AHIP
A Medicare beneficiary has walked into your office and requested that you sit down
with her and discuss her options under the Medicare Advantage program. Before
engaging in such a discussion, what should you do? - ANS-You must have her sign a
scope of appointment form, indicating which products she wishes to discuss. You
may then proceed with the discussion
\Agent Higgins helps Mrs. O'Malley to enroll in AB Medicare Advantage (MA) plan
during the Annual Open Enrollment Period. Mrs. O'Malley's effective enrollment date
is January 1st. Subsequently, Mrs. O'Malley disenrolled on February 12th following a
move outside the plan's service area. What impact will this have on Agent Higgins
compensation? - ANS-AB MA plan does not have to recoup Agent Higgins'
compensation because she has moved away from its service area.
\Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during
the Annual Open Enrollment Period. Ralph's effective enrollment date is January 1st.
Ralph disenrolled on February 12th because he did not understand that the plan did
not cover services furnished by several of his longtime providers. Which of the
following statements best describes the impact of Ralph's action upon Agent Lopez's
compensation? - ANS-Agent Lopez's entire compensation must be recouped
because Ralph disenrolled within 3 months of enrollment.
\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? -
ANS-Marketing representatives may initiate electronic contact through e-mail but an
opt-out process must be provided. Correct
\All plans must cover at least the standard Part D coverage or its actuarial
equivalent. What costs would a beneficiary incur for prescription drugs in 2019 under
the standard coverage? - ANS-Standard Part D coverage would require payment of
an annual deductible, 25% cost-sharing up to the coverage gap, a portion of costs
for both generics and brand-name drugs in the coverage gap, and co-pays or
co-insurance after the coverage gap.
\By contacting plans available in your area, you have learned that the plan you
represent has a significantly lower monthly premium than the others. Furthermore,
you see that the plan you represent has a unique benefit package. What should you
do to make sure your clients know about these pieces of information? - ANS-you
may make comparisons between plans if you can support them by studies or
statistical data and such comparisons are factually based
\Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting
him at severe risk for pneumonia. Otherwise, he has no problems functioning. Which
type of SNP is likely to be most appropriate for him? - ANS-C-SNP
\Dr. Elizabeth Brennan does not contract with the PFFS plan but accepts the plan's
terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment.
How much may Dr. Brennan charge? - ANS-Dr. Brennan can charge Mary Rogers
, no more than the cost sharing specified in the PFFS plan's terms and condition of
payment which may include balance billing up to 15 percent of the Medicare rate.
\During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a
5-star rating in customer service and care coordination, and received an overall plan
performance rating of a 4-star, which of the following would be the correct statement
to say to her? - ANS-The Medicare Advantage plan received a 5-star rating in
customer service and care coordination with an overall performance rating of 4-stars.
\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? - ANS-Tell her that the Medicare agency does not endorse or
recommend any plan.
\For which of the following individuals would a Cost Plan be most appropriate? -
ANS-Ms. Baker who is enrolled in Medicare Part B and is willing to continue paying
Part B premiums plus any plan premiums.
\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? - ANS-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.
\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? -
ANS-If the SEP is for MA coverage, he will generally have one opportunity to change
his MA coverage.
\Mr. Rice has coverage for medical services and medications through his employer's
retiree plan. He is considering switching to a Medicare prescription drug plan
because his retiree plan does not cover two important medications. What should he
consider before making a change? - ANS-If Mr. Rice drops his drug coverage
through the retiree plan, he may not be able to get it back and he also may lose his
medical health coverage.
\Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered
by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA)
PPO plan. Later he sees an out-of-network doctor to receive a Medicare covered
service. How much may the doctor collect from Mr. Rivera? - ANS-The doctor may
only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid
program.
\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? - ANS-f 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).
A Medicare beneficiary has walked into your office and requested that you sit down
with her and discuss her options under the Medicare Advantage program. Before
engaging in such a discussion, what should you do? - ANS-You must have her sign a
scope of appointment form, indicating which products she wishes to discuss. You
may then proceed with the discussion
\Agent Higgins helps Mrs. O'Malley to enroll in AB Medicare Advantage (MA) plan
during the Annual Open Enrollment Period. Mrs. O'Malley's effective enrollment date
is January 1st. Subsequently, Mrs. O'Malley disenrolled on February 12th following a
move outside the plan's service area. What impact will this have on Agent Higgins
compensation? - ANS-AB MA plan does not have to recoup Agent Higgins'
compensation because she has moved away from its service area.
\Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during
the Annual Open Enrollment Period. Ralph's effective enrollment date is January 1st.
Ralph disenrolled on February 12th because he did not understand that the plan did
not cover services furnished by several of his longtime providers. Which of the
following statements best describes the impact of Ralph's action upon Agent Lopez's
compensation? - ANS-Agent Lopez's entire compensation must be recouped
because Ralph disenrolled within 3 months of enrollment.
\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? -
ANS-Marketing representatives may initiate electronic contact through e-mail but an
opt-out process must be provided. Correct
\All plans must cover at least the standard Part D coverage or its actuarial
equivalent. What costs would a beneficiary incur for prescription drugs in 2019 under
the standard coverage? - ANS-Standard Part D coverage would require payment of
an annual deductible, 25% cost-sharing up to the coverage gap, a portion of costs
for both generics and brand-name drugs in the coverage gap, and co-pays or
co-insurance after the coverage gap.
\By contacting plans available in your area, you have learned that the plan you
represent has a significantly lower monthly premium than the others. Furthermore,
you see that the plan you represent has a unique benefit package. What should you
do to make sure your clients know about these pieces of information? - ANS-you
may make comparisons between plans if you can support them by studies or
statistical data and such comparisons are factually based
\Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting
him at severe risk for pneumonia. Otherwise, he has no problems functioning. Which
type of SNP is likely to be most appropriate for him? - ANS-C-SNP
\Dr. Elizabeth Brennan does not contract with the PFFS plan but accepts the plan's
terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment.
How much may Dr. Brennan charge? - ANS-Dr. Brennan can charge Mary Rogers
, no more than the cost sharing specified in the PFFS plan's terms and condition of
payment which may include balance billing up to 15 percent of the Medicare rate.
\During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a
5-star rating in customer service and care coordination, and received an overall plan
performance rating of a 4-star, which of the following would be the correct statement
to say to her? - ANS-The Medicare Advantage plan received a 5-star rating in
customer service and care coordination with an overall performance rating of 4-stars.
\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? - ANS-Tell her that the Medicare agency does not endorse or
recommend any plan.
\For which of the following individuals would a Cost Plan be most appropriate? -
ANS-Ms. Baker who is enrolled in Medicare Part B and is willing to continue paying
Part B premiums plus any plan premiums.
\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? - ANS-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.
\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? -
ANS-If the SEP is for MA coverage, he will generally have one opportunity to change
his MA coverage.
\Mr. Rice has coverage for medical services and medications through his employer's
retiree plan. He is considering switching to a Medicare prescription drug plan
because his retiree plan does not cover two important medications. What should he
consider before making a change? - ANS-If Mr. Rice drops his drug coverage
through the retiree plan, he may not be able to get it back and he also may lose his
medical health coverage.
\Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered
by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA)
PPO plan. Later he sees an out-of-network doctor to receive a Medicare covered
service. How much may the doctor collect from Mr. Rivera? - ANS-The doctor may
only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid
program.
\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? - ANS-f 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).
