Medicare Advantage and Prescription Drug Plans, Exams of Nursing

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Wellcare ACT Mastery Exam 2024

____ Prescription Drug Plans (PDPs) will be offered across all 50 U.S. states and Washington, D.C. - ANSWER-Three ______ 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. - ANSWER-Educational 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. - ANSWER-True A broker/agent who has never had any verbal warnings cannot be issued a Corrective Action Plan. - ANSWER-False A grievance request, or any evidence concerning a grievance, must be fi led 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. - ANSWER- A Health Risk Assessment (HRA) - ANSWER-All of these A Low-Income Subsidy (LIS) member will be assigned one of ____ copay categories depending on the level of need. - ANSWER-Four A request to the plan from a member or provider for a formal review of an Action (Denial) or Adverse Plan Determination (Medicare) is a/an: a. - ANSWER-Appeal All Prescription Drug Plans (PDPs) will continue to offer $0 Tier 1 preferred cost-sharing through Express Scripts Pharmacy (Mail Order). - ANSWER-True All Prescription Drug Plans (PDPs) will feature a $0 Tier 1 benefit when filled at preferred pharmacies. - ANSWER-True All Prescription Drug Plans (PDPs) will off er a $___ copay for most Part D preventive vaccines, regardless of which network pharmacy is used by members. - ANSWER-Zero Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts SOAs in which of the following methods? - ANSWER-All of these

An LEP is assessed by CMS when a member goes ______ days or longer without creditable prescription drug coverage after they become Medicare-eligible. - ANSWER- 63 days An SEP is a period outside of the ICEP, AEP, or MA OEP when beneficiaries can enroll based solely on life events that qualify for an SEP period. - ANSWER-True Any request or distribution of PHI should contain only the minimum amount of PHI required to complete the intended task - ANSWER-True Ascend is a fast, easy, and compliant way for brokers/agents to submit agent-assisted electronic enrollments. - ANSWER-True At the end of this course, there will be a Mastery Exam. Agents must achieve a passing score of 85% or higher to successfully complete this course - ANSWER-True 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. - ANSWER-False Brokers/Agents can access and download enrollment materials through CustomPoint. - ANSWER-True Brokers/Agents can access the following resources under the Shared Resources section in Centene Workbench. - ANSWER-All of these Brokers/Agents can submit a support ticket online through their Centene Workbench portal. - ANSWER-True Brokers/Agents may be investigated after being suspected of noncompliant activity reported through a - ANSWER-Complaint Tracking Module (CTM) Grievance Secret Shop Finding Brokers/Agents MUST complete a Wellcare Contract Recertifi cation case in Centene Workbench (CWB) every two years. - ANSWER-False Centene requires all contracted brokers/agents to read, understand, and agree to Centene's Business Ethics and Code of Conduct Policy. - ANSWER-True Communication of PHI can be: - ANSWER-Written, Electronic, Verbal CustomPoint sales material order dates will be posted on Wellcare.com - ANSWER- False CVS Caremark Mail Order will be in-network for 2024. - ANSWER-False

Dual-eligible and LIS beneficiaries that are not at-risk may use a Dual-Eligible SEP once per each of the ______ calendar quarters only. - ANSWER-First, Second , Third Enrollment applications must be received by Wellcare no later than ___ calendar day(s) following receipt from the beneficiary. - ANSWER- Enrollments through Ascend off er the following unique benefits: - ANSWER-Validation of important data to help prevent incorrect or missing information Search for providers and formularies to validate physician and prescription availability Extra help eligibility status. Digital capture of the broker's/agent's and benefi ciary's electronic signatures through Send for Signature at any timethroughout the enrollment application. 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. - ANSWER-True For Prescription Drug Plan (PDP) Medication Home Delivery, the ____ plan will continue to off er a discount (2.5 x 30-day preferred retail copay) for Tier 2, 3, and 6 prescriptions. - ANSWER-Value Plus From October 1 to October 14, certain activities are Non-Permissible Activities. These include: Assist with completing an application Collect a completed application Advise the beneficiary to complete an application prior to October 15. - ANSWER-All of these If a requested effective date is available for the special election period being selected, ensure you are requesting a date within the correct time frame for the member based on their eligibility date or change date needed. - ANSWER-True 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. - ANSWER-Zero Key areas you as a broker/agent have control over and impact upon regarding Star Ratings for quality are: - ANSWER-All of these Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part D plan premiums - ANSWER-False

Marketing benefits in a service area where those benefits are not available is prohibited and considered misleading unless that is unavoidable because of local/regional or media use. - ANSWER-True Marketing materials that have been developed by a third-party marketing organization (TPMO) for multiple MA organizations or plansmust be pre-reviewed by each MA organization, submitted to CMS in the Health Plan Management System (HPMS), and opted-in by thePlan prior to distribution. - ANSWER-True Materials that include plan comparisons or cost-sharing do not require CMS submission.

• ANSWER-False Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy. Wellcare's quality focus consists of six drivers. Which of the following is not a Wellcare quality driver? - ANSWER-Member Payments Member PHI can be stored on an external hard drive or a cloud storage service like Google Drive or Apple Cloud. - ANSWER-False Members are no longer required to pay a partial deductible due to the Inflation Reduction Act. - ANSWER-True 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. - ANSWER-True Members who have LIS and enroll in other plans will have a premium to pay regardless of the level of LIS the member is granted. - ANSWER-True Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing. - ANSWER-True Prior to completing the enrollment form, broker/agents should always confirm the beneficiary's primary care provider (PCP) and/or specialists - ANSWER-True Prior to the beginning of the enrollment process, a broker/agent is required to cover certain beneficiary specific information, including but not limited to: - ANSWER-All of these Providers may create co-branded marketing pieces using the Wellcare name and logo, as long as they are using the current, approved logo. - ANSWER-False The _________ plan is expected to have one of the lowest premiums in the country! - ANSWER-Value Script

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. - ANSWER-True The beneficiary (or their authorized representative) must indicate the product types to be discussed during the appointment on the Scope of Appointment (SOA). - ANSWER- True The Mastery Exam will lock for a period of 48 hours after each failed attempt. - ANSWER-False The online Centene Workbench self-service portal enables you to - ANSWER-All of these The Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/ will impact which plan(s)? - ANSWER-Both PDP & MAPD The Prescription Drug Plan (PDP) network is expected to include over ____ total pharmacies. - ANSWER-Sixty Thousand The Single Sign-On Portal provides access to several applications, including CustomPoint - ANSWER-True 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: - ANSWER-Included in any marketing materials, including print materials and television advertisements developed, used, or distributed by the TPMO. Verbally conveyed within the first minute of a sales call. Prominently displayed on TPMO websites (regardless of content). Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication (regardless of content). The Wellcare preferred pharmacy network includes Walgreens, CVS, and some grocery chains in 2024. - ANSWER-True Wellcare added which state to its footprint for 2024? - ANSWER-Delaware Wellcare continues to expand its reach by offering more products in a wider geography. ____ new Wellcare plans are going to market. - ANSWER-Twenty-three Wellcare does not need to be informed of all marketing/sales events at which plans or materials will be presented or distributed (formaland informal). - ANSWER-False

Wellcare expanded our county footprint in _____ states for 2024. - ANSWER-Five Wellcare has new All-Dual D-SNP products in AL, AR, FL, GA, KY, LA, MI, MS, NC, NM, OH, OK, TX, and WI. - ANSWER-True Wellcare's _____ plan is designed for Low-Income Subsidy members. - ANSWER- Classic Wellcare's 2024 product expansion represents a __% increase from 2023. - ANSWER- One What are some examples of steps that can be taken when safeguarding and securing PHI and PII? (Select all that apply.) - ANSWER-Shred documents that contain PHI or PII using appropriate means. Never leave laptops, PHI, or PII in an unattended vehicle. Do not include PHI or PII in the subject line or body of an email. Secure emails that contain PHI or PII. When a paper SOA form is used, it must be completed __________ hosting the sales presentation. - ANSWER-48 Hours prior to 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. - ANSWER-True When completing an enrollment, be sure to use the correct enrollment application for the desired plan year. - ANSWER-True When discussing prescription drug coverage, you should: - ANSWER-Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits). Confirm coverage of the beneficiary's current and/or anticipated prescriptions. Explain formulary tiers as well as drug copayment amounts. For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception. When explaining the provider network for D-SNPs and C-SNPs: - ANSWER-Avoid submitting applications with no primary care provider (PCP) to assist these higher-risk members.

If a member is not connected to a primary care provider (PCP), we should always encourage and assist with connecting them with an in-network doctor 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 eligibility may affect enrollment and/or cost sharing. - ANSWER-True Which elements are available as part of Wellcare's Sales Support model? - ANSWER- All of these Which is an example of a top beneficiary complaint that affects Star Ratings? - ANSWER-The beneficiary did not understand that enrolling in a Wellcare plan would change their current Medicare Advantage plan. Which is the Prescription Drug Plan (PDP) Preferred Mail Order network for 2024? - ANSWER-Express Scripts Pharmacy Which LIS category is assigned to members whose costs are fully subsidized and who receive the most assistance? - ANSWER-Three Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activity? - ANSWER-All of these Which of the following is not an example of Protected Health Information (PHI)? - ANSWER-Library Card Which of the following is not considered a grievance? - ANSWER-A dispute of the appeal of an organization determination, coverage determination, or a Late Enrollment Penalty (LEP) determination. Which of the following statements about Scope of Appointment (SOA) is FALSE? - ANSWER-An electronic SOA submitted in Ascend must be in a Pending status prior to beginning the appointment. Which of the Prescription Drug Plan (PDP) products is new to the 6-tier formulary structure for 2024? - ANSWER-Classic Which option is the preferred method to submit enrollment? - ANSWER-Ascend Web/Mobile Application Which Prescription Drug Plan (PDP) product features no deductible on any tier? - ANSWER-Value Plus

Which Prescription Drug Plan (PDP) product has the richest formulary with the most adherence generics on Tier 1? - ANSWER-Value Plus Which standalone Prescription Drug Plan (PDP) is best for a dual-eligible chooser? - ANSWER-Classic 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. - ANSWER-False With which types of inquiries can Wellcare's Corporate Sales Support team assist? - ANSWER-All of these You can help prevent grievances by: - ANSWER-Always confirming availability of the beneficiary's primary and specialist providers by using the provider search tool available on the plan's website. Always using plan materials to clearly explain plan benefits and cost (including medications) and check for understanding. Always confirming a beneficiary's intent to enroll before accepting their enrollment application.