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Test-2

Question 1

Correct
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?
Question 1Select one:

a.

When possible, it is always the best option to have both the employer’s plan and the MA-PD, so he would have no out-of-pocket expenses.

b.

He should compare the benefits in his employer-sponsored retiree group health plan with the benefits in his neighbor’s MA-PD plan to determine which one will provide sufficient coverage for his prescription needs.

 

Correct: The type of Medicare Advantage plans offered vary by employers. Therefore, beneficiaries should compare their employer’s retiree plan with other available plan options.

c.

Generally, employers prefer retirees to enroll in a stand-alone PDP, so he should consider that instead of the MA-PD.

d.

Generally, employers prefer retirees to have both the retiree group plan and the MA-PD plan to fill in the gaps, but he would be better off with just the MA-PD plan.

Question 2

Correct
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?
Question 2Select one:

a.

MSA enrollees may only receive covered health care services from a limited panel of network providers because otherwise, some providers may charge more than Original Medicare rates.

b.

All beneficiaries enrolled in an MSA set-aside the MSA funds on a pre-tax basis in addition to paying their Part B premium.

c.

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.

 

Correct: MSA enrollees must enroll in a stand-alone prescription drug plan (PDP) if they want prescription drug benefits.

d.

For enrollees in an MSA, after the annual deductible is met, the MSA plan generally pays 75% of covered services.

Question 3

Correct

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?

Question 3Select one:

a.

In general, Mrs. Ramos will need a referral to see specialists.

b.

In general, Mrs. Ramos can obtain care from any provider who participates in Original Medicare but will have to pay the difference between the plan’s allowed amount and the provider’s usual and customary charge.

c.

Mrs. Ramos should be aware that generally plan providers can decide, on a case-by-case basis, whether they will treat her.

d.

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.

 

 Correct: MA-PPO enrollees may seek care from any provider who accepts Medicare. However, enrollees are typically responsible for higher cost-sharing payments if their provider is out-of-network.

Question 4

Correct
Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her?
Question 4Select one:

a.

Mrs. Radford must apply to the Medicare Advantage plan, which will include a medical review, before being accepted and enrolled.

b.

Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.

 

Correct: To be eligible to enroll in Medicare Advantage, an individual must be entitled (not enrolled) to Part A and enrolled in Part B.

c.

Mrs. Radford can enroll in any Medicare Advantage plan that operates within the United States.

d.

Mrs. Radford must be enrolled in both Medigap and Part A to enroll in a Medicare Advantage plan.

Question 5

Correct
Mrs. Wang wants to know generally how the benefits under Original Medicare might compare to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans. What could you tell her?
Question 5Select one:

a.

Medicare Advantage 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.

b.

Medicare Advantage Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental services. It must include a maximum out-of-pocket limit on Part A and Part B services.

 

Correct: Some Medicare Advantage Plans offer extra benefits that Original Medicare does not cover. Also, Original Medicare does not have a maximum out-of-pocket limit.

c.

All Medicare Advantage 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.

d.

Medicare Advantage 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.

Question 6

Correct
Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty years ago but is not a citizen. Since his entry into the country, Juan has worked at Smallcap Incorporated and contributed 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?
Question 6Select one:

a.

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 Security 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.

 

 Correct: The Social Security Administration will determine Juan’s eligibility for Medicare. If Juan is entitled to Part A and enrolled in Part B, he is generally eligible for enrollment in a Medicare Advantage plan.

b.

Juan cannot enroll in a Medicare Advantage plan since he was born outside the United States.

c.

Juan cannot enroll in a Medicare Advantage plan because diabetes is a pre-existing condition.

d.

Juan cannot enroll in a Medicare Advantage plan because United States citizenship is a requirement for enrollment in a Medicare Advantage plan.

Question 7

Correct
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him?
Question 7Select one:

a.

In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from providers within the plan’s network (except in an emergency or where care is unavailable within the network).

 

Correct: In most Medicare Advantage HMOs, as a general rule, an enrollee must obtain services only from providers within the plan’s network, otherwise known as participating providers. An exception is made for emergency care.

b.

With any Medicare Advantage HMO, Mr. Kumar will be able to see any provider he likes, so long as that provider participates in Original Medicare.

c.

In Medicare Advantage HMO plans, services provided by primary care physicians are covered at 100%, but those of specialists are covered at 80%.

d.

Mr. Kumar will be able to obtain routine care outside of the plan’s service area but will pay a higher co-payment (except in an emergency).

Question 8

Correct
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?
Question 8Select one:

a.

He is not eligible to enroll in a Medicare Advantage as a naturalized citizen.

b.

He can enroll in a Medicare Advantage plan but it will pay only the benefits associated with Medicare Part A.

c.

He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.

 

Correct: In order to enroll in a Medicare Advantage (MA) plan, an individual must be entitled to Part A and enrolled in Part B. Mr. Castillo is covered by Plan A but no longer enrolled in Medicare Part B so he cannot enroll in MA plan until he re-enrolls in Part B.

d.

He can enroll in a Medicare Advantage plan if he has dropped Part B less than 90 days ago.

Question 9

Correct

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?

Question 9Select one:

a.

SNPs only serve individuals eligible for both Medicaid and Medicare, so he cannot enroll.

b.

SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP.

 

Correct: Mr.Greco’s circumstances would not meet the eligibility criteria to qualify him for any of the SNPs.

c.

SNPs only serve individuals in long-term care facilities, so he cannot enroll.

d.

SNPs do not provide Part D prescription drug coverage, so if he does enroll, he should be aware that he will not have coverage for any medications he may need now or in the future.

Question 10

Correct

Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be the correct description?

 

Question 10Select one:

a.

Medicare Advantage is a new name for the Original Medicare program.

b.

Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies.

 

Correct: Medicare Advantage is a way of covering Original Medicare, Part A and Part B benefits, through private health insurance plans. {mlang es}Correcto. Medicare Advantage es una manera de cubrir los beneficios del programa Medicare Original y de las Partes A y B a través de planes de seguros de salud privados.{mlang}

c.

Medicare Advantage is designed to pick up where Original Medicare leaves off, covering those health care services that would not normally be covered by Original Medicare.

d.

Medicare Advantage is a health insurance program operated jointly by the states with the Federal government.

Question 11

Incorrect
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?
Question 11Select one:

a.

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 time in favor of a Medicare Advantage plan that includes such drug coverage.

b.

She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan.

 

Incorrect: If a beneficiary enrolls in a MA plan that is an HMO or PPO plan that does not include Part D coverage, the beneficiary cannot join a standalone Prescription Drug Plan (PDP).

c.

She can enroll in the PPO and purchase drug coverage through a Medigap plan.

d.

She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan.

Question 12

Correct

Mr. Barker enjoys a comfortable retirement income. He recently had surgery 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 some services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him?

Question 12Select one:

a.

You could suggest he call the doctor who performed the surgery to complain about the costs and ask for a discount on the charges.

b.

You could reassure him that such charges are typical, but if he needs assistance in paying, he should apply to the state for Medicaid assistance.

c.

You could remind him that he cannot do anything until the next Annual Election Period when he will have an opportunity to change plans.

d.

You can offer to review the plans appeal process to help him ask the plan to review the coverage decision.

 

 Correct: Medicare Advantage (MA) plan enrollees have a right to obtain a review (appeal) to certain decisions about health care payment, coverage of services, or prescription drug coverage. Medicare health plans must provide enrollees with a written description of the appeals process.

Question 13

Correct
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?
Question 13Select one:

a.

SNPs offer care from any doctor or hospital Mr. Sinclair would like to use and his costs will always be lower than in Original Medicare.

b.

Since SNPs don’t cover prescription drugs Mr. Sinclair should consider a different option.

c.

SNPs are essentially the same as Original Medicare and are not likely to have a noticeable impact on how Mr. Sinclair receives his care.

d.

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.

 

Correct:  Chronic condition SNPs (C-SNPs) restrict enrollment and tailor services to individuals with chronic conditions, such as Mr. Sinclair. All SNPs include prescription drug coverage.

Question 14

Correct
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 as his current HMO plan requires him to do. What should you tell him?
Question 14Select one:

a.

If he enrolls in the PFFS plan, he can go to any doctor anywhere as long as the doctor accepts Original Medicare.

b.

He may receive services from any physician, regardless of whether or not that physician participates in the plan or Original Medicare.

c.

If he enrolls in the PFFS plan and shows his card to a doctor who participates in Original Medicare, then that doctor is required to accept the plan’s terms and conditions, which could include balance billing.

d.

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.

 

Correct: Mr. Gomez may receive health care services from any doctor allowed to bill Medicare, provided he shows the doctor the plan’s identification card, and the doctor accepts the PFFS’s payment terms and conditions. These terms may include balance billing up to 15% of the Medicare rate.

Question 15

Incorrect
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug coverage since her doctor recently prescribed several expensive medications. Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi?
Question 15Select one:

a.

Mrs. Chi is ineligible for a MA MSA plan because she is ineligible for Medicaid due to her income level.

b.

Mrs. Chi may enroll in a MA MSA plan but if she wishes prescription drug coverage it must be a MSA-PD plan that includes drug coverage.

 

Incorrect. MA MSA plans are prohibited from offering prescription drug coverage. If an MSA member wants prescription drug coverage, the member must enroll in a standalone PDP.

c.

Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D prescription drug plan.

d.

Mrs. Chi may enroll in a MA MSA plan but if she wishes prescription drug coverage she must also enroll in a Medicare Supplement Plan (Medigap) F plan that covers the Medicare Part B deductible and includes drug coverage.

Question 16

Correct
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to be most appropriate for him?
Question 16Select one:

a.

FIDE-SNP

b.

I-SNP

c.

D-SNP

d.

C-SNP

 

Correct: Because Daniel’s bronchitis is a chronic condition, a Chronic condition SNP would be most appropriate for him to enroll in.

Question 17

Correct

Mrs. Burton is a retiree with substantial 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?

Question 17Select one:

a.

She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment.

 

 Correct: Enrollees or their representatives may file a grievance if they experience problems with their health care services, such as timeliness, appropriateness, access to, and/or setting of a provided health service, procedure, or item.

b.

She must write to the plan and wait for a response and then, if she is still dissatisfied, she could file an appeal with her state Medicaid office requesting transfer to one of its managed care plans.

c.

She should not expect to get in to see her doctor any more quickly since she is a Medicare patient.

d.

She should call the doctor’s office to complain since the plan cannot do anything about the doctor’s schedule.

Question 18

Incorrect
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan’s terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge?
Question 18Select one:

a.

Dr. Brennan can charge the beneficiary the same cost-sharing as Original Medicare as long as she sends the claim to Medicare and not the plan.

b.

Dr. Brennan can charge Mary Rodgers no more than the cost sharing specified in the PFFS plan’s terms and conditions of payment which may include balance billing up to 25% of the Medicare rate.

 

Incorrect. The balance billing amount allowed is up to 15% of the Medicare rate.

c.

Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan’s terms and condition of payment which may include balance billing up to 15%of the Medicare rate.

d.

Dr. Brennan can charge Mary Rodgers more than the cost sharing specified in the PFFS plan’s terms and conditions as long as she treats all beneficiaries the same.

Question 19

Correct
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?
Question 19Select one:

a.

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.

 

Correct: Eligibility to enroll in a PFFS plan is based on entitlement to Medicare Part A and enrollment in Part B. In addition, to enroll in a specific PFFS plan, the individual must reside in the plan’s service area.

b.

You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if his doctor will accept the terms and conditions of payment of the PFFS plan.

c.

You would need to ask Mr. Kelly if he is enrolled in Part A and Part B if he is healthy, and how often he expects to visit a doctor.

d.

You would need to ask Mr. Kelly if he is enrolled in Part A and Part D if he needs drug coverage.

Question 20

Incorrect
 Which of the following statement(s) is/are correct about a 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 enrolled in an MSA plan is responsible for a minimal deductible of $500 indexed for inflation.

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

 

Question 20Select one:

a.

I, II, and III only

b.

I, II, and IV only

c.

II and III only

d.

I and II only

 

Incorrect: It is correct that MSAs may not have a network or may have a full or partial network of providers, and MSAs cover Part A and Part B benefits after the deductible. However, it is also correct that all non-network providers must accept the same amount that Original Medicare would pay them as payment in full.  This is the amount the enrollee will pay the provider before the deductible is met.

Question 1

Correct

Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he looks at information on various plans available 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?

Question 1Select one:

a.

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 established by the government.

 

Correct: Part D plans must cover at least the Part D standard benefits or its actuarial equivalent. Part D plans are permitted to offer supplemental benefits that cover certain drugs not covered under Part D.  Some Part D plans may offer these supplemental benefits for an additional monthly premium.

b.

The Part D standard model’s importance is that it is the only type of plan into which low-income beneficiaries can enroll and still receive any extra help for which they may qualify.

c.

The government bases its payments to Part D plans on the standard benefit model. For Part D plans to receive the full government payment, they must offer the standard model, however, they can take a risk and revise their benefit structure to attract more beneficiaries.

d.

The government allows Part D plans to adopt any benefit structure as long as the list of covered drugs meets their approval.

Question 2

Incorrect

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?

Question 2Select one:

a.

As long as he fills out the paperwork to begin withholding from his Social Security check at least 63 days before such withholding should begin, he can change his method of Part D premium payment and withholding will begin the month after his savings account is exhausted.

b.

In general, to pay his Part D premium, he only can have automatic withdrawals made from a checking account, so he will need to transfer the funds prior to beginning such withdrawals.

 

Incorrect: Part D beneficiaries have the option to pay their monthly premiums, not only through automatic payments from a checking account, but also from a savings account or automatic charges against their credit or debit card.

c.

In general, he must select a single Part D premium payment mechanism that will be used throughout the year.

d.

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.

Question 3

Correct
Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree 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?
Question 3Select one:

a.

Yes, but Mrs. Walters must drop the employer coverage before enrolling in a Medicare prescription drug plan.

b.

No. Mrs. Walters will have to enroll in Part B to qualify for enrollment into the Medicare prescription drug program.

c.

No. As long as her employer offers coverage that is equivalent to that available through Medicare, Mrs. Walters cannot enroll in a Medicare prescription drug plan.

d.

Yes. Mrs. Walters must be entitled to Part A and/or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program.

 

Correct. Mrs. Walters is eligible to enroll in Part D because she is entitled to Part A. An individual is eligible to enroll in Part D if the individual is entitled to Part A and/or enrolled in Part B.

Question 4

Correct

Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. She currently does not have creditable coverage. What could you tell her about the implications of such a decision?

Question 4Select one:

a.

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, she will be required to pay a higher premium during the first year that she is enrolled in the Medicare prescription drug program. After that point, her premium will return to the normal amount.

b.

If she does not sign up for a Medicare prescription drug plan, she will incur no penalty, as long as she can demonstrate that she was in good health and did not take any medications.

c.

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, she will have to pay a one-time penalty equal to 10% of the annual premium amount.

d.

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 increased by 1% of the national average premium for every month that she was not covered.

 

Correct: Most Individuals should sign up for Part D as soon as they are eligible to do so. Otherwise, they face a permanent premium penalty of 1% of the national average premium for each month the individual does not have Part D coverage. Beneficiaries who qualify for the low-income subsidy, however, are not subject to the late enrollment penalty.

Question 5

Correct
Mrs. Roberts has Original Medicare and would like to enroll in a Private 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?
Question 5Select one:

a.

A stand-alone prescription drug plan in combination with a PFFS plan or a PFFS Medigap Supplemental Insurance plan.

b.

A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines 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.

 

Correct: The types of permissible plan options include a MA PFFS plan with Part D benefits obtained through that plan, a PFFS plan with only medical benefits, and a PFFS with enrollment in a standalone prescription drug plan.

c.

A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D prescription drug coverage, a PFFS plan offering only medical benefits, or PFFS Medigap Supplemental Insurance plan.

d.

A PFFS plan offering only medical benefits or a PFFS Medigap Supplemental Insurance plan.

Question 6

Correct

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 following count toward reaching the catastrophic coverage phase. What do you say?

I.      Her annual PDP deductible

II.     A drug manufacturer’s discount for brand name drugs after her initial coverage period

III.    The off formulary drug her doctor prescribed but she pays for because the plan denied her exception request

IV.    Her over-the-counter (OTC) allergy medication.

Question 6Select one:

a.

I, II, III, and IV

b.

I only

c.

I, II, and IV only

d.

I and II only

 

Correct: Mrs. Cantwell’s annual PDP deductible and the drug manufacturer’s discount for brand name drugs after her initial coverage period count toward her TrOOP. Also, Mrs. Cantwell’s cost sharing during the initial coverage phase counts toward her TrOOP.

Question 7

Correct

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.

Question 7Select one:

a.

I and II only

b.

I, II, and III only

 

Correct: Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. Also, private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. Additionally, beneficiaries enrolled in an MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP.

c.

I, II, III, and IV

d.

I only

Question 8

Correct
Mr. Schultz was still working when he first qualified for Medicare. At that time, he had employer group coverage that was creditable. During his initial Part D eligibility period, he decided 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 coverage within the last two weeks. How would you advise him?
Question 8Select one:

a.

Mr. Schultz should seek to continue employer group coverage through COBRA because it is likely to have superior benefits at a more permanent solution.

b.

Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty.

 

Correct: Mr. Schultz should enroll in a Part D plan, or otherwise obtain creditable drug coverage, before he has a 63-day break in order to avoid a premium penalty.

c.

Mr. Schultz should immediately enroll in a Part D plan but he can expect to pay a premium penalty because he failed to enroll when first eligible.

d.

Mr. Schultz can wait up to 180 days after the loss of his creditable employer group coverage before enrolling in a Part D plan without worrying payment a premium penalty.

Question 9

Correct

Charles McCarthy is a Medicare beneficiary who suffers from diabetes. Mr. McCarthy is considering enrollment in a MA-PD plan that you represent. He asks you whether his insulin costs will be covered. What should you say?

Question 9Select one:

a.

Mr. McCarthy’s insulin costs for a one-month supply cannot be more than $35 in any coverage phase under the prescription drug plan beginning in 2023.

 

Correct: Mr. McCarthy’s insulin costs for a one-month supply cannot be more than $35 in any coverage phase under the prescription drug plan beginning in 2023.

b.

Mr. McCarthy’s insulin costs will be capped at $50 for a one-month supply beginning in 2026.

c.

Mr. McCarthy’s annual cost-sharing for insulin alone could be in excess of $1,000.

d.

Mr. McCarthy’s insulin costs will be covered in full once he reaches catastrophic coverage under the prescription drug plan. Before that phase, he will be responsible for the full retail cost of his insulin.

Question 10

Correct
 Which of the following individuals is most likely to be eligible to enroll in a Part D Plan?
Question 10Select one:

a.

Guy, who has illegally crossed the Canadian border.

b.

Helena, an overseas college student who has overstayed her visa.

c.

Betsy, a grandmother from overseas who has overstayed her visa.

d.

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 United States thus meeting one of the criteria for Part D eligibility.

Question 11

Correct
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?
Question 11Select one:

a.

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.

 

Correct: To avoid a late enrollment penalty, Mr. Hutchinson must have “creditable” coverage. If he does not, he must enroll in Medicare Part D during his initial eligibility period to avoid a late enrollment penalty.

b.

If he has any sort of employer coverage, regardless of the level of coverage, he will incur no penalty if he does not enroll in a Part D plan when first eligible.

c.

He will need to enroll in a Medicare prescription drug plan upon becoming eligible for the program in order to avoid a premium penalty. To reduce his expenses, he should look for a plan with a zero premium.

d.

He should drop the employer coverage and enroll in a Medicare prescription drug plan. Employer plans are almost always more costly for beneficiaries and most do not cover the same range of drugs available from a Medicare prescription drug plan.

Question 12

Correct
 Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this?
Question 12Select one:

a.

Mrs. Berkowitz can apply for any Medicare Advantage plan and, if it offers drug coverage, ask to have that element of the coverage eliminated, after which she can enroll in a stand-alone Medicare prescription drug plan in her service area.

b.

 Mrs. Berkowitz can enroll in any Medicare Advantage plan, regardless of whether it offers drug coverage, and enroll in any stand-alone Medicare prescription drug plan.

c.

This is not a possibility.  If Mrs. Berkowitz wants health coverage and drug coverage through a plan, she must purchase an MA-PD plan.

d.

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.

 

Correct: An individual may enroll in a stand-alone Medicare Part D prescription drug plan (PDP) if they are enrolled in a PFFS plan that does not include Part D drug coverage or a MSA plan.

Question 13

Correct

Mr. Shapiro gets by on a very small amount of 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?

Question 13Select one:

a.

He must apply for the extra help at the same time he applies for enrollment in a Part D plan. If he missed this opportunity, he will not be able to apply for the extra help again until the next annual enrollment period.

b.

The government pays a per-beneficiary dollar amount to the Medicare Part D prescription drug plans, to offset premiums for their low-income enrollees in accordance with the plan’s set criteria. Mr. Shapiro should check with his plan to see if he qualifies.

c.

The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government.

 

Correct: If a beneficiary has limited income and resources, they may qualify for a low-income subsidy (LIS) to cover all or part of the Part D plan premium and cost-sharing. Beneficiary income may not exceed 150 percent of the Federal Poverty Level (FPL). Assets may not exceed a limited amount also specified by the government.

d.

The extra help is available only to Medicare beneficiaries who are enrolled in Medicaid. He should apply for coverage under his state’s Medicaid program to access the extra help with his drug costs.

Question 14

Correct
 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?
Question 14Select one:

a.

Unless she chooses a Medicare Part D prescription drug plan on her own, she will be automatically enrolled in one available in her area.

 

Correct: If a Medicaid beneficiary does not choose a Part D plan once they become eligible for Medicare, then Medicare will select one for them.

b.

She will continue to obtain her drug coverage through Medicaid.

c.

Medicaid will cover all drugs not covered under the Medicare Part D prescription drug plan into which Mrs. McIntire is enrolled.

d.

 She can expect that all her prescriptions will be automatically delivered on a mail-order basis as a requirement of the Medicare Part D program.

Question 15

Correct
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?
Question 15Select one:

a.

The Part D low-income subsidy will not help her once she reaches the coverage gap, so she need not take the time to apply.

b.

The Part D low-income subsidy is designed for Medicare beneficiaries who also qualify for Medicaid. If she does not qualify for Medicaid, she would likely not qualify for the extra help and therefore should not take the time to apply.

c.

Those who qualify for the Part D low-income subsidy pay nothing for any of their medications. She should apply if she believes there is any chance of her qualifying.

d.

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.

 

Correct. If a beneficiary has limited income and resources, they may qualify for a low-income subsidy (LIS) to cover all or part of the Part D plan premium and cost-sharing. Such individuals can apply for LIS through the State Medicaid office or the Social Security Administration.

Question 16

Correct
Mrs. Fiore is a retired federal worker with coverage under a Federal Employee Health Benefits (FEHB) plan that includes creditable drug coverage. She is ready to turn 65 and become Medicare eligible for the first time. What issues might she consider about whether to enroll in a Medicare prescription drug plan?
Question 16Select one:

a.

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.

 

Correct: Mrs. Fiore should compare the creditable coverage offered by FEHB to Medicare Part D plans available in her area to see if the plans cover specific drugs of importance to her that are not covered under her FEHB plan and whether they offer any other additional benefits worth the Part D premium costs.

b.

 If Mrs. Fiore enrolls in a PDP, Medicare will automatically disenroll her from any other drug or health coverage.

c.

If Mrs. Fiore does not enroll during her initial election period, she will not be able to get Part D at a later date.

d.

Mrs. Fiore may incur a Part D premium penalty if she enrolls in a Medicare prescription drug plan at some point after her initial eligibility date.

Question 17

Correct

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?

Question 17Select one:

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 must enroll in this plan.

c.

If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP.

 

Correct: Mrs. Lopez is enrolled in a Cost plan. This provides her with options as to how she secures Part D benefits. Beneficiaries enrolled in a Cost plan may obtain Part D benefits through their plan (if offered) or through a stand-alone Prescription Drug Plan (PDP).

d.

Mrs. Lopez must first seek COBRA benefits under her husband’s plan before she can apply for Part D coverage.

Question 18

Incorrect

Mrs. Imelda Diaz is a Medicare beneficiary enrolled in a MA-PD plan you represent. Her neighbor recently 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?

Question 18Select one:

a.

Yes, there is no cost sharing for the shingles vaccine even in the deductible phase of her prescription drug plan because it is an adult vaccine recommended by the Advisory Committee on Immunization Practices (AICP).

b.

Yes, 25 percent of the cost of the shingles vaccine will be covered under the provisions of the Inflation Reduction Act (IRA).

c.

Yes, provided she has already satisfied her annual deductible before obtaining the vaccination.

 

Incorrect: There is no cost sharing for the shingles vaccine even in the deductible phase of Mrs. Diaz’s prescription drug plan because it is an adult vaccine recommended by the Advisory Committee on Immunization Practices (AICP).

d.

No, because the shingles vaccine is considered experimental. Mrs. Diaz will be responsible for the full cost of the vaccination out-of-pocket.

Question 19

Correct

Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA), not by the government. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. What should you tell him?

Question 19Select one:

a.

Mr. Carlini can obtain drug coverage through the Federal government’s fallback plans, which are designed to provide an alternative to privately sponsored Medicare Advantage plans.

b.

To obtain prescription drug coverage, Mr. Carlini must enroll in an MA plan. The plan will cover his Part A and Part B services, as well as provide him with the desired prescription drug coverage.

c.

Mr. Carlini can keep Original Medicare, but if he does not sign up for an MA plan that includes prescription drug coverage, he will only be able to obtain prescription drug coverage through a Medigap plan.

d.

Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan through a private company that has contracted with the government to provide only such drug coverage to eligible Medicare beneficiaries.

 

Correct: Mr. Carlini can stay in Original Medicare and obtain prescription drug benefits through a stand-alone Part D plan. He does not have to enroll in a MA plan.

Question 20

Correct
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?
Question 20Select one:

a.

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.

b.

He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means to obtain the medications they need. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses.

 

Correct: Some pharmaceutical manufacturers operate programs that assist low-income individuals. In addition, some states have assistance programs specifically for their residents. Some of the state programs are “qualified” and count toward TrOOP and some do not.

c.

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.

d.

He should look into the possibility of purchasing his medications through the internet from off-shore pharmacies.

Question 1

Correct

You are visiting with Mr. Tully and his daughter at her request. He has advanced Alzheimer’s and is incapable of understanding the implications of choosing a Medicare Advantage or prescription drug plan. Can his daughter fill out the enrollment form and sign it for him?

Question 1Select one:

a.

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 authorized under state surrogate consent laws to make health decisions.

Correct: CMS will permit someone to sign on behalf of a beneficiary if they are a legal representative or individual authorized under state law, such as a court-appointed legal guardian, someone with a durable power of attorney for health care decisions, or someone authorized to make health care decisions under state surrogate consent laws.

b.

Mr. Tully’s daughter can do so because she is an immediate family member who has taken responsibility for her father’s care.

c.

If the enrollment form is countersigned by one of Mr. Tully’s treating physicians, she can sign it for him.

d.

A signature is not necessary since Mr. Tully is not physically or mentally capable of filling out and signing the form.

Source: Part 5, Slide – Who May Complete the Enrollment Form?

 

Question 2

Correct

Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work and is covered by an employer health plan, he has not enrolled in Part B or Part D. He receives a notice on June 1 that his employer is cutting back on prescription drug benefits and that as of July 1 his coverage will no longer be creditable. He has come to you for advice. What advice would you give Mr. Rockwell about special election periods (SEPs)?

Question 2Select one:

a.

Mr. Rockwell is eligible for a SEP that begins three months before the month in which he receives notice of loss of creditable coverage and ends three months after that month.

b.

Mr. Rockwell must wait until the next annual election period (AEP) to sign up for Part D prescription drug coverage.

c.

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.

Correct. His eligibility for a SEP is due to his involuntary loss of creditable drug coverage. The SEP begins the month he was advised of the loss of coverage (i.e. June), and it ends 2 months after the loss of creditable coverage (i.e. September).

d.

Mr. Rockwell is eligible for a SEP that begins in June and ends three months later, during which he may enroll, disenroll, and reenroll in Part D plans, with his last selection considered binding.

Source: Part 5, Slide – Typical SEPs – Involuntary Loss of Creditable Drug Coverage.

Question 3

Correct

Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could you help him take during this time?

Question 3Select one:

a.

He will have a nine month period during which he may enroll in as many Medicare Advantage plans as he chooses, with the last enrollment being the effective one.

b.

He will have one opportunity to enroll in a Medicare Advantage plan.

Correct: During the ICEP, he is permitted to make one enrollment choice. Once the enrollment is effective, the ICEP is used. However, individuals choosing a MA plan during their ICEP have a MA-OEP following their election through the last day of the 3rd month of entitlement.

c.

If he has a disability, he must enroll in Original Fee-for-Service Medicare during the MA Initial Coverage Election Period.

d.

He may change or drop MA plans, but may not drop drug coverage.

Source: Module 5, Slide – Enrollment Periods: MA Initial Coverage Election Period (ICEP) and Slide – Enrollment Periods MAICEP

Question 4

Correct

Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area that has suffered from major flooding that has been declared a major disaster by both the Federal government and her state. As a result of dealing with the flooding issues and being evacuated from her home, Edna missed her chance to enroll in MA during her Initial Coverage Election Period.  Felix lives in an 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 Original 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 special election period (SEP)?

Question 4Select one:

a.

Edna would qualify for a SEP because government officials have declared a major disaster for her area and she did not enroll in MA during 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 would also qualify for a SEP to enroll in a C-SNP because she has developed 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.

Correct. Edna would qualify for a SEP because government officials have declared a major disaster for her area and she did not enroll in MA during 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 would also qualify for a SEP to enroll in a C-SNP because she has developed a chronic condition. Felix would not qualify for a SEP.

b.

Edna, Felix, George, and Harriet would all qualify for SEPs

c.

Edna would qualify for a SEP because government officials have declared a major disaster for her area and she did not enroll in MA during her ICEP due to the emergency. Felix, George, and Harriet would not qualify for SEPs.

d.

Felix would qualify for an SEP because a 4-star plan is available in his geographic area. This SEP is available each year beginning on December 8 and may be used through November 30 of the following year. Edna, George, and Harriet would not qualify for SEPs.

Source: Part 5, Slide – Other common SEPs (Disaster/Emergency SEP/5-Star Plan SEP) and Slide – Other Common SEPs (Medigap SEP/Severe or Disabling Chronic Conditions SEP)

Question 5

Correct

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?

Question 5Select one:

a.

Mr. Roberts must return to Original Medicare within two months of discharge, but he may continue to enroll and disenroll in Part D for 12 months following discharge.

b.

His open enrollment period as an institutionalized individual will continue for 12 months following his date of discharge.

c.

His open enrollment period as an institutionalized individual will continue for two months after the month he moves out of the facility.

Correct. The open enrollment period (OEPI) for institutionalized individuals is a continuous open enrollment period as long as an individual is in an institution. The OEPI ends two months after the month the individual moves out of the institution.

d.

Mr. Roberts has two months following his discharge to continue under his current MA plan before he must return to Original Medicare for the remainder to the calendar year.

Source: Part 5, MA Open Enrollment Period for Institutionalized (OEPI) Individuals Part D SEP for Institutionalized Individuals.

Question 6

Correct

You have come to Mrs. Midler’s home for a sales presentation. At the beginning of the presentation, Mrs. Midler tells you that she has a copy of her medical records 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?

Question 6Select one:

a.

You can only ask Mrs. Midler questions about conditions that affect eligibility, specifically, whether she has one of the conditions that would qualify her for a special needs plan.

Correct: Marketing representatives may ask health screening questions during the completion of an enrollment request if they are necessary to determine eligibility to enroll in a SNP.

b.

You can initiate a detailed discussion of all of Mrs. Midler’s health conditions only to better understand her situation and to advise her to choose a different plan if she is experiencing significant health problems.

c.

 You cannot, under any circumstances, ask Mrs. Midler any health-related questions.

d.

 If she brings up the topic of her health, you can ask Mrs. Midler as many questions as she is willing to answer, so you can determine which plan is most suitable for her health needs.

Source: Part 5, Slide – Enrollment Discrimination Prohibitions​.

Question 7

Correct

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?

Question 7Select one:

a.

He qualifies for a special election period and can enroll in or disenroll from a Part D plan once during that period.

Correct. Because he is entitled to Medicare Part A and Part B and has a change in his low income subsidy status, he is eligible for a special election period. During the SEP, he can enroll in or disenroll from a Part D plan once.

b.

He can only enroll in or disenroll from an MA-PD plan.

c.

He can enroll in a different plan or disenroll from his current plan during the next Annual Election Period.

d.

He can apply the subsidy amount to his existing plan immediately, but he cannot enroll in a different plan.

Source: Part 5, Slide -Typical SEPs – Beneficiaries who are dual eligible or who have LIS eligibility, and Slide – Typical SEPs – Change in Medicaid or LIS Status.

Question 8

Incorrect

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

Question 8Select one:

a.

Tell her you are not permitted to meet with her until after she becomes eligible for Medicare in November.

b.

Tell her that you should meet to discuss her plan choices as soon as possible so she has more time to weigh her options for the current and following plan years before her enrollment would become effective in November.

Incorrect: You are not permitted to discuss the following year’s plan options in August. Marketing representatives are permitted to simultaneously market plans for the current and prospective years starting on October 1, provided marketing materials indicate what plan year is being discussed.

c.

Tell her you can meet with her immediately to discuss plan options for the following plan year only.

d.

Tell her to wait until October to discuss 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 impact her choice.

Source: Module 5, Slide – Enrollment Periods – Annual Election Period, Timeframes for Submitting Enrollment Forms and Slide – Timeframes for Submitting Enrollment Forms

Question 9

Correct

Torie Jones is a new marketing representative. 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?

Question 9Select one:

a.

Torie, there are many required questions and topics regarding beneficiary needs to be discussed prior to enrollment in an MA plan. These include information regarding primary care providers and specialists whether they are in the plan network, whether or not a beneficiary’s current prescriptions are covered as well as premiums, benefits, and costs of health care services.

Correct: CMS requires a series of questions and topics regarding beneficiary needs to be fully discussed before an enrollment. Questions and topics to be discussed include information regarding whether the beneficiary’s primary care providers and specialists are in the plan network, whether or not a beneficiary’s current prescriptions are covered and their costs, as well as premiums, benefits, and cost of health care services. Other required topics include whether or not the beneficiary’s current pharmacy is in the plan’s network and the beneficiary’s specific health care needs.

b.

Torie, all that needs to be discussed with a Medicare beneficiary prior to enrollment is the amount of monthly premium, if any.

c.

Torie, keep talk to a minimum with beneficiaries prior to enrollment. There’s no reason to get deflected from earning a commission.

d.

Torie, beneficiaries just need know the amount of monthly premium, if any, and the costs of health care services.

Source: Part 5, Slide – Beneficiary Information – New for enrollments effective in 2024.

Question 10

Correct

Mrs. Kumar 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?

Question 10Select one:

a.

She should wait for at least six months into the plan year to be sure that she really wants to make the change. If she still wants to do so, she can make any sort of change she likes at that point.

b.

Her daughter should come in November.

Correct. She can enroll in a Part D plan during the Annual Election Period (AEP), which takes place from October 15 to December 7.

c.

Her daughter should come during the three month period that begins on the first day of her birthday month and runs for three full months.

d.

Her daughter should come sometime between January 1 and March 31.

Source: Part 5, Slide -Enrollment Periods: Annual Election Period.

Question 11

Incorrect

Mr. White has Medicare Parts A and B with a Part D plan. Last year, he received 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 current prescription drug needs. He believes 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 individuals?

Question 11Select one:

a.

No. Individuals identified by the plan sponsor as “potential at-risk” must wait 2 years to switch plans, after which time the designation is lifted.

b.

Yes. “Potential at-risk” designations are just a warning. Only “at-risk” beneficiaries are prohibited from using this SEP while the designation is in place.

Incorrect: Typically, an individual with Medicare Parts A and B that receives Medicaid assistance receives a SEP during the first 9 months of each calendar year. However, once an individual is identified by the plan sponsor as a “potential at-risk” or “at-risk” beneficiary and the plan sponsor has sent written notice to the individual, he or she cannot use this SEP to change plans while this designation is in place.

c.

No. Once he is identified by the plan sponsor as a “potential at-risk” beneficiary, he cannot use the dual eligible SEP to change plans while this designation is in place.

d.

Yes. The “potential at-risk” designation only impacts the services he may receive from the Part D plan he enrolls, but it doesn’t affect his ability to change plans during this SEP.

Source: Part 5, Slide – Typical SEPs – Beneficiaries who are dual eligible or who have LIS eligibility; and Slide  – Typical SEPs – Beneficiaries who are dual eligible or who have LIS eligibility, limitations for at-risk and potential at-risk beneficiaries

Question 12

Incorrect

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?

Question 12Select one:

a.

Mary may make one change to either Original Medicare or another MA under the special enrollment period available to institutionalized individuals.

Incorrect. Mary’s admission to a rehabilitation hospital makes her eligible for an Open Enrollment Period for Institutionalized Individuals (OEPI). OEPI-eligible individuals can make unlimited MA enrollment requests, enroll in a Part D plan, as well as return to Original Medicare.

b.

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

c.

Mary may enroll in another MA plan coupled with a Medigap plan under the special enrollment period available to institutionalized individuals.

d.

Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan.

Source: Part 5, Slide – MA Open Enrollment Period for Institutionalized (OEPI) Individuals Part D SEP for Institutionalized Individuals

Question 13

Correct

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?

Question 13Select one:

a.

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.

b.

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.

c.

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.

d.

During the MA Open Enrollment Period, 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.

Correct: During the MA OEP, as an MA-PD enrollee Mrs. Goodman may disenroll from her plan, return to Original Medicare and enroll in a stand-alone Part D prescription drug plan.

Source: Part 5, Slide – Enrollment Periods: MA Open Enrollment Period (MA OEP)

Question 14

Correct

A client wants to give you an enrollment application on October 1 before 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?

Question 14Select one:

a.

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.

Correct. If a beneficiary sends an unsolicited AEP paper enrollment request to the plan on or after October 1 but before the Annual Election Period begins, the plan will process the application beginning on the first day of the election period (October 15).

b.

You must accept the application, but hold it until the annual election period begins, after which you must send it to the plan for processing.

c.

You must send it to the plan for immediate processing, although the enrollment will not become effective until January 1.

d.

You must tell him you are not permitted to take the form and if he sends it to the plan, the application will be rejected and he will need to fill out another form and submit it after the Annual Election Period begins.

Source: Part 5, Slide -Enrollment Periods: Annual Election Period, Timeframe for Submitting Enrollment Forms

Question 15

Correct

Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the Annual Enrollment Period (AEP). At the beginning 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 after speaking to her neighbor. What should you tell her?

Question 15Select one:

a.

There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31 and Ms. Gonzales can use it to change from Original Medicare and Part D to a MA or MA-PD plan.

b.

There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31 and Ms. Gonzales can use it to change from Original Medicare and Part D only to a MA plan that includes prescription drug coverage.

c.

There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31, but Ms. Gonzales cannot use it because eligibility to use the OEP is available only to MA enrollees.

Correct: The Medicare Advantage Open Enrollment Period (MA OEP) is only available to those who have enrolled in Medicare Advantage. It is not available to those who chosen coverage through Original Medicare. Since Ms. Gonzales chose to remain in Original Medicare, she cannot change plans during the MA OEP.

d.

There is a MA Disenrollment Period that takes place between January 1 and February 14 but since Ms. Gonzales enrolled in Original Medicare and Part D during the AEP this would not apply to her.

Source: Part 5, Enrollment Periods MA Open Enrollment Period (MA OEP)

Question 16

Correct

You are doing a sales presentation for Mrs. Pearson. You know that Medicare marketing guidelines prohibit certain types of statements. Apply those guidelines to the following statements and identify which would be prohibited.

Question 16Select one:

a.

“A Private Fee-for-Service plan is not the same as a Medigap supplemental policy.”

b.

“How are you this morning, Mrs. Pearson?”

c.

“Are you interested in a Medicare supplement plan or a Medicare health plan?”

d.

“If you’re not in very good health, you will probably do better with a different product.”

Correct. This statement may discourage Mrs. Pearson from enrollment due to her health status. Therefore, this type of statement would be prohibited.

Source: Part 5, Slide – Enrollment Discrimination Prohibitions

Question 17

Correct

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?

Question 17Select one:

a.

She should wait until the new year to disenroll from Original Medicare and select an MA plan between January 1 and March 31.

b.

She could immediately enroll in MA plan based on the one-time special election period available to those 70 and younger.

c.

She could enroll in an MA plan during the period including the three months before, the month of, and up to three months after turning 68.

d.

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.

Correct. The Annual Election Period (AEP) takes place from October 15 to December 7 each year and is available to all MA and Part D eligible beneficiaries.

Source: Part 5, Slide – Enrollment Periods – MA Initial Coverage Election Period (ICEP) and Slide Enrollment Periods- Annual Election Period.

Question 18

Correct

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?

Question 18Select one:

a.

He must first enroll in a Medicare Part D plan, before enrolling in a Medicare Advantage plan.

b.

He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may only enroll in an MA-PD plan.

c.

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.

Correct: He is currently within his Part D IEP, which begins 3 months before the month he meets the eligibility requirements for Part B and ends 3 months after the month of eligibility. During the Part D IEP, beneficiaries may make one Part D enrollment choice, including enrollment in a stand-alone Part D plan or an MA-PD plan if they are eligible for MA.

d.

He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may only add stand-alone Medicare prescription drug coverage.

Source: Part 5,Slide – Enrollment Periods: Part D Initial Enrollment Period (IEP).

Question 19

Correct

Mrs. Reeves is newly eligible to enroll in a Medicare Advantage plan and her MA Initial Coverage Election Period (ICEP) has just begun. Which of the following can she not do during the ICEP?

Question 19Select one:

a.

During her ICEP, she can make an enrollment choice and change that choice during her MA Open Enrollment Period (MA OEP) that follows her election.

b.

She can choose to enroll in a MA-PD plan, provided that her Part D initial election period and MA ICEP occur at the same time.

c.

She can enroll in a Medigap plan to supplement the benefits of the MA plan that she’s also enrolling in.

Correct: MA ICEP is not an opportunity to enroll in a Medigap plan. Also, Medigap does not supplement MA plan benefits; it is meant to supplement Original Medicare.

d.

She can compare various MA plan options and select one to enroll in.

Source: Part 5, Enrollment Periods MA ICEP

Question 20

Correct

Mrs. Parker likes to handle most of her business matters through telephone 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. Parker asks you whether she can enroll in Senior Health’s MA plan over the telephone. What can you tell her?

  1.       Enrollment requests can only be made in face-to-face interviews or by mail.
  2.      Telephone enrollment request calls must be recorded.

III.      Telephonic enrollments must include all required elements necessary to complete an enrollment.

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

Question 20Select one:

a.

I and IV only

b.

I only

c.

II, III, and IV

d.

II and III only

Correct. Telephone enrollment requests must be recorded. They must include all required elements necessary to complete an enrollment. The “Beneficiary Signature and/or Authorized Representative Signature” element for a telephone request is satisfied with a verbal attestation of intent to enroll.

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