Medicare Advantage and Prescription Drug Plan Overview, Exams of Business Economics

Download Medicare Advantage and Prescription Drug Plan Overview and more Exams Business Economics in PDF only on Docsity! 1 | P a g e WELLNESS MASTERY CERTIFICATION EXAM 2024-2025 WITH ACTUAL QUESTIONS CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS|ALREADY GRADED A+|BRAND NEW!!!|LATEST UPDATE|GUARANTEED PASS Dual-eligible and LIS beneficiaries that are not at-risk may use a Dual-Eligible SEP once per each of the ______ calendar quarters only. (Select all that apply.) a.First b.Second c.Third d.Fourth a.First b.Second c.Third A broker/agent who has never had any verbal warnings cannot be issued a Corrective Action Plan. True False False The Mastery Exam will lock for a period of 48 hours after each failed attempt. True False False Beneficiary-facing marketing materials for multiple MA organizations or plans must be submitted to the HPMS Marketing Module by the third-party marketing organization (TPMO) no later than 30 days of use. 2 | P a g e True False False Failure to inform a beneficiary that a trusted provider is out-of-network or is not available in the newly selected plan can cause a sales allegation. True False True Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing. True False True Once the enrollment is completed, you can save a copy of the application for your reference. True False False With which types of inquiries can Wellcare's Corporate Sales Support team assist? a.Application and Enrollment b.Onboarding and Certifications c.Commissions d.All of thes d. All of these Members who fail to pay the required premiums before the end of the grace period (Wellcare has a three-month grace period) will be terminated. True False True CVS Caremark Mail Order will be in-network for 2024. True False False Which Prescription Drug Plan (PDP) product has the richest formulary with the most adherence generics on Tier 1? a.Classic b.Value Script c.Value Plus 5 | P a g e True When an enrollment application is completed in Ascend, brokers/agents can complete a Health Risk Assessment (HRA) directly in Ascend after the enrollment application, through the Value-Based Enrollment (VBE) portal. True False True Which of the following is not an example of Protected Health Information (PHI)? a.Medical records b.Payment history c.Library card c. Library card A Health Risk Assessment (HRA): a.Provides physicians with an overview of a member's health status. b.Helps us understand the unique health situation of each of our members and allows us to make sure they receive the services that meet their needs. c.Is an important part of our quality initiative, directly impacting our Star Ratings. d.All of these d. All of these The online Centene Workbench self-service portal enables you to: a.Upload applications b.Use the self-service workflows and ticketing system c.Locate valuable documents and resources d.All of these d. All of these Communication of PHI can be: (Select all that apply.) a.Written b.Electronic c.Verbal a.Written b.Electronic c.Verbal You can help prevent grievances by: (Select all that apply.) a.Always confirming availability of the beneficiary's primary and specialist providers by using the provider search tool available on the plan's website. 6 | P a g e b.Always using plan materials to clearly explain plan benefits and cost (including medications) and check for understanding. c.Always confirming a beneficiary's intent to enroll before accepting their enrollment application. a.Always confirming availability of the beneficiary's primary and specialist providers by using the provider search tool available on the plan's website. b.Always using plan materials to clearly explain plan benefits and cost (including medications) and check for understanding. c.Always confirming a beneficiary's intent to enroll before accepting their enrollment application. When a paper SOA form is used, it must be completed __________ hosting the sales presentation. a.48 Hours prior to b.During c.After a.48 Hours prior to Any request or distribution of PHI should contain only the minimum amount of PHI required to complete the intended task. True False True When discussing prescription drug coverage, you should: (Select all that apply.) a.Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits). b.Confirm coverage of the beneficiary's current and/or anticipated prescriptions. c.Explain formulary tiers as well as drug copayment amounts. d.For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception. a.Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits). b.Confirm coverage of the beneficiary's current and/or anticipated prescriptions. c.Explain formulary tiers as well as drug copayment amounts. 7 | P a g e d.For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception. Which option is the preferred method to submit enrollment? a.Centene Workbench Upload b.Ascend Web/Mobile Application c.Fax/Paper b.Ascend Web/Mobile Application A broker/agent may be terminated for cause if they fail to comply with a compliance investigation, encourage others to avoid the compliance interview process, or fail to provide truthful or complete information. True False True The _________ plan is expected to have one of the lowest premiums in the country! a.Classic b.Value Plus c.Value Script c.Value Script All Prescription Drug Plans (PDPs) will feature a $0 Tier 1 benefit when filled at preferred pharmacies. True False True All Prescription Drug Plans (PDPs) will offer a $___ copay for most Part D preventive vaccines, regardless of which network pharmacy is used by members. a.Zero b.Five c.Ten d.Fifteen a. Zero All Prescription Drug Plans (PDPs) will continue to offer $0 Tier 1 preferred cost-sharing through Express Scripts Pharmacy (Mail Order). True False True Which LIS category is assigned to members whose costs are fully subsidized and who receive the most assistance? 10 | P a g e Ascend is a fast, easy, and compliant way for brokers/agents to submit agent-assisted electronic enrollments. True False True Materials that include plan comparisons or cost-sharing do not require CMS submission. True False False If a requested effective date is available for the special election period being selected, ensure you are requesting a date within the correct timeframe for the member based on their eligibility date or change date needed True False True The online Centene Workbench self-service portal enables you to a.Upload applications b.Use the self-service workflows and ticketing system c.Locate valuable documents and resources d.All of these d. All of these The TPMO disclaimer must be used by any TPMO that sells plans on behalf of more than one MA plan provider. The disclaimer must be: (Select all that apply. a.Included in any marketing materials, including print materials and television advertisements developed, used, or distributed by the TPMO. b.Verbally conveyed within the first minute of a sales call. c.Prominently displayed on TPMO websites (regardless of content). d.Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication (regardless of content). a.Included in any marketing materials, including print materials and television advertisements developed, used, or distributed by the TPMO. b.Verbally conveyed within the first minute of a sales call. c.Prominently displayed on TPMO websites (regardless of content). 11 | P a g e d.Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication (regardless of content). When verifying a D-SNP beneficiary's Medicaid eligibility through the Ascend Medicaid search tool, you should confirm their current Medicaid status qualifies for the selected D-SNP being enrolled in and explain that changes in Medicaid eligiblity may affect enrollment and/or cost sharing. True False True When completing an enrollment, be sure to use the correct enrollment application for the desired plan year. True False True Brokers/Agents can access and download enrollment materials through CustomPoint. True False True The 2024 Inflation Reduction Act (IRA) Part D Benefits include reduced insulin copays for all insulins and insulin-combination products that are on the formulary, regardless of tier, and are included in the $35 cap for one month's supply. True False True The Wellcare preferred pharmacy network includes Walgreens, CVS, and some grocery chains in 2024. True False True Which standalone Prescription Drug Plan (PDP) is best for a dual-eligible chooser? a.Value Script b.Value Plus c.Classic C. Classic Wellcare expanded our county footprint in _____ states for 2024. a.One b.Two 12 | P a g e c.Four d.Five d. five Members are no longer required to pay a partial deductible due to the Inflation Reduction Act. True False True Brokers/Agents can access the following resources under the Shared Resources section in Centene Workbench. a.Training Resources b.Commission Resources c.Marketing Resources d.All of these d. All of these Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts SOAs in which of the following methods? a.Ascend b.Telephonic c.Paper d.All of these d. All of these Any request or distribution of PHI should contain only the minimum amount of PHI required to complete the intended task. True False True When discussing prescription drug coverage, you should: (Select all that apply.) a.Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits). b.Confirm coverage of the beneficiary's current and/or anticipated prescriptions. c.Explain formulary tiers as well as drug copayment amounts. d.For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception 15 | P a g e Starting in 2025, a member may move through THREE benefit stages during the plan year. Which benefit stage will no longer exist? Coverage Gap For 2025, Wellcare will offer a Value-Based Insurance Design (VBID) model on select Dual Eligible Special Needs Plans (D-SNPs) that include $0 deductible and $0 copays for covered prescriptions. True Low-Income Subsidy (LIS) Level 4 is ending and moving to Level 1 as new certifications and recertifications take place. True Brokers/Agents can access and download enrollment materials through CustomPoint®. True Self-reporting of a compliance issue must be made to Corporate Compliance or to a Health Plan Sales Leader and must indicate: All Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activity? All Disciplinary actions stemming from the result of a compliance allegation are always progressive. False The Single Sign-On Portal provides access to multiple applications, including CustomPoint®. True ______ events are designed to inform the people who attend about Medicare Advantage, Prescription Drug, or other Medicare programs without going into the specifics of a particular carrier. Educational Materials that include plan comparisons or cost sharing do not require Centers for Medicare & Medicaid Services (CMS) submission. False From October 1 to October 14, certain activities are not permitted for 2025 sales and enrollments. These include: All 16 | P a g e The Third-Party Marketing Organization (TPMO) disclaimer must be used by any TPMO that sells plans on behalf of more than one Medicare Advantage (MA) plan provider. The disclaimer must be: (Select all that apply.) All Which option is the preferred method to submit enrollment? Ascend Failure to inform a beneficiary that a trusted provider is out-of-network or is not available in the newly selected plan can cause a sales allegation. True Enrollments through Ascend offer the following unique benefits: (Select all that apply.) All When verifying a Dual Eligible Special Needs Plan (D-SNP) beneficiary's Medicaid eligibility through the Ascend Medicaid search tool, you should: Both When prospective Wellcare members check online for the status of their submitted application, which element is optional? Confirmation number Grievance procedures are separate and distinct from initial determination and appeal procedures. True A grievance request, or any evidence concerning a grievance, must be filed orally or in writing no later than _____ calendar days from the date of the event or the date the member is made aware of the issue. 60 The Pre-Enrollment Checklist (PECL) should be provided and reviewed with your client after enrollment to ensure the enrollee understands important plan benefits and rules. False When an enrollment application is completed in Ascend, brokers/agents can complete a Health Risk Assessment (HRA) directly in Ascend after the enrollment application, through the Value-Based Enrollment (VBE) portal. True What are some examples of steps that can be taken when safeguarding and securing PHI and PII? (Select all that apply.) All 17 | P a g e Names and/or logos of provider co-branding partners can be displayed on marketing materials, as long as the current and approved logos are used. False The Third-Party Marketing Organization (TPMO) disclaimer must be used by any TPMO that sells plans on behalf of more than one Medicare Advantage (MA) plan provider. The disclaimer must be: (Select all that apply.) All An Election Period Request for Information (RFI) must be resolved within 7 calendar days, or the application will be denied. True All Prescription Drug Plans (PDPs) offer preferred cost-sharing including $0 copay on Tier 1 preferred generic medications through Express Scripts Pharmacy home delivery. True All Prescription Drug Plans (PDPs) will feature a $0 Tier 1 benefit when filled at preferred pharmacies. True Effective 2025, key provisions of the Inflation Reduction Act include a lower annual threshold of $_____ for out-of-pocket (OOP) prescription drug costs in Medicare. 2,000 Which will be Wellcare's Preferred Mail Order pharmacy? express scripts Wellcare does not need to be informed of informal marketing/sales events at which plans or materials will be presented or distributed. False When a paper Scope of Appointment (SOA) form is used, it must be completed __________ hosting the sales presentation. 48 hours prior to When completing an enrollment, be sure to use the correct enrollment application for the desired plan year. True When completing enrollments, be sure to collect the member's ____ and ____ to help ensure they receive important resources throughout and beyond their onboarding journey. Email & Mobile 20 | P a g e Which elements are available as part of Wellcare's Sales Support model? d. All of these Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing. True Wellcare continues to expand its reach by offering more products in a wider geography. ____ new Wellcare plans are going to market. a. Twenty-three In the Catastrophic Coverage stage, the member will pay $___ for brand and generic drugs for the remainder of the year once their total out of pocket costs reach $8,000. d. Zero All Prescription Drug Plans (PDPs) will feature a $0 Tier 1 benefit when filled at preferred pharmacies. True Which Prescription Drug Plan (PDP) product features no deductible on any tier? c. Value Plus With the Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024, existing members can continue to use their current ID card 1/1/2024 and beyond. False All Prescription Drug Plans (PDPs) will offer a $___ copay for most Part D preventive vaccines, regardless of which network pharmacy is used by members. a. Zero Which Prescription Drug Plan (PDP) product has the richest formulary with the most adherence generics on Tier 1? c. Value Plus Members are no longer required to pay a partial deductible due to the Inflation Reduction Act. True Wellcare has new All-Dual D-SNP products in AL, AR, FL, GA, KY, LA, MI, MS, NC, NM, OH, OK, TX, and WI. 21 | P a g e True Which LIS category is assigned to members whose costs are fully subsidized and who receive the most assistance? c. Three For Prescription Drug Plan (PDP) Medication Home Delivery, the ____ plan will continue to offer a discount (2.5 x 30-day preferred retail copay) for Tier 2, 3, and 6 prescriptions. b. Value Plus The Wellcare preferred pharmacy network includes Walgreens, CVS, and some grocery chains in 2024. True