Medicare - study questions

46. 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.

67. 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.

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.

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.

53. 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.

11. 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 and 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 standalone Medicare prescription drug plan what should you tell him about the situation

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

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. 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.

119. Mr. Wendt suffers from diabetes which has gotten progressively worse during the last year he is currently in rolled in original Medicare part a and B and a part D prescription program 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 enrollment period. AEP before enrolling in such a plan what should you tell him

If there is a special-needs plan SNP and Mr Wendt's area Specializes in caring for individuals of diabetes he may enroll in the SNP at any time under a special enrollment period.

28. 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.

159. 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.

Miss Gomez has original Medicare and a PDP but has been considering enrolling in a M a plan it is due five months before the annual election.. However she lives within the service area of super MA Plan Which has a five star rating

Miss Gomez may use the five star SEP special enrollment period to enroll in super MA plan before annual election. Period

206. Ms. Tedeschi Is enrolled in a SNP for individuals with diabetes. Ms Tedeschi has undergone gastric bypass and lost 125 pounds the weight-loss has resolved her diabetes

Miss Tedeschi will have a special enrollment period SEP to enroll in another MAPD because she no longer meets eligibility requirements for enrollment in her SNP

45. Mr. Wu is eligible for Medicare he has limited financial resources but failed to qualify for the part D low income subsidy where my he turn for help with his prescription drug cost

Mr. Wu may still qualify for help in paying part D cost through his state pharmaceutical assistance program

Mr. Young is interested in switching to a PFFS plan because his primary care physician PCP no longer participates in his HMO his PCP is not in the PFFS plans network

Mr. Young should call his PCP before he enrolls to make sure she is willing to see patients enrolled in the PFFS plan

42. Mrs. Parks is an elderly with Tyrie she has a low fixed income what could you tell Mrs. Park that might be of assistance

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

Mrs. Disraeli is in rolled in original Medicare part 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 all so recently learned that her Area is served by a SNP for individuals suffering from such a combination of chronic diseases CSNP Mrs. Disraeli is concerned however that she will have a few rights for protections if she enrolls in a CSNP How would you respond

Enrollees in SNP's must have access to provider networks that include enough doctors Specialist and Hospitals to provide all covered services necessary to meet enrollees needs within reasonable travel time

37. What impact if any will the Medicare access and chip re-authorization 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

An agent assistant Ms. Spalding in enrolling in Medicare advantage plan during the annual enrollment period for affective date is January 1. On February 10. Ms Spaulding disenrolls Because she did not understand that the plan did not cover services furnished by non-network providers

The plan must recoup all commission payments paid to the agent for Ms. Spalding's enrollment

Mrs. J turn 65 in August and is eligible for Medicare for the first time. And Aging helped her in rolled in a MAPD with a September 1 effective date

The plan will pay the agent in initial year compensation amount depending on its contract with the agent the plan may choose to pay for the entire year if she remains in rolled for the contract year or for only September through December for months

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 the prior approval because it does not include information about the plans benefit structures cost sharing more information about measures or ranking standards

137. Mrs. Stuart Has heard about a special-needs plan SNP that one of her friends is in rolled in and is interested in the product she wants to be sure she also has coverage for prescription drugs would should she be able to obtain Drug coverage if she enrolled in the SNP

Yes all SNP's are required to provide party coverage for prescription drugs

17. Mr. Rivera has QMB-Plus 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 States Medicaid program

65. Mr. Shapiro get by on a very small amount of fixed income he has heard there may be extra help paying for part D prescription drugs for Medicare beneficiaries with limited income he wants to know whether he might qualify what should you tell him

The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government

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

127. 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 offering only medical benefits, or a PFFS plan in combination with a stand-alone Prescription drug plan

Mr. Moreno invited his neighbor agent Tom Smith to discuss Medicare advantage MA and part D plans that agent Smith sells at the regular Tuesday brunch the neighbors have for senior citizens. What should agent Tom Smith tell Mr. Moreno about the kinds of foods that can be Provided to potential enrollees who attend the sales presentation

A meal cannot be provided but light snacks would be permitted

36. 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.

Agent Higgins Helps Mrs. O'Malley to enroll in AB Medicare advantage MA plan during the annual enrollment. Mrs. O'Malley effective enrollment date is January 1 subsequently Mrs. O'Malley disenrolled on February 12 following a move outside the plan service area what impact will this have an agent Higgins compensation

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

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 king has a cousin who is a nurse at a local hospital Agent King has asked his cousin to give his card to her patients when she checks in on them in their hospital rounds and encourage them to call him about their Medicare options

Agent King and his cousin will be violating the prohibition against marketing were a beneficiary receives care

Mr. Travis call's agent Watson because he has questions about all the extra benefits Medicare advantage plans may offer and he's thinking about switching from his Medigap plan

Agent Watson discusses the range of supplemental benefits offered by superior care eight plan he represents and furnish is Mr. Travis with a summary of benefits by discussing benefits and promoting enrollment in superior care agent Watson is marketing

Agent King is employed by an agency under contract with Health Max Health Plans in Medicare Advantage organization that offers plans in multiple states. The agency maintains a website marketing the Medicare advantage plans with which it has contracts

Agent king follows up with individuals who request more information about Health Max via the agencies website and tries to persuade them to enroll in Health Max Agent King is a marketing representative of Health Max. Thus he must be licensed and appointed in every state in which beneficiaries to whom he makes market calls for Health Max markets he may not submit enrollment applications or receive commissions for enrollees residing in states in which he is not licensed and appointed

190. Agent Cooper has a face-to-face meeting with Miss Ford Miss Ford indicates that she wants to talk to his son before moving from original Medicare to a Medicare advantage plan

Aging Cooper explains that her son will be proud that she's made the choice on her own and asked Miss Ford whether she trusted agent Cooper continues to encourage her to enroll doing their meeting and tell her son afterwards ( prohibitive practice- high pressure sales)

Agent Jackson sells life insurance in addition to MA plans Agent Jackson makes Cold calls to beneficiaries to sell her life insurance during the conversation Aging Jackson asked the beneficiary if she would like to learn more about Medicare advantage plan

Aging Jackson has violated the prohibition against making unsolicited calls about other business as a means of generating leads for Medicare plans

23. 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 MSA's cover part A and part B benefits but not part D prescription drug benefit which could be obtained by also in rolling 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

Monica is an agent focused on serving seniors eligible for Medicare as she reviewed her records she is trying to determine which of the following items are considered compensation what do you tell her

Answer: 1,2 and four only 1. Commissions 2. Bonuses 4. Referral fees

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

Answer: 1.,2 and 3 1. identifying at risk individuals by using criteria that includes the number of opioid prescriptions the beneficiaries has the number of prescribers who have written those prescriptions. 2. Locking and at risk beneficiary into one pharmacy. 3. Locking and at risk beneficiary into one prescriber

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

Answer: If you're not in good health you probably do better with a different product Other choices noted ( Hi how are you this morning Mrs. Pearson. Next a private fee for service plan is not the same as a Medigap supplemental policy. Next are you interested in a Medicare supplement plan on medicare health plan) acceptable statements

131. For which of the following individuals would a cost plan be most appropriate

Answer: ms. Baker who is enrolled in Medicare part B and is willing to continue paying part B premiums plus any plan premiums. Note other choices: Ms. Darwin -no Mr. Charles- no Mr. able - no

219. Phiona works in the IT department of Bestcare Health plan Phiona is placed in charge of Bestcare's efforts to facilitate electronica enrollment and it's Medicare advantage plans and setting up the enrollment side which of the following mass Phiona consider

Answer: two and three only Note: all data elements required to be complete and enrollment request must be captured next the process must include a clear and distinct step that requires the applicant to activate and enroll now or I agree type of button or tool

Which of the following statements about Medicare part D are correct

Answer;: One, two, and three only 1. part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances 2. Private fee for service PFFS plans are not required to use a pharmacy network but may choose to have one 3. Beneficiaries enrolled in an MA medical savings account MSA plan may only obtain part D benefits through a standalone PDP

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 (PHI) 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. Fitsgerald is selling his home to permanently move into a retirement facility near his daughter in a neighboring state he has a standalone prescription drug plan and has learned it is not available where he's 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. To select a new plan

133. 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.

96. 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).

22. 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 not compliant secures CMS can penalize a plan in which of the following ways

CMS requires plan sponsors to create and complete a correct of action plan and may terminate the sponsors contract

You are scheduled to give a sales presentation at a local senior center at the beginning of the presentation which of the following much you do

Clearly state that no obligation exist to roll if they get a prize is being provided

Bestcare health Plans received a request from a state insurance department in connection with the investigation of several marketing representative licensed by the state to sell Medicare Advantage plans what actions should Bestcare take in response

Cooperate with the state and supply requested information

20. 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 plans enrollees can choose to receive Medicare covered services under the plans benefits by going to the plan network providers and paying plan call SHAREing or May receive services from non-network providers and pay cost sharing due under original Medicare

Ms Gibbons Became eligible for Medicaid in May she decided to take advantage of the SEP for dual eligibles To leave her MAPD to Enroll in an DSNP effective June 1 with the help of an agent

D SNP may only pay the agent commissions for seven months of enrollment if MAPD paid agent commission in advance it will need to recoup payments for months after May

13. Dr. Elizabeth Brennan does not contract with the PFFS plan but except the plans terms and conditions for payment Mary Rogers see Dr. Brennan for treatment how much may Dr. Brennan charge?

Dr. Brennan can charge Mary Rogers know more than the cost sharing specific in the PFFS plans terms and conditions of payment which may include balance billing up to 15% of the Medicare rate

157. Mr. Wong is a single individual he has had a successful business career and is now able to retire with a comfortable income Mr Wong's taxable income is in excess of $100,000 Mr Wong has health coverage through his employer but will sign up for Medicare part A and part B and part D when he leaves the workforce. How would you advise him as he budgets for Medicare premiums

Due to his participation in the workforce he will not have to pay premiums for part A but he will pay higher premiums for part B and part D due to the amount of his income

19. Mr. McTaggett 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 or what should you tell him

Enrollees in a PFFS's plan can obtain care from any provider in the US who excepts original Medicare as long as the provider has a reasonable opportunity to assess the plans terms and conditions and agrees to except them

Mrs. Pierce would like to enroll in a Medicare cost plan that offers part D prescription drug coverage she comes to you for advice about when she can enroll in a plan you have previously discussed what should you tell her

Enrollment in cost plans offering part D coverage is available only doing enrollment periods under the part D program and cost plans must except enrollment during these periods

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.

50. 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 call C 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 effective date of coverage

128. 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.

202. 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. Young's 65th birthday November 12, 2018 he is currently working he is signed up for Medicare part A benefits effective November 1, 2018 however he declined part D because he has employee based insurance

He is eligible for part day since he has part a and lives in the service area even though he did not enroll him part D his part B IEP is still August 1, 2018. Through February 28, 2019 henceHis IEP for part D is also August 1, 2018 through February 28, 2019

180. Mr. Russell first became eligible for party on December 1, 2018. He did not sign up and has not had credible drug coverage Mr. Russell wishes to obtain drug coverage during AEP to be effective for January 1, 2020

He is not LIS eligible Mr. Russell will have to pay a penalty of 13% of the national average beneficiary premium that is 1% for every month he did not have credible drug coverage after becoming eligible for every month that he stayed covered under part D

26. 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.

15. Mr. Costello a naturalized citizen previously enrolled in Medicare part B but has recently stopped paying his part B premium Mr. Costello is still covered by pate he would like to enroll in a Medicare advantage MA plan and is still covered by pate what should you tell him

He is not eligible to enroll in a Medicare advantage plan until he re-enrolled in Medicare part B

24. 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.

44. Mr. Davis is 52 years old and has recently been diagnosed with an stage renal disease ESRD and will soon begin dialysis he is wondering if he can obtain coverage under Medicare what should you tell him

He may sign up for Medicare at anytime however coverage usually begins on the fourth month after dialysis treatment start

Mr. Denton is 52 years old and has recently been diagnosed with an stage renal disease ESRD and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare what should you tell

He may sign up for Medicare at anytime however coverage usually begins on the fourth month after dialysis treatment starts

112. Mr. Johannsen gains the part D low income subsidy how does that affect his ability to roll or disenroll in a part D plan

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

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

109. See 106- 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.

174. Mr. Singh is single still working and recently turned 65. He has not contributed to the Social Security system or Medicare programs for a sufficient number of quarters to be eligible for part a for free

He would have to pay a premium for part A coverage and has decided not to do so he is eligible for part B and has enrolled in that program he would also like to enroll in part D. Mr. Singh can enroll in party since he has opted to enroll in part B even though he is not entitled to part A

Ms. Lee Is enrolled in an MAPD plan but will be moving out of the plan service area next month she is worried that she will not be able to enroll in another plan available in her new residence until annual enrollment period.

He's eligible for special enrollment 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. Typically last an additional two months

213. 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

Ms. Jones Hasn't rolled in an MA MSA Plan

If Miss Jones wants part D coverage she must also enroll in a PDP

220. 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.

4. Mr. Ing decides to obtain standalone part D coverage to use with his original Medicare instead of enrolling in a Medicare advantage plan that office part D coverage

If Mr. Ing decides to roll in a Medicare advantage HMO or PPO plan he can only received part D coverage from the Medicare Advantage plan

3. Mr. O'Hare who is 70 and does not have a part D is retired but he has his health coverage to his wife's current plan employer

If Mr. O'Hare decides to get part D now he can do so without incurring a late enrollment penalty

Mr. Page Has original Medicare and gets his part D coverage through a standalone PDP during the Annual enrollment period.AEP he wishes to a enroll in an MA HMO

If Mr. Paige chooses am a HMO he may no longer get his party benefits through a standalone PDP and must choose a plan through the HMO that includes part D benefits an MAPD if he wishes to maintain prescription drug coverage

184. Mr. Rice Has coverage for medical services and medications through his employer's retirement plan he is considering switching to a Medicare prescription drug plan because his retiree plan does not cover two important medication what should we 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. diamond has employer group coverage that is credible during his initial party eligibility. He decided not to enroll because he was happy with his drug coverage however a year later Mr. diamond loses his employee group coverage

If Mr. diamond and rolls and a party planned before he has a 63 day break in coverage he will not have to pay a late enrollment premium penalty

Mrs. Lenard is enrolled in a Medicare Cost plan. Recently the cost plan announced its intention to end its cost contract and has transitioned 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 new Medicare advantage plan Operated by an organization affiliated with her cost plan what does that 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 and that in a plan she should choose another plan or otherwise opt out of the automatic enrollment

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.

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. 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.

165. Mr. Green purchased Medigap policy June in 2005 and has remain continuously enrolled. Under policy J after a deductible of $250 is met 50% of prescription drug charges are covered up to a maximum amount of $3000 yearly. The Medicare plan determined that the coverage is not creditable. Mr. Green failed to enroll in part D doing the special in Roman. Of loss of credible coverage does if Mr. Green wishes to roll in part D he will incur a late enrollment penalty unless he qualifies for extra help

If the Medigap coverage was not credible coverage (i.e. covered at least as much as part D) and individual dropping Medigap coverage and enrolling in party will have to pay a late enrollment penalty unless they qualify for extra help

Super agency offers its agents $400 for initial enrollment, $200 for renewal in Rome it and mileage reimbursement for sales appointments and attending training

In addition super agency since the agent who sells the most new Medicare vantage policies on an all expense paid trip to Tahiti... Compensation... Includes the enrollment commissions and for the agent who wins at the cost of the trip to Tahiti

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.

18. 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 or where Care is unavailable within the network).

30. Mrs. Kelly at age 65 is entitled to part a but has not yet enrolled into party she is considering enrollment in a Medicare health plan parts see what should you advise her to do before she will be able to roll in a Medicare health plan

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

41. 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.

47. 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.

234. 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.

237. Mr. Cappadonna would like to purchase a Medicare advantage MA plan and a Medigap plan to pick up costs not covered by the plan what should you tell him

It is illegal for you to sell Mr. Cappadonna a Medigap plan if he is in rolled in an MA plan and besides Medicare Only works with original Medicare

209. Mr. Yoos Employer has recently dropped comprehensive creditable prescription drug coverage that was offered to company retirees the company told me do you Mr. Yoo that because he was affected by this change he would qualify for a special enrollment period Mr. Too 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 in a MAPD or part D prescription drug plan

113. Ms. Claggart is sixty six (66) years old she has been covered under original Medicare for the last six years due to her disability and 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 meet the eligibility requirement for part B so she will not be able to use it as a justification for a rolling and a part D plan now

Mr. Wilcox has been in rolled in Lexington PFFS it's Medicare advantage health plan (Lexington) for several years. Recently Mr. Wilcox decided to spend time with his children who live in another state that is not in Lexington's service area in the future he may relocate near his children permanently how does this move to another service area and pack his PFFS coverage

Lexington can allow Mr. Wilcox to continue enrollment for up to 12 months whether or not he is in a visitor/traveler (V/T) program

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.

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

Agent Martinez, wishes to solicit Medicare advantage prospects through email and ask you for advice as to whether this is possible what should you tell her

Marketing representatives may initiate an electronic contact through email but an opt-out process must be provided

Mary Samuels recently suffered a stroke while visiting her daughter and grand children 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 of the geographic areas served by the 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 request and may disenroll from her current MA

25. 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.

72. 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. 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. 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.

Mrs. Brooks has an aggressive cancer and wants to know if Medicare will cover hospice services if she needs it. What should you tell her

Medicare covers hospice services and they will be available for her

27. 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.

40. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through acupuncture she is concerned about whether or not Medicare will cover these items and services what should you tell her

Medicare does not cover acupuncture or in general glasses or dentures

130. 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

33. 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

48. 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.

43. Mr. Moy's Wife has a Medicare advantage plan but he wants to understand what coverage Medicare supplemental insurance provides since his health care needs are different from his wife's needs what could you tell Mr. Moy

Medicare supplemental insurance would help cover his part A and part B cost sharing an original fee for service FFS Medicare as well as possibly some services that Medicare does not cover

Mrs. Sheild's he's 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 coverage of care in a skilled nursing facility

Medicare will cover Mrs. Sheild's skilled nursing services provided during the first 20 days of her stay afterwords she will have a co-pay until she has been in the facility for 100 days

39. 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.

175. Mr. Bingham Is in rolled in a PDP with zero deductible and a $56 per month premium his copayment for generic drugs is $20 and for brand-name is $35

Mr. Bingham him takes five prescription drugs three are generic and two are brand name. Mr. Bingham annual cost is about 1560 a month in addition Mr. Bingham him will pay $672 in premiums per year

Mr. Bradley is 65 years old still working and eligible for Medicare. Mr. Bradley does not enroll in part B since he has similar coverage through his employers plan he is interested in Medicare part D because he believes he can obtain coverage that is better meeting his needs.

Mr. Bradley is eligible to enroll in part D since he is entitled to part A

54. 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. Chen is in rolled in his employer 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 two months of his disenrollment but he should re-evaluate if he really wants to drop his employer coverage

Mr. Crosby will turn 65 on July 13, 2019 he will become eligible for Medicare part a and part B beginning on July 1 and has decided to enroll in part B effective date of July 1

Mr. Crosby is an ICEP it began on April 1, 2019 and ends on October 31, 2019

31. 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. Grisman turn 65 on November 20 he has an ICEP that begins August 1 and ends February 28 the AEP begins October 15 and runs through December 7

Mr. Grisman can choose whether he uses his ICEP or the AEP but he cannot have an effective date prior to November 1 in addition Mr. Grisman may use the OEP to change his election until March 31st

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. Schultz was still working when he first qualified for Medicare at that time he had employer group coverage that was credible during his initial party eligibility. He decided not to enroll because he was satisfied with his drug coverage it is now a year later and Mr. Schultz has lost his employer group coverage within the last two weeks how would you advise him

Mr. Schultz should enroll in a party planned before he has a 63 day break in coverage in order to avoid any 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.

Mr. Smith lost his credible drug coverage that his employer provided when he retired Mr. Smith signed up for a party with an effective date of 60 days after the date he lost his coverage

Mr. Smith will not be subject to a late enrollment penalty

You are visiting with Mr. Tully And his daughters at her request he has advance Alzheimer's and is in capable of understanding the implications of choosing a Medicare advantage prescription drug plan can his daughter fill out the enrollment form and sign it for him

Mr. Tulley's daughter can do so only if she is authorized under state law as a court appointed legal guardian has a durable power of attorney for healthcare decisions or is authorized under state Surrogate consent law to make healthy decisions

Mr. Walker did not enroll in part B or part D when he first became eligible because he had excellent employee group coverage years later Mr. Walker receive notice on October 1 that as of January 1 his employer group plan for coverage will no longer be credible

Mr. Walker has a SEP to enroll in part D beginning October 1 and ending February 28

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.

Mrs.Duarte Is it rolled in original Medicare parts a and B She has recently reviewed her Medicare summary notice MSNN disagrees with a determination that partially denied one of her claims for services what advice would you give her

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

236. 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.

123. 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. Lenard 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.

14. Mrs. Radford asked 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 be charged a lower co-payment if she goes to one of the plan's preferred providers.

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.

225. 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 days of receipt of the enrollment request

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?

NEW 2019 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 During the first nine months of each calendar year beginning in 2019

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?

NEW ANSWER 2019 You may make comparisons between plans if you can support them by studies or statistical data and such comparisons are factually based

106. ****Mr. Gonzalez is entitled to Part A, but has not yet enrolled in Part B. If he wants to enroll in a Medicare advantage MA plan, what will he have to do? NEW 2020

New 2020 He will have to enroll in Part B prior to enrolling in a MA plan.

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 1st that his employer is cutting back on prescription drug benefits and that as of July 1st 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)?

New 2020 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

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?

New 2020 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 a part of the preferred providers.PPO Network

204. 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?

New answer 2020 During the MA open enrollment. Period from January 1 to March 31 she may disenroll from the MAPD plan into original Medicare and also may add a standalone prescription drug plan

121. Willard Works as a representative focused on the Senior marketplace what would be considered for prohibited activity by Willard

New for 2020 ( has a typo) 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

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. 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?

Old answer 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.

Mr. Miller becomes eligible for Medicare for the first time in August and enroll in a Medicare advantage plan with an effective date of August 1 the plan paid the agent the initial year compensation amount for the months of August Through December

On January 1 plan will start paying the agent there a new amount if Mr. Miller remains in rolled

Miss Lopez to address her acid reflex she has been taking a formulary drug and an over the counter medication

Only the amount Miss Lopez pays for the formulary drug house towards her out-of-pocket cost

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.

38. 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. Lee is discussing with you the possibility of enrolling in a private see for service PFFS plan. As part of the 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

29. 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.

35. 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. 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.

132. 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.

134. 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.

12. Mrs. Walters is enrolled in her state Medicaid program in addition to Medicare what should she be aware of when considering enrollment in a Medicare advantage plan

She can enroll in any type of Medicare advantage MA plan except an MA Medicare savings account MSA plan

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.

16. 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 standalone Medicare prescription drug plan

226. 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. Kendricks 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 Medicare part B

51. Mrs. Edwards is enrolled in a Medicare advantage plan that includes prescription drug plan PDP coverage she is traveling and wishes to fill two of the prescriptions that she has lost how would you advise her

She may fill prescriptions for covered drugs at a non-network pharmacies but likely at a higher cost than paid at In-network pharmacy

167. Mrs. Davenport 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. Davenport have regarding her MA door in the next open enrollment

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 the area

161. Mrs.Peña is 66 years old has coverage under an employer plan and will retire next year. She heard she must enroll in part D at the beginning of the year to ensure no gap in coverage what can you tell her

She may roll 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

Ms O'Donnell Learned about a new MA PD plan that her neighbor suggested and you represent she plans to switch from her old MA HMO plan to the new MAPD during the annual enrollment period However she wants to make sure she does not end up paying premiums for 2 plans what can you tell her

She only needs to roll into the new MAPD plan and she will automatically be disenrolled from her old MA plan

210. Mrs. Ridgeway enrolled in original Medicare and Medicare coverage following her retirement several years ago four months ago Mrs. Ridgeway dropped her Medicare 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 plans network she has come to you for Advice what should you tell her

She qualifies for 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. To re-join her Medigap plan

126. 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 room on her scope of appointment form she asked to discuss Medicare advantage plans during the meeting she asked to discuss a standalone prescription drug plan she is leaving the next day to visit her family for a week in another state so it is important for 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 standalone 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

All plans must cover at least the standard party coverage or it's ACTUARIAL Equivalent. What cost with a beneficiary and care for prescription drugs in 2020 under the standard coverage

Standard part D coverage would require payment of an annual deductible of $435, 25% cost sharing between $435 and $4020 and once through the catastrophic coverage trash haul the beneficiary pays either co-pays for generic and brand-name drugs or coinsurance of 5% which ever is greater

Mr. Anderson is a very organized individual and has filled out and brought to you and enrollment form on October 10 for a new plan available January 1 next year. He is currently in rolled in original Medicare what should you do

Tell Mr. Anderson we cannot except any enrollment forms until annual enrollment begins AEP 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.

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

9. 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 coverage service how much may the doctor collect from Mr. Rivera

The Doctor May only collect From Mr Rivera the cost sharing allowable under the states Medicaid program.

218. During a sales presentation to Ms. Daley for a Medicare advantage plan that has a five star rating in customer service and care coordination and received an overall plan performance rating of a four star which of the following would be the correct statement to say to her

The Medicare AdVantage plan received a five star rating in customer service and care coordination with an overall performance rating of four stars

2. 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.

34. 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

The card she received is valid the change has been made to protect Medicare beneficiaries from identity theft and she will now show the new card and destroy her old card

116. Ms. Gonzalez Decided to remain in original Medicare parts A and B and Part D during the annual enrollment 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. That she might be able to use to enroll in a MA plan. Ms. Gonzalez 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 Gonzalez cannot use it because eligibility to use the OEP is only Available to MA enrollees

205. Mr. Landreth Has been diagnosed with congestive heart failure he is currently covered under original Medicare with a PDP for part D benefits

There is a SNP in Mr. Landreth area that specializes in caring for individuals with congestive heart failure Mr. Landreth main role in the SNP anytime

21. 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 have 10 referrals from a third-party that initiates contact with potential clients and usually set 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 to potential Medicare Enrollees in order to set up such appointments or for any other reason related to the marketing of Medicare advantage of part D plans

176. Mr. Reynolds takes blood pressure medication he requested a formulary exception which was denied by his plan he decided to continue taking the non formulary prescription and pay for it out of pocket

This amounts Mr. Reynolds pays for the drug do not count towards his deductible or out-of-pocket cost

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.

Agent Johnson works for an agency that has a contract with prime Medicare health plan a Medicare advantage organization to offer a marketing services agent Johnson returns calls to individuals who fill out a online form indicating that they want to be contacted by a representative of prime Medicare

Thus he is obligated to comply with all marketing requirements including those regarding using only approve call Scripts to conduct marketing

Mrs. Sanchez lives in a state located near Canada she has recently become eligible for Medicare and is considering enrollment and part D prescription drug coverage one of her friends has told her that she needs to be aware of something called TrOOP what should you tell her when she ask you about TrOOP

TrOOP out of pocket cost that counts towards the annual out-of-pocket threshold to move into catastrophic coverage and generally include the annual deductible(s) and cost for drugs on the plans formulary purchased at a plans participating pharmacy. in some instances amounts not directly paid by the enrollee (like manufacturer discounts) count towards TrOOP

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 will begin on the first day of the next month so she would not expect her coverage to begin before she leaves

32. 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

49. 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.

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 removal from the market

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 friends mother just moved to an assisted living facility and he asked if you could present a program for the residence about the MAPD plans that you market what could you tell him

You appreciate the opportunity and would be happy to schedule an appointment with anyone at their request

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.

221. You have come to Mrs. Midler's home for sales presentation at the beginning of the presentation Mrs. Midler tells you that she has a copy of her medical records available because she thinks this will help you understand her needs she suggest 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 Ms midlers of questions about conditions that affect Eligilbility specifically whether she has an stage renal disease or one of the conditions that would qualify her for a special-needs plan

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 team out not the plans that I have the products she sells What could you say to her

You could tell her she's wrong and that only agent selling employee Union route plans or permit it an exemption from testing but some employee in your group plans may require testing to promote agent compliance with CMS marketing requirements

You are meeting with Ms. Berlin and she has completed enrollment form for AMAPD plan you represent you notice that her hand writing is illegible and as a result the spelling of her street looks incorrect she ask you to fill in the correct street name what should you do

You may correct this information as long as you add your initials and date next to the correction

If you are to be in compliance with Medicare guidance regarding educational events which of the following would be Acceptable activities

You may distribute business cards to individuals who requested information on how to contact you for further details on the plans 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.

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 made you offer as a gift to introducing Roman and I plan

You may provide gifts and prizes to all potential Rolleys doing any 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 on October 15 during the appointment what are you committed 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 doing sales presentation 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 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 resigned the scope of appointment form indicating which products she wishes to discuss you made then proceed with a discussion

You would like to market an MA plan at a neighborhood pharmacy what should you keep in mind to comply with the marketing requirement for MA plans

You must set up your table make marketing presentation and except enrollment applications only in common areas outside of where the patient's weight for several services from the pharmacist

You work for a company that has marketed Medicare products for many years the company has added Medicare Van H and part D plans and you will begin marketing those plans this fall you are planning what materials to use to easily show the difference in benefits premiums and cost sharing for each of those products what do you need to do with your materials before using them for marketing proposes

You must submit your materials to the plan you represent so CMS can review and approve the materials to in sure they are accurate

118. You are completing a PFFS plan Sale to Mr. West who is new to Medicare and prefers to be contacted by phone as you are finishing up what should you tell him about the 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 a sure that he understood the nature of the PFFS plan he selected and to verify his intent to enroll

Next week you will be participating in your first educational event for perspective in Rolleys in order to be sure that you do not violate any of the applicable guidelines and what activities shoot 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 except enrollment forms at the event

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 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.

124. 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

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.

10. Mr. Kelly has substantial financial means. He enrolled in original Medicare and purchase a Medigap policy mini 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 he does decides to enroll in Medicare part D?

he will incur a late enrollment penalty.

1. Ms. Stein retired from her job and she is 69 she did not previously enroll in part D because she had employer group coverage Her last month of group coverage is in February

she has until October to roll in Medicare part B without in curing a late enrollment penalty.