Understanding Medicare Part D Prescription Drug Plans, Exams of Nursing

Download Understanding Medicare Part D Prescription Drug Plans and more Exams Nursing in PDF only on Docsity! b. A stand-alone prescription drug plan in combination with a PFFS plan or a c. A PFFS plan offering only medical benefits or a PFFS Medigap Suppleme d. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combinbenefits and Part D prescription drug coverage, a PFFS plan offering only m benefits, or PFFS Medigap Supplemental Insurance plan. Insurance plan. Medigap Supplemental Insurance plan. a. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combin benefits and Part D prescription drug coverage, a PFFS plan offering only m benefits, or a PFFS plan in combination with a stand-alone prescription drug AHIP First Test Questions and Answers Final Exam - Attempt 1 Question1 Marks: 1 Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for- Service (PFFS) plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts consider before selecting a PFFS plan? Choose one answer. Question2 Marks: 1 Mr. Wong is a single individual. He has had a successful business career and is now able to retire with a comfortable income. Mr. Wong's taxable income is in excess of $100,000. Mr. Wong b. Due to his participation in the workforce he will not have to pay premiu c. Due to the provisions of MACRA, his Part B and D coverage will be co d. Due to his participation in the workforce he will not have to pay premiu A but he will pay higher premiums for Part B and Part D due to the amou income. covered through a low-cost Medigap policy to supplement his Part A cove A and will pay reduced premiums for Part B and Part D. a. Due to his participation in the workforce he will not have to pay premiu A and he will pay the lowest monthly premium rates for Part B and Part D c. FIDE-SNP d. I-SNP b. C-SNP a. D-SNP b. Yes, he can execute the enrollment for her. He can do so because he is a c. Yes, he can execute the enrollment for her. A financial power of attorney i immediate family member. No power of attorney is necessary. a. No, he cannot execute the enrollment for her. Only Ms. Duarte can sign t regardless of her mental capacities. has health coverage through his employer but will sign-up Medicare Part A, Part B and Part D when he leaves the workforce. How would you advise him as he budgets for Medicare premiums? Choose one answer. Question3 Marks: 1 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? Choose one answer. Question4 Marks: 1 You are doing a sales presentation for Ms. Duarte and her son. Ms. Duarte has some cognitive impairment and her son informs you that he has power of attorney to make financial decisions for her. Can he execute the enrollment for her? Choose one answer. b. States often volunteer to review marketing materials on behalf of the Med c. Obtaining approval of her materials from the State Department of Insuran d. Materials for marketing Medicare health plans to individuals are subject to uniform national requirements. They do not need to be reviewed by the state company she represents must obtain approval from the Medicare agency (C materials she uses. practice and she should continue it with materials for the Medicare health pl represents. agency. She should check with her Department of Insurance to see if such a available and would satisfy CMS requirements. a. Materials need only be reviewed and approved by the company(s) she re b. During the MA Open Enrollment Period, from January 1 – March 31, s c. During the MA Open Enrollment Period, from January 1 – March 31, s d. During the MA Open Enrollment Period, from January 1 – March 31, s drop a MA or MA-PD plan and go back to Original Medicare, but she ma in a stand-alone prescription drug plan if she also purchases a Medigap only add or drop Part D coverage, so she cannot switch back to Original only disenroll from a MA or MA-PD plan, but cannot enroll in a stand-alo plan. a. During the MA Open Enrollment Period, from January 1 – March 31, s disenroll from the MA-PD plan into Original Medicare and also may add alone prescription drug plan. a. He can send them information about the MA-OEP along with a flyer o he represents. Question10 Marks: 1 Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period. In mid- January of the following year, she wants to switch back to Original Medicare and enroll in a stand-alone prescription drug plan. What should you tell her? Choose one answer. Question11 Marks: 1 Agent Willis had several clients who disenrolled from the plans he represents during the AEP to try new Medicare Advantage plans. Agent Willis believes that the choices they made are not ideal for them and would like to get their business back during the Medicare Advantage Open Enrollment Period (MA-OEP). What can agent Willis do? Choose one answer. c. He can wait until October and send them information about the plans d. He can call them to let them know that if they do not like their new pl can change back during the MA-OEP. represents. b. He can e-mail them in January and ask them to let him know if they a happy with their new plans. b. You do not need to complete a scope of appointment, but CMS can ask you c. You are not required to submit communication and marketing materials spe d. You do not need to take an annual test, but you must not provide potential e more than light snacks at presentations. those employer plans to CMS at the time of use, but CMS may request and re if employee complaints occur. reconstruct one if there is a subsequent employee complaint. a. You can make unsolicited contacts but you cannot cross-sell other products b. Step therapy involves slow changes in the dosages of a given drug in or c. Step therapy involves using one or more lower priced drugs before tryin d. Step therapy involves taking somewhat larger doses but skipping every resulting in lower overall consumption of the drug. expensive drug when all are used to treat the same condition. discover the correct amount. a. Step therapy refers to incentives plans can provide to enrollees to enga walking in order to reduce their need for medications treating heart and ch problems. Question12 Marks: 1 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? Choose one answer. Question13 Marks: 1 Ms. Lewis understands that Medicare prescription drug plans may use various methods to control the use of specific drugs. She has heard about a technique called “step therapy” and is wondering if you can explain what that is. What should you tell her? Choose one answer. Question14 Marks: 1 b. Under the Medicare Advantage program, the MSA plan is a form of pres c. Under the Medicare Advantage program, a MSA plan involves the comb d. Under the Medicare Advantage program, the MSA is funded by money h each year. If he does not use it all on IRS allowable health care expenditur will lose the money the following year. high deductible health plan and a savings account for health expenses. Me make contributions to this savings account to help him pay his health care while in the deductible. coverage. a. Under the Medicare Advantage program, the MSA is only an account to pay for IRS-allowed health expenditures he may have. It does not involve insurance of any kind. b. There is a MA Open Enrollment Period (OEP) that takes place between J c. There is a MA Open Enrollment Period (OEP) that takes place between J d. There is a MA Disenrollment Period that takes place between January 1 a 14 but since Ms. Gonzales enrolled in Original Medicare and Part D during t would not apply to her. and March 31 and Ms. Gonzales can use it to change from Original Medicar to a MA or MA-PD plan. and March 31, but Ms. Gonzales cannot use it because eligibility to use the available only to MA enrollees. a. There is a MA Open Enrollment Period (OEP) that takes place between J and March 31 and Ms. Gonzales can use it to change from Original Medicar only to a MA plan that includes prescription drug coverage. Mr. Chen has heard about a Medical Savings Account (MSA), but wants to know if it is just about saving money, or if he will get insurance coverage for his health care expenditures as well. What should you tell him? Choose one answer. Question15 Marks: 1 Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the Annual Enrollment Period (AEP). At the beginning of January, her neighbor told her about the Medicare Advantage (MA) plan he selected. He also told her there was an open enrollment period that she might be able to use to enroll in a MA plan. Ms. Gonzales comes to you for advice shortly after speaking to her neighbor. What should you tell her? Choose one answer. Question16 Marks: 1 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 b. Part D prescription drug plans are restricted to local service areas. She w c. Part D prescription drug plans generally contract with every pharmacy in d. Part D prescription drug plans use networks of pharmacies within their se She could look for a plan that maintains a network in both states. so she should be able to obtain her drugs in both states with no problem. use mail order to fill all of her prescriptions. a. Part D prescription drug plans focus almost entirely on mail order with fai access to retail pharmacies, so as long as she orders all of her medications mail, she will be fine. TrOOP are out-of-pocket costs that count toward the annual out-of-pocke to move into catastrophic coverage and generally include the annual deduc costs for drugs on the plan's formulary purchased at a plan's participating p some instances, amounts not directly paid by the enrollee (like manufacture count toward TrOOP. TrOOP is calculated on a cumulative basis and consists of the sum of an c. TrOOP are out-of-pocket costs that count toward the annual out-of-pocke d. TrOOP is calculated on an annual basis and consists of an enrollee's out deductible plus any amounts paid on behalf of an enrollee by Medicaid. to move into catastrophic coverage and generally include, in addition to the deductible, costs for drugs not on the Part D plan's formulary and drugs pur outside the United States. out-of-pocket deductibles from the date of his or her enrollment in Part D pl for over-the-counter drugs. 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? Choose one answer. Question22 Marks: 1 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? Choose one answer. Question23 Marks: 1 Alice is enrolled in a MA-PD plan. She makes a permanent move across the country and wonders what her options are for continuing MA-PD coverage. What would you say to her in regard to a special enrollment period (SEP)? b. She is unlikely to qualify for a SEP but will be automatically covered by O c. She is unlikely to qualify for a SEP and should remain on her current pla d. She is likely to qualify for a SEP. She can choose an effective date of up months after the month in which the enrollment form is received by the new the effective date may not be earlier than the date of her permanent move. her current plan’s out-of-network benefits. Medicare and a standalone Part D prescription drug plan. a. She is likely to qualify for a SEP. She can choose an effective date of up months after the month in which the enrollment form is received by the new the effective date may not be earlier than 30 days prior to the date of her m b. Medicare health plans must comply with requests for information from state c. Plan sponsors can use any marketing representative, as long as they are lic d. Plans must contract only with marketing representatives who reside in the st they intend to work. least one state. departments investigating complaints about a marketing representative. a. State licensure laws are pre-empted and do not apply to marketing represen marketing MA and Part D plans b. Ms. Lopez no longer needs to be concerned about state licensure since sh marketing an MA product subject to federal rules. a. Ms. Lopez is considered a marketing representative of BestCare and thus to comply with CMS marketing requirements, including those regarding using approved call scripts. Choose one answer. Question24 Marks: 1 Which of the following is a correct statement about state laws as they pertain to marketing representatives? Choose one answer. Question25 Marks: 1 Ms. Lopez is an independent agent under contract with MarketCo, a third-party marketing organization. MarketCo has a contract with BestCare health plan, a Medicare Advantage (MA) organization, to offer marketing services through its contracted agents and agencies. Ms. Lopez returns calls to individuals who contact MarketCo in response to its mailers promoting BestCare health plan. Which of the following best describes the responsibilities of Ms. Lopez? Choose one answer. d. Ms. Lopez is considered a marketing representative of BestCare but is exe the marketing rules regarding approved call scripts because she works direct MarketCo. c. Ms. Lopez needs to maintain state licensure, but because she is working f party marketing organization she is exempt from CMS training requirements BestCare captive agents. b. Mrs. Ramos should be aware that generally plan providers can decid c. Mrs. Ramos can obtain care from any provider who participates in Ori d. In general, Mrs. Ramos can obtain care from any provider who partici Original Medicare, but will have to pay the difference between the plan’s amount and the provider’s usual and customary charge. Medicare, but generally will have a higher cost-sharing amount if she se provider who/that is not a part of the PPO network. case-by-case basis, whether they will treat her. a. In general, Mrs. Ramos will need a referral to see specialists. b. Those who qualify for the Part D low income subsidy pay nothing for any of c. The Part D low income subsidy will not help her once she reaches the cove d. The Part D low income subsidy could substantially lower her overall costs. apply by contacting her state Medicaid office or calling the Social Security Ad she need not take the time to apply. medications. She should definitely apply if she believes there is any chance of qualifying. a. The Part D low income subsidy is designed for Medicare beneficiaries who for Medicaid. If she does not qualify for Medicaid, she would likely not qualify f help and therefore should not take the time to apply. Question26 Marks: 1 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? Choose one answer. Question27 Marks: 1 Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the time to fill out the paperwork. What could you tell her? Choose one answer. Question28 Marks: 1 b. Tell Julia that you are happy to meet with her once this year’s open enroll c. Tell Julia that you will meet with her to explain Medicare and should she b d. Tell Julia that she must first complete a questionnaire providing her healt that you can recommend an appropriate product before submitting an enroll application, since she qualifies for a special enrollment period. you can accept and submit an enrollment request, since this is an initial enr qualifying her for a special enrollment period. on October 15th. a. Tell Julia that you will meet with her at a time of her convenience within th week, when you can accept a completed enrollment application to be subm October 15th. c. I and II only d. I and III only b. I, III, and IV only a. II and IV only Julia Harris is turning 66 in July, at which time she will retire. She has contacted your office and requested a meeting so that she can learn about Medicare and the products you represent. How should you respond? Choose one answer. Question34 Marks: 1 Which of the following statements is correct about the appeal and grievance processes? I. Enrollees have a right to obtain a review (appeal) of certain decisions about prescription drug coverage. II. The grievance process is used for reviews of coverage decisions on plan benefits. III. Plans must provide a link to the Medicare.gov website where an enrollee can enter a complaint. IV.Enrollees have a right to file complaints (sometimes called grievances) about the quality of their care. Choose one answer. Question35 Marks: 1 Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr. Vaughn takes a prescription for helping to regrow his hair. They are anxious to have their Medicare prescription drug plan cover these drug needs. What should you tell them? Choose one answer. b. Mr. Vaughn’s hair growth medication would only be covered under Part D if c. Medicare prescription drug plans are not permitted to cover the prescription d. The vitamins the Vaughns are taking will be covered under Part D because physician suggested they should take vitamins, but the hair loss medication c covered. the Vaughns are interested in under Part D coverage, however, plans may cov supplemental benefits and the Vaughn’s could look into that possibility. resulted from an illness or was a side effect of a treatment such as chemother a. Medicare prescription drug plans are permitted to cover vitamins, but not dr cosmetic purposes. b. Mr. Landry must enroll in Part B to enroll in Part D, and he still has c. Mr. Landry must wait until the next annual open enrollment period b d. Mr. Landry must enroll in Part B to enroll in Part D, but his initial en period for Part B lapsed when he enrolled in Part A. initial enrollment period for Part D lapsed when he enrolled in Part A. so. a. Mr. Landry is eligible for Part D since he has Part A, and his initial e period (IEP) for Part D will continue for three months after his 65th bir b. Mrs. Wellington is eligible for a two- month SEP that began on Janu c. Mrs. Wellington is eligible for a SEP that may be used once until Nov she should act quickly if she wishes to enroll in the MA five-star plan. a. Mrs. Wellington must first enroll in a standalone PDP before she is e SEP to enroll in the MA five-star plan. Question36 Marks: 1 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? Choose one answer. Question37 Marks: 1 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)? Choose one answer. d. Mrs. Wellington can enroll in the five-star plan in the following Octob the next annual enrollment period (AEP) begins – not before. to enroll in the five-star plan. b. Marketing in health care facilities is an acceptable practice, as long as it c. Marketing in health care facilities is an acceptable practice, regardless of d. As long as the marketing activities are conducted in a way that does not healthy beneficiaries, it does not matter where in the hospital these activitie out. takes place. in common areas where patients are not receiving or waiting to receive hea a. So long as the hospital or its physician staff don’t object, marketing anyw hospital is an acceptable practice. b. She may only make such a change during her “initial coverage election p c. She may make such a change during the Annual Election Period that runs d. She may do it only during the MA Disenrollment Period, which runs from J February 14 of each year. 15 to December 7, or during the MA Open Enrollment Period which takes pl January 1- March 31 of each year (beginning in 2019). occurred when she first became entitled to Medicare. a. Any time that she is dissatisfied with the plan’s network coverage or custo she may make such a change. Question38 Marks: 1 You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. The hospital administration expresses some hesitation about allowing marketing in a health care facility. What should you tell them? Choose one answer. Question39 Marks: 1 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? Choose one answer. Question40 Marks: 1 b. A PFFS plan is a type of Medicare Supplement plan and she may enro c. A PFFS plan is exactly the same as Original Medicare, only offered by d. A PFFS plan is one of the various types of Medicare Advantage plans private entities and she may enroll in one if it is available in her area. entity and she may enroll in one if it is available in her area. is available in her area. a. PFFS plans are designed to cover only prescription drugs and if that is coverage she wants, she may enroll in one if it is available in her area. b. The doctor may only collect the amount allowable under Medicare p c. The doctor may only collect from Mr. Rivera the cost sharing allowa d. The doctor may only collect the amount allowable under Medicare A (MA) PPO plan cost sharing for non-QMB enrollees. the state’s Medicaid program. percent balance billing. a. The doctor may only collect the amount allowable under Medicare p percent balance billing. b. She could enroll in a PFFS plan and a stand-alone Medicare prescrip a. She could enroll in the PFFS plan and a Medigap plan that offers drug but not in a stand-alone Medicare prescription drug plan. 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? Choose one answer. Question46 Marks: 1 Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he sees an out-of-network doctor to receive a Medicare covered service. How much may the doctor collect from Mr. Rivera? Choose one answer. Question47 Marks: 1 Mrs. Chou likes a 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? Choose one answer. d. If she wants drug coverage and a PFFS plan, she could only enroll in plan that includes Medicare prescription drug coverage. c. She could enroll in a PFFS plan, but not in a stand-alone drug plan. plan. b. He will have a three month period during which he may enroll in as m d. He will have one opportunity to enroll in a Medicare Advantage plan. c. He may change or drop MA plans, but may not drop drug coverage. Medicare Advantage plans as he chooses, with the last enrollment bein effective one. a. If he has a disability, he may enroll in Original Fee-for-Service Medic the MA Initial Coverage Election Period. b. Enrollees in a PFFS plan can obtain care from any provider in the U.S. c. If a PFFS enrollee shows his/her card when obtaining services from a p d. If offered, beneficiaries can select a stand-alone Part D prescription dru (PDP) with an HMO or a PPO, but not with a PFFS plan. participates in Original Medicare, then that provider is required to accept t terms and conditions. Original Medicare, as long as the provider has a reasonable opportunity to plan’s terms and conditions and agrees to accept them. a. PFFS plans are the same as Medicare supplement plans and he may o from any provider in the U.S. Question48 Marks: 1 Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could you help him take during this time? Choose one answer. Question49 Marks: 1 Mr. McTaggert notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know what makes them different from an HMO or a PPO. What should you tell him? Choose one answer. Question50 Marks: 1 Richard is a licensed agent who represents Spartan Health Plan and its Medicare Advantage (MA) plans. Richard has several clients who have recently come to him for help who are in their a. Alice and Bob because each of them has had coverage through Spartan H Alice because she will not have a break between her non-Medicare and Me coverage through Spartan Health Plan. Alice and Charlotte because each of them currently have health coverage a initial coverage election period (ICEP). Alice, Bob, and Charlotte because electronic health record interoperability Richard to access any needed information for their applications. Submit all and finish initial coverage election period (ICEP) and are interested in enrolling in one of Spartan Health Plan's MA plans. Alice will soon turn 65 and retire. Alice has coverage through Spartan Health Plan offered by her employer. Bob had health coverage through Spartan but dropped the coverage when he retired early to travel overseas. Bob, who has just turned age 65, is now back in the United States. Charlotte, who will turn 65 next month, has coverage through Athena Health plan – a company Richard also represents. Who qualifies for the opt-in simplified enrollment mechanism? Choose one answer. Time Remaining