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2025 Ethics and Compliance Assessment – MC
EXAM 2025–2026 Accurate Real Exam Questions
and Verified Correct Answers
What might happen if you fail to conduct a needs assessment or conduct an incomplete assessment?
The consumer may be enrolled in a plan that does not best meet their needs
The consumer may experience dissatisfaction after their plan effective date and complain to
Medicare
When are you required to conduct a thorough needs assessment?
I am required to complete a needs assessment prior to making any plan recommendations
A thorough needs assessment will include which of the following components? (Select 3)
Identifying what healthcare coverage attributes are most important to the consumer and what tradeoffs they might be willing to make
Identifying their current providers (including primary care, specialists, hospitals, and pharmacies) and the medications they take
Learning about their current coverage, lifestyle and financial characteristics
Which of the following statements are true when selling Medicare plans over the telephone?
(Select 2)
Which of the following are guidelines you should follow to help consumers understand the information you present? (Select 3)
Speak clearly, at an appropriate volume, and at a moderate pace
Follow the approved call flow and sales and/or enrollment scripts precisely
Mail or email the Enrollment Guide for the plan recommended to the consumer so they can review it in advance of completing the enrollment application Wrong
What are some possible negative outcomes when a consumer misunderstands, is confused by, or does not comprehend what you tell them?
Which of the following best describes a "like" plan change?
When a consumer enrolls in a plan that is of the same type as their current plan, such as any
Medicare Advantage plan to any other Medicare Advantage plan
Sandra is currently enrolled in a Medicare Advantage plan that offers a variety of benefits beyond what is covered by Original Medicare, such as transportation to appointments and an over-the- counter debit card. When comparing an alternative plan, which of the following must you not use to describe benefits of the new plan?
I want to make sure you understand what your current plan has that this plan doesn't so there are no surprises"
"Nothing will change" or "Everything will be the same" Wrong
Simon is currently enrolled in a Medicare Advantage plan. He calls saying he saw an ad on TV that says he can get a plan with dental coverage of $3500 per year. What guidelines must you follow before recommending a new plan to Simon? (Select 3)
Only recommend a plan that is the best fit plan, which may be the consumer's current plan Conduct a thorough needs assessment to gather comprehensive information related to the consumer's situation and needs
Make sure that the consumer's current dental coverage is less than what the ad stated is available Wrong
*What might happen when a member assumes that their new plan has everything their old plan had and more? (*
disatified complans
What are examples of phrases you should avoid using with a consumer when comparing plans? (Select 3)
The individual must be legally authorized in the state in which the consumer resides to act on behalf of the consumer (e.g., Power of Attorney).
In which situation MAY the Medicare Advantage (MA) organization decide to disenroll a member from an MA plan?
Premiums are not paid on a timely basis
To avoid confusing or misleading a consumer, what type of information must the agent provide when presenting a plan? (Select 3)
Factual
Complete
Accurate
What information must you provide to the consumer (at minimum) when you conduct your call greeting?
My name, my title that indicates I am a licensed insurance agent, and the name of the agency I represent
What might happen if you rely on a benefit or plan feature a consumer mentions they saw or heard in an ad?
I might be tempted to skip doing a thorough needs assessment and/or be biased only toward plans with that benefit
What plan should the consumer enroll in?
The plan that best fits their needs, which may be the plan in which they are currently enrolled
Beyond looking up the consumer's current providers and medications, what else should you learn about the consumer when you conduct a thorough needs assessment? (Select 3)
What they have for current coverage and the impacts an enrollment in a new plan might have
Their current coverage, lifestyle and financial characteristics
What healthcare coverage attributes are most important to the consumer and what tradeoffs they might be willing to make
Which of the following are guidelines you should follow to help consumers understand the information you present? (Select 3)
Follow the approved call flow and sales and/or enrollment scripts precisely
Speak clearly, at an appropriate volume, and at a moderate pace
Ask if someone assists the consumer with making enrollment decisions and make sure that person is present to participate in the call
Mail or email the Enrollment Guide for the plan recommended to the consumer so they can review it in advance of completing the enrollment application WRONG
When should you proceed with an enrollment? (Select 3)
If I am certain the consumer understands what they are gaining and what they may be giving up by enrolling in the new plan
Anytime I can get the consumer to consent to enroll
If I am certain the consumer understands and agrees they are enrolling
When the person who assists the consumer make healthcare coverage decisions is present on the call, when applicable
Which of the following are examples of phrases that must not be spoken by an agent when a consumer is contemplating a plan change? (Select 2)
"Nothing will change"
"Everything will be the same"
What might happen when a member assumes that their new plan has everything their old plan had and more? (Select 2)
Member dissatisfaction
Member complaints
Select the three elements you must compare when a consumer is considering changing plans.
What information should be obtained from the consumer when conducting a thorough needs assessment? (Select 2)
Their current health care coverage, including what they like about it and what they don't.
The providers they see and medications they take to determine network and formulary status.
Whose email address may the agent enter into the applicant information section of LEAN enrollment application?
Only the consumer's email (or leave it blank).
The __________ ensures that when consumers provide their verbal agreement during the telephonic enrollment, they acknowledge and understand they are actually enrolling, in which plan they are enrolling, as well as the standard disclosures.
Statement of Understanding
Which of the following must an agent obtain from the consumer no less than 48 hours (unless an exception applies) before an in-person, online, or telephonic marketing appointment?
Scope of Appointment
Which statement is accurate when a consumer has a Power of Attorney (POA)?
If the POA signs the Enrollment Application, they must be able to provide documentation upon request by the Plan that indicates authority under state law to enroll the consumer.
What happens on the plan effective date when a member enrolled in a Medicare Supplement Insurance Plan and stand-alone PDP enrolls in a Medicare Advantage plan that includes drug coverage?
When MUST an MA Plan or stand-alone PDP disenroll a member?
When eligibility requirements are no longer met
Aries is currently a member of a stand-alone PDP. Aries would like to have additional medical coverage. A thorough needs analysis indicates a Medicare Advantage Plan would be a good fit, there are plans available in his area, and he is in a valid election period. Which option is available to Aries?
Aries can enroll into a Medicare Advantage plan with prescription drug coverage, which will disenroll him from his PDP.
As an agent, you have an obligation to only enroll a consumer in a product:
That is suitable for the consumer's needs, goals and financial resources.
Dino, an agent, received a phone call on September 29 from a consumer interested in
Medicare Advantage plans for the new plan year. Dino proceeded to verify the consumer's Medicare eligibility, describe the costs and benefit coverage of the plan, and explained that he could not accept an enrollment application until October 15. What did Dino do that was NOT compliant?
Dino presented a plan prior to October 1.
Which of the following are examples of lead generation materials that might result in an inbound call from a Medicare-eligible consumer?
Direct mail, TV ads, billboards
Jane, a consumer, calls your call center and asks to be enrolled in the plan that will put money back into her Social Security every month. What do you keep in mind when you hear the consumer mention a specific plan benefit from an ad? (Select 3)
While I take note of what might be important to the consumer, I do not want to rely on one benefit and become biased as to what type of plan to recommend
I make sure whatever plan I recommend has that stated benefit because I know it will be the best fit plan for the consumer
I remember to not overlook the importance of a thorough needs assessment Wrong What are you required to do prior to making a plan recommendation?
Conduct a thorough needs assessment to make sure I gather information about the consumer's situation and preferences
What is the purpose of a needs assessment?
To gather as much information about the consumer as possible to ensure I am recommending the plan that is the best fit for the consumer
Only recommend a plan that is the best fit plan, which may be the consumer's current plan
Do not rely only on and become biased by the consumer's stated reason for calling
Next question 4 Questions remaining
Select the three elements you must compare when a consumer is considering changing plans.
(Select 3)
The providers that the consumer sees and how access to those providers might be different by enrolling in the new plan
The consumer's current coverage and costs with the coverage and costs of the new plan that I want to recommend
The providers that the consumer sees and how access to those providers might be different by enrolling in the new plan
The consumer's current coverage and costs with the coverage and costs of the new plan that I want to recommend
What should the consumer understand before they agree to proceed with enrolling in a new plan? (Select 3)
If the plan is network-based, that the providers they want to use are in the new plan's network If the plan has drug coverage, that the medications they use are on the plan's formulary and, if they are, what tier they are in and any utilization management limitations
That their current plan and the new plan that I am recommending are not the same
Cynthia is turning 65 on July 5. Her Medicare Part A and Part B will be effective on July 1. Using her Initial Election Period (IEP), when can she submit an application for a Medicare Advantage or Prescription Drug plan?
April 1 through October 31
Which of the following statements is true about election periods?
MA Open Enrollment Period can only be used by a consumer already enrolled in an MA Plan
When a consumer asks why an MA Plan has a 2-star rating, the agent should tell the consumer what?
That the plan has received a "Below Average" rating.
Which of the following describes Permission to Contact (PTC) guidelines?
Contact can only be made by the method(s) requested by the consumer and the agent can only market the product(s) indicated by the consumer.
Which of the following are examples of what an agent must review with a consumer prior to completing an enrollment application?
The plan's network characteristics and how using out-of-network providers may impact coverage and costs, covered benefits and limitations, and plan related costs such monthly premium and copayments/coinsurance for services received.
Whose email address may the agent enter into the applicant information section of LEAN enrollment application?
Only the consumer's email (or leave it blank).
What is the purpose of the Statement of Understanding?
It ensures that when consumers complete the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding that they are actually enrolling, in which plan they are enrolling, and standard disclosures.
When must the Scope of Appointment be obtained from the consumer for an in-person or telephonic sales presentation (unless an exception applies)?
48
ane, an agent, is speaking to Albert about a Prescription Drug plan. Albert seems confused and is struggling to understand the information Jane is explaining. Which option should Jane consider?
Jane should ask Albert if someone, such as an Authorized Legal Representative, helps him make health care or insurance-related decisions and should be present.
Which of the following options will enable a consumer to obtain prescription drug coverage? (Select 2)
Enroll in a PFFS MA-Only plan and a stand-alone PDP
Enroll in any MA-PD plan
