Wellcare ACT Mastery Exam 25' || 100% Accurate Solutions.
Wellcare's _____ plan is designed for Low-Income Subsidy (LIS) members. correct answers
Classic
Wellcare launched new tiered provider plans in ______ and _____. (Select two options.)
correct answers Arizona
Oregon
Effective 2025, key provisions of the Inflation Reduction Act include a lower annual
threshold of $_____ for out-of-pocket (OOP) prescription drug costs in Medicare. correct
answers $2,000
Which Prescription Drug Plan (PDP) is best for a dual-eligible chooser? correct answers
Classic
Members are no longer required to pay a partial deductible due to the Inflation Reduction
Act. correct answers TRUE
Which Low-Income Subsidy (LIS) category is assigned to members whose costs are fully
subsidized and receive the most assistance? correct answers Three
All Prescription Drug Plans (PDPs) will feature a $0 Tier 1 benefit when filled at preferred
pharmacies. correct answers TRUE
Wellcare is the official Medicare provider partner of The American Legion to serve Veterans
in 24 states. correct answers TRUE
Effective 2025, key provisions of the Inflation Reduction Act include a newly designed
standard Part D benefit design consisting of three phases. Which phase is not included?
correct answers Coverage gap
Which Prescription Drug Plan (PDP) has the richest formulary with the most adherence
generics on Tier 1? correct answers Value Plus
Agents may be investigated after being suspected of noncompliant activity reported through
a: (Select all that apply.) correct answers Complaint Tracking Module (CTM)
Grievance
Secret Shop Finding
Agents must meet all required contracting, training, and certification requirements annually
to be eligible to sell Wellcare's Medicare products. correct answers TRUE
Which of the following actions are required when contacted regarding an allegation of
noncompliant activity? correct answers All of these
Lead-generating activities (either directly or indirectly) facilitated by a Third-Party Marketing
Organization (TPMO) need to include a notice to the beneficiary that their information may
be shared with a licensed agent for future contact. correct answers TRUE
, Which of the following statements about completing telephonic enrollments is FALSE?
correct answers Must include some of the required elements necessary to complete the
enrollment.
The Third-Party Marketing Organization (TPMO) disclaimer must be used by any TPMO
that sells plans on behalf of more than one Medicare Advantage (MA) plan provider. The
disclaimer must be: (Select all that apply.) correct answers Included in any marketing
materials, including print materials and television advertisements developed, used, or
distributed by the TPMO.
Verbally conveyed within the first minute of a sales call.
Prominently displayed on TPMO websites (regardless of content).
Electronically conveyed when communicating with a beneficiary through email, online chat,
or other electronic means of communication (regardless of content).
Verbal permission granted to discuss plan details qualifies an authorized representative to
complete an application on behalf of the beneficiary. correct answers FALSE
When completing an application, you should ensure that you enter the provider ID of a
specialist and not a primary care provider (PCP). correct answers FALSE
To ensure accurate data entry, agents should repeat the Medicare ID back to the beneficiary.
correct answers TRUE
Upon completion of the application, you must provide the beneficiary with the enrollment
application confirmation ID. correct answers TRUE
Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part D plan
premiums. correct answers FALSE
When enrolling a Dual Eligible Special Needs Plan (D-SNP) beneficiary, be sure to verify
plan enrollment eligibility and that the Medicare Savings Program (MSP) level is eligible for
the requested plan. correct answers TRUE
Prior to the beginning of the enrollment process, an agent is required to cover certain
beneficiary specific information, including but not limited to: correct answers All of these
The Pre-Enrollment Checklist (PECL) should be provided and reviewed with the prospective
enrollee after enrollment to ensure the enrollee understands important plan benefits and rules.
correct answers FALSE
The online Member Portal is available Monday - Friday, 8:00am - 8:00pm. correct answers
FALSE
A request to the plan from a member or provider for a formal review of an Action (Denial) or
Adverse Plan Determination (Medicare) is a/an: correct answers Appeal
Grievance procedures are separate and distinct from initial determination and appeal
procedures. correct answers TRUE
A grievance request, or any evidence concerning a grievance, must be filed orally or in
writing no later than _____ calendar days from the date of the event or the date the member is
made aware of the issue. correct answers 60
Wellcare's _____ plan is designed for Low-Income Subsidy (LIS) members. correct answers
Classic
Wellcare launched new tiered provider plans in ______ and _____. (Select two options.)
correct answers Arizona
Oregon
Effective 2025, key provisions of the Inflation Reduction Act include a lower annual
threshold of $_____ for out-of-pocket (OOP) prescription drug costs in Medicare. correct
answers $2,000
Which Prescription Drug Plan (PDP) is best for a dual-eligible chooser? correct answers
Classic
Members are no longer required to pay a partial deductible due to the Inflation Reduction
Act. correct answers TRUE
Which Low-Income Subsidy (LIS) category is assigned to members whose costs are fully
subsidized and receive the most assistance? correct answers Three
All Prescription Drug Plans (PDPs) will feature a $0 Tier 1 benefit when filled at preferred
pharmacies. correct answers TRUE
Wellcare is the official Medicare provider partner of The American Legion to serve Veterans
in 24 states. correct answers TRUE
Effective 2025, key provisions of the Inflation Reduction Act include a newly designed
standard Part D benefit design consisting of three phases. Which phase is not included?
correct answers Coverage gap
Which Prescription Drug Plan (PDP) has the richest formulary with the most adherence
generics on Tier 1? correct answers Value Plus
Agents may be investigated after being suspected of noncompliant activity reported through
a: (Select all that apply.) correct answers Complaint Tracking Module (CTM)
Grievance
Secret Shop Finding
Agents must meet all required contracting, training, and certification requirements annually
to be eligible to sell Wellcare's Medicare products. correct answers TRUE
Which of the following actions are required when contacted regarding an allegation of
noncompliant activity? correct answers All of these
Lead-generating activities (either directly or indirectly) facilitated by a Third-Party Marketing
Organization (TPMO) need to include a notice to the beneficiary that their information may
be shared with a licensed agent for future contact. correct answers TRUE
, Which of the following statements about completing telephonic enrollments is FALSE?
correct answers Must include some of the required elements necessary to complete the
enrollment.
The Third-Party Marketing Organization (TPMO) disclaimer must be used by any TPMO
that sells plans on behalf of more than one Medicare Advantage (MA) plan provider. The
disclaimer must be: (Select all that apply.) correct answers Included in any marketing
materials, including print materials and television advertisements developed, used, or
distributed by the TPMO.
Verbally conveyed within the first minute of a sales call.
Prominently displayed on TPMO websites (regardless of content).
Electronically conveyed when communicating with a beneficiary through email, online chat,
or other electronic means of communication (regardless of content).
Verbal permission granted to discuss plan details qualifies an authorized representative to
complete an application on behalf of the beneficiary. correct answers FALSE
When completing an application, you should ensure that you enter the provider ID of a
specialist and not a primary care provider (PCP). correct answers FALSE
To ensure accurate data entry, agents should repeat the Medicare ID back to the beneficiary.
correct answers TRUE
Upon completion of the application, you must provide the beneficiary with the enrollment
application confirmation ID. correct answers TRUE
Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part D plan
premiums. correct answers FALSE
When enrolling a Dual Eligible Special Needs Plan (D-SNP) beneficiary, be sure to verify
plan enrollment eligibility and that the Medicare Savings Program (MSP) level is eligible for
the requested plan. correct answers TRUE
Prior to the beginning of the enrollment process, an agent is required to cover certain
beneficiary specific information, including but not limited to: correct answers All of these
The Pre-Enrollment Checklist (PECL) should be provided and reviewed with the prospective
enrollee after enrollment to ensure the enrollee understands important plan benefits and rules.
correct answers FALSE
The online Member Portal is available Monday - Friday, 8:00am - 8:00pm. correct answers
FALSE
A request to the plan from a member or provider for a formal review of an Action (Denial) or
Adverse Plan Determination (Medicare) is a/an: correct answers Appeal
Grievance procedures are separate and distinct from initial determination and appeal
procedures. correct answers TRUE
A grievance request, or any evidence concerning a grievance, must be filed orally or in
writing no later than _____ calendar days from the date of the event or the date the member is
made aware of the issue. correct answers 60
