WGU C231 AHIP EXAM QUESTIONS AND ANSWERS CORRECTLY VERIFIED

WGU C231 AHIP EXAM QUESTIONS AND ANSWERS CORRECTLY VERIFIED Mrs. Chou likes a PFFS plan available in her area that does not offer drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What should you tell her? Correct ans - She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her? Correct ans - Part D covers prescription drugs and she should look at her premiums, formulary and cost-sharing among other factors to see if they have changed. 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 Smith tell Mr. Moreno about the kinds of food that can be provided to potential enrollees who attend the sales presentation? Correct ans - A meal cannot be provided, but light snacks would be permitted. Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay that Medicare will cover? Correct ans - Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime. 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? Correct ans - 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. Alternately, he could check to see whether his state has a pharmacy assistance program to help him with expenses. Mr. Wong is a single individual. He has a successful business career and is now able to retire with a comfortable income. Mr. Wong's taxable income is in excess of $80,000. Mr. Wong has health coverage through his employer but will sign-up for Medicare Part A, Part B and Part D when he leaves the workforce. How would you advise him as he budgets for Medicare premiums? Correct ans - Due to his participation in the workforce he will not have to pay a premium for Part A but he will pay higher premiums for Part B and Part D due to the amount of his income. During an appointment scheduled to discuss a Medicare Advantage Prescription Drug plan (MA-PD), Mr. Peters asked his agent to describe a stand-alone prescription drug plan (Part D plan) that his neighbor told him about. What should his agent do? Correct ans - Since Mr. Peters requested a description of the Part D plan, his agent must have Mr. Peters sign a new scope of appointment form that includes Part D, and then the agent may discuss the Part D plan so Mr. Peters can compare plans and make an informed enrollment choice during the appointment. By contacting plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefit package. What should you do to make sure your clients know about these pieces of information? Correct ans - You may make comparisons between plans if you can support them by studies or statistical data and such comparisons are factually based. 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? Correct ans - 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. Mr. Decaro has looked a Medicare prescription drug plans available in his area and noted a wide range in premiums. He thought that all drug plans were required to offer the same standard benefits and would like you to explain why there is such a range in premiums. What should you tell him? Correct ans - Some prescription drug plans may have higher operating costs and/or may offer enhanced coverage in return for an additional premium amount. He could look at plan designs to see if one of the enhanced plans would serve his needs better than a plan based on the standard design. Mrs. Wellington is enrolled in Parts A and B of Original Medicare. A friend recently told her that there is an excellent Medicare Advantage (MA) plan with a five-star rating serving her area. On January 5 she comes to you for advise as to what options, if any, she has. What should you say regarding special enrollment periods (SEPs)? Correct ans - Mrs. Wellington is eligible for a SEP that may be used once until November 30 to enroll in the five-star plan. Mr. Landry is approaching his 65th birthday. He has signed up for Medicare Part A, but he did not enroll in Part B because he has employer-sponsored coverage and intends to keep working for several more years. But he is considering enrolling in Part D prescription drug coverage because he believes it is superior to his employer plan. How would you advise him? Correct ans - Mr. Landry is eligible for Part D since he has Part A, and his initial enrollment period (IEP) for Part D will continue for three months after his 65th birthday. Ms. Gates is dually eligible for Medicare and Medicaid. She is very concerned about being locked into a specific Medicare prescription drug plan for the entire year. what should you tell her? Correct ans - Individuals who are enrolled in Medicaid can change their Part D plans throughout the year, so if she is not satisfied with her prescription drug plan, she can change to a different Part D plan. (NOTE: On the AHIP test this is the best answer. However, She can change once per quarter for the first 9 months of the year) 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? Correct ans - 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. Which of the following steps may a Part D sponsor adopt for beneficiaries who are at risk of misusing or abusing frequently abused drugs? I. Identify at risk individuals by using criteria that includes the number of opioid prescriptions the beneficiary has and the number of prescribers who have written those prescriptions. II. Locking an at-risk beneficiary into one pharmacy. III. Locking an at-risk beneficiary into one prescriber. IV. Increasing deductibles and copays for at-risk beneficiaries Correct ans - I, II and III only Agent Martinez wishes to solicit Medicare Advantage prospects through e- mail and ask you for advice as to whether this is possible. What should you tell her? Correct ans - Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. Mrs. Sanchez lives in a state located near Canada. She has recently become eligible for Medicare and is considering enrollment in Part D prescription drug coverage. One of her friends has told her that she needs to be aware of something called TrOOP. What should you tell her when she asks you about TrOOP? Correct ans - TrOOP are out-of-pocket costs that count toward the annual out-of-pocket threshold to move into catastrophic coverage and generally include the annual deductible(s) and costs from drugs on teh plan's formulary purchased at a plans' participating pharmacy. In some instances, amounts not directly paid by the enrollee (like manufacturers discounts) count toward TrOOP. Ms. Levi is considering enrollment in a Medicare Advantage HMO plan offered in her area. Ms. Levi often travels to visit relatives and is concerned that she may need emergency care outside of her plan's service area. What should you tell her about coverage of emergency care? Correct ans - Plans are required to cover out-of-network emergency. 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 Change take during the event? Correct ans - Discuss plan specific information such as premiums and benefits. Mr. Jackson just turned 65. He has been seeing the same general practitioner for annual check-ups for the past 5 years, likes these yearly visits, and would like to continue obtaining these services as a Medicare beneficiary. What should you tell him about annual check-ups? Correct ans - Medicare will cover an annual wellness visit, even if he has no illness or injuries. Agent Roderick enrolls retiree Mrs. Martinez in a medicare savings account (MSA) Medicare health plan. The MSA plan does not offer prescription drug coverage, so Agent Roderick also enrolls Mrs. Martinez in a stand-alone prescription drug plan (PDP). What CMS compensation rules apply to this situiation? Correct ans - This situation is considered a "dual enrollment," and CMS compensation rules are applied to the two plans at once and independently of each other. You are doing a sales presentation for Ms. Duarte and her son. Ms. Duarte has some cognitive impairment and her son informs you that he has power of attorney to make financial decisions for her. Can he execute the enrollment for her? Correct ans - No, he cannot execute the enrollment for her. He must have a legal authorization, under state law that explicitly allows him to make health care decisions for his mother. Mrs. Roberts has just received a new Medicare identity card in the mail. She is concerned that it is a forgery since it does not have her Social Security number on it. What should you tell her? Correct ans - The card she received is valid, the change has been made to protect Medicare beneficiaries from identity theft, and she should now destroy her old card. If a beneficiary is enrolled in a stand-alone prescription drug plan and wants to keep that plan, what type of Medicare health plan could the individual enroll in, without being automatically dis-enrolled from the stand-alone prescription drug plan? Correct ans - The beneficiary could enroll in a private fee-for-service (PFFS) plan that does not include prescription drug coverage; an 1876 Cost Plan; or a Medicare Medical Savings Account (MSA) plan. Mr. Polanski likes the cost of an HMO plan available in his area, but would like to be able to visit one or two doctors who aren't participating providers. He wants to know if the Point of Service (POS) option available with some HMOs will be of any help in this situation. What should you tell him? Correct ans - The POS option might be a good solution for him as it will allow him to visit out-of-network providers, generally without prior approval. However, he should be aware that it is likely he will have to pay higher cost-sharing for services from out-of-network providers. Ms. Lopez is an independent agent under contract with MarketCo, a third- party marketing organization. MarketCo has a contract with BestCare health plan, a Medicare Advantage (MA) organization, to offer marketing services through its contracted agents and agencies. Ms. Lopez returns calls to individuals who contact MarketCo in response to its mailers promoting BestCare health plan. Which of the following best describes the responsibilities of Ms. Lopez? Correct ans - Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to comply with CMS marketing requirements, including using only approved call scripts. 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? Correct ans - Her daughter should come in November. Agent Higgins helps Mrs. O'Malley to enroll in AB Medicare Advantage (MA) plan during the Annual Open Enrollment Period. Mrs. O'Malley's effective enrollment date is January 1st. Subsequently, Mrs. O'Malley disenrolls on February 12th following a move outside the plan's service area. What impact will this have on Agent Higgins compensation? Correct ans - AB MA does not have to recoup Agent Higgins' compensation because she as moved away from its service area. Mr. Chan is one of your clients and in excellent health. He is enrolled in a Medicare prescription drug plan that you represent. He recently heard about a Medication Therapy Management (MTM) program in which his friend is enrolled. What should you tell him? Correct ans - To be eligible for a MTM program, a Medicare beneficiary must have multiple chronic diseases, be taking multiple Part D prescription drugs, and likely to incur considerable drug costs. Monica is an agent focused on serving seniors eligible for Medicare. As she reviews her records, she is trying to determine which of the following items are considered compensation. What do you tell her? I. Commissions II. Bonuses III. Mileage reimbursement IV. Referral fees Correct ans - I, II, and IV only Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will have considerable income when she retires. She is concerned that her income will make it impossible for her to qualify for Medicare. What could you tell her to address her concern? Correct ans - Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare. Mrs. Allen has a rare condition for which two different brand name drugs are the only available treatment. She is concerned that since no generic prescription drug is available and these drugs are very high cost, she will not be able to find a Medicare Part D prescription drug plan that covers either one of them. What should you tell her? Correct ans - Medicare prescription drug plans are required to cover drugs in each therapeutic category. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. Mrs. Patterson is a new enrollee in the HealthBest Medicare Advantage (MA- PD) plan. she is new to this type of coverage and asks you what materials, if any, she should expect to receive. How would you reply? Correct ans - She should expect either the pharmacy directory in hard copy or a distinct and separate notice (in hard copy) describing where she can find the pharmacy directory online and how to request a hard copy. 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? Correct ans - 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. 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? Correct ans - C-SNP Mr. Lopez takes several high-cost prescription drugs. He would like to enroll in a stand-alone Part D prescription drug plan that is available in his area. In what type of Medicare Health Plan can he enroll? Correct ans - Private Fee-for-service (PFFS) plan that does not include drug coverage. 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? Correct ans - 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. Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he sees an out-of-network doctor to receive a Medicare covered service. How much may the doctor collect from Mr. Rivera? Correct ans - The doctor may only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid program. A client wants to give you an enrollment application on October 1st prior to the beginning of the Annual Election Period because he is leaving on vacation for tow weeks and does not want to forget about turning it in. What should you tell him? Correct ans - 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. Which statement best describes PACE plans? Correct ans - It includes comprehensive medical and social service delivery systems using an interdisciplinary team approach in an adult day health center, supplemented by in-home and referral services. Ms. O'Donnell learned about a new MA-PD plan that her neighbor suggested and that you represent. She plans to switch from her old MA HMO plan to the new MA-PD plan during the Annual Election Period. However, she wants to make sure she does not end up paying premiums for two plans. What can you tell her? Correct ans - She only needs to enroll in a new MA-PD plan and she will automatically be disenrolled from her old MA plan. Alice is enrolled in a MA-PD plan. she makes a permanent move across the country and wonders what her options are for continuing MA-PD coverage. What would you say to her in regard to a special enrollment period (SEP)? Correct ans - She is likely to qualify for a SEP. She can choose an effective date of up to three months after the month in which the enrollment form is received by the new plan, but the effective date may not be earlier than the date of her permanent move. Ms. Jensen has heard about "Original Fee-for-service Medicare" and "Private Fee-for-Service" plans. She wants to know what the difference is, if any. What should you tell her? Correct ans - PFFS plans are a type of Medicare Advantage plan offered by private companies. Who is most likely to be enrolled in a Part D prescription drug plan? Correct ans - Ms. Davis who recently turned 65 and is eligible for Part A and has just enrolled in Part B. Mrs. Lenard is enrolled in a Medicare Cost plan. Recently the cost plan announced its intention to end its cost contract and transition to a Medicare Advantage (MA). Mrs. Lenard received a letter indicating that unless she chooses another plan or opts out she will be automatically enrolled in the New Medicare Advantage plan operated by an organization affiliated with her cost plan. What does this mean? Correct ans - If Mrs. Lenard wants to enroll in a Medicare Advantage plan affiliated with her cost plan effective January 1, she should do nothing and she will be automatically enrolled. If she does not want to enroll in that MA plan, she should choose another plan or otherwise opt out of the automatic enrollment. Mrs. Quinn has recently turned 66 and decided after many years of work to begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn? Correct ans - Part B primarily covers physician services. She will be paying a monthly premium and, with exception of many preventative and screening tests, generally will have 20% co-payments for these services, in addition to an annual deductible. Ms. Gardner is currently enrolled in an MA-PD plan. However, she wants to disenroll from the MA-PD plan and instead enroll in a Part D only plan and go back to Original Medicare. According to Medicare's enrollment guidelines, when could she do this? Correct ans - She may make such a change during the Annual Election Period that runs from Oct. 15 to December 7, or during the MA Open Enrollment Period which takes place from January 1 to March 31 of each year (beginning in 2019) You have decided to focus on doing in-home presentation to market the Medicare Advantage (MA) plans you represent. Before you conduct such sales presentations, what must you do? Correct ans - You must receive an invitation from the beneficiary and document the specific types of products the beneficiary wants to discuss prior to making an in-home presentation. Which of the following is a correct statement about states laws as they pertain to marketing representatives? Correct ans - Medicare health plans must comply with requests for information from state insurance departments investigating complaints about a marketing representative. Last year Agent Melanie Meyers marketed an enrolled several clients in Medicare Advantage (MA) health plans. This year she has decided to focus on non-MA products. What advice would you give Melanie if she wishes to continue to receive renewal fees? Correct ans - Melanie must remain trained, tested, licensed and appointed, regardless of whether she is actively selling MA products.