Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be of assistance?
Question 1Select one:
a.
She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help with Medicare costs for which she is responsible.
b.
She should only seek help from private organizations to cover her Medicare costs.
c.
She should not sign up for a Medicare Advantage plan.
d.
She can apply to the Medicare agency for lower premiums and cost-sharing.
Question 2
Not yet answered
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare. What could you tell him?
Question 2Select one:
a.
Part C, which always covers dental and vision services, is covered under Original Medicare.
b.
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.
c.
Part A, which covers long-term custodial care services, is covered under Original Medicare.
d.
Part D, which covers prescription drug services, is covered under Original Medicare.
Question 3
Not yet answered
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without paying any premiums, because she has been working for 40 years and paying Medicare taxes. What should you tell her?
Question 3Select one:
a.
She is correct because she will be covered under Part A, without paying premiums and she has worked for 40 years so she will not have to pay Part B premiums.
b.
Medicare beneficiaries only pay a Part B premium if they are enrolled in a Medicare Advantage plan.
c.
She is correct that she will not have to pay a premium because State programs cover the cost of Part B premiums for all Medicare beneficiaries.
d.
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes.
Question 4
Not yet answered
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug coverage. She would like to keep the coverage she has but replace her existing Medigap plan with one that provides drug coverage. What should you tell her?
Question 4Select one:
a.
Mrs. Gonzalez should purchase a K or L Medigap plan.
b.
Medigap is a replacement for Original Medicare and she has been paying for double coverage. She should simply drop her Medigap policy.
c.
Mrs. Gonzalez can purchase a Medigap plan that covers drugs, but it likely won’t offer coverage that is equivalent to that provided under Part D.
d.
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.
Question 5
Not yet answered
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. He is wondering whether he can obtain coverage under Medicare. What should you tell him?
Question 5Select one:
a.
Individuals who become eligible for such disability payments only have to wait 12 months before they can apply for coverage under Medicare.
b.
Individuals receiving such disability payments from the Social Security Administration continue to receive those payments but only become eligible for Medicare upon reaching age 65.
c.
He became eligible for Medicare when his disability eligibility determination was first made.
d.
After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.
Question 6
Not yet answered
Mrs. Peňa is 66 years old, has coverage under an employer plan, and will retire next year. She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell her?
Question 6Select one:
a.
She may not enroll in Part B while covered under an employer group health plan and must wait until the standard general enrollment period after she retires.
b.
She may only enroll in Part B during the general enrollment period whether she is retired or not.
c.
She may enroll at any time while she is covered under her employer plan, but she will have a special eight-month enrollment period after the last month on her employer plan that differs from the standard general enrollment period, during which she may enroll in Medicare Part B.
d.
She must wait at least 30 days after her employment terminates before she may enroll in Medicare Part B.
Question 7
Not yet answered
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 Federal government declared this to be a natural disaster which has recently ended. During this period Anthony’s initial enrollment period expired. Anthony asks you how he can now obtain Medicare coverage. What should you say?
Question 7Select one:
a.
Anthony must wait until the next General Enrollment Period (GEP) which runs from January 1 through March 31.
b.
Anthony will be automatically enrolled in Medicare Part A within one month from the date the Federal government declared the disaster ended. If he wishes Part B coverage he must wait until the next General Enrollment Period.
c.
Anthony is eligible for a special enrollment 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 declaration. Anthony may enroll in premium-free Part A at any time and his Part A coverage will be retroactive for up to 6 months.
d.
Anthony will have a special enrollment period (SEP) of 3 months beginning after the end of the emergency declaration, but he will be subject to a late enrollment penalty if he chooses Part B coverage.
Question 8
Not yet answered
Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE). This coverage has recently 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 describes Shirley’s ability to now enroll in Medicare Part B?
Question 8Select one:
a.
Shirley must wait until the next General Enrollment Period which runs from January 1 through March 31.
b.
Shirley is eligible for a Special Enrollment Period (SEP) for up to three months after the termination of her Medicaid coverage. This coverage will begin the month after the month of enrollment.
c.
Shirley is eligible for a Special Enrollment Period (SEP) for up to six months after the termination of her Medicaid coverage. Under this SEP, Shirley can choose retroactive coverage back to the date of termination from Medicaid or coverage beginning the month after the month of enrollment.
d.
Shirley is eligible for a Special Enrollment Period (SEP) for up to nine months after the termination of her Medicaid coverage. This coverage will be retroactive back to the date of her termination from Medicaid and no out-of-pocket premiums will be due for the retroactive coverage.
Question 9
Not yet answered
Mr. Moy’s wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife’s needs. What could you tell Mr. Moy?
Question 9Select one:
a.
Medicare Supplemental Insurance would cover his long-term care services.
b.
Medicare Supplemental Insurance would cover his dental, vision and hearing services only.
c.
Medicare Supplemental Insurance would cover all of his IRS approved health care expenditures not covered under Original Fee-for-Service (FFS) Medicare.
d.
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 cover.
Question 10
Not yet answered
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 10Select one:
a.
D-SNP
b.
I-SNP
c.
FIDE-SNP
d.
C-SNP
Question 11
Not yet answered
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 11Select 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.
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 12
Not yet answered
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 12Select 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.
d.
He can enroll in a Medicare Advantage plan if he has dropped Part B less than 90 days ago.
Question 13
Not yet answered
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 13Select one:
a.
Generally, employers prefer retirees to enroll in a stand-alone PDP, so he should consider that instead of the MA-PD.
b.
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.
c.
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.
d.
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.
Question 14
Not yet answered
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 14Select one:
a.
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.
b.
In general, Mrs. Ramos will need a referral to see specialists.
c.
Mrs. Ramos should be aware that generally plan providers can decide, on a case-by-case basis, whether they will treat her.
d.
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.
Question 15
Not yet answered
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be the correct description?
Question 15Select one:
a.
Medicare Advantage is a health insurance program operated jointly by the states with the Federal government.
b.
Medicare Advantage is a new name for the Original Medicare program.
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 way of covering all the Original Medicare benefits through private health insurance companies.
Question 16
Not yet answered
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him?
Question 16Select one:
a.
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.
b.
In Medicare Advantage HMO plans, services provided by primary care physicians are covered at 100%, but those of specialists are covered at 80%.
c.
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).
d.
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).
Question 17
Not yet answered
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 17Select 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.
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 18
Not yet answered
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 18Select one:
a.
She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan.
b.
She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan.
c.
She can enroll in the PPO and purchase drug coverage through a Medigap plan.
d.
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.
Question 19
Not yet answered
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 19Select one:
a.
A PFFS plan offering only medical benefits 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 PFFS Medigap Supplemental Insurance plan.
c.
A stand-alone prescription drug plan in combination with a PFFS plan or a PFFS Medigap Supplemental Insurance plan.
d.
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.
Question 20
Not yet answered
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 20Select one:
a.
Mr. McCarthy’s insulin costs will be capped at $50 for a one-month supply beginning in 2026.
b.
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.
c.
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.
d.
Mr. McCarthy’s annual cost-sharing for insulin alone could be in excess of $1,000.
Question 21
Not yet answered
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 21Select one:
a.
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.
b.
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.
c.
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.
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.
Question 22
Not yet answered
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?
- Her annual PDP deductible
- 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
- Her over-the-counter (OTC) allergy medication.
Question 22Select one:
a.
I, II, and IV only
b.
I, II, III, and IV
c.
I and II only
d.
I only
Question 23
Not yet answered
Which of the following individuals is most likely to be eligible to enroll in a Part D Plan?
Question 23Select one:
a.
Betsy, a grandmother from overseas who has overstayed her visa.
b.
Helena, an overseas college student who has overstayed her visa.
c.
Jose, a grandfather who was granted asylum and has worked in the United States for many years.
d.
Guy, who has illegally crossed the Canadian border.
Question 24
Not yet answered
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 24Select one:
a.
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.
b.
Mr. Schultz should seek to continue employer group coverage through COBRA because it is likely to have superior benefits at a more permanent solution.
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 should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty.
Question 25
Not yet answered
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 25Select 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.
Question 26
Not yet answered
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 26Select one:
a.
Mrs. Lopez must first seek COBRA benefits under her husband’s plan before she can apply for Part D coverage.
b.
If a Part D benefit is offered through her plan she must enroll in this plan.
c.
Mrs. Lopez must enroll in either a HMO or PPO Medicare Advantage plan in order to obtain Part D coverage.
d.
If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP.
Question 27
Not yet answered
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 27Select 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.
b.
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.
c.
Medicaid will cover all drugs not covered under the Medicare Part D prescription drug plan into which Mrs. McIntire is enrolled.
d.
She will continue to obtain her drug coverage through Medicaid.
Question 28
Not yet answered
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?
Question 28Select one:
a.
You appreciate the opportunity and would be happy to schedule an appointment with anyone at their request.
b.
You appreciate the opportunity and will ask the facility to provide a plan brochure and enrollment application in every resident’s room before the meeting to promote interest in the event.
c.
You appreciate the opportunity and would ask the facility to provide enrollment applications for the MA-PD plans you represent.
d.
You appreciate the opportunity and your friend would just need to complete scope of appointment forms on behalf of all the residents who would like to attend.
Question 29
Not yet answered
You are working several plans and community organizations to sponsor an educational event. When putting together advertisements for this event, what should you do?
Question 29Select one:
a.
You must only ensure that the advertisement is factually accurate.
b.
You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event.
c.
You must state in the advertisement that it will be an educational event and that the education will consist of specific information about the participating plans.
d.
Plans may not participate in advertising such an event. All advertising must be done by community organizations.
Question 30
Not yet answered
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?
Question 30Select one:
a.
As long as the meal is paid for by another person or entity, you are permitted to invite your clients and their friends to partake of the meal at your sales presentation.
b.
There is no limitation on meals. You may continue to provide your Thanksgiving style meal, to any individual, in any manner you see fit.
c.
You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal.
d.
You may offer meals to existing enrollees of the plan(s) you represent, but potential enrollees may not have a meal.
Question 31
Not yet answered
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?
Question 31Select one:
a.
It must obtain a HIPAA compliant authorization from an enrollee that indicates the plan or plan sponsor may use their information for marketing purposes.
b.
Once a plan sends out a written request for consent, a beneficiary can authorize consent by simply failing to reply within 21 days.
c.
It is not necessary for ABC to obtain an authorization to simply explain pending state or federal legislation since there is no anticipation of selling a non-health related product in these circumstances.
d.
The request for authorization may include a brief synopsis of non-health related content.
Question 32
Not yet answered
You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. The hospital administration expresses some hesitation about allowing marketing in a health care facility. What should you tell them?
Question 32Select one:
a.
So long as the hospital or its physician staff don’t object, marketing anywhere in the hospital is an acceptable practice.
b.
Marketing in health care facilities is an acceptable practice, regardless of where it takes place.
c.
Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving health care services.
d.
As long as the marketing activities are conducted in a way that does not target healthy beneficiaries, it does not matter where in the hospital these activities are carried out.
Question 33
Not yet answered
Your client, Alexis Jones, calls you on December 4th about changing her Medicare Advantage plan during the annual election period which ends December 7th. What should you do?
Question 33Select one:
a.
Inform Alexis that due to new rules, you can no longer meet with her until the beginning of the following year’s open enrollment period on October 15th.
b.
Wait at least 12 hours before completing a scope of enrollment (SOA) to comply with the mandatory “cooling off” period.
c.
Complete a scope of appointment (SOA) during the call and wait at least two days (48 hours) before meeting with Alexis.
d.
Complete a scope of appointment (SOA) during the call and indicate that they will meet to discuss Medicare Advantage plans during an appointment the following day.
Question 34
Not yet answered
Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. She agreed to sign a scope of appointment form and meet with you on October 15. During the appointment, what are you permitted to do?
Question 34Select one:
a.
You may leave an enrollment kit and discuss a new life insurance product she might like.
b.
You may provide her with the required enrollment materials and take her completed enrollment application.
c.
You may leave enrollment kits for several MA plans and offer to discuss a Medigap and Part D prescription drug plan she might like.
d.
You may begin her enrollment application and require her to provide names of any of friends who may be interested in enrolling before completing her application.
Question 35
Not yet answered
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. What should you tell her?
Question 35Select one:
a.
Marketing representatives may initiate electronic contact through e-mail and as long as an e-mail is opened marketing representatives may also follow-up with unsolicited telephone calls.
b.
Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided.
c.
While unsolicited contacts may be made through print media such as direct mail, marketing representatives may not initiate electronic contact.
d.
Marketing representatives may only use internet pop-up ads providing plan-specific information that have been approved by CMS when soliciting prospects through electronic means of communication.
Question 36
Not yet answered
You have approached a hospital administrator about marketing in her facility. The administrator is uncomfortable with the suggestion. How could you address her concerns?
Question 36Select one:
a.
Tell her that Medicare guidelines allow you to conduct marketing activities in common areas of a provider’s facility.
b.
Tell her that Medicare guidelines allow you to conduct marketing activities anywhere in the facility, so long as the affected providers agree to that event.
c.
Tell her that if a plan obtains permission from CMS for a marketing event in a provider facility, the event may go forward, regardless of where it occurs in the facility.
d.
Tell her that Medicare guidelines only allow you to conduct marketing activities in areas of the facility where individuals are waiting to receive health care services, but not in places where they would be receiving health care such as an examining room.
Question 37
Not yet answered
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 37Select one:
a.
Mr. Tully’s daughter can do so because she is an immediate family member who has taken responsibility for her father’s care.
b.
If the enrollment form is countersigned by one of Mr. Tully’s treating physicians, she can sign it for him.
c.
A signature is not necessary since Mr. Tully is not physically or mentally capable of filling out and signing the form.
d.
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.
Question 38
Not yet answered
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 38Select one:
a.
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.
b.
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.
c.
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.
d.
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.
Question 39
Not yet answered
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 39Select one:
a.
Mary’s only option in this situation is to return to Original Medicare.
b.
Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan.
c.
Mary may make one change to either Original Medicare or another MA under the special enrollment period available to institutionalized individuals.
d.
Mary may enroll in another MA plan coupled with a Medigap plan under the special enrollment period available to institutionalized individuals.
Question 40
Not yet answered
Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could you help him take during this time?
Question 40Select one:
a.
He will have one opportunity to enroll in a Medicare Advantage plan.
b.
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.
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.
Question 41
Not yet answered
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 41Select 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.
b.
You cannot, under any circumstances, ask Mrs. Midler any health-related questions.
c.
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.
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.
Question 42
Not yet answered
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 42Select one:
a.
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.
b.
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.
c.
She could immediately enroll in MA plan based on the one-time special election period available to those 70 and younger.
d.
She should wait until the new year to disenroll from Original Medicare and select an MA plan between January 1 and March 31.
Question 43
Not yet answered
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 43Select one:
a.
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.
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 and Ms. Gonzales can use it to change from Original Medicare and Part D to a MA or MA-PD plan.
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.
Question 44
Not yet answered
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?
- Enrollment requests can only be made in face-to-face interviews or by mail.
- Telephone enrollment request calls must be recorded.
III. Telephonic enrollments must include all required elements necessary to complete an enrollment.
- The signature element must be completed via certified mail.
Question 44Select one:
a.
I and IV only
b.
II and III only
c.
I only
d.
II, III, and IV
Question 45
Not yet answered
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 45Select one:
a.
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.
b.
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.
c.
She can enroll in a Medigap plan to supplement the benefits of the MA plan that she’s also enrolling in.
d.
She can compare various MA plan options and select one to enroll in.
Question 46
Not yet answered
Agent Chan is conducting a sales presentation on senior issues where he hopes to enroll some attendees in the Medicare Advantage (MA) plans he represents. What action(s) may Agent Chan take during the event?
Question 46Select one:
a.
Provide full meals for attendees.
b.
Indicate that in order participate attendees must provide their contact information.
c.
Discuss plan specific information such as premiums and benefits.
d.
Conduct free health screenings as part of the event.
Question 47
Not yet answered
Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage (MA) and Part D plans that Agent Smith sells at the regular Tuesday brunch the neighbors have for senior citizens. What should Agent Tom Smith tell Mr. Moreno about the kinds of food that can be provided to potential enrollees who attend the sales presentation?
Question 47Select one:
a.
Nothing may be provided to eat or drink during the sales presentation.
b.
A meal cannot be provided, but light snacks would be permitted.
c.
Any type of meal or food is allowed, as long as it is available to the general public and not just those who are eligible to enroll in the plans.
d.
Any meal is allowed, as long as it is valued at less than $15.
Question 48
Not yet answered
This year you decide to focus your efforts on marketing to employer and union groups. Which of the following statements best describes what you can and cannot do in order to stay in compliance?
Question 48Select one:
a.
You do not need to take an annual test, but you must not provide potential enrollees with more than light snacks at presentations.
b.
You do not need to complete a scope of appointment, but CMS can ask you to reconstruct one if there is a subsequent employee complaint.
c.
You can make unsolicited contacts but you cannot cross-sell other products.
d.
You are not required to submit communication and marketing materials specific only to those employer plans to CMS at the time of use, but CMS may request and review copies if employee complaints occur.
Question 49
Not yet answered
Mr. Cole has been a Medicaid beneficiary for some time, and recently qualified for Medicare as well. He is concerned about changes in his cost-sharing. What should you tell him?
Question 49Select one:
a.
Medicaid will cover his cost-sharing, regardless of from which physician or hospital he receives his Medicare-covered services.
b.
He should know that Medicaid will pay cost sharing only for services provided by Medicaid participating providers.
c.
Medicaid will no longer pay any cost sharing once he is eligible for Medicare, so he will need to rely only on Medicare providers.
d.
For Medicaid beneficiaries, Medicare reduces its cost-sharing amounts to match those charged by the state Medicaid program so there will be no change in his cost-sharing amounts.
Question 50
Not yet answered
Able, Baker, and Charles are engaged in the marketing to and enrollment of beneficiaries into Medicare health plans. Mr. Able is an independent agent paid directly by a health plan. Ms. Baker is an independent agent paid through a field marketing organization (FMO). Mr. Charles is an independent agent paid for his work by a third-party marketing organization (TMO). How do the CMS compensation rules apply to these three agents?
Question 50Select one:
a.
Able is subject to CMS compensation rules because he is paid directly by a health plan. Agents Baker and Charles are not because they are paid by third parties.
b.
Baker and Charles are subject to CMS compensation rules because they are paid by third parties. Able is not because he is paid directly by a health plan.
c.
Charles is subject to CMS compliance rules because he works for a TMO and CMS applies an extra layer of scrutiny to such organizations. Able and Baker are not.
d.
All three are treated as independent agents under CMS compensation rules.