Understanding Medicare Advantage and Supplemental Insurance, Exams of Advanced Education

Download Understanding Medicare Advantage and Supplemental Insurance and more Exams Advanced Education in PDF only on Docsity! AHIP 2024 Exam With 100% Correct And Verified Answers Medicare Advantage - Correct Answer--Cover all Part A and Part B benefits; -Provide plan cost-sharing actuarially equivalent to cost sharing under Medicare Parts A and B, but may be different for specific services; and -Include an annual maximum out-of-pocket (MOOP) limit on total enrollee cost sharing (deductibles, coinsurance, and copayments) for Part A and Part B services. -Cover the following services even when provided by non-network providers: emergency services: out-of-area urgently needed services; and out-of-area renal dialysis Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will have considerable income when she retires. She is concerned that her income will make it impossible for her to qualify for Medicare. What could you tell her to address her concern? - Correct Answer-Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, end stage renal disease or Lou Gehrig's disease, so she will be eligible for Medicare. Mr. Styles 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 Answer- Part 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. Mr. Hudson is concerned that if he signs up for a Medicare health plan, the health plan may, at some time in the future, reduce his benefits below what is available in Original Medicare. What should you tell him about his concern? - Correct Answer-Medicare health plans must cover all benefits available under Medicare Part A and Part B. Many also cover Part D prescription drugs. Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her? - Correct Answer-Part D covers prescription drugs and she should look at her premiums, formulary, and cost sharing to see if they have changed. Mrs. Weems wants to know generally how the benefits under Original Medicare might compare to the benefit package of a Medicare Health Plan before she starts looking at specific plans. What could you tell her? - Correct Answer-Medicare Health Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental services and must include a maximum out-of-pocket limit on Part A and Part B services. Mr. Meoni's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs. What could you tell Mr.Meoni? - Correct Answer- Medicare Supplemental Insurance would help cover his Part A and Part B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover. Mr. Meoni's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs. What could you tell Mr.Meoni? - Correct Answer-Most individuals who are citizens and over age 65 are covered under Part A by virtue of having paid Medicare taxes while working, though some may be covered as a result of paying monthly premiums. Mr. 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 wondering whether he can obtain coverage under Medicare. What should you tell him? - Correct Answer-After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. Mr. Davis is 49 years old and has been receiving disability benefits from the Social Security Administration for 12 months. Can you sell him a Medicare Advantage or Part D Prescription Drug policy? - Correct Answer-No, he cannot purchase a Medicare Advantage or Part D policy because he has not received Social Security or Railroad Retirement disability benefits for 24 months. 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 Medicare taxes. What should you tell her? - Correct Answer-In order to obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. He has heard that there is a premium penalty for those who did not sign up for Part B when first eligible and wants to know how much he will have to pay. What should you tell him? - Correct Answer-Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. 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 Answer-She may enroll at any time while she is covered under her employer plan, but she will have a special eight-month Answer-It 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. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug coverage. She would like to keep the coverage she has, but replace her existing Medigap plan with one that provides drug coverage. What should you tell her? - Correct Answer-Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug plan. Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about what type of plan designs are available through this program. What should you tell him about the types of health plans that are available through the Medicare Advantage program? - Correct Answer-They are Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs. Mr. Whalen is trying to understand the difference between Original Medicare and Medicare Advantage. What would be a correct description? - Correct Answer-Medicare Advantage is a way of covering all of the Original Medicare benefits through private health insurance companies. During a sales presentation in Ms. Sully'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? - Correct Answer-A PFFS plan is exactly the same as Original Medicare, only offered by a private entity and she may enroll in one if it is available in her area. Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her? - Correct Answer-Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. Ms. Bass lives on a limited fixed income and is concerned about the cost of healthcare. What should you tell her about the sort of help available to low income individuals under the Medicare program? - Correct Answer-As a Medicare beneficiary with limited income and resources she may contact her state Medicaid agency to apply for assistance paying for the Part B premium and cost sharing and Part D prescription drug coverage. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him? - Correct Answer-In most Medicare Advantage HMOs, Mr. Kumar must obtain his services only from providers who have a contractual relationship with the plan (except in an emergency). Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care. What should you tell her? - Correct Answer- Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally will be charged a lower co-payment if she goes to one of the plan's preferred providers. Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). What could you tell him? - Correct Answer- SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as well. Mr. 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 would like to join that plan. What should you tell him - Correct Answer- SNPs limit enrollment to certain sub-populations of beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know if he must use doctors in a network like his current HMO plan requires him to do. What should you tell him? - Correct Answer-He 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. Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-Service (PFFS) plan. As part of that discussion, what should you be sure to tell her? - Correct Answer-If she uses non-network providers, her doctors and hospital could decide whether to treat her on a visit-by-visit basis. 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? - Correct Answer-Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts Original Medicare, as long as the provider has a reasonable opportunity to access the plan's terms and conditions and agrees to accept them. If Dr. Elizabeth Brennan does not contract with the PFFS plan, but accepts the plan's terms and conditions for payment, how will she be paid? - Correct Answer-Generally, the PFFS plan will pay Dr. Brennan directly the same amount Original Medicare would pay her. Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. She is attracted by the idea of maintaining control over a Medical Savings Account (MSA), but is not sure if the plan associated with the account will fit her needs. What specific piece of information about a Medicare MSA plan would it be important for her to know, prior to enrolling in such a plan? - Correct Answer-All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be obtained by also enrolling in a separate prescription drug plan. Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan, but does not want to be limited in terms of where he obtains his care. What should you tell him about how a Medicare Cost Plan might fit his needs? - Correct Answer-Cost plan enrollees can choose to receive Medicare covered services under the plan's benefits by going to plan network providers and paying plan cost sharing, or may receive services from non-network providers and pay cost-sharing due under Original Medicare. Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group health plan that includes drug coverage with nominal copays. He heard about a neighbor's MA-PD plan that you represent and because he takes numerous prescription drugs, he is considering signing up for it. What should you tell him? - Correct Answer-It is always the best option to talk with his benefits administrator to see whether he needs both an employer sponsored plan and a private MA-PD and what might happen if he were to sign up for both. Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare Health Plan? 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 Answer-Medicaid will coordinate benefits only with Medicaid participating providers. 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 Answer-Medicaid may provide additional benefits, but Medicaid will coordinate benefits only with Medicaid participating providers. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does not include drug coverage and intends to obtain his drug coverage through a stand-alone Medicare prescription drug plan. What should you tell him about this situation? - Correct Answer-He could enroll in one of the MA plans that include prescription drug coverage or a Medigap plan and a stand-alone prescription drug plan, but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan. Mrs. Chou likes a PFFS plan available in her area that does not offer drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What should you tell her? - Correct Answer-She could enroll in a PFFS plan and a stand- alone Medicare prescription drug plan. Mr. Katz reached the Part D coverage gap in August last year. His prescriptions have not changed, he is keeping the same Part D plan and the benefits, cost-sharing, and coverage of his drugs are all the same as last year. He asked what to expect for this year about his out-of-pocket costs. What could you tell him? - Correct Answer-Because he reached the coverage gap last year, he will probably reach it again this year close to the same time. Mrs. Grant uses several very expensive drugs and anticipates that she will enter catastrophic coverage at some point during the year. To help her determine when she is likely to qualify for catastrophic coverage, she asked which expenses count toward the out-of-pocket limit that qualifies her for catastrophic coverage. Which one of the following would count? - Correct Answer-Prescription drugs she purchases when in the Part D coverage gap. Mr. Shapiro gets by on a very small fixed income. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know whether he might qualify. What should you tell him? - Correct Answer- The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. 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? - Correct Answer-The Part D low income subsidy could substantially lower her overall costs. She can apply by contacting her state Medicaid office, or calling the Social Security Administration. Mr. Fitzgerald did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. What should you tell him? - Correct Answer-He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means obtain the medications they need. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. 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. What could you tell her about the implications of such a decision? - Correct Answer-If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, if she does sign up at a later date, her premium will be permanently increased by 1% of the national average premium for every month that she was not covered. Mr. 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 Answer-In general, he must select a single Part D premium payment mechanism that will be used throughout the year. Mrs. Fiore was in the Army for 35 years and is now retired. She has drug coverage through the VA. What issues might she consider with regard to whether to enroll in a Medicare prescription drug plan? - Correct Answer-She could compare the coverage to see if the Medicare Part D plan offers better benefits and coverage than the VA for the specific medications she needs and whether any additional benefits are worth the Part D premium costs. Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to purchase extra coverage that he will not need. What should you tell him? - Correct Answer-If the drug coverage he has is not expected to pay, on average, at least as much as Medicare's standard Part D coverage expects to pay, then he will need to enroll in Medicare Part D during his initial eligibility period to avoid the late enrollment penalty. Mr. Jenkins has coverage for medical services and medications through his employer's retiree plan. He is considering switching to a Medicare prescription drug plan because his retiree plan does not cover two important medications. What should he consider before making a change? - Correct Answer-If Mr. Jenkins drops his drug coverage through the retiree plan, he may not be able to get it back and he also may lose his medical health coverage. Since 1999, Mrs. Patel has had a Medigap policy that covers drugs. This year she received a letter from her Medigap insurer telling her that her Medigap drug coverage is not "creditable." She wants you to explain what this means and what she should do. What should you tell her? - Correct Answer-The letter is letting her know that her Medigap drug coverage is coverage that does not expect to pay, on average, at least as much as Medicare's standard Part D coverage expects to pay. If she signs up for a Medicare prescription drug plan now, she may have to pay a premium penalty if her special enrollment period has expired. 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 with respect to her drug coverage? - Correct Answer-Unless she chooses a Medicare Part D prescription drug plan on her own, she will be automatically enrolled in one available in her area. Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for Medicare & Medicaid Services' Marketing Guidelines to ensure he is compliant for which type of products? - Correct Answer-Medicare Advantage (MA) and Prescription Drug (PDP) plans Another agent working for your agency claims that because you are not employed by the Medicare Advantage plans that you represent, you are not subject to the same requirements as the plans themselves. How should you respond to such a statement? - Correct Answer-Your coworker is not correct. Marketing on behalf of a plan is considered marketing by the plan and requires that all contracted and employed agents comply with all Medicare marketing rules. You work for a company that has marketed Medigap products for many years. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. What do you need to do with your materials before using them for marketing purposes? - Correct Answer-You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate. Which of the following is a correct statement about state laws as they pertain to marketing representatives? - Correct Answer-Medicare health plans must comply with requests for information from state insurance departments investigating complaints about a marketing representative. 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 not achieve a passing score on the tests that came after the training. What can you do in this situation? - Correct Answer-You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score, although you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing. Your colleague works at a third party marketing organization (TMO) and she said she did not need to take the Medicare training for brokers and agents or pass a test to market Medicare plans since her contract is with the TMO, not the plans that have the products she sells. What could you say to her? - Correct Answer-You could tell her she is wrong, and that only agents selling employer/union group plans are permitted an exemption from testing, but some employer/union group plans may require testing to promote agent compliance with CMS marketing requirements. You are mailing invitations to new Medicare beneficiaries for a marketing event. You want an idea of how many people to expect, so you would like to request RSVPs. What should you keep in mind? - Correct Answer-You may request RSVPs, but you are not permitted to require contact information. You have set up an appointment for an in-home sales presentation with Mrs. Fowler, who expressed interest in the Medicare plans you represent. In preparation for the sales presentation, what must you do? - Correct Answer-Prior to conducting the presentation, obtain, and document having obtained her permission to visit, along with her interest in the specific products you will present. Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. She agreed to sign a scope of appointment form and meet with you October 15. During the appointment, what are you permitted to do? - Correct cannot require face to face meetings in order to answer questions or enroll a Medicare beneficiary. Mr. Moreno's neighbor, Tom Smith, invited him to discuss Medicare Advantage (MA) and Part D plans that he sells at the regular Tuesday brunch the neighbors have for senior citizens. What should Mr. Moreno tell agent Tom Smith about the kinds of food that can be provided to potential enrollees who attend the sales presentation? - Correct Answer-A meal cannot be provided, but light snacks would be permitted. Ordinarily, you provide clients who purchase various types of insurance products from you with a gift when they enroll and you let them know that they will receive it after their enrollment is complete. When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan? - Correct Answer-You may not provide any gift or prize as an inducement to enroll. Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled a marketing event and expects about 40 people to attend. He has hired a magician at a cost of $200 to entertain attendees. Can he do this in a way that complies with guidance from the Medicare agency? - Correct Answer-He can do this, because the estimated number of attendees is based on the venue size and response rate and the value of the gift does not exceed $15. You will be holding a sales event in the near future, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation? - Correct Answer-Gift cards or gift certificates of $15 or less that can be readily converted to cash. You are scheduled to give a sales presentation at a local senior center. At the beginning of the presentation, which of the following must you do? - Correct Answer-Clearly state that no obligation exists to enroll if a gift or prize is being offered. Ordinarily, you ask your clients for referrals to people they think would benefit from the products you offer. When selling Medicare Advantage or Part D products, how might you solicit referrals? - Correct Answer-You may solicit referrals from current MA and Part D enrollees and offer one thank you gift per member per year of less than $15, based on retail purchase price for the item, although you may not inform enrollees of the availability of the gift in your letter soliciting referrals. When soliciting referrals from current members of an MA or Part D plan, what may you do? - Correct Answer-You may request names and mailing addresses. A health plan made a bulk order of items to be used as promotional prizes. Taking into account the discount they received for their bulk order, each item cost them $14.99. Can they use these items as promotional prizes? - Correct Answer-No, the retail cost of the items would be more than $15.00. A broker plans to offer Visa gift cards that can be used anywhere, as if they were cash. Is this permissible? - Correct Answer-No, cash or cash equivalent prizes cannot be offered. Several agents you work with are planning sales events in your area. One plans on giving door prizes worth $5, refreshments valued at $8 per anticipated attendee, and coupon books with discounts worth $10. Since no gift or prize exceeds the $15 limit he believes his plan is acceptable. What should you tell them - Correct Answer-He can give away more than one gift during a single event, but the aggregate retail value cannot exceed $15 You have approached a hospital administrator about marketing in her facility. The administrator is uncomfortable with the suggestion. How could you address her concerns? - Correct Answer-Tell her that Medicare guidelines allow you to conduct marketing activities in common areas of a provider's facility. You would like to market an MA plan at a neighborhood pharmacy. What should you keep in mind to comply with the marketing requirements for MA plans? - Correct Answer-You must set up your table, make marketing presentations, and accept enrollment applications only in common areas outside of where the patient waits for services from the pharmacist. A large physician group in your area contracts with the plans you represent. You have an opportunity to work with them to market the plans, but want to be sure you follow the CMS requirements. What can you ask the physician group to do? - Correct Answer- Provide names of the plans they contract with along with information from the CMS website. 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 tell him? - Correct Answer-You appreciate the opportunity and would be happy to schedule an appointment with anyone at their request. 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? - Correct Answer-Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving or waiting to receive health care and as long as the hospital displays materials for all plans that provide them to the hospital. One of your colleagues has a spouse that works in the records department of a large physician practice in your area. He suggests that she could ask the physicians to provide information about Medicare beneficiaries who could benefit from enrolling in the plan you represent. How should you respond? - Correct Answer-Under Federal rules, physicians are not permitted to release such information, nor are plans or their agents or brokers permitted to work with physicians to direct any beneficiaries to a specific plan. Plan sponsors may undertake the following marketing activities with current Medicare Advantage plan members? - Correct Answer-Market non-Medicare health-related products, such a dental insurance, to current members as permitted by HIPAA Privacy Rules. This year you have decided to focus your efforts on marketing to employer group plans. One employer provides you with a list of their retirees and asks you to contact them to explain the characteristics of the plan they have selected. What should you do? - Correct Answer-You may go ahead and call them. Next week you will be participating in your first "educational event." In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage? - Correct Answer-You should plan to ensure that the educational event is a social event, and must not conduct a sales presentation or distribute or accept enrollment forms at the event. If you are to be in compliance with Medicare's guidance regarding educational events, which of the following would be acceptable activities? - Correct Answer-You may distribute business cards to individuals who request information on how to contact you for further details on the plan(s) you represent. You plan to participate in an educational event sponsored by a large regional health care system. One of your colleagues suggests that you do a presentation on one of the Medicare Health plans you market, and modify it to include information about preventive screening tests showcased at the event. How should you respond to your colleague's suggestion? - Correct Answer-You should tell your colleague no, because marketing representatives are not permitted to participate, in any way, in an educational 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 Answer-The plan may withhold commission, require retraining, report the misconduct to a state department of insurance or terminate the contract. The Medicare agency has requested a list of contracted representatives from a Private Fee-for-Service (PFFS) plan that you represent. In this situation, what will the plan do? - Correct Answer-Plans will provide to the Medicare agency a complete list of all of their contracted representatives who are marketing PFFS products, and will authorize the agency to provide those names to state departments of insurance when they request it. With regard to the training you are currently taking, what involvement will CMS have in ensuring that it takes place? - Correct Answer-CMS will conduct oversight of plan training programs and plans must provide the agency with any information necessary for the agency to conduct such oversight. wishes to enroll in the stand-alone prescription drug plan in addition to his MA-PD plan. What should you tell him? - Correct Answer-If Mr. Block enrolls in the stand-alone Medicare prescription drug plan, he will be disenrolled from the Medicare Advantage plan. You are doing a sales presentation for Mrs. Peck. You know that the Medicare marketing guidelines prohibit certain types of statements. Apply those guidelines to the following statements and identify which would be prohibited. - Correct Answer-"If you're not in very good health, you will probably do better with a different product." You have come to Mrs. Brown's home for a sales presentation. At the beginning of the presentation, Mrs. Brown tells you that she has a copy of her medical record available because she thinks this will help you understand her needs. She suggests that you will know which questions to ask her about her health status in order to best assist her in selecting a plan. What should you do? - Correct Answer-You can only ask Mrs. Brown questions about conditions that affect eligibility, specifically, whether she has end stage renal disease or one of the conditions that would qualify her for a special needs plan. Mr. Grant has just entered his MA Initial Coverage Election Period (ICEP). What action could you help him take during this time? - Correct Answer-He will have one opportunity to enroll in a Medicare Advantage plan Mrs. Kenny is six months away from turning 65. She wants to know what she will have to do to enroll in a Medicare Advantage (MA) plan as soon as possible. What could you tell her? - Correct Answer-She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. Mr. Ziegler is turning 65 next month and has asked you what he can do, and when he must do it, with respect to enrolling in Part D. What could you tell him? - Correct Answer-He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may make one Part D enrollment choice, including enrollment in a stand-alone Part D plan or an MA-PD plan. Ms. Claggett is sixty-six (66) years old. She has been covered under both Parts A and B of Original Medicare for the last six years due to her disability, has never been enrolled in a Medicare Advantage or a Part D plan before. She wants to enroll in a Part D plan. She knows that there is such a thing as the "Part D Initial Enrollment Period" and has concluded that, since she has never enrolled in such a plan before, she should be eligible to enroll under this period. What should you tell her about how the Part D Initial Enrollment Period applies to her situation? - Correct Answer-It occurs three months before and three months after the month when a beneficiary meets the eligibility requirements for Part B, so she will not be able to use it as a justification for enrolling in a Part D plan now. Mr. Ford enrolled in an MA-only plan in mid November. On December 1, he calls you up and says that he has changed his mind and would like to enroll into an MA-PD plan. What enrollment rules would apply in this case? - Correct Answer-He can make as many enrollment changes as he likes during the Annual Election Period and the last choice made prior to the end of the period will be the effective one as of January 1. Mrs. Townsend would like her daughter, who lives in another state, to meet with you during the Annual Election Period to help her complete her enrollment in a Part D plan. She asked you when she should have her daughter plan to visit. What could you tell her? - Correct Answer-Her daughter should come in November. Mr. Anderson is a very organized individual and has filled out and brought to you an enrollment form on October 10 for a new plan available January 1 next year. What should you do? - Correct Answer-Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. A client wants to give you an enrollment application prior to the beginning of the Annual Election Period because he is leaving on vacation for two weeks and does not want to forget about turning it in. What should you tell him? - Correct Answer-You must tell him you are not permitted to take the form. If he sends the form directly to the plan, the plan will process the enrollment on the day the Annual Election Period begins. 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? - Correct Answer- During the MA Disenrollment Period, from January 1 - February 14, she may disenroll from the MA-PD plan into Original Medicare and also may add a stand-alone prescription drug plan. 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? - Correct Answer-She may make such a change during the Annual Election Period that runs from Oct. 15 to December 7, or during the MA Disenrollment Period that runs from January 1 to February 14 of each year. Mrs. Schmidt is moving and a friend told her she might qualify for a "Special Election Period" to enroll in a new Medicare Advantage plan. She contacted you to ask what a Special Election Period is. What could you tell her? - Correct Answer-It is a time period, outside 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 Period is beneficiary specific and results from events, such as when the beneficiary moves outside of the service area. Mr. Grace was told he qualifies for a Special Election Period (SEP), but he lost the paper that explains what he could do during the SEP. What can you tell him? - Correct Answer-If the SEP is for MA coverage, he will have one opportunity to change his MA coverage. Mrs. Gunner thought she was enrolling in a stand-alone PDP, but when she received her plan materials, she found out she was enrolled in a Private Fee-for-Service (PFFS) plan with drug coverage. She called her marketing representative for help. What should the marketing representative tell her? - Correct Answer-If she believes she received misleading information, she must contact 1-800-MEDICARE and, if she qualifies for a Special Enrollment Period, she can select a new option, which could include a different MA plan, a PDP, or Original Medicare Ms. Lee is enrolled in an MA-PD plan, but will be moving out of the plan's service area next month. She is worried that she will not be able to enroll in another plan available in her new residence until the Annual Election Period. What should you tell her? - Correct Answer-She is eligible for a Special Election Period that begins either the month before her permanent move, if the plan is notified in advance, or the month she provides notice of the move, and this period typically lasts an additional two months. Mr. Yoo's employer has recently dropped comprehensive creditable prescription drug coverage that was offered to company retirees. The company told Mr. Yoo that, because he was affected by this change, he would qualify for a Special Election Period. Mr. Yoo contacted you to find out more about what this means. What can you tell him? - Correct Answer-It means that he qualifies for a one-time opportunity to enroll into an MA-PD or Part D prescription drug plan. Mrs. Steeley has Original Medicare Parts A and B and has just qualified for her state's Medicaid program, so the state is now paying her Part B premium. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan? - Correct Answer-Yes. Qualifying for this state program gives Mrs. Steeley access to a Special Election Period that allows her to make changes to her MA and/or Part D enrollment at any time. If Mr. Johnson gains the Part D low-income subsidy, how does that affect his ability to enroll or disenroll in a Part D plan? - Correct Answer-He can enroll in or disenroll from a Part D plan at any time and the subsidy will apply to the plan he chooses. Mr. Charles, who is enrolled in a stand-alone Part D plan, receives the Part D low- income subsidy and just received a letter from the Social Security Administration informing him that he will no longer qualify for the subsidy? He is wondering if he can switch to a lower cost Part D plan. What should you tell him? - Correct Answer-He qualifies for a Special Election Period which begins the month he was notified of his loss and continues for two more months. This SEP allows him one opportunity to enroll into another PDP or an MA-PD. Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He would like to know his options since he has decided to drop his retiree coverage and is eligible for Medicare. What should you tell him? - Correct Answer-Mr. Chen can disenroll from his employer-sponsored coverage to elect a Medicare Advantage or Part