, Question 1
An agent completes a telephonic enrollment for a Medicare Advantage plan on
October 20. The beneficiary's Part A and Part B effective dates are both
November 1. Applying CMS enrollment-timing rules and the UHC Enrollment
Timeliness standard, what is the latest permissible submission date for this
application?
A. Within 24 hours of the enrollment call
B. Within 48 hours of the enrollment call
C. By the 7th calendar day of the following month
D. Within 7 calendar days of the enrollment call
Correct Answer: B - Within 48 hours of the enrollment call
RATIONALE
CMS and UHC require telephonic/online enrollment applications to be
submitted within 48 hours of the enrollment call, not 24 hours (paper
applications use a different rule). The 7th-day and 7-calendar-day
options confuse the paper-application timeliness standard with the
telephonic standard. Only the 48-hour rule matches the current
CMS/UHC Enrollment Timeliness requirement.
Question 2
A beneficiary is currently enrolled in a Medicare Advantage Prescription Drug
(MA-PD) plan and wants to enroll in a stand-alone Medicare Prescription Drug
Plan (PDP) during the Annual Enrollment Period. Which statement about this
election is accurate?
A. The beneficiary may enroll in the PDP and remain in the MA-PD plan
simultaneously
B. Enrolling in a PDP will automatically disenroll the beneficiary from
the MA-PD plan and return them to Original Medicare
C. The beneficiary must first request a voluntary disenrollment from the
MA-PD plan before the PDP enrollment can be processed
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, D. The PDP enrollment will be rejected by CMS unless the beneficiary
also enrolls in a Medicare Supplement plan
Correct Answer: B - Enrolling in a PDP will automatically
disenroll the beneficiary from the MA-PD plan and return them
to Original Medicare
RATIONALE
CMS rules prohibit simultaneous enrollment in an MA-PD and a
stand-alone PDP; a PDP election triggers automatic disenrollment
from the MA plan, returning the beneficiary to Original Medicare. The
other options misstate CMS coordination-of-benefits rules or invent
requirements (Medigap or pre-dis-enrollment) that do not exist.
Question 3
During an appointment, a beneficiary states they are enrolled in Medicaid and
asks how their UHC Dual Complete plan coordinates benefits. Which
statement best reflects the correct coordination-of-benefits explanation an agent
may provide?
A. Medicare pays primary and Medicaid pays secondary for
Medicare-covered services, with Medicaid potentially covering
cost-sharing and some non-Medicare services
B. Medicaid pays primary and Medicare pays secondary for all services,
including long-term care
C. The beneficiary must choose one payer per service and cannot use both
D. The dual plan eliminates all cost-sharing regardless of Medicaid level
Correct Answer: A - Medicare pays primary and Medicaid pays
secondary for Medicare-covered services, with Medicaid
potentially covering cost-sharing and some non-Medicare services
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An agent completes a telephonic enrollment for a Medicare Advantage plan on
October 20. The beneficiary's Part A and Part B effective dates are both
November 1. Applying CMS enrollment-timing rules and the UHC Enrollment
Timeliness standard, what is the latest permissible submission date for this
application?
A. Within 24 hours of the enrollment call
B. Within 48 hours of the enrollment call
C. By the 7th calendar day of the following month
D. Within 7 calendar days of the enrollment call
Correct Answer: B - Within 48 hours of the enrollment call
RATIONALE
CMS and UHC require telephonic/online enrollment applications to be
submitted within 48 hours of the enrollment call, not 24 hours (paper
applications use a different rule). The 7th-day and 7-calendar-day
options confuse the paper-application timeliness standard with the
telephonic standard. Only the 48-hour rule matches the current
CMS/UHC Enrollment Timeliness requirement.
Question 2
A beneficiary is currently enrolled in a Medicare Advantage Prescription Drug
(MA-PD) plan and wants to enroll in a stand-alone Medicare Prescription Drug
Plan (PDP) during the Annual Enrollment Period. Which statement about this
election is accurate?
A. The beneficiary may enroll in the PDP and remain in the MA-PD plan
simultaneously
B. Enrolling in a PDP will automatically disenroll the beneficiary from
the MA-PD plan and return them to Original Medicare
C. The beneficiary must first request a voluntary disenrollment from the
MA-PD plan before the PDP enrollment can be processed
Page 2
, D. The PDP enrollment will be rejected by CMS unless the beneficiary
also enrolls in a Medicare Supplement plan
Correct Answer: B - Enrolling in a PDP will automatically
disenroll the beneficiary from the MA-PD plan and return them
to Original Medicare
RATIONALE
CMS rules prohibit simultaneous enrollment in an MA-PD and a
stand-alone PDP; a PDP election triggers automatic disenrollment
from the MA plan, returning the beneficiary to Original Medicare. The
other options misstate CMS coordination-of-benefits rules or invent
requirements (Medigap or pre-dis-enrollment) that do not exist.
Question 3
During an appointment, a beneficiary states they are enrolled in Medicaid and
asks how their UHC Dual Complete plan coordinates benefits. Which
statement best reflects the correct coordination-of-benefits explanation an agent
may provide?
A. Medicare pays primary and Medicaid pays secondary for
Medicare-covered services, with Medicaid potentially covering
cost-sharing and some non-Medicare services
B. Medicaid pays primary and Medicare pays secondary for all services,
including long-term care
C. The beneficiary must choose one payer per service and cannot use both
D. The dual plan eliminates all cost-sharing regardless of Medicaid level
Correct Answer: A - Medicare pays primary and Medicaid pays
secondary for Medicare-covered services, with Medicaid
potentially covering cost-sharing and some non-Medicare services
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