2022 AHIP UNIT 4 MEDICARE ADVANTAGE AND PART D PLANS

2022 AHIP UNIT 4 MEDICARE ADVANTAGE AND PART D PLANS QUESTION 1 Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings distributes materials that are solely educational. However, she gives a brief presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that has been advertised as educational? a.No. This action is permissible. Handing out enrollment forms, on the other hand, would not be permissible. Incorrect: Discussion of plan-specific information is prohibited at educational events. b.No. Attendees expect some “puffery” at any event on a product in which they may be potentially interested. . When an event has been advertised as “educational,” discussing plan-specific premiums is impermissible. d.Yes. Whether or not an event has been advertised as “educational” or a “sales presentation,” discussing plan-specific information is impermissible. Source: Module 4, Slide - Educational Events, Impermissible Activities. Question 2 Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a website marketing the MA plans with which it has contracts. Agent Armstrong follows up with individuals who request more information about ABC MA plans via the website and tries to persuade them to enroll in ABC plans. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? a.Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. b.Agent Armstrong needsto be licensed and appointed only in hisstate of residence. c.Agent Armstrong needs to be licensed and appointed only in the state where ABC Health Plan is headquartered. d.Agent Armstrong needsto be licensed and appointed only in the state where XYZ Agency is headquartered. Source: Module 4, Slide - Requirement to act as Plan Marketing Representative and Slide - Marketing Representatives - State Licensure Case Study Question 3 You will be holding a sales event soon, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation? a.Two or more gifts whose combined value does not exceed $15. Incorrect: Thisstatement isincorrect because marketing representatives may offer more than one gift to sales event attendees provided the combined value of all items does not exceed $15. b.Gifts worth more than $15 but based on anticipated attendance will not exceed $15 per attendee. c.Gift cards or gift certificates of $15 or less that can be readily converted to cash. d.Gifts of nominal retail value ($15 or less) Source: Module 4, Slide - Gifts and Promotional Items. Question 4 Another agent you know has engaged in misconduct that has been verified by the plan she represented. What sort of penalty might the plan impose on this individual? a. Plans must immediately terminate their contracts with such individuals. b.Plans do not impose penalties. Instead, the Medicare agency has specific authority to fine such individuals for each violation. c. Her name will be reported to a publicly accessible database and could be advertised in local newspapers. d.The plan may withhold commission, require retraining, report the misconduct to a state department of insurance or terminate the contract. Source: Module 4, Slide - Plan Oversight and Enforcement. Question 5 Miguel Sanchez is a relatively new agent who has come to you for advice as to what he can do during the Medicare Advantage Open Enrollment Period (MA-OEP). What advice should you give Miguel? a.During the MA-OEP Miguel can purchase a list of individuals who have chosen MA plans during Annual Enrollment Period (AEP) and create a marketing plan aimed at targeting them to select a plan he sells. b.During the MA-OEP Miguel can send unsolicited print materials to seniors in his area advertising the opportunity to change from one MA plan to another. c.During the MA-OEP Miguel can make unsolicited calls to former enrollees who have selected a new plan during the Annual Enrollment Period (AEP). d.During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. Source: Module 4, Slide - Open Enrollment Period - Marketing Prohibitions and Slide - Promoting Health Plans During Open Enrollment Period. Question 6 You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. You have completed the required training for each plan, but you did not achieve a passing score on the tests that came after the training. What can you do in this situation? a.Your name will be registered with the Medicare agency by the plans you are seeking to represent and you will be unable to contract with any Medicare Advantage or Part D plan. b.You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score. However, you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing. c.You will have to repeat the tests in three months, but may begin enrolling beneficiaries while you are waiting. d.You will have to attend one ofseveral remedial training eventssponsored by the Medicare agency before being allowed to retake the test. Source: Module 4, Slide - Requirements to act as Plan Marketing Representatives. Question 7 A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. Before engaging in such a discussion, what should you do? a.Before speaking with the individual, you must inquire as to her eligibility for MA and Part D plans and then complete a scope of appointment form for the plans for which she is eligible. b.You must set an appointment for another time, at least 48 hours from the point when she walked into your office. c.You do not have to do anything. You may proceed with the discussion and enroll the individual ifshe so desires. d.You must have hersign a scope of appointment form, indicating which productsshe wishesto discuss. You may then proceed with the discussion. Source: Module 4, Slide - Required Practices: Scope of Appointment. Question 8 You are working several plans and community organizationsto sponsor an educational event. When putting together advertisements for this event, what should you do? a.You must ensure that the advertisementsindicate it is an educational event, otherwise it will be considered a marketing event. b.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. c.You must only ensure that the advertisement isfactually accurate. d.Plans may not participate in advertising such an event. All advertising must be done by community organizations. Source: Module 4, Slide - Educational Events and Slide - Marketing and Educational Events. Question 9 Plan sponsors may undertake the following marketing activities with current Medicare Advantage plan members? a.Market non-health related itemssuch as accident-only plans without the need for obtaining a HIPAA compliant authorization form from an enrollee. b.Market contact information lists of current membersto third-party vendors of ancillary health products as permitted by Dodd-Frank legislation. Incorrect: Plan sponsors cannot market lists of current members without compliant permission. HIPAA Privacy Rules are applicable, not Dodd-Frank legislation. c.Market non-health related items orservices such aslife insurance or annuities policies to current members as permitted following HIPAA Privacy Rules. d.Market non-Medicare health-related products, such as financial planning, to current members as permitted by Dodd-Frank legislation. Source: Module 4, Slide - Required Practices: HIPAA and Confidentiality of Enrollee Information and Slide - Required Practices: Marketing & Non-Health Related Activities. Question 10 Another agent working for your agency claims that because you are not employed by the Medicare Advantage plans that you represent, you are not subject to the same marketing requirements asthe plans themselves. How should you respond to such a statement? a.Your coworker is not correct. Marketing on behalf of a plan is considered marketing by the plan and requires that all contracted and employed agents comply with all Medicare marketing rules. b.Your coworker is correct. You are subject only to marketing requirementsissued by yourstate department of insurance. c.Your coworker is correct because employed agents have to follow a stricterset of rulesthan do independent agents, such as yourself. d.Your coworkeris correct. You may use any marketing techniquesthat do not involve providing misinformation to potential enrollees. Source: Module 4, Slide - Applicability of Medicare Marketing and Communication Rules to Marketing Representatives. Question 11 Agent Martinez wishesto solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. What should you tell her? a.Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. b.While unsolicited contacts may be made through print media such as direct mail, marketing representatives may not initiate electronic contact. c.Marketing representatives may only use internet pop-up ads providing plan-specific information that have been approved by CMS when soliciting prospectsthrough electronic means of communication. d.Marketing representatives may initiate electronic contact through e-mail and aslong as an e-mail is opened marketing representatives may also follow-up with unsolicited telephone calls. Source: Module 4, Slide - Permitted Contracts and Slide - General Audience Marketing. Question 12 Melissa Meadows is a marketing representative for Best Care which hasrecently introduced a Medicare Advantage plan offering comprehensive dental benefits for $15 per month. Best Care has not submitted any potential posts to CMS for approval. Melissa would like to use the power of social media to reach potential prospects. What advice would you give her? a.Agent Meadows should post a tweet telling readers to contact her directly to learn more about Best Care’s comprehensive dental benefits at only $15 per month. b.As soon as CMS approves Best Care's social media posts, Agent Meadows could post a tweetstating that “Best Care offers an array of Medicare Advantage benefit packages. One might be right for you. Call me to find out more!” c.Due to cybersecurity dangers, social media cannot be used in the promotion of Medicare Advantage products. d.Despite the terms of her contract forbidding the use of social media, Agent Meadows could send out a tweet stating that “Best Care offers a Medicare Advantage benefit package offering the lowest cost comprehensive dental benefit package available. Call me direct to learn more.” because the content does not contain any plan-specific information about benefits, premiums, cost-sharing, or Star Ratings. Source: Module 4, Slide - Use of Social Media to Market and Slide - Social Media Example. Question 13 You have been providing a pre-Thanksgiving meal during sales presentationsin 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? a.There is no limitation on meals. You may continue to provide your Thanksgiving style meal, to any individual, in any manner you see fit. b.You may provide lightsnacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. c.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. d.You may offer mealsto existing enrollees of the plan(s) you represent, but potential enrollees may not have a meal. Source: Module 4, Slide - Medicare Communications and Marketing Rules: Sales Events and Slide - Sales Events, Prohibited Activity and Light Snacks versus Meals. Question 14 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? 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.It is not necessary for ABC to obtain an authorization to simply explain pending state or federal legislation since there is no anticipation ofselling a non-health related product in these circumstances. c.Once a plan sends out a written request for consent, a beneficiary can authorize consent by simply failing to reply within 21 days. d.The request for authorization may include a briefsynopsis of non-health related content. Source: Module 4, Slide - Required Practices: Marketing & Non-Health Activities. Question 15 You have approached a hospital administrator about marketing in her facility. The administrator is uncomfortable with the suggestion. How could you address her concerns? a.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. b.Tell herthat 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 Medicare guidelines allow you to conduct marketing activitiesin common areas of a provider’s facility. d.Tell her that Medicare guidelines only allow you to conduct marketing activitiesin 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. Source: Module 4, Slide - Marketing Activities: Marketing in a Health Care Setting. Question 16 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? a.You may leave an enrollment kit and discuss a new life insurance productshe might like. b.You may provide her with the required enrollment materials and take her completed enrollment application. c.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. d.You may leave enrollment kitsforseveral MA plans and offer to discuss a Medigap and Part D prescription drug plan she might like. Incorrect: Because Mrs. Lu only requested help regarding Medicare Advantage plan selection, that is her scope of appointment. Therefore, your offer to discuss Medigap and/or Part D would go beyond the scope of appointment. Source: Module 4, Slide - What are Individual Marketing Appointments?, Slide - Individual Marketing Appointments, Prohibited Activities and Slide - Required Practices: Scope of Appointment. Question 17 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? a.You appreciate the opportunity and would ask the facility to provide enrollment applicationsfor the MA-PD plans you represent. b. You appreciate the opportunity and would be happy to schedule an appointment with anyone at their request. c.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. Incorrect: Marketing representatives may schedule an appointment with a beneficiary in a long-term care facility only upon the request of the beneficiary (or authorized representative). While your friend may be an authorized representative for his mother, it is highly unlikely that he would be an authorized representative for others in the facility. d.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. Source: Module 4, Slide - Marketing Activities: Marketing in a Long-term Care Facility and Slide - Marketing Activities in a Health Care Setting: Example. Question 18 During a sales presentation, your client asks you whether the Medicare agency recommends that she sign up for your plan or stay in Original Medicare. What should you tell her? a.Tell her that Medicare or CMS (the Medicare agency) has approved and endorsed the plan. b.Tell her that, because you represent a Medicare health plan, you therefore work for Medicare, and the information you offer her is a good basis of any decision she makes. c.Tell her that the Medicare agency does not endorse or recommend any plan. her that Medicare recommends that beneficiaries enroll in a Medicare Advantage plan because it will serve her better than Original Medicare. Source: Module 4, Slide - Prohibited Practices: Marketing and Communications Material and Activities and Prohibited Practices: Examples. Question 19 Next week you will be participating in your first “educational event” for prospective enrollees. To be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage? a.You should plan to answer questions and accept enrollment forms. b.You should plan to conduct sales presentations but must not accept enrollment forms. c.You should plan to conduct sales presentations and accept enrollment forms. d.You should plan to ensure that the educational event is an informative event and must not conduct a sales presentation or distribute or accept enrollment forms at the event. Source: Module 4, Slide - Marketing and Educational Events and Slide - Educational Events, Impermissible Activities. Question 20 One of your colleagues argues that it is better to focus your time and energy exclusively in neighborhoods with single-family homes. He further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. How should you respond? a.Thisis not a discriminatory activity since this is merely a widely recommended sales practice. b.This could be considered discriminatory activity, but it is not a prohibited practice. c.This is not a discriminatory activity since it is based on the incomes of likely prospects and not based onrace or gender. d.This could be considered discriminatory activity and a prohibited practice. Source: Module 4, Slide - Prohibited Practices: Marketing and Communications Materials and Activities.