Optimum/Freedom - 2026 Certifications
test review questions and answers.
The Special Election Period (SEP) for Dual Eligible and Other LIS Eligible Individuals
previously allowed one time per-calendar-quarter during the first nine months of the
year was replaced beginning Calendar Year 2025 with a monthly SEP to enroll in a
standalone PDP. Eligible beneficiaries can switch PDPs or leave a MA/MAPD plan for
Original Medicare plus a standalone PDP. - n
ANS ✔
True
Qs
Which of the following statements is NOT true about a disenrollment? - n
ANS ✔
Disenrollment requests can be taken verbally
Qs
How does a cancellation differ from a disenrollment? - n
ANS ✔
Both A and B are correct
A. A cancellation applies if a request is received prior to a member's effective date
or by the date on the Outbound Enrollment Verification (OEV) letter
B. Cancellation requests are initiated by the member and can be received either
verbally or in writing
Qs
FEMA disaster SEPs can only be used if members missed a valid enrollment period.
-n
ANS ✔
True
Qs
, A monthly integrated care SEP beginning calendar year 2025 allows full dual
eligible individuals to elect an integrated Dual Eligible Special Needs Plan (D-SNP)
(for example, Fully Integrated Dual Eligible (FIDE), Highly Integrated Dual Eligible
(HIDE), and Applicable Integrated Plan (AIP)). This SEP is allowed only when the
individual receives Medicaid through an affiliated managed care plan. - n
ANS ✔
True
Qs
A member can add or drop prescription drug coverage during the Annual Election
Period (AEP). - n
ANS ✔
True
Qs
If a beneficiary has agreed to an in-home appointment to discuss a PDP product, an
agent can discuss an HMO product with them during that same meeting, if the
beneficiary requests it and a new scope of appointment form is completed. - n
ANS ✔
True
Qs
The Open Election Period (OEP) is for beneficiaries who are enrolled in a MA-only or
MA-PD plan, or those who are enrolled in Original Medicare, including those enrolled
in stand-alone PDPs. - n
ANS ✔
False
Qs
Which of the following is not a valid reason for involuntary disenrollment? - n
ANS ✔
Moving to a new address in the same plan service area
, Qs
Prior to making an enrollment decision, beneficiaries must review and complete the
pre-enrollment checklist. - n
ANS ✔
True
Qs
If a beneficiary currently has drug coverage through another carrier, you must
verify their prescriptions would be covered under our plan's formulary, too. The
drugs that are actually covered may vary from one carrier to another or one plan to
another. - n
ANS ✔
True
Qs
You MUST tell your PPO plan clients they will have to pay more when seeking non-
emergent eligible services outside of the network. - n
ANS ✔
True
Qs
You receive a questionnaire regarding a sales misrepresentation inquiry. You must
respond within the designated time frame, addressing all concerns in the allegation
and include any pertinent notes from your sales appointment, event, etc. that may
apply to the allegation. - n
ANS ✔
True
Qs
You MUST EXPLAIN the Part D late enrollment penalty. - n
ANS ✔
True
test review questions and answers.
The Special Election Period (SEP) for Dual Eligible and Other LIS Eligible Individuals
previously allowed one time per-calendar-quarter during the first nine months of the
year was replaced beginning Calendar Year 2025 with a monthly SEP to enroll in a
standalone PDP. Eligible beneficiaries can switch PDPs or leave a MA/MAPD plan for
Original Medicare plus a standalone PDP. - n
ANS ✔
True
Qs
Which of the following statements is NOT true about a disenrollment? - n
ANS ✔
Disenrollment requests can be taken verbally
Qs
How does a cancellation differ from a disenrollment? - n
ANS ✔
Both A and B are correct
A. A cancellation applies if a request is received prior to a member's effective date
or by the date on the Outbound Enrollment Verification (OEV) letter
B. Cancellation requests are initiated by the member and can be received either
verbally or in writing
Qs
FEMA disaster SEPs can only be used if members missed a valid enrollment period.
-n
ANS ✔
True
Qs
, A monthly integrated care SEP beginning calendar year 2025 allows full dual
eligible individuals to elect an integrated Dual Eligible Special Needs Plan (D-SNP)
(for example, Fully Integrated Dual Eligible (FIDE), Highly Integrated Dual Eligible
(HIDE), and Applicable Integrated Plan (AIP)). This SEP is allowed only when the
individual receives Medicaid through an affiliated managed care plan. - n
ANS ✔
True
Qs
A member can add or drop prescription drug coverage during the Annual Election
Period (AEP). - n
ANS ✔
True
Qs
If a beneficiary has agreed to an in-home appointment to discuss a PDP product, an
agent can discuss an HMO product with them during that same meeting, if the
beneficiary requests it and a new scope of appointment form is completed. - n
ANS ✔
True
Qs
The Open Election Period (OEP) is for beneficiaries who are enrolled in a MA-only or
MA-PD plan, or those who are enrolled in Original Medicare, including those enrolled
in stand-alone PDPs. - n
ANS ✔
False
Qs
Which of the following is not a valid reason for involuntary disenrollment? - n
ANS ✔
Moving to a new address in the same plan service area
, Qs
Prior to making an enrollment decision, beneficiaries must review and complete the
pre-enrollment checklist. - n
ANS ✔
True
Qs
If a beneficiary currently has drug coverage through another carrier, you must
verify their prescriptions would be covered under our plan's formulary, too. The
drugs that are actually covered may vary from one carrier to another or one plan to
another. - n
ANS ✔
True
Qs
You MUST tell your PPO plan clients they will have to pay more when seeking non-
emergent eligible services outside of the network. - n
ANS ✔
True
Qs
You receive a questionnaire regarding a sales misrepresentation inquiry. You must
respond within the designated time frame, addressing all concerns in the allegation
and include any pertinent notes from your sales appointment, event, etc. that may
apply to the allegation. - n
ANS ✔
True
Qs
You MUST EXPLAIN the Part D late enrollment penalty. - n
ANS ✔
True
