Medicare Agent & Broker Certification
Questions And Answers Rated A+.
A prospective beneficiary asks an agent if plan XYZ has an urgent care benefit and if
so, what the benefit includes. Where would the agent find this information for plan XYZ?
- correct answer. Evidence of Coverage
Because the beneficiary asked if plan XYZ has an urgent care benefit and what the
benefit includes.
If the beneficiary only wanted to know if plan XYZ has an urgent care benefit, the
answer would be Summary of Benefits & Evidence of Coverage.
If a beneficiary who is enrolled in an HMO tells you that she wants to see a specialist,
you should tell her: - correct answer. You will likely need a referral from your primary
care physician (PCP) to see a specialist. If you see your specialist without this referral,
the plan may not pay for your visit.
Because the beneficiary is enrolled in an HMO, she should work with her PCP prior to
seeing a specialist (except in an emergency).
True or False?
Once a beneficiary is enrolled in an MA plan and has paid his plan-specific monthly
premium, he no longer needs to pay his Part B premium. - correct answer. False
Beneficiaries are required to continue paying their Part B premium (unless they receive
Extra Help) in addition to any plan-specific premium.
Define: Medicare Part A - correct answer. Part A of Medicare covers hospital inpatient
care, some SNF care, and home health and hospice care
Define: Medicare Part B - correct answer. Part B of Medicare covers physician
services, outpatient hospital care, lab tests, mental health services, some preventative
services, and medical equipment considered medically necessary to treat a disease or
condition
Define: Medicare Part C - correct answer. Part C of Medicare provides an option for
beneficiaries to receive private health plan coverage in lieu of Original Medicare
, Define: Medicare Part D - correct answer. Part D of Medicare provides prescription
drug benefit
Mrs. Doe will turn 65 at the end of March and signed up for an MA plan in January
during her Initial Coverage Election Period (ICEP). When will her coverage begin? -
correct answer. On March 1
The ICEP coverage begins the first day of the month of entitlement to Medicare Part A
and Part B, OR the first of the month following the month the enrollment request was
made (if after entitlement has occurred).
What enrollment period provides an opportunity for a beneficiary to move from Original
Medicare to an MA plan? - correct answer. The Annual Election Period (AEP) for
enrolling in an MA Plan is October 15 through December 7.
The beneficiary is already enrolled in Original Medicare, so there is no Initial Coverage
Election Period (ICEP) that is applicable.
What is the enrollment period for enrolling in an MADP? - correct answer. January 1
through February 14
This period only allows a beneficiary to change from an MA plan to Original Medicare
(with/without a stand-alone PDP).
Which conditions would qualify an MA plan member to switch plans during a Special
Enrollment Period? - correct answer. The member recently moved into a nursing
home
The member's plan was terminated
The member has moved to another state
If an individual moves into, resides in, or moves out of a long-term care facility, such as
a nursing home, he or she is eligible for a SEP. He/She would also be eligible for an
SEP as a result of moving out of the plan's service area or if his/her current plan is
terminated.
During a formal sales event held on October 5, an agent tells attendees, "You can enroll
in Acme's Traditional Medicare Advantage HMO plan between October 15 and
December 7, but the plan won't take effect until January 1. However, if you don't like the
plan after you enroll, you have until March 1 to switch back to Original Medicare."
Following the presentation, the agent assists a couple in filling out an enrollment form
for Acme's Traditional HMO plan, and tells the couple that she will "hold on to it" until
the October 15 enrollment date.
What is inaccurate? - correct answer. The agent is not allowed to accept an
enrollment prior to October 15
The presenter provided incorrect Medicare Advantage Disenrollment Period (MADP)
information
Questions And Answers Rated A+.
A prospective beneficiary asks an agent if plan XYZ has an urgent care benefit and if
so, what the benefit includes. Where would the agent find this information for plan XYZ?
- correct answer. Evidence of Coverage
Because the beneficiary asked if plan XYZ has an urgent care benefit and what the
benefit includes.
If the beneficiary only wanted to know if plan XYZ has an urgent care benefit, the
answer would be Summary of Benefits & Evidence of Coverage.
If a beneficiary who is enrolled in an HMO tells you that she wants to see a specialist,
you should tell her: - correct answer. You will likely need a referral from your primary
care physician (PCP) to see a specialist. If you see your specialist without this referral,
the plan may not pay for your visit.
Because the beneficiary is enrolled in an HMO, she should work with her PCP prior to
seeing a specialist (except in an emergency).
True or False?
Once a beneficiary is enrolled in an MA plan and has paid his plan-specific monthly
premium, he no longer needs to pay his Part B premium. - correct answer. False
Beneficiaries are required to continue paying their Part B premium (unless they receive
Extra Help) in addition to any plan-specific premium.
Define: Medicare Part A - correct answer. Part A of Medicare covers hospital inpatient
care, some SNF care, and home health and hospice care
Define: Medicare Part B - correct answer. Part B of Medicare covers physician
services, outpatient hospital care, lab tests, mental health services, some preventative
services, and medical equipment considered medically necessary to treat a disease or
condition
Define: Medicare Part C - correct answer. Part C of Medicare provides an option for
beneficiaries to receive private health plan coverage in lieu of Original Medicare
, Define: Medicare Part D - correct answer. Part D of Medicare provides prescription
drug benefit
Mrs. Doe will turn 65 at the end of March and signed up for an MA plan in January
during her Initial Coverage Election Period (ICEP). When will her coverage begin? -
correct answer. On March 1
The ICEP coverage begins the first day of the month of entitlement to Medicare Part A
and Part B, OR the first of the month following the month the enrollment request was
made (if after entitlement has occurred).
What enrollment period provides an opportunity for a beneficiary to move from Original
Medicare to an MA plan? - correct answer. The Annual Election Period (AEP) for
enrolling in an MA Plan is October 15 through December 7.
The beneficiary is already enrolled in Original Medicare, so there is no Initial Coverage
Election Period (ICEP) that is applicable.
What is the enrollment period for enrolling in an MADP? - correct answer. January 1
through February 14
This period only allows a beneficiary to change from an MA plan to Original Medicare
(with/without a stand-alone PDP).
Which conditions would qualify an MA plan member to switch plans during a Special
Enrollment Period? - correct answer. The member recently moved into a nursing
home
The member's plan was terminated
The member has moved to another state
If an individual moves into, resides in, or moves out of a long-term care facility, such as
a nursing home, he or she is eligible for a SEP. He/She would also be eligible for an
SEP as a result of moving out of the plan's service area or if his/her current plan is
terminated.
During a formal sales event held on October 5, an agent tells attendees, "You can enroll
in Acme's Traditional Medicare Advantage HMO plan between October 15 and
December 7, but the plan won't take effect until January 1. However, if you don't like the
plan after you enroll, you have until March 1 to switch back to Original Medicare."
Following the presentation, the agent assists a couple in filling out an enrollment form
for Acme's Traditional HMO plan, and tells the couple that she will "hold on to it" until
the October 15 enrollment date.
What is inaccurate? - correct answer. The agent is not allowed to accept an
enrollment prior to October 15
The presenter provided incorrect Medicare Advantage Disenrollment Period (MADP)
information
