AHIP Final Exam EXAM 2024 AND PRACTICE QUESTIONS |ACCURATE ANSWERS| VERIFIED, Exams of Nursing

Download AHIP Final Exam EXAM 2024 AND PRACTICE QUESTIONS |ACCURATE ANSWERS| VERIFIED and more Exams Nursing in PDF only on Docsity! AHIP Final Exam EXAM 2024 AND PRACTICE QUESTIONS |ACCURATE ANSWERS| VERIFIED FOR GUARANTEED PASS |GRADED A |NEW VERSION WITH 150+ QUESTIONS Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Plan F in which he is enrolled. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. What should you tell her? - CORRECT ANS-You are sorry to disappoint Anita, but a Medigap F plan is no longer available to those who turn age 65 after January 1, 2020. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida. Hank, the store owner, has provided excellent health benefits to the store's workforce. William, one of the store's long-time employees, will soon be reaching age 65 and eligible for Medicare. William is in good health. He intends to remain an active full-time employee, working several years after becoming eligible for Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to offer William? - CORRECT ANS-Hank's can continue to offer William the same employee health benefit plan, or, if William enrolls in Medicare Part B, it can enroll him in a Medicare Advantage plan that is offered to the public. Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do? - CORRECT ANS-He will have to enroll in Part B. Mrs. Velasquez cares for her frail elderly mother, Maria, who lives in North Carolina. She is worried that without additional support, her mother will need to go into a nursing home. Mrs. Velasquez asks you if there is any Medicare plan that might allow her mother to remain in the community rather than going into a nursing home. How should you advise Mrs. Velasquez? - CORRECT ANS-There are Programs of All-Inclusive Care for the Elderly (PACE) for frail elderly beneficiaries certified as needing a nursing home level of care but are able to live safely in the community at the time of enrolment. 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 ANS-I, II, and IV only 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 ANS-Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D 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 ? - CORRECT ANS-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. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What should you tell her? - CORRECT ANS-She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. 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? - CORRECT ANS-There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. 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 ANS-You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare Advantage (MA) plan? - CORRECT ANS-She cannot enroll in an MA Medical Savings Account (MSA) plan. Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know whether he might qualify. What should you tell him? - CORRECT ANS-The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. 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? - CORRECT ANS-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. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. In addition to drugs on his plan's formulary, he takes several other medications. These include a prescription drug not on his plan's formulary, over-the-counter medications for colds and allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to promote hair growth and reduce joint swelling. His neighbor recently told him about a concept called TrOOP and he asks you if any of his other medications could count toward TrOOP should he ever reach the Part D catastrophic limit. What should you say. - CORRECT ANS-None of the costs of Mr. Wingate's other medications would currently count toward TrOOP but he may wish to ask his plan for an exception to cover the prescription, not on its formulary. What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? - CORRECT ANS-Part D plans do not have to cover all medications. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. In addition, they can use cost containment techniques such as tiered co-payments and step therapy. Mrs. Mulcahy, age 65, 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? - CORRECT ANS-An individual 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. 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 ANS-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 ANS-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. Who is most likely to benefit from the Medicare Prescription Payment Plan? - CORRECT ANS-Kevin, who suffered a heart attack at the beginning of the year requiring him to take an expensive brand name blood thinner on a daily, as well as an equally expensive injectable cholesterol medication on a bi-weekly basis for which he incurs high out-of-pocket costs. Mr. Rice is 68, actively working, and has coverage for medical services and medications through his employer's group health plan. He is entitled to premium free Part A and thinking of enrolling in Part B and switching to an MA-PD because he is paying a very large part of his group coverage premium, and it does not provide coverage for a number of his medications. Which of the following is NOT a consideration when making the change? - CORRECT ANS-Mr. Rice's retiree plan is required to take him back if, within 63 days of having voluntarily quit the employer's plan, he decides that he prefers it to his Medicare Part D plan. Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. She is interested in selecting a Medicare Part D prescription drug plan. She takes several 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? - CORRECT ANS-Every Part D drug plan is required to cover a single one-month fill of her existing medications sometime during a 90- day transition period. 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? - CORRECT ANS-You must have her sign a scope of appointment form, indicating which products she wishes to discuss. You may then proceed with the discussion. While making an appointment to discuss Medicare Advantage (MA) and Part D plans with a potential enrollee, you are asked to describe other types of insurance products that your client might wish to purchase. What additional types of insurance can you present during the MA and Part D marketing appointments? - CORRECT ANS-You can present only health care related lines of business but must obtain the beneficiary's permission to do so before the presentation occurs and document that you have obtained that permission. One of your colleagues argues that it is better to focus your time and energy exclusively on neighborhoods with single-family homes. He further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. How should you respond? - CORRECT ANS- This could be considered discriminatory activity and a prohibited practice. Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings distributes materials that are solely educational. 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? - CORRECT ANS-Yes. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for Medicare & Medicaid Services (CMS) Communication and Marketing Guidelines to ensure he is compliant with which type of products. - CORRECT ANS-Medicare Advantage (MA) and Prescription Drug (PDP) plans. Next week you will be participating in your first "educational event" for prospective enrollees. To be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage? - CORRECT ANS-You should plan to ensure that the educational event is informative and must not conduct a sales presentation or distribute or accept enrollment forms at the event. You market many different types of insurance and ordinarily you spend time each evening calling potential clients. To comply with requirements for marketing Medicare Advantage and Part D plans, what must you do about contacting potential clients to market those plansl? - CORRECT ANS-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. If you are to comply with Medicare's guidance regarding educational events, which of the following would be acceptable activities? - CORRECT ANS-You may distribute business cards to individuals who request information on how to contact you for further details on the plan(s) you represent. 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 benefits package. What should you do to make sure your clients know about these pieces of information? - CORRECT ANS-You may make comparisons between plans if you can support them with studies or statistical data and such comparisons are factually based and referenced. You have set up an appointment for an in-home sales presentation with Mrs. Fernandez, who expressed interest in the Medicare plans you represent. In preparation for the sales presentation, what must you do? - CORRECT ANS-Before conducting the presentation, obtain and document having obtained her permission to visit, along with her interest in the specific products you will present. 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? - CORRECT ANS-Winthrop Brokerage does not need to submit the advertisement to CMS for prior approval because it does not include information about the plans' benefits structures, cost-sharing, or information about measures or ranking standards. 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? - CORRECT ANS-You may request RSVPs, but you are not permitted to require contact information. Your colleague works at a third-party marketing organization (TMO) and she said she did not need to take the Medicare training for brokers and agents or pass a test to market Medicare plans since her contract is with the TMO, not the plans that have the products she sells. What could you say to her? - CORRECT ANS-You could tell her she is wrong, and that only agents selling employer/union group plans are permitted an exemption from testing, but some employer/union group plans may require testing to promote agent compliance with CMS marketing requirements. You are meeting with Mrs. Hall in her home. On her scope of appointment form, she asked to discuss Medicare Advantage plans. During the meeting, she asked to discuss a stand-alone prescription drug plan. She is leaving the next day to visit her family for a week in another state, so she needs to decide before she leaves. What must happen before that additional discussion can take place? - CORRECT ANS-Since Mrs. Hall specifically asked that you discuss the stand- alone Part D plan, you may do so, as long as she signs a new scope of appointment form first, indicating that she wants to discuss the Part D plan. 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? - CORRECT ANS-You should tell your colleague no, because marketing representatives are not permitted to participate, in any way, in an educational event. You will be holding a sales event soon, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation - CORRECT ANS-Gift cards or gift certificates of $15 or less that can be readily converted to cash. When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan? - CORRECT ANS-You may provide gifts or prizes to all potential enrollees during an event that does not exceed $15 in retail value. residence until the Annual Election Period. What should you tell her? - CORRECT ANS-She is eligible for a special election period (SEP) that begins either the month before her permanent move, if the plan is notified in advance, or the month she provides notice of the move, and this period typically lasts an additional two months. 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? - CORRECT ANS-If Mr. Block enrolls in the stand-alone Medicare prescription drug plan, he will be disenrolled from the Medicare Advantage plan. Mr. Wendt suffers from diabetes which has gotten progressively worse during the last year. He is currently enrolled in Original Medicare (Parts A and B) and a Part D prescription drug plan and did not enroll in a Medicare Advantage (MA) plan during the last annual open enrollment period (AEP) which has just closed. Mr. Wendt has heard certain MA plans might provide him with more specialized coverage for his diabetes and wants to know if he must wait until the next annual open enrollment period (AEP) before enrolling in such a plan. What should you tell him? - CORRECT ANS-If there is a special needs plan (SNP) in Mr. Wendt's area that specializes in caring for individuals with diabetes, he may enroll in the SNP at any time under a special election period (SEP). Mr. Yoo's employer has recently dropped comprehensive creditable prescription drug coverage that was offered to company retirees. The company told Mr. Yoo that, because he was affected by this change, he would qualify for a special election period. Mr. Yoo contacted you to find out more about what this means. What can you tell him? - CORRECT ANS-It means that he qualifies for a one-time opportunity to enroll in an MA-PD or Part D prescription drug plan. Ms. Claggett 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" (IEP) 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? - CORRECT ANS-Ms. Claggett has had two IEPs and missed them both. The first occurred three months before and three months after the month when she was first entitled to Part A OR enrolled in Part B. Because she was eligible for Medicare before age 65, Ms. Claggett had a second IEP based on turning age 65, which has also expired. Ms. Thomas has worked for many years and is turning 68 in June. She is eligible for Medicare Part A and did not enroll for Part B when first eligible because she has insurance through her employer - Coffee Brew, Inc. She also did not enroll in Part D because she had creditable coverage. She would like to retire in June and enroll in a Medicare Advantage plan. She has been informed that her group coverage will end on her retirement effective date. How would you advise Ms. Thomas? - CORRECT ANS-Ms. Thomas can enroll in Part B without a late penalty at any time she is still covered by her employer group and 8 months after her last month of employer group coverage without a penalty. However, because she wants to enroll in a MA plan after retirement, she should make sure her Part B coverage is effective in time to use the Medicare Advantage/Part D special election period for individuals changing from employer group coverage to enroll in a MA plan or MA-PD. The SEP begins while she has employer group coverage and will last until 2 months after the month after the month her employer coverage ends. If she wants Part D coverage she should enroll in an MA-PD or a PDP (depending on how she decides to receive her Part A and B benefits) during this time. 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? - CORRECT ANS-If the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage. 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? - CORRECT ANS-It is a period, outside of the Annual Election Period, when a Medicare beneficiary can select a new or different Medicare Advantage and/or Part D prescription drug plan. Typically, the special election period is beneficiary specific and results from events, such as when the beneficiary moves outside of the service area. Mrs. Kendrick is in good health, has worked for many years, and 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? - CORRECT ANS-She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. Which of the following individuals has enrolled in a plan based on a fixed enrollment period? - CORRECT ANS-Ben enrolls in a Medicare Advantage plan during the Medicare Advantage Open Enrollment Period (MA OEP). Mrs. Ridgeway enrolled in Original Medicare and Medigap coverage following her retirement several years ago. Four months ago, Mrs. Ridgeway dropped her Medigap policy to enroll in a Medicare Advantage (MA) plan for the first time. Unfortunately, Mrs. Ridgeway has found that many of her providers are not in the MA plan's network. She has come to you for advice. What should you tell her? - CORRECT ANS-She qualifies for a special election period (SEP) that will allow her to make a one-time election to return to Original Medicare and she also has a guaranteed eligibility period to rejoin her Medigap plan. Mrs. 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 before the start of the annual enrollment period (AEP). What would you say If you were advising Agent Adams? - CORRECT ANS-This is a bad idea. Agents are generally prohibited from soliciting or accepting an enrollment form before the start of the AEP. 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 ANS-Alice and Charlotte because each of them currently have health coverage and is in their initial coverage election period (ICEP). 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 ANS-She is likely to qualify for a SEP. She can choose an effective date of up to three months after the month in which the enrollment form is received by the new plan, but the effective date may not be earlier than the date of her permanent move. 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 ANS-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 ANS-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. Choose one answer. - CORRECT ANS- - CORRECT ANS-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 ANS-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 ANS-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 ANS-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 ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-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 ANS-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 ANS-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 ANS-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 ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-a. In general, he must select a single Part D premium payment mechanism that will be used throughout the year. - CORRECT ANS-b. As long as he fills out the paperwork to begin withholding from his Social Security check at least 63 days before such withholding should begin, he can change his method of Part D premium payment and withholding will begin the month after his savings account is exhausted. - CORRECT ANS-c. During 2017, many people experienced significant problems with deductions from their Social Security check for their Part D premium. As a result, this method of payment is no longer an option for Part D premium payments - CORRECT ANS-d. In general, to pay his Part D premium, he only can have automatic withdrawals made from a checking account, so he will need to transfer the funds prior to beginning such withdrawals. Question10 - CORRECT ANS- Marks: 1 - CORRECT ANS- Since 2004 Ms. Eisenberg has had a Medigap plan that provides some drug coverage. She has recently received a letter from her Medigap carrier informing her that her drug coverage is not "creditable." She wants to know what this means. What should you tell her? - CORRECT ANS- - CORRECT ANS-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 ANS-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 ANS-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 ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-a. You may only contact the retirees after the employer has notified them that they will be receiving a call. - CORRECT ANS-b. You may call them but must record every call. - CORRECT ANS-c. You may go ahead and call them. - CORRECT ANS-d. You may not make any unsolicited contact with Medicare beneficiaries. The employer will have to tell its retirees to call you. Question14 - CORRECT ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-a. So long as the hospital or its physician staff don't object, marketing anywhere in the hospital is an acceptable practice. - CORRECT ANS-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 ANS-c. Marketing in health care facilities is an acceptable practice, regardless of where it takes place. - CORRECT ANS-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 ANS- Marks: 1 - CORRECT ANS- Mrs. Disraeli is enrolled in Original Medicare (Parts A and B) and a standalone Part D prescription drug plan. She has recently developed diabetes and has suffered from heart disease for several years. She has also recently learned that her area is served by a SNP for individuals suffering from such a combination of chronic diseases (C-SNP). Mrs. Disraeli is concerned however, that she will have few rights or protections if she enrolls in a C-SNP. How would you respond? - CORRECT ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-a. The SNP would select her primary care provider (PCP) but she could file a grievance within 90 days if the PCP proved incapable. - CORRECT ANS-b. Mrs. Disraeli would have substantial restrictions on obtaining emergency care and must use network facilities or be responsible for most emergency care costs. - CORRECT ANS-c. Enrollees, while able to select their primary care provider (PCP), do have substantial restrictions and financial responsibilities regarding emergency care whether obtained at in-network or out-of-network facilities. - CORRECT ANS-d. Enrollees in SNPs must have access to provider networks that include enough doctors, specialists, and hospitals to provide all covered services necessary to meet enrollee needs within reasonable travel time. Question16 - CORRECT ANS- Marks: 1 - CORRECT ANS- Mr. Lopez takes several high-cost prescription drugs. He would like to enroll in a standalone Part D prescription drug plan that is available in his area. In what type of Medicare Health Plan can he enroll? - CORRECT ANS- Choose one answer. - CORRECT ANS- Question19 - CORRECT ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-a. Yes, but Mrs. Walters must drop the employer coverage prior to enrolling in a Medicare prescription drug plan. - CORRECT ANS-b. No. Mrs. Walters will have to enroll in Part B in order to qualify for enrollment into the Medicare prescription drug program. - CORRECT ANS-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 ANS-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 ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-a. A PFFS plan offering only medical benefits or a PFFS Medigap Supplemental Insurance plan. - CORRECT ANS-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 ANS-c. A stand-alone prescription drug plan in combination with a PFFS plan or a PFFS Medigap Supplemental Insurance plan. - CORRECT ANS-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 ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-a. Mr. Wu has no alternative but to liquidate his remaining assets and apply for coverage through his state's Medicaid program. - CORRECT ANS-b. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. - CORRECT ANS-c. Mr. Wu may still qualify for help in paying for Part D costs through the Federal Pharmaceutical Assistance Program. - CORRECT ANS-d. Mr. Wu may still qualify for help in paying for Part D costs through the local Office of the Aging. Question22 - CORRECT ANS- Marks: 1 - CORRECT ANS- Ms. Stuart has heard about a special needs plan (SNP) that one of her friends is enrolled in and is interested in that product. She wants to be sure she also has coverage for prescription drugs. Would she be able to obtain drug coverage if she enrolled in the SNP? - CORRECT ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-a. Yes. All SNPs are required to provide Part D coverage for prescription drugs. - CORRECT ANS-b. Yes, but only if she qualifies for Part D prescription drug coverage under her state Medicaid program. - CORRECT ANS-c. Maybe. Some SNPs offer Part D coverage for prescription drugs and some do not. - CORRECT ANS-d. No. Medicare beneficiaries who enroll in an SNP must always obtain their drug coverage through a stand-alone Part D Medicare prescription drug plan that they sign up for independent of their enrollment in the SNP. - CORRECT ANS-c. Indicate that in order participate attendees must provide their contact information. - CORRECT ANS-d. Conduct free health screenings as part of the event. Question26 - CORRECT ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-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 ANS-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 ANS-c. The premiums differ because some plans intend to market to sicker beneficiaries and have set their premiums to reflect expected greater costs. - CORRECT ANS-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 ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-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 ANS-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 ANS-c. Mrs. Duarte has no right to appeal this determination since her claim has been partially paid. - CORRECT ANS-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 ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-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. - CORRECT ANS-b. Materials for marketing Medicare health plans to individuals are subject to Medicare's uniform national requirements. They do not need to be reviewed by the state, but the company she represents must obtain approval from the Medicare agency (CMS) for any materials she uses. - CORRECT ANS-c. Materials need only be reviewed and approved by the company(s) she represents. - CORRECT ANS-d. States often volunteer to review marketing materials on behalf of the Medicare agency. She should check with her Department of Insurance to see if such a review is available and would satisfy CMS requirements. Question29 - CORRECT ANS- Marks: 1 - CORRECT ANS- Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know whether he might qualify. What should you tell him? - CORRECT ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-d. He can wait until October and send them information about the plans he represents. Question32 - CORRECT ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-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 ANS-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 ANS-c. PFFS plans are the same as Medicare supplement plans and he may obtain care from any provider in the U.S. - CORRECT ANS-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 ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-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 ANS-b. You can make unsolicited contacts but you cannot cross-sell other products. - CORRECT ANS-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 ANS-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 ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-a. Tell the client that she cannot speak to her until after open enrollment begins on January 1st of the following year. - CORRECT ANS-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 ANS-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 ANS-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. Question35 - CORRECT ANS- Marks: 1 - CORRECT ANS- Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What should you tell him? - CORRECT ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-a. Part D prescription drug coverage can only be obtained by enrollment into a Medicare Advantage plan that also covers Part A and Part B services. - CORRECT ANS-b. Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare. - CORRECT ANS-a. Inpatient psychiatric services are not covered under Original Medicare. - CORRECT ANS-b. Medicare inpatient psychiatric coverage is limited to the same number of days covered for typical inpatient stays. - CORRECT ANS-c. Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime. - CORRECT ANS-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 ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-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 ANS-b. She can enroll in the PPO and purchase drug coverage through a Medigap plan. - CORRECT ANS-c. She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan. - CORRECT ANS-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 ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-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 ANS-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 ANS-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 ANS-d. Medicare Advantage plans differ from Original Medicare in that they are required to cover any service ordered by a physician. Question41 - CORRECT ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-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 ANS-b. Medicare does not cover hospice services. Hospice services are only available through state Medicaid programs, if the state offers such coverage. - CORRECT ANS-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 ANS-d. Medicare covers hospice services and they will be available for her. Question42 - CORRECT ANS- Marks: 1 - CORRECT ANS- Which of the following statements is correct about the appeal and grievance processes? - CORRECT ANS- I. Enrollees have a right to obtain a review (appeal) of certain decisions about prescription drug coverage. - CORRECT ANS- - CORRECT ANS-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 ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-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 ANS-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 ANS-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 ANS-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 ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-a. The neighbors may not provide a meal, but light snacks would be permitted. - CORRECT ANS-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 ANS-c. The neighbors may not provide anything to either eat or drink during the sales presentation. - CORRECT ANS-d. Any meal is allowed, as long as it is valued at less than $15. Question47 - CORRECT ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-a. Medicaid beneficiaries are not eligible for enrollment into a PFFS plan. They must obtain their care through their state's Medicaid program. - CORRECT ANS-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 ANS-c. Medicaid may provide additional benefits, but Medicaid will coordinate benefits only with Medicaid participating providers. - CORRECT ANS-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 ANS- Marks: 1 - CORRECT ANS- 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 ANS- Choose one answer. - CORRECT ANS- - CORRECT ANS-a. She is unlikely to qualify for a SEP but will be automatically covered by Original Medicare and a standalone Part D prescription drug plan. - CORRECT ANS-b. She is likely to qualify for a SEP. She can choose an effective date of up to three months after the month in which the enrollment form is received by the new plan, but the effective date may not be earlier than the date of her permanent move.