Medicare Supplemental Insurance and Medicare Advantage, Exams of Nursing

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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

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

enrollme

nt

standard general

enrollment period,

during which she may enroll in Medicare Part B.

Page 1 of 70

Mr. Moy's wife has a Medicare Advantage plan, but he wants to

understand what

Supplemental

Insurance

period after the last month on her employer plan that

differs from the

time,

and

paid taxes during that entire period. She is concerned that she will not qualify

for

you tell

her?correct answersMost individuals who are citizens and age 65

or over are

Part A by virtue of having paid Medicare taxes while

working, though

some may be

covered

as a result of paying monthly premiums.

Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well,

but it

her her?

correct

answersMrs. Gonzalez cannot purchase a Medigap plan that covers

drugs,

could keep her Medigap policy and enroll in a Part D prescription drug plan.

Mrs. West wears glasses and dentures and has enjoyed considerable pain relief

from

arthritis through massage therapy. She is concerned about whether or not

Medicare

will does

not

cover massage therapy, or, in general, glasses or dentures.

Mr. Patel is in good health and is preparing a budget in anticipation

of his retirement

whe

n

he turns 66. He wants to understand the health care costs he

might be exposed to

unde

r

Medicare if he were to require hospitalization as a result of an

illness. In genera

lterms,

what

could you tell him about his costs for inpatient hospital services

under Original Medicare?correct answersUnder Original Medicare, there is a

single

deductible amount due for the first 60 days of any inpatient hospital stay, after

which it

converts into a per-day coinsurance amount through day 90. After day

90, he would pay

a

daily amount up to 60 days over his lifetime, after which he would be

responsible for

all

Mrs. Chen will be 65 soon, has been a citizen for twelve years, has

been employed full

coverage under part A because she was not born in the United

States. What should covered

under

provides no drug coverage. She would like to keep the coverage she

has but replace existing Medigap plan with one that provides drug coverage. What

should you tell but

she

cover these items and services. What should you tell her?correct

answersMedicare

costs.

Ms. Henderson believes that she will qualify for Medicare Coverage when she

turns 65,

without paying any premiums, because she has been working for 40 years and

paying

she must

pay a

standard monthly premium, though it is higher for individuals with higher

incomes.

Mr. Alonso receives some help paying for his two generic prescription drugs

from his

plan.

into a

standard

MedicarePart D prescription drug plan. What should you tell him?correct

answersHe generally would pay a monthly premium, annual deductible, and

per-

prescription cost-sharing.

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.

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.

her

Page 3 of 70

Medicare taxes. What should you tell her?correct answersTo obtain

Part B coverage,

employer's retiree coverage, but he wants to compare it to a Part D

prescription drug He asks you what costs he would generally expect to encounter

when enrolling

Ms. Moore plans to retire when she turns 65 in a few months. She is in

excellent health

Mr. Xi will soon turn age 65 and has come to you for advice as to

what services are

Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has

recently reviewed

Medicare Summary Notice (MSN) and disagrees with a determination that

partially

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 answersP

art

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

denie

d

drug benefits. How

would you advise Agent John Miller to

proceed?correct a

nswersTell 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

him?

correct

ans

wersAfter 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

Medicare covers cancer screening.

What should you tell him?correct answersMedicare covers the periodic

performance of

range of screening tests that are meant to provide early detection of disease.

Mr.

Buck will need to check specific tests before obtaining them to see if they will

be covered.

Which of the following statement

is/are

correct about a Medicare Savings

Account (MSA)

Plans?

I.

An individual who is

enrolled in an

MSA plan is

responsible for a minimal deductible of

$500 indexed for inflation.

Non-network providers must accept the same amount that Original Medicare would pay

them as payment in full.correct answersI, 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

Page 5 of 70

which he has had for several years. However, the plan does

not provide

wondering whether he can obtain coverage under Medicare. What

should you tell

know

if

a

MSAs may have either a partial network, full network,

or no network of providers. II. MSA plans cover Part A and Part B benefits but not Part

D prescription drug benefits.

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 tel

lhim 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?corre

ct

answersMrs.

Ramos can obtain care from any provider who participates in Original Medicare,

but

generally will have a higher cost-sharing 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

abou

t

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

plan does not include drug coverage, but the other two plans do.

Mr. Lombardi

a neighbor's MA-PD plan that you represent and because he

takes numerous

much

Page 7 of 70

terms and conditions for payment. Mary Rodgers sees Dr. Brennan for

treatment. How

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.

Page 9 of 70

Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available

in his area has

an

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.

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

expensive

medications. Currently, she is enrolled in Original Medicare and a

standalone

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

likely to be

most

appropriate for him?correct

answers.

C-SNP

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 w

ould not have to put up with

such poor

attractive premium. He wants to know if he must use doctors in a

network as his

Mr. Wells is trying to understand the difference between Original

Medicare and

have prescription drug coverage since her doctor recently

prescribed several Part D

plan.

SNP

is

Mrs. Burton is a retiree with substantial income. She is enrolled in an

MA-PD plan and

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

answersSNPs limit enrollment

to

certain subpopulations of beneficiaries. Given

his

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

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.

recently

stopped paying his Part B premium. Mr. Castillo is still covered by

Part A. He

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.

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

ope

n

Page 11 of 70

would like to join that plan. What should you tell

him?correct current situation, he is

unlikely to

Part

A

Mr. Castillo, a naturalized citizen, previously enrolled in Medicare

Part B but has would like

to

Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan

several years ago.

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.

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

clients, Lauren Nichols, has heard about a Medica

Mr. Barker enjoys a comfortable retirement income. He recently

had surgery and

expecte

d

minimal out-of-

However, when he

received

the bill, he was surprised to see large charges in

excess of

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.

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

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

shoul

d

enrollment season?correct answersShe may remain in her ABC MA

plan, enroll in

Mr. Kumar is considering a Medicare Advantage HMO and has

questions about his

the

network).ur

that he would have certain services and items covered by

the plan with pocket costs because his MA-PD coverage has been

very good.

his maximum out-of-pocket

limit

Mr. Sinclair has diabetes and heart trouble and is generally satisfied

with the care he

provid

e

Medicare

Advantage program?correct answersThey are Medicare health

plans such as

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.

Mr. Zachow has a condition for which three drugs are available. He

has tried two but

had

an

allergic reaction to them. Only the third drug works for him and

it is not on his

Part D

plan's

formulary. What could you tell him to do?correct answersMr.

Zachow has

a right to

request

physician could

obtain the standardized request form on the plan's

website, fill it out, plan.

Mr. Bickford did not quite qualify for the extra help low-income

subsidy under the

Medicar

e

option he has for

obtaining help

with his considerable drug costs. What should you tell him?

correct answersHe could check with the manufacturers of his

medications to see if

assistance program to help people with limited means

to obtain the

medications they

need.

Alternatively, he could check to see whether his

state has a

pharmacy assistance

program

Page 13 of 70

you tell him about the types of health plans that are available

through the HMOs,

PPOs,

a formulary exception to obtain coverage for his Part D

drug. He or his and submit it to

his

Part D Prescription Drug program and he is wondering if there

is any other

they offer

an

to help him with his expenses.

Vaughn

their

Medicare them?

correct

answersMedicare prescription drug plans are not permitted to cover the

however,

plans may

cover them as supplemental benefits and the Vaughn's could look

Mr. Wingate is a newly enrolled Medicare Part D

beneficiary and one of your clients. In

include

a

prescription drug not on his plan's formulary, over-the-counter

medications for

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.

plan

(PDP) coverage. She is traveling and wishes to fill two of the

prescriptions that she

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.

Mr. and Mrs. Vaughn both take a specialized multivitamin

prescription each day. Mr. takes a prescription for helping to regrow his hair. They are

anxious to have prescription drug plan cover these drug needs. What

should you tell

prescripti

on medications the Vaughns are interested in under Part

D coverage,

into that

possibility.

addition to drugs on his plan's formulary he takes several other

medications. These colds

and

Ms. Edwards is enrolled in a Medicare Advantage plan that includes

prescription drug has

lost.

Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently

lost

interested in

enrolling in a Medicare Part D prescription drug plan (PDP). What

should

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

availabl

e

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 tel

lher?

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.

Page 15 of 70

creditable coverage previously available through her husband's

employer. She is you tell

her?

decision?correct answersIf she

does

not

sign up for a Medicare prescription

drug plan will be permanently

increased by 1%

of the national average premium for every month

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,

decided not to enroll because he was satisfied with his drug

coverage. It is now a

year

later

weeks. How would

you advise him?correct answersMr. Schultz should enroll in

a Part D

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

Medicar

e

enrolled under

Medicare Part B. What should you tell her?correct

answersAn individual

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

cover all

medications. As a

result, their formularies, or lists of covered drugs, will vary co-payments

and prior authorization.

What could you tell her about the implications

of such a (^) as soon as she is eligible to

do so, and if she does sign up at a later date, her

premium

that she was not

covered.

he

and Mr. Shultz has lost his employer group coverage within

the last two plan before he has

a 63-

prescription drug plan because, although she is entitled to Part

A, she is not who is entitled

to

their enrollees can access medications?correct answersPart D plans

do not have to from plan

to plan. In addition, they can use cost containment techniques

such as tiered

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

catastrophic coverage threshold, the beneficiary pays whichever is greater of

either the

brand name drugs or coinsurance of 5%.

benefit, but

when he looks at information on various plans available in

his area, he sees you explain this to him?correct answersMedicare Part D drug

plans may have different

on average, they must all be at least as good as

the standard

model established by

the

government.

Mr. Carlini has heard that Medicare prescription drug plans are only

offered through

privat

e

companies under a program known as Medicare Advantage

(MA), not by the

governme

nt.

product, but he also

wants prescription drug coverage. What should you tell

him?correct

stay 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

Page 17 of 70

All plans must cover at least the standard Part D coverage or its

actuarial equivalent.

D

coverage would require payment of an annual deductible, and

once past the co-pays for generic

and

Mr. Jacob understands that there is a standard Medicare Part D

prescription drug a wide range

in what they charge for deductibles, premiums, and cost

sharing. How can benefit structures,

but

He likes Original Medicare and does not want to sign

up for an MA answersMr. Carlini

can

coverage to eligible Medicare beneficiaries.

Plan? correct

answersJose, a grandfather who was granted asylum and has

worked in

States for many years.

Mr. Hutchinson has drug coverage through his former employer's retiree plan.

He is

prescription

drug plan, but does not want to purchase extra coverage

that he will not

need. What

should

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 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

Privat

e

Fee-for-Service (PFFS) plan that does not offer drug

coverage or a Medica

lSavings

Account

Which of the following individuals is most likely to be eligible to

enroll in a Part D the

United

concerned about the Part D premium penalty if he does not enroll

in a Medicare

you tell him?correct answersIf the drug coverage

he has is not

period to avoid the late

enrollment

plan, Mrs. Berkowitz can do this.

Which of the following statements about Medicare Part D are

correct?

Part D plans must enroll any eligible beneficiary who applies regardless

of health circumstances.

Private fee-for-service (PFFS) plans are not required to use a pharmacy

network but III. Beneficiaries enrolled in a MA-Medical Savings Account

(MSA) plan may only obtain

standalone PDP.

IV. Beneficiaries enrolled in a MA-PPO may obtain Part D

benefits through a standalone

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

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

th

e

Medicare Advantage plans that you represent, you are not

subject to the same

marketin

g

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

marketing rules.

Page 19 of 70

status except in

limited

may choose to

have one. Part D benefits

through a

PDP or

through their

woul

d

requirements as the plans themselves. How should you

respond to such a

comply with all

Medicare

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

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

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

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

tel

l

him?correct answersYou appreciate the opportunity and would

be happy to

schedule

an

appointment with anyone at their request.

introduced a

Medicare Advantage plan offering comprehensive dental

benefits for $

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

Mrs. Lu is turning 65 in November and called to ask for your help

deciding on a

answersYou

may

in

neighborhoods with single-family homes. He further argues that

their older owners

in such

a

Melissa Meadows is a marketing representative for Best Care

which has recently per month.

Best

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

impermissible.

Agent Martinez wishes to solicit Medicare Advantage prospects through e-

mail and

asks answersMarketing representatives may initiate

electronic contact through e-mail but an

be provided.

can

do during the Medicare Advantage Open Enrollment Period

(MA-OEP). What

advice

should

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?

Page 21 of 70

advice would you give her?correct answersAs soon as CMS

approves Best Care's

advertised as "educational," discussing plan-specific

premiums is

yo

u for advice as to whether this is possible. What should you

tell her?correct opt-out process

must

Miguel Sanchez is a relatively new agent who has come to you for

advice as to what he

you give Miguel?correct answersDuring the MA-OEP,

Miguel can have

correct answersTell her that Medicare guidelines allow you to

conduct

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

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

Novemb

er

for many years and your clients look forward to attending this

annual event

.Whe

n

marketing

activities in

the website and tries to persuade them to enroll in ABC plans.

What statement

with respect

to

meals?correct answersYou may provide light snacks, but a

Thanksgiving

be prohibited, regardless of who provides or pays for the meal.

Next week you will be participating in your first "educational event" for

prospective

enrollees. To be sure that you do not violate any of the applicable guidelines, in

what

activities should you plan to engage?correct answersYou should plan to ensure

that the educational event is an informative event and must not conduct a sales

presentation or

distribute or accept enrollment forms at the event.

You are working several plans and community organizations to sponsor an

educational event. When putting together advertisements for this event, what

should you do?correct answersYou must ensure that the advertisements

indicate it is an educational event,

otherwise it will be considered a marketing event.

Another agent you know has engaged in misconduct that has been verified 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

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

you do in this

situation?correct answersYou will not be able to represent any

Medicare

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

Page 23 of 70

marketing Medicare Advantage and Part D plans, what are you

permitted to do style meal

would

a

not achieve a passing score on the tests that came after the

training. What can Advantage

or

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 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

months

after the loss of creditable coverage.

Mrs. Young is currently enrolled in Original Medicare (Parts A and B), but she has

been

midsuggesting

that he and Mrs. Young complete the application together before she leaves.

submit the paper application before the start of the annual

enrollment

period (AEP).

What

answersThis is a bad idea.

Agents

are generally prohibited from soliciting or

accepting 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

HIPA

A

creditable drug coverage; the SEP begins in June and ends on

September 1- two

working with Agent Neil Adams in the selection of a Medicare Advantage

(MA) plan. It is September, and Mrs. Young is going on vacation. Agent Adams

is considering

He will

then

would you say If you were advising Agent

Adams?correct

an enrollment form before the

start of

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-

incom

e

plan?correct

answersHe qualifies for a special election period and can

enroll in or

plan once during that period.

Mr. Yoo's employer has recently dropped comprehensive creditable prescription

drug

because he

was

affected by this change, he would qualify for a Special election period.

him?correct

answersIt means that he qualifies for a one-time opportunity to

enroll in an

prescription drug plan.

period"

to enroll in a new Medicare Advantage plan. She contacted you

to ask what a

speci

al

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

beneficiary specific and results from events, such as when

the beneficiary

moves outside

of

the service area.

Mrs. Margolis contacts you in August because she will become eligible for

Medicare for

first time in November. She would like to meet and discuss plan choices with

you.

What advice should you give her?correct answersTell her to wait

until October to

discus

s

plan choices with you so that you can share plan benefits for

the current year as

well as

any

Page 25 of 70

disenrolled from the Medicare

Advantage

subsidy. How does that affect his ability to enroll or

disenroll in a Part D disenroll from a

Part D

coverage that was offered to company retirees. The company

told Mr. Yoo that, Mr.

Yoo

contacted you to find out more about what this means. What

can you tell MA-PD or

Part D

Mrs. Schmidt is moving and a friend told her she might qualify for a

"Special election

election period is. What could you tell her?correct answersIt is a

period, outside

period

is

th

e