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

2022 OVERVIEW of MEDICARE PROGRAM BASICS: CHOICE, ELIGIBILTY, AND BENEFITS MARKETING MEDICARE ADVANTAGE AND PART D PLANS PART 4 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? a. CMS requires the dismissal ofsenior plan management. Incorrect b. CMS requires plan sponsors to create and complete a corrective action plan and may terminate a sponsor’s contract. Correct c. CMS cannot penalize the plan sponsor for marketing representative non-compliance. That isthe role of the state. Incorrect d. 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. Incorrect 2. ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' protected health information (PHI) to market non-health related products such as life insurance and annuities. To do so it must obtain authorization from the enrollees. Which statement best describes the authorization process? a. 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. Incorrect c. The request for authorization may include a briefsynopsis of non-health related content. Incorrect d. Once a plan sends out a written request for consent, a beneficiary can authorize consent by simply failing to reply within 21 days. Incorrect 3. Mr. Lynn, an agent for Acme Insurance, Inc. thinksthat, since state laws are preempted with regard to the marketing of Medicare health plans, he doesn't have much to worry about. What might you, as his colleague, advise him concerning the type of scrutiny he will be under? a. The state sets most requirementsfor marketing Medicare health plans, but each plan has different policies that he must adhere to. Incorrect b. Organizations sponsoring Medicare health plans are responsible for the behavior of their contracted representatives and will be conducting monitoring activities to ensure compliance with all applicable Federal law and guidance and plan policies. Furthermore, state agent licensure laws are not preempted and he must abide by their requirements. Correct c. Organizationssponsoring Medicare health plans are not responsible for enforcing compliance with applicable law and guidance. This job belongs solely to the Medicare agency. Incorrect the website includes a mechanism for an electronic signature that is valid under applicable law. Correct b. Authorization may be obtained by directing a beneficiary to a website to provide consent as long as d. The Medicare agency conducts only complaint-based oversight and he can market the products he represents as he sees fit, as long as he does so in a manner that would be considered ethical by a reasonable lay person. Incorrect 4. You are mailing invitationsto new Medicare beneficiaries for a marketing event. You want an idea of how many people to expect, so you would like to request RSVPs. What should you keep in mind a. You are not permitted to request RSVPs,so you will need to find a different way to estimate how many people are coming. Incorrect b. You may not require RSVPs, but when people arrive, you may require completion of contact information on a sign-up sheet. Incorrect c. You may require RSVPs and an e-mail address so you can follow up in the event of a cancellation. Incorrect d. You may request RSVPs, but you are not permitted to require contact information. Correct 5. You work for a company that has marketed Medigap products for many years. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. What do you need to do with your materials before using them for marketing purposes? a. You do not need to get CMS approval of the materials, so long as the materials are not misleading or materially inaccurate. Incorrect b. You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate. Correct c. Only scripts and marketing practices must be approved by CMS, so you do not need to do anything further with your marketing materials, aslong as you make them available to anyone who attends the marketing event Incorrect d. You need to include a statement that the plans you are marketing are approved by the Centers for Medicare & Medicaid Services and the Department of Health and Human Services. Incorrect 6. You are scheduled to give a sales presentation at a localsenior center. At the beginning of the presentation, which of the following must you do? a. Make sure that those present provide leads. Incorrect b. Explain, in your own words, how the plan you represent compares to other companies’ plans. Incorrect c. Determine whether the beneficiaries present are healthy enough for the plan. Incorrect d. Clearly state that no obligation exists to enroll if a gif t or prize is being provided. Correct 7. 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? a. You should plan to answer questions and accept enrollment forms. Incorrect 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. Correct c. You should plan to conductsales presentations but must not accept enrollment forms. Incorrect d. You should plan to conductsales presentations and accept enrollment forms Incorrect 8. 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 only in the state where ABC Health Plan is headquartered. Incorrect b. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. Correct c. Agent Armstrong needs to be licensed and appointed only in the state where XYZ Agency is headquartered. Incorrect d. Agent Armstrong needs to be licensed and appointed only in his state of residence. Incorrect 9. 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? a. Your coworker is correct. You may use any marketing techniquesthat do not involve providing misinformation to potential enrollees. Incorrect requiresthat all contracted and employed agents comply with all Medicare marketing rules. Correct c. Your coworker is correct. You are subject only to requirements issued by yourstate department of insurance. Incorrect d. Your coworker is correct because employed agents have to follow a stricterset of rules than do independent agents, such as yourself. Incorrect 10. You market many different types of insurance and ordinarily you spend time each evening calling potential clients. To be in compliance with requirementsfor marketing Medicare Advantage and Part D plans, what must you do about contacting potential clients to market those plans? a. As long as you market only health-related products, you can make an initial call to any beneficiary, but then must honor