Download AHIP Final Exam Test Questions and Answers
(2022/2023) (Verified Answers) and more Exams Nursing in PDF only on Docsity!
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AHIP Final Exam Test Questions and Answers
(2022/2023) (Verified Answers)
Mr. ,Davis ,is , 52 ,years ,old ,and ,has ,recently ,been ,diagnosed ,with ,end-stage ,renal ,disease ,(ESRD) ,and ,will ,soon ,begin ,dialysis. ,He ,is ,wondering ,if ,he ,can ,obtain ,coverage ,under ,Medicare. ,What ,should ,you ,tell ,him?correct ,answersHe ,may ,sign-up ,for ,Medicare ,at ,any ,time ,however ,coverage ,usually ,begins ,on ,the ,fourth ,month ,after ,dialysis ,treatments ,start. Juan ,Perez, ,who ,is ,turning ,age , 65 ,next ,month, ,intends ,to ,work ,for ,several ,more ,years ,at ,Smallcap, ,Incorporated. ,Smallcap ,has ,a ,workforce ,of ,employees ,and ,offers employer-sponsored ,healthcare ,coverage. ,Juan ,is ,a ,naturalized ,citizen ,and ,has ,contributed ,to ,the ,Medicare ,system ,for ,over , 20 ,years. ,Juan ,asks ,you ,if ,he ,will ,be ,entitled ,to ,Medicare ,and ,if ,he ,enrolls ,how ,that ,will ,impact ,his ,employer-sponsored ,healthcare ,coverage. ,How ,would ,you ,respond?correct ,answersJuan ,is ,likely ,to ,be ,eligible ,for ,Medicare ,once ,he ,turns ,age , 65 ,and ,if ,he ,enrolls ,Medicare ,would ,become ,the ,primary ,payor ,of ,his ,healthcare ,claims ,and ,Smallcap ,does ,not ,have ,to ,continue ,to ,offer ,him ,coverage ,comparable ,to ,those ,under ,age , 65 ,under ,its ,employersponsored ,group ,health ,plan. 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.
2 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.
Mr. ,Alonso ,receives ,some ,help ,paying ,for ,his ,two ,generic ,prescription ,drugs ,from ,his ,employer's ,retiree ,coverage, ,but ,he ,wants ,to ,compare ,it ,to ,a ,Part ,D ,prescription ,drug ,plan. ,He ,asks ,you ,what ,costs ,he ,would ,generally ,expect ,to ,encounter ,when ,enrolling ,into ,a ,standard ,MedicarePart ,D ,prescription ,drug ,plan. ,What ,should ,you ,tell ,him?correct ,answers ,He ,generally ,would ,pay ,a ,monthly ,premium, ,annual ,deductible, ,and ,per- ,prescription ,cost-sharing. Ms. ,Moore ,plans ,to ,retire ,when ,she ,turns , 65 ,in ,a ,few ,months. ,She ,is ,in ,excellent ,health ,and ,will ,have ,considerable ,income ,when ,she ,retires. ,She ,is ,concerned ,that ,her ,income ,will ,make ,it ,impossible ,for ,her ,to ,qualify ,for ,Medicare. ,What ,could ,you ,tell ,her ,to ,address ,her ,concern?correct ,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.
,Medicare ,would ,pay ,them ,as ,payment ,in ,full. ,correct ,answers ,I, ,II, ,and ,IV ,only Mr. ,Lombardi ,is ,interested ,in ,a ,Medicare ,Advantage ,(MA) ,PPO ,plan ,that ,you ,represent. ,It ,is ,one ,of ,three ,plans ,operated ,by ,the ,same ,organization ,in ,Mr. ,Lombardi's ,area. ,The ,MA ,PPO ,plan ,does ,not ,include ,drug ,coverage, ,but ,the ,other ,two ,plans ,do. ,Mr. ,Lombardi ,likes ,the ,PPO ,plan ,that ,does ,not ,include ,drug ,coverage ,and ,intends ,to ,obtain ,his ,drug ,coverage ,through ,a ,stand-alone ,Medicare ,prescription ,drug ,plan. ,What ,should ,you ,tell ,him ,about ,this ,situation?correct ,answersHe ,could ,enroll ,either ,in ,one ,of ,the ,MA ,plans ,that ,include ,prescription ,drug ,coverage ,or ,Original ,Medicare ,with ,a ,Medigap ,plan ,and ,standalone ,Part ,D ,prescription ,drug ,coverage, ,but ,he ,cannot ,enroll ,in ,the ,MA-only ,PPO ,plan ,and ,a ,stand-alone ,prescription ,drug ,plan. Mrs. ,Ramos ,is ,considering ,a ,Medicare ,Advantage ,PPO ,and ,has ,questions ,about ,which ,providers ,she ,can ,go ,to ,for ,her ,health ,care. ,What ,should ,you ,tell ,her?correct ,answersMrs. ,Ramos ,can ,obtain ,care ,from ,any ,provider ,who ,participates ,in ,Original ,Medicare, ,but ,generally ,will ,have ,a ,higher ,costsharing ,amount ,if ,she ,sees ,a ,provider ,who/that ,is ,not ,a ,part ,of ,the ,PPO ,network. Mr. ,Romero ,is ,64, ,retiring ,soon, ,and ,considering ,enrollment ,in ,his ,employer-sponsored ,retiree ,group ,health ,plan ,that ,includes ,drug ,coverage ,with ,nominal ,copays. ,He ,heard ,about ,a ,neighbor's ,MA-PD ,plan ,that ,you ,represent ,and ,because ,he ,takes ,numerous ,prescription ,drugs, ,he ,is ,considering ,signing ,up ,for ,it. ,What ,should ,you ,tell ,him?correct ,answersHe ,should ,compare ,the ,benefits ,in ,his ,employer-sponsored ,retiree ,group ,health
,plan ,with ,the ,benefits ,in ,his ,neighbor's ,MA-PD ,plan ,to ,determine ,which ,one ,will ,provide ,sufficient ,coverage ,for ,his ,prescription ,needs. Dr. ,Elizabeth ,Brennan ,does ,not ,contract ,with ,the ,ABC ,PFFS ,plan ,but ,accepts ,the ,plan's ,terms ,and ,conditions ,for ,payment. ,Mary ,Rodgers ,sees ,Dr. ,Brennan ,for ,treatment. ,How ,much ,may ,Dr. ,Brennan ,charge?correct ,answersDr. ,Brennan ,can ,charge ,Mary ,Rogers ,no ,more ,than ,the ,cost ,sharing ,specified ,in ,the ,PFFS ,plan's ,terms ,and ,condition ,of ,payment ,which ,may ,include ,balance ,billing ,up ,to ,15% ,of ,the ,Medicare ,rate. 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 ,highincome ,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
,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 ,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 ,answersYou ,can ,offer ,to ,review ,the ,plans ,appeal ,process ,to ,help ,him ,ask ,the ,plan ,to ,review ,the ,coverage ,decision. Mr. ,Sinclair ,has ,diabetes ,and ,heart ,trouble ,and ,is ,generally ,satisfied ,with ,the ,care ,he ,has ,received ,under ,Original ,Medicare, ,but ,he ,would ,like ,to ,know ,more ,about ,Medicare ,Advantage ,Special ,Needs ,Plans ,(SNPs). ,What ,could ,you ,tell ,him?correct ,answersSNPs ,have ,special ,programs ,for ,enrollees ,with ,chronic ,conditions, ,like ,Mr. ,Sinclair, ,and ,they ,provide ,prescription ,drug ,coverage ,that ,could ,be ,very ,helpful ,as ,well. 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 ,answersThey ,are ,Medicare ,health ,plans ,such ,as ,HMOs, ,PPOs, ,PFFS, ,and ,MSAs. 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 ,answersHe ,will ,have ,to ,enroll ,in ,Part ,B.
,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 ,nonnetwork ,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
,with ,Original ,Medicare ,and ,also ,enroll ,in ,a ,Medicare ,prescription ,drug ,plan ,through ,a ,private ,company ,that ,has ,contracted ,with ,the ,government ,to ,provide ,only ,such ,drug ,coverage ,to ,eligible ,Medicare ,beneficiaries. Which ,of ,the ,following ,individuals ,is ,most ,likely ,to ,be ,eligible ,to ,enroll ,in ,a ,Part ,D ,Plan?correct ,answersJose, ,a ,grandfather ,who ,was ,granted ,asylum ,and ,has ,worked ,in ,the ,United ,States ,for ,many ,years. 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 ,answersIf ,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. Mrs. ,McIntire ,is ,enrolled ,in ,her ,state's ,Medicaid ,plan ,and ,has ,just ,become ,eligible ,for ,Medicare ,as ,well. ,What ,can ,she ,expect ,will ,happen ,to ,her ,drug ,coverage?correct ,answersUnless ,she ,chooses ,a ,Medicare ,Part ,D ,prescription ,drug ,plan ,on ,her ,own, ,she ,will ,be ,automatically ,enrolled ,in ,one ,available ,in ,her ,area. Mrs. ,Berkowitz ,wants ,to ,enroll ,in ,a ,Medicare ,Advantage ,plan ,that ,does ,not ,include ,drug ,coverage ,and ,also ,enroll ,in ,a ,stand-alone ,Medicare ,prescription ,drug ,plan. ,Under ,what ,circumstances ,can ,she ,do ,this?correct ,answersIf ,the ,Medicare ,Advantage ,plan ,is ,a ,Private ,Fee-for-Service ,(PFFS) ,plan ,that ,does ,not ,offer ,drug ,coverage ,or ,a ,Medical ,Savings ,Account ,plan, ,Mrs. ,Berkowitz ,can ,do ,this.
Which ,of ,the ,following ,statements ,about ,Medicare ,Part ,D ,are ,correct? I. Part ,D ,plans ,must ,enroll ,any ,eligible ,beneficiary ,who ,applies ,regardless ,of ,health ,status ,except ,in ,limited ,circumstances. II. Private ,fee-for-service ,(PFFS) ,plans ,are ,not ,required ,to ,use ,a ,pharmacy ,network ,but ,may ,choose ,to ,have ,one. III. Beneficiaries ,enrolled ,in ,a ,MA-Medical ,Savings ,Account ,(MSA) ,plan ,may ,only ,obtain ,Part ,D ,benefits ,through ,a ,standalone ,PDP. IV. Beneficiaries ,enrolled ,in ,a ,MA-PPO ,may ,obtain ,Part ,D ,benefits ,through ,a ,standalone ,PDP ,or ,through ,their ,plan.correct ,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.
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 ,planspecific ,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. ABC ,is ,a ,Medicare ,Advantage ,(MA) ,plan ,sponsor. ,It ,would ,like ,to ,use ,its ,enrollees' ,information ,to ,market ,non-health ,related ,products ,such ,as ,life ,insurance ,and ,annuities. ,Which ,statement ,best ,describes ,ABC's ,obligation ,to ,its ,enrollees ,regarding ,marketing ,such ,products?correct ,answersIt ,must ,obtain ,a ,HIPAA ,complaint ,authorization ,from ,an ,enrollee ,that ,indicates ,the
,plan ,or ,plan ,sponsor ,may ,use ,their ,information ,for ,marketing ,purposes. You ,have ,approached ,a ,hospital ,administrator ,about ,marketing ,in ,her ,facility. ,The ,administrator ,is ,uncomfortable ,with ,the ,suggestion. ,How ,could ,you ,address ,her ,concerns?correct ,answersTell ,her ,that ,Medicare ,guidelines ,allow ,you ,to ,conduct ,marketing ,activities ,in ,common ,areas ,of ,a ,provider's ,facility. During ,a ,sales ,presentation, ,your ,client ,asks ,you ,whether ,the ,Medicare ,agency ,recommends ,that ,she ,sign ,up ,for ,your ,plan ,or ,stay ,in ,Original ,Medicare. ,What ,should ,you ,tell ,her?correct ,answersTell ,her ,that ,the ,Medicare ,agency ,does ,not ,endorse ,or ,recommend ,any ,plan. Agent ,Armstrong ,is ,employed ,by ,XYZ ,Agency, ,which ,is ,under ,contract ,with ,ABC ,Health ,Plan, ,a ,Medicare ,Advantage ,(MA) ,plan ,that ,offers ,plans ,in ,multiple ,states. ,XYZ ,Agency ,maintains ,a ,website ,marketing ,the ,MA ,plans ,with ,which ,it ,has ,contracts. ,Agent Armstrong ,follows ,up ,with ,individuals ,who ,request ,more ,information ,about ,ABC ,MA ,plans ,via ,the ,website ,and ,tries ,to ,persuade ,them ,to ,enroll ,in ,ABC ,plans. ,What ,statement ,best ,describes ,the ,marketing ,and ,compliance ,rules ,that ,apply ,to ,Agent ,Armstrong?correct ,answersAgent ,Armstrong ,needs ,to ,be ,licensed ,and ,appointed ,in ,every ,state ,in ,which ,beneficiaries ,to ,whom ,he ,markets ,ABC ,MA ,plans ,are ,located. You ,have ,been ,providing ,a ,pre-Thanksgiving ,meal ,during ,sales ,presentations ,in ,November ,for ,many ,years ,and ,your ,clients ,look ,forward ,to ,attending ,this ,annual ,event. ,When ,marketing ,Medicare ,Advantage ,and ,Part ,D ,plans, ,what ,are ,you ,permitted ,to ,do ,with ,respect ,to ,meals?correct ,answersYou ,may ,provide ,light ,snacks, ,but ,a ,Thanksgiving ,style ,meal ,would ,be ,prohibited, ,regardless ,of ,who ,provides ,or ,pays ,for ,the ,meal.
