AHIP FINAL EXAM Questions and Answers Rated A+ Latest Versions 2024, Exams of Nursing

Download AHIP FINAL EXAM Questions and Answers Rated A+ Latest Versions 2024 and more Exams Nursing in PDF only on Docsity! AHIP FINAL EXAM Questions and Answers Rated A+ Latest Versions 2024 Mr., Moy’s, wife ,has ,a ,Medicare ,Advantage ,plan, ,but ,he ,wants ,to ,understand ,what coverage ,Medicare ,Supplemental ,Insurance ,provides ,since ,his ,health ,care ,needs ,are,different ,from ,his ,wife's ,needs. ,What ,could ,you ,tell ,Mr. ,Moy?correct ,answersMedicare,Supplemental ,Insurance ,would ,help ,cover ,his ,Part ,A ,and ,Part ,B ,deductibles ,or coinsurance ,in ,Original ,Fee-for- Service ,(FFS) ,Medicare ,as ,well ,as ,possibly ,some services ,that ,Medicare ,does ,not ,cover. 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 ,answersShe ,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. Mrs. ,Chen ,will ,be ,65 ,soon, ,has ,been ,a ,citizen ,for ,twelve ,years, ,has ,been ,employed ,full time, ,and ,paid ,taxes ,during ,that ,entire ,period. ,She ,is ,concerned ,that ,she ,will ,not ,qualify,for ,coverage ,under ,part ,A ,because ,she ,was ,not ,born ,in ,the ,United ,States. ,What ,should,you ,tell ,her?correct ,answersMost ,individuals ,who ,are ,citizens ,and ,age ,65 ,or ,over ,are covered ,under ,Part ,A ,by ,virtue ,of ,having ,paid ,Medicare ,taxes ,while ,working, ,though some ,may ,be ,covered ,as ,a ,result ,of ,paying ,monthly ,premiums. ,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 ,answersMedicare ,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. ,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 ,answersBeneficiaries ,under,Original ,Medicare ,have ,no ,cost-sharing ,for ,most ,preventive ,services ,which ,include immunizations ,such ,as ,annual ,flu ,shots. 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 answersMrs. ,Duarte ,should ,file ,an ,appeal ,of ,this ,initial ,determination ,within ,120 ,days ,of,the ,date ,she ,received ,the ,MSN ,in ,the ,mail. 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 ,answersIt ,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 ,answersShe ,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. ,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 ,answersMedicare will ,cover ,a ,total ,of ,190 ,days ,of ,inpatient ,psychiatric ,care ,during ,Mr. ,Rainey's ,entire lifetime. 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 ,answersPart,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. 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 ,answersTell prospect ,Jerry ,Smith ,that ,he ,should ,consider ,adding ,a ,standalone ,Part ,D ,prescription drug ,coverage ,policy ,to ,his ,present ,coverage. 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 ,answersAfter ,receiving ,such ,disability ,payments ,for ,24 ,months, ,he ,will ,be,automatically ,enrolled ,in ,Medicare, ,regardless ,of ,age. Mr. ,Buck ,has ,several ,family ,members ,who ,died ,from ,different ,cancers. ,He ,wants ,to,know ,if ,Medicare ,covers ,cancer ,screening. Mr. ,Gomez ,notes ,that ,a ,Private ,Fee-for-Service ,(PFFS) ,plan ,available ,in ,his ,area ,has an ,attractive ,premium. ,He ,wants ,to ,know ,if ,he ,must ,use ,doctors ,in ,a ,network ,as ,his current ,HMO ,plan ,requires ,him ,to ,do. ,What ,should ,you ,tell ,him?correct ,answersHe ,may ,receive ,health ,care ,services ,from ,any ,doctor ,allowed ,to ,bill ,Medicare, ,as ,long ,as ,he shows ,the ,doctor ,the ,plan's ,identification ,card ,and ,the ,doctor ,agrees ,to ,accept ,the ,PFFS,plan's ,payment ,terms ,and ,conditions, ,which ,could ,include ,balance ,billing. Mr. ,Wells ,is ,trying ,to ,understand ,the ,difference ,between ,Original ,Medicare ,and Medicare ,Advantage. ,What ,would ,be ,the ,correct ,description?correct ,answersMedicare Advantage ,is ,a ,way ,of ,covering ,all ,the ,Original ,Medicare ,benefits ,through ,private ,health,insurance ,companies. 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 ,answersMrs. ,Chi ,may ,enroll ,in ,a ,MA ,MSA ,plan ,and ,remain ,in ,her ,current ,standalone ,Part ,D ,prescription ,drug ,plan. 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 ,answers. C-SNP 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 ,answersShe could ,file ,a ,grievance ,with ,her ,plan ,to ,complain ,about ,the ,lack ,of ,timeliness ,in ,getting ,an,appointment. 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 answersSNPs ,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. Mrs. ,Radford ,asks ,whether ,there ,are ,any ,special ,eligibility ,requirements ,for ,Medicare Advantage. ,What ,should ,you ,tell ,her?correct ,answersMrs. ,Radford ,must ,be ,entitled ,to,Part ,A ,and ,enrolled ,in ,Part ,B ,to ,enroll ,in ,Medicare ,Advantage. 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 ,answersMedicaid ,may ,provide ,additional ,benefits, ,but,Medicaid ,will ,coordinate ,benefits ,only ,with ,Medicaid ,participating ,providers. 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 ,answersHe ,is ,not ,eligible ,to ,enroll ,in ,a ,Medicare Advantage ,plan ,until ,he ,re-enrolls ,in ,Medicare ,Part ,B. Mrs. ,Davenport ,enrolled ,in ,the ,ABC ,Medicare ,Advantage ,(MA) ,plan ,several ,years ,ago. In ,mid-February ,of ,2021, ,her ,doctor ,confirms ,a ,diagnosis ,of ,end-stage ,renal ,disease ,(ESRD). ,What ,options ,will ,Mrs. ,Davenport ,have ,regarding ,her ,MA ,plan ,during ,the ,next open ,enrollment ,season?correct ,answersShe ,may ,remain ,in ,her ,ABC ,MA ,plan, ,enroll ,in ,another ,MA ,plan ,in ,her ,service ,area, ,or ,enroll ,in ,a ,Special ,Needs ,Plan ,(SNP) ,for individuals ,suffering ,from ,ESRD ,if ,one ,is ,available ,in ,her ,area. Mr. ,Kumar ,is ,considering ,a ,Medicare ,Advantage ,HMO ,and ,has ,questions ,about ,his ability ,to ,access ,providers. ,What ,should ,you ,tell ,him?correct ,answersIn ,most ,Medicare,Advantage ,HMOs, ,Mr. ,Kumar ,must ,generally ,obtain ,his ,services ,only ,from ,providers within ,the ,plan's ,network ,(except ,in ,an ,emergency ,or ,where ,care ,is ,unavailable ,within the ,network).ur ,clients, ,Lauren ,Nichols, ,has ,heard ,about ,a ,Medica Mr. ,Barker ,enjoys ,a ,comfortable ,retirement ,income. ,He ,recently ,had ,surgery ,and expected ,that ,he ,would ,have ,certain ,services ,and ,items ,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 ,answersNone ,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. Ms. ,Edwards ,is ,enrolled ,in ,a ,Medicare ,Advantage ,plan ,that ,includes ,prescription ,drug plan ,(PDP) ,coverage. ,She ,is ,traveling ,and ,wishes ,to ,fill ,two ,of ,the ,prescriptions ,that ,she,has ,lost. ,How ,would ,you ,advise ,her?correct ,answersShe ,may ,fill ,prescriptions ,for covered ,drugs ,at ,non- network ,pharmacies, ,but ,likely ,at ,a ,higher ,cost ,than ,paid ,at ,an ,in- ,network ,pharmacy. 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 ,answersIf ,a ,Part ,D ,benefit ,is ,offered ,through ,her ,plan ,she ,may choose ,to ,enroll ,in ,that ,plan ,or ,a ,standalone ,PDP. 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 ,answersMedicare ,prescription ,drug ,plans ,are ,required ,to ,cover ,drugs ,in each ,therapeutic ,category. ,She ,should ,be ,able ,to ,enroll ,in ,a ,Medicare ,prescription ,drug ,plan ,that ,covers ,the ,medications ,she ,needs. Mrs. ,Quinn ,has ,just ,turned ,65, ,is ,in ,excellent ,health ,and ,has ,a ,relatively ,high ,income. She ,uses ,no ,medications ,and ,sees ,no ,reason ,to ,spend ,money ,on ,a ,Medicare prescription ,drug ,plan ,if ,she ,does ,not ,need ,the ,coverage. ,She ,currently ,does ,not ,have creditable ,coverage. ,What ,could ,you ,tell ,her ,about ,the ,implications ,of ,such ,a decision?correct ,answersIf ,she ,does ,not ,sign ,up ,for ,a ,Medicare ,prescription ,drug ,plan as ,soon ,as ,she ,is ,eligible ,to ,do ,so, ,and ,if ,she ,does ,sign ,up ,at ,a ,later ,date, ,her ,premium,will ,be ,permanently ,increased ,by ,1% ,of ,the ,national ,average ,premium ,for ,every ,month that ,she ,was ,not ,covered. Mr. ,Shultz ,was ,still ,working ,when ,he ,first ,qualified ,for ,Medicare. ,At ,that ,time, ,he ,had employer ,group ,coverage ,that ,was ,creditable. ,During ,his ,initial ,Part ,D ,eligibility ,period, he ,decided ,not ,to ,enroll ,because ,he ,was ,satisfied ,with ,his ,drug ,coverage. ,It ,is ,now ,a year ,later ,and ,Mr. ,Shultz ,has ,lost ,his ,employer ,group ,coverage ,within ,the ,last ,two weeks. ,How ,would ,you ,advise ,him?correct ,answersMr. ,Schultz ,should ,enroll ,in ,a ,Part ,D,plan ,before ,he ,has ,a ,63-day ,break ,in ,coverage ,in ,order ,to ,avoid ,a ,premium ,penalty. Mrs. ,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 ,answersAn ,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. What ,types ,of ,tools ,can ,Medicare ,Part ,D ,prescription ,drug ,plans ,use ,that ,affect ,the ,way,their ,enrollees ,can ,access ,medications?correct ,answersPart ,D ,plans ,do ,not ,have ,to cover ,all ,medications. ,As ,a ,result, ,their ,formularies, ,or ,lists ,of ,covered ,drugs, ,will ,vary from ,plan ,to ,plan. ,In ,addition, ,they ,can ,use ,cost ,containment ,techniques ,such ,as ,tiered co-payments ,and ,prior ,authorization. All ,plans ,must ,cover ,at ,least ,the ,standard ,Part ,D ,coverage ,or ,its ,actuarial ,equivalent. Which ,of ,the ,following ,statements ,best ,describes ,some ,of ,the ,costs ,a ,beneficiary ,would,incur ,for ,prescription ,drugs ,under ,the ,standard ,coverage?correct ,answersStandard ,Part,D ,coverage ,would ,require ,payment ,of ,an ,annual ,deductible, ,and ,once ,past ,the ,catastrophic ,coverage ,threshold, ,the ,beneficiary ,pays ,whichever ,is ,greater ,of ,either ,the co-pays ,for ,generic ,and ,brand ,name ,drugs ,or ,coinsurance ,of ,5%. IV. Beneficiaries ,enrolled ,in ,a ,MA-PPO ,may ,obtain ,Part ,D ,benefits ,through ,a ,standalone,PDP ,or ,through ,their ,plan.correct ,answersI, ,II, ,and ,III ,only 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 ,answersIn ,general, ,he ,must ,select ,a ,single ,Part ,D ,premium,payment ,mechanism ,that ,will ,be ,used ,throughout ,the ,year. 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 ,answersGift ,cards ,or ,gift ,certificates ,of $15 ,or ,less ,that ,can ,be ,readily ,converted ,to ,cash. Another ,agent ,working ,for ,your ,agency ,claims ,that ,because ,you ,are ,not ,employed ,by the ,Medicare ,Advantage ,plans ,that ,you ,represent, ,you ,are ,not ,subject ,to ,the ,same ,marketing ,requirements ,as ,the ,plans ,themselves. ,How ,should ,you ,respond ,to ,such ,a statement?correct ,answersYour ,coworker ,is ,not ,correct. ,Marketing ,on ,behalf ,of ,a ,plan ,is,considered ,marketing ,by ,the ,plan ,and ,requires ,that ,all ,contracted ,and ,employed ,agents comply ,with ,all ,Medicare ,marketing ,rules. 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,answersYou ,may ,provide ,her ,with ,the ,required ,enrollment ,materials ,and ,take ,her ,completed ,enrollment ,application. One ,of ,your ,colleagues ,argues ,that ,it ,is ,better ,to ,focus ,your ,time ,and ,energy ,exclusively,in ,neighborhoods ,with ,single-family ,homes. ,He ,further ,argues ,that ,their ,older ,owners are ,more ,likely ,to ,have ,higher ,incomes ,and ,purchase ,the ,Medicare ,Advantage ,products,you ,represent ,compared ,to ,those ,living ,in ,apartment ,complexes. ,How ,should ,you respond?correct ,answersThis ,could ,be ,considered ,discriminatory ,activity ,and ,a prohibited ,practice. 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 ,answersYou ,must ,have ,her ,sign ,a scope ,of ,appointment ,form, ,indicating ,which ,products ,she ,wishes ,to ,discuss. ,You ,may then ,proceed ,with ,the ,discussion. Your ,friend's ,mother ,just ,moved ,to ,an ,assisted ,living ,facility ,and ,he ,asked ,if ,you ,could present ,a ,program ,for ,the ,residents ,about ,the ,MA-PD ,plans ,you ,market. ,What ,could ,you,tell ,him?correct ,answersYou ,appreciate ,the ,opportunity ,and ,would ,be ,happy ,to schedule ,an ,appointment ,with ,anyone ,at ,their ,request. Melissa ,Meadows ,is ,a ,marketing ,representative ,for ,Best ,Care ,which ,has ,recently ,introduced ,a ,Medicare ,Advantage ,plan ,offering ,comprehensive ,dental ,benefits ,for ,$15,per ,month. ,Best ,Care ,has ,not ,submitted ,any ,potential ,posts ,to ,CMS ,for ,approval. Melissa ,would ,like ,to ,use ,the ,power ,of ,social ,media ,to ,reach ,potential ,prospects. ,What ,advice ,would ,you ,give ,her?correct ,answersAs ,soon ,as ,CMS ,approves ,Best ,Care's social ,media ,posts, ,Agent ,Meadows ,could ,post ,a ,tweet ,stating ,that ,"Best ,Care ,offers ,an,array ,of ,Medicare ,Advantage ,benefit ,packages. ,One ,might ,be ,right ,for ,you. ,Call ,me ,to find ,out ,more!" 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 ,answersYes. ,When ,an ,event,has ,been ,advertised ,as ,"educational," ,discussing ,plan-specific ,premiums ,is impermissible. 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 answersMarketing ,representatives ,may ,initiate ,electronic ,contact ,through ,e-mail ,but ,an opt-out ,process ,must ,be ,provided. 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 ,give ,Miguel?correct ,answersDuring ,the ,MA-OEP, ,Miguel ,can ,have one-on-one ,meetings ,with ,beneficiaries ,who ,have ,requested ,such ,meetings. ,by ,the ,plan she ,represented. ,What ,sort ,of ,penalty ,might ,the ,plan ,impose ,on ,this ,individual?correct ,answersThe ,plan ,may ,withhold ,commission, ,require ,retraining, ,report ,the ,misconduct ,to,a ,state ,department ,of ,insurance ,or ,terminate ,the ,contract. You ,are ,seeking ,to ,represent ,an ,individual ,Medicare ,Advantage ,plan ,and ,an ,individual Part ,D ,plan ,in ,your ,state. ,You ,have ,completed ,the ,required ,training ,for ,each ,plan, ,but you ,did ,not ,achieve ,a ,passing ,score ,on ,the ,tests ,that ,came ,after ,the ,training. ,What ,can,you ,do ,in ,this ,situation?correct ,answersYou ,will ,not ,be ,able ,to ,represent ,any ,Medicare Advantage ,or ,Part ,D ,plan ,until ,you ,complete ,the ,training ,and ,achieve ,an ,adequate score. ,However, ,you ,will ,not ,have ,to ,take ,a ,test ,if ,you ,exclusively ,market employer/union ,group ,plans ,and ,the ,companies ,do ,not ,require ,testing. Plan ,sponsors ,may ,undertake ,the ,following ,marketing ,activities ,with ,current ,Medicare Advantage ,plan ,members?correct ,answersMarket ,non-health ,related ,items ,or ,services,such ,as ,life ,insurance ,or ,annuities ,policies ,to ,current ,members ,as ,permitted ,following ,HIPAA ,Privacy ,Rules. Mr. ,Rockwell, ,age ,67, ,is ,enrolled ,in ,Medicare ,Part ,A, ,but ,because ,he ,continues ,to ,work and ,is ,covered ,by ,an ,employer ,health ,plan, ,he ,has ,not ,enrolled ,in ,Part ,B ,or ,Part ,D. ,He receives ,a ,notice ,on ,June ,1 ,that ,his ,employer ,is ,cutting ,back ,on ,prescription ,drug benefits ,and ,that ,as ,of ,July ,1 ,his ,coverage ,will ,no ,longer ,be ,creditable. ,He ,has ,come ,to you ,for ,advice. ,What ,advice ,would ,you ,give ,Mr. ,Rockwell ,about ,special ,election ,periods (SEPs)?correct ,answersMr. ,Rockwell ,is ,eligible ,for ,a ,SEP ,due ,to ,his ,involuntary ,loss ,of,creditable ,drug ,coverage; ,the ,SEP ,begins ,in ,June ,and ,ends ,on ,September ,1- ,two months ,after ,the ,loss ,of ,creditable ,coverage. 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 answersThis ,is ,a ,bad ,idea. ,Agents ,are ,generally ,prohibited ,from ,soliciting ,or ,accepting an ,enrollment ,form ,before ,the ,start ,of ,the ,AEP. 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 ,answersIf ,Mr. ,Block ,enrolls ,in ,the ,stand-alone Medicare ,prescription ,drug ,plan, ,he ,will ,be ,disenrolled ,from ,the ,Medicare ,Advantage plan. 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 ,answersShe ,can ,enroll ,in ,a ,Medigap ,plan ,to ,supplement ,the benefits ,of ,the ,MA ,plan ,that ,she's ,also ,enrolling ,in. 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 ,answersHe ,qualifies ,for ,a ,special ,election ,period ,and ,can ,enroll ,in ,or,disenroll ,from ,a ,Part ,D ,plan ,once ,during ,that ,period. 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 ,answersIt ,means ,that ,he ,qualifies ,for ,a ,one-time ,opportunity ,to ,enroll ,in ,an,MA-PD ,or ,Part ,D ,prescription ,drug ,plan. 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 ,answersIt ,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. Mr. ,Garrett ,has ,just ,entered ,his ,MA ,Initial ,Coverage ,Election ,Period ,(ICEP). ,What ,action ,could ,you ,help ,him ,take ,during ,this ,time?correct ,answersHe ,will ,have ,one ,opportunity ,to ,enroll ,in ,a ,Medicare ,Advantage ,plan. You ,are ,meeting ,with ,Ms. ,Berlin ,and ,she ,has ,completed ,an ,enrollment ,form ,for ,a ,MA- ,PD ,plan ,you ,represent. ,You ,notice ,that ,her ,handwriting ,is ,illegible ,and ,as ,a ,result, ,the ,spelling ,of ,her ,street ,looks ,incorrect. ,She ,asks ,you ,to ,fill ,in ,the ,corrected ,street ,name. What ,should ,you ,do?correct ,answersYou ,may ,correct ,this ,information ,as ,long ,as ,you add ,your ,initials ,and ,date ,next ,to ,the ,correction. You ,have ,come ,to ,Mrs. ,Midler's ,home ,for ,a ,sales ,presentation. ,At ,the ,beginning ,of ,the presentation, ,Mrs. ,Midler ,tells ,you ,that ,she ,has ,a ,copy ,of ,her ,medical ,records ,available because ,she ,thinks ,this ,will ,help ,you ,understand ,her ,needs. ,She ,suggests ,that ,you ,will know ,which ,questions ,to ,ask ,her ,about ,her ,health ,status ,in ,order ,to ,best ,assist ,her ,in selecting ,a ,plan. ,What ,should ,you ,do?correct ,answersYou ,can ,only ,ask ,Mrs. ,Midler questions ,about ,conditions ,that ,affect ,eligibility, ,specifically, ,whether ,she ,has ,one ,of ,the,conditions ,that ,would ,qualify ,her ,for ,a ,special ,needs ,plan. Mr. ,and ,Mrs. ,Nunez ,attended ,one ,of ,your ,sales ,presentations. ,They've ,asked ,you ,to ,come ,to ,their ,home ,to ,clear ,up ,a ,few ,questions. ,During ,the ,presentation, ,Mrs. ,Nunez feels ,tired ,and ,tells ,you ,that ,her ,husband ,can ,finish ,things ,up. ,She ,goes ,to ,bed. ,At ,the end ,of ,your ,discussion, ,Mr. ,Nunez ,says ,that ,he ,wants ,to ,enroll ,both ,himself ,and ,his wife. ,What ,should ,you ,do?correct ,answersAs ,long ,as ,she ,can ,do ,so, ,only ,Mrs. ,Nunez can ,sign ,her ,enrollment ,form. ,Mrs. ,Nunez ,will ,have ,to ,wake ,up ,to ,sign ,her ,form ,or ,do ,so,at ,another ,time. When ,Myra ,first ,became ,eligible ,for ,Medicare, ,she ,enrolled ,in ,Original ,Medicare ,(Parts,A ,and ,B). ,She ,is ,now ,67 ,and ,will ,turn ,68 ,on ,July ,1. ,She ,would ,now ,like ,to ,enroll ,in ,a Medicare ,Advantage ,(MA) ,plan ,and ,approaches ,you ,about ,her ,options. ,What ,advice would ,you ,give ,her?correct ,answersShe ,should ,remain ,in ,Original ,Medicare ,until ,the annual ,election ,period ,running ,from ,October ,15 ,to ,December ,7, ,during ,which ,she ,can select ,an ,MA ,plan. 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 ,answersIf ,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) 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 ,answersThe ,letter ,is ,to ,inform ,her ,that ,the ,drug ,coverage ,offered ,through her ,Medigap ,plan ,does ,not ,offer ,drug ,coverage ,that ,is ,at ,least ,comparable ,to ,that provided ,under ,the ,Medicare ,Part ,D ,prescription ,drug ,program. ,If ,she ,does ,not ,have ,such ,creditable ,coverage ,during ,periods ,when ,she ,is ,first ,eligible ,for ,the ,Part ,D program, ,she ,will ,face ,a ,premium ,penalty ,if ,she ,enrolls ,in ,a ,Part ,D ,plan ,at ,a ,later ,date. Mr. ,Cole ,has ,been ,a ,Medicaid ,beneficiary ,for ,some ,time, ,and ,recently ,qualified ,for Medicare ,as ,well. ,He ,is ,concerned ,about ,changes ,in ,his ,cost- sharing. ,What ,should ,you,tell ,him?correct ,answersHe ,should ,know ,that ,Medicaid ,will ,pay ,cost ,sharing ,only ,for services ,provided ,by ,Medicaid ,participating ,providers. 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. ,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 ,answersSince ,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. 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 ,answersYou ,must ,have ,her ,sign ,a scope ,of ,appointment ,form, ,indicating ,which ,products ,she ,wishes ,to ,discuss. ,You ,may then ,proceed ,with ,the ,discussion. 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 ,softwarecorrect ,answersI, ,II, ,III, ,and ,IV Which ,entity ,enforces ,Section ,1557 ,for ,programs ,that ,receive ,funding ,from ,on ,are,administered ,by ,HHS?correct ,answersThe ,Office ,of ,Civil ,Rights ,(OCR) ,of ,HHS. Which ,of ,these ,actions ,is ,most ,likely ,to ,be ,permitted ,in ,dealing ,with ,a ,person ,with ,limited,English ,proficiency?correct ,answersAllowing ,a ,child ,to ,interpret ,in ,an ,emergency. Under ,ACA ,Section ,1557, ,a ,health ,plancorrect ,answerscannot ,deny ,coverage ,to ,LEP,individuals ,and ,is ,required ,to ,provide ,language ,assistance ,to ,them, ,free ,of ,charge. For ,a ,health ,plan, ,what ,are ,the ,possible ,consequences ,of ,violations ,of ,ACA ,Section,1557?correct ,answersLoss ,of ,federal ,business ,and ,compensatory ,damages. Which ,of ,the ,following ,is ,NOT ,potentially ,a ,penalty ,for ,violation ,of ,a ,law ,or ,regulation,prohibiting ,fraud, ,waste, ,and ,abuse ,(FWA)?correct ,answersDeportation Which ,of ,the ,following ,requires ,intent ,to ,obtain ,payment ,and ,the ,knowledge ,the ,actions,are ,wrong?correct ,answersFraud You ,are ,performing ,a ,regular ,inventory ,of ,the ,controlled ,substances ,in ,the ,pharmacy.,You ,discover ,a ,minor ,inventory ,discrepancy. ,What ,should ,you ,do?correct answersFollow ,your ,pharmacy's ,procedures 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 ,answersReport ,the ,incident ,to ,the ,compliance ,department ,(via ,compliance ,hotline ,or ,other ,mechanism) You ,are ,in ,charge ,of ,paying ,claims ,submitted ,by ,providers. ,You ,notice ,a ,certain diagnostic ,provider ,("Doe ,Diagnostics") ,requested ,a ,substantial ,payment ,for ,a ,large number ,of ,members. ,Many ,of ,these ,claims ,are ,for ,a ,certain ,procedure. ,You ,review ,the,same ,type ,of ,procedure ,for ,other ,diagnostic ,providers ,and ,realize ,Doe ,Diagnostics' claims ,far ,exceed ,any ,other ,provider ,you ,reviewed. ,What ,should ,you ,do?correct ,answersConsult ,with ,your ,immediate ,supervisor ,for ,next ,steps ,or ,contact ,the compliance ,department ,(via ,compliance ,hotline, ,Special ,Investigations ,Unit ,[SIU], ,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 You ,can ,help ,prevent ,fraud, ,waste, ,and ,abuse ,(FWA) ,by ,doing ,all ,the ,following:,Look ,for ,suspicious ,activity Conduct ,yourself ,in ,an ,ethical ,manner Ensure ,accurate ,and ,timely ,data ,and ,billing,Ensure ,you ,coordinate ,with ,other ,payers Keep ,up ,to ,date ,with ,FWA ,policies ,and ,procedures, ,standards ,of ,conduct, ,laws, ,regulations, ,and ,the ,Centers ,for ,Medicare ,& ,Medicaid ,Services ,(CMS) ,guidance ,Verify ,all ,information ,provided ,to ,youcorrect ,answersTrue You ,are ,performing ,a ,regular ,inventory ,of ,the ,controlled ,substances ,in ,the ,pharmacy.,You ,discover ,a ,minor ,inventory ,discrepancy. ,What ,should ,you ,do?correct answersFollow ,your ,pharmacy's ,procedures You ,work ,for ,a ,Sponsor. ,Last ,month, ,while ,reviewing ,a ,Centers ,for ,Medicare ,& ,Medicaid,Services ,(CMS) ,monthly ,report, ,you ,identified ,multiple ,individuals ,not ,enrolled ,in ,the plan ,but ,for ,whom ,the ,Sponsor ,is ,paid. ,You ,spoke ,to ,your ,supervisor ,who ,said ,don't worry ,about ,it. ,This ,month, ,you ,identify ,the ,same ,enrollees ,on ,the ,report ,again. ,What should ,you ,do?correct ,answersAlthough ,you ,know ,about ,the ,Sponsor's ,non- retaliation policy, ,you ,are ,still ,nervous ,about ,reporting—to ,be ,safe, ,you ,submit ,a ,report ,through,your ,compliance ,department's ,anonymous ,tip ,line ,to ,avoid ,identification 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 ,answersContact ,your ,compliance ,department ,(via ,compliance,hotline ,or ,other ,mechanism) A ,sales ,agent, ,employed ,by ,the ,Sponsor's ,first-tier, ,downstream, ,or ,related ,entity ,(FDR),,submitted ,an ,application ,for ,processing ,and ,requested ,two ,things: ,1) ,to ,back-date ,the enrollment ,date ,by ,one ,month, ,and ,2) ,to ,waive ,all ,monthly ,premiums ,for ,the ,beneficiary. What ,should ,you ,do?correct ,answersProcess ,the ,application ,properly ,(without ,the requested ,revisions)— inform ,your ,supervisor ,and ,the ,compliance ,officer ,about ,the ,sales,agent's ,request Ways ,to ,report ,a ,compliance ,issue ,include: a.In-person ,reporting ,to ,the ,compliance ,department/supervisor,b.Report ,on ,the ,Sponsor's ,website c.Telephone ,hotlines d.All ,of ,the ,abovecorrect ,answersAll ,of ,the ,above Compliance ,is ,the ,responsibility ,of ,the ,Compliance ,Officer, ,Compliance ,Committee, ,and,Upper ,Management ,only.correct ,answersFalse What ,is ,the ,policy ,of ,non-retaliation?correct ,answersProtects ,employees, ,who ,in ,good,faith ,report ,suspected ,non-compliance Medicare ,Parts ,C ,and ,D ,sponsors ,are ,not ,required ,to ,have ,a ,compliance ,program.correct ,answersFalse At ,a ,minimum, ,an ,effective ,compliance ,program ,includes ,four ,core ,requirements.correct,answersFalse Correcting ,non-compliance correct ,answersProtects ,enrollees, ,avoids,recurrence ,of ,same ,non-compliance, ,and ,promotes ,efficiency 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 ,answersTrue 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 ,answersFalse enrolled ,in ,the ,SNP?correct ,answersYes. ,All ,SNPs ,are ,required ,to ,provide ,Part ,D,coverage ,for ,prescription ,drugs. Agent ,Roderick ,enrolls ,retiree ,Mrs. ,Martinez ,in ,a ,medical ,savings ,account ,(MSA) Medicare ,health ,plan. ,The ,MSA ,plan ,does ,not ,offer ,prescription ,drug ,coverage, ,so Agent ,Roderick ,also ,enrolls ,Mrs. ,Martinez ,in ,a ,standalone ,prescription ,drug ,plan ,(PDP).,What ,CMS ,compensation ,rules ,apply ,to ,this ,situation?correct ,answersThis ,situation ,is considered ,a ,"dual ,enrollment," ,and ,CMS ,compensation ,rules ,are ,applied ,to ,the ,two plans ,at ,once ,and ,independently ,of ,each ,other. 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 ,answersThough ,their ,cost-sharing ,may ,differ ,from ,Original Medicare's, ,Medicare ,Advantage ,plans ,are ,required ,to ,cover ,all ,services ,covered ,by original ,Medicare. Mrs. ,Wellington ,is ,enrolled ,in ,Parts ,A ,and ,B ,of ,Original ,Medicare. ,A ,friend ,recently ,told her ,that ,there ,is ,an ,excellent ,Medicare ,Advantage ,(MA) ,plan ,with ,a ,five-star ,rating serving ,her ,area. ,On ,January ,15 ,she ,comes ,to ,you ,for ,advice ,as ,to ,what ,options, ,if ,any,,she ,has. ,What ,should ,you ,say ,regarding ,special ,enrollment ,periods ,(SEPs)?correct answersMrs. ,Wellington ,is ,eligible ,for ,a ,SEP ,that ,may ,be ,used ,once ,until ,November ,30 to ,enroll ,in ,the ,five-star ,plan. Ms. ,Gardner ,is ,currently ,enrolled ,in ,an ,MA-PD ,plan. ,However, ,she ,wants ,to ,disenroll from ,the ,MA-PD ,plan ,and ,instead ,enroll ,in ,a ,Part ,D ,only ,plan ,and ,go ,back ,to ,Original Medicare. ,According ,to ,Medicare's ,enrollment ,guidelines, ,when ,could ,she ,do this?correct ,answersShe ,may ,make ,such ,a ,change ,during ,the ,Annual ,Election ,Period that ,runs ,from ,Oct. ,15 ,to ,December ,7, ,or ,during ,the ,MA ,Open ,Enrollment ,Period ,which,takes ,place ,from ,January ,1- ,March ,31 ,of ,each ,year. Mr. ,Lopez, ,who ,is ,fairly ,well-off ,financially, ,would ,like ,to ,enroll ,in ,a ,Medicare ,prescription,drug ,plan ,you ,represent ,and ,simply ,give ,you ,a ,check ,to ,cover ,his ,premiums ,for ,the entire ,year. ,What ,should ,you ,tell ,him?correct ,answersEnrollees ,should ,pay ,using automatic ,withdrawal ,from ,a ,bank ,account ,or ,credit ,or ,debit ,card, ,direct ,monthly ,billing from ,the ,plan, ,or ,deductions ,from ,their ,Social ,Security ,check. Ms. ,Jensen ,has ,heard ,about ,"Original ,Fee-for-Service ,Medicare" ,and ,"Private ,Fee-for-,Service" ,plans. ,She ,wants ,to ,know ,what ,the ,difference ,is ,if ,any. ,What ,should ,you ,tell her?correct ,answersPFFS ,plans ,are ,a ,type ,of ,Medicare ,Advantage ,plan ,offered ,by private ,companies. 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 ,answersPart ,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. ,NOT ,SURE Who ,is ,most ,likely ,to ,be ,eligible ,to ,enroll ,in ,a ,Part ,D ,prescription ,drug ,plan?correct ,answersMs. ,Davis ,who ,is ,entitled ,to ,Part ,A ,and ,has ,just ,enrolled ,in ,Part ,B.a ,sales presentation, ,your ,client ,asks ,you ,wh 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 ,answersPrivate ,Fee-for-Service ,(PFFS),plan ,that ,does ,not ,include ,drug ,coverage. 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 answersThe ,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. Mr. ,Moreno ,invited ,his ,neighbor, ,Agent ,Tom ,Smith, ,to ,discuss ,Medicare ,Advantage (MA) ,and ,Part ,D ,plans ,that ,Agent ,Smith ,sells ,at ,the ,regular ,Tuesday ,brunch ,the neighbors ,have ,for ,senior ,citizens. ,What ,should ,Agent ,Tom ,Smith ,tell ,Mr. ,Moreno ,about,the ,kinds ,of ,food ,that ,can ,be ,provided ,to ,potential ,enrollees ,who ,attend ,the ,sales presentation?correct ,answersA ,meal ,cannot ,be ,provided, ,but ,light ,snacks ,would ,be permitted Which ,of ,the ,following ,is/are ,most ,likely ,to ,be ,characterized ,as ,an ,involuntary,disenrollment ,from ,a ,Medicare ,Advantage ,(MA) ,plan? Mrs. ,Turner ,is ,comparing ,her ,employer's ,retiree ,insurance ,to ,Original ,Medicare ,and would ,like ,to ,know ,which ,of ,the ,following ,services ,Original ,Medicare ,will ,cover ,if ,the appropriate ,criteria ,are ,met? ,What ,could ,you ,tell ,her?correct ,answersOriginal ,Medicare,covers ,ambulance ,services. Anita ,Magri ,will ,turn ,age ,65 ,in ,August ,2022. ,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 ,Part ,F ,plan ,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 ,answersYou ,are ,sorry ,to ,disappoint ,Anita ,but ,a ,Medigap ,Part ,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. Mrs. ,Quinn ,recently ,turned ,66 ,and ,decided ,after ,many ,years ,of ,work ,to ,begin ,receiving Social ,Security ,benefits. ,Shortly ,thereafter ,Mrs. ,Quinn ,received ,a ,letter ,informing ,her that ,she ,has ,been ,automatically ,enrolled ,in ,Medicare ,Part ,B. ,She ,wants ,to ,understand what ,this ,means. ,What ,should ,you ,tell ,Mrs. ,Quinn?correct ,answersPart ,B ,primarily covers ,physician ,services. ,She ,will ,be ,paying ,a ,monthly ,premium ,and, ,with ,the ,exception ,of ,many ,preventive ,and ,screening ,tests, ,generally ,will ,have ,20% ,coinsurance,for ,these ,services, ,in ,addition ,to ,an ,annual ,deductible. What ,impact, ,if ,any, ,have ,recent ,regulatory ,changes ,had ,upon ,Medigap ,plans?correct,answersThe ,Part ,B ,deductible ,is ,no ,longer ,covered ,for ,individuals ,newly ,eligible ,for Medicare ,starting ,January ,1, ,2020. Mrs. ,Shields ,is ,covered ,by ,Original ,Medicare. ,She ,sustained ,a ,hip ,fracture ,and ,is ,being successfully ,treated ,for ,that ,condition. ,However, ,she ,and ,her ,physicians ,feel ,that ,after her ,lengthy ,hospital ,stay ,she ,will ,need ,a ,month ,or ,two ,of ,nursing ,and ,rehabilitative ,care. ,What ,should ,you ,tell ,them ,about ,Original ,Medicare's ,coverage ,of ,care ,in ,a ,skilled nursing ,facility?correct ,answersMedicare ,will ,cover ,Mrs. ,Shield's ,skilled ,nursing ,services,provided ,during ,the ,first ,20 ,days ,of ,her ,stay, ,after ,which ,she ,would ,have ,a ,copay ,until she ,has ,been ,in ,the ,facility ,for ,100 ,days. Mrs. ,Willard ,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 ,answersMedicare ,Advantage Plans ,may ,offer ,extra ,benefits ,that ,Original ,Medicare ,does ,not ,offer ,such ,as ,vision, hearing, ,and ,dental ,services ,and ,must ,include ,a ,maximum ,out-of-pocket ,limit ,on ,Part ,A,and ,Part ,B ,services. Mrs. ,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 ,answersMedicaid ,may ,provide ,additional ,benefits, ,but Medicaid ,will ,only ,pay ,for ,these ,services ,if ,they ,are ,furnished ,by ,Medicaid ,participating providers. Mrs. ,Walters ,is ,enrolled ,in ,her ,state's ,Medicaid ,program ,in ,addition ,to ,Medicare. ,What should ,she ,be ,aware ,of ,when ,considering ,enrollment ,in ,a ,Medicare ,Advantage ,(MA) plan?correct ,answersShe ,can ,submit ,any ,bills ,she ,has ,for ,co-payments ,under ,Medicare,to ,the ,state's ,Medicaid ,program ,and ,they ,will ,always ,be ,fully ,covered. Mrs. ,Kelly, ,age ,65, ,is ,entitled ,to ,Part ,A ,but ,has ,not ,yet ,enrolled ,in ,Part ,B. ,She ,is considering ,enrollment ,in ,a ,Medicare ,Advantage ,plan ,(Part ,C). ,What ,should ,you ,advise,her ,to ,do ,before ,she ,will ,be ,able ,to ,enroll ,in ,a ,Medicare ,Advantage ,plan?correct answersTo ,join ,a ,Medicare ,Advantage ,plan, ,she ,also ,must ,enroll ,in ,Part ,B. 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 ,answersShe ,can ,enroll ,in ,the ,PPO, ,but ,she ,will,not ,be ,able ,to ,purchase ,a ,stand-alone ,Medicare ,Part ,D ,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 ,answersShe ,could ,enroll ,in ,a ,PFFS ,plan ,and ,a ,stand-alone ,Medicare ,prescription ,drug ,plan. Part ,D ,catastrophic ,limit ,and ,include ,not ,only ,expenses ,paid ,by ,a ,beneficiary ,but ,also ,in,some ,instances ,drug ,manufacturer ,discounts. 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 answersThe ,extra ,help ,is ,available ,to ,beneficiaries ,whose ,income ,and ,assets ,do ,not ,exceed ,annual ,limits ,specified ,by ,the ,government. 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 ,answersMr. ,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. 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 answersYou ,may ,go ,ahead ,and ,call ,them. Alice ,is ,a ,marketing ,representative ,employed ,by ,a ,health ,plan. ,Betty ,is ,a ,captive ,agent of ,a ,health ,plan ,who ,markets ,to ,multiple ,plans ,and ,sponsors. ,Carl ,is ,a ,captive ,agent who ,markets ,to ,only ,one ,plan/sponsor. ,Denise ,is ,an ,independent ,agent ,who ,markets ,to,different ,types ,of ,groups. ,Edward ,is ,an ,independent ,agent ,who ,markets ,only ,to employer ,and ,union ,groups. ,CMS ,marketing ,representative ,compensation ,rules generally ,apply ,to:correct ,answersBetty ,and ,Denise, ,but ,not ,Alice ,(the ,employee) ,or Carl ,or ,Edward ,(to ,whom ,exceptions ,apply). During ,a ,sales ,presentation ,to ,Ms. ,Daley ,for ,a ,Medicare ,Advantage ,plan ,that ,has ,a ,5- star ,rating ,in ,customer ,service ,and ,care ,coordination, ,and ,received ,an ,overall ,plan ,performance ,rating ,of ,a ,4-star, ,which ,of ,the ,following ,would ,be ,the ,best ,statement ,to ,say,to ,her?correct ,answersThe ,Medicare ,Advantage ,plan ,received ,a ,5-star ,rating ,in customer ,service ,and ,care ,coordination ,with ,an ,overall ,performance ,rating ,of ,4-stars. BestCare ,Health ,Plan ,has ,received ,a ,request ,from ,a ,state ,insurance ,department ,in connection ,with ,the ,investigation ,of ,several ,marketing ,representatives ,licensed ,by ,the,state ,who ,sell ,Medicare ,Advantage ,plans. ,What ,action(s) ,should ,BestCare ,take ,in response?correct ,answersCooperate ,with ,the ,state ,and ,supply ,requested ,information. You ,are ,mailing ,invitations ,to ,new ,Medicare ,beneficiaries ,for ,a ,marketing ,event. ,You want ,an ,idea ,of ,how ,many ,people ,to ,expect, ,so ,you ,would ,like ,to ,request ,RSVPs. ,What,should ,you ,keep ,in ,mind?correct ,answersYou ,may ,request ,RSVPs, ,but ,you ,are ,not ,permitted ,to ,require ,contact ,information. 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 ,plans?correct ,answersYou ,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. Monica ,is ,an ,agent ,focused ,on ,serving ,seniors ,eligible ,for ,Medicare. ,As ,she ,reviews ,her,records, ,she ,is ,trying ,to ,determine ,which ,of ,the ,following ,items ,are ,considered compensation. ,What ,do ,you ,tell ,her? I. ,Commissions ,II. ,Bonuses III. Mileage ,reimbursement IV. Awardscorrect ,answersI, ,II ,and ,IV ,only 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 ,answersYou ,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. Mr. ,Lynn, ,an ,agent ,for ,Acme ,Insurance, ,Inc. ,thinks ,that, ,since ,state ,laws ,offer ,as ,a ,gift ,to,induce ,enrollment ,in ,a ,plan?correct ,answersYou ,may ,provide ,gifts ,or ,prizes ,to ,all potential ,enrollees ,during ,an ,event ,that ,does ,not ,exceed ,$15 ,in ,retail ,value. You ,are ,scheduled ,to ,give ,a ,sales ,presentation ,at ,a ,local ,senior ,center ,at ,which ,a drawing ,will ,be ,held ,for ,a ,prize. ,At ,the ,beginning ,of ,the ,presentation, ,which ,of ,the following ,must ,you ,do?correct ,answersClearly ,state ,that ,no ,obligation ,exists ,to ,enroll ,if ,a,gift ,or ,prize ,is ,being ,offered. 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 answersWinthrop ,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. If ,you ,are ,to ,comply ,with ,Medicare's ,guidance ,regarding ,educational ,events, ,which ,of ,the ,following ,would ,be ,acceptable ,activities?correct ,answersYou ,may ,distribute business ,cards ,to ,individuals ,who ,request ,information ,on ,how ,to ,contact ,you ,for ,further,details ,on ,the ,plan(s) ,you ,represent. While ,making ,an ,appointment ,to ,discuss ,Medicare ,Advantage ,(MA) ,and ,Part ,D ,plans,with ,a ,potential ,enrollee, ,you ,are ,asked ,to ,describe ,other ,types ,of ,insurance ,products,that ,your ,client ,might ,wish ,to ,purchase. ,What ,additional ,types ,of ,insurance ,can ,you present ,during ,the ,MA ,and ,Part ,D ,marketing ,appointment?correct ,answersYou ,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. 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 ,for $200 ,to ,entertain ,attendees. ,Can ,he ,do ,this ,in ,a ,way ,that ,complies ,with ,guidance ,from the ,Medicare ,agency?correct ,answersHe ,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. Willard ,works ,as ,a ,representative ,focused ,on ,the ,senior ,marketplace. ,What ,would ,be considered ,prohibited ,activity ,by ,Willard?correct ,answersImplying ,that ,only ,seniors ,can,enroll ,in ,a ,Medicare ,Advantage ,plan ,when ,meeting ,with ,Mr. ,Hernandez, ,who ,is ,58 ,but qualifies ,for ,Medicare ,because ,he ,is ,disabled. Which ,of ,the ,following ,individuals ,has ,enrolled ,in ,a ,plan ,based ,on ,a ,fixed ,enrollment,period?correct ,answersBen, ,who ,enrolls ,in ,a ,Medicare ,Advantage ,plan ,during ,the Medicare ,Advantage ,Open ,Enrollment ,Period ,(MA ,OEP). Mr. ,Wilcox ,has ,been ,enrolled ,in ,Lexington ,Private ,Fee-for-Service ,(PFFS) ,Medicare Advantage ,Health ,Plan ,(Lexington) ,for ,several ,years. ,Recently, ,Mr. ,Wilcox ,decided ,to ,spend ,time ,with ,his ,children ,who ,live ,in ,another ,state ,that ,is ,not ,in ,Lexington's ,service area. ,In ,the ,future, ,he ,may ,relocate ,near ,his ,children ,permanently. ,How ,does ,this ,move ,to ,another ,service ,area ,impact ,his ,PFFS ,MA ,coverage?correct ,answersLexington ,can allow ,for ,Mr. ,Wilcox's ,continued ,enrollment ,for ,up ,to ,12 ,months ,whether ,or ,not ,he ,is ,in ,a,visitor/traveler ,(V/T) ,program ,since ,it ,is ,a ,PFFS ,plan. Miles ,is ,a ,licensed ,agent ,who ,represents ,Colgate ,Health ,and ,its ,Medicare ,Advantage (MA) ,plans. ,Miles ,has ,several ,clients ,who ,have ,recently ,come ,to ,him ,for ,help. ,They ,are,in ,their ,initial ,coverage ,periods) ,(ICEP) ,and ,are ,interested ,in ,enrolling ,in ,one ,of ,Colgate,Health's ,MA ,plans. ,Adam ,will ,soon ,turn ,68 ,and ,has ,decided ,to ,retire. ,Betty ,is ,about ,to turn ,65 ,and ,has ,also ,decided ,to ,retire. ,Adam ,and ,Betty ,both ,currently ,have ,coverage through ,Colgate ,Health. ,Charles ,had ,health ,coverage ,through ,Colgate ,but ,dropped ,the,coverage ,when ,he ,retired ,early ,to ,travel ,to ,Europe. ,Charles ,has ,just ,turned ,age ,65 ,and,is ,now ,back ,in ,the ,United ,States. ,Diedre, ,who ,will ,turn ,65 ,next ,month, ,currently ,has coverage ,through ,Ditmas ,Health ,- ,a ,company ,that ,Miles ,also ,represents. ,Who ,qualifies,for ,the ,opt-in ,simplified ,enrollment ,mechanism?correct ,answersAdam ,and ,Betty because ,each ,of ,them ,will ,not ,have ,a ,break ,between ,their ,non-Medicare ,and ,Medicare coverage ,through ,Colgate ,Health ,Plan. 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. ,Liu ,turns ,65 ,on ,June ,19. ,He ,has ,never ,previously ,qualified ,for ,Medicare ,so ,his ,first Medicare ,eligibility ,date ,will ,be ,by ,June ,1. ,Mr. ,Liu's ,ICEP ,and ,Part ,D ,IEP ,begin ,March ,1,and ,end ,on ,September ,30. ,He ,wants ,prescription ,drug ,coverage ,with ,his ,Part ,A ,and Part ,B ,benefits. ,What ,advice ,can ,you ,provide ,him?correct ,answersHe ,can ,enroll ,in ,a ,MA- PD ,as ,long ,as ,he ,enrolls ,in ,Part ,B ,and ,is ,entitled ,to ,Part ,A. 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 ,answersMs. ,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. ,O'Donnell ,learned ,about ,a ,new ,MA-PD ,plan ,that ,her ,neighbor ,suggested ,and ,that you ,represent. ,She ,plans ,to ,switch ,from ,her ,old ,MA ,HMO ,plan ,to ,the ,new ,MA-PD ,plan during ,the ,Annual ,Election ,Period. ,However, ,she ,wants ,to ,make ,sure ,she ,does ,not ,end,up ,paying ,premiums ,for ,two ,plans. ,What ,can ,you ,tell ,her?correct ,answersShe ,only needs ,to ,enroll ,in ,the ,new ,MA-PD ,plan ,and ,she ,will ,automatically ,be ,disenrolled ,from ,her ,old ,MA ,plan. You ,work ,for ,Caring ,Health, ,a ,Medicare ,Advantage ,(MA) ,plan ,sponsor. ,Recently, ,Mrs. Garcia ,has ,completed ,an ,enrollment ,application ,for ,a ,plan ,offered ,by ,Caring ,Health, which ,is ,waiting ,for ,a ,reply ,from ,CMS ,indicating ,whether ,or ,not ,Mrs. ,Garcia's ,enrollment has ,been ,accepted. ,Once ,CMS ,replies, ,how ,long ,does ,Caring ,Health ,have ,to ,notify ,Mrs.,Garcia ,that ,her ,enrollment ,has ,been ,accepted ,and ,in ,what ,format?correct ,answersThe plan ,has ,10 ,calendar ,days ,to ,notify ,Mrs. ,Garcia ,in ,writing. 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 ,answersShe may ,enroll ,in ,an ,MA ,plan ,beginning ,three ,months ,immediately ,before ,her ,first,entitlement ,to ,both ,Medicare ,Part ,A ,and ,Part ,B. Mrs. ,Reynolds ,is ,in ,her ,Medicare ,initial ,coverage ,election ,period ,(ICEP) ,and ,the ,date ,of,her ,entitlement ,to ,Part ,A ,and ,B ,has ,already ,occurred. ,Mrs. ,Reynolds ,has ,just ,signed ,up,for ,a ,Medicare ,Advantage ,plan ,on ,the ,second ,of ,the ,month. ,She ,is ,leaving ,for ,vacation in ,two ,weeks ,and ,wants ,to ,know ,if ,her ,new ,coverage ,will ,start ,before ,she ,leaves. ,What should ,you ,tell ,her?correct ,answersTypically, ,her ,coverage ,would ,begin ,on ,the ,first ,day,of ,the ,next ,month, ,so ,she ,should ,not ,expect ,her ,coverage ,to ,begin ,before ,she ,leaves. Mr. ,Robinson ,was ,quite ,ill ,recently ,and ,forgot ,to ,pay ,his ,monthly ,premium ,for ,his ,MA-PD,plan. ,He ,is ,worried ,that ,he ,will ,lose ,his ,coverage ,now ,when ,he ,needs ,it ,the ,most. ,He ,is certain ,his ,plan ,will ,disenroll ,him ,because ,that ,is ,what ,happened ,to ,a ,friend ,of ,his ,in ,a similar ,type ,of ,plan. ,What ,can ,you ,tell ,Mr. ,Robinson ,about ,his ,situation?correct answersPlan ,sponsors ,have ,the ,option ,to ,do ,nothing ,when ,a ,plan ,member ,does ,not ,pay ,their ,premiums ,or ,disenroll ,the ,member ,after ,a ,grace ,period ,and ,notice. Mrs. ,Johnson ,calls ,to ,tell ,you ,she ,has ,not ,received ,her ,new ,plan ,ID ,card ,yet, ,but ,she needs ,to ,see ,a ,doctor. ,What ,can ,she ,expect ,to ,receive ,from ,the ,plan ,after ,the ,plan ,has,received ,her ,enrollment ,form?correct ,answersEvidence ,of ,plan ,membership, information ,on ,how ,to ,obtain ,services, ,and ,the ,effective ,date ,of ,coverage. Mr. ,Anderson ,is ,a ,very ,organized ,individual ,and ,has ,filled ,out ,and ,brought ,to ,you ,an enrollment ,form ,on ,October ,10 ,for ,a ,new ,plan ,available ,January 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 ,answersA ,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. 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 ,answersTrOOP ,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. Mr. ,Polanski ,likes ,the ,cost ,of ,an ,HMO ,plan ,available ,in ,his ,area ,but ,would ,like ,to ,be ,able,to ,visit ,one ,or ,two ,doctors ,who ,aren't ,participating ,providers. ,He ,wants ,to ,know ,if ,the Point ,of ,Service ,(POS) ,option ,available ,with ,some ,HMOs ,will ,be ,of ,any ,help ,in ,this situation. ,What ,should ,you ,tell ,him?correct ,answersThe ,POS ,option ,might ,be ,a ,good solution ,for ,him ,as ,it ,will ,allow ,him ,to ,visit ,out-of-network ,providers, ,generally ,without prior ,approval. ,However, ,he ,should ,be ,aware ,that ,it ,is ,likely ,he ,will ,have ,to ,pay ,higher,cost-sharing ,for ,services ,from ,out-of-network ,providers. 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 ,answersMr. ,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. You ,have ,decided ,to ,focus ,on ,doing ,in-home ,presentations ,to ,market ,the ,Medicare Advantage ,(MA) ,plans ,you ,represent. ,Before ,you ,conduct ,such ,sales ,presentations, what ,must ,you ,do?correct ,answersYou ,must ,receive ,an ,invitation ,from ,the ,beneficiary,and ,document ,the ,specific ,types ,of ,products ,the ,beneficiary ,wants ,to ,discuss ,prior ,to making ,an ,in-home ,presentation. 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 ,answersYou ,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. 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 ,answersDiscuss ,plan ,specific,information ,such ,as ,premiums ,and ,benefits. 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 ,answersMaterials ,need ,only ,be reviewed ,and ,approved ,by ,the ,company(s) ,she ,represents. Mr. ,Lee ,was ,intending ,to ,enroll ,in ,MaxCare's ,Medicare ,Advantage ,plan ,this ,year. However, ,due ,to ,his ,current ,medical ,condition, ,his ,daughter ,Debbie ,has ,been ,appointed,as ,his ,legal ,representative ,over ,both ,health ,and ,financial ,matters. ,Debbie ,would ,like ,to ensure ,that ,her ,father ,is ,still ,able ,to ,enroll ,in ,MaxCare's ,plan, ,but ,she ,is ,unsure ,what ,her,role ,is ,to ,help ,with ,his ,enrollment ,request. ,What ,advice ,can ,you ,give ,her?correct answersLegal ,representatives ,are ,only ,permitted ,to ,submit ,a ,paper ,enrollment ,request. ??????????? Last ,year ,Agent ,Melanie ,Meyers ,marketed ,and ,enrolled ,several ,clients ,in ,Medicare Advantage ,(MA) ,health ,plans. ,This ,year ,she ,has ,decided ,to ,focus ,on ,non-MA ,products.,What ,advice ,would ,you ,give ,Melanie ,if ,she ,wishes ,to ,continue ,to ,receive ,renewal