Medicare Agent & Broker Certification
A beneficiary enrolled into Acme Health Plan in 2012 as an preliminary enrollment and has
remained within the plan considering the fact that. How a lot ought to Acme pay in CY2015 to
the agent that facilitated the enrollment? - ANS-Up to 50% of CY2015 honest marketplace price
Renewal compensation must be paid as much as 50% of the current truthful marketplace price
(FMV), regardless of whether the member is new to the agency or now not. The initial fee while
the member first entered the plan will no longer be utilized to decide the renewal charge.
A beneficiary enrolls into Acme Health Plan in November 2014 as an preliminary enrollment.
Assuming the beneficiary remains enrolled inside the plan in 2015, in what month does their first
renewal cycle begin? - ANS-January 2015
The compensation yr is January via December. "Rolling years" are not accredited. In this
situation, the beneficiaries first preliminary year ends December 31, 2014 and their first renewal
yr would be January 1, 2015 through December 31, 2015.
A plan might also stop an enrollee's membership if... - ANS-The enrollee is far from the carrier
region for extra than 6 months
The enrollee does no longer live constantly enrolled in Medicare Part A or Part B
The enrollee is now not eligible for the plan's SNP category
A plan may cease an enrollee's club for any of the motives listed (involuntary disenrollment), as
long as the enrollee is a part of a plan for which the rule of thumb applies.
A prospective beneficiary asks an agent if plan XYZ has an pressing care advantage and if so,
what the gain consists of. Where would the agent find this records for plan XYZ? -
ANS-Evidence of Coverage
Because the beneficiary requested if plan XYZ has an pressing care benefit and what the
benefit consists of.
If the beneficiary only desired to know if plan XYZ has an pressing care gain, the solution might
be Summary of Benefits & Evidence of Coverage.
At a formal advertising and marketing occasion that happened on December 1st, an agent
provided information on the MA/MA-PD plans available from Acme Health Plan, and cited that
as compared to all other plans in the region, Acme has the largest network of docs to be had
and is likewise the most nicely preferred. At the Agent and Broker Training & Testing Guidelines
12 give up of the presentation, the agent instructed the beneficiaries that if they do now not sign
on for coverage today, they will probably lose their possibility to accomplish that. Are these
, actions suitable? - ANS-No. The agent made unsubstantiated absolute statements and
additionally inappropriately forced beneficiaries into enrolling.
Plans might not use absolute superlatives (e.G., we're the pleasant), until they may be
substantiated with helping information furnished to CMS as part of the marketing overview
technique or they're utilized in logos/taglines. Additionally, plans are prohibited from the usage
of "scare tactics" or pressuring beneficiaries into enrolling.
Define: Medicare Part A - ANS-Part A of Medicare covers hospital inpatient care, a few SNF
care, and domestic health and hospice care
Define: Medicare Part B - ANS-Part B of Medicare covers physician services, outpatient health
facility care, lab exams, intellectual health offerings, some preventative offerings, and medical
system considered medically necessary to deal with a sickness or situation
Define: Medicare Part C - ANS-Part C of Medicare presents an option for beneficiaries to get
hold of non-public health plan coverage in lieu of Original Medicare
Define: Medicare Part D - ANS-Part D of Medicare presents prescription drug benefit
During a proper income occasion held on October five, an agent tells attendees, "You can sign
up in Acme's Traditional Medicare Advantage HMO plan between October 15 and December 7,
however the plan won't take impact until January 1. However, if you don't just like the plan after
you enroll, you have until March 1 to exchange lower back to Original Medicare." Following the
presentation, the agent assists a couple in filling out an enrollment shape for Acme's Traditional
HMO plan, and tells the couple that she can "hold on to it" until the October 15 enrollment date.
What is incorrect? - ANS-The agent isn't allowed to simply accept an enrollment previous to
October 15
The presenter provided wrong Medicare Advantage Disenrollment Period (MADP) records
Although marketers may also assist beneficiaries in completing their paperwork, an agent might
not accept, gather, or take possession of completed enrollment bureaucracy earlier than
October 15 and won't inspire beneficiaries to mail the enrollment shape to the plan previous to
October 15. Further, despite the fact that the agent furnished the correct dates for the AEP
(October 15 - December 7), she misstated the window for which a beneficiary may additionally
disenroll and revert again to Original Medicare. In 2015, the MADP is January 1 - February 14.
If a beneficiary makes a plan exchange to a plan supplied by using any other agency, and the
brand new enterprise doesn't use agent and brokers, what happens to the fee? - ANS-The new
organisation would now not make bills and the initial plan would must recoup for the wide variety
of months the member turned into not in the plan.
A beneficiary enrolled into Acme Health Plan in 2012 as an preliminary enrollment and has
remained within the plan considering the fact that. How a lot ought to Acme pay in CY2015 to
the agent that facilitated the enrollment? - ANS-Up to 50% of CY2015 honest marketplace price
Renewal compensation must be paid as much as 50% of the current truthful marketplace price
(FMV), regardless of whether the member is new to the agency or now not. The initial fee while
the member first entered the plan will no longer be utilized to decide the renewal charge.
A beneficiary enrolls into Acme Health Plan in November 2014 as an preliminary enrollment.
Assuming the beneficiary remains enrolled inside the plan in 2015, in what month does their first
renewal cycle begin? - ANS-January 2015
The compensation yr is January via December. "Rolling years" are not accredited. In this
situation, the beneficiaries first preliminary year ends December 31, 2014 and their first renewal
yr would be January 1, 2015 through December 31, 2015.
A plan might also stop an enrollee's membership if... - ANS-The enrollee is far from the carrier
region for extra than 6 months
The enrollee does no longer live constantly enrolled in Medicare Part A or Part B
The enrollee is now not eligible for the plan's SNP category
A plan may cease an enrollee's club for any of the motives listed (involuntary disenrollment), as
long as the enrollee is a part of a plan for which the rule of thumb applies.
A prospective beneficiary asks an agent if plan XYZ has an pressing care advantage and if so,
what the gain consists of. Where would the agent find this records for plan XYZ? -
ANS-Evidence of Coverage
Because the beneficiary requested if plan XYZ has an pressing care benefit and what the
benefit consists of.
If the beneficiary only desired to know if plan XYZ has an pressing care gain, the solution might
be Summary of Benefits & Evidence of Coverage.
At a formal advertising and marketing occasion that happened on December 1st, an agent
provided information on the MA/MA-PD plans available from Acme Health Plan, and cited that
as compared to all other plans in the region, Acme has the largest network of docs to be had
and is likewise the most nicely preferred. At the Agent and Broker Training & Testing Guidelines
12 give up of the presentation, the agent instructed the beneficiaries that if they do now not sign
on for coverage today, they will probably lose their possibility to accomplish that. Are these
, actions suitable? - ANS-No. The agent made unsubstantiated absolute statements and
additionally inappropriately forced beneficiaries into enrolling.
Plans might not use absolute superlatives (e.G., we're the pleasant), until they may be
substantiated with helping information furnished to CMS as part of the marketing overview
technique or they're utilized in logos/taglines. Additionally, plans are prohibited from the usage
of "scare tactics" or pressuring beneficiaries into enrolling.
Define: Medicare Part A - ANS-Part A of Medicare covers hospital inpatient care, a few SNF
care, and domestic health and hospice care
Define: Medicare Part B - ANS-Part B of Medicare covers physician services, outpatient health
facility care, lab exams, intellectual health offerings, some preventative offerings, and medical
system considered medically necessary to deal with a sickness or situation
Define: Medicare Part C - ANS-Part C of Medicare presents an option for beneficiaries to get
hold of non-public health plan coverage in lieu of Original Medicare
Define: Medicare Part D - ANS-Part D of Medicare presents prescription drug benefit
During a proper income occasion held on October five, an agent tells attendees, "You can sign
up in Acme's Traditional Medicare Advantage HMO plan between October 15 and December 7,
however the plan won't take impact until January 1. However, if you don't just like the plan after
you enroll, you have until March 1 to exchange lower back to Original Medicare." Following the
presentation, the agent assists a couple in filling out an enrollment shape for Acme's Traditional
HMO plan, and tells the couple that she can "hold on to it" until the October 15 enrollment date.
What is incorrect? - ANS-The agent isn't allowed to simply accept an enrollment previous to
October 15
The presenter provided wrong Medicare Advantage Disenrollment Period (MADP) records
Although marketers may also assist beneficiaries in completing their paperwork, an agent might
not accept, gather, or take possession of completed enrollment bureaucracy earlier than
October 15 and won't inspire beneficiaries to mail the enrollment shape to the plan previous to
October 15. Further, despite the fact that the agent furnished the correct dates for the AEP
(October 15 - December 7), she misstated the window for which a beneficiary may additionally
disenroll and revert again to Original Medicare. In 2015, the MADP is January 1 - February 14.
If a beneficiary makes a plan exchange to a plan supplied by using any other agency, and the
brand new enterprise doesn't use agent and brokers, what happens to the fee? - ANS-The new
organisation would now not make bills and the initial plan would must recoup for the wide variety
of months the member turned into not in the plan.
