AHIP 2024 FINAL EXAM QUESTIONS AND VERIFIED SOLUTIONS RATED A+

1. Mr. Buck has several family members who died from different cancers. He wants to know if Medicare covers cancer screening. What should you tell him? 2. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be of assistance? 3. Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare Summary Notice (MSN) and disagrees with a de- termination that partially denied one of her claims for services. What advice would you give her? 4. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxes during that entire period. She is con- cerned that she will not qualify for coverage under part A because she was not born in the United States. What should you tell her? Medicare covers the periodic performance of a range of screen- ing tests that are meant to provide ear- ly detection of dis- ease. Mr. Buck will need to check specif- ic tests before obtain- ing them to see if they will be covered. She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help with Medicare costs for which she is respon- sible. Mrs. Duarte should file an appeal of this initial determina- tion within 120 days of the date she re- ceived the MSN in the mail. Most individuals who are citizens and age 65 or over are cov- ered under Part A by virtue of having paid Medicare taxes while working, though some may be cov- ered as a result of 5. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? 6. Juan Perez, who is turning age 65 next month, intends to work for several more years at Small- cap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-sponsored health- care coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he enrolls how that will im- pact his employer-sponsored healthcare cover- age. How would you respond? 7. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through massage therapy. She is concerned about whether or not Medicare will cover these items and services. What should you tell her? 8. Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. He wants to understand the health care costs he might be exposed to under Medicare if he were to require hospitalization as a result of paying monthly pre- miums. Beneficiaries under Original Medicare have no cost-shar- ing for most preven- tive services which in- clude immunizations such as annual flu shots. Juan is likely to be eligible for Medicare once he turns age 65 and if he en- rolls Medicare would become the primary payor of his health- care claims and Smallcap does not have to continue to offer him cover- age comparable to those under age 65 under its employ- er-sponsored group health plan. Medicare does not cover massage ther- apy, or, in general, glasses or dentures Under Original Medicare, there is a single deductible amount due for the first 60 days of any in- an illness. In general terms, what could you tell him about his costs for inpatient hospital services under Original Medicare? 9. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug coverage. She would like to keep the cover- age she has but replace her existing Medigap plan with one that provides drug coverage. What should you tell her? 10. Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without paying any premiums, because she has been working for 40 years and paying Medicare taxes. What should you tell her? 11. Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will have considerable income when she retires. She is concerned that her income will make it impossible for her to qualify for Medicare. What could you tell her to address her concern? 12. 12. patient hospital stay, after which it con- verts into a per-day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over his life- time, after which he would be responsible for all costs. Mrs. Gonzalez can- not purchase a Medi- gap plan that cov- ers drugs, but she could keep her Medi- gap policy and enroll in a Part D prescrip- tion drug plan. To obtain Part B cov- erage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. Medicare is a pro- gram for people age 65 or older and those under age 65 with certain disabil- ities, end-stage re- nal disease, and Lou Gehrig's disease so she will be eligible for Medicare. Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs. What could you tell Mr. Moy? 13. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? What could you tell him? 14. Mrs. PeHa is 66 years old, has coverage under an employer plan, and will retire next year. She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell her? Medicare Supple- mental Insurance would help cover his Part A and Part B deductibles or coinsurance in Original Fee-for-Ser- vice (FFS) Medicare as well as possibly some services that Medicare does not cover. Part A, which covers hospital, skilled nurs- ing facility, hospice, and home health ser- vices and Part B, which covers profes- sional services such as those provided by a doctor are cov- ered under Original Medicare. She may enroll at any time while she is covered under her employer plan, but she will have a spe- cial eight-month en- rollment period after the last month on her employer plan that differs from the stan- dard general enroll- ment period, during which she may enroll in Medicare Part B. 15. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick It is illegal for you to sell Mr. Capadona up costs not covered by that plan. What should you a Medigap plan if tell him? 16. Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. He is wondering whether he can obtain coverage under Medicare. What should you tell him? 17. Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's re- tiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he would generally expect to encounter when en- rolling into a standard Medicare Part D prescrip- tion drug plan. What should you tell him? 18. 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? 19. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in he is enrolled in an MA plan, and be- sides, Medigap only works with Original Medicare. After receiving such disability payments for 24 months, he will be automatically en- rolled in Medicare, re- gardless of age. He generally would pay a monthly pre- mium, annual de- ductible, and per-pre- scription cost-shar- ing. He may sign-up for Medicare at any time however cover- age usually begins on the fourth month after dialysis treat- ments start. Tell prospect Jerry Smith that he should Medicare Parts A and B. Jerry has also purchased consider adding a 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? standalone Part D prescription drug cov- erage policy to his present coverage. 20. Mr. Rainey is experiencing paranoid delusions and Medicare will cover his physician feels that he should be hospitalized. a total of 190 days What should you tell Mr. Rainey (or his represen- tative) about the length of an inpatient psychiatric hospital stay that Medicare will cover? 21. Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her? 22. Mr. Wells is trying to understand the difference be- of inpatient psychi- atric care during Mr. Rainey's entire life- time Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Ad- vantage. Medicare Advantage tween Original Medicare and Medicare Advantage. is a way of cov- What would be the correct description? 23. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him? 24. Mr. Barker enjoys a comfortable retirement in- come. He recently had surgery and expected that ering all the Orig- inal Medicare ben- efits through pri- vate health insurance companies. In most Medicare Ad- vantage HMOs, Mr. Kumar must general- ly obtain his services only from providers within the plan's net- work (except in an emergency or where care is unavailable within the network). You can offer to re- view the plans appeal he would have certain services and items covered process to help him by the plan with minimal out-of-pocket costs be- cause his MA-PD coverage has been very good. However, when he received the bill, he was sur- prised to see large charges in excess of his max- ask the plan to re- view the coverage de- cision. imum out-of-pocket limit that included some ser- vices and items he thought would be fully covered. He called you to ask what he could do? What could you tell him? 25. Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do? 26. Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about what type of plan designs are available through this program. What should you tell him about the types of health plans that are available through the Medicare Advantage program? 27. Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care. What should you tell her? 28. Mrs. Davenport enrolled in the ABC Medicare Ad- vantage (MA) plan several years ago. In mid-Feb- ruary of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD). What options will Mrs. Davenport have regarding her MA plan during the next open enrollment season? He will have to enroll in Part B. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.&p Mrs. Ramos can ob- tain care from any provider who par- ticipates in Original Medicare, but gener- ally will have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO network. She may remain in her ABC MA plan, enroll in another MA plan in her service area, or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. 29. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. Mary Rodgers sees Dr. Dr. Brennan can charge Mary Rogers no more than the Brennan for treatment. How much may Dr. Brennan cost sharing specified charge? 30. Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have prescrip- tion drug coverage since her doctor recently pre- in the PFFS plan's terms and condition of payment which may include balance billing up to 15% of the Medicare rate. Mrs. Chi may enroll in a MA MSA plan and remain in her cur- rent standalone Part D prescription drug scribed several expensive medications. Currently, plan. she is enrolled in Original Medicare and a stand- alone Part D plan. How would you advise Mrs. Chi? 31. Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his in- vestments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. What should you tell him? 32. Which of the following statement is/are correct about a Medicare Savings Account (MSA) Plans? 33. Mr. Lombardi is interested in a Medicare Advan- tage (MA) PPO plan that you represent. It is one of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does not include drug coverage and intends to obtain his drug coverage through a stand-alone Medicare SNPs limit enrollment to certain subpopula- tions of beneficiaries. Given his current situ- ation, he is unlikely to qualify and would not be able to enroll in the SNP. I, II, and IV only He could enroll ei- ther in one of the MA plans that include prescription drug cov- erage or Original Medicare with a Medigap plan and standalone Part D prescription drug plan. What should you tell him about this situation? 34. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. What should you tell him? 35. Mr. Castillo, a naturalized citizen, previously en- rolled in Medicare Part B but has recently stopped paying his Part B premium. Mr. Castillo is still cov- ered by Part A. He would like to enroll in a Medicare prescription drug cov- erage, but he cannot enroll in the MA-only PPO plan and a stand-alone prescrip- tion drug plan. He may receive health care ser- vices from any doc- tor allowed to bill Medicare, as long as he shows the doc- tor the plan's iden- tification card and the doctor agrees to accept the PFFS plan's payment terms and conditions, which could include balance billing. He is not eligible to enroll in a Medicare Advantage plan un- til he re-enrolls in Advantage (MA) plan and is still covered by Part A. Medicare Part B. What should you tell him? 36. Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). What could you tell him? 37. 37. SNPs have special programs for en- rollees with chronic conditions, like Mr. Sinclair, and they pro- vide prescription drug coverage that could be very helpful as well. Mr. Romero is 64, retiring soon, and consider- ing enrollment in his employer-sponsored retiree group health plan that includes drug coverage with nominal copays. He heard about a neighbor's MA-PD plan that you represent and because he takes numerous prescription drugs, he is consid- ering signing up for it. What should you tell him? 38. Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no prob- lems functioning. Which type of SNP is likely to be most appropriate for him? 39. Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and was dis- appointed with the service she received from her primary care physician because she was told she would have to wait five weeks to get an appoint- ment when she was feeling ill. She called you to ask what she could do so she would not have to put up with such poor access to care. What could you tell her? He should compare the benefits in his em- ployer-sponsored re- tiree group health plan with the bene- fits in his neighbor's MA-PD plan to deter- mine which one will provide sufficient cov- erage for his prescrip- tion needs. C-SNP She could file a griev- ance with her plan to complain about the lack of timeliness in getting an appoint- ment. 40. Mrs. Andrews asked how a Private Fee-for-Service Medicaid may pro- (PFFS) plan might affect her access to services vide additional ben- since she receives some assistance for her health efits, but Medicaid care costs from the State. What should you tell her? 41. Mrs. Allen has a rare condition for which two dif- ferent brand name drugs are the only available treatment. She is concerned that since no gener- will only pay for these services if they are furnished by Medicaid partici- pating providers. Medicare prescrip- tion drug plans are re- quired to cover drugs ic prescription drug is available and these drugs are very high cost, she will not be able to find a Medicare Part D prescription drug plan that covers either one of them. What should you tell her? 42. Mr. Schultz was still working when he first qualified for Medicare. At that time, he had employer group coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll be- cause he was satisfied with his drug coverage. It is now a year later and Mr. Schultz has lost his em- ployer group coverage within the last two weeks. How would you advise him? 43. Mr. Hutchinson has drug coverage through his for- mer employer's retiree plan. He is concerned about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to purchase extra coverage that he will not need. What should you tell him? 44. Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his savings account until it is exhausted, and then have his in each therapeutic category. She should be able to enroll in a Medicare prescrip- tion drug plan that covers the medica- tions she needs. Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty. If the drug coverage he has is not expect- ed to pay, on average, at least as much as Medicare's standard Part D coverage ex- pects to pay, then he will need to enroll in Medicare Part D dur- ing his initial eligibili- ty period to avoid the late enrollment penal- ty. In general, he must select a single Part D premium payment mechanism that will premiums withheld from his Social Security check. be used throughout What should you tell him? the year. 45. Part D plans do not have to cover all med- What types of tools can Medicare Part D prescrip- tion drug plans use that affect the way their en- rollees can access medications? 46. Mr. and Mrs. Vaughn both take a specialized multi- vitamin prescription each day. Mr. Vaughn takes a prescription for helping to regrow his hair. They are anxious to have their Medicare prescription drug plan cover these drug needs. What should you tell them? 47. Mr. Carlini has heard that Medicare prescription drug plans are only offered through private com- panies under a program known as Medicare Ad- vantage (MA), not by the government. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. What should you tell him? ications. As a re- sult, their formula- ries, or lists of cov- ered drugs, will vary from plan to plan. In addition, they can use cost containment techniques such as tiered co-payments and prior authoriza- tion. Medicare prescrip- tion drug plans are not permitted to cover the prescription med- ications the Vaugh- ns are interested in under Part D cover- age, however, plans may cover them as supplemental bene- fits and the Vaughn's could look into that possibility. Mr. Carlini can stay with Origi- nal Medicare and also enroll in a Medicare prescrip- tion drug plan through a private company that has contracted with the government to pro- vide only such drug coverage to eligible 48. Mrs. Berkowitz wants to enroll in a Medicare Ad- vantage plan that does not include drug coverage and also enroll in a stand-alone Medicare prescrip- tion drug plan. Under what circumstances can she do this? 49. Which of the following individuals is most likely to be eligible to enroll in a Part D Plan? 50. Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollment in a Medicare prescrip- tion drug plan because, although she is entitled to Part A, she is not enrolled under Medicare Part B. What should you tell her? 51. 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? Medicare beneficia- ries. If the Medicare Ad- vantage plan is a Private Fee-for-Ser- vice (PFFS) plan that does not offer drug coverage or a Med- ical Savings Account plan, Mrs. Berkowitz can do this. Jose, a grandfather who was granted asy- lum and has worked in the United States for many years. An individual who is entitled to Part A or enrolled under Part B is eligible to en- roll in a Medicare pre- scription drug plan. As long as Mrs. Mulc- ahy is entitled to Part A, she does not need to enroll under Part B before enrolling in a prescription drug plan. He could check with the manufacturers of his medications to see if they offer an as- sistance program to help people with lim- ited means to ob- 52. Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. She is traveling and wishes to fill two of the prescriptions that she has lost. How would you advise her? 53. 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? 54. Which of the following statements about Medicare Part D are correct? 55. All plans must cover at least the standard Part D coverage or its actuarial equivalent. Which of the following statements best describes some of the costs a beneficiary would incur for prescription drugs under the standard coverage? tain the medications they need. Alterna- tively, he could check to see whether his state has a phar- macy assistance pro- gram to help him with his expenses. She may fill pre- scriptions for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an in-network pharmacy. Medicare Part D drug plans may have differ- ent benefit structures, but on average, they must all be at least as good as the standard model established by the government. I, II, and III only Standard Part D cov- erage would require payment of an annual deductible, and once past the catastrophic coverage threshold, the beneficiary pays whichever is greater of either the co-pays for generic and brand 56. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. In addition to drugs on his plan's formulary he takes several other medications. These include a prescription drug not on his plan's formulary, over-the-counter medications for colds and allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to promote hair growth and reduce joint swelling. His neighbor recently told him about a concept called TrOOP and he asks you if any of his oth- er medications could count toward TrOOP should he ever reach the Part D catastrophic limit. What should you say? 57. Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. She currently does not have creditable coverage. What could you tell her about the implications of such a decision? 58. Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently lost creditable coverage previously available through her hus- band's employer. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). What should you tell her? 59. Mr. Zachow has a condition for which three drugs are available. He has tried two but had an allergic name drugs or coin- surance of 5% None of the costs of Mr. Wingate's oth- er medications would currently count to- ward TrOOP but he may wish to ask his plan for an exception to cover the prescrip- tion not on its formu- lary. If she does not sign up for a Medicare pre- scription drug plan as soon as she is eligi- ble to do so, and if she does sign up at a later date, her pre- mium will be perma- nently increased by 1% of the national average premium for every month that she was not covered. If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. Mr. Zachow has a right to request a for- reaction to them. Only the third drug works for him and it is not on his Part D plan's formulary. What could you tell him to do? 60. Mrs. McIntire is enrolled in her state's Medicaid plan and has just become eligible for Medicare as well. What can she expect will happen to her drug coverage? 61. Melissa Meadows is a marketing representative for Best Care which has recently introduced a Medicare Advantage plan offering comprehensive dental benefits for $15 per month. Best Care has not submitted any potential posts to CMS for ap- proval. Melissa would like to use the power of social media to reach potential prospects. What advice would you give her? 62. Your friend's mother just moved to an assisted living facility and he asked if you could present a program for the residents about the MA-PD plans you market. What could you tell him? 63. You have been providing a pre-Thanksgiving meal during sales presentations in November for many mulary exception to obtain coverage for his Part D drug. He or his physician could obtain the standard- ized request form on the plan's website, fill it out, and submit it to his plan. Unless she choos- es a Medicare Part D prescription drug plan on her own, she will be automatically enrolled in one avail- able in her area. As soon as CMS approves Best Care's social media posts, Agent Mead- ows could post a tweet stating that "Best Care offers an array of Medicare Ad- vantage benefit pack- ages. One might be right for you. Call me to find out more!" You appreciate the opportunity and would be happy to schedule an appoint- ment with anyone at their request. You may provide light snacks, but a Thanks- years and your clients look forward to attending this annual event. When marketing Medicare Ad- vantage and Part D plans, what are you permitted to do with respect to meals? 64. Next week you will be participating in your first "educational event" for prospective enrollees. To be sure that you do not violate any of the applic- able guidelines, in what activities should you plan to engage? 65. One of your colleagues argues that it is better to focus your time and energy exclusively in neigh- borhoods with single-family homes. He further ar- gues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. How should you respond? 66. Agent Martinez wishes to solicit Medicare Advan- tage prospects through e-mail and asks you for advice as to whether this is possible. What should you tell her? 67. 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 marketing requirements as the plans themselves. How should you respond to such a statement? giving style meal would be prohibited, regardless of who provides or pays for the meal. You should plan to ensure that the edu- cational event is an informative event and must not conduct a sales presentation or distribute or accept enrollment forms at the event. This could be con- sidered discriminato- ry activity and a pro- hibited practice. Marketing represen- tatives may initi- ate electronic contact through e-mail but an opt-out process must be provided. Your coworker is not correct. Marketing on behalf of a plan is considered market- ing by the plan and requires that all con- tracted and employed agents comply with 68. Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent Jen- nings distributes materials that are solely educa- tional. However, she gives a brief presentation that mentions plan-specific premiums. Is this a prohib- ited activity at an event that has been advertised as educational? 69. 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? 70. You are working several plans and community organizations to sponsor an educational event. When putting together advertisements for this event, what should you do? 71. 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 web- site marketing the MA plans with which it has contracts. Agent Armstrong follows up with indi- viduals 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? 72. You will be holding a sales event soon, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what all Medicare market- ing rules. Yes. When an event has been advertised as "educational," dis- cussing plan-specific premiums is imper- missible. Tell her that the Medicare agency does not endorse or recommend any plan. You must ensure that the advertisements indicate it is an ed- ucational event, oth- erwise it will be con- sidered a marketing event. Agent Armstrong needs to be li- censed and appoint- ed in every state in which beneficiaries to whom he markets ABC MA plans are lo- cated. Gift cards or gift cer- tificates of $15 or less that can be readily converted to cash. types of gifts or prizes would not be allowed in this situation? 73. A Medicare beneficiary has walked into your office and requested that you sit down with her and dis- cuss her options under the Medicare Advantage program. Before engaging in such a discussion, what should you do? 74. Another agent you know has engaged in miscon- duct that has been verified by the plan she repre- sented. What sort of penalty might the plan impose on this individual? 75. Plan sponsors may undertake the following mar- keting activities with current Medicare Advantage plan members? 76. You have approached a hospital administrator about marketing in her facility. The administrator is uncomfortable with the suggestion. How could you address her concerns? 77. Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. She agreed to sign a scope of appointment You must have her sign a scope of ap- pointment form, indi- cating which products she wishes to dis- cuss. You may then proceed with the dis- cussion. The plan may with- hold commission, re- quire retraining, re- port the misconduct to a state department of insurance or termi- nate the contract. Market non-health re- lated items or ser- vices such as life in- surance or annuities policies to current members as permit- ted following HIPAA Privacy Rules. Tell her that Medicare guidelines allow you to conduct marketing activities in common areas of a provider's facility. You may provide her with the required enrollment materials and take her complet- form and meet with you on October 15. During the appointment, what are you permitted to do? 78. Miguel Sanchez is a relatively new agent who has come to you for advice as to what he can do during the Medicare Advantage Open Enrollment Period (MA-OEP). What advice should you give Miguel? 79. ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' information to market non-health related products such as life insurance and annuities. Which statement best de- scribes ABC's obligation to its enrollees regarding marketing such products? 80. You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. You have completed the re- quired training for each plan, but you did not achieve a passing score on the tests that came af- ter the training. What can you do in this situation? 81. Mr. Yoo's employer has recently dropped compre- hensive creditable prescription drug coverage that was offered to company retirees. The company told Mr. Yoo that, because he was affected by this ed enrollment appli- cation. During the MA-OEP, Miguel can have one-on-one meet- ings with beneficia- ries who have re- quested such meet- ings. It must obtain a HIPAA compliant au- thorization from an enrollee that indi- cates the plan or plan sponsor may use their information for marketing purpos- es. You will not be able to represent any Medicare Advantage or Part D plan un- til you complete the training and achieve an adequate score. However, you will not have to take a test if you exclu- sively market employ- er/union group plans and the companies do not require testing. It means that he qual- ifies for a one-time opportunity to enroll in an MA-PD or Part change, he would qualify for a Special election period. Mr. Yoo contacted you to find out more about what this means. What can you tell him? D prescription drug plan. 82. Mr. Rockwell, age 67, is enrolled in Medicare Part A, Mr. Rockwell is eligi- but because he continues to work and is covered by an employer health plan, he has not enrolled in Part B or Part D. He receives a notice on June 1 that his employer is cutting back on prescription drug benefits and that as of July 1 his coverage ble for a SEP due to his involuntary loss of creditable drug cov- erage; the SEP be- gins in June and ends will no longer be creditable. He has come to you for on September 1- two advice. What advice would you give Mr. Rockwell about special election periods (SEPs)? 83. Mr. Block is currently enrolled in a Medicare Ad- vantage plan that includes drug coverage. He found a stand-alone Medicare prescription drug plan in his area that offers better coverage than that available through his MA-PD plan and in addi- tion, has a low premium. It won't cost him much more and, because he has the means to do so, he wishes to enroll in the stand-alone prescrip- tion drug plan in addition to his MA-PD plan. What should you tell him? 84. Mr. Ziegler is turning 65 next month and has asked you what he can do, and when he must do it, with respect to enrolling in Part D. What could you tell him? 85. Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-income subsidy. months after the loss of creditable cover- age. If Mr. Block enrolls in the stand-alone Medicare prescrip- tion drug plan, he will be disenrolled from the Medicare Advan- tage plan. He is currently in the Part D Ini- tial Enrollment Peri- od (IEP) and, dur- ing this time, he may make one Part D en- rollment choice, in- cluding enrollment in a stand-alone Part D plan or an MA-PD plan. He qualifies for a spe- cial election period How does that affect his ability to enroll or disen- roll in a Part D plan? 86. Mrs. Schmidt is moving and a friend told her she might qualify for a "Special election period" to enroll in a new Medicare Advantage plan. She con- and can enroll in or disenroll from a Part D plan once during that period. It is a period, out- side of the Annu- al Election Period, tacted you to ask what a special election period is. when a Medicare What could you tell her? 87. A client wants to give you an enrollment appli- cation on October 1 before the beginning of the Annual Election Period because he is leaving on vacation for two weeks and does not want to forget about turning it in. What should you tell him? 88. You are meeting with Ms. Berlin and she has com- pleted an enrollment form for a MA-PD plan you represent. You notice that her handwriting is illegi- ble and as a result, the spelling of her street looks incorrect. She asks you to fill in the corrected street name. What should you do? beneficiary can se- lect a new or dif- ferent Medicare Ad- vantage and/or Part D prescription drug plan. Typically the Special election pe- riod is beneficiary specific and results from events, such as when the beneficiary moves outside of the service area. You must tell him you are not permitted to take the form. If he sends the form direct- ly to the plan, the plan will process the en- rollment on the day the Annual Election Period begins. You may correct this information as long as you add your ini- tials and date next to the correction. 89. Mrs. Margolis contacts you in August because she will become eligible for Medicare for the first time in November. She would like to meet and discuss plan choices with you. What advice should you give her? 90. Mrs. Young is currently enrolled in Original Medicare (Parts A and B), but she has been work- ing with Agent Neil Adams in the selection of a Medicare Advantage (MA) plan. It is mid-Septem- ber, and Mrs. Young is going on vacation. Agent Tell her to wait un- til October to dis- cuss plan choices with you so that you can share plan ben- efits for the current year as well as any changes for the fol- lowing year that may impact her choice. This is a bad idea. Agents are generally prohibited from solic- iting or accepting an enrollment form be- Adams is considering suggesting that he and Mrs. fore the start of the Young complete the application together before she leaves. He will then submit the paper applica- tion before the start of the annual enrollment peri- od (AEP). What would you say If you were advising Agent Adams? 91. Mrs. Kumar would like her daughter, who lives in another state, to meet with you during the Annual Election Period to help her complete her enroll- ment in a Part D plan. She asked you when she should have her daughter plan to visit. What could you tell her? 92. 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 pre- sentation, Mrs. Nunez feels tired and tells you that AEP. Her daughter should come in November. As long as she can do so, only Mrs. Nunez can sign her en- rollment form. Mrs. her husband can finish things up. She goes to bed. Nunez will have to 93. 93. At the end of your discussion, Mr. Nunez says that he wants to enroll both himself and his wife. What should you do? wake up to sign her form or do so at an- other time. 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? 94. When Myra first became eligible for Medicare, she enrolled in Original Medicare (Parts A and B). She is now 67 and will turn 68 on July 1. She would now like to enroll in a Medicare Advantage (MA) plan and approaches you about her options. What advice would you give her? 95. Mr. White has Medicare Parts A and B with a Part D plan. Last year, he received a notice that his plan sponsor identified him as a "potential at-risk" beneficiary. This month, he started receiving assis- tance from Medicaid. He wants to find a different Part D plan that's more suitable to his current prescription drug needs. He believes he's entitled to a SEP since he is now a dual eligible. Is he able to change to a different Part D plan during a SEP for dual eligible individuals? 96. 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 dur- ing the last annual open enrollment period (AEP) which has just closed. Mr. Wendt has heard certain MA plans might provide him with more specialized coverage for his diabetes and wants to know if he must wait until the next annual open enrollment Mr. Chen can disen- roll from his employ- er-sponsored cover- age to elect a Medicare Advantage or Part D plan within 2 months of his disen- rollment. She should remain in Original Medicare un- til the annual elec- tion period running from October 15 to December 7, during which she can select an MA plan. No. Once he is iden- tified by the plan sponsor as a "poten- tial at-risk" beneficia- ry, he cannot use the dual eligible SEP to change plans while this designation is in place. If there is a special needs plan (SNP) in Mr. Wendt's area that specializes in caring for individuals with di- abetes, he may en- roll in the SNP at any time under a special election period (SEP) period (AEP) before enrolling in such a plan. What should you tell him? 97. You have come to Mrs. Midler's home for a sales You can only ask presentation. At the beginning of the presentation, Mrs. Midler ques- Mrs. Midler tells you that she has a copy of her medical records available because she thinks this will help you understand her needs. She suggests that you will know which questions to ask her about her health status in order to best assist her in selecting a plan. What should you do? 98. Mr. Roberts is enrolled in an MA plan. He recently suffered complications following hip replacement surgery. As a result, he has spent the last three tions about condi- tions that affect el- igibility, specifically, whether she has one of the conditions that would qualify her for a special needs plan. His open enrollment period as an in- stitutionalized individ- months in Resthaven, a skilled nursing facility. Mr. ual will continue for Roberts is about to be discharged. What advice would you give him regarding his health coverage options? 99. Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could you help him take during this time? 100. Ms. Lopez is an independent agent under contract with MarketCo, a third-party marketing organiza- tion. MarketCo has a contract with BestCare health plan, a Medicare Advantage (MA) organization, to offer marketing services through its contracted agents and agencies. Ms. Lopez returns calls to individuals who contact MarketCo in response to its mailers promoting BestCare health plan. Which of the following best describes the responsibilities of Ms. Lopez? 101. Ms. Brooks has an aggressive cancer and would like to know if Medicare will cover hospice ser- two months after the month he moves out of the facility. He will have one op- portunity to enroll in a Medicare Advantage plan. Ms. Lopez is consid- ered a marketing rep- resentative of Best- Care and thus is ob- ligated to comply with CMS marketing re- quirements, including those regarding us- ing only approved call scripts. Medicare covers hos- pice services and vices in case she needs them. What should you tell her? 102. If a beneficiary is enrolled in a stand-alone pre- scription drug plan and wants to keep that plan, what type of Medicare health plan could the indi- vidual also enroll in, without being automatically disenrolled from the stand-alone prescription drug plan? 103. 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 cov- erage. What would you say to her in regard to a special enrollment period (SEP)? 104. Last year Agent Melanie Meyers marketed and en- rolled several clients in Medicare Advantage (MA) health plans. This year she has decided to focus on non-MA products. What advice would you give Melanie if she wishes to continue to receive renew- al fees? 105. Agent Chan is conducting a sales presentation on senior issues where he hopes to enroll some at- tendees in the Medicare Advantage (MA) plans he represents. What action(s) may Agent Chan take during the event? they will be available for her. The beneficiary could enroll in a pri- vate fee-for-service (PFFS) plan that does not include pre- scription drug cover- age; an 1876 cost plan; or a Medicare Medical Savings Ac- count (MSA) plan She is likely to qual- ify for a SEP. She can choose an ef- fective date of up to three months af- ter the month in which the enrollment form is received by the new plan, but the effective date may not be earli- er than the date of her permanent move. Melanie must re- main trained, test- ed, licensed, and ap- pointed, regardless of whether she is active- ly selling MA prod- ucts. Discuss plan specif- ic information such as premiums and bene- fits. 106. Mrs. Sanchez lives in a state located near Canada. TrOOP are She has recently become eligible for Medicare and is considering enrollment in Part D prescription drug coverage. One of her friends has told her that out-of-pocket costs that count toward the annual out-of-pocket she needs to be aware of something called TrOOP. threshold to move What should you tell her when she asks you about TrOOP? 107. Mr. Chen has heard about a Medical Savings Ac- count (MSA), but wants to know if it is just about saving money, or if he will get insurance cover- age for his health care expenditures as well. What should you tell him? 108. During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a type of Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would be available to her. What should you tell her about PFFS plans? into catastrophic cov- erage and general- ly include the annu- al deductible(s) and costs for drugs on the plan's formulary pur- chased at a plan's participating pharma- cy. In some instances, amounts not direct- ly paid by the en- rollee (like manufac- turer discounts) count toward TrOOP. Under the Medicare Advantage program, the MSA is only an account to help him pay for IRSallowed health expenditures he may have. It does not involve health in- surance of any kind. A PFFS plan is one of the various types of Medicare Advantage plans offered by pri- vate entities and she may enroll in one if it is available in her area 109. Mr. Lopez takes several high-cost prescription drugs. He would like to enroll in a standalone Part D prescription drug plan that is available in his area. In what type of Medicare Health Plan can he enroll? 110. Mr. Wong is a single individual. He has had a suc- cessful business career and is now able to retire with a comfortable income. Mr. Wong's taxable in- come is in excess of $100,000. Mr. Wong has health coverage through his employer but will sign-up Private Fee-for-Ser- vice (PFFS) plan that does not include drug coverage. Due to his participa- tion in the workforce he will not have to pay premiums for Part A but he will pay higher Medicare Part A, Part B and Part D when he leaves premiums for Part B the workforce. How would you advise him as he budgets for Medicare premiums? 111. Mrs. Wellington is enrolled in Parts A and B of Orig- inal Medicare. A friend recently told her that there is an excellent Medicare Advantage (MA) plan with a five-star rating serving her area. On January 15 she comes to you for advice as to what options, if any, she has. What should you say regarding special enrollment periods (SEPs)? 112. Which of the following is/are most likely to be char- acterized as an involuntary disenrollment from a Medicare Advantage (MA) plan? 113. Agent Willis had several clients who disenrolled from the plans he represents during the AEP to en- roll in Medicare Advantage plans that are competi- tors of his. Agent Willis believes that the choices they made are not ideal for them and would like to get their business back during the Medicare Ad- vantage Open Enrollment Period (MAOEP). What can agent Willis do? 114. Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare prescription drug plan you represent and simply give you a check to cov- and Part D due to the amount of his income Mrs. Wellington is el- igible for a SEP that may be used once until November 30 to enroll in the five-star plan. I, II, III, and IV He can send them a flyer on the plans he represents during the MA-OEP. Enrollees should pay using automatic with- drawal from a bank account or credit er his premiums for the entire year. What should you tell him? 115. Mr. Landry is approaching his 65th birthday. He has signed up for Medicare Part A, but he did not enroll in Part B because he has employer-spon- sored coverage and intends to keep working for several more years. But he is considering enrolling in Part D prescription drug coverage because he believes it is superior to his employer plan. How would you advise him? 116. Ms. Hernandez has marketed several different types of insurance products in her home state and has typically sought approval of her materials from her State Department of Insurance. What would you advise her regarding seeking such approval for materials she uses to market Medicare Advan- tage plans? 117. During an appointment scheduled to discuss a Medicare Advantage Prescription Drug plan (MA-PD), Mr. Peters asked his agent to describe a stand-alone prescription drug plan (Part D plan) that his neighbor told him about. What should his agent do? or debit card, direct monthly billing from the plan, or deduc- tions from their Social Security check. Mr. Landry is eligible for Part D since he has Part A, and his initial enrollment pe- riod (IEP) for Part D will continue for three months after his 65th birthday. Materials for market- ing Medicare health plans to individ- uals are subject to Medicare's uni- form national require- ments. They do not need to be reviewed by the state, but the company she represents must ob- tain approval from the Medicare agency (CMS) for any materi- als she uses. Since Mr. Peters re- quested a description of the Part D plan, his agent must have Mr. Peters sign a new scope of appointment form that includes Part D, and then the 118. Mr. Perry is entitled to Medicare Part A but has not yet enrolled in Part B, even though he is 69 years old. He would like to enroll in a Medicare Part D prescription drug plan but is concerned that he will have to sign up for Part B as well in order to qualify for enrollment in a Part D plan. What should you tell him? 119. Agent Marvin Millner wants to reach out to his current clients for referrals. What advice would you give to Marvin? 120. Ms. Morris will turn 65 on June 10th. She has never previously qualified for Medicare. She is entitled to Medicare Part A and intends to enroll in Part B. She wants to know if she is eligible to enroll in a Medicare Advantage plan that includes prescrip- tion drug coverage. What do you tell her? 121. Ms. Stuart has heard about a special needs plan (SNP) that one of her friends is enrolled in and agent may discuss the Part D plan so Mr. Peters can com- pare plans and make an informed enroll- ment choice during the appointment. He does not have to enroll in Part B but, must pay a penalty for his failure to do so when he first turned 65. After that, he can enroll in a Part D pre- scription drug plan. Marvin should under- stand that under CMS guidelines he can no longer provide gifts, even of minimal val- ue, in exchange for referrals. Ms. Morris can en- roll in an MA-PD plan now since her ini- tial election period (IEP) for Part D pre- scription drug cover- age and initial cov- erage period are oc- curring together be- ginning March 1st and ending Septem- ber 30th./P Yes. All SNPs are re- quired to provide Part is interested in that product. She wants to be D coverage for pre- sure she also has coverage for prescription drugs. scription drugs. Would she be able to obtain drug coverage if she enrolled in the SNP? 122. Ms. Jensen has heard about "Original Fee-for-Ser- vice Medicare" and "Private Fee-for-Service" plans. She wants to know what the difference is if any. What should you tell her? 123. Richard is a licensed agent who represents Spar- tan Health Plan and its Medicare Advantage (MA) plans. Richard has several clients who have re- cently come to him for help who are in their initial coverage election period (ICEP) and are interested in enrolling in one of Spartan Health Plan's MA plans. Alice will soon turn 65 and retire. Alice has coverage through Spartan Health Plan offered by her employer. Bob had health coverage through Spartan but dropped the coverage when he retired early to travel overseas. Bob, who has just turned age 65, is now back in the United States. Charlotte, who will turn 65 next month, has coverage through Athena Health plan - a company Richard also rep- resents. Who qualifies for the opt-in simplified en- rollment mechanism? 124. You are doing a sales presentation for Ms. Duarte and her son. Ms. Duarte has some cognitive im- pairment and her son informs you that he has power of attorney to only make financial not health care decisions for her. Can he execute the enroll- ment for her? 125. Mr. Polanski likes the cost of an HMO plan avail- able in his area, but would like to be able to PFFS plans are a type of Medicare Ad- vantage plan offered by private compa- nies. Alice because she will not have a break between her non-Medicare and Medicare cover- age through Spartan Health Plan. No, he cannot exe- cute the enrollment for her. He must have a legal autho- rization, under state law that explicitly al- lows him to make health care decisions for his mother. The POS option might be a good visit one or two doctors who aren't participating providers. He wants to know if the Point of Service (POS) option available with some HMOs will be of any help in this situation. What should you tell him? 126. Mr. Olsen is concerned that a Medicare Advantage plan will not cover the same range of services that would be covered under Original fee-for-service Medicare. What should you tell him? 127. Agent Suma has recently had several clients re- quest his assistance in completing their paper en- rollment form. What advice would you give him? 128. Mr. Zachow has a condition for which three drugs are available. He has tried two, but had an allergic reaction to them. Only the third drug works for him and it is not on his Part D plan's formulary. What could you tell him to do? solution for him as it will allow him to visit out-of-net- work providers, gen- erally without pri- or approval. However, he should be aware that it is likely he will have to pay higher cost-sharing for ser- vices from out-of-net- work providers. Though their cost-sharing may dif- fer from Original Medicare's, Medicare Advantage plans are required to cover all services covered by original Medicare Agent Suma must apologize and tell them that, because he is their market- ing representative, he is prohibited from fill- ing out any portion of an applicant's enroll- ment form. Mr. Zachow has a right to request a for- mulary exception to obtain coverage for his Part D drug. He or his physician could obtain the standard- 129. Ms. Levi is considering enrollment in a Medicare Advantage HMO plan offered in her area. Ms. Levi often travels to visit relatives and is concerned that she may need emergency care outside of her plan's service area. What should you tell her about coverage of emergency care? 130. Ms. Bushman has two homes in different states and is concerned about restrictions on where she can get her medications. What should you tell her? ized request form on the plan's website, fill it out, and submit it to his plan. Plans are required to cover all charges for in-network emer- gency care, but cov- erage of out-ofnet- work emergency care is not required Part D prescription drug plans use net- works of pharmacies within their service areas. She could look for a plan that main- tains a network in both states 131. Mr. Moreno invited his neighbor, Agent Tom Smith, A meal cannot be to discuss Medicare Advantage (MA) and Part D plans that Agent Smith sells at the regular Tues- provided, but light snacks would be per- day brunch the neighbors have for senior citizens. mitted. What should Agent Tom Smith tell Mr. Moreno about the kinds of food that can be provided to potential enrollees who attend the sales presenta- tion? 132. Mrs. Wu was primarily a homemaker and employed in jobs that provided taxable income only sporad- ically. Her husband worked full-time throughout his long career. She has heard that to qualify for Medicare Part A she has to have worked and paid Medicare taxes for a sufficient time. What should you tell her? Since her husband paid Medicare tax- es during the entire time he was working, she will automatical- ly qualify for Medicare Part A without having to pay any premiums. 133. Since 2004 Ms. Eisenberg has had a Medigap plan that provides some drug coverage. She has re- cently received a letter from her Medigap carrier informing her that her drug coverage is not "cred- itable." She wants to know what this means. What should you tell her? 134. Mr. Jackson just turned 65. He has been seeing the same general practitioner for annual check-ups for the past 15 years, likes these yearly visits, and would like to continue obtaining these services as a Medicare beneficiary. What should you tell him about annual check-ups? 135. Agent Roderick enrolls retiree Mrs. Martinez in a medical savings account (MSA) Medicare health plan. The MSA plan does not offer prescription drug coverage, so Agent Roderick also enrolls Mrs. Martinez in a standalone prescription drug plan (PDP). What CMS compensation rules apply to this situation? 136. Ms. Gardner is currently enrolled in an MA-PD plan. However, she wants to disenroll from the MA-PD plan and instead enroll in a Part D only plan and go back to Original Medicare. According to The letter is to in- form her that her Medigap plan's cov- erage has been de- termined by the Fed- eral government to be inadequate and the plan must there- fore discontinue of- fering such coverage. Ms. Eisenberg will have to select a dif- ferent Medigap plan if she wants drug cov- erage. Medicare will cover only a one-time "Wel- come to Medicare" wellness visit MSA Medicare health plans are subject to special rules limiting initial year compen- sation to 50 per- cent of the fair mar- ket value (FMV) pub- lished annually by CMS. Regular initial year enrollment rules apply to the PDP. She may make such a change during the Annual Election Pe- riod that runs from Medicare's enrollment guidelines, when could she do this? 137. This year you decide to focus your efforts on mar- keting to employer and union groups. Which of the following statements best describes what you can and cannot do in order to stay in compliance? 138. Ms. Lewis understands that Medicare prescription drug plans may use various methods to control the use of specific drugs. She has heard about a technique called "step therapy" and is wondering if you can explain what that is. What should you tell her? 139. 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-shar- ing. What should you tell him? 140. Mrs. Tanner is enrolled in a Medicare Advantage HMO that offers a point of service option. This allows Mrs. Tanner to do which of the following? Oct. 15 to Decem- ber 7, or during the MA Open Enrollment Period which takes place from January 1- March 31 of each year. You are not required to submit communi- cation and market- ing materials specif- ic only to those em- ployer plans to CMS at the time of use, but CMS may request and review copies if employee complaints occur. Step therapy involves slow changes in the dosages of a giv- en drug in order to discover the correct amount. He should know that Medicaid will pay cost sharing only for ser- vices provided by Medicaid participat- ing providers. Mrs. Tanner can go to non-plan doctors for certain services with- out receiving prior ap- proval. 141. Able, Baker, and Charles are engaged in the mar- keting to and enrollment of beneficiaries into Medicare health plans. Mr. Able is an independent agent paid directly by a health plan. Ms. Baker is an independent agent paid through a field marketing organization (FMO). Mr. Charles is an independent agent paid for his work by a third-party marketing organization (TMO). How do the CMS compensa- tion rules apply to these three agents? 142. Madeline Martinez was widowed several years ago. Her husband worked for many years and contributed into the Medicare system. He also left a substantial estate which provides Madeline Able is subject to CMS compensation rules because he is paid directly by a health plan. Agents Baker and Charles are not because they are paid by third par- ties. You should tell Made- line that she will be able to enroll in Medicare Part A with- with an annual income of approximately $130,000. out paying monthly Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. She comes to you for advice. What should you tell her? 143. Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. He has heard that there is a premium penalty for those who did not sign up for Part B when first eligible and wants to know how much he will have to pay. What should you tell him? 144. Mrs. Paterson is concerned about the de- ductibles and co-payments associated with Origi- premiums due to her husband's long work record and participa- tion in the Medicare system. You should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest rate due her substantial income./P Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. Medigap plans help beneficiaries cover nal Medicare. What can you tell her about Medigap as an option to address this concern? 145. Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Se- curity benefits. Shortly thereafter Mrs. Quinn re- ceived a letter informing her that she has been au- tomatically enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn? 146. Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are met? What could you tell her? 147. Mr. Singh would like drug coverage but does not Original Medicare benefits, but they co- ordinate with Original Medicare coverage. Part B primarily cov- ers physician ser- vices. She will be pay- ing a monthly premi- um and, with the ex- ception of many pre- ventive and screen- ing tests, generally will have 20% coin- surance for these ser- vices, in addition to an annual deductible. Original Medicare covers ambulance services. Mr. Singh can enroll want to be enrolled in a Medicare Advantage plan. in a stand-alone pre- What should you tell him? 148. Mr.