Understanding Medicare Supplemental Insurance and Medicare Advantage Plans, Exams of Psychology

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1. Mrs. Burton is a retiree with sub- stantial income. She is enrolled in an MA-PD plan and 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 would not have to put up with such poor access to care. What could you tell her? She could file a grievance with her plan to complain about the lack of timeliness in getting an appoint- ment.
2. Edward IP suffered from serious kid- ney disease. As a result. Edward became eligible for Medicare cov- erage due to end-stage renal dis- ease (ESRD). A close relative donat- ed their kidney and Edward success- fully underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his Medicare cov- erage will continue, what should you say? Individuals eligible for Medicare based on ESRD generally lose el- igibility 36 months after the month in which the individual receives a kidney transplant unless they are el- igible for Medicare on another ba- sis such as age or disability. Ed- ward may, however, remain enrolled in Part B but solely for coverage of immunosuppressive drugs if he has no other health care coverage that would cover the drugs.
3. Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred recently learned that she is suffering from inoperable cancer and has just a few months to live. She would like to spend these final months in hospice care. Mil- dred's family asks you whether hos- pice benefits will be paid for un- der the Allcare Medicare Advantage plan. What should you say? Mildred may remain enrolled in All- care and make a hospice election. Hospice benefits will be paid for by Original Medicare under Part A and Allcare will continue to pay for any non-hospice services.

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? Mr. Diaz will not pay any penalty be- cause he had continuous coverage under his employer's plan.

5. Mr. Moy's wife has a Medicare Ad- vantage plan, but he wants to under- stand what coverage Medicare Sup- plemental Insurance provides since his health care needs are different from his wife's needs. What could you tell Mr. Moy? Medicare Supplemental Insurance 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 cov- er.
6. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxes during that entire period. She is con- cerned that she will not qualify for coverage under part A because she was not born in the United States. What should you tell her? Most individuals who are citizens and age 65 or over 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.
7. Mr. Bauer is 49 years old, but eigh- teen months ago he was declared disabled by the Social Security Ad- ministration and has been receiving disability payments. He is wondering whether he can obtain coverage un- der Medicare. What should you tell him? After receiving such disability pay- ments for 24 months, he will be au- tomatically enrolled in Medicare, re- gardless of age.
8. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. What should you tell Mr. Xi Beneficiaries under Original Medicare have no cost-sharing for most preventive services which in-

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that best describes the health cover- age provided to Medicare beneficia- ries? clude immunizations such as annual flu shots.

9. Mrs. PeHa is 66 years old, has cover- age 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 cover- age. What can you tell her? She may enroll at any time while she is covered under her employ- er plan, but she will have a special eight-month enrollment period after the last month on her employer plan that differs from the standard gen- eral enrollment period, during which she may enroll in Medicare Part B.
10. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is won- dering if he can obtain coverage un- der Medicare. What should you tell him? He may sign-up for Medicare at any time however coverage usually be- gins on the fourth month after dialy- sis treatments start.
11. Madeline Martinez was widowed sev- eral years ago. Her husband worked for many years and contributed into the Medicare system. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Origi- nal Medicare. She comes to you for advice. What should you tell her? You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly pre- miums due to her husband's long work record and participation in the Medicare system. You should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest rate due her substantial income.
12. Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without paying any pre- miums, because she has been work- ing for 40 years and paying Medicare taxes. What should you tell her? To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes.

13. To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. 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.
14. 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 which he has had for several years. However, the plan does not provide drug benefits. How would you advise Agent John Miller to pro- ceed? Tell prospect Jerry Smith that he should consider adding a stand- alone Part D prescription drug cov- erage policy to his present coverage.
15. Ms. Moore plans to retire when she turns 65 in a few months. She is in ex- cellent health and will have consider- able 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? Medicare is a program for peo- ple age 65 or older and those un- der age 65 with certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eli- gible for Medicare.
16. 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? It is illegal for you to sell Mr. Ca- padona a Medigap plan if he is en- rolled in an MA plan, and besides, Medigap only works with Original Medicare.
17. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be of assistance? She should contact her state Med- icaid agency to see if she qualifies for one of several programs that can help with Medicare costs for which she is responsible.

Mr. Schmidt would like to plan for re- tirement and has asked you what is covered under Original Fee-for-Ser- vice (FFS) Medicare. What could you tell him? 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.

19. Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-in- come subsidy. Where might he turn for help with his prescription drug costs? Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program.
20. Shirly Thomas was enrolled in Med- icaid during the Public Health Emer- gency (PHE). This coverage has re- cently been terminated due to the end of the PHE. While Shirley was enrolled in Medicaid, she missed an opportunity to enroll in Medicare and now wants Part B. Which of the following statements best de- scribes Shirley's ability to now enroll in Medicare Part B? Shirley is eligible for a Special En- rollment Period (SEP) for up to six months after the termination of her Medicaid coverage. Under this SEP, Shirley can choose retroactive cov- erage back to the date of termina- tion from Medicaid or coverage be- ginning the month after the month of enrollment.
21. Anthony Boniface turned 65 in 2023. He was not receiving Social Security or Railroad Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and is eligible for premium-free Part A. Before he could enroll in Medicare, his entire area was impacted by a hurricane causing massive flooding and severe wind damage. The Feder- al government declared this to be a natural disaster which has recently ended. During this period Anthony's Anthony is eligible for a special en- rollment period (SEP) because he missed an enrollment period due to the impact of the Federally declared disaster. This SEP will allow Anthony to enroll in Part B up to six months after the end of the emergency de- claration. Anthony may enroll in pre- mium-free Part A at any time and his Part A coverage will be retroactive for up to 6 months.

initial enrollment period expired. An- thony asks you how he can now ob- tain Medicare coverage. What should you say?

22. Mrs. Lyons is in good health, uses a single prescription, and lives inde- pendently in her own home. She is attracted by the idea of maintaining control over a Medical Savings Ac- count (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? All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be ob- tained by also enrolling in a separate prescription drug plan.
23. 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? Mrs. 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.
24. Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group health plan that includes drug cover- age 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? He should compare the benefits in his employer-sponsored retiree group health plan with the benefits in his neighbor's MA-PD plan to de- termine which one will provide suf- ficient coverage for his prescription needs.
25. Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under Original Medicare, but he would like SNPs have special programs for en- rollees with chronic conditions, like Mr. Sinclair, and they provide pre-

to know more about Medicare Ad- vantage Special Needs Plans (SNPs). What could you tell him? scription drug coverage that could be very helpful as well.

26. Dr. Elizabeth Brennan does not con- tract with the ABC PFFS plan but accepts the plan's terms and con- ditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge? Dr. Brennan can charge Mary Rogers no more than the cost shar- ing specified in the PFFS plan's terms and condition of payment which may include balance billing up to 15%of the Medicare rate.
27. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan avail- able in his area has an attractive pre- mium. He wants to know if he must use doctors in a network as his cur- rent HMO plan requires him to do. What should you tell him? He may receive health care ser- vices 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 bal- ance billing.
28. Juan Hernandez is turning 65 next month, Juan legally entered the Unit- ed States over twenty years ago but is not a citizen. Since his entry into the country, Juan has worked at Smallcap Incorporated and con- tributed to the Medicare system. Juan suffers from diabetes. He will soon retire and asks you if he can enroll in a Medicare Advantage plan that you represent. How would you respond? Juan is eligible to enroll in a Medicare Advantage as long as he is entitled to Part A and enrolled in Part B. Juan should go to the Social Se- curity website to enroll in Medicare Part A and B if he has not done so already. Once he is enrolled, he can choose a Medicare Advantage plan.
29. Mrs. Radford asks whether there are any special eligibility require- ments for Medicare Advantage. What should you tell her? Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
30. Mr. Barker enjoys a comfortable re- tirement income. He recently had You can offer to review the plans appeal process to help him ask the

surgery and expected that he would have certain services and items covered by the plan with mini- mal 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 maxi- mum out-of-pocket limit that includ- ed some services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him? plan to review the coverage deci- sion.

31. Which of the following statement(s) is/are correct about a Medicare Sav- ings Account (MSA) Plans? I. MSAs may have either a partial net- work, 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 enrolled in an MSA plan is responsible for a min- imal deductible of $500 indexed for inflation. IV. Non-network providers must ac- cept the same amount that Original Medicare would pay them as pay- ment in full. I, II, and IV only
32. 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 Ad- vantage Special Needs Plan (SNP). His friend has mentioned that the 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.

SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. What should you tell him?

33. Daniel is a middle-income Medicare beneficiary. He has chronic bronchi- tis, putting him at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to be most appropriate for him?

C-SNP

34. Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him? He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.
35. Mrs. Chi is age 75 and enjoys a com- fortable but not extremely high-in- come level. She wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug coverage since her doctor recently prescribed several expensive medications. Cur- rently, she is enrolled in Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi? Mrs. Chi may enroll in a MA MSA plan and remain in her current stand- alone Part D prescription drug plan.
36. Mrs. Wang wants to know general- ly how the benefits under Original Medicare might compare to the ben- efits package of a Medicare Advan- tage Plan before she starts looking Medicare Advantage Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental ser- vices. It must include a maximum

at specific plans. What could you tell her? out-of-pocket limit on Part A and Part B services.

37. Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be the correct descrip- tion? Medicare Advantage is a way of cov- ering all the Original Medicare bene- fits through private health insurance companies.
38. Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS) plan. What questions would you need to ask to determine his eligibility? You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS plan's service area.
39. Ms. Gibson recently lost her employ- er 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 ob- taining drug coverage? She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D pre- scription drug plan.
40. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him? In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from providers with- in the plan's network (except in an emergency or where care is unavail- able within the network).
41. Mrs. Quinn has just turned 65, is in excellent health and has a rel- atively high income. She uses no medications and sees no reason to spend money on a Medicare pre- scription drug plan if she does not need the coverage. She currently does not have creditable coverage. What could you tell her about the implications of such a decision? If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign up at a later date, her premium will be permanently in- creased by 1% of the national aver- age premium for every month that she was not covered.

42. Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra help pay- ing for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know whether he might qualify. What should you tell him? The extra help is available to benefi- ciaries whose income and assets do not exceed annual limits specified by the government.
43. Charles McCarthy is a Medicare ben- eficiary who suffers from diabetes. Mr. McCarthy is considering enroll- ment in a MA-PD plan that you repre- sent. He asks you whether his insulin costs will be covered. What should you say? Mr. McCarthy's insulin costs for a one-month supply cannot be more than $35 in any coverage phase un- der the prescription drug plan begin- ning in 2023.
44. Mrs. Imelda Diaz is a Medicare ben- eficiary enrolled in a MA-PD plan you represent. Her neighbor recent- ly suffered from a painful case of shingles. Mrs. Diaz hopes to avoid such an illness through vaccination. She asks you whether the cost of shingles vaccination will be covered under the plan you represent. What should you say? Yes, there is no cost sharing for the shingles vaccine even in the de- ductible phase of her prescription drug plan because it is an adult vac- cine recommended by the Advisory Committee on Immunization Prac- tices (AICP).
45. Mr. Schultz was still working when he first qualified for Medicare. At that time, he had employer group cover- age that was creditable. During his initial Part D eligibility period, he de- cided not to enroll because he was satisfied with his drug coverage. It is now a year later and Mr. Schultz has lost his employer group cover- age within the last two weeks. How would you advise him? Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a pre- mium penalty.

46. Mrs. Roberts has Original Medicare and would like to enroll in a Pri- vate Fee-for-Service (PFFS) plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts consider before selecting a PFFS plan? A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that com- bines medical benefits and Part D prescription drug coverage, a PFFS plan offering only medical benefits, or a PFFS plan in combination with a stand-alone prescription drug plan.
47. Which of the following individuals is most likely to be eligible to enroll in a Part D Plan? a.Guy, who has illegally crossed the Canadian border. b. Jose, a grandfather who was granted asylum and has worked in the United States for many years. Correct: Jose, having been granted asylum, is legally present in the Unit- ed States thus meeting one of the criteria for Part D eligibility. c.Betsy, a grandmother from over- seas who has overstayed her visa. d.Helena, an overseas college stu- dent who has overstayed her visa. Jose, a grandfather who was grant- ed asylum and has worked in the United States for many years.
48. Mr. Carlini has heard that Medicare prescription drug plans are only of- fered through private companies un- der a program known as Medicare Advantage (MA), not by the govern- ment. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescrip- tion drug coverage. What should you tell him? Mr. Carlini can stay with Origi- nal 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 coverage to eligible Medicare beneficiaries.
49. Mrs. Walters is entitled to Part A and has medical coverage without drug Yes. Mrs. Walters must be entitled to Part A and/or enrolled in Part

coverage through an employer re- tiree plan. She is not enrolled in Part B. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to? B to be eligible for coverage under the Medicare prescription drug pro- gram.

50. Mr. Hutchinson has drug coverage through his former employer's re- tiree 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 pur- chase extra coverage that he will not need. What should you tell him? If the drug coverage he has is not ex- pected 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.
51. Mr. Jacob understands that there is a standard Medicare Part D prescrip- tion drug benefit, but when he looks at information on various plans avail- able in his area, he sees a wide range in what they charge for deductibles, premiums, and cost sharing. How can you explain this to him? Medicare Part D drug plans may have different benefit structures, but on average, they must all be at least as good as the standard model es- tablished by the government.
52. 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? Unless she chooses a Medicare Part D prescription drug plan on her own, she will be automatically enrolled in one available in her area.
53. Mrs. Cantwell is enrolled in a prescription drug plan. She has heard about something called True-Out-Pocket costs or "TrOOP" and asks you if any of the follow- ing count toward reaching the cat- astrophic coverage phase. What do you say? I. Her annual PDP deductible I and II only

II. A drug manufacturer's discount for brand name drugs after her initial coverage period III. The off formulary drug her doc- tor prescribed but she pays for be- cause the plan denied her exception request IV. Her over-the-counter (OTC) aller- gy medication.

54. Mrs. Fiore is a retired federal worker with coverage under a Federal Em- ployee Health Benefits (FEHB) plan that includes creditable drug cover- age. She is ready to turn 65 and be- come Medicare eligible for the first time. What issues might she con- sider about whether to enroll in a Medicare prescription drug plan? She could compare the coverage to see if the Medicare Part D plan offers better benefits and coverage than the FEHB plan for the specific medications she needs and whether any additional benefits are worth the Part D premium costs on top of her FEHB contribution.
55. Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and also enroll in a stand-alone Medicare pre- scription drug plan. Under what cir- cumstances can she do this? If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this.
56. Mr. Torres has a small savings ac- count. He would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his savings account until it is ex- hausted, and then have his premi- ums withheld from his Social Securi- ty check. What should you tell him? In general, he must select a single Part D premium payment mecha- nism that will be used throughout the year.
57. Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescrip- tion Drug program and he is wonder- He could check with the manufac- turers of his medications to see if they offer an assistance program to help people with limited means to

ing if there is any other option he has for obtaining help with his consider- able drug costs. What should you tell him? 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.

58. 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? 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.
59. Which of the following statements about Medicare Part D are correct? I. Part D plans must enroll any eligi- ble beneficiary who applies regard- less of health status except in limited circumstances. II. Private fee-for-service (PFFS) plans are not required to use a phar- macy 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 bene- fits through a standalone PDP or through their plan. I, II, and III only
60. Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently lost creditable cover- age previously available through her husband's employer. She is interest- ed in enrolling in a Medicare Part D prescription drug plan (PDP). What should you tell her? If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP.

61. Agent Daniel Webber has properly set up a sales appointment to meet with client Edward Young at Agent Webber's office. At the agreed upon appointment time, Mr. Young arrives with his elderly neighbor - Clara Bur- ton, who wants to learn about her Medicare Advantage options. What should Agent Daniel Webber do? After executing a scope of appoint- ment (SOA) with Clara Burton, meet with Edward Young and Clara Burton to discuss their Medicare Advantage options.
62. Mrs. Lu is turning 65 in November and called to ask for your help decid- ing on a Medicare Advantage plan. She agreed to sign a scope of ap- pointment form and meet with you on October 15. During the appoint- ment, what are you permitted to do? You may provide her with the re- quired enrollment materials and take her completed enrollment applica- tion.
63. You have approached a hospital ad- ministrator about marketing in her facility. The administrator is uncom- fortable with the suggestion. How could you address her concerns? Tell her that Medicare guidelines al- low you to conduct marketing activi- ties in common areas of a provider's facility.
64. You are working several plans and community organizations to spon- sor an educational event. When putting together advertisements for this event, what should you do? You must ensure that the advertise- ments indicate it is an educational event, otherwise it will be considered a marketing event.
65. Miguel Sanchez is a relatively new agent who has come to you for ad- vice as to what he can do during the Medicare Advantage Open En- rollment Period (MA-OEP). What ad- vice should you give Miguel? During the MA-OEP, Miguel can have one-on-one meetings with ben- eficiaries who have requested such meetings.
66. Wendy Park becomes eligible for Medicare for the first time in July. With the help of Agent James Chan, FeelBetter will pay Agent Chan initial year compensation for July through December. The renewal amounts

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? will be paid starting in January if Ms. Park remains enrolled the following year.

67. Melissa Meadows is a marketing rep- resentative for Best Care which has recently introduced a Medicare Ad- vantage plan offering comprehen- sive dental benefits for $15 per month. Best Care has not submitted any potential posts to CMS for ap- proval. Melissa would like to use the power of social media to reach po- tential prospects. What advice would you give her? As soon as CMS approves Best Care's social media posts, Agent Meadows could post a tweet stating that "Best Care offers an array of Medicare Advantage benefit pack- ages. One might be right for you. Call me to find out more!"
68. 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? You appreciate the opportunity and would be happy to schedule an ap- pointment with anyone at their re- quest.
69. Your client, Alexis Jones, calls you on December 4th about changing her Medicare Advantage plan dur- ing the annual election period which ends December 7th. What should you do? Complete a scope of appointment (SOA) during the call and indi- cate that they will meet to discuss Medicare Advantage plans during an appointment the following day.
70. Linda Sanchez is conducting a previ- ously agreed upon appointment with client, Maria Gomez about a MA-Part D plan she represents. Before an en- rollment form is completed, Linda needs to provide Maria with informa- tion about ____ I. whether or not Maria's primary I, II, and III only

care provider is in the plan's net- work.II. whether Maria's current pre- scriptions are covered by the plan.III. the monthly premium cost(s).IV. the life insurance products that Linda also sells

71. You are seeking to represent an indi- vidual Medicare Advantage plan and an individual Part D plan in your state. You have completed the re- quired 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? You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score. Howev- er, you will not have to take a test if you exclusively market employ- er/union group plans and the com- panies do not require testing.
72. Another agent you know has en- gaged in misconduct that has been verified by the plan she represented. What sort of penalty might the plan impose on this individual? The plan may withhold commission, require retraining, report the miscon- duct to a state department of insur- ance or terminate the contract.
73. 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? It must obtain a HIPAA compliant au- thorization from an enrollee that indi- cates the plan or plan sponsor may use their information for marketing purposes.
74. You have been providing a pre-Thanksgiving meal during sales presentations in November for many years and your clients look forward to attending this annual event. When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals? You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who pro- vides or pays for the meal.

75. You have sought permission from a hospital to place brochures for your product in their gift shop and cafe- teria. The hospital administration ex- presses some hesitation about al- lowing marketing in a health care fa- cility. What should you tell them? Marketing in health care facilities is an acceptable practice, as long as it takes place in common ar- eas where patients are not receiving health care services.
76. Another agent working for your agency claims that because you are not employed by the Medicare Ad- vantage plans that you represent, you are not subject to the same marketing requirements as the plans themselves. How should you re- spond to such a statement? Your coworker is not correct. Market- ing 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.
77. Evan Marsh is a newly appointed agent. Evan intends to conduct an educational session on Medicare at a senior citizens center near his home. He has advertised the session as an educational event. Evan asks you what is permissible at such an event. What should you say? Evan may provide a meal as long as its value is $15 or less per attendee and he may make available business reply cards (BRCs).
78. Hector Hernandez is an independent agent. Hector sells plans on behalf of three Medicare Advantage organiza- tions that offer a total of 10 plans but does not represent all Medicare Ad- vantage organizations offering plans that are available in his area. Which of the following statements best de- scribes any steps Hector is required to take? During the first minute of a sales call, Hector must use a dis- claimer that says "I do not rep- resent every plan available in your area. I represent 3 organiza- tions that offer 10 plans in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all your options."
79. Agent Martinez wishes to solic- it Medicare Advantage prospects through e-mail and asks you for ad- Marketing representatives may initi- ate electronic contact through e-mail

vice as to whether this is possible. What should you tell her? but an opt-out process must be pro- vided.

80. Sal D'Angelo is new to the Medicare marketplace having previously been focused on life insurance and dis- ability income protection products. He intends to conduct an education- al seminar during the AEP at a lo- cal hotel and then invite those who attend to a subsequent marketing meeting to discuss the benefits of next year's plans. How would you ad- vise Sal? Sal should conduct the education seminar as an early morning meet- ing and the marketing meeting on the following day in the late after- noon so that there are at least 12 hours between the two meetings.
81. Mrs. Reeves is newly eligible to en- roll in a Medicare Advantage plan and her MA Initial Coverage Election Period (ICEP) has just begun. Which of the following can she not do dur- ing the ICEP? She can enroll in a Medigap plan to supplement the benefits of the MA plan that she's also enrolling in.
82. You are visiting with Mr. Tully and his daughter at her request. He has advanced Alzheimer's and is inca- pable of understanding the implica- tions of choosing a Medicare Advan- tage or prescription drug plan. Can his daughter fill out the enrollment form and sign it for him? Mr. Tully's daughter can do so only, if she is authorized under state law as a court-appointed legal guardian, has a durable power of attorney for health care decisions, or is autho- rized under state surrogate consent laws to make health decisions.
83. Mrs. Kumar would like her daugh- ter, 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? Her daughter should come in No- vember.

84. Mr. White has Medicare Parts A and B with a Part D plan. Last year, he re- ceived a notice that his plan sponsor identified him as a "potential at-risk" beneficiary. This month, he started receiving assistance from Medicaid. He wants to find a different Part D plan that's more suitable to his cur- rent prescription drug needs. He be- lieves he's entitled to a SEP since he is now a dual eligible. Is he able to change to a different Part D plan during a SEP for dual eligible individ- uals? No. Once he is identified by the plan sponsor as a "potential at-risk" ben- eficiary, he cannot use the dual eli- gible SEP to change plans while this designation is in place.
85. No. Once he is identified by the plan sponsor as a "potential at-risk" ben- eficiary, he cannot use the dual eli- gible SEP to change plans while this designation is in place. Mary may make an unlimited num- ber of MA enrollment requests and may disenroll from her current MA plan.
86. Mrs. Parker likes to handle most of her business matters through tele- phone calls. She currently is enrolled in Original Medicare Parts A and B but has heard about a Medicare Advantage plan offered by Senior Health from a neighbor. Mrs. Park- er asks you whether she can enroll in Senior Health's MA plan over the telephone. What can you tell her? I. Enrollment requests can only be made in face-to-face interviews or by mail. II. Telephone enrollment request calls must be recorded. III. Telephonic enrollments must in- clude all required elements neces- sary to complete an enrollment. II and III only

IV. The signature element must be completed via certified mail.

87. Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could you help him take during this time? He will have one opportunity to enroll in a Medicare Advantage plan.
88. Mrs. Margolis contacts you in Au- gust because she will become eligi- ble for Medicare for the first time in November. She would like to meet and discuss plan choices with you. What advice should you give her? Tell her to wait until October to dis- cuss plan choices with you so that you can share plan benefits for the current year as well as any changes for the following year that may im- pact her choice.
89. Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the Annual En- rollment Period (AEP). At the begin- ning of January, her neighbor told her about the Medicare Advantage (MA) plan he selected. He also told her there was an open enrollment period that she might be able to use to enroll in a MA plan. Ms. Gonzales comes to you for advice shortly af- ter speaking to her neighbor. What should you tell her? There is a MA Open Enrollment Pe- riod (OEP) that takes place between January 1 and March 31, but Ms. Gonzales cannot use it because el- igibility to use the OEP is available only to MA enrollees.
90. Mr. Roberts is enrolled in an MA plan. He recently suffered complications following hip replacement surgery. As a result, he has spent the last three months in Resthaven, a skilled nursing facility. Mr. Roberts is about to be discharged. What advice would you give him regarding his health coverage options? His open enrollment period as an in- stitutionalized individual will contin- ue for two months after the month he moves out of the facility.

Torie Jones is a new marketing rep- resentative. Torie asks you for advice as to what topics must be discussed with a Medicare beneficiary prior to enrollment in a Medicare Advantage (MA-PD) plan. What should you say? Torie, there are many required ques- tions and topics regarding beneficia- ry needs to be discussed prior to enrollment in an MA plan. These in- clude information regarding prima- ry care providers and specialists whether they are in the plan net- work, whether or not a beneficia- ry's current prescriptions are cov- ered as well as premiums, benefits, and costs of health care services.

92. Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-income subsidy. How does that affect his ability to enroll or disenroll in a Part D plan? He qualifies for a special election period and can enroll in or disenroll from a Part D plan once during that period.
93. You have come to Mrs. Midler's home for a sales presentation. At the be- ginning of the presentation, Mrs. Mi- dler tells you that she has a copy of her medical records available be- cause 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? You can only ask Mrs. Midler ques- tions about conditions that affect eli- gibility, specifically, whether she has one of the conditions that would qualify her for a special needs plan.
94. Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he con- tinues to work and is covered by an employer health plan, he has not en- rolled in Part B or Part D. He receives a notice on June 1 that his employ- er is cutting back on prescription drug benefits and that as of July 1 his coverage will no longer be cred- Mr. Rockwell is eligible for a SEP due to his involuntary loss of creditable drug coverage; the SEP begins in June and ends on September 1- two months after the loss of creditable coverage.

itable. He has come to you for ad- vice. What advice would you give Mr. Rockwell about special election pe- riods (SEPs)?

95. A client wants to give you an en- rollment application on October 1 before the beginning of the Annual Election Period because he is leav- ing on vacation for two weeks and does not want to forget about turn- ing it in. What should you tell him? You must tell him you are not permit- ted 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.
96. 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? She should remain in Original Medicare until the annual election period running from October 15 to December 7, during which she can select an MA plan.
97. 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? He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may make one Part D enrollment choice, including enroll- ment in a stand-alone Part D plan or an MA-PD plan.
98. Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area that has suffered from ma- jor flooding that has been declared a major disaster by both the Federal government and her state. As a re- sult of dealing with the flooding is- sues and being evacuated from her home, Edna missed her chance to enroll in MA during her Initial Cover- age Election Period. Felix lives in an Edna would qualify for a SEP be- cause government officials have de- clared a major disaster for her area and she did not enroll in MA dur- ing her ICEP due to the emergency. George would qualify for an SEP because he enrolled in Medicare Advantage (MA) plan for the first time and would now like to return to Original Medicare within the first 12 months of his enrollment. Harriet

area with a Medicare Advantage plan with a 4-star rating that he would like to join. George dropped his Medigap policy six months ago when he first enrolled in a Medicare Advantage plan. He now wants to return to Orig- inal Medicare. Harriet has recently developed diabetes and would like to enroll in a Medicare Advantage plan that focuses on care for those with that disease. Which, if any, of these individuals would qualify for a spe- cial election period (SEP)? would also qualify for a SEP to enroll in a C-SNP because she has devel- oped a chronic condition. Felix would not qualify for a SEP since he seeks to enroll in a 4-star not a 5-star MA plan.

99. You are doing a sales presenta- tion for Mrs. Pearson. You know that Medicare marketing guidelines pro- hibit certain types of statements. Ap- ply those guidelines to the following statements and identify which would be prohibited. "If you're not in very good health, you will probably do better with a differ- ent product."
100. Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Pe- riod. In mid-January of the follow- ing year, she wants to switch back to Original Medicare and enroll in a stand-alone prescription drug plan. What should you tell her? During the MA Open Enrollment Pe- riod, from January 1 - March 31, she may disenroll from the MA-PD plan into Original Medicare and also may add a stand-alone prescription drug plan.
101. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap poli- cy 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? 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.