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,100 VERIFIED QUESTIONS ,ANSWERS AND RATIONALES
CONTENTS
1. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan
to pick up costs not covered by that plan. What should you tell him?
A) You can sell him a Medigap plan to help with costs not covered under Medicare Advantage.
B) It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and
besides, Medigap only works with Original Medicare.
C) Medigap plans are designed to work alongside Medicare Advantage plans.
D) He must disenroll from his MA plan before buying a Medigap plan.
Correct Answer: B) It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an
MA plan, and besides, Medigap only works with Original Medicare.
Expert Rationale: Medicare Supplement (Medigap) policies are strictly designed to supplement
Original Medicare (Parts A and B). Federal law makes it illegal for anyone to sell a Medigap
policy to a beneficiary who is actively enrolled in a Medicare Advantage plan, unless the
beneficiary is already in the process of returning to Original Medicare.
2. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan
which he has had for several years. However, the plan does not provide drug benefits. How
would you advise Agent John Miller to proceed?
A) Advise Jerry to switch to a Medicare Advantage plan for drug coverage.
B) Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription
drug coverage policy to his present coverage.
C) Inform Jerry that Medigap automatically covers prescription drugs.
D) Recommend canceling the Medigap plan.
Correct Answer: B) Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
Expert Rationale: Medigap plans sold after 2006 do not include prescription drug coverage.
Beneficiaries needing drug coverage must enroll in a standalone Medicare Part D plan. This
allows individuals to retain their Medigap coverage while accessing necessary medications.
,3. Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for
the Part D low income subsidy. Where might he turn for help with his prescription drug costs?
A) Apply for Medicaid to cover prescription costs.
B) Seek assistance from pharmaceutical company discount programs.
C) Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program (SPAP).
D) Try to enroll in a Medigap plan with drug coverage.
Correct Answer: C) Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
Expert Rationale: States may offer SPAPs to assist residents who do not qualify for the federal
Low Income Subsidy but still need help with Part D drug costs. Eligibility and benefits vary by
state, but these programs can provide meaningful financial support when other federal options
aren't available.
4. Mrs. Davis is turning 65 next month and has been receiving Social Security retirement
benefits for the past year. She is wondering what she needs to do to enroll in Original
Medicare. How should you advise her?
A) She must visit her local Social Security office to manually enroll in both Part A and Part B.
B) She will be automatically enrolled in Part A and Part B and will receive her Medicare card in
the mail.
C) She is automatically enrolled in Part A only and must actively sign up for Part B to avoid a late
enrollment penalty.
D) She needs to enroll through the CMS website during her Initial Coverage Election Period
(ICEP).
Correct Answer: B) She will be automatically enrolled in Part A and Part B and will receive her
Medicare card in the mail.
Expert Rationale: Individuals who have been receiving Social Security or Railroad Retirement
Board (RRB) benefits for at least four months prior to turning 65 are automatically enrolled in
both Medicare Part A and Part B. Their Medicare card is typically mailed to them about three
, months before their 65th birthday, and no manual enrollment action is required unless they
choose to decline Part B.
5. Mr. Henderson is enrolled in a Medicare Advantage (MA) plan. He recently moved to a new
state to be closer to his family, which is entirely outside of his current MA plan's service area.
What options does he have regarding his Medicare coverage?
A) He must remain in his current MA plan until the next Annual Election Period (AEP).
B) His current MA plan is required by CMS to continue providing his network coverage in the
new state.
C) He qualifies for a Special Enrollment Period (SEP) to join a new MA plan or return to Original
Medicare.
D) He loses his Medicare eligibility temporarily and must reapply after establishing residency.
Correct Answer: C) He qualifies for a Special Enrollment Period (SEP) to join a new MA plan or
return to Original Medicare.
Expert Rationale: Moving permanently outside of a Medicare Advantage plan's service area is a
qualifying life event that triggers a Special Enrollment Period (SEP). During this SEP, the
beneficiary can select a new Medicare Advantage plan available in their new location or choose
to return to Original Medicare, along with the opportunity to purchase a standalone Part D
prescription drug plan.
6. Agent Sarah is reviewing marketing guidelines. She wants to know if she can leave business
cards or flyers at a residence where she was not invited. What does CMS state regarding this
practice?
A) She may leave flyers but not business cards on the doorstep. B) She is permitted to leave
information at a residence only if she previously spoke to the beneficiary on the phone. C)
Unsolicited door-to-door marketing, including leaving flyers or business cards at a residence
without a prior appointment, is strictly prohibited. D) She may leave marketing materials as long
as she does not knock on the door or ring the doorbell.
Correct Answer: C) Unsolicited door-to-door marketing, including leaving flyers or business
cards at a residence without a prior appointment, is strictly prohibited.
Expert Rationale: CMS strictly prohibits any form of unsolicited door-to-door marketing. This
includes leaving information such as leaflets, flyers, or business cards at a residence or on
,100 VERIFIED QUESTIONS ,ANSWERS AND RATIONALES
CONTENTS
1. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan
to pick up costs not covered by that plan. What should you tell him?
A) You can sell him a Medigap plan to help with costs not covered under Medicare Advantage.
B) It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and
besides, Medigap only works with Original Medicare.
C) Medigap plans are designed to work alongside Medicare Advantage plans.
D) He must disenroll from his MA plan before buying a Medigap plan.
Correct Answer: B) It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an
MA plan, and besides, Medigap only works with Original Medicare.
Expert Rationale: Medicare Supplement (Medigap) policies are strictly designed to supplement
Original Medicare (Parts A and B). Federal law makes it illegal for anyone to sell a Medigap
policy to a beneficiary who is actively enrolled in a Medicare Advantage plan, unless the
beneficiary is already in the process of returning to Original Medicare.
2. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan
which he has had for several years. However, the plan does not provide drug benefits. How
would you advise Agent John Miller to proceed?
A) Advise Jerry to switch to a Medicare Advantage plan for drug coverage.
B) Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription
drug coverage policy to his present coverage.
C) Inform Jerry that Medigap automatically covers prescription drugs.
D) Recommend canceling the Medigap plan.
Correct Answer: B) Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
Expert Rationale: Medigap plans sold after 2006 do not include prescription drug coverage.
Beneficiaries needing drug coverage must enroll in a standalone Medicare Part D plan. This
allows individuals to retain their Medigap coverage while accessing necessary medications.
,3. Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for
the Part D low income subsidy. Where might he turn for help with his prescription drug costs?
A) Apply for Medicaid to cover prescription costs.
B) Seek assistance from pharmaceutical company discount programs.
C) Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program (SPAP).
D) Try to enroll in a Medigap plan with drug coverage.
Correct Answer: C) Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
Expert Rationale: States may offer SPAPs to assist residents who do not qualify for the federal
Low Income Subsidy but still need help with Part D drug costs. Eligibility and benefits vary by
state, but these programs can provide meaningful financial support when other federal options
aren't available.
4. Mrs. Davis is turning 65 next month and has been receiving Social Security retirement
benefits for the past year. She is wondering what she needs to do to enroll in Original
Medicare. How should you advise her?
A) She must visit her local Social Security office to manually enroll in both Part A and Part B.
B) She will be automatically enrolled in Part A and Part B and will receive her Medicare card in
the mail.
C) She is automatically enrolled in Part A only and must actively sign up for Part B to avoid a late
enrollment penalty.
D) She needs to enroll through the CMS website during her Initial Coverage Election Period
(ICEP).
Correct Answer: B) She will be automatically enrolled in Part A and Part B and will receive her
Medicare card in the mail.
Expert Rationale: Individuals who have been receiving Social Security or Railroad Retirement
Board (RRB) benefits for at least four months prior to turning 65 are automatically enrolled in
both Medicare Part A and Part B. Their Medicare card is typically mailed to them about three
, months before their 65th birthday, and no manual enrollment action is required unless they
choose to decline Part B.
5. Mr. Henderson is enrolled in a Medicare Advantage (MA) plan. He recently moved to a new
state to be closer to his family, which is entirely outside of his current MA plan's service area.
What options does he have regarding his Medicare coverage?
A) He must remain in his current MA plan until the next Annual Election Period (AEP).
B) His current MA plan is required by CMS to continue providing his network coverage in the
new state.
C) He qualifies for a Special Enrollment Period (SEP) to join a new MA plan or return to Original
Medicare.
D) He loses his Medicare eligibility temporarily and must reapply after establishing residency.
Correct Answer: C) He qualifies for a Special Enrollment Period (SEP) to join a new MA plan or
return to Original Medicare.
Expert Rationale: Moving permanently outside of a Medicare Advantage plan's service area is a
qualifying life event that triggers a Special Enrollment Period (SEP). During this SEP, the
beneficiary can select a new Medicare Advantage plan available in their new location or choose
to return to Original Medicare, along with the opportunity to purchase a standalone Part D
prescription drug plan.
6. Agent Sarah is reviewing marketing guidelines. She wants to know if she can leave business
cards or flyers at a residence where she was not invited. What does CMS state regarding this
practice?
A) She may leave flyers but not business cards on the doorstep. B) She is permitted to leave
information at a residence only if she previously spoke to the beneficiary on the phone. C)
Unsolicited door-to-door marketing, including leaving flyers or business cards at a residence
without a prior appointment, is strictly prohibited. D) She may leave marketing materials as long
as she does not knock on the door or ring the doorbell.
Correct Answer: C) Unsolicited door-to-door marketing, including leaving flyers or business
cards at a residence without a prior appointment, is strictly prohibited.
Expert Rationale: CMS strictly prohibits any form of unsolicited door-to-door marketing. This
includes leaving information such as leaflets, flyers, or business cards at a residence or on
