2022 OVERVIEW of MEDICARE PROGRAM BASICS: CHOICE, ELIGIBILTY, AND BENEFITS ENROLLMENT GUIDANCE MEDICARE ADVANTAGE AND PART D PLANS

2022 OVERVIEW of MEDICARE PROGRAM BASICS: CHOICE, ELIGIBILTY, AND BENEFITS ENROLLMENT GUIDANCE MEDICARE ADVANTAGE AND PART D PLANS PART 5 1. 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? a. Mr. Tully’s daughter can do so only, ifshe is authorized understate 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. Correct b. Mr. Tully’s daughter can do so because she is an immediate family member who has taken responsibility for her father’s care. Incorrect c. A signature is not necessary since Mr. Tully is not physically or mentally capable of filling out and signing the form. Incorrect d. If the enrollment form is countersigned by one of Mr. Tully’streating physicians,she can sign it for him. Incorrect 2. Mrs. Burton is in an MA-PD plan and was disappointed in the service she received from her primary care physician because she was told she would have to wait five weeks to get an appointment when she was feeling ill. She called you to ask what she could do so she wouldn’t continue to have to put up with such poor access to care. What could you tell her? a. She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. Correct b. She should call the doctor’s office to complain since the plan cannot do anything about the doctor’s schedule. Incorrect c. She must write to the plan and wait for a response and then she could file a grievance if she is still dissatisfied. Incorrect d. She should not expect to get in to see her doctor any more quickly since she is a Medicare patient. Incorrect 3. You have come to Mrs. Midler’s home for a sales presentation. At the beginning of the presentation, Mrs. Midler tells you that she has a copy of her medical record available because she thinks this will help you understand her needs. She suggests that you will know which questions to ask her about her health status in order to best assist her in selecting a plan. What should you do? a. You cannot, under any circumstances, ask Mrs. Midler any health-related questions. Incorrect b. You can initiate a detailed discussion of all of Mrs. Midler's health conditions only to better understand her situation and to advise her to choose a different plan if she is experiencing significant health problems. Incorrect c. You can only ask Mrs. Midler questions about conditions that affect eligibility,specifically, whethershe has end-stage renal disease or one of the conditions that would qualify her for a special needs plan. Correct d. If she brings up the topic of her health, you can ask Mrs. Midler as many questions as she is willing to answer, so you can determine which plan is most suitable for her health needs. Incorrect 4. You are meeting with Ms. Berlin and she has completed an enrollment form for a MA-PD plan you represent. You notice that her handwriting is illegible and as a result, the spelling of her street looks incorrect. She asks you to fill in the corrected street name. What should you do? a. You may correct the information since it was a simple mistake. You do not need to do anything further to the application form. Incorrect b. Under no circumstances may you make correctionsto information a beneficiary has provided. Review of enrollment forms is the sole responsibility of the plan sponsor. Incorrect c. You may correct the information, but she will need to write a briefstatement indicating she authorized you to make the change. Incorrect d. You may correct this information as long as you add your initials and date next to the correction Correct 5. Mrs. Johnson calls to tell you she has not received her new plan ID card yet, but she needs to see a doctor. What can she expect to receive from the plan after the plan has received her enrollment form? a. A $20 gift certificate thanking her for enrolling. Incorrect b. Evidence of plan membership, information on how to obtain services, and the effective date of coverage. Correct c. A solicitation for friends who might be interested in enrolling in the plan, with a postcard for her to list their names, addresses, and phone numbers. Incorrect d. She will not receive anything from the plan until her ID card arrives, so she should not expect the plan to cover her medical needs until then. Incorrect 6. Mr. Garcia was told he qualifies for a Special Enrollment Period (SEP), but he lost the paper that explains what he could do during the SEP. What can you tell him? a. If the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage. Correct b. If the SEP is for Part D coverage, he may only drop, but not add or change, his Part D coverage one time before the SEP expires. Incorrect c. He may only use the SEP to disenroll from his MA plan and return to Original Medicare. Incorrect d. If the SEP is for MA coverage, he may make as many changes to his MSA enrollment as he wants and the last choice made before the end of the SEP period will be the effective one. Incorrect 7. Mr. and Mrs. Nunez attended one of yoursales presentations. They’ve asked you to come to their home to clear up a few questions. During the presentation, Mrs. Nunez feels tired and tells you that her husband can finish things up. She goes to bed. At the end of your discussion, Mr. Nunez says that he wants to enroll both himself and his wife. What should you do? a. Legalspouses can sign enrollment formsfor one another under federal law. You may enroll both Mr. and Mrs. Nunez, as long as her husband signs on her behalf Incorrect b. You can countersign Mrs. Nunez’ application, along with her husband, indicating that she approved this choice verbally. This witness signature is sufficient to make the enrollment valid. Incorrect c. You should sign the form for Mrs. Nunez yourself,since she informed you, asthe plan’srepresentative, that she wanted to enroll. Incorrect d. As long as she is able to do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will have to wake up to sign her form or do so at another time. Correct 8. Mrs. Valentino is currently enrolled in a Medicare Cost plan. This plan is no longer meeting her needs, but it is now mid-year and past the annual election period (AEP). What would you say to Mrs. Valentino regarding her options? a. Mrs. Valentino must remain enrolled in the Medicare Cost plan until the next AEP. Incorrect b. Mrs. Valentino can call Medicare, request to be disenrolled from the Cost plan, and enroll in Original Medicare. Incorrect c. Mrs. Valentino qualifiesfor a special enrollment period, which will allow her to immediately enroll in a MA-PD plan of her choice. Incorrect d. Mrs. Valentino can submit a written request to Medicare to be disenrolled from the Cost plan and enroll in Original Medicare. Correct 9. Mrs. Disraeli is enrolled in Original Medicare (Parts A and B) and a standalone Part D prescription drug plan. She has recently developed diabetes and has suffered from heart disease for several years. She has also recently learned that her area is served by a SNP for individuals suffering from such a combination of chronic diseases (C-SNP). Mrs. Disraeli is concerned however, that she will have few rights or protections if she enrolls in a C-SNP. How would you respond? a. The SNP would select her primary care provider (PCP) but she could file a grievance within 90 days if the PCP proved incapable. Incorrect b. Enrollees in SNPs must have access to provider networks that include enough doctors, specialists, and hospitals to provide all covered services necessary to meet enrollee needs within reasonable travel time. Correct c. Enrollees, while able to select their primary care provider (PCP), do have substantial restrictions and financial responsibilities regarding emergency care whether obtained at in-network or out-of-network facilities. Incorrect d. Mrs. Disraeli would have substantial restrictions on obtaining emergency care and must use network facilities or be responsible for most emergency care costs. 10. If Mr. Johannsen gains the Part D low-income subsidy, how does that affect his ability to enroll or disenroll in a Part D plan? a. He qualifies for a special enrollment period and can enroll in or disenroll from a Part D plan and the subsidy will apply to the plan he chooses. Correct b. The subsidy will become effective next year when he can enroll in a different plan or disenroll from his current plan during the next Annual Election Period. Incorrect c. He can only enroll in or disenroll from an MA-PD plan. Incorrect d. He can apply the subsidy amount to his existing plan immediately, but he cannot enroll in a different plan. Incorrect 1 Marks: 1 Mr. Torres has a smallsavings account. He would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his savings account until it is exhausted, and then have his premiums withheld from his Social Security check. What should you tell him? Choose one answer. a. As long as he fills out the paperwork to begin withholding from his Social Security check at least 63 days before such withholding should begin, he can change his method of Part D premium payment and withholding will begin the month after his savings account is exhausted. b. During 2017, many people experienced significant problems with deductions from their Social Security check for their Part D premium. As a result, this method of payment is no longer an option for Part D premium payments c. In general, to pay his Part D premium, he only can have automatic withdrawals made from a checking account, so he will need to transfer the funds prior to beginning such withdrawals. d. In general, he must select a single Part D premium payment mechanism that will be used throughout the year. Question2 Marks: 1 Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He wantsto know whether he might qualify. What should you tell him? Choose one answer. a. The government pays a per-beneficiary dollar amount to the Medicare Part D prescription drug plans, to offset premiums for their low-income enrolleesin accordance with the plan’sset criteria. Mr. Shapiro should check with his plan to see if he qualifies. b. He must apply for the extra help at the same time he applies for enrollment in a Part D plan. If he missed this opportunity, he will not be able to apply for the extra help again until the next annual enrollment period. c. The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. d. The extra help is available only to Medicare beneficiaries who are enrolled in Medicaid. He should apply for coverage under his state’s Medicaid program to access the extra help with his drug costs. Question3 Marks: 1 Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. What should you tell him? Choose one answer. a. Medigap policies designed to cover costs not paid for by an MA plan can be purchased, but only if the MA plan’s design is considered to be the “defined standard benefit.” b. Medigap plans that cover costs not paid for by an MA plan are available only in Massachusetts, Minnesota, and Wisconsin. c. Medigap plans are a form of Medicare Advantage, so purchasing both would be redundant coverage. d. It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original Medicare. Question4 Marks: 1 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? Choose one answer. a. All beneficiaries enrolled in an MSA pay a plan premium in addition to their Part B premium. b. 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. c. For enrollees in an MSA, after the annual deductible is met, the MSA plan generally pays 75% of covered services. d. MSA enrollees may only receive covered health care services from a limited panel of network providers because otherwise some providers may charge more than Original Medicare rates. Question5 Marks: 1 You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. The hospital administration expressessome hesitation about allowing marketing in a health care facility. What should you tell them? Choose one answer. a. Marketing in health care facilities is an acceptable practice, regardless of where it takes place. b. So long as the hospital or its physician staff don’t object, marketing anywhere in the hospital is an acceptable practice. c. Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving or waiting to receive health care. d. As long as the marketing activities are conducted in a way that does not target healthy beneficiaries, it does not matter where in the hospital these activities are carried out. Question6 Marks: 1 Next week you will be participating in your first “educational event” for prospective enrollees. In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage? Choose one answer. a. You should plan to conductsales presentations but must not accept enrollment forms. b. You should plan to ensure that the educational event is a social event, and must not conduct a sales presentation or distribute or accept enrollment forms at the event. c. You should plan to conductsales presentations and accept enrollment forms d. You should plan to answer questions and accept enrollment forms. Question7 Marks: 1 Ms. Bushman hastwo homes in different states and is concerned about restrictions on where she can get her medications. What should you tell her? Choose one answer. a. Part D prescription drug plans focus almost entirely on mail order with fairly limited access to retail pharmacies, so as long as she orders all of her medications through the mail, she will be fine. b. Part D prescription drug plans generally contract with every pharmacy in the country, so she should be able to obtain her drugs in both states with no problem. c. Part D prescription drug plans are restricted to localservice areas. She will have to use mail order to fill all of her prescriptions. d. Part D prescription drug plans use networks of pharmacies within their service areas. She could look for a plan that maintains a network in both states. Question8 Marks: 1 Richard is a licensed agent who represents Spartan Health Plan and its Medicare Advantage (MA) plans. Richard has several clients who have recently come to him for help who are in their initial coverage election period (ICEP) and are interested in enrolling in one of Spartan Health Plan's MA plans. Alice will soon turn 65 and retire. Alice has coverage through Spartan Health Plan offered by her employer. Bob had health coverage through Spartan but dropped the coverage when he retired early to travel overseas. Bob, who has just turned age 65, is now back in the United States. Charlotte, who will turn 65 next month, has coverage through Athena Health plan – a company Richard also represents. Who qualifiesfor the opt-in simplified enrollment mechanism? Choose one answer. a. Alice and Charlotte because each of them currently have health coverage and is in their initial coverage election period (ICEP). b. Alice because she will not have a break between her non-Medicare and Medicare coverage through Spartan Health Plan. c. Alice, Bob, and Charlotte because electronic health record interoperability will allow Richard to access any needed information for their applications. d. Alice and Bob because each of them has had coverage through Spartan Health Plan. Question9 Marks: 1 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 requirements as the plans themselves. How should you respond to such a statement? Choose one answer. a. Your coworker is correct because employed agents have to follow a stricterset of rules than do independent agents, such as yourself. b. Your coworker is correct. You may use any marketing techniquesthat do not involve providing misinformation to potential enrollees. c. Your coworker is correct. You are subject only to requirementsissued by yourstate department of insurance. d. Your coworker is not correct. Marketing on behalf of a plan is considered marketing by the plan and requiresthat all contracted and employed agents comply with all Medicare marketing rules. Question10 Marks: 1 Mr. Cole has been a Medicaid beneficiary for some time, and recently qualified for Medicare as well. He is concerned about changes in his cost-sharing. What should you tell him? Choose one answer. a. Medicaid will cover his cost-sharing, regardless of from which physician or hospital he receives his Medicare-covered services. b. He should know that Medicaid will pay cost sharing only for services provided by Medicaid participating providers. c. Medicaid will no longer pay any cost sharing once he is eligible for Medicare, so he will need to rely only on Medicare providers. d. For Medicaid beneficiaries, Medicare reduces its cost-sharing amounts to match those charged by the state Medicaid program so there will be no change in his cost-sharing amounts. Question11 Marks: 1 Which of the following statement is correct about a Medicare Savings Account (MSA) Plans? I. MSAs may have either a partial network, full network, or no network of providers. II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits . III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of $500 indexed for inflation. IV.Non-network providers must accept the same amount that Original Medicare would pay them as payment in full. Choose one answer. a. II and III only b. I, II, and IV only c. I, II, and III only d. I and II only Question12 Marks: 1 Ms. Brooks has an aggressive cancer and would like to know if Medicare will cover hospice services in case she needs them. What should you tell her? Choose one answer. a. The Federal government facilitates competition between hospice programs to lower the price of their services for Medicare beneficiaries, but does not offer coverage for hospice services through the Medicare program. b. Medicare does not cover hospice services. Hospice services are only available through state Medicaid programs, if the state offers such coverage. c. Hospice services are currently only offered under a limited demonstration project. Whether they will eventually become available nationally depends on the outcomes of the demonstration. d. Medicare covers hospice services and they will be available for her. Question13 Marks: 1 Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS) plan. What questions would you need to ask to determine his eligibility? Choose one answer. a. You would need to ask Mr. Kelly if he is enrolled in Part A and Part B, if he is healthy, and how often he expects to visit a doctor. b. You would need to ask Mr. Kelly if he is enrolled in Part A and Part D and if he needs drug coverage. c. You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PFFS plan’s service area. d. You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if his doctor will accept the terms and conditions of payment of the PFFS plan Question14 Mr. Wong is a single individual. He has had a successful business career and is now able to retire with a comfortable income. Mr. Wong'staxable income isin excess of $100,000. Mr. Wong has health coverage through his employer but will sign-up Medicare Part A, Part B and Part D when he leaves the workforce. How would you advise him as he budgets for Medicare premiums? a. Due to his participation in the workforce he will not have to pay premiums for Part A and will pay reduced premiums for Part B and Part D. b. Due to his participation in the workforce he will not have to pay premiums for Part A and he will pay the lowest monthly premium rates for Part B and Part D. c. Due to his participation in the workforce he will not have to pay premiums for Part A but he will pay higher premiums for Part B and Part D due to the amount of his income. d. Due to the provisions of MACRA, his Part B and D coverage will be combined and covered through a low-cost Medigap policy to supplement his Part A coverage. Question15 Mr. Garrett hasjust entered his MA Initial Coverage Election Period (ICEP). What action could you help him take during this time? a. He will have one opportunity to enroll in a Medicare Advantage plan. b. He will have a three month period during which he may enroll in as many Medicare Advantage plans as he chooses, with the last enrollment being the effective one. c. He may change or drop MA plans, but may not drop drug coverage. d. If he has a disability, he may enroll in Original Fee-for-Service Medicare during the MA Initial Coverage Election Period. Question16 Marks: 1 Mr. Wellsistrying to understand the difference between Original Medicare and Medicare Advantage. What would be the correct description? Choose one answer. a. Medicare Advantage is a way of covering all the Original Medicare benefitsthrough private health insurance companies. b. Medicare Advantage is designed to pick up where Original Medicare leaves off, covering those health care services that would not normally be covered by Original Medicare. c. Medicare Advantage is a new name for the Original Medicare program. d. Medicare Advantage is a health insurance program operated jointly by the states with the Federal government. Question17 Marks: 1 Able, Baker, and Charles are engaged in the marketing to and enrollment of beneficiaries into Medicare health plans. Mr. Able is an independent agent paid directly by a health plan. Ms. Baker is an independent agent paid through a field marketing organization (FMO). Mr. Charles is an independent agent paid for his work by a third-party marketing organization (TMO). How do the CMS compensation rules apply to these three agents? Choose one answer. a. Baker and Charles are subject to CMS compensation rules because they are paid by third parties. Able is not because he is paid directly by a health plan. b. Charles is subject to CMS compliance rules because he works for a TMO and CMS applies an extra layer of scrutiny to such organizations. Able and Baker are not. c. All three are treated as independent agents under CMS compensation rules. d. Able is subject to CMS compensation rules because he is paid directly by a health plan. Agents Baker and Charles are not because they are paid by third parties. Question18 Marks: 1 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? Choose one answer. a. You can make unsolicited contacts but you cannot cross-sell other products. b. 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. c. You do not need to take an annual test, but you must not provide potential enrollees with more than light snacks at presentations. d. You do not need to complete a scope of appointment, but CMS can ask you to reconstruct one if there is a subsequent employee complaint. Question19 Marks: 1 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 Tom Smith tell Mr. Moreno about the kinds of food that can be provided to potential enrollees who attend the sales presentation? Choose one answer. a. A meal cannot be provided, but light snacks would be permitted. b. Any type of meal or food is allowed, as long as it is available to the general public and not just those who are eligible to enroll in the plans. c. Any meal is allowed, as long as it is valued at less than $15. d. Nothing may be provided to eat or drink during the sales presentation. Question20 Marks: 1 Mr. Wendt suffers from diabetes which has gotten progressively worse during the last year. He is currently enrolled in Original Medicare (Parts A and B) and a Part D prescription drug plan and did not enroll in a Medicare Advantage (MA) plan during the last annual open enrollment period (AEP) which has just closed. Mr. Wendt has heard that there are certain MA plans that might provide him with more specialized coverage for his diabetes and wants to know if he must wait until the next annual open enrollment period (AEP) before enrolling in such a plan. What should you tell him? Choose one answer. a. If there is a special needs plan (SNP) in Mr. Wendt’s area that specializes in caring for individuals with diabetes, he may enroll in the SNP at any time under a special enrollment period (SEP). b. As long as there is a special needs plan (SNP) specializing in diabetes within 500 miles of Mr. Wendt’s residence, he can enroll in the SNP at any time under a special enrollment period (SEP). c. Mr. Wendt must wait until the next annual open enrollment period (AEP) before he can enroll in a special needs plan (SNP). d. If there is a special needs plan (SNP) in Mr. Wendt’s area that specializes in caring for individuals with diabetes, he may enroll in the SNP during the MA Open Enrollment Period which takes place between January 1 and March 31. Question21 Marks: 1 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? Choose one answer. a. The card is indeed a forgery since newly issued Medicare cards will have both a beneficiary’s Social Security number and date of birth imprinted on them. b. 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. c. The card is indeed a forgery since all identity cards are being phased out in favor of a new electronic identity system developed by the Social Security Administration. d. The card she received is valid but she should keep her old card for at least two years and present it whenever she receives health care. Question22 Marks: 1 Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritisthrough acupuncture. She is concerned about whether or not Medicare will cover these items and services. What should you tell her? Choose one answer. a. Medicare covers 80% of the cost of these three services. b. Medicare covers glasses, but not dentures or acupuncture. c. Medicare does not cover acupuncture, or, in general, glasses or dentures. d. Medicare covers 50% of the cost of these three services. Question23 Marks: 1 Mr. Jackson just turned 65. He has been seeing the same general practitioner for annual check-ups for the past 15 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? Choose one answer. a. He can have as many preventive physical exams as he feels that he needs. They will all be covered by Medicare. b. Medicare will cover an annual wellness visit, even if he has no illnesses or injuries. c. Physical exams, in the absence of readily observable illness or injury, are never covered under any circumstances. d. Medicare will cover only a one-time “Welcome to Medicare” wellness visit. Question24 Marks: 1 Ms. Stuart has heard about a special needs plan (SNP) that one of her friends is enrolled in and is interested in that product. She wants to be sure she also has coverage for prescription drugs. Would she be able to obtain drug coverage if she enrolled in the SNP? Choose one answer. a. Yes, but only ifshe qualifiesfor Part D prescription drug coverage under herstate Medicaid program. b. Maybe. Some SNPs offer Part D coverage for prescription drugs and some do not. c. Yes. All SNPs are required to provide Part D coverage for prescription drugs. d. No. Medicare beneficiaries who enroll in an SNP must always obtain their drug coverage through a stand-alone Part D Medicare prescription drug plan that they sign up for independent of their enrollment in the SNP. Question25 Marks: 1 What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? Choose one answer. a. Part D plans do not have to cover all medications. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. b. The Federal government establishes a set formulary, or list of covered drugs, each year that the Part D plans must use. Beneficiaries should consult the government’s list prior to deciding whether they wish to enroll in a Part D plan during that year. c. Part D plans may use varying co-payments, but they are required to cover all prescription medications on the market. d. Part D plans may use varying co-payments for brand name and generic drugs, but they may not restrict access through prior authorization. Question26 Marks: 1 Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug coverage. She would like to keep the coverage she has but replace her existing Medigap plan with one that provides drug coverage. What should you tell her? Choose one answer. a. Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug plan. b. Mrs. Gonzalez should purchase a K or L Medigap plan. c. Mrs. Gonzalez can purchase a Medigap plan that covers drugs, but it likely won’t offer coverage that is equivalent to that provided under Part D. d. Medigap is a replacement for Original Medicare and she has been paying for double coverage. She should simply drop her Medigap policy. Question27 Marks: 1 Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs. Davenport have in regard to her MA plan during the next open enrollment season? Choose one answer. a. She must immediately drop her ABC MA plan and enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. b. She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. c. She must remain enrolled in her ABC MA plan unless the plan terminates. d. She must immediately drop her ABC MA plan and enroll in Original Medicare. Question28 Marks: 1 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? Choose one answer. a. Medicare prescription drug plans are required to include only a certain percentage of brand name drugs among those they cover. It may be possible that plans available in her area have opted not to include in their formularies the brand name drugs she needs. She may need to pay for this particular medication out of pocket. b. Medicare prescription drug plans are allowed to restrict their coverage to generic drugs. She will need to pay for her brand name medications out of pocket. c. 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. d. When medication costs exceed a certain threshold amount, which rises each year, a Medicare prescription drug plan is permitted to exclude coverage for all but the least expensive of the medications in a given category. Mrs. Allen will need to encourage her physician to prescribe the least expensive of the two alternatives. Question29 Marks: 1 Who is most likely to be eligible to enroll in a Part D prescription drug plan? Choose one answer. a. Mr. Charles, an undocumented immigrant, entered the country illegally. b. Ms. Adams, a healthy early retiree who has just begun to collect Social Security at age 62. c. Ms. Bradley is currently living abroad for a multi-year job assignment. d. Ms. Davis who recently turned age 65 and is eligible for Part A and has just enrolled in Part B. Question30 Marks: 1 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? Choose one answer. a. No, he cannot execute the enrollment for her. Only Ms. Duarte can sign the form, regardless of her mental capacities. b. Yes, he can execute the enrollment for her. A financial power of attorney issufficient. c. Yes, he can execute the enrollment for her. He can do so because he is an immediate family member. No power of attorney is necessary. d. 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. Question31 Marks: 1 Mr. Chen has heard about a Medical Savings Account (MSA), but wants to know if it is just about saving money, or if he will get insurance coverage for his health care expenditures as well. What should you tell him? Choose one answer. a. Under the Medicare Advantage program, a MSA plan involves the combination of a high deductible health plan and a savings account for health expenses. Medicare will make contributions to this savings account to help him pay his health care expenses while in the deductible. b. Under the Medicare Advantage program, the MSA is only an account to help him pay for IRSallowed health expenditures he may have. It does not involve health insurance of any kind. c. Under the Medicare Advantage program, the MSA plan is a form of prescription drug coverage. d. Under the Medicare Advantage program, the MSA is funded by money he sets aside each year. If he does not use it all on IRS allowable health care expenditures then he will lose the money the following year. Question32 Marks: 1 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? Choose one answer. a. Original Medicare and PFFS plans are essentially the same thing. b. PFFS plans are a type of Medicare Advantage plan offered by private companies. c. PFFS is a form ofsupplemental coverage that fills in the gaps where Original Medicare leaves off. d. PFFS plans primarily cover drugs that Original FFS Medicare does not cover. Question33 Marks: 1 You have decided to focus on doing in-home presentationsto market the Medicare Advantage (MA) plans you represent. Before you conduct such sales presentations, what must you do? Choose one answer. a. A proper introduction at the door that includes a disclaimer regarding your relationship with the plan you represent is the only required action you must take, prior to entering the beneficiary’s home. b. 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. c. You must first contact the Medicare agency to ensure that the individual is actually a Medicare beneficiary. d. There is no special action that you must take. If they choose, you may go to an individual’s house to provide presentations and offer assistance with enrolling in a plan. Question34 Marks: 1 Ms. Lewis understands that Medicare prescription drug plans may use various methods to control the use of specific drugs. She has heard about a technique called “step therapy” and is wondering if you can explain what that is. What should you tell her? Choose one answer. a. Step therapy involves slow changes in the dosages of a given drug in order to discover the correct amount. b. Step therapy involves using one or more lower priced drugs before trying a more expensive drug when all are used to treat the same condition. c. Step therapy refers to incentives plans can provide to enrollees to engage in regular walking in order to reduce their need for medications treating heart and cholesterol problems. d. Step therapy involvestaking somewhat larger doses but skipping every other day, resulting in lower overall consumption of the drug. Question35 Marks: 1 Agent Willis had several clients who disenrolled from the plans he represents during the AEP to try new Medicare Advantage plans. Agent Willis believes that the choices they made are not ideal for them and would like to get their business back during the Medicare Advantage Open Enrollment Period (MA-OEP). What can agent Willis do? Choose one answer. a. He can send them information about the MA-OEP along with a flyer on the plans he represents. b. He can wait until October and send them information about the plans he represents. c. He can e-mail them in January and ask them to let him know if they are not happy with their new plans. d. He can call them to let them know that if they do not like their new plans, they can change back during the MA-OEP. Question36 Marks: 1 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. Lopezreturns 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? Choose one answer. a. Ms. Lopezis considered a marketing representative of BestCare but is exempt from the marketing rules regarding approved call scripts because she works directly for MarketCo. b. Ms. Lopez no longer needsto be concerned about state licensure since she is marketing an MA product subject to federal rules. c. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to comply with CMS marketing requirements, including those regarding using only approved callscripts. d. Ms. Lopez needs to maintain state licensure, but because she is working for a third-party marketing organization she is exempt from CMS training requirementsthat apply to BestCare captive agents. Question37 Marks: 1 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 also enroll in, without being automatically disenrolled from the stand-alone prescription drug plan? Choose one answer. a. The beneficiary could only stay in a stand-alone prescription drug plan if he orshe has original fee-for-service Medicare b. 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 c. The beneficiary could only choose an 1876 Cost Plan. d. The beneficiary could only choose a Medicare Medical Savings Account (MSA) plan. Question38 Marks: 1 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? Choose one answer. a. You may provide her with the required enrollment materials and take her completed enrollment application. b. You may leave an enrollment kit and discuss a new life insurance product she might like. c. You may leave enrollment kits for several MA plans and offer to discuss a Medigap and Part D prescription drug plan she might like. d. 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. Question39 Marks: 1 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? Choose one answer. a. The POS option will allow him to visit out-of-network providers and generally the plan must provide the same level of cost sharing as if he went to in-network providers. b. The POS option is only to allow him to visit in-network specialists without a referral. He will have no coverage if he goes out-of-network. c. The POS option refers to a method of processing claims in real time so that Mr. Polanski will be able to finalize his bill at the point of service with the provider, rather than waiting for the plan to mail him statements several weeks later. It does not have anything to do with his ability to access out-ofnetwork providers. d. 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. Question40 Marks: 1 Mr. Lopez, who isfairly well-off financially, would like to enroll in a Medicare prescription drug plan you represent and simply give you a check to cover his premiums for the entire year. What should you tell him? Choose one answer. a. Thisis perfectly acceptable. You will be happy to forward his payment to the plan. b. You can take his first payment, but after that, he will need to make arrangementsto send his monthly premium payment to the plan. c. He will need to mail in his payment with his enrollment form. d. Enrollees should pay using automatic withdrawal from a bank account or credit or debit card, direct monthly billing from the plan, or deductions from their Social Security check. Question41 Marks: 1 Mr. Robinson was quite ill recently and forgot to pay his monthly premium for his MA-PD plan. He is worried that he will lose his coverage now when he needs it the most. He is certain his plan will disenroll him because that is what happened to a friend of his in a similar type of plan. What can you tell Mr. Robinson about hissituation? Choose one answer. a. Plan sponsors must disenroll members who do not pay their premiums, but he will have a special enrollment period to sign up for a different MA-PD plan. b. Plan sponsors have the option to disenroll members who do not pay their premiums, but they must first provide each member with a grace period of not less than 2 months. c. Plan sponsors must disenroll members who do not pay their premiums, but they have the discretion to make exceptions for certain members, so he should ask for an exception for this special circumstance. d. Plan sponsors have the option to disenroll members, but if they choose to do so, they must act immediately and cannot permit a grace period. Question42 Marks: 1 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? Choose one answer. a. Plans are required to cover out-of-network emergency care only if she has the ambulance driver or ER doctor call her plan for approval prior to receiving emergency services. b. Plans are required to cover at least 20% of the cost of out-of-network emergency care. c. Plans are required to cover out-of-network emergency care. d. Plans are required to cover all chargesfor in-network emergency care, but coverage of out-ofnetwork emergency care is not required. Question43 Marks: 1 Ms. Henderson believes that she will qualify for Medicare coverage when she turns 65, without paying any premiums, because she has been working for 40 years and paying Medicare taxes. Whatshould you tell her? Choose one answer. a. She is correct because she will be covered under Part A, without paying premiums and she has worked for 40 years so she will not have to pay Part B premiums. b. She is correct that she will not have to pay a premium because State programs cover the cost of Part B premiums for all Medicare beneficiaries. c. Medicare beneficiaries only pay a Part B premium if they are enrolled in a Medicare Advantage plan. d. In order to obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. Question44 Marks: 1 Medicare health plans establish provisionsin marketing representative contractsto ensure compliance with applicable laws and policies. If non-compliance occurs, CMS can penalize a plan in which of the following ways? Choose one answer. a. CMS cannot penalize the plan sponsor for marketing representative non-compliance. That is the role of the state. b. CMS requires plan sponsors to publish in local newspapers the names and misdeeds of the marketing representatives who have not complied with the terms of their contracts, so that potential clients can know whom to avoid. c. CMS requires the dismissal of senior plan management. d. CMS requires plan sponsors to create and complete a corrective action plan and may terminate a sponsor’s contract. Question45 Marks: 1 Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from hisinvestments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. What should you tell him? Choose one answer. a. SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. b. SNPs only serve individuals eligible for both Medicaid and Medicare, so he cannot enroll. c. SNPs only serve individuals in long-term care facilities,so he cannot enroll. d. SNPs do not provide Part D prescription drug coverage, so if he does enroll, he should be aware that he will not have coverage for any medications he may need now or in the future. Question46 Marks: 1 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? Choose one answer. a. She may do it only during the MA Disenrollment Period, which runs from January 1 to February 14 of each year. b. 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- March 31 of each year (beginning in 2019). c. She may only make such a change during her “initial coverage election period,” which occurred when she first became entitled to Medicare. d. Any time thatshe is dissatisfied with the plan’s network coverage or customer service she may make such a change. Question47 Marks: 1 Mrs. Tanner is enrolled in a Medicare Advantage HMO that offers a point ofservice option. This allows Mrs. Tanner to do which of the following? Choose one answer. a. Mrs. Tanner can go to non-plan doctors without receiving prior approval for allservices. b. Mr. Tanner can go to non-network doctors without worrying about a cap on the amount of out-of-network services she may receive. c. Mrs. Tanner can go to non-plan doctors knowing that cost sharing will generally be the same as with network providers. d. Mrs. Tanner can go to non-plan doctors for certain services without receiving prior approval. Question48 Marks: 1 Mr. Perry is entitled to Medicare Part A but has not yet enrolled in Part B, even though he is 69 years old. He would like to enroll in a Medicare Part D prescription drug plan but is concerned that he will have to sign up for Part B as well in order to qualify for enrollment in a Part D plan. What should you tell him? Choose one answer. a. He will have to enroll in Part B before he can enroll in a Part D prescription drug plan. b. He does not have to enroll in Part B but, must pay a penalty for his failure to do so when he first turned 65. After that, he can enroll in a Part D prescription drug plan. c. He need not be entitled to Part A or enrolled in Part B to be eligible for the Part D prescription drug benefit. He must only be aged 65 to qualify for enrollment in Part D, so he can go ahead and enroll in a Part D prescription drug plan. d. He is eligible for the Part D prescription drug benefit because he is entitled to Part A and he does not have to be enrolled in Part B. Question49 Marks: 1 Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA), not by the government. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. What should you tell him? Choose one answer. a. Mr. Carlini can obtain drug coverage through the Federal government’sfallback plans, which are designed to provide an alternative to privately sponsored Medicare Advantage plans. b. In order to obtain prescription drug coverage, Mr. Carlini must enroll in an MA plan. The plan will cover his Part A and Part B services, as well as provide him with the desired prescription drug coverage. c. Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan through a private company that has contracted with the government to provide only such drug coverage to eligible Medicare beneficiaries. d. Mr. Carlini can keep Original Medicare, but if he does not sign up for an MA plan that includes prescription drug coverage, he will only be able to obtain prescription drug coverage through a Medigap plan. Question50 Marks: 1 Mary Samuels recently suffered a stroke while visiting her daughter and grandchildren. As a result, Mary has been admitted to a rehabilitation hospital where she is expected to reside for several months. The rehabilitation hospital is located outside the geographic area served by her current Medicare Advantage (MA) plan. What options are available to Mary regarding her health plan coverage? Choose one answer. a. Mary may enroll in another MA plan coupled with a Medigap plan under the special enrollment period available to institutionalized individuals. b. Mary may make one change to either Original Medicare or another MA under the special enrollment period available to institutionalized individuals. c. Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan. d. Mary’s only option in this situation is to return to Original Medicare.