AHIP EXAM 2024 AND PRACTICE EXAM TEST BANK WITH A STUDY GUIDE, Exams of Nursing

Download AHIP EXAM 2024 AND PRACTICE EXAM TEST BANK WITH A STUDY GUIDE and more Exams Nursing in PDF only on Docsity! AHIP EXAM 2024 AND PRACTICE EXAM TEST BANK WITH A STUDY GUIDE | ACCURATE REAL EXAM QUESTIONS WITH DETAILED ANSWERS | LATEST UPDATE FOR GUARANTEED PASS | GRADED A Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years. However, the plan does not provide drug benefits. How would you advise Agent John Miller to proceed? - CORRECT ANSWER Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. 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? - CORRECT ANSWER Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. What should you tell him? - CORRECT ANSWER It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original Medicare. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be of assistance? - CORRECT ANSWER She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help with Medicare costs for which she is responsible. 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? - CORRECT ANSWER 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. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Where might he turn for help with his prescription drug costs? - CORRECT ANSWER Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE). This coverage has recently been terminated due to the end of the PHE. While Shirley was enrolled in Medicaid, she missed an opportunity to enroll in Medicare and now wants Part B. Which of the following statements best describes Shirley's ability to now enroll in Medicare Part B? - CORRECT ANSWER Shirley is eligible for a Special Enrollment Period (SEP) for up to six months after the termination of her Medicaid coverage. Under this SEP, Shirley can choose retroactive coverage back to the date of termination from Medicaid or coverage beginning the month after the month of enrollment. Anthony Boniface turned 65 in 2023. He was not receiving Social Security or Railroad Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and is eligible for premium-free Part A. Before he could enroll in Medicare, his entire area was impacted by a hurricane causing massive flooding and severe wind damage. The Federal government declared this to be a natural disaster which has recently ended. During this period Anthony's initial enrollment period expired. Anthony asks you how he can now obtain Medicare coverage. What should you say? - CORRECT ANSWER Anthony is eligible for a special enrollment period (SEP) because he missed an enrollment period due to the impact of the Federally declared disaster. This SEP will allow Anthony to enroll in Part B up to six months after the end of the emergency declaration. Anthony may enroll in premium-free Part A at any time and his Part A coverage will be retroactive for up to 6 months. 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? - CORRECT ANSWER All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be obtained by also enrolling in a separate prescription drug plan. Mrs. 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? - CORRECT ANSWER 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 PPO network. virtue of having paid Medicare taxes while working, though some may be covered as a result of paying monthly premiums. 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? - CORRECT ANSWER After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? - CORRECT ANSWER Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. Mrs. Peňa is 66 years old, has coverage under an employer plan, and will retire next year. She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell her? - CORRECT ANSWER She may enroll at any time while she is covered under her employer plan, but she will have a special eight-month enrollment period after the last month on her employer plan that differs from the standard general enrollment period, during which she may enroll in Medicare Part B. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? - CORRECT ANSWER He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. Madeline Martinez was widowed several years ago. Her husband worked for many years and contributed into the Medicare system. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. She comes to you for advice. What should you tell her? - CORRECT ANSWER You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums due to her husband's long work record and participation in the Medicare system. You should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest rate due her substantial income. 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? - CORRECT ANSWER To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. - CORRECT ANSWER 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. Mr. Barker enjoys a comfortable retirement income. He recently had surgery 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 some services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him? - CORRECT ANSWER You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and was disappointed with 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 would not have to put up with such poor access to care. What could you tell her? - CORRECT ANSWER She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. Which of the following statement(s) is/are correct about a Medicare Savings Account (MSA) Plans? I. MSAs may have either a partial network, full network, or no network of providers. II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits. III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of $500 indexed for inflation. IV. Non-network providers must accept the same amount that Original Medicare would pay them as payment in full. - CORRECT ANSWER I, II, and IV only 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? - CORRECT ANSWER SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to be most appropriate for him? - CORRECT ANSWER C-SNP Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him? - CORRECT ANSWER He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug coverage since her doctor recently prescribed several expensive medications. Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi? - CORRECT ANSWER Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D prescription drug plan. Mrs. Wang wants to know generally how the benefits under Original Medicare might compare to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans. What could you tell her? - CORRECT ANSWER Medicare Advantage Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental services. It must include a maximum out-of-pocket limit on Part A and Part B services. Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be the correct description? - CORRECT ANSWER Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies. 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? - CORRECT ANSWER You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS plan's service area. Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to? - CORRECT ANSWER Yes. Mrs. Walters must be entitled to Part A and/or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. 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? - CORRECT ANSWER 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. 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? - CORRECT ANSWER 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. McIntire is enrolled in her state's Medicaid plan and has just become eligible for Medicare as well. What can she expect will happen to her drug coverage? - CORRECT ANSWER Unless she chooses a Medicare Part D prescription drug plan on her own, she will be automatically enrolled in one available in her area. Mrs. Cantwell is enrolled in a prescription drug plan. She has heard about something called True-Out-Pocket costs or "TrOOP" and asks you if any of the following count toward reaching the catastrophic coverage phase. What do you say? I. Her annual PDP deductible II. A drug manufacturer's discount for brand name drugs after her initial coverage period III. The off formulary drug her doctor prescribed but she pays for because the plan denied her exception request IV. Her over-the-counter (OTC) allergy medication. - CORRECT ANSWER I and II only Mrs. Fiore is a retired federal worker with coverage under a Federal Employee Health Benefits (FEHB) plan that includes creditable drug coverage. She is ready to turn 65 and become Medicare eligible for the first time. What issues might she consider about whether to enroll in a Medicare prescription drug plan? - CORRECT ANSWER She could compare the coverage to see if the Medicare Part D plan offers better benefits and coverage than the FEHB plan for the specific medications she needs and whether any additional benefits are worth the Part D premium costs on top of her FEHB contribution. 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? - CORRECT ANSWER If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this. 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? - CORRECT ANSWER In general, he must select a single Part D premium payment mechanism that will be used throughout the year. 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? - CORRECT ANSWER He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means to 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. 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? - CORRECT ANSWER 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. Which of the following statements about Medicare Part D are correct? I. Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP. IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a standalone PDP or through their plan. - CORRECT ANSWER I, II, and III only Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently lost creditable coverage previously available through her husband's employer. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). What should you tell her? - CORRECT ANSWER If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. Agent Daniel Webber has properly set up a sales appointment to meet with client Edward Young at Agent Webber's office. At the agreed upon appointment time, Mr. Young arrives with his elderly neighbor - Clara Burton, who wants to learn about her Medicare Advantage options. What should Agent Daniel Webber do? - CORRECT ANSWER After executing a scope of appointment (SOA) with Clara Burton, meet with Edward Young and Clara Burton to discuss their Medicare Advantage options. 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 permitted to do? - CORRECT ANSWER You may provide her with the required enrollment materials and take her completed enrollment application. You have approached a hospital administrator about marketing in her facility. The administrator is uncomfortable with the suggestion. How could you address her concerns? - CORRECT ANSWER Tell her that Medicare guidelines allow you to conduct marketing activities in common areas of a provider's facility. You are working several plans and community organizations to sponsor an educational event. When putting together advertisements for this event, what should you do? - CORRECT ANSWER You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. Miguel Sanchez is a relatively new agent who has come to you for advice as to what he can do during the Medicare Advantage Open Enrollment Period (MA-OEP). What advice should you Evan Marsh is a newly appointed agent. Evan intends to conduct an educational session on Medicare at a senior citizens center near his home. He has advertised the session as an educational event. Evan asks you what is permissible at such an event. What should you say? - CORRECT ANSWER Evan may provide a meal as long as its value is $15 or less per attendee and he may make available business reply cards (BRCs). Hector Hernandez is an independent agent. Hector sells plans on behalf of three Medicare Advantage organizations that offer a total of 10 plans but does not represent all Medicare Advantage organizations offering plans that are available in his area. Which of the following statements best describes any steps Hector is required to take? - CORRECT ANSWER During the first minute of a sales call, Hector must use a disclaimer that says "I do not represent every plan available in your area. I represent 3 organizations that offer 10 plans in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all your options." Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. What should you tell her? - CORRECT ANSWER Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. Sal D'Angelo is new to the Medicare marketplace having previously been focused on life insurance and disability income protection products. He intends to conduct an educational seminar during the AEP at a local hotel and then invite those who attend to a subsequent marketing meeting to discuss the benefits of next year's plans. How would you advise Sal? - CORRECT ANSWER Sal should conduct the education seminar as an early morning meeting and the marketing meeting on the following day in the late afternoon so that there are at least 12 hours between the two meetings. Mrs. Reeves is newly eligible to enroll in a Medicare Advantage plan and her MA Initial Coverage Election Period (ICEP) has just begun. Which of the following can she not do during the ICEP? - CORRECT ANSWER She can enroll in a Medigap plan to supplement the benefits of the MA plan that she's also enrolling in. You are visiting with Mr. Tully and his daughter at her request. He has advanced Alzheimer's and is incapable of understanding the implications of choosing a Medicare Advantage or prescription drug plan. Can his daughter fill out the enrollment form and sign it for him? - CORRECT ANSWER Mr. Tully'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 health care decisions, or is authorized under state surrogate consent laws to make health decisions. Mrs. Kumar would like her daughter, who lives in another state, to meet with you during the Annual Election Period to help her complete her enrollment in a Part D plan. She asked you when she should have her daughter plan to visit. What could you tell her? - CORRECT ANSWER Her daughter should come in November. Mr. White has Medicare Parts A and B with a Part D plan. Last year, he received a notice that his plan sponsor identified him as a "potential at-risk" beneficiary. This month, he started receiving assistance from Medicaid. He wants to find a different Part D plan that's more suitable to his current prescription drug needs. He believes he's entitled to a SEP since he is now a dual eligible. Is he able to change to a different Part D plan during a SEP for dual eligible individuals? - CORRECT ANSWER No. Once he is identified by the plan sponsor as a "potential at-risk" beneficiary, he cannot use the dual eligible SEP to change plans while this designation is in place. No. Once he is identified by the plan sponsor as a "potential at-risk" beneficiary, he cannot use the dual eligible SEP to change plans while this designation is in place. - CORRECT ANSWER Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan. Mrs. Parker likes to handle most of her business matters through telephone calls. She currently is enrolled in Original Medicare Parts A and B but has heard about a Medicare Advantage plan offered by Senior Health from a neighbor. Mrs. Parker asks you whether she can enroll in Senior Health's MA plan over the telephone. What can you tell her? I. Enrollment requests can only be made in face-to-face interviews or by mail. II. Telephone enrollment request calls must be recorded. III. Telephonic enrollments must include all required elements necessary to complete an enrollment. IV. The signature element must be completed via certified mail. - CORRECT ANSWER II and III only Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could you help him take during this time? - CORRECT ANSWER He will have one opportunity to enroll in a Medicare Advantage plan. Mrs. Margolis contacts you in August because she will become eligible for Medicare for the first time in November. She would like to meet and discuss plan choices with you. What advice should you give her? - CORRECT ANSWER Tell her to wait until October to discuss plan choices with you so that you can share plan benefits for the current year as well as any changes for the following year that may impact her choice. Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the Annual Enrollment Period (AEP). At the beginning of January, her neighbor told her about the Medicare Advantage (MA) plan he selected. He also told her there was an open enrollment period that she might be able to use to enroll in a MA plan. Ms. Gonzales comes to you for advice shortly after speaking to her neighbor. What should you tell her? - CORRECT ANSWER There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31, but Ms. Gonzales cannot use it because eligibility to use the OEP is available only to MA enrollees. 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? - CORRECT ANSWER His open enrollment period as an institutionalized individual will continue for two months after the month he moves out of the facility. Torie Jones is a new marketing representative. Torie asks you for advice as to what topics must be discussed with a Medicare beneficiary prior to enrollment in a Medicare Advantage (MA-PD) plan. What should you say? - CORRECT ANSWER Torie, there are many required questions and topics regarding beneficiary needs to be discussed prior to enrollment in an MA plan. These include information regarding primary care providers and specialists whether they are in the plan network, whether or not a beneficiary's current prescriptions are covered as well as premiums, benefits, and costs of health care services. Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-income subsidy. How does that affect his ability to enroll or disenroll in a Part D plan? - CORRECT ANSWER He qualifies for a special election period and can enroll in or disenroll from a Part D plan once during that period. Able, Baker, and Charles are engaged in the marketing to and enrollment of beneficiaries into Medicare health plans. Mr. Able is an independent agent paid directly by a health plan. Ms. Baker is an independent agent paid through a field marketing organization (FMO). Mr. Charles is an independent agent paid for his work by a third-party marketing organization (TMO). How do the CMS compensation rules apply to these three agents? - CORRECT ANSWER Baker and Charles are subject to CMS compensation rules because they are paid by third parties. Able is not because he is paid directly by a health plan. Mr. Landry is approaching his 65th birthday. He has signed up for Medicare Part A, but he did not enroll in Part B because he has employer-sponsored coverage and intends to keep working for several more years. But he is considering enrolling in Part D prescription drug coverage because he believes it is superior to his employer plan. How would you advise him? - CORRECT ANSWER Mr. Landry is eligible for Part D since he has Part A, and his initial enrollment period (IEP) for Part D will continue for three months after his 65th birthday. Who is most likely to be eligible to enroll in a Part D prescription drug plan? - CORRECT ANSWER Ms. Davis who is entitled to Part A and has just enrolled in Part B. Ms. Bushman has two homes in different states and is concerned about restrictions on where she can get her medications. What should you tell her? - CORRECT ANSWER Part D prescription drug plans use networks of pharmacies within their service areas. She could look for a plan that maintains a network in both states. Which of the following statements best describes Section 1557 of the Affordable Care Act (ACA)? - CORRECT ANSWER Section 1557 incorporates earlier civil rights protections in regard to race, color, national origin, disability, age and sex. Under ACA Section 1557, a health plan premium sold through a state exchange may, based on an individual's age and - CORRECT ANSWER charge higher premiums As a result of violations of ACA Section 1557 nondiscrimination rules, - CORRECT ANSWER a health plan may revoke an agent or broker's appointment with the health plan. Which Medicare programs are covered by ACA Section 1557 under the Biden Administration's Proposed Rule? - CORRECT ANSWER Parts A, C, and D, and as proposed Part B. ACA Section 1557 rules for disability concern - CORRECT ANSWER policies and procedures, physical access, and communication. Which of these actions is most likely to be permitted in dealing with a person with limited English proficiency? - CORRECT ANSWER Allowing a child to interpret in an emergency. Under Section 1557, the 2020 Final Rule issued during the Trump Administration sex was initially defined____________ - CORRECT ANSWER as biologic sex only, meaning whether a person was determined to be male or female at birth. Which of the following statements best describes the scope of operations subject to Section 1557 under the Proposed Rule of the Biden Administration? - CORRECT ANSWER Health insurers under the Biden Administration's Proposed Rule are not considered to be principally engaged in delivering health care, and thus lines of business that do not receive federal funding or administered under Title I of the ACA, such as disability income insurance, do not fall under the scope of 1557. Which entity enforces Section 1557 for programs that receive funding from on are administered by HHS? - CORRECT ANSWER The Office of Civil Rights (OCR) of HHS. Section 1557 of the Affordable Care Act applies to - CORRECT ANSWER all health programs and activities administered by or receiving federal financial assistance from HHS. Auxiliary aids and services must be provided to individuals with disabilities, such as those suffering from vision or hearing impairments, free of charge, and in a timely manner. Auxiliary aids and services include which of the following: I. large print materials II. qualified sign language interpreters III. braille materials and displays IV. screen reader software - CORRECT ANSWER I, II, III, and IV For a health plan, what are the possible consequences of violations of ACA Section 1557? - CORRECT ANSWER Loss of federal business and compensatory damages. Loss of federal business and compensatory damages. - CORRECT ANSWER cannot deny coverage to LEP individuals and is required to provide language assistance to them, free of charge. cannot deny coverage to LEP individuals and is required to provide language assistance to them, free of charge. - CORRECT ANSWER Broker Mary Jones has recruited a diverse workforce. She encourages her agents to prospect through community-based marketing and within their community of influence. Your job is to submit a risk diagnosis to the Centers for Medicare & Medicaid Services (CMS) for the purpose of payment. As part of this job, you use a process to verify the data is accurate. Your immediate supervisor tells you to ignore the Sponsor's process and to adjust or add risk diagnosis codes for certain individuals. What should you do? - CORRECT ANSWER Report the incident to the compliance department (via compliance hotline or other mechanism) A person drops off a prescription for a beneficiary who is a "regular" customer. The prescription is for a controlled substance with a quantity of 160. This beneficiary normally receives a quantity of 60, not 160. You review the prescription and have concerns about possible forgery. What is your next step? - CORRECT ANSWER Call the prescriber to verify the quantity Which of the following is NOT potentially a penalty for violation of a law or regulation prohibiting fraud, waste, and abuse (FWA)? - CORRECT ANSWER Deportation Which of the following requires intent to obtain payment and the knowledge the actions are wrong? - CORRECT ANSWER Fraud You are performing a regular inventory of the controlled substances in the pharmacy. You discover a minor inventory discrepancy. What should you do? - CORRECT ANSWER Follow your pharmacy's procedures. do? - CORRECT ANSWER Process the application properly (without the requested revisions)—inform your supervisor and the compliance officer about the sales agent's request You discover an unattended email address or fax machine in your office receiving beneficiary appeals requests. You suspect no one is processing the appeals. What should you do? - CORRECT ANSWER Contact your compliance department (via compliance hotline or other mechanism) Correcting non-compliance________ - CORRECT ANSWER Protects enrollees, avoids recurrence of same non-compliance, and promotes efficiency What is the policy of non-retaliation? - CORRECT ANSWER Protects employees, who in good faith report suspected non-compliance Standards of Conduct are the same for every Medicare Parts C and D sponsor. - CORRECT ANSWER False At a minimum, an effective compliance program includes four core requirements. - CORRECT ANSWER False Compliance is the responsibility of the Compliance Officer, Compliance Committee, and Upper Management only. - CORRECT ANSWER False These are examples of issues that can be reported to a Compliance Department: suspected fraud, waste, and abuse (FWA), potential health privacy violation, and unethical behavior/employee misconduct. - CORRECT ANSWER True Medicare Parts C and D sponsors are not required to have a compliance program. - CORRECT ANSWER False Once a corrective action plan begins addressing non-compliance for fraud, waste, and abuse (FWA) committed by a Sponsor's employee or first-tier, downstream, or related entity's (FDR's) employee, ongoing monitoring of the corrective actions is not necessary. - CORRECT ANSWER False What are some of the consequences for non-compliance, fraudulent, or unethical behavior? a.Disciplinary action b.Termination of employment c.Exclusion from participating kin all Federal health care programs d.All of the above - CORRECT ANSWER All of the above Ways to report a compliance issue include: a.Telephone hotlines b.Report on the Sponsor's website c.In-person reporting to the compliance department/supervisor d.All of the above - CORRECT ANSWER All of the above Mary Samuels recently suffered a stroke while visiting her daughter and grandchildren. As a result, Mary has been admitted to a rehabilitation hospital where she is expected to reside for several months. The rehabilitation hospital is located outside the geographic area served by her current Medicare Advantage (MA) plan. What options are available to Mary regarding her health plan coverage? - CORRECT ANSWER Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan Richard is a licensed agent who represents Spartan Health Plan and its Medicare Advantage (MA) plans. Richard has several clients who have recently come to him for help who are in their initial coverage election period (ICEP) and are interested in enrolling in one of Spartan Health Plan's MA plans. Alice will soon turn 65 and retire. Alice has coverage through Spartan Health Plan offered by her employer. Bob had health coverage through Spartan but dropped the coverage when he retired early to travel overseas. Bob, who has just turned age 65, is now back in the United States. Charlotte, who will turn 65 next month, has coverage through Athena Health plan - a company Richard also represents. Who qualifies for the opt-in simplified enrollment mechanism? - CORRECT ANSWER Alice because she will not have a break between her non-Medicare and Medicare coverage through Spartan Health Plan. Mrs. Wu was primarily a homemaker and employed in jobs that provided taxable income only sporadically. Her husband worked full-time throughout his long career and paid Medicare taxes. She has heard that to qualify for Medicare Part A she has to have worked and paid Medicare taxes for a sufficient time. What should you tell her? - CORRECT ANSWER Since her husband paid Medicare taxes during the entire time he was working, she will automatically qualify for Medicare Part A without having to pay any premiums. Mr. Nguyen understands that Medicare prescription drug plans can use a formulary or list of covered drugs. He is suspicious about how plans establish these formularies. What should you tell him? - CORRECT ANSWER Formularies must be developed with input from pharmacists, doctors, and other experts. If a beneficiary is enrolled in a stand-alone prescription drug plan and wants to keep that plan, what type of Medicare health plan could the individual also enroll in, without being automatically disenrolled from the stand-alone prescription drug plan? - CORRECT ANSWER The beneficiary could enroll in a private fee-for-service (PFFS) plan that does not include prescription drug coverage; a Cost plan; or a Medicare Medical Savings Account (MSA) plan. Under ACA Section 1557, a health plan - CORRECT ANSWER cannot deny coverage to LEP individuals and is required to provide language assistance to them, free of charge. Which of the following would be considered permissible under Section 1557? - CORRECT ANSWER Broker Mary Jones has recruited a diverse workforce. She encourages her agents to prospect through community-based marketing and within their community of influence. Any person who knowingly submits false claims to the Government is liable for five times the Government's damages caused by the violator plus a penalty. - CORRECT ANSWER False You are working with several plans and community organizations to sponsor an educational event. When putting together advertisements for this event, what should you do? - CORRECT ANSWER You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. Agent Willis had several clients who disenrolled from the plans he represents during the AEP to enroll in Medicare Advantage plans that are competitors of his. Agent Willis believes that the choices they made are not ideal for them and would like to get their business back during the 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? - CORRECT ANSWER a. Cost plan enrollees can choose to receive Medicare covered services under the plan's benefits by going to plan network providers and paying plan cost sharing, or may receive services from non-network providers and pay cost-sharing due under Original Medicare. b. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to comply with CMS marketing requirements, including those regarding using only approved call scripts. - CORRECT ANSWER Ms. Lopez is an independent agent under contract with MarketCo, a third-party marketing organization. MarketCo has a contract with BestCare health plan, a Medicare Advantage (MA) organization, to offer marketing services through its contracted agents and agencies. Ms. Lopez returns calls to individuals who contact MarketCo in response to its mailers promoting BestCare health plan. Which of the following best describes the responsibilities of Ms. Lopez? a. Ms. Lopez is considered a marketing representative of BestCare but is exempt from the marketing rules regarding approved call scripts because she works directly for MarketCo. b. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to comply with CMS marketing requirements, including those regarding using only approved call scripts. c. Ms. Lopez no longer needs to be concerned about state licensure since she is marketing an MA product subject to federal rules. d. Ms. Lopez needs to maintain state licensure, but because she is working for a third-party marketing organization she is exempt from CMS training requirements that apply to BestCare captive agents. 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? - CORRECT ANSWER a. 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. 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? - CORRECT ANSWER b. Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO network. Julia Harris is turning 66 in July, at which time she will retire. She has contacted your office and requested a meeting so that she can learn about Medicare and the products you represent. How should you respond? - CORRECT ANSWER c. Tell Julia that you will meet with her to explain Medicare and should she be interested you can accept and submit an enrollment request, since this is an initial enrollment qualifying her for a special enrollment period. Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he sees an out-of-network doctor to receive a Medicare covered service. How much The doctor may only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid program.may the doctor collect from Mr. Rivera? - CORRECT ANSWER The doctor may only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid program. During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a type of Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would be available to her. What should you tell her about PFFS plans? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. A PFFS plan is a type of Medicare Supplement plan and she may enroll in one if it is available in her area. - CORRECT ANSWER b. A PFFS plan is exactly the same as Original Medicare, only offered by a private entity and she may enroll in one if it is available in her area. - CORRECT ANSWER c. PFFS plans are designed to cover only prescription drugs and if that is the type of coverage she wants, she may enroll in one if it is available in her area. - CORRECT ANSWER d. A PFFS plan is one of the various types of Medicare Advantage plans offered by private entities and she may enroll in one if it is available in her area. Question8 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER During an appointment scheduled to discuss a Medicare Advantage Prescription Drug plan (MA- PD), Mr. Peters asked his agent to describe a stand-alone prescription drug plan (Part D plan) that his neighbor told him about. What should his agent do? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. Since Mr. Peters requested a description of the Part D plan, his agent must leave the Part D plan brochure, but not an enrollment form, and would have to schedule another appointment after at least 48 hours have passed to discuss the Part D plan with Mr. Peters. - CORRECT ANSWER b. Since Mr. Peters requested a description of the Part D plan, his agent must have Mr. Peters sign a new scope of appointment form that includes Part D, and then the agent may discuss the Part D plan so Mr. Peters can compare plans and make an informed enrollment choice during the appointment. - CORRECT ANSWER c. Since Mr. Peters requested a description of the Part D plan, his agent must inform Mr. Peters that he can only sign up for the MA-PD plan and cannot receive a brochure or any other information about the Part D plan now because he did not agree in advance to discuss that plan - CORRECT ANSWER d. Since Mr. Peters requested a description of the Part D plan, his agent must discuss both the Part D and the MA-PD plans and return after at least 48 hours to complete the Part D plan enrollment form with Mr. Peters. Question9 - CORRECT ANSWER in the United States. Charlotte, who will turn 65 next month, has coverage through Athena Health plan - a company Richard also represents. Who qualifies for the opt-in simplified enrollment mechanism? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. Alice because she will not have a break between her non-Medicare and Medicare coverage through Spartan Health Plan. - CORRECT ANSWER b. Alice and Charlotte because each of them currently have health coverage and is in their initial coverage election period (ICEP). - CORRECT ANSWER c. Alice and Bob because each of them has had coverage through Spartan Health Plan. - CORRECT ANSWER d. Alice, Bob, and Charlotte because electronic health record interoperability will allow Richard to access any needed information for their applications. Question12 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER Under what conditions can a Medicare prescription drug plan reduce its coverage for a given drug during the first 60 days of the year? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. When a formulary change is in response to a drug's removal from the market. - CORRECT ANSWER b. When the Part D plan can demonstrate to CMS that no enrollee has accessed the medication in the past six months, generally the plan can remove the drug from its formulary within the first 60 days of the year. - CORRECT ANSWER c. Under no conditions can a Medicare Part D prescription drug plan reduce its coverage for a given drug at any point during the year. - CORRECT ANSWER d. If the Medicare prescription drug plan can show that reducing coverage early in the year will result in savings for the Part D plan and the Medicare program, generally the plan may make such a change. Question13 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER 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? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. You may only contact the retirees after the employer has notified them that they will be receiving a call. - CORRECT ANSWER b. You may call them but must record every call. - CORRECT ANSWER c. You may go ahead and call them. - CORRECT ANSWER d. You may not make any unsolicited contact with Medicare beneficiaries. The employer will have to tell its retirees to call you. Question14 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER 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? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. So long as the hospital or its physician staff don't object, marketing anywhere in the hospital is an acceptable practice. - CORRECT ANSWER b. As long as the marketing activities are conducted in a way that does not target healthy beneficiaries, it does not matter where in the hospital these activities are carried out. - CORRECT ANSWER c. Marketing in health care facilities is an acceptable practice, regardless of where it takes place. - CORRECT ANSWER d. 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. Question15 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER Mrs. Disraeli is enrolled in Original Medicare (Parts A and B) and a standalone Part D prescription drug plan. She has recently developed diabetes and has suffered from heart disease for several years. She has also recently learned that her area is served by a SNP for individuals suffering from such a combination of chronic diseases (C-SNP). Mrs. Disraeli is concerned Question18 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER Mrs. Sanchez lives in a state located near Canada. She has recently become eligible for Medicare and is considering enrollment in Part D prescription drug coverage. One of her friends has told her that she needs to be aware of something called TrOOP. What should you tell her when she asks you about TrOOP? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. TrOOP are out-of-pocket costs that count toward the annual out-of- pocket threshold to move into catastrophic coverage and generally include the annual deductible(s) and costs for drugs on the plan's formulary purchased at a plan's participating pharmacy. In some instances, amounts not directly paid by the enrollee (like manufacturer discounts) count toward TrOOP. - CORRECT ANSWER b. TrOOP is calculated on a cumulative basis and consists of the sum of an enrollee's out-of-pocket deductibles from the date of his or her enrollment in Part D plus outlays for over-the-counter drugs. - CORRECT ANSWER c. TrOOP is calculated on an annual basis and consists of an enrollee's out-of-pocket deductible plus any amounts paid on behalf of an enrollee by Medicaid. - CORRECT ANSWER d. TrOOP are out-of-pocket costs that count toward the annual out-of- pocket threshold to move into catastrophic coverage and generally include, in addition to the annual deductible, costs for drugs not on the Part D plan's formulary and drugs purchased outside the United States. Question19 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. Yes, but Mrs. Walters must drop the employer coverage prior to enrolling in a Medicare prescription drug plan. - CORRECT ANSWER b. No. Mrs. Walters will have to enroll in Part B in order to qualify for enrollment into the Medicare prescription drug program. - CORRECT ANSWER c. No. As long as her employer offers coverage that is equivalent to that available through Medicare, Mrs. Walters cannot enroll in a Medicare prescription drug plan. - CORRECT ANSWER d. Yes. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. Question20 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER 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? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. A PFFS plan offering only medical benefits or a PFFS Medigap Supplemental Insurance plan. - CORRECT ANSWER b. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D prescription drug coverage, a PFFS plan offering only medical benefits, or a PFFS plan in combination with a stand-alone prescription drug plan. - CORRECT ANSWER c. A stand-alone prescription drug plan in combination with a PFFS plan or a PFFS Medigap Supplemental Insurance plan. - CORRECT ANSWER d. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D prescription drug coverage, a PFFS plan offering only medical benefits, or PFFS Medigap Supplemental Insurance plan. Question21 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Where might he turn for help with his prescription drug costs? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. Mr. Wu has no alternative but to liquidate his remaining assets and apply for coverage through his state's Medicaid program. - CORRECT ANSWER b. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. - CORRECT ANSWER c. Mr. Wu may still qualify for help in paying for Part D costs through the Federal Pharmaceutical Assistance Program. - CORRECT ANSWER b. All that she needs to do is meet state licensure requirements moving forward. - CORRECT ANSWER c. Melanie will need to do nothing to continue receiving renewal fees since the initial sale was made when she met all requirements. - CORRECT ANSWER d. Melanie must remain trained, tested, licensed, and appointed, regardless of whether she is actively selling MA products. Question25 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER Agent Chan is conducting a sales presentation on senior issues where he hopes to enroll some attendees in the Medicare Advantage (MA) plans he represents. What action(s) may Agent Chan take during the event? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. Sell personal information obtained as part of a raffle to a third-party marketeer. - CORRECT ANSWER b. Discuss plan specific information such as premiums and benefits. - CORRECT ANSWER c. Indicate that in order participate attendees must provide their contact information. - CORRECT ANSWER d. Conduct free health screenings as part of the event. Question26 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER Mr. Decaro has looked at Medicare prescription drug plans available in his area and noted a wide range in premiums. He thought that all the drug plans were required to offer the same standard benefits and would like you to explain why there is such a range in premiums. What should you tell him? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. Medicare permits plans that have the highest quality services to reduce their premiums below the standard amount in order to increase their market share. This accounts for the variation in premium amounts. - CORRECT ANSWER b. Some prescription drug plans may have higher operating costs and/or may offer enhanced coverage in return for an additional premium amount. He could look at plan designs to see if one of the enhanced plans would serve his needs better than a plan based on the standard design. - CORRECT ANSWER c. The premiums differ because some plans intend to market to sicker beneficiaries and have set their premiums to reflect expected greater costs. - CORRECT ANSWER d. All drug plans must offer exactly the same coverage model. The difference in premium is a result of the differing financial estimates of the companies offering the plans. Question27 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims for services. What advice would you give her? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received the MSN in the mail. - CORRECT ANSWER b. Mrs. Duarte should file an appeal of this initial determination within 90 days of the date she received the MSN in the mail. If she still disagrees with Medicare Administrative Contractor's (MAC's) further decision she should request a reconsideration by a qualified independent party within 10 days. - CORRECT ANSWER c. Mrs. Duarte has no right to appeal this determination since her claim has been partially paid. - CORRECT ANSWER d. Mrs. Duarte should request a reconsideration of the decision by a qualified independent party within 60 days of the date she received the MSN in the mail. Question28 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER Ms. Hernandez has marketed several different types of insurance products in her home state and has typically sought approval of her materials from her State Department of Insurance. What would you advise her regarding seeking such approval for materials she uses to market Medicare Advantage plans? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. Obtaining approval of her materials from the State Department of Insurance is a good practice and she should continue it with materials for the Medicare health plans she represents. Marks: 1 - CORRECT ANSWER Agent Willis had several clients who disenrolled from the plans he represents during the AEP to try new Medicare Advantage plans. Agent Willis believes that the choices they made are not ideal for them and would like to get their business back during the Medicare Advantage Open Enrollment Period (MA-OEP). What can agent Willis do? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. He can call them to let them know that if they do not like their new plans, they can change back during the MA-OEP. - CORRECT ANSWER b. He can e-mail them in January and ask them to let him know if they are not happy with their new plans. - CORRECT ANSWER c. He can send them information about the MA-OEP along with a flyer on the plans he represents. - CORRECT ANSWER d. He can wait until October and send them information about the plans he represents. Question32 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER Mr. McTaggert notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know what makes them different from an HMO or a PPO. What should you tell him? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. If offered, beneficiaries can select a stand-alone Part D prescription drug plan (PDP) with an HMO or a PPO, but not with a PFFS plan. - CORRECT ANSWER b. Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts Original Medicare, as long as the provider has a reasonable opportunity to access the plan's terms and conditions and agrees to accept them. - CORRECT ANSWER c. PFFS plans are the same as Medicare supplement plans and he may obtain care from any provider in the U.S. - CORRECT ANSWER d. If a PFFS enrollee shows his/her card when obtaining services from a provider who participates in Original Medicare, then that provider is required to accept the plan's terms and conditions. Question33 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER This year you decide to focus your efforts on marketing to employer and union groups. Which of the following statements best describes what you can and cannot do in order to stay in compliance? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. You do not need to complete a scope of appointment, but CMS can ask you to reconstruct one if there is a subsequent employee complaint. - CORRECT ANSWER b. You can make unsolicited contacts but you cannot cross-sell other products. - CORRECT ANSWER c. You do not need to take an annual test, but you must not provide potential enrollees with more than light snacks at presentations. - CORRECT ANSWER d. You are not required to submit communication and marketing materials specific only to those employer plans to CMS at the time of use, but CMS may request and review copies if employee complaints occur. Question34 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER 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? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. Tell the client that she cannot speak to her until after open enrollment begins on January 1st of the following year. - CORRECT ANSWER b. Inquire whether the client qualifies for a special enrollment period, and if not, solicit an enrollment application once the annual open enrollment election period begins on October 15th. - CORRECT ANSWER c. Solicit and complete the enrollment application in September and wait until the open enrollment date to submit it so that the client does not purchase a plan through another agent. - CORRECT ANSWER d. Tell the client that she should also consider non-health products (such as cash value life insurance) to meet some of her health needs and offer to submit a life insurance application to see if client Jones is insurable. - CORRECT ANSWER d. Mrs. Tanner can go to non-plan doctors for certain services without receiving prior approval. Question38 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER 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? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. Inpatient psychiatric services are not covered under Original Medicare. - CORRECT ANSWER b. Medicare inpatient psychiatric coverage is limited to the same number of days covered for typical inpatient stays. - CORRECT ANSWER c. Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime. - CORRECT ANSWER d. Medicare will cover, at its allowable amount, as many stays as are needed throughout Mr. Rainey's life, as long as no single stay exceeds 190 days. Question39 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a PPO that does not include drug coverage. What should you tell her about obtaining drug coverage? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. - CORRECT ANSWER b. She can enroll in the PPO and purchase drug coverage through a Medigap plan. - CORRECT ANSWER c. She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan. - CORRECT ANSWER d. She can enroll in the PPO and if she decides that she wants drug coverage, she will be able to drop her PPO at any time in favor of a Medicare Advantage plan that includes such drug coverage. Question40 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER Mr. Olsen is concerned that a Medicare Advantage plan will not cover the same range of services that would be covered under Original fee-for-service Medicare. What should you tell him? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. Medicare Advantage plans are required to create a benefits package that results in roughly equivalent costs and may exclude coverage for some items and services that are covered under Part A and/or Part B of Original Medicare. - CORRECT ANSWER b. Though their cost-sharing may differ from Original Medicare's, Medicare Advantage plans are required to cover all services covered by original Medicare. - CORRECT ANSWER c. Medicare Advantage plans are required to cover services mandated under health care reform and applicable state law, which may differ from the Original Medicare package of benefits. - CORRECT ANSWER d. Medicare Advantage plans differ from Original Medicare in that they are required to cover any service ordered by a physician. Question41 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER Ms. Brooks has an aggressive cancer and would like to know if Medicare will cover hospice services in case she needs them. What should you tell her? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. The Federal government facilitates competition between hospice programs to lower the price of their services for Medicare beneficiaries, but does not offer coverage for hospice services through the Medicare program. - CORRECT ANSWER b. Medicare does not cover hospice services. Hospice services are only available through state Medicaid programs, if the state offers such coverage. - CORRECT ANSWER c. Hospice services are currently only offered under a limited demonstration project. Whether they will eventually become available nationally depends on the outcomes of the demonstration. - CORRECT ANSWER d. Medicare covers hospice services and they will be available for her. - CORRECT ANSWER a. She will have to obtain a job and work enough years to qualify for Medicare Part A. - CORRECT ANSWER b. She will have to pay the monthly Part A premium in order to obtain the coverage. - CORRECT ANSWER c. Because her husband paid Medicare taxes, and she rarely did, she will have to pay Part A premiums but will do so at a reduced rate. - CORRECT ANSWER d. Since her husband paid Medicare taxes during the entire time he was working, she will automatically qualify for Medicare Part A without having to pay any premiums. Question45 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefits package of a Medicare Health Plan before she starts looking at specific plans. What could you tell her? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. All Medicare Health Plans offer cost-sharing that is lower than Original Medicare for all Part A and Part B covered services, but the maximum out-of-pocket limit is higher than in Original Medicare. - CORRECT ANSWER b. Medicare Health Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental services and must include a maximum out-of-pocket limit on Part A and Part B services. - CORRECT ANSWER c. Medicare Health Plans do not necessarily have to cover all of the Original Medicare Part A and Part B services, but must include a maximum out-of-pocket limit. - CORRECT ANSWER d. Medicare Health Plans are not permitted to offer any benefits beyond those available under the Original Medicare program and must have the same maximum out-of-pocket limit on Part A and Part B services as FFS Medicare. Question46 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER 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? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. The neighbors may not provide a meal, but light snacks would be permitted. - CORRECT ANSWER b. Any type of meal or food is allowed, as long as it is available to the general public and not just to those who are eligible to enroll in the plans. - CORRECT ANSWER c. The neighbors may not provide anything to either eat or drink during the sales presentation. - CORRECT ANSWER d. Any meal is allowed, as long as it is valued at less than $15. Question47 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER 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? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER - CORRECT ANSWER a. Medicaid beneficiaries are not eligible for enrollment into a PFFS plan. They must obtain their care through their state's Medicaid program. - CORRECT ANSWER b. Medicaid will cover all of her PFFS out-of-pocket costs and Medicaid providers will accept amounts paid by the PFFS plan as payment in full. - CORRECT ANSWER c. Medicaid may provide additional benefits, but Medicaid will coordinate benefits only with Medicaid participating providers. - CORRECT ANSWER d. If Mrs. Andrews joins a PFFS plan, the State will not cover any of her medical expenses because she will be using only Medicare providers. Question48 - CORRECT ANSWER Marks: 1 - CORRECT ANSWER Alice is enrolled in a MA-PD plan. She makes a permanent move across the country and wonders what her options are for continuing MA-PD coverage. What would you say to her in regard to a special enrollment period (SEP)? - CORRECT ANSWER Choose one answer. - CORRECT ANSWER