has contracts. Agent Armstrong follows up with individuals who request more information about ABC MA plans via the website and tries to persuade them to enroll in ABC plans. What statement best describes the marketing and compliance rules that apply to Agent Armstrong?

Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located

Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a website marketing the MA plans with which it has contracts. Agent Armstrong follows up with individuals who request more information about ABC MA plans via the website and tries to persuade them to enroll in ABC plans. What statement best describes the marketing and compliance rules that apply to Agent Armstrong?

Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located.

c

Agent Harriet Walker has recently begun marketing Medicare Advantage and related products aimed at meeting the needs of senior citizens. Client Mildred Jones has expressed interest in a Medicare Advantage plan. It is now the beginning of September. If you were in Agent Walker's position, what would you do? a. Solicit and complete the enrollment application in September and wait until the open enrollment date to submit it so that the client does not purchase a plan through another agent. b. Tell the client that she cannot speak to her until after open enrollment begins on January 1st of the following year. c. Inquire whether the client qualifies for a special enrollment period, and if not, solicit an enrollment application once the annual open enrollment election period begins on October 15th. d. Tell the client that she should also consider non-health products (such as cash value life insurance) to meet some of her health needs and offer to submit a life insurance application to see if client Jones is insurable.

Agent Higgins helps Mrs. O'Malley to enroll in AB Medicare Advantage (MA) plan during the Annual Open Enrollment Period. Mrs. O'Malley's effective enrollment date is January 1st. Subsequently, Mrs. O'Malley disenrolls on February 12th following a move outside the plan's service area. What impact will this have on Agent Higgins compensation?

Agent Higgins entire compensation must be recouped because Mrs. O'Malley has disenrolled within 3 months of enrollment.

d

Agent Higgins helps Mrs. O'Malley to enroll in AB Medicare Advantage (MA) plan during the Annual Open Enrollment Period. Mrs. O'Malley's effective enrollment date is January 1st. Subsequently, Mrs. O'Malley disenrolls on February 12th following a move outside the plan's service area. What impact will this have on Agent Higgins compensation? a. AB MA plan must recoup a pro rata amount of Agent Higgins' compensation and pay him only for the month of January. b. AB MA plan must recoup a pro rata amount of Agent Higgins' compensation if Mrs. O'Malley subsequently enrolls in Original Medicare and Part D c. Agent Higgins entire compensation must be recouped because Mrs. O'Malley has disenrolled within 3 months of enrollment. d. AB MA plan does not have to recoup Agent Higgins' compensation because she has moved away from its service area.

a

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 entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. b. Agent Lopez's compensation is not impacted because Ralph's disenrollment occurred more than 30 days after the effective date of coverage. c. Agent Lopez is entitled to a pro rata amount of the compensation earned including the full amount for the month of February. d. Agent Lopez's compensation is not impacted because Ralph's disenrollment occurred after the Annual Open Enrollment Period.

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?

Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment.

d

Agent Mary Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings distributes materials that are solely educational in nature. However, she gives a brief presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that has been advertised as educational? a. No. This action is permissible. Handing out enrollment forms, on the other hand, would not be permissible. b. No. Attendees expect some "puffery" at any event on a product in which they may be potentially interested. c. Yes. Whether or not an event has been advertised as "educational" or a "sales presentation," discussing plan-specific information is impermissible. d. Yes. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible.

b

Ajax Agency is targeting potential enrollees for MSA plans. Which of the following statements best describes the rules that apply to the MSA materials it distributes? a. The materials must make clear that beneficiaries are automatically enrolled in a prescription drug plan as part of the MSA. b. The materials must make clear that Medicare MSA plans do not cover prescription drugs and that beneficiaries can join a separate Part D prescription drug plan. c. The materials must make clear that those who enroll must make monthly deposits into the custodial savings account associated with plan. d. The materials must make clear that money in the MSA custodial account can be used for all medical expenses and both Medicare-covered and non-covered expenses count toward the beneficiary's deductible.

b

Alice is a marketing representative employed by a health plan. Betty is a captive agent of a health plan who markets to multiple plans and sponsors. Carl is a captive agent who markets to only one plan/sponsor. Denise is an independent agent who markets to different types of groups. Edward is an independent agent who markets only to employer and union groups. CMS marketing representative compensation rules generally apply to: a. All of these people. b. Betty and Denise, but not Alice (the employee) or Carl or Edward (to whom exceptions apply). c. Denise and Edward (the independent agents), but not Alice (the employee) or Betty or Carl (the captive agents). d. All of these people except Alice, the employee.

Ways to report a compliance issue include:

All of the above

What are some of the consequences for non-compliance, fraudulent, or unethical behavior?

All of the above

c

All plans must cover at least the standard Part D coverage or its actuarial equivalent. What costs would a beneficiary incur for prescription drugs in 2019 under the standard coverage? a. Standard Part D coverage would require payment of an annual deductible, fixed per-prescription co-payments, 35% of the costs in the coverage gap, and once catastrophic coverage begins, the plan covers 100% of all costs. b. Standard Part D coverage would require payment of fixed per-prescription co-payments and 75% of the costs in the coverage gap. c. Standard Part D coverage would require payment of an annual deductible, 25% cost-sharing up to the coverage gap, a portion of costs for both generics and brand-name drugs in the coverage gap, and co-pays or co-insurance after the coverage gap. d. Standard Part D coverage would require payment of only fixed per-prescription co-payments.

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

Allowing a child to interpret in an emergency

ABC Health Plan has just learned that several individuals marketing their Medicare Advantage plans in a state are unlicensed. What actions must ABC take in response?

Among other steps, ABC must terminate these individuals and report to both the state and CMS incidences of submission of applications by unlicensed agents and or brokers

ABC Health Plan has just learned that several individuals marketing their Medicare Advantage plans in a state are unlicensed. What actions must ABC take in response?

Among other steps, ABC must terminate these individuals and report to both the state and CMS incidences of submission of applications by unlicensed agents and or brokers.

c

Another agent working for your agency claims that because you are not employed by the Medicare Advantage plans that you represent, you are not subject to the same requirements as the plans themselves. How should you respond to such a statement? a. Your coworker is correct. You may use any marketing techniques that do not involve providing misinformation to potential enrollees. b. Your coworker is correct because employed agents have to follow a stricter set of rules than do independent agents, such as yourself. c. Your coworker is not correct. Marketing on behalf of a plan is considered marketing by the plan and requires that all contracted and employed agents comply with all Medicare marketing rules. d. Your coworker is correct. You are subject only to requirements issued by your state department of insurance.

c

Another agent you know has engaged in misconduct that has been verified by the plan she represented. What sort of penalty might the plan impose on this individual? a. Plans do not impose penalties. Instead, the Medicare agency has specific authority to fine such individuals for each violation. b. Her name will be reported to a publicly accessible database and could be advertised in local newspapers. c. The plan may withhold commission, require retraining, report the misconduct to a state department of insurance or terminate the contract. d. Plans must immediately terminate their contracts with such individuals.

Agent Antonio is preparing for a presentation on Medicare and Medicare Advantage before a local senior citizen civic group where he hopes to enroll some attendees. Which of the following steps should he take in order to be in compliance with Medicare marketing rules?

Antonio should include on the invitation a statement that a salesperson will be present with information and applications

Agent Antonio is preparing for a presentation on Medicare and Medicare Advantage before a local senior citizen civic group where he hopes to enroll some attendees. Which of the following steps should he take in order to be in compliance with Medicare marketing rules?

Antonio should include on the invitation a statement that a salesperson will be present with information and applications.

Ms. Bass lives on a limited fixed income and is concerned about the cost of healthcare. What should you tell her about the sort of help available to low income individuals under the Medicare program?

As a Medicare beneficiary with limited income and resources she may contact her state Medicaid agency to apply for assistance paying for the Part B premium and cost sharing and Part D prescription drug coverage.

Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you to come to their home to clear up a few questions. During the presentation, Mrs. Nunez feels tired and tells you that her husband can finish things up. She goes to bed. At the end of your discussion, Mr. Nunez says that he wants to enroll both himself and his wife. What should you do?

As long as she is able to do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will have to wake up to sign her form or do so at another time

You are scheduled to give a sales presentation at a local senior center. At the beginning of the presentation, which of the following must you do?

Clearly state that no obligation exists to enroll if a gift or prize is being provided.

Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you to come to their home to clear up a few questions. During the presentation, Mrs. Nunez feels tired and tells you that her husband can finish things up. She goes to bed. At the end of your discussion, Mr. Nunez says that he wants to enroll both himself and his wife. What should you do?

As long as she is able to do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will have to wake up to sign her form or do so at another time.

ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' protected health information to market non-health related products such as life insurance and annuities. To do so it must obtain authorization from the enrollees. Which statement best describes the authorization process?

Authorization may be obtained by directing a beneficiary to a website to provide consent

ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' protected health information to market non-health related products such as life insurance and annuities. To do so it must obtain authorization from the enrollees. Which statement best describes the authorization process?

Authorization may be obtained by directing a beneficiary to a website to provide consent.

*MR. FITZGERALD* IS SELLING HIS HOME TO PERMANENTLY MOVE INTO A RETIREMENT FACILITY NEAR HIS DAUGHTER..............

BECAUSE HE IS MOVING OUTSIDE OF THE SERVICE AREA, THE PLAN MUST AUTOMATICALLY DISENROLL HIM. SEP

*MR. ROMERO* IS 64, RETIRING SOON AND CONSIDERING ENROLLMENT IN HIS EMPLOYER SPONSORED RETIREE GROUP HEALTH PLAN THAT INCLUDES DRUG COVERAGE WITH NOMINAL COPAYS. HE HEARD ABOUT A NEIGHBOR'S MA-PD PLAN THAT YOU RESPRESENT AND BECAUSE HE TAKES NUMEROUS PRESCRIPTION DRUGS, HE IS CONSIDERING SIGNING UP FOR IT. WHAT SHOULD YOU TELL HIM.

BENEFICIARIES SHOULD CHECK WITH THEIR EMPLOYER OR UNION GROUP BENEFITS ADMINISTRATOR BEFORE CHANGING PLANS TO AVOID LOSING COVERAGE THEY WANT TO KEEP

*ALICE* IS A MARKETING REPRESENTATIVE EMPLOYED BY A HEALTH PLAN. BETTY IS A CAPTIVE AGENT OF A HEALTH PLAN WHO MARKETS TO MULTIPLE PLAN AND SPONSORS. CARL IS A CAPTIVE AGENT WHO............

BETTY AND DENISE, BUT NOT ALICE (THE EMPLOYER) OR CARL OR EDWARD (TO WHOM EXCEPTIONS APPLY).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

d

BestCare Health Plan has received a request from a state insurance department in connection with the investigation of several marketing representatives licensed by the state who sell Medicare Advantage plans. What action(s) should BestCare take in response? a. Under Federal privacy statutes, BestCare is not obligated to provide information about marketing representatives to the state and should refuse to do so. b. Immediately meet with the marketing representatives and suggest they obtain licensing in another jurisdiction. c. Immediately terminate all the agents involved as a precaution against potential legal liability. d. Cooperate with the state and supply requested information.

Alice is a marketing representative employed by a health plan. Betty is a captive agent of a health plan who markets to multiple plans and sponsors. Carl is a captive agent who markets to only one plan/sponsor. Denise is an independent agent who markets to different types of groups. Edward is an independent agent who markets only to employer and union groups. CMS marketing representative compensation rules generally apply to:

Betty and Denise, but not Alice (the employee) or Carl or Edward (to whom exceptions apply).

Alice is a marketing representative employed by a health plan. Betty is a captive agent of a health plan who markets to multiple plans and sponsors. Carl is a captive agent who markets to only one plan/sponsor. Denise is an independent agent who markets to different types of groups. Edward is an independent agent who markets only to employer and union groups. CMS marketing representative compensation rules generally apply to:

Betty and Denise, but not Alice (the employee) or Carl or Edward (to whom exceptions apply). Correct

a

By contacting plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefit package. What should you do to make sure your clients know about these pieces of information? a. You may present comparative information that has been created and approved by the Medicare agency (CMS), such as a print-out from the Medicare plan comparison website. b. To obtain information about another plan's benefits, you must refer clients to those other plans, because you may not provide comparative information, regardless of the source, to demonstrate any differences among the plans. c. You have clear evidence that your plan is the best and can say so to your clients. d. You may create a chart that lists each plan in the beneficiary's service area along with the benefits of the plan you represent, compared to those of the other available plans.

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?

C-SNP

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?

C-SNP

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?

C-SNP.

Medicare health plans establish provisions in marketing representative contracts to ensure compliance with applicable laws and policies. If non-compliance occurs, CMS can penalize a plan in which of the following ways?

CMS requires plan sponsors to create and complete a corrective action plan and may terminate a sponsor's contract

Medicare health plans establish provisions in marketing representative contracts to ensure compliance with applicable laws and policies. If non-compliance occurs, CMS can penalize a plan in which of the following ways?

CMS requires plan sponsors to create and complete a corrective action plan and may terminate a sponsor's contract.

Medicare health plans establish provisions in marketing representative contracts to ensure compliance with applicable laws and policies. If non-compliance occurs, CMS can penalize a plan in which of the following ways?

CMS requires plan sponsors to create and complete a corrective action plan and may terminate a sponsor's contract.

With regard to the training you are currently taking, what involvement will CMS have in ensuring that it takes place?

CMS will conduct oversight of plan training programs and plans must provide the agency with any information necessary for the agency to conduct such oversight.

BESTCARE HEALTH PLAN HAS RECIEVED A REQUEST FROM A STATE INSURANCE DEPARTMENT IN CONNECTION WITH THE INVESTIGATION OF SEVERAL MARKETING REPRESENTATIVES LICENSED BY THE STATE WHO SELL MEDICARE ADVANTAGE PLANS.

COOPERATE WITH THE STATE AND SUPPLY REQUESTED INFORMATION

A person comes to your pharmacy to drop off a prescription for a beneficiary who is a "regular" customer. The prescription is for a controlled substance with a quantity of 160. This beneficiary normally receives a quantity of 60, not 160. You review the prescription and have concerns about possible forgery. What is your next step?

Call the prescriber to verify the quantity

You are scheduled to give a sales presentation at a local senior center. At the beginning of the presentation, which of the following must you do?

Clearly state that no obligation exists to enroll if a gift or prize is being offered

You are scheduled to give a sales presentation at a local senior center. At the beginning of the presentation, which of the following must you do?

Clearly state that no obligation exists to enroll if a gift or prize is being offered.

You are in charge of payment of claims submitted by providers. You notice a certain diagnostic provider ("Doe Diagnostics") requested a substantial payment for a large number of members. Many of these claims are for a certain procedure. You review the same type of procedure for other diagnostic providers and realize that Doe Diagnostics' claims far exceed any other provider that you reviewed. What should you do?

Consult with your immediate supervisor for next steps or contact the compliance department (via compliance hotline, Special Investigations Unit (SIU), or other mechanism)

BestCare Health Plan has received a request from a state insurance department in connection with the investigation of several marketing representatives licensed by the state who sell Medicare Advantage plans. What action(s) should BestCare take in response?

Cooperate with the state and supply requested information

BestCare Health Plan has received a request from a state insurance department in connection with the investigation of several marketing representatives licensed by the state who sell Medicare Advantage plans. What action(s) should BestCare take in response?

Cooperate with the state and supply requested information.

BestCare Health Plan has received a request from a state insurance department in connection with the investigation of several marketing representatives licensed by the state who sell Medicare Advantage plans. What action(s) should BestCare take in response?

Cooperate with the state and supply requested information.

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?

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.

Mrs. Austin 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?

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

Which of the following is NOT potentially a penalty for violation of a law or regulation prohibiting Fraud, Waste, and Abuse (FWA)?

Deportation

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

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

d

During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a 5-star rating in customer service and care coordination, and received an overall plan performance rating of a 4-star, which of the following would be the correct statement to say to her? Choose one answer. a. This Medicare Advantage plan is a 5-star rated plan due to its high rating in customer service. b. The Medicare Advantage plan received the best star rating in customer service and care coordination. c. The Medicare Advantage plan is a top rated plan. d. The Medicare Advantage plan received a 5-star rating in customer service and care coordination with an overall performance rating of 4-stars.

c

During a sales presentation, your client asks you whether the Medicare agency recommends that she sign up for your plan or stay in Original Medicare. What should you tell her? a. Tell her that, because you represent a Medicare health plan, you therefore work for Medicare, and the information you offer her is a good basis of any decision she makes. b. Tell her that Medicare recommends that beneficiaries enroll in a Medicare Advantage plan because it will serve her better than Original Medicare c. Tell her that the Medicare agency does not endorse or recommend any plan. d. Tell her that Medicare or CMS (the Medicare agency) has approved and endorsed the plan.

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

During the MA Disenrollment Period, from January 1 - February 14, she may disenroll from the MA-PD plan into Original Medicare and also may add a stand-alone prescription drug plan

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

During the MA Disenrollment Period, from January 1 - February 14, she may disenroll from the MA-PD plan into Original Medicare and also may add a stand-alone prescription drug plan.

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

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

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

Every Part D drug plan is required to cover a 30 day supply of her existing medications sometime during a 90 day transition period.

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

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

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

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

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

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

part C countinued

Extras Benifits- Medicare may cover extra benefits such as: •Vision services •Hearing Aids •Routine Dental Services and/or Dentures •Routine Transportation to Medical Appointments •Chiropractic services •Annual Physical Exams •In Home Safety Assessment and fall prevention devices •Over the Counter Drugs *An annual physical is different from the annual wellness visit covered under medicare, which does not include a physical exam.

*WENDY PARK* BECOMES ELIGIBLE FOR MEDICARE FOR THE FIRST TIME IN JULY. WITH THE HELP OF AGENT JAMES CHAN, SHE ENROLLS IN FEELBETTER MEDICARE ADVANTAGE PLAN.........

FEELBETTER WILL PAY AGENT CHAN INITIAL YEAR COMPENSATION FOR THE MONTHS JULY THROUGH DECEMBER. RENEWAL AMOUNTS WILL BE PAID STARTING IN JANUARY...........

At a minimum, an effective compliance program includes four core requirements.

False

Compliance is the responsibility of the Compliance Officer, Compliance Committee, and Upper Management only.

False

Medicare Parts C and D plan Sponsors are not required to have a compliance program.

False

Once a corrective action plan begins addressing non-compliance or Fraud, Waste, and Abuse (FWA) committed by a Sponsor's employee or First-Tier, Downstream, or Related Entity's (FDR's) employee, ongoing monitoring of the corrective actions is not necessary.

False

Standards of Conduct are the same for every Medicare Parts C and D Sponsor.

False

Wendy Park becomes eligible for Medicare for the first time in July. With the help of Agent James Chan, she enrolls in FeelBetter Medicare Advantage plan with an effective date of July 1st. How will Agent Chan be compensated under CMS rules?

FeelBetter will pay Agent Chan initial year compensation for the months July through December. Renewal amounts will be paid starting in January if Ms. Park remains enrolled the following year

Wendy Park becomes eligible for Medicare for the first time in July. With the help of Agent James Chan, she enrolls in FeelBetter Medicare Advantage plan with an effective date of July 1st. How will Agent Chan be compensated under CMS rules?

FeelBetter will pay Agent Chan initial year compensation for the months July through December. Renewal amounts will be paid starting in January if Ms. Park remains enrolled the following year.

Wendy Park becomes eligible for Medicare for the first time in July. With the help of Agent James Chan, she enrolls in FeelBetter Medicare Advantage plan with an effective date of July 1st. Which statement best describes how Agent Chan may be compensated under CMS rules?

FeelBetter will pay Agent Chan initial year compensation for the months July through December. Renewal amounts will be paid starting in January if Ms. Park remains enrolled the following year.

You are performing a regular inventory of the controlled substances in the pharmacy. You discover a minor inventory discrepancy. What should you do?

Follow your pharmacy's procedures

Which of the following requires intent to obtain payment and the knowledge that the actions are wrong?

Fraud

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

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

You will be holding a sales event in the near future, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation?

Gift cards or gift certificates of $15 or less that can be readily converted to cash

You will be holding a sales event in the near future, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situat

Gift cards or gift certificates of $15 or less that can be readily converted to cash.

You will be holding a sales event in the near future, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation?

Gift cards or gift certificates of $15 or less that can be readily converted to cash.

IF *MR. JOHANNSEN* GAINS THE PART D LOW INCOME SUBSIDY HOW DOES THAT AFFECT HIS ABILITY TO ENROLL OR DISENROLL.

HE CAN ENROLL IN OR DISENROLL FORM A PART D PLAN AT ANY TIME AND THE SUBSIDY WILL APPLY TO THE PLAN HE CHOOSES.

*MR. RIVERA* HAS A QMB-PLUS ELIGIBILITY AND IS THUS COVERED BY BOTH MEDICARE AND MEDICAID. HE DECIDES TO ENROLL IN A MEDICARE ADVANTAGE(MA) PLAN. LATER IN THE YEAR, MR. RIVERA NEEDS DENTURES, A SERVICE ONLY COVERED UNDER MEDICAID. WHAT ACTION WOULD YOU RECOMMEND HE TAKE IN ORDER TO HAVE THIS COST COVERED?

HE SHOULD GO TO A MEDICAID PROVIDER OR OBTAIN THE SERVICES THROUGH A MEDICAID MANAGE CARE PLAN IF HE IS ENROLLED IN ONE.

*MR. GARRETT* HAS JUST ENTERED HIS MA INITIAL COVERAGE ELECTION PERIOD (ICEP). WHAT ACTION COULD YOU.....

HE WILL HAVE ONE OPPORTUNITY TO ENROLL IN A MEDICARE ADVANTAGE PLAN

*MR. SANCHEZ* IS ENTITLED TO PART A, BUT HAS NOT ENROLLED IN PART B BECAUSE HE HAS COVERAGE THROUGH AN EMPLOYER PLAN. IF............

HE WILL HAVE TO ENROLL IN PART B

*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?

HE WILL INCUR A LATE ENROLLMENT PENALTY

*MRS. KUMAR* WOULD LIKE HER DAUGHTER, WHOL LIVES IN ANOTHER STATE TO MEET WITH YOU DURING........

HER DAUGHTER SHOULD COME IN NOVEMBER

*MR. ROBERTS* IS ENROLLED IN AN MA PLAN. HE RECENTLY SUFFERED COMPLICATIONS FOLLOWING HIP REPLACEMENT SURGERY. AS A RESULT, THE LAST THREE MONTHS IN RESTHAVEN, A SKILLED.............

HIS OPEN ENROLLMENT PERIOD AS AN INSTITUTIONALIZED INDIVDUAL WILL CONTINUE FOR TWO MONTHS AFTER THE MONTH HE MOVES OUT OF THE FACILITY.

Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled a marketing event and expects about 40 people to attend. He has hired a magician at a cost of $200 to entertain attendees. Can he do this in a way that complies with guidance from the Medicare agency?

He can do this, because the estimated number of attendees is based on the venue size and response rate and the value of the gift does not exceed $15.

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

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

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

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

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

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

Several agents you work with are planning sales events in your area. One plans on giving door prizes worth $5, refreshments valued at $8 per anticipated attendee, and coupon books with discounts worth $10. Since no gift or prize exceeds the $15 limit he believes his plan is acceptable. What should you tell them

He can give away more than one gift during a single event, but the aggregate retail value cannot exceed $15

Several agents you work with are planning sales events in your area. One plans on giving door prizes worth $5, refreshments valued at $8 per anticipated attendee, and coupon books with discounts worth $10. Since no gift or prize exceeds the $15 limit he believes his plan is acceptable. What should you tell them

He can give away more than one gift during a single event, but the aggregate retail value cannot exceed $15 Correct

Several agents you work with are planning sales events in your area. One plans on giving door prizes worth $5, refreshments valued at $8 per anticipated attendee, and coupon books with discounts worth $10. Since no gift or prize exceeds the $15 limit he believes his plan is acceptable. What should you tell them?

He can give away more than one gift during a single event, but the aggregate retail value cannot exceed $15.

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

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

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

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.

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

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.

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

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

Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. What should you tell him?

He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means obtain the medications they need. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses.

Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. What should you tell him?

He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means obtain the medications they need. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses.

Mr. Fitzgerald did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. What should you tell him?

He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means obtain the medications they need. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses.

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

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

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

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

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

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

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

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

Mr. Pintok is interested in joining a MA-PD plan and wants advice on which type would allow him to select or change his personal primary care physician. What can you tell him?

He has a right to select or change his primary care provider from within the plan's network without interference.

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

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

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

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

Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his Part B premium. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him?

He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B

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?

He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.

Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his Part B premium. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him?

He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.

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?

He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.

After a sales presentation, Mr. Brooks announces that he is ready to enroll in the plan you represent. He would like to know if he can have his plan premiums deducted from his Social Security check. What should you tell him?

He may choose withholding from his Social Security check when he completes the enrollment form.

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

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.

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

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

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

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

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

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

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

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

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

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

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

He qualifies for a special enrollment period and can enroll in or disenroll from a Part D plan and the subsidy will apply to the plan he chooses.

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

He should go to a Medicaid provider or obtain the services through a Medicaid manage care plan if he is enrolled in one

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

He should go to a Medicaid provider or obtain the services through a Medicaid manage care plan if he is enrolled in one.

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

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

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?

He will incur a late enrollment penalty

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?

He will incur a late enrollment penalty.

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?

He will incur a late enrollment penalty.

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

He will need to mail in his payment with his enrollment form.

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

Her daughter should come in November

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

Her daughter should come in November.

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

Her daughter should come in November.

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

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

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

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

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

I, II and III only

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

I, II and III only.

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

I, II, and III only

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

I, II, and III only.

Monica is an agent focused on serving seniors eligible for Medicare. As she reviews her records, she is trying to determine which of the following items are considered compensation. What do you tell her? I. Commissions II. Bonuses III. Mileage reimbursement IV. Referral fees

I, II, and IV only

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

I, II, and IV only

Monica is an agent focused on serving seniors eligible for Medicare. As she reviews her records, she is trying to determine which of the following items are considered compensation. What do you tell her?

I, II, and IV only Correct

Monica is an agent focused on serving seniors eligible for Medicare. As she reviews her records, she is trying to determine which of the following items are considered compensation. What do you tell her? I. Commissions II. Bonuses III. Mileage reimbursement IV. Referral fees

I, II, and IV only.

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

I, II, and IV only.

*MONICA* IS AN AGENT FOCUSED ON SERVING SENIORS ELIGIBLE FOR MEDICARE. AS SHE REVIEWS HER RECORDS, SHE IS TRYING TO DETERMINE WHICH OF THE FOLLOWING ITEMS ARE CONSIDERED.........

I,II, AND IV ONLY

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.

I. Enrollees have a right to obtain a review (appeal) of certain decisions about prescription drug coverage. 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.

Which of the following steps may a Part D sponsor adopt for beneficiaries who are at risk of misusing or abusing frequently abused drugs?

I. Identifying at risk individuals by using criteria that includes the number of opioid prescriptions the beneficiary has and the number of prescribers who have written those prescriptions. II. Locking an at-risk beneficiary into one pharmacy. III. Locking an at-risk beneficiary into one prescriber.

*MRS. LOPEZ* IS ENROLLED IN A MEDICARE ADVANTAGE COST PLAN. SHE HAS RECENTLY LOST CREDITABLE COVERAGE PREVIOUSLY AVAILABLE THROUGH HER HUSBAND'S EMPLOYER. SHE IS INTERESTED IN ENROLLING A MEDICARE PART D PRESCRIPTION DRUG PLAN (PDP). WHAT SHOULD YOU TELL HER?

IF A PART D BENEFIT IS OFFERED THROUGH HER PLAN SHE MAY CHOOSE IN ENROLL IN THAT PLAN OR A STANDALONE PDP.

*MRS. BERKOWITZ* WANTS TO ENROLL IN A MEDICARE ADVANTAGE PLAN THAT DOES NOT INCLUDE DRUG COVERAGE AND ALSO ENROLL IN A STAND...............

IF MEDICARE ADVANTAGE PLAN IS A PFFS PLAN THAT DOES NOT OFFER DRUG COVERAGE OR A MEDICAL SAVING ACCOUNT...........

*MR. GARCIA* WAS TOLD HE QUALIFIES FOR SEP BUT HE LOST THE PAPER THAT EXPLAINS WHAT HE COULD DO DURING THE SEP.

IF THE SEP IS FOR MA COVERAGE HE WILL GENERALLY HAVE ONE OPPORTUNITY TO CHANGE HIS MA COVERAGE

PHIONA WORKS IN THE IT DEPARTMENT OF BESTCARE HEALTH PLAN. PHIONA IS PLACED IN CHARGE OF BESTCARE'S EFFORTS TO FACILIATE ELECTRONIC ENROLLMENT IN ITS MEDICARE ADVANTAGE PLANS.................................

II AND III ONLY

WHICH OF THE FOLLOWING INDIVIDUALS ARE LIKELY TO QUALIFY FOR A SPECIAL ENROLLMENT PERIOD FOR BOTH MA AND PART D DUE TO A CHANGE OF RESIDENCE?

II AND IV ONLY

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

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

Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. In setting up the enrollment site, which of the following must Phiona consider? I. If a legal representative is completing an electronic enrollment request, he or she must first upload proof of his or her authority. II. All data elements required to complete an enrollment request must be captured. III. The process must include a clear and distinct step that requires the applicant to activate an "Enroll Now" or "I Agree" type of button or tool. IV. The mechanism must capture an accurate time and date stamp at the time the applicant enters the online site.

II and III only

Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. In setting up the enrollment site, which of the following must Phiona consider?

II and III only Correct

Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. In setting up the enrollment site, which of the following must Phiona consider? I. If a legal representative is completing an electronic enrollment request, he or she must first upload proof of his or her authority. II. All data elements required to complete an enrollment request must be captured. III. The process must include a clear and distinct step that requires the applicant to activate an "Enroll Now" or "I Agree" type of button or tool. IV. The mechanism must capture an accurate time and date stamp at the time the applicant enters the online site.

II and III only.

Which of the following individuals are likely to qualify for a special enrollment period (SEP) for both MA and Part D due to a change of residence? I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area. II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service area. III. Gilbert moves into a plan service area where there is no Part D plan available. IV. Henry makes a permanent move providing him with new MA and Part D options.

II and IV only

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

II and IV only Correct

Which of the following individuals are likely to qualify for a special enrollment period (SEP) for both MA and Part D due to a change of residence? I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area. II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service area. III. Gilbert moves into a plan service area where there is now a Part D plan available to him from a service area where no Part D plan was available. IV. Henry makes a permanent move providing him with new MA and Part D options.

II, III, and IV only

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

II, III, and IV only.

Which of the following individuals are likely to qualify for a special enrollment period (SEP) for both MA and Part D due to a change of residence? I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area. II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service area. III. Gilbert moves into a plan service area where there is now a Part D plan available to him from a service area where no Part D plan was available. IV. Henry makes a permanent move providing him with new MA and Part D options.

II, III, and IV only.

Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. In setting up the enrollment site, which of the following must Phiona consider? I. If a legal representative is completing an electronic enrollment request, he or she must first upload proof of his or her authority. II. All data elements required to complete an enrollment request must be captured. III. The process must include a clear and distinct step that requires the applicant to activate an "Enroll Now" or "I Agree" type of button or tool. IV. The mechanism must capture an accurate time and date stamp at the time the applicant enters the online site.

II. All data elements required to complete an enrollment request must be captured. III. The process must include a clear and distinct step that requires the applicant to activate an "Enroll Now" or "I Agree" type of button or tool.

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

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

*WILLARD* WORKS AS A REPRESENTATIVE FOCUSED ON THE SENIOR MARKETPLACE. WHAT WOULD BE CONSIDERED PROHIBITED ACTIVITY BY WILLARD?

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.

AGENT *HARRIET WALKER* HAS RECENTLY BEGUN MARKETING MEDICARE ADVANTAGE AND RELATED PRODUCTS AIMED AT MEETING THE NEEDS OF SENIOR CITIZENS. CLIENT MILDRED JONES HAS EXPRESSED..........

INQUIRE WHETHER THE CLIENT QUALIFIES FOR A SPECIAL ENROLLMENT PERIOD, AND IF NOT, SOLICT AN ENROLLMENT APPLICATION ONCE THE ANNUL OPEN..........

WHICH STATEMENT BEST DESCRIBES PACE PLANS?

IT INCLUDES COMPREHENSIVE MEDICAL AND SOCIAL SERVICE DELIVERY SYSTEMS USING AN INTERDISCIPLINARY TEAN APPROACH IN AN ADULT DAY HEALTH CENTER, SUPPLEMENTED BY IN-HOME AND REFERRAL SERVICES.

Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug coverage. He found a stand-alone Medicare prescription drug plan in his area that offers better coverage than that available through his MA-PD plan and in addition has a low premium. It won't cost him much more and, because he has the means to do so, he wishes to enroll in the stand-alone prescription drug plan in addition to his MA-PD plan. What should you tell him?

If Mr. Block enrolls in the stand-alone Medicare prescription drug plan, he will be disenrolled from the Medicare Advantage plan

Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug coverage. He found a stand-alone Medicare prescription drug plan in his area that offers better coverage than that available through his MA-PD plan and in addition has a low premium. It won't cost him much more and, because he has the means to do so, he wishes to enroll in the stand-alone prescription drug plan in addition to his MA-PD plan. What should you tell him?

If Mr. Block enrolls in the stand-alone Medicare prescription drug plan, he will be disenrolled from the Medicare Advantage plan.

Mr. Jenkins has coverage for medical services and medications through his employer's retiree plan. He is considering switching to a Medicare prescription drug plan because his retiree plan does not cover two important medications. What should he consider before making a change?

If Mr. Jenkins drops his drug coverage through the retiree plan, he may not be able to get it back and he also may lose his medical health coverage

Mr. Jenkins has coverage for medical services and medications through his employer's retiree plan. He is considering switching to a Medicare prescription drug plan because his retiree plan does not cover two important medications. What should he consider before making a change?

If Mr. Jenkins drops his drug coverage through the retiree plan, he may not be able to get it back and he also may lose his medical health coverage.

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?

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

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?

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.

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?

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.

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

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

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?

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

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

If she believes she received misleading information, she must contact 1-800-MEDICARE and, if she qualifies for a Special Enrollment Period, she can select a new option, which could include a different MA plan, a PDP, or Original Medicare

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

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

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

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

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

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.

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

If she uses non-network providers, her doctors and hospital could decide whether to treat her on a visit-by-visit basis

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

If she uses non-network providers, her doctors and hospital could decide whether to treat her on a visit-by-visit basis.

Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this?

If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account, Mrs. Berkowitz can do this

Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this?

If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account, Mrs. Berkowitz can do this.

Mrs. Brown wants to enroll in a Medicare Advantage plan that does not include drug coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this?

If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account, Mrs. Brown can do this.

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

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

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

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

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

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

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

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

Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to purchase extra coverage that he will not need. What should you tell him?

If the drug coverage he has is not expected to pay, on average, at least as much as Medicare's standard Part D coverage expects to pay, then he will need to enroll in Medicare Part D during his initial eligibility period to avoid the late enrollment penalty.

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

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

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

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

b

If you are to be in compliance with Medicare's guidance regarding educational events, which of the following would be acceptable activities? a. You may ask passers-by to provide you with their names, addresses and phone numbers so that you could contact them later with information about the plan(s) you represent. b. You may distribute business cards to individuals who request information on how to contact you for further details on the plan(s) you represent. c. You may set up personal sales appointments with any beneficiary who expresses interest. d. You may have a stack of enrollment forms on the table in your booth, but may only pass them out to individuals who request one.

You are doing a sales presentation for Mrs. Pearson. You know that the Medicare marketing guidelines prohibit certain types of statements. Apply those guidelines to the following statements and identify which would be prohibited.

If you're not in very good health, you will probably do better with a different product."

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

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

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

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.

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?

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

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

In most Medicare Advantage HMOs, Mr. Kumar must obtain his services only from providers who have a contractual relationship with the plan (except in an emergency).

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

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

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

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

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

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

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

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

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

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

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

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

Agent Harriet Walker has recently begun marketing Medicare Advantage and related products aimed at meeting the needs of senior citizens. Client Mildred Jones has expressed interest in a Medicare Advantage plan. It is now the beginning of September. If you were in Agent Walker's position, what would you do?

Inquire whether the client qualifies for a special enrollment period, and if not, solicit an enrollment application once the annual open enrollment election period begins on October 15th

Agent Harriet Walker has recently begun marketing Medicare Advantage and related products aimed at meeting the needs of senior citizens. Client Mildred Jones has expressed interest in a Medicare Advantage plan. It is now the beginning of September. If you were in Agent Walker's position, what would you do?

Inquire whether the client qualifies for a special enrollment period, and if not, solicit an enrollment application once the annual open enrollment election period begins on October 15th.

Which statement best describes PACE plans?

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

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

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

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

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

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

It is always the best option to talk with his benefits administrator to see whether he needs both an employer sponsored plan and a private MA-PD and what might happen if he were to sign up for both.

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

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

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

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

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

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

Mr. Valesquez asked if the Private Fee-for-Service plan you have discussed is like Original Medicare or a Medigap supplement plan. What should you say about a Private Fee-for-Service (PFFS) plan to explain it to Mr. Valesquez?

It is not Original Medicare and it works differently than a Medicare supplement plan

Mr. Valesquez asked if the Private Fee-for-Service plan you have discussed is like Original Medicare or a Medigap supplement plan. What should you say about a Private Fee-for-Service (PFFS) plan to explain it to Mr. Valesquez?

It is not Original Medicare and it works differently than a Medicare supplement plan.

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

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

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

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

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

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

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

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

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

It would not be unusual for her costs to be a bit less because each year until 2020, an enrollee's share of the drug costs in the coverage gap are less

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

It would not be unusual for her costs to be a bit less because each year until 2020, an enrollee's share of the drug costs in the coverage gap are less.

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

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

Which of the following individuals is most likely to be eligible to enroll in a Medicare Advantage or Part D Plan?

Jose, a grandfather who was granted asylum and has worked in the United States for many years.

For a health plan, what are the possible consequences of violations of ACA Section 1557?

Loss of federal business and compensatory damages

*MARY SAMUELS* RECENTLY SUFFERED A STROKE WHILE VISITING HER DAUGHTER AND GRANDCHILDREN. AS A RESULT, MARY HAS BEEN ADMITTED TO A REHABILITATION HOSPITAL WHERE SHE IS EXCEPTED TO RESIDE FOR SEVERAL MONTHS.........

MARY MAY MAKE AN UNLIMITED NUMBER OF MA ENROLLMENT REQUESTS AND MAY DISENROLL FROM HER CURRENT MA PLAN.

*MR BUCK* HAS SEVERAL FAMILY MEMBERS WHO DIED FROM DIFFERENT CANCERS HE WANT...................

MEDICARE COVERS PERIODIC PREFORMANCE OF RANGE OF SCREENING TESTS THAT ARE MEANT TO PROVIDE EARLY DETECTION OF DISEASE............

*MRS. WOLF* WEARS GLASSES AND DENTURES AND HAS ENJOYED CONSIDERABLE PAIN RELIEF FROM ARTGRITIS THROUGH ACUPNCTURE................

MEDICARE DOES NOT COVER ACUPUNCTURE, OR IN GENERAL GLASSES........

*MRS. WILLARD* WANTS TO KNOW GENERALLY HOW BENEFITS UNDER ORIGINAL MEDICARE MIGHT COMPARE TO THE BENEFIT PACKAGE OF MEDICARE HEALTH PLAN BEFORE SHE START LOOKING AT SPECIFIC PLAN.........

MEDICARE HEALTH PALNS MAY OFFER EXTRA BENEFITS THAT ORIGINAL MEDICARE DOES NOT OFFER SUCH AS VISION, HEARING, AMD DENTAL SERVICES.......

*MR. HERNANDEZ* IS CONCERNED THAT IF HE SIGNS UP FOR A MEDICARE ADVANTAGE PLAN, THE HEALTH PLAN MAY, AT SOME TIME IN THE FUTURE, REDUCE HIS BENEFITS BELOW WHAT IS AVAILABLE IN ORIGINAL MEDICARE. WHAT SHOULD YOU TELL HIM ABOUT HIS CONCERN?

MEDICARE HEALTH PLANS MUST COVER ALL BENEFITS AVAILABLE UNDER MEDICARE PART A AND PART B. MANY ALSO COVER PART D PRESCRIPTION DRUGS.

*MRS. SHIELDS* IS COVERED BY ORIGINAL MEDICARE. SHE IS SUSTAINED A HIP FRACTURE AND IS BEING SUCCESSFULLY TREATED FOT THAT CONDITION............

MEDICARE WILL COVER MRS. SHIELD'S SKILLED NURSING SERVICES PROVIDED DURING THE FIRST 20 DAYS...................

*MR. WELLS* IS TRYING TO UNDERSTAND THE DIFFERENCE BETWEEN ORIGINAL MEDICARE AND MEDICARE ADVANTAGE...........

MEIDCARE ADVANTAGE IS A WAY OF COVERING ALL OF THE ORIGINAL MEDICARE BENEFITS THROUGH PRIVATE HEALTH............................

*MR. ROCKWELL* AGE 67, IS ENROLLED IN MEDICARE PART A, BUT BECAUSE HE CONTINUES TO WORK AND IS COVERED BY AN EMPLOYER HEALTH PLAN, HE HAS NOT ENROLLED IN PART B OR PART D. HE RECIEVES A NOTICE THAT HIS EMPLOYER...........

MR. ROCKWELL IS ELIGIBLE FOR A SEP DUE TO HIS INVOLUNTARY LOSS OF CREDITABLE DRUG COVERAGE; THE SEP BEGINS IN JUNE ABD ENDS TWO MONTHS LATER.

*MR. SHULTZ* WAS STILL WORKING WHEN HE FIRST QUALIFIED FOR MEDICARE. AT THAT TIME, HE HAD EMPLOYER GROUP COVERAGE THAT WAS CREDITABLE. DURING HIS INITIAL PART D ELIGIBILITY PERIOD, HE DECIDED NOT TO ENROLL BECAUSE HE WAS SATISFIED WITH HIS DRUG COVERAGE. IT IS NOW A YEAR LATER AND MR. SHULTZ HAS LOST HIS EMPLOYER GROUP COVERAGE. HOW WOULD YOU ADVISE HIM

MR. SCHULTZ SHOULD ENROLL IN A PART D PLAN BEFORE HE HAS A 63- DAY BREAK IN COVERAGE IN ORDER TO AVOID A PREMIUM PENALTY

*MRS GONZALEZ* IS ENROLLED IN ORIGINAL MEDICARE AND HAS A MEDIGAP POLICY, AS WELL BUT IT PROVIDES NO DRUG COVERAGE. SHE WOULD LIKE TO KEEP THE COVERAGE SHE HAS...............

MRS. GONZALEZ CANNOT PURCHASE A MEDIGAP PLAN THAT COVERS DRUGS, BUT SHE COULD KEEP HER MEDIGAP..............

* MRS. LENARD* IS ENROLLED IN A MEDICARE COST PLAN. RECENTLY THE COST PLAN HAS TRANSITIONED TO A MEDICARE ADVANTAGE (MA) CONTRACT, AND MRS. LENARD HAS BEEN TOLD THAT SHE HAS BEEN SUBJECT TO DEEMED ENROLLMENT.....

MRS. LEONARD WILL BE AUTOMATICALLY ENROLLED IN AN MA PLAN OFFERED BY THE SAME ORGANIZATION AS THE COST PLAN, NOTIFIED BY CMS, AND GIVEN THE OPPORTUNITY TO CHOOSE ANOTHER OPTION.

*MRS. VALENTINO* IS CURRENTLY ENROLLED IN A MEDICARE COST PLAN. THIS PLAN IS NO LONGER MEETING HER NEEDS BUT IT IS NOW MID-YEAR AND PAST THE ANNUAL ELECTION PERIOD(AEP). WHAT WOULD YOU SAY TO MRS. VALENTINO REGARDING.............

MRS. VALENTINO CAN SUBMIT A WRITTEN REQUEST TO MEDICARE TO BE DISENROLLED FROM THE COST PLAN AND ENROLL IN ORIGINAL MEDICARE.

YOU MEET WITH *MRS. WILSON* TO COMPLETE HER ENROLLMENT IN A MEDICARE ADVANTAGE PLAN. YOU TELL HER THAT THERE WILL BE AN ENROLLMENT VERIFICATION PROCESS TO CONFIRM THAT SHE IS ENROLLED IN THE PLAN THAT SHE REQUESTED AND UNDERSTANDS THE PLAN.....................................

MRS. WILSON WILL BE CONTACTED BY THE PLAN SPONSOR WITHIN 15 CALENDAR DAYS OF RECEIPT OF THE ENROLLMENT REQUEST.

Plan sponsors may undertake the following marketing activities with current Medicare Advantage plan members?

Market non-Medicare health-related products, such a dental insurance, to current members as permitted by HIPAA Privacy Rules.

Plan sponsors may undertake the following marketing activities with current Medicare Advantage plan members?

Market non-Medicare health-related products, such as dental insurance, to current members as permitted by HIPAA Privacy Rules

Plan sponsors may undertake the following marketing activities with current Medicare Advantage plan members?

Market non-Medicare health-related products, such as dental insurance, to current members as permitted by HIPAA Privacy Rules.

You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. The hospital administration expresses some hesitation about allowing marketing in a health care facility. What should you tell them?

Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving or waiting to receive health care

You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. The hospital administration expresses some hesitation about allowing marketing in a health care facility. What should you tell them?

Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving or waiting to receive health care and as long as the hospital displays materials for all plans that provide them to the hospital

You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. The hospital administration expresses some hesitation about allowing marketing in a health care facility. What should you tell them?

Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving or waiting to receive health care and as long as the hospital displays materials for all plans that provide them to the hospital.

You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. The hospital administration expresses some hesitation about allowing marketing in a health care facility. What should you tell them?

Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving or waiting to receive health care and as long as the hospital displays materials for all plans that provide them to the hospital.

Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. What should you tell her?

Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. Correct

Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. What should you tell her?

Marketing representatives may initiate electronic contact through e-mail but the subject line must say "marketing" and an opt-out process must be provided.

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

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

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

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

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

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

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

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

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

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

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

Medicaid will coordinate benefits only with Medicaid participating providers

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

Medicaid will coordinate benefits only with Medicaid participating providers.

Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare Health Plan? Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access to services since she receives some assistance for her health care costs from the State. What should you tell her?

Medicaid will coordinate benefits only with Medicaid participating providers.

Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for Medicare & Medicaid Services' Marketing Guidelines to ensure he is compliant for which type of products?

Medicare Advantage (MA) and Prescription Drug (PDP) plans

Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for Medicare & Medicaid Services' Marketing Guidelines to ensure he is compliant for which type of products?

Medicare Advantage (MA) and Prescription Drug (PDP) plans.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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?

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.

Mr. Meoni's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs. What could you tell Mr.Meoni?

Medicare Supplemental Insurance would help cover his Part A and Part B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover.

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

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

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

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

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

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

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

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

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

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

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

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

d

Medicare health plans establish provisions in marketing representative contracts to ensure compliance with applicable laws and policies. If non-compliance occurs, CMS can penalize a plan in which of the following ways? a. CMS requires plan sponsors to publish in local newspapers the names and misdeeds of the marketing representatives who have not complied with the terms of their contracts, so that potential clients can know whom to avoid. b. CMS requires the dismissal of senior plan management. c. CMS cannot penalize the plan sponsor for marketing representative non-compliance. That is the role of the state. d. CMS requires plan sponsors to create and complete a corrective action plan and may terminate a sponsor's contract.

Which of the following is a correct statement about state laws as they pertain to marketing representatives?

Medicare health plans must comply with requests for information from state insurance departments investigating complaints about a marketing representative.

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

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

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

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

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

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

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

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

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?

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

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?

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

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?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally will be charged a lower co-payment if she goes to one of the plan's preferred providers.

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

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

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

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

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

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

(W) 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?

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

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?

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

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

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

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?

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

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?

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

b

Monica is an agent focused on serving seniors eligible for Medicare. As she reviews her records, she is trying to determine which of the following items are considered compensation. What do you tell her? I. Commissions II. Bonuses III. Mileage reimbursement IV. Referral fees a. I, II and III only b. I, II, and IV only c. I and II only d. I, II, III, and IV

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?

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.

(W) 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?

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.

Mr. Meoni's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs. What could you tell Mr.Meoni?

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.

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?

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.

c

Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. What should you tell him? a. He generally would pay only a monthly premium. Medicare covers all other costs. b. He generally would pay only a per-prescription co-payment. Medicare covers all other costs. c. He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. d. He generally would pay only a monthly premium and deductible. Medicare covers all other costs.

c

Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. He is wondering whether he can obtain coverage under Medicare. What should you tell him? a. Individuals who become eligible for such disability payments only have to wait 12 months before they can apply for coverage under Medicare. b. He became eligible for Medicare when his disability eligibility determination was first made. c. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. d. Individuals receiving such disability payments from the Social Security Administration continue to receive those payments, but only become eligible for Medicare upon reaching age 65.

d

Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. What should you tell him? a. He should contact his neighbors and family members and let them know that any contributions they make toward his drug expenses will be tax deductible. b. The only option available is to reduce his income so that he can qualify for the Part D extra help or wait until next year to see if the annual limits change. c. He should look into the possibility of purchasing his medications through the internet from off-shore pharmacies. d. He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means obtain the medications they need. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses.

b

Mr. Buck has several family members who died from different cancers. He wants to know if Medicare covers cancer screening. What should you tell him? a. Medicare covers some screening tests that must be performed within the first year after enrollment. Beyond that point expenses for screening tests are the responsibility of the beneficiary. b. Medicare covers periodic performance of a range of screening tests that are meant to provide early detection of disease. Mr. Buck will need to check specific tests before obtaining them to see if they will be covered. c. Medicare covers all screening tests that have been approved by the FDA on a frequency determined by the treating physician. d. Medicare covers treatments for existing disease, injury and malformed limbs or body parts. As such, it does not cover any screening tests and these must be paid for by the beneficiary out of pocket. Incorrect

d

Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. What should you tell him? a. Medigap policies designed to cover costs not paid for by a MA plan can be purchased, but only if the MA plan's design is considered to be the "defined standard benefit." b. Medigap plans are a form of Medicare Advantage, so purchasing both would be redundant coverage. c. Medigap plans that cover costs not paid for by a MA plan are available only in Massachusetts, Minnesota, and Wisconsin. d. It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original Medicare.

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?

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

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?

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

b

Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA), not by the government. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. What should you tell him? a. Mr. Carlini can keep Original Medicare, but if he does not sign up for an MA plan that includes prescription drug coverage, he will only be able to obtain prescription drug coverage through a Medigap plan. b. 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. c. Mr. Carlini can obtain drug coverage through the Federal government's fallback plans, which are designed to provide an alternative to privately sponsored Medicare Advantage plans. d. In order to obtain prescription drug coverage, Mr. Carlini must enroll in an MA plan. The plan will cover his Part A and Part B services, as well as provide him with the desired prescription drug coverage.

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

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

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

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

c

Mr. Denton is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? a. He may sign-up for Medicare at any time however coverage usually begins on the sixth month after dialysis treatments start. b. He may sign-up for Medicare at any time and coverage usually begins immediately. c. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. d. He may not sign-up for Medicare until he reaches age 62, the date he first becomes eligible for Social Security benefits

d

Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. He has heard that there is a premium penalty for those who did not sign up for Part B when first eligible and wants to know how much he will have to pay. What should you tell him? a. During the first year he is covered under Part B, his premiums will be 10% higher than they otherwise would be, after which point they will return to normal. b. The penalty will be a permanent 10% increase in his Part B premium for every 12 month period that passed during which he could have enrolled and did not. c. Mr. Diaz will pay a penalty, which will be a flat amount each year, paid during the first month of coverage. d. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.

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

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

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

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

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

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

b

Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled a marketing event and expects about 40 people to attend. He has hired a magician at a cost of $200 to entertain attendees. Can he do this in a way that complies with guidance from the Medicare agency? a. He can do this because the gift is not a cash gift and is not readily converted to cash. b. He can do this, because the estimated number of attendees is based on the venue size and response rate and the value of the gift does not exceed $15. c. He can do this because the ads for the event are distributed both to enrollees and non-enrollees, so no restrictions apply d. He cannot do this because the total value of the gift exceeds the maximum $15 retail gift value.

c

Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the health plan may, at some time in the future, reduce his benefits below what is available in Original Medicare. What should you tell him about his concern? a. He should not be concerned because Medicare health plans must cover all IRS-approved health care expenses, which means that all of them provide substantially greater benefits than are available under Medicare Part A and Part B. b. Medicare health plans offer a menu of benefits, from which he may choose, so if he ever wants to increase his coverage, he need only contact the plan and select other options. c. Medicare health plans must cover all benefits available under Medicare Part A and Part B. Many also cover Part D prescription drugs. d. Medicare health plans have the option of deciding, each year, what services they will cover. He is correct that the health plan could eliminate some benefits covered by Medicare and he should think carefully before enrolling in a Medicare health plan.

b

Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to purchase extra coverage that he will not need. What should you tell him? a. He will need to enroll in a Medicare prescription drug plan upon becoming eligible for the program in order to avoid a premium penalty. To reduce his expenses, he should look for a plan with a zero premium. b. If the drug coverage he has is not expected to pay, on average, at least as much as Medicare's standard Part D coverage expects to pay, then he will need to enroll in Medicare Part D during his initial eligibility period to avoid the late enrollment penalty. c. As long as he has any sort of employer coverage, regardless of the level of coverage, he will incur no penalty if he does not enroll in a Part D plan when first eligible. d. He should drop the employer coverage and enroll in a Medicare prescription drug plan. Employer plans are almost always more costly for beneficiaries and most do not cover the same range of drugs available from a Medicare prescription drug plan.

b

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. 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. 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. 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.

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?

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

b

Mr. Katz reached the Part D coverage gap in August last year. His prescriptions have not changed, he is keeping the same Part D plan and the benefits, cost-sharing, and coverage of his drugs are all the same as last year. He asked what to expect for this year about his out-of-pocket costs. What could you tell him? a. Because he reached the coverage gap in August last year, he probably will reach it much earlier this year. b. Because he reached the coverage gap last year, he will probably reach it again this year close to the same time. c. Because he reached the coverage gap in August last year, he probably won't reach it until much later this year. d. Because he reached the coverage gap last year, he will not have to go through it again this year.

a

Mr. Kelly has substantial financial means. He enrolled in Original Medicare and purchased a Medigap policy many years ago that offered prescription drug coverage. The prescription drug coverage has not been comparable to that offered by Medicare Part D for several years and despite notification, Mr. Kelly took no action. Which of the following statements best describes what will occur if Mr. Kelly now decides to enroll in Medicare Part D? a. He will incur a late enrollment penalty. b. He will not be able to enroll in Part D unless he decides to also enroll in a Medicare Advantage plan. c. He will incur a one-time financial penalty equal to 30 percent of the annual Part D premium. d. He will avoid any financial penalty or late enrollment fee under the grandfathering provisions of Medicare Part D.

b

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. Organizations sponsoring Medicare health plans are not responsible for enforcing compliance with applicable law and guidance. This job belongs solely to the Medicare agency. b. 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. c. 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. d. The state sets most requirements for marketing Medicare health plans, but each plan has different policies that he must adhere to.

d

Mr. Meoni's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs. What could you tell Mr.Meoni? a. Medicare Supplemental Insurance would cover all of his IRS approved health care expenditures not covered under Original Fee-for-Service (FFS) Medicare. b. Medicare Supplemental Insurance would cover his dental, vision and hearing services only. c. Medicare Supplemental Insurance would cover his long-term care services. d. Medicare Supplemental Insurance would help cover his Part A and Part B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover.

a

Mr. Murphy is an agent. A neighbor invited him to discuss the Medicare Advantage (MA) and Part D plans he sells at the regular Tuesday brunch the neighbors have for senior citizens. What should Mr. Murphy tell his neighbor about the kinds of food that can be provided to potential enrollees who attend the sales presentation? a. The neighbors may not provide a meal, but light snacks would be permitted. b. Any type of meal or food is allowed, as long as it is available to the general public and not just to those who are eligible to enroll in the plans. c. Any meal is allowed, as long as it is valued at less than $15. d. The neighbors may not provide anything to either eat or drink during the sales presentation.

c

Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. He wants to understand the health care costs he might be exposed to under Medicare if he were to require hospitalization as a result of an illness. In general terms, what could you tell him about his costs for inpatient hospital services under Original Medicare? a. Under Original Medicare, the inpatient hospital co-payment is a flat per-day amount that remains the same throughout the first 60 days of a beneficiary's stay. After day 60 the amount gradually increases until day 90. After 90 days he would pay the full amount of all costs. b. Under Original Medicare, if the inpatient hospital service is provided by a participating Medicare provider, the co-payment is waived. Co-payments are only charged when a beneficiary opts to receive care from a non-participating provider. c. Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over his lifetime, after which he would be responsible for all costs d. Under Original Medicare, the inpatient hospital co-payment is a percentage of allowed charges. The percentage increases after 60 days and again after 90 days.

c

Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay that Medicare will cover? a. Inpatient psychiatric services are not covered under Original Medicare. b. Medicare inpatient psychiatric coverage is limited to the same number of days covered for typical inpatient stays. c. Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime. d. Medicare will cover, at its allowable amount, as many stays as are needed throughout Mr. Rainey's life, as long as no single stay exceeds 190 days.

d

Mr. Rice has coverage for medical services and medications through his employer's retiree plan. He is considering switching to a Medicare prescription drug plan because his retiree plan does not cover two important medications. What should he consider before making a change? a. If his drug coverage through the retiree plan is "creditable" he should not switch, even though it is possible to do so. b. Mr. Rice's retiree plan is required to take him back if, within 63 days of having voluntarily quit the employer's plan, he decides that he prefers it to his Medicare Part D plan. c. Mr. Rice can only receive his prescription drug coverage through a Medicare Advantage prescription drug plan so he should drop his employer coverage. d. 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.

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

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

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

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

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

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

b

Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? What could you tell him? a. Part D, which covers prescription drug services, is covered under Original Medicare. b. Part A, which covers hospital, skilled nursing facility, hospice and home health services and Part B, which covers professional services such as those provided by a doctor are covered under Original Medicare. c. Part C, which always covers dental and vision services, is covered under Original Medicare. d. Part A, which covers long term custodial care services, is covered under Original Medicare.

Mr. Shultz was still working when he first qualified for Medicare. At that time, he had employer group coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. It is now a year later and Mr. Shultz has lost his employer group coverage. How would you advise him?

Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty

Mr. Shultz was still working when he first qualified for Medicare. At that time, he had employer group coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. It is now a year later and Mr. Shultz has lost his employer group coverage. How would you advise him?

Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty.

c

Mr. Shapiro gets by on a very small fixed income. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know whether he might qualify. What should you tell him? a. 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. b. 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. c. The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. d. The extra help is available only to Medicare beneficiaries who are enrolled in Medicaid. He should apply for coverage under his state's Medicaid program to access the extra help with his drug costs.

b

Mr. Shultz was still working when he first qualified for Medicare. At that time, he had employer group coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. It is now a year later and Mr. Shultz has lost his employer group coverage. How would you advise him? a. Mr. Schultz should immediately enroll in a Part D plan but he can expect to pay a premium penalty because he failed to enroll when first eligible. b. Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty. c. Mr. Schultz should seek to continue employer group coverage through COBRA because it is likely to have superior benefits at a more reasonable price. d. Mr. Schultz can wait up to 180 days after the loss of his creditable employer group coverage before enrolling in a Part D plan without worrying payment a premium penalty.

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

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.

b

Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. What should you tell him? a. Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Health Plan. b. Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare. c. Part D prescription drug coverage can only be obtained by enrollment into a Medicare Health Plan that also covers Part A and Part B services. d. Mr. Singh must leave Original Medicare to receive drug coverage.

*MRS. PARK* HAS A LOW FIXED INCOME. WHAT COULD YOU TELL HER THAT MIGHT BE OF ASSISTANCE

SHE SHOULD CONTACT HER STATE MEDICAID AGENCY TO SEE IF SHE QUALIFIES FOR ONE OF SEVERAL PROGRAMS...........

d

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

You are visiting with Mr. Tully and his daughter at her request. He has advanced Alzheimer's and is incapable of understanding the implications of choosing a Medicare Advantage or prescription drug plan. Can his daughter fill out the enrollment form and sign it for him?

Mr. Tully's daughter can do so only, if she is authorized under state law as a court-appointed legal guardian, has durable power of attorney for health care d

You are visiting with Mr. Tully and his daughter at her request. He has advanced Alzheimer's and is incapable of understanding the implications of choosing a Medicare Advantage or prescription drug plan. Can his daughter fill out the enrollment form and sign it for him?

Mr. Tully's daughter can do so only, if she is authorized under state law as a court-appointed legal guardian, has durable power of attorney for health care decisions, or is authorized under state surrogate consent laws to make health decisions

You are visiting with Mr. Tully and his daughter at her request. He has advanced Alzheimer's and is incapable of understanding the implications of choosing a Medicare Advantage or prescription drug plan. Can his daughter fill out the enrollment form and sign it for him?

Mr. Tully's daughter can do so only, if she is authorized under state law as a court-appointed legal guardian, has durable power of attorney for health care decisions, or is authorized under state surrogate consent laws to make health decisions.

a

Mr. Valesquez asked if the Private Fee-for-Service plan you have discussed is like Original Medicare or a Medigap supplement plan. What should you say about a Private Fee-for-Service (PFFS) plan to explain it to Mr. Valesquez? a. It is not Original Medicare and it works differently than a Medicare supplement plan. b. It is like a Medicare supplement or Medigap plan. c. It is a type of Medicare Advantage plan that allows you to go to any doctor anywhere. d. It is the same as Original Medicare, but offered by a private company.

d

Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Where might he turn for help with his prescription drug costs? a. Mr. Wu may still qualify for help in paying for Part D costs through the local Office of the Aging. b. Mr. Wu has no alternative but to liquidate his remaining assets and apply for coverage through his state's Medicaid program. c. Mr. Wu may still qualify for help in paying for Part D costs through the Federal Pharmaceutical Assistance Program. d. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program.

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?

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

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?

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

c

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 will need to enroll in a Special Needs Plan to obtain coverage for his medication. b. 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. c. 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. d. Mr. Zachow could immediately disenroll from the Part D plan and select a new Part D plan that covers the drug that works for him.

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?

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

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?

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. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr. Vaughn takes a prescription for helping to regrow his hair. They are anxious to have their Medicare prescription drug plan cover these drug needs. What should you tell them? a. Medicare prescription drug plans are permitted to cover vitamins, but not drugs for cosmetic purposes. b. Mr. Vaughn's hair growth medication would only be covered under Part D if his balding resulted from an illness or was a side effect of a treatment such as chemotherapy. c. Medicare prescription drug plans are not permitted to cover the prescription medications the Vaughns are interested in under Part D coverage, however, plans may cover them as supplemental benefits and the Vaughn's could look into that possibility. d. The vitamins the Vaughns are taking will be covered under Part D, because their physician suggested they should take vitamins, but the hair loss medication cannot be covered.

b

Mrs. Allen has a rare condition for which two different brand name drugs are the only available treatment. She is concerned that since no generic prescription drug is available and these drugs are very high cost, she will not be able to find a Medicare Part D prescription drug plan that covers either one of them. What should you tell her? a. Medicare prescription drug plans are required to include only a certain percentage of brand name drugs among those they cover. It may be possible that plans available in her area have opted not to include in their formularies the brand name drugs she needs. She may need to pay for this particular medication out of pocket. b. Medicare prescription drug plans are required to cover drugs in each therapeutic category. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. c. When medication costs exceed a certain threshold amount, which rises each year, a Medicare prescription drug plan is permitted to exclude coverage for all but the least expensive of the medications in a given category. Mrs. Allen will need to encourage her physician to prescribe the least expensive of the two alternatives. d. Medicare prescription drug plans are allowed to restrict their coverage to generic drugs. She will need to pay for her brand name medications out of pocket.

All plans must cover at least the standard Part D coverage or its actuarial equivalent. What costs would a beneficiary incur for prescription drugs in 2017 under the standard coverage?

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

a

Mrs. Andrews was preparing a budget for next year because she takes quite a few prescription drugs, she will reach the coverage gap, and wants to be sure she has enough money set aside for those months. She received assistance calculating her projected expenses from her daughter who is a pharmacist, but she doesn't think the calculations are correct because her out-of-pocket expenses would be lower than last year. She calls to ask if you can help. What might you tell her? a. It would not be unusual for her costs to be a bit less because the Bipartisan Budget Act of 2018 moved up the date for closing the so-called "donut hole" for brand name drugs to 2019. b. There is likely an error in the calculations because prescription drug costs continue to rise, so her costs will probably be much higher next year. c. There is likely an error because she will be paying 86 percent of the cost of generic drugs in the coverage gap in 2019. d. It would not be unusual for her costs to be substantially less because a new requirement will result in generic drugs being automatically substituted for brand name drugs in the coverage gap.

c

Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxes during that entire period. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. What should you tell her? a. All individuals who are citizens and over age 65 will be covered under Part A. b. Most individuals who are citizens and over age 65 and are covered under Part A must pay a monthly premium for that coverage. c. Most individuals who are citizens and over age 65 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. 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.

a

Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the time to fill out the paperwork. What could you tell her? a. The Part D low income subsidy could substantially lower her overall costs. She can apply by contacting her state Medicaid office, or calling the Social Security Administration. b. The Part D low income subsidy is designed for Medicare beneficiaries who also qualify for Medicaid. If she does not qualify for Medicaid, she would likely not qualify for the extra help and therefore should not take the time to apply. c. Those who qualify for the Part D low income subsidy pay nothing for any of their medications. She should definitely apply if she believes there is any chance of her qualifying. d. The Part D low income subsidy will not help her once she reaches the coverage gap, so she need not take the time to apply.

b

Mrs. Fiore was in the Army for 35 years and is now retired. She has drug coverage through the VA. What issues might she consider with regard to whether to enroll in a Medicare prescription drug plan? a. Costs under the VA are significantly higher than those under a Medicare Part D plan. b. She could compare the coverage to see if the Medicare Part D plan offers better benefits and coverage than the VA for the specific medications she needs and whether any additional benefits are worth the Part D premium costs. c. The VA will not offer drug coverage to Mrs. Fiore once she qualifies for the Medicare Part D program. d. The VA does not offer creditable coverage and Mrs. Fiore may incur a Part D premium penalty if she enrolls in a Medicare prescription drug plan at some point after her initial eligibility date.

c

Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her? a. Part D covers physician and non-physician practitioner services and the deductible has not changed this year, but the physician charges may go up. b. Part D covers hospital and home health services and the cost sharing has changed this year. c. Part D covers prescription drugs and she should look at her premiums, formulary, and cost sharing among other factors to see if they have changed. d. Part D covers long-term care services and she shouldn't worry because there has been no change in coverage.

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

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

b

Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug coverage. She would like to keep the coverage she has, but replace her existing Medigap plan with one that provides drug coverage. What should you tell her? a. Medigap is a replacement for Original Medicare and she has been paying for double coverage. She should simply drop her Medigap policy. b. Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug plan. c. Mrs. Gonzalez can purchase a Medigap plan that covers drugs, but it likely won't offer coverage that is equivalent to that provided under Part D. d. Mrs. Gonzalez should purchase a K or L Medigap plan.

b

Mrs. Grant uses several very expensive drugs and anticipates that she will enter catastrophic coverage at some point during the year. To help her determine when she is likely to qualify for catastrophic coverage, she asked which expenses count toward the out-of-pocket limit that qualifies her for catastrophic coverage. Which one of the following would count? a. Prescription drugs she purchases on her own that are not on her Part D plan's formulary. b. Prescription drugs she purchases when in the Part D coverage gap. c. Prescription drugs she purchases on her vacation to Canada. d. Non-prescription, over-the-counter medications she purchases.

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

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

a

Mrs. Kelly, age 65, is entitled to Part A, but has not yet enrolled in Part B. She is considering enrollment in a Medicare health plan (Part C). What should you advise her to do before she will be able to enroll into a Medicare health plan? a. In order to join a Medicare health plan, she also must enroll in Part B. b. Since she is age 65 she may enroll in any Medicare health plan, regardless of whether she is entitled to Part A or Part B coverage. c. To enroll in a Medicare health plan, she need only be entitled to Part A, so she does not need to take any further steps. d. In order to join a Medicare health plan, she must be enrolled in Parts A, B and D.

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

Mrs. Leonard will be automatically enrolled in an MA plan offered by the same organization as the cost plan, notified by CMS, and given the opportunity to choose another option

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

Mrs. Leonard will be automatically enrolled in an MA plan offered by the same organization as the cost plan, notified by CMS, and given the opportunity to choose another option.

a

Mrs. Lopez is enrolled in a Medicare Advantage cost plan. She has recently lost creditable coverage previously available through her husband's employer. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). What should you tell her? a. If a Part D benefit is offered through her plan she may choose in enroll in that plan or a standalone PDP. b. Mrs. Lopez must first seek COBRA benefits under her husband's plan before she can apply for Part D coverage. c. If a Part D benefit is offered through her plan she must enroll in this plan. d. Mrs. Lopez must enroll in either a HMO or PPO Medicare Advantage plan in order to obtain Part D coverage.

a

Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. She agreed to sign a scope of appointment form and meet with you October 15. During the appointment, what are you permitted to do? a. You may provide her with the required enrollment materials and take her completed enrollment application. b. You may leave enrollment kits for several MA plans and offer to discuss a Medigap and Part D prescription drug plan she might like. c. You may leave an enrollment kit and discuss a new life insurance product she might like. d. You may take her completed enrollment application and ask her to provide names of any of her friends who may be interested in enrolling.

a

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. For enrollees in an MSA, after the annual deductible is met, the MSA plan generally pays 75% of covered services. c. All beneficiaries enrolled in an MSA pay a plan premium in addition to their Part B premium. d. 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.

d

Mrs. McIntire is enrolled in her state's Medicaid plan and has just become eligible for Medicare as well. What can she expect will happen with respect to her drug coverage? a. She can change Medicare Part D prescription drug plans only during the annual election period. b. Medicaid will cover all drugs not covered under the Medicare Part D prescription drug plan into which Mrs. McIntire is enrolled. c. She will continue to obtain her drug coverage through Medicaid. d. Unless she chooses a Medicare Part D prescription drug plan on her own, she will be automatically enrolled in one available in her area.

c

Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare prescription drug plan because, although she is entitled to Part A, she is not enrolled under Medicare Part B. What should you tell her? a. To qualify for enrollment into a Medicare prescription drug plan, Mrs. Mulcahy must be entitled to Part A and enrolled under Part B. She should contact her local Social Security office and make arrangements to enroll in Part B prior to selecting a prescription drug plan. b. As long as Mrs. Mulcahy is 65, eligibility for a Medicare prescription drug plan is not dependent on entitlement to Part A or enrollment under Part B, so she should not be concerned. c. Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she does not need to enroll under Part B before enrolling in a prescription drug plan. d. Like all Medicare beneficiaries, Mrs. Mulcahy will be automatically enrolled into a Medicare prescription drug plan when she turns 65. She will have a six month window during which she can select a plan other than the one into which she has been automatically enrolled.

a

Mrs. Park is an elderly retiree. She has a low, fixed income. What could you tell Mrs. Park that might be of assistance? a. She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help with Medicare costs for which she is responsible. Correct b. She can apply to the Medicare agency for lower premiums and cost-sharing. Incorrect c. She should not sign up for a Medigap or Medicare Advantage plan. Incorrect d. She should only seek help from private organizations to cover her Medicare costs.

b

Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. What can you tell her about Medigap as an option to address this concern? a. If Mrs. Paterson applies during the Medigap open enrollment period, she will have to undergo a medical review to determine if she has a pre-existing condition that would increase the premium for a Medigap policy. b. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. c. All costs not covered by Medicare are covered by some Medigap plans. d. Medigap plans are not sold by private companies and are a government insurance product.

c

Mrs. Peňa is 66 years old, has coverage under an employer plan and will retire next year. She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell her? a. She may not enroll in Part B while covered under an employer group health plan and must wait until the standard general enrollment period after she retires. b. She may only enroll in Part B during the general enrollment period whether she is retired or not. c. She may enroll at any time while she is covered under her employer plan, but she will have a special eight-month enrollment period that differs from the standard general enrollment period, during which she may enroll in Medicare Part B. d. She must wait at least 30 days after her employment terminates before she may enroll in Medicare Part B.

c

Mrs. Quinn has just turned 65, is in excellent health, and has a relatively high income. She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. What could you tell her about the implications of such a decision? a. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, if she does sign up at a later date, she will be required to pay a higher premium during the first year that she is enrolled in the Medicare prescription drug program. After that point, her premium will return to the normal amount. b. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, if she does sign up at a later date, she will have to pay a one-time penalty equal to 10% of the annual premium amount. c. If she does not sign up for a Medicare prescription drug plan 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. d. If she does not sign up for a Medicare prescription drug plan, she will incur no penalty, as long as she can demonstrate that she was in good health and did not take any medications.

d

Mrs. Quinn has recently turned 66 and decided after many years of work to begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn and received a letter informing her that she has been automatically enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn? a. She should disenroll if she does not want to pay the monthly premiums. There is no disadvantage to doing so. b. Part B will cover her dental and vision needs. c. She will need to pay no premiums for Part B as she qualifies for premium free coverage due to the number of quarters she has worked. d. Part B primarily covers physician services. She will be paying a monthly premium and, with the exception of many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an annual deductible.

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

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

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

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

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

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

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

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

b

Mrs. Roberts has just received a new Medicare identity card in the mail. She is concerned that it is a forgery since it does not have her Social Security number on it. What should you tell her? a. The card is indeed a forgery since newly issued Medicare cards will have both a beneficiary's Social Security number and date of birth imprinted on them. b. The card she received I valid, the change has been made to protect Medicare beneficiaries from identity theft, and she should now destroy her old card. c. The card is indeed a forgery since all identity cards are being phased-out in favor of a new electronic identity system developed by the Social Security Administration. d. The card she received is valid but she should keep her old card for at least two years and present it whenever she receives health care.

c

Mrs. Roswell is a new Medicare beneficiary and is interested in selecting a Medicare Part D prescription drug plan. She takes a number of medications and is concerned that she has not been able to identify a plan that covers all of her medications. She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. What should you tell her? a. There is no possibility of obtaining coverage for her existing medications once coverage under the Medicare Part D plan begins. She will need to have her physician help her select a new drug that is covered. b. The Medicare Part D drug plan is required to offer her coverage of the exact same drugs that she is currently stabilized on, so she does not need to be concerned about transitioning to any new medications. c. Every Part D drug plan is required to cover a single one-month fill of her existing medications sometime during a 90 day transition period. d. She should use any existing prescription drug coverage to get as large a supply of her existing drugs as possible, and then pick new drugs that are covered under her Medicare plan's formulary.

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

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

b

Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treated for that condition. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? a. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields' long-term care costs. b. Medicare will cover Mrs. Shields' skilled nursing services provided during the first 20 days of her stay, after which she would have a coinsurance until she has been in the facility for 100 days. c. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered because Medicare does not provide such a benefit. d. Medicare will cover an unlimited number of days in a skilled-nursing facility, as long as a physician certifies that such care is needed.

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?

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

d

Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are met? What could you tell her? a. Original Medicare covers orthopedic shoes. b. Original Medicare covers cosmetic surgery. c. Original Medicare covers routine foot care. d. Original Medicare covers ambulance services.

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

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

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

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

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)?

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

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

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

a

Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefit package of a Medicare Health Plan before she starts looking at specific plans. What could you tell her? a. Medicare Health Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental services and must include a maximum out-of-pocket limit on Part A and Part B services. b. Medicare Health Plans do not necessarily have to cover all of the Original Medicare Part A and Part B services, but must include a maximum out-of-pocket limit. c. Medicare Health Plans are not permitted to offer any benefits beyond those available under the Original Medicare program and must have the same maximum out-of-pocket limit on Part A and Part B services as FFS Medicare. d. All Medicare Health Plans offer cost-sharing that is lower than Original Medicare for all Part A and Part B covered services, but the maximum out-of-pocket limit is higher than in Original Medicare.

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

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

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

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

c

Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from arthritis through acupuncture. She is concerned about whether or not Medicare will cover these items and services. What should you tell her? a. Medicare covers 50% of the cost of these three services. b. Medicare covers 80% of the cost of these three services. c. Medicare does not cover acupuncture, or, in general, glasses or dentures. d. Medicare covers glasses, but not dentures or acupuncture.

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

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

c

Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. She is traveling and wishes to fill two of her prescriptions that she has lost. How would you advise her? a. She should wait to fill her prescriptions until she is back home since only her local pharmacy is likely to be in her plan's network. b. She may fill one prescription out-of-network per year and it will be fully covered. Her second prescription will require her to pay the full cost out-of-pocket. c. She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an in-network pharmacy. d. She may fill both prescriptions and they will be fully covered at in-network pricing due the fact that she is traveling.

d

Ms. Henderson believes that she will qualify for Medicare coverage when she turns 65, without paying any premiums, because she has been working for 40 years and paying Medicare taxes. What should you tell her? a. She is correct because she will be covered under Part A, without paying premiums and she has worked for 40 years so she will not have to pay Part B premiums. b. Medicare beneficiaries only pay a Part B premium if they are enrolled in a Medicare Health Plan. c. She is correct that she will not have to pay a premium because State programs cover the cost of Part B premiums for all Medicare beneficiaries. d. In order to obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes.

d

Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will have considerable income when she retires. She is concerned that her income will make it impossible for her to qualify for Medicare. What could you tell her to address her concern? a. Eligibility for Medicare is based on whether or not a person has ever been employed by the federal government. If she or her husband were ever employed by the federal government, she can enroll in Medicare. b. Medicare is a program for people of all ages with specific mental health disabilities. Since she is in excellent health, she would not qualify, but should instead look into her state's Medicaid program if she wants further coverage. c. Medicare is a program for people who have incomes and assets below specific limits, so you will have to find out her exact financial situation before telling her whether she can obtain Medicare coverage. d. 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.

c

Next week you will be participating in your first "educational event" for prospective enrollees. In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage? a. You should plan to conduct sales presentations, but must not accept enrollment forms. b. You should plan to answer questions and accept enrollment forms. c. You should plan to ensure that the educational event is a social event, and must not conduct a sales presentation or distribute or accept enrollment forms at the event. d. You should plan to conduct sales presentations and accept enrollment forms

A broker plans to offer Visa gift cards that can be used anywhere, as if they were cash. Is this permissible?

No, cash or cash equivalent prizes cannot be offered.

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

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

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

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

Can marketing representatives request information from providers regarding Medicare beneficiaries with specific health conditions for marketing purposes?

No, providers are legally prohibited from sharing such information

A health plan made a bulk order of items to be used as promotional prizes. Taking into account the discount they received for their bulk order, each item cost them $14.99. Can they use these items as promotional prizes?

No, the retail cost of the items would be more than $15.00.

a

One of your colleagues argues that it is better to focus your time and energy exclusively in neighborhoods with single family homes. He further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. How should you respond? a. This could be considered discriminatory activity and a prohibited practice. b. This is not a discriminatory activity since this is merely a widely recommended sales practice. c. This is not a discriminatory activity since it is based on the incomes of likely prospects and not based on race or gender. d. This could be considered discriminatory activity, but it is not a prohibited practice.

c

Ordinarily, you ask your clients for referrals to people they think would benefit from the products you offer. When selling Medicare Advantage or Part D products, how might you solicit referrals? a. You may call current MA and Part D enrollees to solicit referrals and offer thank you gifts of less than $15 for each referral received. b. You may send an e-mail to all current plan members who have given permission to email them asking for the names, e-mail addresses, and phone numbers of referrals. c. You may solicit referrals from current MA and Part D enrollees and offer one thank you gift per member per year of less than $15, based on retail purchase price for the item, although you may not inform enrollees of the availability of the gift in your letter soliciting referrals. d. You may enter referring individuals in a drawing for substantial prizes as long as they are not told in advance of the drawing the value of the prize.

d

Ordinarily, you obtain referrals from a third-party that initiates contact with potential clients and usually sets up appointments for you. How would the guidelines for marketing Medicare Advantage and Part D plans apply to this practice? a. Third parties may make initial calls to a potential client, but they must then pass the name and phone number on to you and it will be your responsibility to set up the sales appointment and obtain a completed scope of appointment form. b. Third parties may only make initial contact with a beneficiary if they first obtain certification from the Medicare agency as an approved marketing entity and are licensed under applicable state law. c. This is an acceptable practice, as long as the third party clearly states, during a call that it is calling on behalf of a Medicare Advantage or Part D plan, or the plan's marketing representative. d. Third parties may not make unsolicited calls, visits, or emails to Medicare beneficiaries in order to set up such appointments, or for any other reason related to the marketing of Medicare Advantage or Part D plans.

b

Ordinarily, you provide clients who purchase various types of insurance products from you with a gift when they enroll and you let them know that they will receive it after their enrollment is complete. When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan? a. You may provide any gift to induce enrollment, as long as its retail value does not exceed $15 in value. b. You may not provide any gift or prize as an inducement to enroll. c. You may provide cash promotions or giveaways as long they are offered to everyone, whether they are a Medicare beneficiary or the general public. d. You may give enrollees post-enrollment gifts to compensate them for their time.

d

Ordinarily, you provide clients who purchase various types of insurance products from you with a gift when they enroll and you let them know that they will receive it after their enrollment is complete. When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan? a. You may provide cash promotions or give-aways as long they are offered to everyone, whether they are a Medicare beneficiary or the general public b. You may give enrollees post-enrollment gifts to compensate them for their time. c. You may provide any gift to induce enrollment, as long as its retail value does not exceed $15 in value. d. You may not provide any gift or prize as an inducement to enroll.

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?

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

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?

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.

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

Original Medicare covers ambulance services

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

Original Medicare covers ambulance services.

*MR. SCHMIDT* WOULD LIKE TO PLAN FOR RETIREMENT AND HAS ASKED YOU WHAT IS COVERED UNDER ORIGINAL FEE FOR SERVICE

PART A WHICH COVER HOSPITAL SKILLED NURSING FACILITY, HOSPICE AND HOME HEALTH SERVICES AND PART B........

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

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

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

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

*MR. ROBINSON* WAS QUITE ILL RECENTLY AND FORGOT TO PAY HIS MONTHLY PREMIUM FOR HIS MAPD PLAN. HE IS WORRIED THAT HE WILL LOSE HIS COVERAGE NOW WHEN HE NEEDS IT THE MOST. HE IS CERTAIN HIS PLAN..............................

PLAN SPONSORS HAVE THE OPTION TO DISENROLL MEMBERS WHO DO NOT PAY THEIR PREMIUMS, BUT THEY MUST FIRST PROVIDE EACH MEMBER WITH A GRACE PERIOD OF NOT LESS THAN 2 MONTHS.

*MR. RASKIN* IS A WIDOW WHO WILL ATTAIN AGED 65 AND ENROLL IN MEDICARE IN JUST A FEW WEEKS. SHE CONCERNED ABOUT HAVING PRESCRIPTION DRUG COVERAGE. WHICH OF THE FOLLOWING STATEMENTS PROVIDES THE BEST ADVICE?

PRESCRIPTION DRUG COVERAGE CAN BE OBTAINED BY ENROLLING IN A MEDICARE ADVANTAGE PLAN THAT INCLUEDS PART D COVERAGE

YOU HAVE SET UP AN APPOINTMENT OFR AN IN HOME SALES PRESENTATION WITH *MRS. FERNANDEZ* WHO.......

PRIOR TO CONDUCTING THE PRESENTATION, OBTAIN, AND DOCUMENTS HAVING OBTAINED........

AGENT *MARK ANDREWS* WOULD LIKE TO EMPLOY TECHNOLOGY TO FACILITATE THE GROWTH OF HIS MEDICARE ADVANTAGE (MA) PRACTICE. WHAT STEPS WOULD YOU RECOMMEND THAT MARK TAKE?

PURCHASE INTERNET POP-UP ADS PROVIDING PLAN-SPECIFIC INFORMATION THAT HAVE BEEN REVIEWED AND APPROVED BY CMS.

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

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

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

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

original medicare

Part A- Hospital,skilled nursing facility, hospice, and some health care services Part B- Professional services such as those provided by a doctor or non-physician professional, outpatient care, clinic lab services, and other medical services

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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?

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

c

Plan sponsors may undertake the following marketing activities with current Medicare Advantage plan members? a. Market non-Medicare health-related products, such as financial planning, to current members as permitted by HIPAA Privacy Rules. b. Market non-health related products, such as life insurance, to current members without the need to consider HIPAA Privacy Rules. c. Market non-Medicare health-related products, such as dental insurance, to current members as permitted by HIPAA Privacy Rules. d. Market contact information lists of current member to third-party vendors of ancillary health products as permitted by HIPAA Privacy Rules.

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

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

The Medicare agency has requested a list of contracted representatives from a Private Fee-for-Service (PFFS) plan that you represent. In this situation, what will the plan do?

Plans will provide to the Medicare agency a complete list of all of their contracted representatives who are marketing PFFS products, and will authorize the agency to provide those names to state departments of insurance when they request it.

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

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

Mrs. Grant uses several very expensive drugs and anticipates that she will enter catastrophic coverage at some point during the year. To help her determine when she is likely to qualify for catastrophic coverage, she asked which expenses count toward the out-of-pocket limit that qualifies her for catastrophic coverage. Which one of the following would count?

Prescription drugs she purchases when in the Part D coverage gap

Mrs. Grant uses several very expensive drugs and anticipates that she will enter catastrophic coverage at some point during the year. To help her determine when she is likely to qualify for catastrophic coverage, she asked which expenses count toward the out-of-pocket limit that qualifies her for catastrophic coverage. Which one of the following would count?

Prescription drugs she purchases when in the Part D coverage gap.

Mrs. Grant uses several very expensive drugs and anticipates that she will enter catastrophic coverage at some point during the year. To help her determine when she is likely to qualify for catastrophic coverage, she asked which expenses count toward the out-of-pocket limit that qualifies her for catastrophic coverage. Which one of the following would count?

Prescription drugs she purchases when in the Part D coverage gap.

You have set up an appointment for an in-home sales presentation with Mrs. Fernandez, who expressed interest in the Medicare plans you represent. In preparation for the sales presentation, what must you do?

Prior to conducting the presentation, obtain, and document having obtained her permission to visit, along with her interest in the specific products you will present.

You have set up an appointment for an in-home sales presentation with Mrs. Fowler, who expressed interest in the Medicare plans you represent. In preparation for the sales presentation, what must you do?

Prior to conducting the presentation, obtain, and document having obtained her permission to visit, along with her interest in the specific products you will present.

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?

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

What is the policy of non-retaliation?

Protects employees who, in good faith, report suspected non-compliance

Correcting non-compliance ______________.

Protects enrollees, avoids recurrence of the same non-compliance, and promotes efficienc

A large physician group in your area contracts with the plans you represent. You have an opportunity to work with them to market the plans, but want to be sure you follow the CMS requirements. What can you ask the physician group to do?

Provide names of the plans they contract with along with information from the CMS website.

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

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

ROBERTA IS A RETIREE WHO HAS JUST LEARNED THAT SHE HAS PURCHASED A MEDICARE ADVANTAGE (MA) PLAN FROM AN UNLICENSED INDIVIDUAL REPRESENTING BESTCARE HEALTH PLAN...............

ROBERTA MAY REQUEST TO CHANGE PLANS UPON RECEIVING NOTIFICATION OF THE AGENT UNLICENSED STATUS

Your job is to submit a risk diagnosis to the Centers for Medicare & Medicaid Services (CMS) for the purpose of payment. As part of this job you verify, through a certain process, that the data is accurate. Your immediate supervisor tells you to ignore the Sponsor's process and to adjust/add risk diagnosis codes for certain individuals. What should you do?

Report the incident to the compliance department (via compliance hotline or other mechanism

Mr. Quinn is a marketing representative who markets an MA plan. He is a very good speaker and was asked to make a presentation at a local event that was advertised as educational. He accepted the invitation and the MA plan reported the event to CMS. CMS' secret shopper attended the event and heard Mr. Quinn's sales presentation. Which of the following could CMS do?

Require the MA plan to suspend marketing and enrollment for a period of time.

Roberta is a retiree who has just learned that she has purchased a Medicare Advantage (MA) plan from an unlicensed individual representing BestCare Health Plan. What are Roberta's options, if any?

Roberta may request to change plans upon receiving notification of the agent's unlicensed status

*MS. EDWARDS* IS ENROLLED IN A MEDICARE ADVANTAGE PLAN THAT INCLUDES PRESCRIPTION DRUG PLAN (PDP) COVERAGE. SHE IS TRAVELING AND WISHES TO FILL TWO OF HER PRESCRIPTIONS THAT HAS LOST. HOW WOULD YOU ADVISE HER?

SHE MAY FILL PRESCRIPTIONS FOR COVERED DRUGS AT NON-NETWORK PHARMACIES, BUT LIKELY AT A HIGHER COST THAN PAID AT AN IN-NETWORK PHARMACY.

*MRS. BILLINGS* ENROLLED IN THE ABC MEDICARE ADVANTAGE (MA) PLAN SEVERAL YEARS AGO. HER DOCTOR RECENTLY CONFIRMED A DIAGNOSIS OF END-STAGE RENAL DISEASE (ESRD). WHAT OPTIONS DOES MRS. BILLINGS HAVE IN REGARD TO HER MA PLAN DURING THE NEXT OPEN ENROLLMENT SEASON?

SHE MAY REMAIN IN HER ABC MA PLAN OR ENROLL IN A SPECIAL NEEDS PLAN (SNP) FOR INDIVIDUALS SUFFERING FROM ESRD IF ONE IS AVAILABLE IN HER AREA.

WHEN *MYRA* FIRST BECAME ELIGIBLE FOR MEDICARE, SHE ENROLLED IN ORIGINAL MEDICARE (PARTS A AND B). SHE IS NOW 67 AND WILL TURN 68 ON JULY 1. SHE WOULD NOW LIKE TO ENROLL...............................

SHE SHOULD REMAIN IN ORIGINAL MEDICARE UNTIL THE ANNUAAL ELECTION PERIOD RUNNING FROM OCTOBER 15 TO DECEMBER 7, DURING WHICH SHE CAN SELECT AN MA PLAN.

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?

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

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?

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.

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

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

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

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

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

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

a

Several agents you work with are planning sales events in your area. One plans on giving door prizes worth $5, refreshments valued at $8 per anticipated attendee, and coupon books with discounts worth $10. Since no gift or prize exceeds the $15 limit he believes his plan is acceptable. What should you tell them a. He can give away more than one gift during a single event, but the aggregate retail value cannot exceed $15 b. Gifts and prizes are not permitted under the Marketing Guidelines promulgated by the Medicare agency c. Only a single prize or give away can be made at any one event, regardless of its value d. He is correct. He can offer multiple prizes or give-aways at a single event, as long as no one item has a retail value that exceeds $15

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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?

She may make such a change during the Annual Election Period that runs from Oct. 15 to December 7, or during the MA Disenrollment Period that runs from January 1 to February 14 of each year.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You are meeting with Mrs. Hall in her home. On her scope of appointment form she asked to discuss Medicare Advantage plans. During the meeting, she asks to discuss a stand-alone prescription drug plan. She is leaving the next day to visit her family for a week in another state, so it is important to her to make a decision before she leaves. What must happen before that additional discussion can take place?

Since Mrs. Hall specifically asked that you discuss the stand-alone Part D plan, you may do so, as long as she signs a new scope of appointment form first, indicating that she wants to discuss the Part D plan.

During a sales presentation, your client asks you whether the Medicare agency recommends that she sign up for your plan or stay in Original Medicare. What should you tell her?

Tell her that the Medicare agency does not endorse or recommend any plan

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

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

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

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

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?

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

AJAX AGENCY IS TARGETING POTENTIAL ENROLLEES FOR MSA PLANS. WHICH OF THE FOLLOWING STATEMENTS BEST DESCRIBES THE RULES THAT APPLY TO THE MSA MATERIALS IT DISTRIBUTES?

THE MATERIALS MUST MAKE CLEAR THAT MEDICARE MSA PLANS DO NOT COVER PRESCRIPTION DRUGS AND THAT BENEFICIARIES CAN JOIN A SEPARATE PART D PRESCRIPTION DRUG PLAN.

*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.......

THE NEIGHBORS MAY NOT PROIVDE A MEAL, BUT LIGHT SNACKS WOULD BE PERMITTED.

WHAT IMPACT, IF ANY, WILL THE MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT OF 2015 (MACRA) HAVE UPON MEDIGAP PLANS?

THE PART B DEDUCTIBLE WILL NO LONGER BE COVERED FOR INDIVIDUALS NEWLY ELIGIBLE FOR MEDICARE STARTING JANUARY 1, 2020

*MRS. MURDOCK* HAS BEEN VERY ILL AND HAS BEEN IN THE HOSPITAL MULTIPLE TIMES THIS YEAR. SHE IS CONCERNED THAT HER EXPENSES MOOP

THERE IS NO LIMIT ON THE EXPENSES A PLAN CAN INCUR ON BEHALF OF ANY ONE BENEFICIARY AND A PLAN SPONSOR MAY NOT END A MEMBER ENROLLMENT

*MRS. YOUNG* IS CURRENTLY ENROLLED IN ORIGINAL MEDICARE (PARTS A AND B), BUT SHE HAS BEEN WORKING WITH AGENT NEIL ADAMS IN THE SELECTION OF MEDICARE ADVANTAGE (MA) PLAN. IT IS MID-SEPTEMBER, AND MRS. YOUNG IS GOING ON VACATION.......

THIS IS A BAD IDEA. AGENTS ARE GENERALLY PROHIBITED FROM SOLICITING OR ACCEPTING AN ENROLLMENT FORM PRIOR TO THE START OF THE AEP.

*MRS. REYNOLDS* JUST SIGNED UP FOR A MEDICARE ADVANTAGE PLAN ON THE SECOND OF THE MONTH. SHE IS LEAVING VACATION..........

TYPICALLY HER COVERAGE WOULD BEGIN ON THE FIRST DAY OF THE NEXT MONTH, SO SHE SHOULD NOT EXCEPT HER COVERAGE TO BEGIN......

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

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

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

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

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

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

You have approached a hospital administrator about marketing in her facility. The administrator is uncomfortable with the suggestion. How could you address her concerns?

Tell her that Medicare guidelines allow you to conduct marketing activities in common areas of a provider's facility

You have approached a hospital administrator about marketing in her facility. The administrator is uncomfortable with the suggestion. How could you address her concerns?

Tell her that Medicare guidelines allow you to conduct marketing activities in common areas of a provider's facility.

You have approached a hospital administrator about marketing in her facility. The administrator is uncomfortable with the suggestion. How could you address her concerns?

Tell her that Medicare guidelines allow you to conduct marketing activities in common areas of a provider's facility.

During a sales presentation for a Private Fee-for-Service (PFFS) plan, which of the following points should you explain?

That the beneficiary, not the plan, is responsible for the entire cost for services she obtains that are not medically necessary.

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?

The Medicare Advantage plan received a 5-star rating in customer service and care coordination with an overall performance rating of 4-stars

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?

The Medicare Advantage plan received a 5-star rating in customer service and care coordination with an overall performance rating of 4-stars.

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

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

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

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

Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the time to fill out the paperwork. What could you tell her?

The Part D low income subsidy could substantially lower her overall costs. She can apply by contacting her state Medicaid office, or calling the Social Security Administration

Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the time to fill out the paperwork. What could you tell her?

The Part D low income subsidy could substantially lower her overall costs. She can apply by contacting her state Medicaid office, or calling the Social Security Administration.

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?

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

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?

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

Mr. Shapiro gets by on a very small fixed income. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know whether he might qualify. What should you tell him?

The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government

Mr. Shapiro gets by on a very small fixed income. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know whether he might qualify. What should you tell him?

The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government.

Since 1999, Mrs. Patel has had a Medigap policy that covers drugs. This year she received a letter from her Medigap insurer telling her that her Medigap drug coverage is not "creditable." She wants you to explain what this means and what she should do. What should you tell her?

The letter is letting her know that her Medigap drug coverage is coverage that does not expect to pay, on average, at least as much as Medicare's standard Part D coverage expects to pay. If she signs up for a Medicare prescription drug plan now, she may have to pay a premium penalty if her special enrollment period has expired.

Ajax Agency is targeting potential enrollees for MSA plans. Which of the following statements best describes the rules that apply to the MSA materials it distributes?

The materials must make clear that Medicare MSA plans do not cover prescription drugs and that beneficiaries can join a separate Part D prescription drug plan.

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?

The neighbors may not provide a meal, but light snacks would be permitted

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?

The neighbors may not provide a meal, but light snacks would be permitted.

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?

The plan may withhold commission, require retraining, report the misconduct to a state department of insurance or terminate the contract

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?

The plan may withhold commission, require retraining, report the misconduct to a state department of insurance or terminate the contract.

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

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

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

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

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

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

Mrs. Murdock has been very ill and has been in the hospital multiple times this year. She is concerned that her expenses have reached the maximum out-of-pocket costs and now her special needs plan (SNP) will disenroll her. What can you tell her?

There is no limit on the expenses a plan can incur on behalf of any one beneficiary and a plan sponsor may not end a member's enrollment just because of high costs, so she should not be concerned

Mrs. Murdock has been very ill and has been in the hospital multiple times this year. She is concerned that her expenses have reached the maximum out-of-pocket costs and now her special needs plan (SNP) will disenroll her. What can you tell her?

There is no limit on the expenses a plan can incur on behalf of any one beneficiary and a plan sponsor may not end a member's enrollment just because of high costs, so she should not be concerned.

Mrs. Murphy has been very ill and has been in the hospital multiple times this year. She is concerned that her expenses have reached the maximum out-of-pocket costs and now her special needs plan (SNP) will disenroll her. What can you tell her?

There is no limit on the expenses a plan can incur on behalf of any one beneficiary and a plan sponsor may not end a member's enrollment just because of high costs, so she should not be concerned.

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

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

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

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

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

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

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

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

Ordinarily, you obtain referrals from a third-party that initiates contact with potential clients and usually sets up appointments for you. How would the guidelines for marketing Medicare Advantage and Part D plans apply to this practice?

Third parties may not make unsolicited calls, visits, or emails to Medicare beneficiaries in order to set up such appointments, or for any other reason related to the marketing of Medicare Advantage or Part D plans.

One of your colleagues argues that it is better to focus your time and energy exclusively in neighborhoods with single family homes. He further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. How should you respond?

This could be considered discriminatory activity and a prohibited practice.

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

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

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

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

One of your colleagues argues that face-to-face meetings with potential enrollees should be required because they cannot make an appropriate decision with the minimal information that can be provided over the phone or in small brochures. How should you respond to this argument?

This is incorrect. Brokers and agents cannot require face to face meetings in order to answer questions or enroll a Medicare beneficiary

One of your colleagues argues that face-to-face meetings with potential enrollees should be required because they cannot make an appropriate decision with the minimal information that can be provided over the phone or in small brochures. How should you respond to this argument?

This is incorrect. Brokers and agents cannot require face to face meetings in order to answer questions or enroll a Medicare beneficiary.

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?

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

c

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? a. You may not make any unsolicited contact with Medicare beneficiaries. The employer will have to tell its retirees to call you. b. You may only contact the retirees after the employer has notified them that they will be receiving a call. c. You may go ahead and call them. d. You may call them, but must record every call.

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

True

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

d. Her daughter should come in November. Correct

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?

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

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?

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.

*MRS. MCLNTIRE IS ENROLLED IN HER STATE'S MEDICAID PLAN AND HAS JUST BECOME ELIGIBLE FOR MEDICARE AS WELL. WHAT CAN SHE EXCEPT WILL HAPPEN WITH RESPECT TO HER DRUG COVERAGE?

UNLESS SHE CHOOSES A MEDICARE PART D PRESCRIPTION DRUG PLAN ON HER OWN, SHE WILL BE AUTOMATICALLY ENROLLED IN ONE AVAILABLE IN HER AREA

One of your colleagues has a spouse that works in the records department of a large physician practice in your area. He suggests that she could ask the physicians to provide information about Medicare beneficiaries who could benefit from enrolling in the plan you represent. How should you respond?

Under Federal rules, physicians are not permitted to release such information, nor are plans or their agents or brokers permitted to work with physicians to direct any beneficiaries to a specific plan.

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

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

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

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

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

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

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

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

d

Under what conditions can a Medicare prescription drug plan reduce its coverage for a given drug during the first 60 days of the year? Choose one answer. a. If the Medicare prescription drug plan can show that reducing coverage early in the year will result in savings for the Part D plan and the Medicare program, generally the plan may make such a change. b. Under no conditions can a Medicare Part D prescription drug plan reduce its coverage for a given drug at any point during the year. c. When the Part D plan can demonstrate to CMS that no enrollee has accessed the medication in the past six months, generally the plan can remove the drug from its formulary within the first 60 days of the year. d. When a formulary change is in response to a drug's removal from the market.

Mrs. McIntire is enrolled in her state's Medicaid plan and has just become eligible for Medicare as well. What can she expect will happen with respect to her drug coverage?

Unless she chooses a Medicare Part D prescription drug plan on her own, she will be automatically enrolled in one available in her area

Mrs. McIntire is enrolled in her state's Medicaid plan and has just become eligible for Medicare as well. What can she expect will happen with respect to her drug coverage?

Unless she chooses a Medicare Part D prescription drug plan on her own, she will be automatically enrolled in one available in her area.

b

Wendy Park becomes eligible for Medicare for the first time in July. With the help of Agent James Chan, she enrolls in FeelBetter Medicare Advantage plan with an effective date of July 1st. Which statement best describes how Agent Chan may be compensated under CMS rules? a. FeelBetter will pay Agent Chan initial year compensation for the period July 1 through October 15th -(the date open enrollment begins). If Ms. Park remains enrolled in the plan, renewal amounts will be paid. b. FeelBetter will pay Agent Chan initial year compensation for the months July through December. Renewal amounts will be paid starting in January if Ms. Park remains enrolled the following year. c. FeelBetter will pay Agent Chan a bonus equal to three months initial year compensation since he has successfully enrolled Ms. Park in a MA plan when she is both first eligible and a younger, and likely healthier, enrollee. d. FeelBetter will pay Agent Chan initial year compensation for the 12 months of July through July. Renewal amount will be paid thereafter if Ms. Park remains enrolled.

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

sex.

d

What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) have upon Medigap plans? a. The Part A deductible is no longer covered under Medigap plans for all enrollees staring January 1, 2020. b. MACRA provides funding to help individuals age 59 and above enroll in Medigap plans. c. The Part A deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. d. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020.

d

What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? a. Part D plans may use varying co-payments, but they are required to cover all prescription medications on the market. b. Part D plans may use varying co-payments for brand name and generic drugs, but they may not restrict access through prior authorization. c. The Federal government establishes a set formulary, or list of covered drugs, each year that the Part D plans must use. Beneficiaries should consult the government's list prior to deciding whether they wish to enroll in a Part D plan during that year. d. Part D plans do not have to cover all medications. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. In addition, they can use cost containment techniques such as tiered co-payments and prior authorization.

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

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

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

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

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

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

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

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

b

When soliciting referrals from current members of an MA or Part D plan, what may you do? a. You may offer gifts or prizes worth $15 or less in retail value to obtain referrals. b. You may request names and mailing addresses. c. You may offer gifts and prizes worth $15 or less in retail value for each individual on the list of referrals who chooses to enroll. d. You may request names and phone numbers.

d

Which of the following is a correct statement about state laws as they pertain to marketing representatives? a. State licensure laws are pre-empted and do not apply to marketing representatives marketing MA and Part D plans b. Plan sponsors can use any marketing representative, as long as they are licensed in at least one state. c. Plans must contract only with marketing representatives who reside in the state where they intend to work. d. Medicare health plans must comply with requests for information from state insurance departments investigating complaints about a marketing representative.

d

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

b

Which of the following statements best describes how business reply cards (BRCs) may be employed in the marketing of Medicare Advantage products? a. A BRC may be used to document a beneficiary's scope of appointment agreement provided it has been submitted to CMS for approval. b. A BRC may be used to document a beneficiary's scope of appointment agreement provided it has been submitted to CMS for approval and includes a statement informing the beneficiary that a salesperson may call. c. Since they are a common marketing technique, plan sponsors simply need to have them approved by their internal compliance departments. d. Since they are a common marketing technique, agents can simply send them to lists of prospects.

a

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

c

While making an appointment to discuss Medicare Advantage (MA) and Part D plans with a potential enrollee, you are asked to describe other types of insurance products that your client might wish to purchase. What additional types of insurance can you present during the MA and Part D marketing appointment? a. You cannot present any line of business other than MA or Part D during such a presentation, regardless of whether or not it is health care related. b. You can present only end of life and life insurance lines of business. c. You can present only health care related lines of business, but must obtain the beneficiary's permission to do so before the presentation occurs and document that you have obtained that permission. d. You can present any line of business you represent as long as you obtain the beneficiary's permission first.

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?

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

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?

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.

b

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.

*MRS. SCHNEIDER* HAS ORIGINAL MEDICARE PART A AND B AND HAS JUST QUAILFIED FOR HER STATE MEDICAID PROGRAM............

YES, QUALIFYING FIR THIS STATE PROGRAM GIVES MRS. SCHNEIDER ACCESS TO A SPECIAL ELECTION PERIOD THAT ALLOWS HER TO MAKE.....

*MRS.WALTERS* IS ENTITLED TO PART A AND HAS MEDICAL COVERAGE WITHOUT DRUG COVERAGE THROUGH AN EMPLOYER RETIREE PLAN. SHE IS NOT ENROLLED IN PART B. SINCE .............

YES. MRS WALTERS MUST BE ENTITLED TO PART A OR ENROLLED IN PART B TO BE ELIGIBLE FOR COVERAGE UNDER THE MEDICARE PRESCRIPTION DRUG PROGRAM

AGENT *MARY JENNINGS* MAKES A PRESENTATION ON MEDICARE ADVERTISED AS AN EDUCATIONAL EVENT. AGENT JENNINGS DISTRIBUTES MATERIALS THAT ARE SOLELY EDUCATIONAL IN NATURE.........

YES. WHEN AN EVENT HAS BEEN ADVERTISED AS EDUCATIONAL DISCUSSING PLAN SPECIFIC PREMIUMS IS IMPERISSIBLE

YOU HAVE COME TO *MRS. MIDLER'S* HOME FOR A SALES PRESENTATION. AT THE BEGINNING

YOU CAN ONLY ASK MRS. MILDER QUESTIONS ABOUT CONDITIONS THAT AFFECT ELIGIBILITY, SPECIFICALLY...

YOU ARE WORKING WITH A NUMBER OF PLAN AND COMMUNITY ORGANIZATION TO SPONSOR AN EDUCATIONAL EVENT. WHEN PUTTING TOGETHER ADVERTISEMENTS FOR THIS EVENT,........

YOU MUST ENSURE THAT THE ADVERTISEMENTS INDICATE IT IS AN EDUCATIONAL EVENT, OTHERWISE IT WILL BE CONSIDERED........

YOU ARE COMPLETING A PFFS PLAN SALE TO * MR. WEST* WHO IS NEW TO MEDICARE AND AS.........

YOU NEED TO GET MR. WEST PHONE NUMBER AND INCLUDE IT ON THE ENROLLMENT FORM BECAUSE *THE PLAN MUST CALL HIM AFTER YOU LEAVE*.......

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?

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

Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to?

Yes. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program

Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to?

Yes. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program.

Mrs. Weiss is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to?

Yes. Mrs. Weiss must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program.

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. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan?

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

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

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

Agent Mary Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings distributes materials that are solely educational in nature. However, she gives a brief presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that has been advertised as educational?

Yes. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible

Agent Mary Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings distributes materials that are solely educational in nature. However, she gives a brief presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that has been advertised as educational?

Yes. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible.

Your friend's mother just moved to an assisted living facility and he asked if you could present a program for the residents about the MA-PD plans you market. What could you tell him?

You appreciate the opportunity and would be happy to schedule an appointment with anyone at their request

Your friend's mother just moved to an assisted living facility and he asked if you could present a program for the residents about the MA-PD plans you market. What could you tell him?

You appreciate the opportunity and would be happy to schedule an appointment with anyone at their request.

Your friend's mother just moved to an assisted living facility and he asked if you could present a program for the residents about the MA-PD plans you market. What could you tell him?

You appreciate the opportunity and would be happy to schedule an appointment with anyone at their request.

b

You are mailing invitations to new Medicare beneficiaries for a marketing event. You want an idea of how many people to expect, so you would like to request RSVPs. What should you keep in mind? a. You may not require RSVPs, but when people arrive, you may require completion of contact information on a sign-up sheet. b. You may request RSVPs, but you are not permitted to require contact information. c. You are not permitted to request RSVPs, so you will need to find a different way to estimate how many people are coming. d. You may require RSVPs and an e-mail address so you can follow up in the event of a cancellation.

d

You are meeting with Mrs. Hall in her home. On her scope of appointment form she asked to discuss Medicare Advantage plans. During the meeting, she asks to discuss a stand-alone prescription drug plan. She is leaving the next day to visit her family for a week in another state, so it is important to her to make a decision before she leaves. What must happen before that additional discussion can take place? a. You must refer Mrs. Hall to another agent in order for her to be able to engage in such a discussion. b. Since Mrs. Hall is leaving the state, you can immediately present her with information on the prescription drug plan, so she can make a decision before it is too late. c. You must make a telephone call from a location outside Mrs. Hall's home to ensure that the discussion of the prescription drug plan can take place. d. Since Mrs. Hall specifically asked that you discuss the stand-alone Part D plan, you may do so, as long as she signs a new scope of appointment form first, indicating that she wants to discuss the Part D plan.

b

You are scheduled to give a sales presentation at a local senior center. At the beginning of the presentation, which of the following must you do? a. Determine whether the beneficiaries present are healthy enough for the plan. b. Clearly state that no obligation exists to enroll if a gift or prize is being offered. c. Make sure that those present provide leads. d. Explain, in your own words, how the plan you represent compares to other companies' plans.

b

You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. You have completed the required training for each plan, but you did not achieve a passing score on the tests that came after the training. What can you do in this situation? a. Your name will be registered with the Medicare agency by the plans you are seeking to represent and you will be unable to contract with any Medicare Advantage or Part D plan. b. You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score, although you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing. c. You will have to attend one of several remedial training events sponsored by the Medicare agency before being allowed to retake the test. d. You will have to repeat the tests in three months, but may begin enrolling beneficiaries while you are waiting.

a

You are working with a number of plans and community organizations to sponsor an educational event. When putting together advertisements for this event, what should you do? a. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. b. You must state in the advertisement that it will be an educational event and that the education will consist of specific information about the participating plans. c. You must only ensure that the advertisement is factually accurate. d. Plans may not participate in advertising such an event. All advertising must be done by the community organizations.

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

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

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

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

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

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

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

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

While making an appointment to discuss Medicare Advantage (MA) and Part D plans with a potential enrollee, you are asked to describe other types of insurance products that your client might wish to purchase. What additional types of insurance can you present during the MA and Part D marketing appointment?

You can present only health care related lines of business, but must obtain the beneficiary's permission to do so before the presentation occurs and document that you have obtained that permission.

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?

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.

a

You have approached a hospital administrator about marketing in her facility. The administrator is uncomfortable with the suggestion. How could you address her concerns? a. Tell her that Medicare guidelines allow you to conduct marketing activities in common areas of a provider's facility. b. Tell her that if a plan obtains permission from CMS for a marketing event in a provider facility, the event may go forward, regardless of where it occurs in the facility. c. Tell her that Medicare guidelines only allow you to conduct marketing activities in areas of the facility where individuals are waiting to receive health care services, but not in places where they would be receiving health care such as an examining room. d. Tell her that Medicare guidelines allow you to conduct marketing activities anywhere in the facility, so long as the affected providers agree to that event.

a

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. You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. b. You may offer meals to existing enrollees of the plan(s) you represent, but potential enrollees may not have a meal. c. 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. 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.

b

You have set up an appointment for an in-home sales presentation with Mrs. Fernandez, who expressed interest in the Medicare plans you represent. In preparation for the sales presentation, what must you do? a. Seven days prior to the appointment, you must notify the company(s) you represent regarding which products you will be presenting, so they can report the nature of your meeting to the Medicare agency. b. Prior to conducting the presentation, obtain, and document having obtained her permission to visit, along with her interest in the specific products you will present. c. Prior to arriving at her home, request approval from CMS to use special materials that you developed to explain the plan benefits instead of the plan's materials, which you think are confusing. d. At the time you arrive for the appointment, let her know which products you will be going over.

c

You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. The hospital administration expresses some hesitation about allowing marketing in a health care facility. What should you tell them? a. So long as the hospital or its physician staff don't object, marketing anywhere in the hospital is an acceptable practice. b. As long as the marketing activities are conducted in a way that does not target healthy beneficiaries, it does not matter where in the hospital these activities are carried out. c. Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving or waiting to receive health care and as long as the hospital displays materials for all plans that provide them to the hospital. d. Marketing in health care facilities is an acceptable practice, regardless of where it takes place.

a

You market many different types of insurance and ordinarily you spend time each evening calling potential clients. To be in compliance with requirements for marketing Medicare Advantage and Part D plans, what must you do about contacting potential clients to market those plans? a. You will have to avoid calling any potential client, unless he or she initiates contact with you and specifically asks that you give him or her a call. b. Because the Medicare health plans are important federal programs for beneficiaries, federal law regarding the "Do Not Call" registry is waived so you will be able to call and enroll beneficiaries over the telephone. c. As long as you market only health-related products, you can make an initial call to any beneficiary, but then must honor "do not call again" requests. d. You only need to comply with requirements of federal and state "Do Not Call" registries.

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?

You may correct this information as long as you add your initials and date next to the correction

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?

You may correct this information as long as you add your initials and date next to the correction Correct

If you are to be in compliance with Medicare's guidance regarding educational events, which of the following would be acceptable activities?

You may distribute business cards to individuals who request information on how to contact you for further details on the plan(s) you represent

If you are to be in compliance with Medicare's guidance regarding educational events, which of the following would be acceptable activities?

You may distribute business cards to individuals who request information on how to contact you for further details on the plan(s) you represent.

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?

You may go ahead and call them

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?

You may go ahead and call them.

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?

You may go ahead and call them.

Ordinarily, you provide clients who purchase various types of insurance products from you with a gift when they enroll and you let them know that they will receive it after their enrollment is complete. When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan?

You may not provide any gift or prize as an inducement to enroll

Ordinarily, you provide clients who purchase various types of insurance products from you with a gift when they enroll and you let them know that they will receive it after their enrollment is complete. When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan?

You may not provide any gift or prize as an inducement to enroll.

By contacting plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefit package. What should you do to make sure your clients know about these pieces of information?

You may present comparative information that has been created and approved by the Medicare agency (CMS), such as a print-out from the Medicare plan comparison website

By contacting plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefit package. What should you do to make sure your clients know about these pieces of information?

You may present comparative information that has been created and approved by the Medicare agency (CMS), such as a print-out from the Medicare plan comparison website.

When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan?

You may provide gifts or prizes to all potential enrollees during an event that do not exceed $15 in retail value.

Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. She agreed to sign a scope of appointment form and meet with you October 15. During the appointment, what are you permitted to do?

You may provide her with the required enrollment materials and take her completed enrollment application

Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. She agreed to sign a scope of appointment form and meet with you October 15. During the appointment, what are you permitted to do?

You may provide her with the required enrollment materials and take her completed enrollment application.

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?

You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal

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?

You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal.

You are mailing invitations to new Medicare beneficiaries for a marketing event. You want an idea of how many people to expect, so you would like to request RSVPs. What should you keep in mind?

You may request RSVPs, but you are not permitted to require contact information

You are mailing invitations to new Medicare beneficiaries for a marketing event. You want an idea of how many people to expect, so you would like to request RSVPs. What should you keep in mind?

You may request RSVPs, but you are not permitted to require contact information.

When soliciting referrals from current members of an MA or Part D plan, what may you do?

You may request names and mailing addresses.

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

You may send an e-mail to a beneficiary about Medicare Advantage plan information if the beneficiary provides his/her email address to the plan and agrees to receive e-mails from the plan

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

You may send an e-mail to a beneficiary about Medicare Advantage plan information if the beneficiary provides his/her email address to the plan and agrees to receive e-mails from the plan.

Ordinarily, you ask your clients for referrals to people they think would benefit from the products you offer. When selling Medicare Advantage or Part D products, how might you solicit referrals?

You may solicit referrals from current MA and Part D enrollees and offer one thank you gift per member per year of less than $15, based on retail purchase price for the item, although you may not inform enrollees of the availability of the gift in your letter soliciting referrals

Ordinarily, you ask your clients for referrals to people they think would benefit from the products you offer. When selling Medicare Advantage or Part D products, how might you solicit referrals?

You may solicit referrals from current MA and Part D enrollees and offer one thank you gift per member per year of less than $15, based on retail purchase price for the item, although you may not inform enrollees of the availability of the gift in your letter soliciting referrals.

Ordinarily, you ask your clients for referrals to people they think would benefit from the products you offer. When selling Medicare Advantage or Part D products, how might you solicit referrals?

You may solicit referrals from current MA and Part D enrollees and provide one thank you gift per member per year of up to $15, based on retail purchase price for the item, although you may not inform enrollees of the availability of the gift in your letter soliciting referrals.

You are working with a number of plans and community organizations to sponsor an educational event. When putting together advertisements for this event, what should you do?

You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event

You are working with a number of plans and community organizations to sponsor an educational event. When putting together advertisements for this event, what should you do?

You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event.

A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. Before engaging in such a discussion, what should you do?

You must have her sign a scope of appointment form, indicating which products she wishes to discuss, and note on the form that she is a "walk in." You may then proceed with the discussion

A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. Before engaging in such a discussion, what should you do?

You must have her sign a scope of appointment form, indicating which products she wishes to discuss, and note on the form that she is a "walk in." You may then proceed with the discussion.

A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. Before engaging in such a discussion, what should you do?

You must have her sign a scope of appointment form, indicating which products she wishes to discuss. You may then proceed with the discussion

A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. Before engaging in such a discussion, what should you do?

You must have her sign a scope of appointment form, indicating which products she wishes to discuss. You may then proceed with the discussion.

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?

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

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?

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.

You work for a company that has marketed Medigap products for many years. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. What do you need to do with your materials before using them for marketing purposes?

You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate

You work for a company that has marketed Medigap products for many years. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. What do you need to do with your materials before using them for marketing purposes?

You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate.

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?

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

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?

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.

A client wants to give you an enrollment application 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?

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.

You are completing a PFFS plan sale to Mr. Schmidt who is new to Medicare, and as you are finishing up, what should you tell him about next steps in the enrollment process?

You need to get Mr. Schmidt's phone number and include it on the enrollment form because the plan must call him after you leave to ensure that he understood the nature of the PFFS plan he selected and to verify his intent to enroll.

You are completing a PFFS plan sale to Mr. West who is new to Medicare, and as you are finishing up, what should you tell him about next steps in the enrollment process?

You need to get Mr. 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

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

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.

You are completing a PFFS plan sale to Mr. West who is new to Medicare, and as you are finishing up, what should you tell him about next steps in the enrollment process?

You need to get Mr. 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.

a

You plan to participate in an educational event sponsored by a large regional health care system. One of your colleagues suggests that you do a presentation on one of the Medicare Health plans you market, and modify it to include information about preventive screening tests showcased at the event. How should you respond to your colleague's suggestion? a. You should tell your colleague no because participation in an educational event may not include a sales presentation. b. As long as your sales presentation includes information that is about healthy living or clinically effective screening exams, you could talk about the Medicare plans in your presentation. c. Whether or not a sales presentation is allowed at this educational event is entirely up to the sponsor of the event. d. You should tell your colleague no, because marketing representatives are not permitted to participate, in any way, in an educational event.

Next week you will be participating in your first "educational event" for prospective enrollees. In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage?

You should plan to ensure that the educational event is a social event, and must not conduct a sales presentation or distribute or accept enrollment forms at the event

Next week you will be participating in your first "educational event" for prospective enrollees. In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage?

You should plan to ensure that the educational event is a social event, and must not conduct a sales presentation or distribute or accept enrollment forms at the event.

Next week you will be participating in your first "educational event." In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage?

You should plan to ensure that the educational event is a social event, and must not conduct a sales presentation or distribute or accept enrollment forms at the event.

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

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

You plan to participate in an educational event sponsored by a large regional health care system. One of your colleagues suggests that you do a presentation on one of the Medicare Health plans you market, and modify it to include information about preventive screening tests showcased at the event. How should you respond to your colleague's suggestion?

You should tell your colleague no, because marketing representatives are not permitted to participate, in any way, in an educational event.

b

You will be holding a sales event in the near future, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation? Choose one answer. a. Gifts worth more than $15 but based on anticipated attendance will not exceed $15 per attendee. b. Gift cards or gift certificates of $15 or less that can be readily converted to cash. c. Gifts of nominal retail value ($15 or less) d. Two or more gifts whose combined value does not exceed $15.

You market many different types of insurance and ordinarily you spend time each evening calling potential clients. To be in compliance with requirements for marketing Medicare Advantage and Part D plans, what must you do about contacting potential clients to market those plans?

You will have to avoid calling any potential client, unless he or she initiates contact with you and specifically asks that you give him or her a call

You market many different types of insurance and ordinarily you spend time each evening calling potential clients. To be in compliance with requirements for marketing Medicare Advantage and Part D plans, what must you do about contacting potential clients to market those plans?

You will have to avoid calling any potential client, unless he or she initiates contact with you and specifically asks that you give him or her a call.

You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. You have completed the required training for each plan, but you did not achieve a passing score on the tests that came after the training. What can you do in this situation?

You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score, although you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing.

c

You work for a company that has marketed Medigap products for many years. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. What do you need to do with your materials before using them for marketing purposes? a. Only scripts and marketing practices must be approved by CMS, so you do not need to do anything further with your marketing materials, as long as you make them available to anyone who attends the marketing event b. You do not need to get CMS approval of the materials, so long as the materials are not misleading or materially inaccurate. c. You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate. d. You need to include a statement that the plans you are marketing are approved by the Centers for Medicare & Medicaid Services and the Department of Health and Human Services.

c

You would like to market an MA plan at a neighborhood pharmacy. What should you keep in mind to comply with the marketing requirements for MA plans? a. You may not market in a pharmacy if you are not a pharmacist or do not have the pharmacist's permission. b. You must set up your table and make marketing presentations only in common areas, but you may accept enrollment applications anywhere in the pharmacy. c. 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. d. You must set up your table, make marketing presentations, and accept enrollment applications near the pharmacy counter where people wait for their prescriptions.

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?

You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PFFS plan's service area

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?

You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PFFS plan's service area.

c

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 employed by the plans are exempt from training and testing requirements. b. You could tell her she is right and ask if you could get a contract with the TMO too. c. 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. d. 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.

Another agent working for your agency claims that because you are not employed by the Medicare Advantage plans that you represent, you are not subject to the same requirements as the plans themselves. How should you respond to such a statement?

Your coworker is not correct. Marketing on behalf of a plan is considered marketing by the plan and requires that all contracted and employed agents comply with all Medicare marketing rules

Another agent working for your agency claims that because you are not employed by the Medicare Advantage plans that you represent, you are not subject to the same requirements as the plans themselves. How should you respond to such a statement?

Your coworker is not correct. Marketing on behalf of a plan is considered marketing by the plan and requires that all contracted and employed agents comply with all Medicare marketing rules.

You work for a company that has marketed Medigap products for many years. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. What do you need to do with your materials before using them for marketing purposes?

Your coworker is not correct. Marketing on behalf of a plan is considered marketing by the plan and requires that all contracted and employed agents comply with all Medicare marketing rules.

a

Your friend's mother just moved to an assisted living facility and he asked if you could present a program for the residents about the MA-PD plans you market. What could you tell him? a. You appreciate the opportunity and would be happy to schedule an appointment with anyone at their request. b. You appreciate the opportunity and would ask the facility to provide enrollment applications for the MA-PD plans you represent. c. You appreciate the opportunity and will ask the facility to provide a plan brochure and enrollment application in every resident's room prior to the meeting to promote interest in the event. d. You appreciate the opportunity and would just need to complete scope of appointment forms on behalf of all the residents who would like to attend.

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

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

Agent Higgins helps Mrs. O'Malley to enroll in AB Medicare Advantage (MA) plan during the Annual Open Enrollment Period. Mrs. O'Malley's effective enrollment date is January 1st. Subsequently, Mrs. O'Malley disenrolls on February 12th following a move outside the plan's service area. What impact will this have on Agent Higgins compensation?

a. AB MA plan does not have to recoup Agent Higgins' compensation because she has moved away from its service area. Correct

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. Correct

Agent Antonio is preparing for a presentation on Medicare and Medicare Advantage before a local senior citizen civic group where he hopes to enroll some attendees. Which of the following steps should he take in order to be in compliance with Medicare marketing rules?

a. Antonio should include on the invitation a statement that a salesperson will be present with information and applications. Correct

Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you to come to their home to clear up a few questions. During the presentation, Mrs. Nunez feels tired and tells you that her husband can finish things up. She goes to bed. At the end of your discussion, Mr. Nunez says that he wants to enroll both himself and his wife. What should you do?

a. As long as she is able to do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will have to wake up to sign her form or do so at another time. Correct

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

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

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

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

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

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

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. C-SNP Correct

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

a. During the MA Open Enrollment Period, from January 1 - March 31, she may disenroll from the MA-PD plan into Original Medicare and also may add a stand-alone prescription drug plan. Correct

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

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

ABC is a long-term care facility provider. What steps may it take to inform residents of the Medicare options available to them?

b. ABC may provide residents that meet the I-SNP criteria an explanatory brochure, reply card, and phone number for additional information for each I-SNP with which it contracts. Correct

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

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

You will be holding a sales event in the near future, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation?

a. Gift cards or gift certificates of $15 or less that can be readily converted to cash. Correct

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

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

Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. What should you tell him?

a. He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means obtain the medications they need. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. Correct

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

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

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?

a. He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Correct

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

a. He may receive 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. Correct

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

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

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

a. He will incur a late enrollment penalty. Correct

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

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

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

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

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

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

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

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

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

a. 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. Correct

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

a. In most Medicare Advantage HMOs, Mr. Kumar must obtain his services only from providers who have a contractual relationship with the plan (except in an emergency). Correct

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

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

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

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

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

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

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

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

You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. The hospital administration expresses some hesitation about allowing marketing in a health care facility. What should you tell them?

a. Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving or waiting to receive health care and as long as the hospital displays materials for all plans that provide them to the hospital. Correct

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

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

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

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

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

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

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

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

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. 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. Correct

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

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

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

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

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

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

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

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

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

Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxes during that entire period. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. What should you tell her? Choose one answer. a. Most individuals who are citizens and over age 65 are covered under Part A by virtue of having paid Medicare taxes while working, though some may be covered as a result of paying monthly premiums. b. Most individuals who are citizens and over age 65 and wish to be covered under Part A must enroll in a Medicare Health Plan. c. Most individuals who are citizens and over age 65 and are covered under Part A must pay a monthly premium for that coverage. d. All individuals who are citizens and over age 65 will be covered under Part A.

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.

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

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

Mr. Shultz was still working when he first qualified for Medicare. At that time, he had employer group coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. It is now a year later and Mr. Shultz has lost his employer group coverage. How would you advise him?

a. Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty. Correct

Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Where might he turn for help with his prescription drug costs?

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

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

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

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

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

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

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

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

a. Original Medicare covers ambulance services.

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

a. Original Medicare covers ambulance services. Correct

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

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

Mrs. Grant uses several very expensive drugs and anticipates that she will enter catastrophic coverage at some point during the year. To help her determine when she is likely to qualify for catastrophic coverage, she asked which expenses count toward the out-of-pocket limit that qualifies her for catastrophic coverage. Which one of the following would count?

a. Prescription drugs she purchases when in the Part D coverage gap. Correct

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

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

Mrs. Fiore was in the Army for 35 years and is now retired. She has drug coverage through the VA. What issues might she consider with regard to whether to enroll in a Medicare prescription drug plan?

a. She could compare the coverage to see if the Medicare Part D plan offers better benefits and coverage than the VA for the specific medications she needs and whether any additional benefits are worth the Part D premium costs. Correct

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?

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

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

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

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

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

You are meeting with Mrs. Hall in her home. On her scope of appointment form she asked to discuss Medicare Advantage plans. During the meeting, she asks to discuss a stand-alone prescription drug plan. She is leaving the next day to visit her family for a week in another state, so it is important to her to make a decision before she leaves. What must happen before that additional discussion can take place?

a. Since Mrs. Hall specifically asked that you discuss the stand-alone Part D plan, you may do so, as long as she signs a new scope of appointment form first, indicating that she wants to discuss the Part D plan. Correct

During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a 5-star rating in customer service and care coordination, and received an overall plan performance rating of a 4-star, which of the following would be the correct statement to say to her?

a. The Medicare Advantage plan received a 5-star rating in customer service and care coordination with an overall performance rating of 4-stars. Correct

Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the time to fill out the paperwork. What could you tell her?

a. The Part D low income subsidy could substantially lower her overall costs. She can apply by contacting her state Medicaid office, or calling the Social Security Administration. Correct

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. Correct

Mr. Shapiro gets by on a very small fixed income. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know whether he might qualify. What should you tell him?

a. The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. Correct

Ajax Agency is targeting potential enrollees for MSA plans. Which of the following statements best describes the rules that apply to the MSA materials it distributes?

a. The materials must make clear that Medicare MSA plans do not cover prescription drugs and that beneficiaries can join a separate Part D prescription drug plan. Correct

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

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

One of your colleagues argues that it is better to focus your time and energy exclusively in neighborhoods with single family homes. He further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. How should you respond?

a. This could be considered discriminatory activity and a prohibited practice. Correct

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

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

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

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. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan?

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

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?

a. You may go ahead and call them. Correct

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. You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. Correct

When soliciting referrals from current members of an MA or Part D plan, what may you do?

a. You may request names and mailing addresses. Correct

Next week you will be participating in your first "educational event" for prospective enrollees. In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage?

a. You should plan to ensure that the educational event is a social event, and must not conduct a sales presentation or distribute or accept enrollment forms at the event. Correct

You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. You have completed the required training for each plan, but you did not achieve a passing score on the tests that came after the training. What can you do in this situation?

a. You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score, although you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing. Correct

Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS) plan. What questions would you need to ask to determine his eligibility?

a. You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PFFS plan's service area. Correct

Section 1557 of the Affordable Care Act applies to

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

Which of the following statements best describes how business reply cards (BRCs) may be employed in the marketing of Medicare Advantage products?

b. A BRC may be used to document a beneficiary's scope of appointment agreement provided it has been submitted to CMS for approval and includes a statement informing the beneficiary that a salesperson may call. Correct

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?

b. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. Correct

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?

b. 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. Correct

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

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

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?

b. C-SNP Correct

BestCare Health Plan has received a request from a state insurance department in connection with the investigation of several marketing representatives licensed by the state who sell Medicare Advantage plans. What action(s) should BestCare take in response?

b. Cooperate with the state and supply requested information. Correct

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

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

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

b. During the MA Disenrollment Period, from January 1 - March 31, she may disenroll from the MA-PD plan into Original Medicare and also may add a stand-alone prescription drug plan. Correct

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?

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

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

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

Wendy Park becomes eligible for Medicare for the first time in July. With the help of Agent James Chan, she enrolls in FeelBetter Medicare Advantage plan with an effective date of July 1st. Which statement best describes how Agent Chan may be compensated under CMS rules?

b. FeelBetter will pay Agent Chan initial year compensation for the months July through December. Renewal amounts will be paid starting in January if Ms. Park remains enrolled the following year. Correct

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

b. He can enroll in or disenroll from a Part D plan at any time and the subsidy will apply to the plan he chooses. Correct

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

b. 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. Correct

Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. What should you tell him?

b. He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means obtain the medications they need. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. Correct

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

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

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

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

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

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

Mr. Sanchez is entitled to Part A, but has not enrolled in Part B because he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do?

b. He will have to enroll in Part B. Correct

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

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

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

b. I, II and III only Correct

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

b. I, II, and III only Correct

Monica is an agent focused on serving seniors eligible for Medicare. As she reviews her records, she is trying to determine which of the following items are considered compensation. What do you tell her? I. Commissions II. Bonuses III. Mileage reimbursement IV. Referral fees

b. I, II, and IV only Correct

Which of the following statement is correct about Medicare Savings Account (MSA) Plans? I. MSAs may have not have a network or may have a full or partial network of providers. II. MSA plans must cover preventive services that have no cost sharing before the enrollee has met the deductible. III. An individual who is eligible for health care benefits through the Veteran's Administration may enroll in an MSA. IV. Non-network providers must accept the same amount that Original Medicare would pay them as payment in full.

b. I, II, and IV only Correct

Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. In setting up the enrollment site, which of the following must Phiona consider? I. If a legal representative is completing an electronic enrollment request, he or she must first upload proof of his or her authority. II. All data elements required to complete an enrollment request must be captured. III. The process must include a clear and distinct step that requires the applicant to activate an "Enroll Now" or "I Agree" type of button or tool. IV. The mechanism must capture an accurate time and date stamp at the time the applicant enters the online site.

b. II and III only Correct

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

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

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

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, her premium will be permanently increased by 1% of the national average premium for every month that she was not covered. Correct

Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this?

b. If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account, Mrs. Berkowitz can do this. Correct

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

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

Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to purchase extra coverage that he will not need. What should you tell him?

b. If the drug coverage he has is not expected to pay, on average, at least as much as Medicare's standard Part D coverage expects to pay, then he will need to enroll in Medicare Part D during his initial eligibility period to avoid the late enrollment penalty. Correct

Which statement best describes PACE plans?

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

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

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

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?

b. 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. Correct

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

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

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

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

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?

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

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?

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

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?

b. 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.

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?

b. 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. Correct

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

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

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

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

Mr. Shultz was still working when he first qualified for Medicare. At that time, he had employer group coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. It is now a year later and Mr. Shultz has lost his employer group coverage. How would you advise him?

b. Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty. Correct

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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?

b. 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. Correct

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

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

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

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

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

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

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

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

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

b. Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. Correct

Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the time to fill out the paperwork. What could you tell her?

b. The Part D low income subsidy could substantially lower her overall costs. She can apply by contacting her state Medicaid office, or calling the Social Security Administration. Correct

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?

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

Mr. Shapiro gets by on a very small fixed income. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know whether he might qualify. What should you tell him?

b. The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. Correct

ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' protected health information to market non-health related products such as life insurance and annuities. To do so it must obtain authorization from the enrollees. Which statement best describes the authorization process?

b. The request for authorization may include a brief synopsis of non-health related content. Incorrect

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

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

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

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

Mrs. McIntire is enrolled in her state's Medicaid plan and has just become eligible for Medicare as well. What can she expect will happen with respect to her drug coverage?

b. Unless she chooses a Medicare Part D prescription drug plan on her own, she will be automatically enrolled in one available in her area. Correct

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?

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. Correct

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. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan?

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

Your friend's mother just moved to an assisted living facility and he asked if you could present a program for the residents about the MA-PD plans you market. What could you tell him?

b. You appreciate the opportunity and would be happy to schedule an appointment with anyone at their request. Correct

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

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

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

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

If you are to be in compliance with Medicare's guidance regarding educational events, which of the following would be acceptable activities?

b. You may distribute business cards to individuals who request information on how to contact you for further details on the plan(s) you represent. Correct

Ordinarily, you provide clients who purchase various types of insurance products from you with a gift when they enroll and you let them know that they will receive it after their enrollment is complete. When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan?

b. You may not provide any gift or prize as an inducement to enroll. Correct

By contacting plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefit package. What should you do to make sure your clients know about these pieces of information?

b. You may present comparative information that has been created and approved by the Medicare agency (CMS), such as a print-out from the Medicare plan comparison website. Correct

You work for a company that has marketed Medigap products for many years. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. What do you need to do with your materials before using them for marketing purposes?

b. You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate. Correct

You are doing a sales presentation for Mrs. Pearson. You know that the Medicare marketing guidelines prohibit certain types of statements. Apply those guidelines to the following statements and identify which would be prohibited.

c. "If you're not in very good health, you will probably do better with a different product." Correct

Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for-Service (PFFS) plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts consider before selecting a PFFS plan?

c. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D prescription drug coverage, a PFFS plan offering only medical benefits, or a PFFS plan in combination with a stand-alone prescription drug plan. Correct

Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a website marketing the MA plans with which it has contracts. Agent Armstrong follows up with individuals who request more information about ABC MA plans via the website and tries to persuade them to enroll in ABC plans. What statement best describes the marketing and compliance rules that apply to Agent Armstrong?

c. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. Correct

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

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

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?

c. 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. Correct

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

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

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

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

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

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

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

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

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

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

Mr. Gonzalez is entitled to Part A, but has not yet enrolled in Part B. If he wants to enroll in a Private Fee-for-Service (PFFS) plan, what will he have to do?

c. He will have to enroll in Part B prior to enrolling in the PFFS plan. Correct

Mr. Sanchez is entitled to Part A, but has not enrolled in Part B because he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do?

c. He will have to enroll in Part B. Correct

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?

c. He will incur a late enrollment penalty.

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

c. I, II and III only Correct

Which of the following statement is correct about Medicare Savings Account (MSA) Plans? I. MSAs may have not have a network or may have a full or partial network of providers. II. MSA plans must cover preventive services that have no cost sharing before the enrollee has met the deductible. III. An individual who is eligible for health care benefits through the Veteran's Administration may enroll in an MSA. IV. Non-network providers must accept the same amount that Original Medicare would pay them as payment in full.

c. I, II, and IV only Correct

Which of the following individuals are likely to qualify for a special enrollment period (SEP) for both MA and Part D due to a change of residence? I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area. II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service area. III. Gilbert moves into a plan service area where there is no Part D plan available. IV. Henry makes a permanent move providing him with new MA and Part D options.

c. II, III, and IV only

Which of the following individuals are likely to qualify for a special enrollment period (SEP) for both MA and Part D due to a change of residence? I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area. II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service area. III. Gilbert moves into a plan service area where there is now a Part D plan available to him from a service area where no Part D plan was available. IV. Henry makes a permanent move providing him with new MA and Part D options.

c. II, III, and IV only Correct

Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug coverage. He found a stand-alone Medicare prescription drug plan in his area that offers better coverage than that available through his MA-PD plan and in addition has a low premium. It won't cost him much more and, because he has the means to do so, he wishes to enroll in the stand-alone prescription drug plan in addition to his MA-PD plan. What should you tell him?

c. If Mr. Block enrolls in the stand-alone Medicare prescription drug plan, he will be disenrolled from the Medicare Advantage plan. Correct

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?

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. Correct

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

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

Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this?

c. If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account, Mrs. Berkowitz can do this. Correct

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

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

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?

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

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

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

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

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

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

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

Plan sponsors may undertake the following marketing activities with current Medicare Advantage plan members?

c. Market non-Medicare health-related products, such as dental insurance, to current members as permitted by HIPAA Privacy Rules. Correct

Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. What should you tell her?

c. Marketing representatives may initiate electronic contact through e-mail but the subject line must say "marketing" and an opt-out process must be provided. Correct

Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for Medicare & Medicaid Services' Marketing Guidelines to ensure he is compliant for which type of products?

c. Medicare Advantage (MA) and Prescription Drug (PDP) plans Correct

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

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

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

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

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

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

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

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

You are visiting with Mr. Tully and his daughter at her request. He has advanced Alzheimer's and is incapable of understanding the implications of choosing a Medicare Advantage or prescription drug plan. Can his daughter fill out the enrollment form and sign it for him?

c. Mr. Tully's daughter can do so only, if she is authorized under state law as a court-appointed legal guardian, has durable power of attorney for health care decisions, or is authorized under state surrogate consent laws to make health decisions. Correct

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

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

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

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

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

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

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

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

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

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

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

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

You have set up an appointment for an in-home sales presentation with Mrs. Fernandez, who expressed interest in the Medicare plans you represent. In preparation for the sales presentation, what must you do?

c. Prior to conducting the presentation, obtain, and document having obtained her permission to visit, along with her interest in the specific products you will present. Correct

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

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

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

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

Mrs. Fiore was in the Army for 35 years and is now retired. She has drug coverage through the VA. What issues might she consider with regard to whether to enroll in a Medicare prescription drug plan?

c. She could compare the coverage to see if the Medicare Part D plan offers better benefits and coverage than the VA for the specific medications she needs and whether any additional benefits are worth the Part D premium costs. Correct

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

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

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

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

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

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

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

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

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

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

During a sales presentation, your client asks you whether the Medicare agency recommends that she sign up for your plan or stay in Original Medicare. What should you tell her?

c. Tell her that the Medicare agency does not endorse or recommend any plan. Correct

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

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

You are doing a sales presentation for Mrs. Pearson. You know that the Medicare marketing guidelines prohibit certain types of statements. Apply those guidelines to the following statements and identify which would be prohibited.

d. "If you're not in very good health, you will probably do better with a different product." Correct

Ordinarily, you obtain referrals from a third-party that initiates contact with potential clients and usually sets up appointments for you. How would the guidelines for marketing Medicare Advantage and Part D plans apply to this practice?

c. Third parties may not make unsolicited calls, visits, or emails to Medicare beneficiaries in order to set up such appointments, or for any other reason related to the marketing of Medicare Advantage or Part D plans. Correct

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

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

Mrs. McIntire is enrolled in her state's Medicaid plan and has just become eligible for Medicare as well. What can she expect will happen with respect to her drug coverage?

c. Unless she chooses a Medicare Part D prescription drug plan on her own, she will be automatically enrolled in one available in her area. Correct

Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to?

c. Yes. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. Correct

Agent Mary Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings distributes materials that are solely educational in nature. However, she gives a brief presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that has been advertised as educational?

c. Yes. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. Correct

While making an appointment to discuss Medicare Advantage (MA) and Part D plans with a potential enrollee, you are asked to describe other types of insurance products that your client might wish to purchase. What additional types of insurance can you present during the MA and Part D marketing appointment?

c. You can present only health care related lines of business, but must obtain the beneficiary's permission to do so before the presentation occurs and document that you have obtained that permission. Correct

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?

c. You may correct this information as long as you add your initials and date next to the correction Correct

Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. She agreed to sign a scope of appointment form and meet with you October 15. During the appointment, what are you permitted to do?

c. You may provide her with the required enrollment materials and take her completed enrollment application. Correct

You are working with a number of plans and community organizations to sponsor an educational event. When putting together advertisements for this event, what should you do?

c. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. Correct

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?

c. 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. Correct

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?

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. Correct

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

c. 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. Correct

You plan to participate in an educational event sponsored by a large regional health care system. One of your colleagues suggests that you do a presentation on one of the Medicare Health plans you market, and modify it to include information about preventive screening tests showcased at the event. How should you respond to your colleague's suggestion?

c. You should tell your colleague no because participation in an educational event may not include a sales presentation. Correct

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?

c. You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PFFS plan's service area. Correct

Another agent working for your agency claims that because you are not employed by the Medicare Advantage plans that you represent, you are not subject to the same requirements as the plans themselves. How should you respond to such a statement?

c. Your coworker is not correct. Marketing on behalf of a plan is considered marketing by the plan and requires that all contracted and employed agents comply with all Medicare marketing rules. Correct

Under ACA Section 1557, a person

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

Under ACA Section 1557, a health plan

cannot deny coverage to LEP individuals and is required to provide language assistance to them, free of charge.

Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for-Service (PFFS) plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts consider before selecting a PFFS plan?

d. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D prescription drug coverage, a PFFS plan offering only medical benefits, or a PFFS plan in combination with a stand-alone prescription drug plan. Correct

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

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

Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you to come to their home to clear up a few questions. During the presentation, Mrs. Nunez feels tired and tells you that her husband can finish things up. She goes to bed. At the end of your discussion, Mr. Nunez says that he wants to enroll both himself and his wife. What should you do?

d. As long as she is able to do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will have to wake up to sign her form or do so at another time. Correct

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

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

Alice is a marketing representative employed by a health plan. Betty is a captive agent of a health plan who markets to multiple plans and sponsors. Carl is a captive agent who markets to only one plan/sponsor. Denise is an independent agent who markets to different types of groups. Edward is an independent agent who markets only to employer and union groups. CMS marketing representative compensation rules generally apply to:

d. Betty and Denise, but not Alice (the employee) or Carl or Edward (to whom exceptions apply). Correct

Medicare health plans establish provisions in marketing representative contracts to ensure compliance with applicable laws and policies. If non-compliance occurs, CMS can penalize a plan in which of the following ways?

d. CMS requires plan sponsors to create and complete a corrective action plan and may terminate a sponsor's contract. Correct

You are scheduled to give a sales presentation at a local senior center. At the beginning of the presentation, which of the following must you do?

d. Clearly state that no obligation exists to enroll if a gift or prize is being offered. Correct

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?

d. 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. Correct

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?

d. 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. Correct

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?

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. Correct

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

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

Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled a marketing event and expects about 40 people to attend. He has hired a magician at a cost of $200 to entertain attendees. Can he do this in a way that complies with guidance from the Medicare agency?

d. He can do this, because the estimated number of attendees is based on the venue size and response rate and the value of the gift does not exceed $15. Correct

Several agents you work with are planning sales events in your area. One plans on giving door prizes worth $5, refreshments valued at $8 per anticipated attendee, and coupon books with discounts worth $10. Since no gift or prize exceeds the $15 limit he believes his plan is acceptable. What should you tell them

d. He can give away more than one gift during a single event, but the aggregate retail value cannot exceed $15 Correct

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

d. 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. Correct

Mr. Gonzalez is entitled to Part A, but has not yet enrolled in Part B. If he wants to enroll in a Private Fee-for-Service (PFFS) plan, what will he have to do?

d. He will have to enroll in Part B prior to enrolling in the PFFS plan. Correct

Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. In setting up the enrollment site, which of the following must Phiona consider? I. If a legal representative is completing an electronic enrollment request, he or she must first upload proof of his or her authority. II. All data elements required to complete an enrollment request must be captured. III. The process must include a clear and distinct step that requires the applicant to activate an "Enroll Now" or "I Agree" type of button or tool. IV. The mechanism must capture an accurate time and date stamp at the time the applicant enters the online site.

d. II and III only Correct

Which of the following individuals are likely to qualify for a special enrollment period (SEP) for both MA and Part D due to a change of residence? I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area. II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service area. III. Gilbert moves into a plan service area where there is now a Part D plan available to him from a service area where no Part D plan was available. IV. Henry makes a permanent move providing him with new MA and Part D options.

d. II, III, and IV only Correct

Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug coverage. He found a stand-alone Medicare prescription drug plan in his area that offers better coverage than that available through his MA-PD plan and in addition has a low premium. It won't cost him much more and, because he has the means to do so, he wishes to enroll in the stand-alone prescription drug plan in addition to his MA-PD plan. What should you tell him?

d. If Mr. Block enrolls in the stand-alone Medicare prescription drug plan, he will be disenrolled from the Medicare Advantage plan. Correct

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?

d. 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. Correct

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

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

Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to purchase extra coverage that he will not need. What should you tell him?

d. If the drug coverage he has is not expected to pay, on average, at least as much as Medicare's standard Part D coverage expects to pay, then he will need to enroll in Medicare Part D during his initial eligibility period to avoid the late enrollment penalty. Correct

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

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

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

d. 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. Correct

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?

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

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

d. In most Medicare Advantage HMOs, Mr. Kumar must obtain his services only from providers who have a contractual relationship with the plan (except in an emergency). Correct

Agent Harriet Walker has recently begun marketing Medicare Advantage and related products aimed at meeting the needs of senior citizens. Client Mildred Jones has expressed interest in a Medicare Advantage plan. It is now the beginning of September. If you were in Agent Walker's position, what would you do?

d. Inquire whether the client qualifies for a special enrollment period, and if not, solicit an enrollment application once the annual open enrollment election period begins on October 15th. Correct

Which statement best describes PACE plans?

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

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

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

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

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

Mr. Valesquez asked if the Private Fee-for-Service plan you have discussed is like Original Medicare or a Medigap supplement plan. What should you say about a Private Fee-for-Service (PFFS) plan to explain it to Mr. Valesquez?

d. It is not Original Medicare and it works differently than a Medicare supplement plan. Correct

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

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

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

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

Which of the following individuals is most likely to be eligible to enroll in a Medicare Advantage or Part D Plan?

d. Jose, a grandfather who was granted asylum and has worked in the United States for many years. Correct

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

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

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

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

Which of the following is a correct statement about state laws as they pertain to marketing representatives?

d. Medicare health plans must comply with requests for information from state insurance departments investigating complaints about a marketing representative. Correct

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

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

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

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

You are visiting with Mr. Tully and his daughter at her request. He has advanced Alzheimer's and is incapable of understanding the implications of choosing a Medicare Advantage or prescription drug plan. Can his daughter fill out the enrollment form and sign it for him?

d. Mr. Tully's daughter can do so only, if she is authorized under state law as a court-appointed legal guardian, has durable power of attorney for health care decisions, or is authorized under state surrogate consent laws to make health decisions. Correct

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?

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. Correct

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

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

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

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

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

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

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?

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. Correct

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You have approached a hospital administrator about marketing in her facility. The administrator is uncomfortable with the suggestion. How could you address her concerns?

d. Tell her that Medicare guidelines allow you to conduct marketing activities in common areas of a provider's facility. Correct

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

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

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

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

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?

d. The neighbors may not provide a meal, but light snacks would be permitted. Correct

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?

d. The plan may withhold commission, require retraining, report the misconduct to a state department of insurance or terminate the contract. Correct

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

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

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

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

Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to?

d. Yes. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. Correct

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

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

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?

d. 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. Correct

Ordinarily, you provide clients who purchase various types of insurance products from you with a gift when they enroll and you let them know that they will receive it after their enrollment is complete. When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan?

d. You may not provide any gift or prize as an inducement to enroll. Correct

You are mailing invitations to new Medicare beneficiaries for a marketing event. You want an idea of how many people to expect, so you would like to request RSVPs. What should you keep in mind?

d. You may request RSVPs, but you are not permitted to require contact information. Correct

Ordinarily, you ask your clients for referrals to people they think would benefit from the products you offer. When selling Medicare Advantage or Part D products, how might you solicit referrals?

d. You may solicit referrals from current MA and Part D enrollees and offer one thank you gift per member per year of less than $15, based on retail purchase price for the item, although you may not inform enrollees of the availability of the gift in your letter soliciting referrals. Correct

A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. Before engaging in such a discussion, what should you do?

d. You must have her sign a scope of appointment form, indicating which products she wishes to discuss. You may then proceed with the discussion. Correct

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?

d. 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. Correct

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

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. Correct

You market many different types of insurance and ordinarily you spend time each evening calling potential clients. To be in compliance with requirements for marketing Medicare Advantage and Part D plans, what must you do about contacting potential clients to market those plans?

d. You will have to avoid calling any potential client, unless he or she initiates contact with you and specifically asks that you give him or her a call. Correct

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

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

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?

ll 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.

You are mailing invitations to new Medicare beneficiaries for a marketing event. You want an idea of how many people to expect, so you would like to request RSVPs. What should you keep in mind?

ou may request RSVPs, but you are not permitted to require contact information.

different ways to get medicare: Pace plans

programs for-All inclusive care for the Elderly (Pace) is a medicare and medicaid program offered in many states that allows people who otherwise need a nursing home level of care to remain in the community. To qualify an individual must meet these conditions: •Be age 55 or older •live in the service area of a pace organization •Be certified by the state as needing a nursing home level of care. •At the time the individual joins, he or sheis able to live safely in the community with the help of pace services.

If a health plan violates ACA Section 1557 nondiscrimination protections, it may be

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

Under ACA Section 1557, sex discrimination includes a person's

sex, pregnancy, sex stereotypes, or gender identity

By contacting plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefit package. What should you do to make sure your clients know about these pieces of information?

you may make comparisons between plans if you can support them by studies or statistical data and such comparisons are factually based

different way to get medicare, countinued: medicare-Medicaid plans

•Medicare-Medicaid plans serve individuals eligible for both medicare and medicade. •The individuals are sometimes referred to as duel-eligible. •Medicare-Medicaid plans also include part D perscription drug coverage.