Medicare Agent & Broker Certification
Questions & 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?
- 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: - 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. - 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 - ANSWER Part A of Medicare covers hospital inpatient care,
some SNF care, and home health and hospice care
Define: Medicare Part B - 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 - 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 - 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? -
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).
A person who is enrolled in an MSA or an MA-PFFS plan without drug coverage and is
joining a PDP will not be automatically disenrolled from the MSA or MA-PFFS plan. To
disenroll, the beneficiary must call 1-800-MEDICARE or submit a written disenrollment
request to the plan. A person enrolled in any MA coordinated care plan (HMO, PPO), or
an MAPFFS plan that includes drug coverage, who is joining a PDP will be
automatically disenrolled from their current plan upon enrolling in a PDP.
A plan may end an enrollee's membership if... - ANSWER The enrollee is away from the
service area for more than 6 months
The enrollee does not stay continuously enrolled in Medicare Part A or Part B
The enrollee is no longer eligible for the plan's SNP category
A plan may end an enrollee's membership for any of the reasons listed (involuntary
disenrollment), so long as the enrollee is part of a plan for which the rule applies.
True or False?
A state insurance department would like to investigate a sales agent that they suspect is
violating Medicare marketing regulations. The plan does not need to allow the
investigation because the agent is licensed and has followed the guidelines to date -
ANSWER FALSE
Plans must comply with requests from state insurance departments or other state
agencies investigating sales agents licensed by that agency.
Which of the following is NOT considered a plan sales agent?
A. A marketing entity
B. An independent plan agent
C. A member of the plan who speaks highly of the plan
D. A plan broker - ANSWER C. A member of the plan who speaks highly of the plan
Plan sales agents include those employed by the plan itself and those who are
contracted with the plan through direct or downstream contracts. They do not
necessarily have to be an employee of the plan but they must be contracted with the
plan.
True or False?
CMS requires plans to record the names of all attendees attending their plansponsored
marketing/sales events. - ANSWER FALSE
There is no such requirement. On the contrary, any sign-in or attendance sheet
distributed during an event must clearly indicate that providing personal information is
Questions & 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?
- 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: - 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. - 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 - ANSWER Part A of Medicare covers hospital inpatient care,
some SNF care, and home health and hospice care
Define: Medicare Part B - 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 - 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 - 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? -
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).
A person who is enrolled in an MSA or an MA-PFFS plan without drug coverage and is
joining a PDP will not be automatically disenrolled from the MSA or MA-PFFS plan. To
disenroll, the beneficiary must call 1-800-MEDICARE or submit a written disenrollment
request to the plan. A person enrolled in any MA coordinated care plan (HMO, PPO), or
an MAPFFS plan that includes drug coverage, who is joining a PDP will be
automatically disenrolled from their current plan upon enrolling in a PDP.
A plan may end an enrollee's membership if... - ANSWER The enrollee is away from the
service area for more than 6 months
The enrollee does not stay continuously enrolled in Medicare Part A or Part B
The enrollee is no longer eligible for the plan's SNP category
A plan may end an enrollee's membership for any of the reasons listed (involuntary
disenrollment), so long as the enrollee is part of a plan for which the rule applies.
True or False?
A state insurance department would like to investigate a sales agent that they suspect is
violating Medicare marketing regulations. The plan does not need to allow the
investigation because the agent is licensed and has followed the guidelines to date -
ANSWER FALSE
Plans must comply with requests from state insurance departments or other state
agencies investigating sales agents licensed by that agency.
Which of the following is NOT considered a plan sales agent?
A. A marketing entity
B. An independent plan agent
C. A member of the plan who speaks highly of the plan
D. A plan broker - ANSWER C. A member of the plan who speaks highly of the plan
Plan sales agents include those employed by the plan itself and those who are
contracted with the plan through direct or downstream contracts. They do not
necessarily have to be an employee of the plan but they must be contracted with the
plan.
True or False?
CMS requires plans to record the names of all attendees attending their plansponsored
marketing/sales events. - ANSWER FALSE
There is no such requirement. On the contrary, any sign-in or attendance sheet
distributed during an event must clearly indicate that providing personal information is
