Medicare Certification Exam Questions and Answers A Pass

Medicare Certification Exam Questions and Answers A Pass In order to qualify for Medicare, an individual must be 65 years old, lawfully present in the United States, and meet one more CMS enrollment criteria. What is that? - Be eligible to recieve Social Security A plan is not required to disenroll a member under CMS guidelines if the member..... - Fails to pay plan premium. In fact an MAO is never required to terminate a member on their own. Mrs. Smith submits an enrollment request on November 11 and has no special election period. What regular election period may she use and what will her coverage effective date be? - Annual Election Period, Jan 1 Are there open enrollment risks when a beneficiary has a Employer Group Plan? - Yes, members should check with their benefits administrator at work to avoid possibly losing coverage. Beneficiaries may still be able to use employer coverage with the plan that they join What is the first step in finding appropriate Medicare coverage? - The first step is to determine if the individual is elegible to be covered under employer group coverage. What is the second step in finding appropriate Medicare coverage? - Decide whether to select original Medicare A & B or Medicare part C If an individual chooses Medicare Part C, what is the next important choice? - To decide if they want medical benefits only or Part C with drug coverage. If an individual wants Parts A and B original Medicare, what are the next two choices to be made? - Decide if they want Part D perscription Drug coverage, and decide if they want supplemental coverage. Can a Part D PDP be added to Original Medicare without cancelling Original Medicare? - Yes, these work together Can a Part D PDP be added to another Part D PDP without cancelling the original Part D PDP? - No, only one plan is allowed Can a Part D PDP be added to a Med Sup plan without cancelling the Med Sup plan? - Yes, a stand alone works with Medigap Can a Part D PDP be added to a Medical only part C plan without cancelling the Medical only part C plan? - Not unless the Medical only part C plan is a PFFS plan, an MSA plan or a 1876 cost plan Can a Part D PDP be added to a part C plan with prescription drug coverage without cancelling the part C plan with prescription drug coverage? - No, this enrollment will result in the beneficiary being on original Medicare with a stand-alone PDP Can a Part D PDP be added to a part C PFFS plan without cancelling the part C PFFS plan? - Yes, PFFS works with Stand-alone Can a Part D PDP be added to a part C PFFS MA-PD plan without cancelling the part C PFFS MA-PD plan? - No, since the plan already has drug coverage, this would duplicate the coverage Can a Part D PDP be added to a part C MSA plan without cancelling the part C MSA plan? - Yes, an MSA plan will work with a stand alone PDP. Can a Part D PDP be added to a 1876 cost plan without cancelling the 1876 cost plan? - Yes, because these plans are not Advantage plans What are the three main questions that you must clarify completely about a clients situation before you can make an appropriate reccomendation for them? - What is their financial situation, What is their current coverage, What are their coverage needs? What are the three requirements a client must meet in order to enroll in a MA-only or an MA-PD plan? - Must have Medicare A and B, Must be a permanent resident in the plans coverage area, Must not have end stage renal disease If a client has end stage renal disease, is there any way that they can they still have a part C plan? - Yes, if the client has had a kidney transplant which has ended the need for regular dialysis, Yes, if they had a plan with a Medicare Provider Organization that lost or failed to renew their contract with CMS, Yes. if they "age in" to Medicare while a member of a plan with the same Medicare Provider Organization What is "Medicare Advantage Lock-In?" - After the effective date of enrollment, the member will remain in the plan and will not be permitted to disenroll or change plans. The member is "locked in" until an applicable election period arises, either the annual election period or a special election period. As regards Medicare Advantage, the term Election means what? - Either enrollment in, or disenrollment from, a Medicare Advantage plan As regards Medicare Advantage, the term Election Period means what? - The specific dates between which an individual can elect to enroll in, or disenroll from a Medicare Advantage Plan AEP stands for what? - Annual Election Period AEP applies to what Medicare Advantage family of plans? - MA Only, MA-PD, and PDP Stand-Alone plans ICEP stands for what? - Initial Coverage Election Period ICEP applies to what two types of Medicare Advantage plans? - MA Only, and MA-PD plans SEP stands for what? - Special Election Period The acronym "SEP" stands for what, and is used in discussions of what Medicare family of plans? - It stands for Special Election Period, and this applies to Medicare Advantage plans (Part C) and Medicare Prescription Drug plans. (Part D) OEIP stands for what? - Open enrollment for institutionalized persons OEIP applies to what Medicare Advantage family of plans? - MA Only, and MA-PD plans MADP stands for what? - Medicare Advantage Disenrollment Period Medicare Part C plans fall under three broad categories. What are they? - MA Only, MA-PD, and PDP Stand-Alone plans IEP for part D stands for what? - Initial Election Period for Part D IEP for part D applies to what Medicare Advantage family of plans? - MA-PD and PDP Stand-Alone plans What is the Initial Coverage Election Period? - It is a seven month time period that includes the three months before the clients birth month, the birth month, and the three month time period after the birth month of the year that the client becomes eligible for Medicare, usually their 65th birthday. How many ICEPs does an individual have? - One. Once it is used or elapses, it is irretrievable and lost forever. When does the IEP for part D take place? - The Initial Election Period (IEP) for part D begins three months before they become entitled to Part A OR enroll in Part B, includes the month they become entitled to Part A OR enroll in Part B, and continues for three months after they become entitled to Part A OR have enrolled in Part B. When would the ICEP for MA and the IEP for part D coincide? - When the individual enrolls in both Medicare Part A and Medicare Part B when they are first eligible If an individual delays enrollment in Medicare Part B, when do their ICEP and IEP for Part D occur? - The seven month IEP for Part D is centered around the automatic enrollment in Medicare part A, usually the 65th birthday. The seven month ICEP for a Medicare Advantage plan is centered around the enrollment in Medicare part B, which is usually when group coverage ends for that individual. When does the AEP occur? - The Annual Election Period (AEP) occurs every year starting on October 15th and ending on December 7th. During this period, the lock-in ends and everyone can choose a new plan effective on Jan 1 of the following year. What are the three types of Medicare Beneficiaries that can change plans at any time, as long as their status does not change? - Dual-eligibles (those who have both Medicare and Medicaid) Institutionalized individuals LIS (Low income subsidy) eligible individuals In all of these cases, their plan choice will become effective the first of the month following their election. When would the OEPI be discontinued for an institutionalized person? - It ends two months after the month that the individual moves out of the institution. What is the Election Period of the OEPI? - It is continuous, and never ends for as long as the individual qualifies. What is the election period of the MADP? - The Medicare Advantage Disenrollment Period starts on Jan 1 and ends Feb 14th each year. Does any individual who makes use of the MADP have any sort of Special Election Period? - Yes, they may enroll in a stand alone PDP. What is an "enrollment request mechanism?" - The method of enrollment What four materials at a minimum must always be present at a face to face meeting? - A paper enrollment form Plan star ratings information, Summary of benefits, A multi-language insert What four materials at a minimum must always be available to the client at an online enrollment? - A link to an electronic enrollment form, A downloadable plan star ratings document, A downloadable summary of benefits, A downloadable multi-language insert What is the main difference in a client qualifying for Medicaid while not on Medicare verses qualifying for Medicaid after being enrolled in Medicare? - Once a Medicaid beneficiary becomes enrolled in Medicare, there is an asset test added to the income level test. The net worth is what counts, and a significant amount of assets are added to the qualification number, which excludes many Medicare recipients from Medicaid. What are the costs that the client is responsible for with original Medicare? - The part A and Part B deductibles, The monthly part B premium, Usually 20 percent of the Medicare approved amount for the Medicare approved services, 100 Percent of the cost for services that Medicare does not cover. Are Section 1876 Cost plans also Medicare Advantage plans? - No, they are authorized under a different part of the Social Security Act, but they do present a health care option for a small number of Medicare beneficiaries. Are Section 1876 Cost plans being discontinued? - Yes, new plans have not been created since 2010, and since 2012, Section 1876 Cost plans located in areas which have adaquate coverage by MA and MA-PD plans are not being renewed. There are three major requirements for a Medicare Advantage enrollment request form to be considered complete. What are they? - 1. Permanant residence is determined to be in the service area. 2. The beneficiary must be in BOTH part A and part B of original Medicare, 3. The enrollment form must be entirely complete and signed by the Medicare Beneficiary or the legal representative. This requirement is waived for online enrollments. In order to be considered legally binding, the beneficiary must completely understand and agree to five things during the enrollment process. What are they? - 1. They must agree to the disclosure and exchange of personal and medical information. They must understand that they have to keep Original Medicare both parts A and B. In the case of a stand-alone PDP, its either A or B, 3. They must understand that they can only enroll in one part C plan at a time, and that enrollment in another Part C plan will automatically disenroll them from whatever part C plan that they currently have. 4. They must agree to abide by the rules of the organization providing the plan. 5. They must understand their right to appeal service and payment denials made by their provider organization. Who determines the effective date of a part C plan and when must the effective date be understood by all parties to the agreement? - The provider organization determines the effective date of a plan, but the beneficiary must also be clear as to their effective date before it passes. Who must sign a Medicare enrollment form? - In general, the person enrolling in the plan and the enrolling agent must sign the enrollment form If the person enrolling in a Part C plan is unable to sign the enrollment form, who may sign it? - State law would determine what other individuals may sign a Medicare enrollment form for the enrollee, but that person must attest to having the authority required by state law, and be prepared to present proof of that authority to CMS upon request. That person must also provide valid contact information in order for CMS to reach them should such proof be required. The attestation and contact information must be retained by the enrolling organization as a part of the record of the enrollment request.