Understanding Medicare Advantage Plans, Exams of Nursing

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d. I, II, III, and IV

AHIP FINAL EXAM Test Questions and

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Mrs. Paterson is concerned about the deductibles and co-payments associated with Original

MedicareWhat can you tell her about Medigap as an option to address this concern?

a. Medigap plans are not sold by private companies and are a government insurance product. b. All costs not covered by Medicare are covered by some Medigap plans. c. If Mrs. Paterson applies during the Medigap open enrollment period, she will have to undergo a medical review to determine if she has a pre-existing condition that would increase the premium for a Medigap policy. d. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services.

2. Mr Valesquez asked if the Private Fee-for-Service plan you have discussed is like Original Medicare or a

Medigap supplement plan. What should you say about a Private Fee-for-Service (PFFS) plan to explain

it to Mr. Valesquez?

a. It is a type of Medicare Advantage plan that allows you to go to any doctor anywhere. c. It is the same as Original Medicare, but offered by a private company. d. It is not Original Medicare and it works differently than a Medicare supplement plan.

3. Which of the following statements about Medicare Part D are correct?

I. Part D plans must enroll any eligible beneficiary who applies regardless of health status except in

limited circumstances.

II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to

have one.

III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D

benefits through a standalone PDP.

IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a standalone PDP or

through their plan.

a. I and II only b. I only c. I, II, and III only

4. You are completing a PFFS plan sale to Mr. West who is new to Medicare and prefers to be contacted

by telephone. As you are finishing up, what should you tell him about next steps in the enrollment

process?

a. You need to ask Mr. West a few final questions to ensure he understands the nature of the plan and really wants to enroll. You also should tell Mr. Schmidt that after you leave, he should not answer any questions about his enrollment in the plan because it could result in a disenrollment. b. You need to get Mr. West’s phone number and include it on the enrollment form because the PFFS plan will contact him once the organization receives the enrollment form and will ask about the quality of your service. You should not discuss the phone call with Mr. West to avoid influencing his answers. c. You need to get Mr. West’s phone number and include it on the enrollment form because the plan must call him after you leave to ensure that he understood the nature of the PFFS plan he selected and to verify his intent to enroll. d. You should not include Mr. West’s phone number on the enrollment form in case he is on the “Do Not Call” registry.

5. What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) have

upon Medigap plans?

a. The Part A deductible will no longer be covered for individuals newly eligible for Medicare starting January 1,

b. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1,

c. The Part A deductible is no longer covered under Medigap plans for all enrollees staring January 1, 2020. d. MACRA provides funding to help individuals age 59 and above enroll in Medigap plans.

6. Able, Baker, and Charles are engaged in the marketing to and enrollment of beneficiaries into Medicare

health plans. Mr. Able is an independent agent paid directly by a health plan. Ms. Baker is an

independent agent paid through a field marketing organization (FMO). Mr. Charles is an independent

agent paid for his work by a third-party marketing organization (TMO). How do the CMS compensation

rules apply to these three agents?

a. All three are treated as independent agents under CMS compensation rules. b. Baker and Charles are subject to CMS compensation rules because they are paid by third parties. Able is not bec he is paid directly by a health plan. c. Able is subject to CMS compensation rules because he is paid directly by a health plan. Agents Baker and Charle not because they are paid by third parties. d. Charles is subject to CMS compliance rules because he works for a TMO and CMS applies an extra layer of scru such organizations. Able and Baker are not.

7. Mr. and Mrs. Nunez attended one of your sales presentations. They’ve asked you to come to their home

to clear up a few questions. During the presentation, Mrs. Nunez feels tired and tells you that her

husband can finish things up. She goes to bed. At the end of your discussion, Mr. Nunez says that he

wants to enroll both himself and his wife. What should you do?

a. You should sign the form for Mrs. Nunez yourself, since she informed you, as the plan’s representative, that she w

to enroll. b. As long as she is able to do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will have to wake up to sign her form or do so at another time. c. Legal spouses can sign enrollment forms for one another under federal law. You may enroll both Mr. and Mrs. Nun as long as her husband signs on her behalf d. You can countersign Mrs. Nunez’ application, along with her husband, indicating that she approved this choice ver This witness signature is sufficient to make the enrollment valid.

8. 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?

a. As long as he fills out the paperwork to begin withholding from his Social Security check at least 63 days before su withholding should begin, he can change his method of Part D premium payment and withholding will begin the mont after his savings account is exhausted. b. During 2017, many people experienced significant problems with deductions from their Social Security check for their Part D premium. As a result, this method of payment is no longer an option for Part D premium payments c. In general, to pay his Part D premium, he only can have automatic withdrawals made from a checking account, so will need to transfer the funds prior to beginning such withdrawals. d. In general, he must select a single Part D premium payment mechanism that will be used throughout the year.

9. Mr. Decaro has looked at Medicare prescription drug plans available in his area and noted a wide range

in premiums. He thought that all the drug plans were required to offer the same standard benefits and

would like you to explain why there is such a range in premiums. What should you tell him?

a. Some prescription drug plans may have higher operating costs and/or may offer enhanced coverage in return for an additional premium amount. He could look at plan designs to see if one of the enhanced plans would serve his needs better than a plan based on the standard design. b. All drug plans must offer exactly the same coverage model. The difference in premium is a result of the differing financial estimates of the companies offering the plans. c. The premiums differ because some plans intend to market to sicker beneficiaries and have set their premiums to reflect expected greater costs. d. Medicare permits plans that have the highest quality services to reduce their premiums below the standard amount in order to increase their market share. This accounts for the variation in premium amounts.

10. Which of the following statement is correct about Medicare Savings Account (MSA) Plans?

I. 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.

III. An individual who is eligible for health care benefits through the Veteran's Administration may

enroll in an MSA.

IV. Non-network providers must accept the same amount that Original Medicare would pay them as

payment in full.

a. II and III only b. I, II, and III

only d. I and II only

11. Mr. James has end stage renal disease (ESRD). He has been covered under Original Medicare but would like to know if he can enroll in a Medicare Advantage plan. What should you tell him? a. Individuals with end stage renal disease may enroll in a Medicare Advantage plan, but only if they are willing to pa extra premium to do so. b. Individuals with end stage renal disease can only enroll in a Medicare Advantage plan after they have been on dia for 12 months. c. Individuals with end stage renal disease can enroll in any Medicare Advantage plan that they choose without payin extra premium. d. He will not be able to enroll in a Medicare Advantage plan because he has end stage renal disease, unless a spec needs plan for beneficiaries with ESRD is available in his service area.
12. Ms. Jensen has heard about “Original Fee-for-Service Medicare” and “Private Fee-for-Service” plans. She wants to know what the difference is, if any. What should you tell her? a. Original Medicare and PFFS plans are essentially the same thing. b. PFFS plans are a type of Medicare Advantage plan offered by private companies. c. PFFS plans primarily cover drugs that Original FFS Medicare does not cover. d. PFFS is a form of supplemental coverage that fills in the gaps where Original Medicare leaves c. I, II, and IV only

off.

13. Agent Herman works in the senior marketplace and depends on referrals and leads to grow and maintain his business. Which of the following situations may Agent Herman contact and speak with the Medicare Advantage prospect?
14. a. Agent Herman recognizes some elderly neighbors in the lobby of his condominium complex and would like to appr them about how Medicare Advantage compares to Original Medicare. b. Agent Herman’s wife called a former neighbor and told her about Herman’s extensive knowledge of Medicare and rules. The neighbor agreed to meet with Herman about the Medicare Advantage products he represents. c. Agent Herman has left business cards with Edgar, one of his clients. Edgar passes one of the cards to Sam who expresses an interest in meeting with Herman about Medicare Advantage. Sam subsequently calls Herman’s office. d. Agent Herman learns during a meeting of his book club that fellow member Eleanor is voluntarily disenrolling from her current Medicare Advance plan.

14. Mrs. Kendrick 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?

a. She must first enroll in a Medicare Part D plan, before enrolling in a Medicare Advantage plan. b. She must have previously been enrolled in Original Fee-for-Service Medicare for at least one year before she m enroll in an MA plan. c. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare and Part B. d. MA plans are only available to those who have been enrolled in a Medigap plan for at least six months. Therefor before enrolling in an MA plan, she must first use a Medigap plan to supplement her Original Medicare coverage .

15. This year you decide to focus your efforts on marketing to employer and union groups. Which of the

following statements best describes what you can and cannot do in order to stay in compliance?

a. You can make unsolicited contacts but you cannot cross-sell other products. b. You do not need to take an annual test, but you must not provide potential enrollees with more than light snacks at presentations. c. You are not required to submit copies of disseminated materials to CMS at the time of use, but CMS may reques and review copies if employee complaints occur. d. You do not need to complete a scope of appointment, but CMS can ask you to reconstruct one if there is a subsequent employee complaint.

16. 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?

a. Part D covers prescription drugs and she should look at her premiums, formulary, and cost sharing among other to see if they have changed. b. Part D covers physician and non-physician practitioner services and the deductible has not changed this year, b physician charges may go up. c. Part D covers long-term care services and she shouldn’t worry because there has been no change

in coverage. d. Part D covers hospital and home health services and the cost sharing has changed this year.

a. Winthrop Brokerage does not need to submit the advertisement to CMS for prior approval because it

does not include information about the plans’ benefit structures, cost sharing, or information about measures or ranking standards.

17. Mr. Rice 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? a. Mr. Rice’s retiree plan is required to take him back if, within 63 days of having voluntarily quit the employer’s pla he decides that he prefers it to his Medicare Part D plan. b. Mr. Rice can only receive his prescription drug coverage through a Medicare Advantage prescription drug plan so he should drop his employer coverage. c. If his drug coverage through the retiree plan is “creditable” he should not switch, even though it is possible to do d. If Mr. Rice drops his drug coverage through the retiree plan, he may not be able to get it back and he also may l his medical health coverage.

18. Winthrop Brokerage wishes to place an advertisement in the local newspaper that says: "We offer

Medicare Advantage plans offered by AB Health and Top Choice Health. Contact us if you would like

to learn more." Which of the following best describes the obligation(s) of Winthrop Brokerage

regarding the advertisement?

b. Winthrop Brokerage must submit the advertisement to CMS for prior approval because it is considered gene audience marketing. c. Winthrop Brokerage does not need to submit the advertisement to CMS for prior approval and may also inclu the advertisement information about the plans’ benefit structures and star rankings. d. Winthrop Brokerage must submit the advertisement to CMS for prior approval because it meets the definition of marketing material.

19. Ms. Bushman has two homes in different states and is concerned about restrictions on where she can

get her medications. What should you tell her?

a. Part D prescription drug plans focus almost entirely on mail order with fairly limited access to retail pharmacies, as long as she orders all of her medications through the mail, she will be fine. b. Part D prescription drug plans generally contract with every pharmacy in the country, so she should be able to o her drugs in both states with no problem. c. Part D prescription drug plans use networks of pharmacies within their service areas. She could look for a plan that maintains a network in both states. d. Part D prescription drug plans are restricted to local service areas. She will have to use mail order to fill all of her prescriptions.

20. Mr. Barker had surgery recently and expected that he would have certain services and items covered

by the plan with minimal out-of-pocket costs because his MA-PD coverage has been very good.

However, when he received the bill, he was surprised to see large charges in excess of his maximum

out-of-pocket limit that included a number of services and items he thought would be fully covered.

He called you to ask what he could do? What could you tell him?

a. You could remind him that he cannot do anything until the next Annual Election Period when he will have an opportunity to change plans. b. You could reassure him that such charges are typical, but if he needs assistance in paying, he should apply to the state. c. You can offer to review the plans appeal process to help him ask the plan to review the coverage decision.

b. Ms. Davis who recently turned age 65 and is eligible for Part A and has just enrolled in Part B. d. You could suggest he call the doctor who performed the surgery to complain about the costs and ask for a discount on the charges.

21. Eleanor takes several high cost prescription drugs. She would like to enroll in a standalone Part D

prescription drug plan that is available in her area. In what type of Medicare Health Plan can she enroll

if she also wishes to enroll in the standalone Part D plan?

a. A MA PPO plan only if it does not offer drug coverage. b. A Cost Plan that does not offer drug coverage or a Cost Plan that does offer drug coverage if she chooses not to enroll in it. c. A Cost Plan only if it does not offer drug coverage. d. A MA PPO plan that offers drug coverage if she chooses not to enroll in it.

22. Who is most likely to be eligible to enroll in a Part D prescription drug plan?

a. Mr. Charles, an undocumented immigrant, entered the country illegally. c. Ms. Bradley is currently living abroad for a multi-year job assignment. d. Mr. Adams, a healthy early retiree who has just begun to collect Social Security at age

23. Last year Agent Melanie Meyers marketed and enrolled several clients in Medicare Advantage (MA)

health plans. This year she has decided to focus on non-MA products. What advice would you give Melanie if

she wishes to continue to receive renewal fees?

a. All that she needs to do is meet state licensure requirements moving forward. b. Melanie must remain trained, tested, licensed, and appointed, regardless of whether she is actively selling MA products. c. All that she needs to do is avoid being terminated for cause. d. Melanie need do nothing to continue receiving renewal fees since the initial sale was made when she met all requirements.

24. Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the health plan may, at some time in

future, reduce his benefits below what is available in Original Medicare. What should you tell him about his concern?

a. Medicare health plans must cover all benefits available under Medicare Part A and Part B. Many also cover Part D prescription drugs. b. Medicare health plans offer a menu of benefits, from which he may choose, so if he ever wants to increase his coverag

need only contact the plan and select other options. c. Medicare health plans have the option of deciding, each year, what services they will cover. He is correct that the healt plan could eliminate some benefits covered by Medicare and he should think carefully before enrolling in a Medicare heal plan. d. He should not be concerned because Medicare health plans must cover all IRS-approved health care expenses, which means

that all of them provide substantially greater benefits than are available under Medicare Part A and Part B.

25. Mrs. Quinn has recently turned 66 and decided after many years of work to begin receiving Social Security

benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled

in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn?

a. Part B primarily covers physician services. She will be paying a monthly premium and, with the exception of many prevent and screening tests, generally will have 20% co-payments for these services, in addition to an annual deductible. b. She will need to pay no premiums for Part B as she qualifies for premium free coverage due to the number of quarters sh has worked. c. She should disenroll if she does not want to pay the monthly premiums. There is no disadvantage to doing so. d. Part B will cover her dental and vision needs.

26. Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treated for tha

condition. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of

nursing and rehabilitative care. What should you tell them about Original Medicare’s coverage of care in a

skilled nursing facility?

a. Medicare will cover Mrs. Shields' skilled nursing services provided during the first 20 days of her stay, after which she would have a coinsurance until she has been in the facility for 100 days. b. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields' long-term care costs. c. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered because Medicare does not provide such a benefit. d. Medicare will cover an unlimited number of days in a skilled-nursing facility, as long as a physician certifies that such care is needed.

27. Which of the following individuals are likely to qualify for a special enrollment period (SEP) for both MA and

Part D due to a change of residence?

I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's

service area.

II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service area.

III. Gilbert moves into a plan service area where there is now a Part D plan available to him from a service area where

no Part D plan was available.

IV. Henry makes a permanent move providing him with new MA and Part D options.

a. II and III only b. I, II, III and IV c. I and II only d. II, III, and IV only

28. Mary Samuels recently suffered a stroke while visiting her daughter and grandchildren. As a result, Mary

has been admitted to a rehabilitation hospital where she is expected to reside for several months. The

rehabilitation hospital is located outside the geographic area served by her current Medicare Advantage (MA)

plan. What options are available to Mary regarding her health plan coverage?

a. Mary may make one change to either Original Medicare or another MA under the special enrollment period available to institutionalized individuals. b. Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan. c. Mary may enroll in another MA plan coupled with a Medigap plan under the special enrollment period available to

institutionalized individuals. d. Mary’s only option in this situation is to return to Original Medicare.

29. Mr. McTaggert notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium.

He wants to Mr know what makes them different from an HMO or a PPO. What should you tell him?

a. PFFS plans are the same as Medicare supplement plans and he may obtain care from any provider in the U.S. b. 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. c. If a PFFS enrollee shows his/her card when obtaining services from a provider who participates in Original Medicare, t that provider is required to accept the plan’s terms and conditions. d. If offered, beneficiaries can select a stand-alone Part D prescription drug plan (PDP) with an HMO or a PPO, but not w PFFS plan.

30. 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?

a. You may request RSVPs, but you are not permitted to require contact information. b. You are not permitted to request RSVPs, so you will need to find a different way to estimate how many people are com c. You may require RSVPs and an e-mail address so you can follow up in the event of a cancellation. d. You may not require RSVPs, but when people arrive, you may require completion of contact information on a sign-up s

31. Wendy Park becomes eligible for Medicare for the first time in July. With the help of Agent James Chan, she

enrolls in FeelBetter Medicare Advantage plan with an effective date of July 1st. Which statement best describes

how Agent Chan may be compensated under CMS rules?

a. FeelBetter will pay Agent Chan initial year compensation for the period July 1 through October 15th - (the date open enrollment begins). If Ms. Park remains enrolled in the plan, renewal amounts will be paid. b. FeelBetter will pay Agent Chan initial year compensation for the 12 months of July through July. Renewal amount will b paid thereafter if Ms. Park remains enrolled. c. FeelBetter will pay Agent Chan a bonus equal to three months initial year compensation since he has successfully enro Ms. Park in a MA plan when she is both first eligible and a younger, and likely healthier, enrollee. d. FeelBetter will pay Agent Chan initial year compensation for the months July through December. Renewal amounts wil be paid starting in January if Ms. Park remains enrolled the following year.

32. Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both Medicare and

Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he sees an out-of-network

doctor to receive a Medicare covered service. How much may the doctor collect from Mr. Rivera?

a. The doctor may only collect the amount allowable under Medicare Advantage (MA) PPO plan cost sharing for non-QMB enrollees. b. The doctor may only collect the amount allowable under Medicare plus 25 percent balance billing. c. The doctor may only collect the amount allowable under Medicare plus 15 percent balance billing. d. The doctor may only collect from Mr. Rivera the cost sharing allowable under the state’s Medicaid program.

33. 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?

a. They are long-term care plans for people with Medicare. b. They are Medigap Supplemental plans that fill in the gaps not covered by Medicare. c. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. d. They are major medical policies, but are only for low-income beneficiaries with Medicare.

34. 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?

a. During the MA Open Enrollment Period, from January 1 – March 31, she may disenroll from the MA-PD plan into Origin Medicare and also may add a stand-alone prescription drug plan. b. During the MA Open Enrollment Period, from January 1 – March 31, she may only disenroll from a MA or MA-PD plan, but cannot enroll in a stand-alone Part D plan. c. During the MA Open Enrollment Period, from January 1 – March 31, she may drop a MA or MA-PD plan and go back to Original Medicare, but she may only enroll in a stand-alone prescription drug plan if she also purchases a Medigap policy d. During the MA Open Enrollment Period, from January 1 – March 31, she may only add or drop Part D coverage, so she cannot switch back to Original Medicare.

35. Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What

should you tell her?

a. Mrs. Radford must apply to the Medicare Advantage plan, which will include a medical review, prior to being accepted enrolled. b. Mrs. Radford can enroll in any Medicare Advantage plan that operates within the United States. c. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. d. Even if Mrs. Radford has end stage renal disease, she will be able to enroll in any Medicare Advantage plan in her serv area.

36. Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor recently

confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs. Billings have in regard to her

MA plan during the next open enrollment season?

a. She must remain enrolled in her ABC MA plan unless the plan terminates. b. She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one available in her area. c. She must immediately drop her ABC MA plan and enroll in Original Medicare. d. She must immediately drop her ABC MA plan and enroll in a Special Needs Plan (SNP) for individuals suffering from E if one is available in her area.

37. When Myra first became eligible for Medicare, she enrolled in Original Medicare (Parts A and B). She is

now 67 and will turn 68 on July 1. She would now like to enroll in a Medicare Advantage (MA) plan and

approaches you about her options. What advice would you give her?

a. She should wait until the new year to disenroll from Original Medicare and select an MA plan between January 1 and M

b. She could enroll in an MA plan during the period including the three months before, the month of, and up to three mont after turning 68. c. She could immediately enroll in MA plan based on the one-time special enrollment period available to those 70 and you d. She should remain in Original Medicare until the annual election period running from October 15 to December 7, durin which she can select an MA plan.

38. Julia Harris is turning 66 in July, at which time she will retire. She has contacted your office and requested

a meeting so that she can learn about Medicare and the products you represent. How should you respond?

a. Tell Julia that you will meet with her to explain Medicare and should she be interested you can accept and submit an enrollment request, since this is an initial enrollment qualifying her for a special enrollment period. b. Tell Julia that she must first complete a questionnaire providing her health history so that you can recommend an appropriate product before submitting an enrollment application, since she qualifies for a special enrollment period. c. Tell Julia that you will meet with her at a time of her convenience within the next week, when you can accept a completed enrollment application to be submitted after October 15th. d. Tell Julia that you are happy to meet with her once this year’s open enrollment begins on October 15th.

39. BestCare Health Plan has received a request from a state insurance department in connection with the

investigation of several marketing representatives licensed by the state who sell Medicare Advantage plans.

What action(s) should BestCare take in response?

a. Immediately meet with the marketing representatives and suggest they obtain licensing in another jurisdiction. b. Immediately terminate all the agents involved as a precaution against potential legal liability. c. Under Federal privacy statutes, BestCare is not obligated to provide information about marketing representatives to the and should refuse to do so. d. Cooperate with the state and supply requested information.

40. Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a

PPO that does not include drug coverage. What should you tell her about obtaining drug coverage?

a. She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan. b. She can enroll in the PPO and purchase drug coverage through a Medigap plan. c. She can enroll in the PPO and if she decides that she wants drug coverage, she will be able to drop her PPO at any tim favor of a Medicare Advantage plan that includes such drug coverage. d. She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan.

41. 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 available 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

tell her?

a. When medication costs exceed a certain threshold amount, which rises each year, a Medicare prescription drug plan is permitted to exclude coverage for all but the least expensive of the medications in a given category. Mrs. Allen will need to encoura her physician to prescribe the least expensive of the two alternatives. b. Medicare prescription drug plans are allowed to restrict their coverage to generic drugs. She will need to pay for her br name medications out of pocket. c. Medicare prescription drug plans are required to include only a certain percentage of brand name drugs among those t cover. It may be possible that plans available in her area have opted not to include in their formularies the brand name drugs sh needs. She may need to pay for this particular medication out of pocket. d. Medicare prescription drug plans are required to cover drugs in each therapeutic category. She should be able to enrol Medicare prescription drug plan that covers the medications she needs.

42. Mrs. Willard 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?

a. 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. b. All Medicare Health Plans offer cost-sharing that is lower than Original Medicare for all Part A and Part B covered services, but the maximum out-of-pocket limit is higher than in Original Medicare. c. Medicare Health Plans do not necessarily have to cover all of the Original Medicare Part A and Part B services, but must include a maximum out-of-pocket limit. d. Medicare Health Plans are not permitted to offer any benefits beyond those available under the Original Medicare program and must have the same maximum out-of-pocket limit on Part A and Part B services as FFS Medicare.

43. Mr. Denton is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will

soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him?

a. He may sign-up for Medicare at any time however coverage usually begins on the sixth month after dialysis treatments b. He may sign-up for Medicare at any time and coverage usually begins immediately. c. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatment start. d. He may not sign-up for Medicare until he reaches age 62, the date he first becomes eligible for Social Security benefits

44. 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?

a. Clearly state that no obligation exists to enroll if a gift or prize is being provided. b. Determine whether the beneficiaries present are healthy enough for the plan. c. Explain, in your own words, how the plan you represent compares to other companies’ plans. d. Make sure that those present provide leads.

45. Mr. Bickford 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?

a. He should contact his neighbors and family members and let them know that any contributions they make toward his drug expenses will be tax deductible. b. 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 pharma assistance program to help him with his expenses. c. He should look into the possibility of purchasing his medications through the internet from off-shore pharmacies. d. The only option available is to reduce his income so that he can qualify for the Part D extra help or wait until next year to see if the annual limits change.

46. You have had a good meeting with Mr. Claggett and he has selected a Medicare Advantage plan. He would

like you to help him complete the enrollment application because he wants to make sure he gets into the right

plan. You offer to help, but you tell him that you cannot do which of the following?

a. Help him place a phone call to the plan sponsor’s enrollment center. b. Help him correct any information on the enrollment form if he makes a mistake.

c. Help him fill out any portion of the enrollment form. d. Help him find the plan’s enrollment website on your laptop computer.

47. Ms. Goldstein is required by the plan she represents to obtain enrollment forms that have carbon copies in

the back. She gives one to the beneficiary, sends another to the plan and retains the third. What should she do

with her copies of the enrollment forms?

a. She should retain them until she is informed by the plan that they have been successfully processed and then she can them in the garbage, as is, without shredding them. b. She should retain them for six years and then throw them in the garbage, as is, without shredding them. c. She should make every effort to safeguard the beneficiary information on those enrollment forms. d. There are no specific requirements to which she is subject with regard to safekeeping the information.

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

previously available through her husband’s employer. She is interested in enrolling in a Medicare Part D

prescription drug plan (PDP). What should you tell her?

a. Mrs. Lopez must enroll in either a HMO or PPO Medicare Advantage plan in order to obtain Part D coverage. b. If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. c. Mrs. Lopez must first seek COBRA benefits under her husband’s plan before she can apply for Part D coverage. d. If a Part D benefit is offered through her plan she must enroll in this plan.

49. 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?

a. Gift cards or gift certificates of $15 or less that can be readily converted to cash. b. Two or more gifts whose combined value does not exceed $15. c. Gifts worth more than $15 but based on anticipated attendance will not exceed $15 per attendee. d. Gifts of nominal retail value ($15 or less)

50. If you are to be in compliance with Medicare’s guidance regarding educational events, which of the

following would be acceptable activities?

a. You may ask passers-by to provide you with their names, addresses and phone numbers so that you could contact the later with information about the plan(s) you represent. b. You may have a stack of enrollment forms on the table in your booth, but may only pass them out to individuals who re one. c. You may distribute business cards to individuals who request information on how to contact you for further details on th plan(s) you represent. d. You may set up personal sales appointments with any beneficiary who expresses interest.