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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? - Correct Answers-Agent Armstrong needs to be licensed and appointed in every state in
which beneficiaries to whom he markets ABC MA plans are located.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings
distributes materials that are solely educational in nature. However, she gives a brief presentation that
mentions plan-specific premiums. Is this a prohibited activity at an event that has been advertised as
educational? - Correct Answers-Yes. When an event has been advertised as "educational," discussing
plan-specific premiums is impermissible.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice
as to whether this is possible. What should you tell her? - Correct Answers-Marketing representatives
may initiate electronic contact through e-mail but the subject line must say "marketing" and an opt-out
process must be provided.
Alice is enrolled in a MA-PD plan. She makes a permanent move across the country and wonders what
her options are for continuing MA-PD coverage. What would you say to her in regard to a special
enrollment period (SEP)? - Correct Answers-She is likely to qualify for a SEP. She can choose an
effective date of up to three months after the month in which the enrollment form is received by the new
plan, but the effective date may not be earlier than the date of her permanent move.
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? - Correct Answers-Your coworker is not correct.
Marketing on behalf of a plan is considered marketing by the plan and requires that all contracted and
employed agents comply with all Medicare marketing rules.
During a sales presentation, your client asks you whether the Medicare agency recommends that she sign
up for your plan or stay in Original Medicare. What should you tell her? - Correct Answers-Tell her
that the Medicare agency does not endorse or recommend any plan.
Mr. and Mrs. Nunez attended one of your sales 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? - Correct Answers-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.
, Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would
have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD
coverage has been very good. However, when he received the bill, he was surprised to see large charges
in excess of his maximum out-of-pocket limit that included a number of services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell him? - Correct
Answers-You can offer to review the plans appeal process to help him ask the plan to review the coverage
decision.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D
Prescription Drug program and he is wondering if there is any other option he has for obtaining help with
his considerable drug costs. What should you tell him? - Correct Answers-He could check with the
manufacturers of his medications to see if they offer an assistance program to help people with limited
means obtain the medications they need. Alternatively, he could check to see whether his state has a
pharmacy assistance program to help him with his expenses.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying
his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll in a Medicare
Advantage (MA) plan and is still covered by Part A. What should you tell him? - Correct Answers-He
is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.
Mr. Chen has heard about 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? - Correct Answers-Under the Medicare Advantage program. an MSA plan involves the
combination of high deductible health plan and 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.
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He would like to know
his options since he has decided to drop his retiree coverage and is eligible for Medicare. What should
you tell him? - Correct Answers-Mr. Chen can disenroll from his employer-sponsored coverage to
elect a Medicare Advantage or Part D plan within 2 months of his disenrollment, but he should revaluate
if he really wants to drop his employer coverage.
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? - Correct Answers-He
should know that Medicaid will pay cost sharing only for services provided by Medicaid participating
providers.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will
soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell
him? - Correct Answers-He may sign-up for Medicare at any time however coverage usually begins
on the fourth month after dialysis treatments start.
Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he
looks at information on various plans available in his area, he sees a wide range in what they charge for
deductibles, premiums and cost sharing. How can you explain this to him? - Correct Answers-
Medicare Part D drug plans may have different benefit structures, but on average, they must all be at least
as good as the standard model established by the government.
Questions and Answers Key Download
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? - Correct Answers-Agent Armstrong needs to be licensed and appointed in every state in
which beneficiaries to whom he markets ABC MA plans are located.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings
distributes materials that are solely educational in nature. However, she gives a brief presentation that
mentions plan-specific premiums. Is this a prohibited activity at an event that has been advertised as
educational? - Correct Answers-Yes. When an event has been advertised as "educational," discussing
plan-specific premiums is impermissible.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice
as to whether this is possible. What should you tell her? - Correct Answers-Marketing representatives
may initiate electronic contact through e-mail but the subject line must say "marketing" and an opt-out
process must be provided.
Alice is enrolled in a MA-PD plan. She makes a permanent move across the country and wonders what
her options are for continuing MA-PD coverage. What would you say to her in regard to a special
enrollment period (SEP)? - Correct Answers-She is likely to qualify for a SEP. She can choose an
effective date of up to three months after the month in which the enrollment form is received by the new
plan, but the effective date may not be earlier than the date of her permanent move.
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? - Correct Answers-Your coworker is not correct.
Marketing on behalf of a plan is considered marketing by the plan and requires that all contracted and
employed agents comply with all Medicare marketing rules.
During a sales presentation, your client asks you whether the Medicare agency recommends that she sign
up for your plan or stay in Original Medicare. What should you tell her? - Correct Answers-Tell her
that the Medicare agency does not endorse or recommend any plan.
Mr. and Mrs. Nunez attended one of your sales 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? - Correct Answers-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.
, Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would
have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD
coverage has been very good. However, when he received the bill, he was surprised to see large charges
in excess of his maximum out-of-pocket limit that included a number of services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell him? - Correct
Answers-You can offer to review the plans appeal process to help him ask the plan to review the coverage
decision.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D
Prescription Drug program and he is wondering if there is any other option he has for obtaining help with
his considerable drug costs. What should you tell him? - Correct Answers-He could check with the
manufacturers of his medications to see if they offer an assistance program to help people with limited
means obtain the medications they need. Alternatively, he could check to see whether his state has a
pharmacy assistance program to help him with his expenses.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying
his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll in a Medicare
Advantage (MA) plan and is still covered by Part A. What should you tell him? - Correct Answers-He
is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.
Mr. Chen has heard about 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? - Correct Answers-Under the Medicare Advantage program. an MSA plan involves the
combination of high deductible health plan and 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.
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He would like to know
his options since he has decided to drop his retiree coverage and is eligible for Medicare. What should
you tell him? - Correct Answers-Mr. Chen can disenroll from his employer-sponsored coverage to
elect a Medicare Advantage or Part D plan within 2 months of his disenrollment, but he should revaluate
if he really wants to drop his employer coverage.
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? - Correct Answers-He
should know that Medicaid will pay cost sharing only for services provided by Medicaid participating
providers.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will
soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell
him? - Correct Answers-He may sign-up for Medicare at any time however coverage usually begins
on the fourth month after dialysis treatments start.
Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he
looks at information on various plans available in his area, he sees a wide range in what they charge for
deductibles, premiums and cost sharing. How can you explain this to him? - Correct Answers-
Medicare Part D drug plans may have different benefit structures, but on average, they must all be at least
as good as the standard model established by the government.
