Module 3 Final Review Review of attempt 1

• Medicare Course Home • Course (2021 Module 3: Part D) • Transcript Module 3 Final Review Review of attempt 1 Started on Saturday, May 1, 2021, 12:56 PM Complete d on Saturday, May 1, 2021, 01:20 PM Time taken 24 mins 21 secs Marks 19/20 Grade 95 out of a maximum of 100 (95%) Feedback You have completed this Knowledge Check. To proceed, please return to the training dashboard and select the next available section. Question 1 Marks: 1 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 other medications could count toward TrOOP should he ever reach the Part D catastrophic limit. What should you say? Choose one answer. Correct: None of the costs of Mr. Wingate’s other medications would currently count toward TrOOP but he may wish to ask his plan for an exception to cover the prescription not on its formulary. If he receives an exception under which the plan covers the drug, it could count toward TrOOP. a. The cost of the prescription drugs that are not on his plan’s formulary as well as the cost of the drug(s) to reduce joint swelling from the Canadian pharmacy will count toward TrOOP but the other medications in question will not count toward TrOOP. b. None of the costs of Mr. Wingate’s other medications would currently count toward TrOOP but he may wish to ask his plan for an exception to cover the prescription not on its formulary. Source: Module 3, Slide – True Out-of-Pocket Counts? (TrOOP): What Counts, Slide - True Out-of-Pocket Costs (TrOOP): What is Excluded? Correct Marks for this submission: 1/1. Question 2 Marks: 1 Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know whether he might qualify. What should you tell him? Choose one answer. d. The cost of the prescription drug that is not on his plan’s formulary will count toward TrOOP but the other medications in question will not count toward TrOOP. c. The cost of all medications bought within the United States not covered by his plan would count toward TrOOP. The cost of the Canadian bought medications would not count toward TrOOP. a. The extra help is available only to Medicare beneficiaries who are enrolled in Medicaid. He should apply for coverage under his state’s Medicaid program to access the extra help with his drug costs. Source: Module 3, Slide - Help for Individuals with Limited Income and Limited Resources and Slide - Encourage Individuals with Limited Income/Resources to Apply to the State Medicaid Office Correct Marks for this submission: 1/1. Question 3 Marks: 1 Correct: If a beneficiary has limited income and resources, they may qualify for a low-income subsidy (LIS) to cover all or part of the Part D plan premium and cost-sharing. Beneficiary income may not exceed 150 percent of the Federal Poverty Level (FPL). Assets may not exceed a limited amount also specified by the government. c. He must apply for the extra help at the same time he applies for enrollment in a Part D plan. If he missed this opportunity, he will not be able to apply for the extra help again until the next annual enrollment period. b. The government pays a per-beneficiary dollar amount to the Medicare Part D prescription drug plans, to offset premiums for their lowincome enrollees in accordance with the plan’s set criteria. Mr. Shapiro should check with his plan to see if he qualifies. d. The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. 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? Choose one answer. Incorrect: The premium penalty exists as long as the enrollee has Part D coverage, and the premium penalty amount is 1% of the national average premium for each month the individual does not have Part D coverage. d. If she does not sign up for a Medicare prescription drug plan, she will incur no penalty, as long as she can demonstrate that she was in good health and did not take any medications. a. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign up at a later date, she will have to pay a one-time penalty equal to 10% of the annual premium amount. b. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign up at a later date, she will be required to pay a higher premium during the first year that she is enrolled in the Medicare prescription drug program. After that point, her premium will return to the normal amount. c. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign up at a later date, her premium will be permanently increased by 1% of the national average premium for every month that she was not covered. Source: Module 3, Slide -Part D Late Enrollment Penalty, Slide – Part D Late Enrollment Penalty Examples Incorrect Marks for this submission: 0/1. Question 4 Marks: 1 Mr. Shultz 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 because he was satisfied with his drug coverage. It is now a year later and Mr. Shultz has lost his employer group coverage within the last two weeks. How would you advise him? Choose one answer. Correct: Mr. Schultz should enroll in a Part D plan, or otherwise obtain creditable drug coverage, before he has a 63- day break in order to avoid a premium penalty. d. 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. a. Mr. Schultz should immediately enroll in a Part D plan but he can expect to pay a premium penalty because he failed to enroll when first eligible. c. Mr. Schultz should seek to continue employer group coverage through COBRA because it is likely to have superior benefits at a more reasonable price. b. Mr. Schultz can wait up to 180 days after the loss of his creditable employer group coverage before enrolling in a Part D plan without worrying payment a premium penalty. Source: Module 3, Slide – Employer Coverage of Drugs, Slide – Employer/Union Coverage of Drugs, continued Correct Marks for this submission: 1/1. Question 5 Marks: 1 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 premiums withheld from his Social Security check. What should you tell him? Choose one answer. Source: Module 3, Slide -Part D Premiums Correct Correct: General ly, a Part D beneficiary must stay with a premium payment option for the entire plan year. a. As long as he fills out the paperwork to begin withholding from his Social Security check at least 63 days before such withholding should begin, he can change his method of Part D premium payment and withholding will begin the month after his savings account is exhausted. b. In general, to pay his Part D premium, he only can have automatic withdrawals made from a checking account, so he will need to transfer the funds prior to beginning such withdrawals. c. In general, he must select a single Part D premium payment mechanism that will be used throughout the year. d. During 2017, many people experienced significant problems with deductions from their Social Security check for their Part D premium. As a result, this method of payment is no longer an option for Part D premium payments. Marks for this submission: 1/1. Question 6 Marks: 1 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? Choose one answer. Source: Module 3, Slide - Other Help for Low-Income - Pharmaceutical Assistance Programs Correct Marks for this submission: 1/1. Correct: Some pharmaceutical manufacturers operate programs that assist lowincome individuals. In addition, some states have assistance programs specifically for their residents. Some of the state programs are “qualified” and count toward TrOOP and some do not. b. The only option available is to reduce his income so that he can qualify for the Part D extra help or wait until next year to see if the annual limits change. c. He should contact his neighbors and family members and let them know that any contributions they make toward his drug expenses will be tax deductible. a. He should look into the possibility of purchasing his medications through the internet from off-shore pharmacies. d. He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means to obtain the medications they need. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. Question 7 Marks: 1 Mrs. Allen has a rare condition for which two different brand name drugs are the only available treatment. She is concerned that since no generic 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? Choose one answer. Correct: Part D formularies must include at least two drugs in each therapeutic category whether or not generic versions are available. Mrs. Allen should be able to find a plan that covers the medications she needs. a. Medicare prescription drug plans are allowed to restrict their coverage to generic drugs. She will need to pay for her brand name medications out of pocket. c. Medicare prescription drug plans are required to include only a certain percentage of brand name drugs among those they cover. It may be possible that plans available in her area have opted not to include in their formularies the brand name drugs she needs. She may need to pay for this particular medication out of pocket. b. Medicare prescription drug plans are required to cover drugs in each therapeutic category. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. Source: Module 3, Slide - Covered Part D Drugs, continued, Slide – Formularies Correct Marks for this submission: 1/1. Question 8 Marks: 1 Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (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? Choose one answer. d. When medication costs exceed a certain threshold amount, which rises each year, a Medicare prescription drug plan is permitted to exclude coverage for all but the least expensive of the medications in a given category. Mrs. Allen will need to encourage her physician to prescribe the least expensive of the two alternatives. Correct: Mr. Carlini can stay in Original Medicare and obtain prescription drug benefits through a stand-alone Part D plan. He does not have to enroll in a MA plan. a. Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan through a private company that has contracted with the government to provide only such drug coverage to eligible Medicare beneficiaries. b. Mr. Carlini can keep Original Medicare, but if he does not sign up for an MA plan that includes prescription drug coverage, he will only be able to obtain prescription drug coverage through a Medigap plan. Source: Module 3, Slide - Medicare Part D Prescription Drug Program Basic, Slide - Medicare - Medicare Part D Prescription Drug Program Basics, continued Correct Marks for this submission: 1/1. Question 9 Marks: 1 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? Choose one answer. d. In order to obtain prescription drug coverage, Mr. Carlini must enroll in an MA plan. The plan will cover his Part A and Part B services, as well as provide him with the desired prescription drug coverage. c. Mr. Carlini can obtain drug coverage through the Federal government’s fallback plans, which are designed to provide an alternative to privately sponsored Medicare Advantage plans. Correct: Formulary exception requests can be used to request coverage of a drug not on a Part D plan’s formulary or to cover a formulary drug at a lower cost formulary. b. Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. He or his physician could obtain the standardized request form on the plan’s website, fill it out, and submit it to his plan. a. Mr. Zachow could immediately disenroll from the Part D plan and select a new Part D plan that covers the drug that works for him. Source: Module 3, Slide - Enrollee Rights: Requesting Exceptions for Drugs Correct Marks for this submission: 1/1. Question 10 Marks: 1 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? Choose one answer. d. Mr. Zachow will have to wait until the Annual Election Period when he can switch Part D plans. In the meantime, he will have to pay for his drug out of pocket. c. Mr. Zachow will need to enroll in a Special Needs Plan to obtain coverage for his medication. Correct: There are some circumstances that allow for enrollees to utilize a non-network pharmacy. However, these prescriptions are typically filled at a higher cost to these enrollees. b. She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an innetwork pharmacy. c. She may fill one prescription out-of-network per year and it will be fully covered. Her second prescription will require her to pay the full cost out-ofpocket. a. She should wait to fill her prescriptions until she is back home since only her local pharmacy is likely to be in her plan’s network. Source: Module 3, Slide – Part D Pharmacy Networks Correct Marks for this submission: 1/1. Question 11 Marks: 1 Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. She is interested in selecting a Medicare Part D prescription drug plan. She takes a number of medications and is concerned that she has not been able to identify a plan that covers all of her medications. She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. What should you tell her? Choose one answer. d. She may fill both prescriptions and they will be fully covered at in-network pricing due to the fact that she is traveling. b. She should use an existing prescription drug coverage to get as large a supply of her existing drugs as possible, and then pick new drugs that are covered under her Medicare plan’s formulary. a. There is no possibility of obtaining coverage for her existing medications once coverage under the Medicare Part D plan begins. She will need to have her physician help her select a new drug that is covered. Source: Module 3, Slide - Transition Requirements Correct Marks for this submission: 1/1. Question 12 Marks: 1 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? Choose one answer. Correct: Mrs. Roswell is a new enrollee. Those initially enrolling in Part D, those switching plans, and current enrollees affected by formulary changes must receive coverage of a single one-month fill of their non-formulary drugs. d. The Medicare Part D drug plan is required to offer her coverage of the exact same drugs that she is currently stabilized on, so she does not need to be concerned about transitioning to any new medications. c. Every Part D drug plan is required to cover a single onemonth fill of her existing medications sometime during a 90-day transition period. a. The government allows Part D plans to adopt any benefit structure as long as the list of covered drugs meets their approval. Source: Module 3, Slide - Part D Plan Benefits and Slide – Part D Benefits. Continued Correct Marks for this submission: 1/1. Question 13 Marks: 1 One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. She asks you to explain it. What do you say? Choose one answer. Correct: Part D plans must cover at least the Part D standard benefits or its actuarial equivalent. Part D plans are permitted to offer supplemental benefits that cover certain drugs not covered under Part D. Some Part D plans may offer these supplemental benefits for an additional monthly premium. d. The Part D standard model’s importance is that it is the only type of plan into which lowincome beneficiaries can enroll and still receive any extra help for which they may qualify. c. Medicare Part D drug plans may have different benefit structures, but on average, they must all be at least as good as the standard model established by the government. b. The government bases its payments to Part D plans on the standard benefit model. For Part D plans to receive the full government payment, they must offer the standard model, however, they can take a risk and revise their benefit structure to attract more beneficiaries. Source: Module 3, Slide – Part D Standard Benefits for 2021, Catastrophic Coverage, Slide – True Out-of-Pocket Counts? (TrOOP): What Counts, Slide - True Out-of-Pocket Costs (TrOOP): What is Excluded? Correct Marks for this submission: 1/1. Question 14 Marks: 1 Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently lost creditable coverage previously available through her Correct: TrOOP stands for true out-of-pocket expenses that count toward the Medicare Part D catastrophic limit and include not only expenses paid by a beneficiary but also in some instances drug manufacturer discounts. d. TrOOP refers to true out-ofpocket expenses paid by a Part D beneficiary for nonprescription over-the-counter (OTC) drugs and vitamins that are not covered by his or her plan. c. TrOOP stands for true out-ofpocket expenses that count toward the Medicare Part D catastrophic limit and include only expenses paid directly by a Medicare Part D beneficiary. b. TrOOP refers to true out-ofpocket expenses paid by drug manufacturers on behalf of Medicare Part D beneficiaries. a. TrOOP stands for true out-ofpocket expenses that count toward the Medicare Part D catastrophic limit and include not only expenses paid by a beneficiary but also in some instances drug manufacturer discounts. husband’s employer. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). What should you tell her? Choose one answer. Source: Module 3, Slide – Medicare Part D Prescription Drug Program Basics, continued, Slide – Medicare Part D Prescription Drug Eligibility – Examples Correct Marks for this submission: 1/1. Question 15 Correct: Mrs. Lopez is enrolled in a Cost plan. This provides her with options as to how she secures Part D benefits. Beneficiaries enrolled in a Cost plan may obtain Part D benefits through their plan (if offered) or alternatively through a stand-alone Prescription Drug Plan (PDP). c. Mrs. Lopez must enroll in either a HMO or PPO Medicare Advantage plan in order to obtain Part D coverage. d. If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. a. Mrs. Lopez must first seek COBRA benefits under her husband’s plan before she can apply for Part D coverage. b. If a Part D benefit is offered through her plan she must enroll in this plan. Marks: 1 Which of the following statements about Medicare Part D are correct? I. Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP. IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a standalone PDP or through their plan. Choose one answer. Correct: Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. Also, private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. Additionally, beneficiaries enrolled in an MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP. a. I an d II on ly b. I, II, III, an d IV c. I, II, an d III on ly Source: Module 3, Slide – Medicare Part D Prescription Drug Program Basics, continued, Slide – Medicare Part D Eligibility Correct Marks for this submission: 1/1. Question 16 Marks: 1 Mr. Hutchinson has drug coverage through his former 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? Choose one answer. d. I on ly b. As long as he has any sort of employer coverage, regardless of the level of coverage, he will incur no penalty if he does not enroll in a Part D plan when first eligible. a. He should drop the employer coverage and enroll in a Medicare prescription drug plan. Employer plans are almost always more costly for beneficiaries and most do not cover the same range of drugs available from a Medicare prescription drug plan. Source: Part 3, Slide - Employer/Union Coverage of Drugs, Slide – Part D Late Enrollment Penalty Correct Marks for this submission: 1/1. Question 17 Marks: 1 What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? Choose one answer. Correct: To avoid a late enrollment penalty, Mr. Hutchinson must have “creditable” coverage. If he does not, he must enroll in Medicare Part D during his initial eligibility period to avoid a late enrollment penalty. d. He will need to enroll in a Medicare prescription drug plan upon becoming eligible for the program in order to avoid a premium penalty. To reduce his expenses, he should look for a plan with a zero premium. c. If the drug coverage he has is not expected to pay, on average, at least as much as Medicare’s standard Part D coverage expects to pay, then he will need to enroll in Medicare Part D during his initial eligibility period to avoid the late enrollment penalty. a. The Federal government establishes a set formulary, or list of covered drugs, each year that the Part D plans must use. Beneficiaries should consult the government’s list prior to deciding whether they wish to enroll in a Part D plan during that year. Source: Module 3, Slide – Part D Drug Management Tools, Slide – Part D Drug Management Tools continued Correct Marks for this submission: 1/1. Question 18 Marks: 1 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? Choose one answer. Correct: Part D plans are not required to cover all prescriptions on the market. But they have various methods to manage costs including formularies, costsharing tiers, step therapy, prior authorization and substitution. c. Part D plans may use varying copayments for brand name and generic drugs, but they may not restrict access through prior authorization. d. Part D plans may use varying copayments, but they are required to cover all prescription medications on the market. b. Part D plans do not have to cover all medications. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. a. Standard Part D coverage would require payment of fixed per-prescription co-payments and 75% of the costs in the coverage gap. Source: Module 3, Slides - Part D Plan Benefits, Slide - Part D Benefits: The Standard Benefits for 2021, Catastrophic Coverage Correct Marks for this submission: 1/1. Question 19 Marks: 1 Mr. and Mrs. Vaughn both take a specialized multivitamin 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? Choose one answer. Correct: Standard Part D coverage would require payment of an annual deductible, and once through the catastrophic coverage threshold the beneficiary pays either co-pays for generic and brand name drugs or co-insurance of 5%, whichever is greater. b. Standard Part D coverage would require payment of an annual deductible, fixed perprescription co-payments, and once catastrophic coverage begins, the plan covers 100% of all costs. c. Standard Part D coverage would require payment of only fixed per-prescription copayments. d. Standard Part D coverage 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 name drugs or coinsurance of 5%. a. The vitamins the Vaughns are taking will be covered under Part D because their physician suggested they should take vitamins, but the hair loss medication cannot be covered. Source: Module 3, Slide – Drugs Excluded from Part D Coverage Correct Marks for this submission: 1/1. Question 20 Marks: 1 Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare prescription drug plan because, although she is entitled to Part A, she is not enrolled under Medicare Part B. What should you tell her? Choose one answer. Correct. The drugs the Vaughns are interested in may be covered as supplemental benefits. b. Medicare prescription drug plans are permitted to cover vitamins, but not drugs for cosmetic purposes. c. Mr. Vaughn’s hair growth medication would only be covered under Part D if his balding resulted from an illness or was a side effect of a treatment such as chemotherapy. d. Medicare prescription drug plans are not permitted to cover the prescription medications the Vaughns are interested in under Part D coverage, however, plans may cover them as supplemental benefits and the Vaughn’s could look into that possibility. a. To qualify for enrollment into a Medicare prescription drug plan, Mrs. Mulcahy must be entitled to Part A and enrolled under Part B. She should contact her local Social Security office and make arrangements to enroll in Part B prior to selecting a prescription drug plan. Source: Module 3, Slide - Medicare Part D Eligibility Correct Marks for this submission: 1/1. AHIP©2020. All rights reserved. You are logged in as A. M. Early (Logout) Powered by CourseStage from Web Courseworks Ltd. Correct: Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. d. An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she does not need to enroll under Part B before enrolling in a prescription drug plan. b. Like all Medicare beneficiaries, Mrs. Mulcahy will be automatically enrolled in a Medicare prescription drug plan when she turns 65. She will have a six-month window during which she can select a plan other than the one into which she has been automatically enrolled. c. As long as Mrs. Mulcahy is 65, eligibility for a Medicare prescription drug plan is not dependent on entitlement to Part A or enrollment under Part B, so she should not be concerned. Choose one answer. Question 2 Marks: 1 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? Choose one answer. Question 3 Marks: 1 Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treated for that condition. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What should you a. Original Medicare covers ambulance services. b. Original Medicare covers cosmetic surgery. c. Original Medicare covers routine long-term custodial care. d. Original Medicare covers routine dental care. a. Medicare Supplemental Insurance would cover his long-term care services. b. Medicare Supplemental Insurance would cover all of his IRS approved health care expenditures not covered under Original Fee-for-Service (FFS) Medicare. c. Medicare Supplemental Insurance would help cover his Part A and Part B cost sharing in Original Fee-forService (FFS) Medicare as well as possibly some services that Medicare does not cover. d. Medicare Supplemental Insurance would cover his dental, vision and hearing services only. tell them about Original Medicare’s coverage of care in a skilled nursing facility? Choose one answer. Question 4 Marks: 1 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? Choose one answer. Question a. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered because Medicare does not provide such a benefit. b. Medicare will cover Mrs. Shield’s skilled nursing services provided during the first 20 days of her stay, after which she would have a copay until she has been in the facility for 100 days. c. Medicare will cover an unlimited number of days in a skilled-nursing facility, as long as a physician certifies that such care is needed. d. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields long-term care costs. a. Part D, which covers prescription drug services, is covered under Original Medicare. b. Part A, which covers hospital, skilled nursing facility, hospice, and home health services and Part B, which covers professional services such as those provided by a doctor are covered under Original Medicare. c. Part C, which always covers dental and vision services, is covered under Original Medicare. d. Part A, which covers long term custodial care services, is covered under Original Medicare. 5 Marks: 1 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 concerned that she will not qualify for coverage under part A because she was not born in the United States. What should you tell her? Choose one answer. Question 6 Marks: 1 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? Choose one answer. a. Most individuals who are citizens and age 65 or over and wish to be covered under Part A must enroll in a Medicare Advantage Plan. b. All individuals who are citizens and age 65 or over will be covered under Part A. c. Most individuals who are citizens and age 65 or over are covered under Part A by virtue of having paid Medicare taxes while working, though some may be covered as a result of paying monthly premiums. d. Most individuals who are citizens and age 65 or over and are covered under Part A must pay a monthly premium for that coverage. a. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. b. Mr. Wu may still qualify for help in paying for Part D costs through the Federal Pharmaceutical Assistance Program. Question 7 Marks: 1 Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What should you tell him? Choose one answer. Question 8 Marks: 1 Anita Magri will turn age 65 in August 2020. Anita intends to enroll in Original Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita’s older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. What should you tell her? Choose one answer. c. Mr. Wu has no alternative but to liquidate his remaining assets and apply for coverage through his state’s Medicaid program. d. Mr. Wu may still qualify for help in paying for Part D costs through the local Office of the Aging. a. Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare. b. Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Advantage plan. c. Mr. Singh must leave Original Medicare to receive drug coverage. d. Part D prescription drug coverage can only be obtained by enrollment into a Medicare Advantage plan that also covers Part A and Part B services. Question 9 Marks: 1 What impact, if any, will recent regulatory changes have upon Medigap plans? Choose one answer. a. You are sorry to disappoint Anita but Medigap plans are no longer available to those who turn age 65 after January 1, 2020. Anita should instead consider a Medicare Advantage plan. b. You are sorry to disappoint Anita but a Medigap Part F plan is no longer available to those who turn age 65 after January 1,2020. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. c. You would be happy to help Anita enroll in a Medigap Part F plan will provide foreign travel benefits as a well as cover her Part B deductible. d. You would be happy to help Anita enroll in a Medigap plan but before she can do so, she must also enroll in a Medicare Part D prescription drug plan. a. The Part A deductible is no longer covered under Medigap plans for all enrollees starting January 1, 2020. b. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. c. The Part B deductible will be covered for some newly eligible individuals depending on their financial status. d. The Part A deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. Question 10 Marks: 1 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? Choose one answer. Question 11 Marks: 1 Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn? Choose one answer. a. During the first year, he is covered under Part B, his premiums will be 10% higher than they otherwise would be, after which point they will return to normal. b. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer’s plan. c. Mr. Diaz will pay a penalty, which will be a flat amount each year, paid during the first month of coverage. d. The penalty will be a permanent 10% increase in his Part B premium for every 12-month period that passed during which he could have enrolled and did not. Question 12 Marks: 1 Mrs. Geisler’s neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can’t remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her? Choose one answer. a. Part B will cover her dental and vision needs. b. Part B primarily covers physician services. She will be paying a monthly premium and, with the exception of many preventive and screening tests, generally will have 20% coinsurance for these services, in addition to an annual deductible. c. She will need to pay no premiums for Part B as she qualifies for premium-free coverage due to the number of quarters she has worked. d. She should disenroll if she does not want to pay the monthly premiums. There is no disadvantage in doing so. a. Part D covers hospital and home health services and the cost sharing has changed this year. b. Part D covers physician and non-physician practitioner services and the deductible has not changed this year, but the physician charges may go up. c. Part D covers prescription drugs and she should look at her premiums, formulary, and cost-sharing among other factors to see if they have changed. d. Part D covers long-term care services and she shouldn’t worry because there has been no change in coverage. Question 13 Marks: 1 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? Choose one answer. Question 14 Marks: 1 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? Choose one answer. a. Tell prospect Jerry Smith that he should drop his Medigap coverage and put those premium dollars toward the purchase of a standalone Part D prescription drug plan because he can always reactivate his Medigap policy on a guaranteed issue basis. Furthermore, because he has had Medigap Jerry will not incur a Part D late enrollment penalty. b. Tell prospect Jerry Smith that he should keep his Medigap plan but he should supplement his healthcare coverage by purchasing a Medicare Advantage plan that offers prescription drug coverage (MA-PD). c. Tell prospect Jerry Smith that Medigap is simply a variation of a Medicare Advantage plan and the companies John represents offer more comprehensive coverage for a lower price. d. Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. Question 15 Marks: 1 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? Choose one answer. a. Benefits covered by Medicare Parts A and B include routine dental care, hearing aids, and routine eye care. b. Beneficiaries under Original Medicare have no costsharing for most preventive services which include immunizations such as annual flu shots. c. Medicare Part B generally provides prescription drug coverage. d. Medicare Part A generally covers medically necessary physician and other health care professional services. a. Medicare is a program for people who have incomes and assets below specific limits, so you will have to find out her exact financial situation before telling her whether she can obtain Medicare coverage. b. Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, endstage renal disease, and Lou Gehrig’s disease so she will be eligible for Medicare. c. Eligibility for Medicare is based on whether or not a person has ever been employed by the federal government. If she or her husband were ever employed by the federal government, she can enroll in Medicare. Question 16 Marks: 1 Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare 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 impact his employer-sponsored healthcare coverage. How would you respond? Choose one answer. d. Medicare is a program for people of all ages with specific mental health disabilities. Since she is in excellent health, she would not qualify, but should instead look into her state’s Medicaid program if she wants further coverage. a. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his healthcare claims and Smallcap does not have to continue to offer him coverage comparable to those under age 65 under its employer-sponsored group health plan. b. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls his employer-sponsored coverage would continue to be the primary payor while Medicare would be considered a secondary payor of his healthcare claims. c. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his healthcare claims but Smallcap must continue to offer him coverage under its employer-sponsored group health plan and would become a secondary payor. d. Juan is likely to be ineligible for Medicare since he was born outside the United States and has only contributed to the Medicare system for 20 years. Question 17 Marks: 1 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? Choose one answer. Question 18 Marks: 1 Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. What can you tell her about Medigap as an option to address this concern? Choose one answer. a. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. b. Individuals who become eligible for such disability payments only have to wait 12 months before they can apply for coverage under Medicare. c. Individuals receiving such disability payments from the Social Security Administration continue to receive those payments but only become eligible for Medicare upon reaching age 65. d. He became eligible for Medicare when his disability eligibility determination was first made. a. Medigap plans are not sold by private companies and are a government insurance product. b. All costs not covered by Medicare are covered by some Medigap plans. Question 19 Marks: 1 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 with an annual income of approximately $130,000. 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? Choose one answer. c. If Mrs. Paterson applies during the Medigap open enrollment period, she will have to undergo a medical review to determine if she has a pre-existing condition that would increase the premium for a Medigap policy. d. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. a. You should tell Madeline that she will be able to enroll in both Medicare Part A and Part B without paying monthly premiums due to her husband’s long work record and participation in the Medicare system. b. You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums due to her husband’s long work record and participation in the Medicare system. You should also tell Madeline that she will pay Part B premiums at the highest rate because her income over the last several years has exceeded $100,000. c. You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums due to her husband’s long work record and participation 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. Question 20 Marks: 1 Mr. Davis is 52 years old and has recently been diagnosed with endstage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? Choose one answer. AHIP©2020. All rights reserved. You are logged in as A. M. Early (Logout) Powered by CourseStage from Web Courseworks Ltd. d. You should tell Madeline that she will need to pay premiums for Part A because of her short work history. You should also tell Madeline that she will pay Part B premiums at the highest rate because her income over the last several years has exceeded $100,000. a. He may sign-up for Medicare at any time however coverage usually begins on the sixth month after dialysis treatments start. b. He may not sign-up for Medicare until he reaches age 62, the date he first becomes eligible for Social Security benefits. c. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. d. He may sign-up for Medicare at any time and coverage usually begins immediately.