10/13/ Final Exam: Final Exam https://www.ahipmedicaretraining.com/mod/quiz/attempt.php?q=942&forcenew=0&uniqueid=/15 1 Marks: 1 Choose one answer. a. Plans must contract only with marketing representatives who reside in the state where

10/13/ Final Exam: Final Exam 1 Marks: 1 Choose one answer. a. Plans must contract only with marketing representatives who reside in the state where they intend to work. b. State licensure laws are pre-empted and do not apply to marketing representatives marketing MA and Part D plans c. Plan sponsors can use any marketing representative, as long as they are licensed in at least one state. d. Medicare health plans must comply with requests for information from state insurance departments investigating complaints about a marketing representative. Which of the following is a correct statement about state laws as they pertain to marketing representatives? 2 Marks: 1 Choose one answer. a. Any type of meal or food is allowed, as long as it is available to the general public and not just those who are eligible to enroll in the plans. b. Any meal is allowed, as long as it is valued at less than $15. c. A meal cannot be provided, but light snacks would be permitted. d. Nothing may be provided to eat or drink during the sales presentation. Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage (MA) and Part D plans that Agent Smith sells at the regular Tuesday brunch the neighbors have for senior citizens. What should Agent Tom Smith tell Mr. Moreno about the kinds of food that can be provided to potential enrollees who attend the sales presentation? 3 Marks: 1 Choose one answer. a. The beneficiary could only choose an 1876 Cost Plan. b. The beneficiary could only choose a Medicare Medical Savings Account (MSA) plan. c. The beneficiary could enroll in a private fee-for-service (PFFS) plan that does not include prescription drug coverage; an 1876 cost plan; or a Medicare Medical Savings Account (MSA) plan d. The beneficiary could only stay in a stand-alone prescription drug plan if he or she has original fee-for-service Medicare If a beneficiary is enrolled in a stand-alone prescription drug plan and wants to keep that plan, what type of Medicare health plan could the individual also enroll in, without being automatically disenrolled from the stand-alone prescription drug plan? 4 Marks: 1 Final Exam - Attempt 1 Medicare Course Home Course (2020 Final Exam) Transcript Time Remaining 0:04:10 10/13/ Final Exam: Final Exam Choose one answer. a. Plans may not participate in advertising such an event. All advertising must be done by community organizations. b. You must only ensure that the advertisement is factually accurate. c. You must state in the advertisement that it will be an educational event and that the education will consist of specific information about the participating plans. d. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. You are working with a number of plans and community organizations to sponsor an educational event. When putting together advertisements for this event, what should you do? 5 Marks: 1 Choose one answer. a. 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. 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. 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. d. 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. 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? 6 Marks: 1 Choose one answer. a. 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 parties. b. Charles is subject to CMS compliance rules because he works for a TMO and CMS applies an extra layer of scrutiny to such organizations. Able and Baker are not. c. All three are treated as independent agents under CMS compensation rules. d. Baker and Charles are subject to CMS compensation rules because they are paid by third parties. Able is not because he is paid directly by a health plan. Able, Baker, and Charles are engaged in the marketing 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 compensation rules apply to these three agents? 7 Marks: 1 Choose one answer. a. Yes. When an event has been advertised as “educational,” discussing plan-specific premiums is impermissible. Agent Mary Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings distributes materials that are solely educational in nature. However, she gives a brief presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that has been advertised as educational? 10/13/ Final Exam: Final Exam b. No. Attendees expect some “puffery” at any event on a product in which they may be potentially interested. c. No. This action is permissible. Handing out enrollment forms, on the other hand, would not be permissible. d. Yes. Whether or not an event has been advertised as “educational” or a “sales presentation,” discussing plan-specific information is impermissible. 8 Marks: 1 Choose one answer. a. Mrs. Berkowitz can apply for any Medicare Advantage plan and, if it offers drug coverage, ask to have that element of the coverage eliminated, after which she can enroll in a stand-alone Medicare prescription drug plan in her service area. b. If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account, Mrs. Berkowitz can do this. c. Mrs. Berkowitz can enroll in any Medicare Advantage plan, regardless of whether it offers drug coverage, and enroll in any stand-alone Medicare prescription drug plan. d. This is not a possibility. If Mrs. Berkowitz wants health coverage and drug coverage through a plan, she must purchase an MA-PD plan. Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this? 9 Marks: 1 Choose one answer. a. He will need to mail in his payment with his enrollment form. b. This is perfectly acceptable. You will be happy to forward his payment to the plan. c. Enrollees should pay using automatic withdrawal from a bank account or credit or debit card, direct monthly billing from the plan, or deductions from their Social Security check. d. You can take his first payment, but after that, he will need to make arrangements to send his monthly premium payment to the plan. 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 cover his premiums for the entire year. What should you tell him? 10 Marks: 1 Choose one answer. a. The letter is to inform her that the drug coverage offered through her Medigap plan does not offer drug coverage that is at least comparable to that provided under the Medicare Part D prescription drug program. If she does not have such creditable coverage during periods when she is first eligible for the Part D program, she will face a premium penalty if she enrolls in a Part D plan at a later date. b. The letter is to inform her that her Medigap plan’s coverage has been determined by the Federal government to be inadequate and the plan must therefore discontinue offering such coverage. Ms. Eisenberg will have to select a different Medigap plan if she wants drug coverage. c. The letter is to inform her that Medicare Part D prescription drug coverage is available, but there is no need for her to change her drug coverage since it is just as good as Part D. She may keep her current coverage through the Medigap plan. d. The letter is to inform her that her Medigap drug coverage must be supplemented by purchasing coverage under a Part D plan. If she does not do so within 63 days, she will not be able to obtain Part D coverage at a later date. Since 2004 Ms. Eisenberg has had a Medigap plan that provides some drug coverage. She has recently received a letter from her Medigap carrier informing her that her drug coverage is not "creditable." She wants to know what this means. What should you tell her? 10/13/ Final Exam: Final Exam 11 Marks: 1 Choose one answer. a. In general, Mrs. Ramos will need a referral to see specialists. b. In general, Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but will have to pay the difference between the plan’s allowed amount and the provider’s usual and customary charge. c. Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO network. d. Mrs. Ramos should be aware that generally plan providers can decide, on a case-bycase basis, whether they will treat her. 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? 12 Marks: 1 Choose one answer. a. Plans must use a single, standard formulary developed by the Federal government to keep costs down and quality high for beneficiaries. b. Formularies are developed purely on the basis of drug costs and include the least expensive drugs to keep costs down for beneficiaries and the Medicare program. c. Formularies must be developed with input from pharmacists, doctors, and other experts. d. Formularies are developed by a consortium of health plans. Mr. Nguyen understands that Medicare prescription drug plans can use a formulary or list of covered drugs. He is suspicious about how plans establish these formularies. What should you tell him? 13 Marks: 1 Choose one answer. a. Tell Julia that you will meet with her to explain Medicare and should she be interested you can accept and submit an enrollment request, since this is an initial enrollment qualifying her for a special enrollment period. b. Tell Julia that she must first complete a questionnaire providing her health history so that you can recommend an appropriate product before submitting an enrollment application, since she qualifies for a special enrollment period. c. Tell Julia that you are happy to meet with her once this year’s open enrollment begins on October 15th. d. Tell Julia that you will meet with her at a time of her convenience within the next week, when you can accept a completed enrollment application to be submitted after October 15th. Julia Harris is turning 66 in July, at which time she will retire. She has contacted your office and requested a meeting so that she can learn about Medicare and the products you represent. How should you respond? 14 Marks: 1 Choose one answer. a. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. b. Mr. Wu has no alternative but to liquidate his remaining assets and apply for coverage through his state’s Medicaid program. 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? 10/13/ Final Exam: Final Exam c. Mr. Wu may still qualify for help in paying for Part D costs through the local Office of the Aging. d. Mr. Wu may still qualify for help in paying for Part D costs through the Federal Pharmaceutical Assistance Program. 15 Marks: 1 Choose one answer. a. No. Medicare beneficiaries who enroll in an SNP must always obtain their drug coverage through a stand-alone Part D Medicare prescription drug plan that they sign up for independent of their enrollment in the SNP. b. Maybe. Some SNPs offer Part D coverage for prescription drugs and some do not. c. Yes. All SNPs are required to provide Part D coverage for prescription drugs. d. Yes, but only if she qualifies for Part D prescription drug coverage under her state Medicaid program. Ms. Stuart has heard about a special needs plan (SNP) that one of her friends is enrolled in and is interested in that product. She wants to be sure she also has coverage for prescription drugs. Would she be able to obtain drug coverage if she enrolled in the SNP? 16 Marks: 1 Choose one answer. a. The Part D low income subsidy will not help her once she reaches the coverage gap, so she need not take the time to apply. b. The Part D low income subsidy is designed for Medicare beneficiaries who also qualify for Medicaid. If she does not qualify for Medicaid, she would likely not qualify for the extra help and therefore should not take the time to apply. c. Those who qualify for the Part D low income subsidy pay nothing for any of their medications. She should definitely apply if she believes there is any chance of her qualifying. d. The Part D low income subsidy could substantially lower her overall costs. She can apply by contacting her state Medicaid office or calling the Social Security Administration. Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the time to fill out the paperwork. What could you tell her? 17 Marks: 1 Choose one answer. a. Due to his participation in the workforce he will not have to pay premiums for Part A and will pay reduced premiums for Part B and Part D. b. Due to the provisions of MACRA, his Part B and D coverage will be combined and covered through a low-cost Medigap policy to supplement his Part A coverage. c. Due to his participation in the workforce he will not have to pay premiums for Part A and he will pay the lowest monthly premium rates for Part B and Part D. d. Due to his participation in the workforce he will not have to pay premiums for Part A but he will pay higher premiums for Part B and Part D due to the amount of his income. Mr. Wong is a single individual. He has had a successful business career and is now able to retire with a comfortable income. Mr. Wong's taxable income is in excess of $100,000. Mr. Wong has health coverage through his employer but will sign-up Medicare Part A, Part B and Part D when he leaves the workforce. How would you advise him as he budgets for Medicare premiums? 18 Marks: 1 10/13/ Final Exam: Final Exam Choose one answer. a. You must receive an invitation from the beneficiary and document the specific types of products the beneficiary wants to discuss prior to making an in-home presentation. b. There is no special action that you must take. If they choose, you may go to an individual’s house to provide presentations and offer assistance with enrolling in a plan. c. A proper introduction at the door that includes a disclaimer regarding your relationship with the plan you represent is the only required action you must take, prior to entering the beneficiary’s home. d. You must first contact the Medicare agency to ensure that the individual is actually a Medicare beneficiary. You have decided to focus on doing in-home presentations to market the Medicare Advantage (MA) plans you represent. Before you conduct such sales presentations, what must you do? 19 Marks: 1 Choose one answer. a. A MTM program is available to all Medicare Part D enrollees who seek help in selecting the prescription drugs most appropriate to their needs. b. To be eligible for a MTM program, a Medicare beneficiary must suffer from at least one chronic disease, such as asthma, and be likely to incur considerable drug costs. c. A MTM program is an excellent choice for someone taking very few prescription drugs such as Mr. Chan. d. To be eligible for a MTM program, a Medicare beneficiary must have multiple chronic diseases, be taking multiple Part D prescription drugs, and likely to incur considerable drug costs. Mr.Chan is one of your clients and in excellent health. He is enrolled in a Medicare prescription drug plan that you represent. He recently heard about a Medication Therapy Management (MTM) program in which his friend is enrolled. What should you tell him? 20 Marks: 1 Choose one answer. a. A MA PPO plan only if it does not offer drug coverage. b. A Cost Plan only if it does not offer drug coverage. c. A Cost Plan that does not offer drug coverage or a Cost Plan that does offer drug coverage if she chooses not to enroll in it. d. A MA PPO plan that offers drug coverage if she chooses not to enroll in it. Eleanor takes several high-cost prescription drugs. She would like to enroll in a standalone Part D prescription drug plan that is available in her area. In what type of Medicare Health Plan can she enroll if she also wishes to enroll in the standalone Part D plan? 21 Marks: 1 Choose one answer. a. He could enroll in the MA-only plan and purchase a Medigap plan with drug coverage. b. He could enroll in the MA-only PPO plan and a stand-alone Medicare prescription drug plan. c. He cannot enroll in a stand-alone prescription drug plan because you do not represent Mr. Lombardi is interested in a Medicare Advantage (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 prescription drug plan. What should you tell him about this situation? 10/13/ Final Exam: Final Exam such a plan. d. He could enroll in one of the MA plans that include prescription drug coverage or a Medigap plan and a stand-alone prescription drug plan, but he cannot enroll in the MAonly PPO plan and a stand-alone prescription drug plan. 22 Marks: 1 Choose one answer. a. Medicare Advantage plans differ from Original Medicare in that they are required to cover any service ordered by a physician. b. Medicare Advantage plans are required to cover services mandated under health care reform and applicable state law, which may differ from the Original Medicare package of benefits. c. Though their cost-sharing may differ from Original Medicare’s, Medicare Advantage plans are required to cover all services covered by original Medicare. d. Medicare Advantage plans are required to create a benefits package that results in roughly equivalent costs and may exclude coverage for some items and services that are covered under Part A and/or Part B of Original Medicare. 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? 23 Marks: 1 Choose one answer. a. The card she received is valid, the change has been made to protect Medicare beneficiaries from identity theft, and she should now destroy her old card. b. The card is indeed a forgery since all identity cards are being phased out in favor of a new electronic identity system developed by the Social Security Administration. c. The card is indeed a forgery since newly issued Medicare cards will have both a beneficiary’s Social Security number and date of birth imprinted on them. d. The card she received is valid but she should keep her old card for at least two years and present it whenever she receives health care. Mrs. Roberts has just received a new Medicare identity card in the mail. She is concerned that it is a forgery since it does not have her Social Security number on it. What should you tell her? 24 Marks: 1 Choose one answer. a. She may make such a change during the Annual Election Period that runs from Oct. 15 to December 7, or during the MA Open Enrollment Period which takes place from January 1- March 31 of each year (beginning in 2019). b. Any time that she is dissatisfied with the plan’s network coverage or customer service she may make such a change. c. She may do it only during the MA Disenrollment Period, which runs from January 1 to February 14 of each year. d. She may only make such a change during her “initial coverage election period,” which occurred when she first became entitled to Medicare. 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 Medicare's enrollment guidelines, when could she do this? 25 Marks: 1 10/13/ Final Exam: Final Exam Choose one answer. a. PFFS plans primarily cover drugs that Original FFS Medicare does not cover. b. PFFS plans are a type of Medicare Advantage plan offered by private companies. c. Original Medicare and PFFS plans are essentially the same thing. d. PFFS is a form of supplemental coverage that fills in the gaps where Original Medicare leaves off. Ms. Jensen has heard about “Original Fee-for-Service Medicare” and “Private Fee-for-Service” plans. She wants to know what the difference is, if any. What should you tell her? 26 Marks: 1 Choose one answer. a. MSA enrollees may only receive covered health care services from a limited panel of network providers because otherwise some providers may charge more than Original Medicare rates. b. All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be obtained by also enrolling in a separate prescription drug plan. c. For enrollees in an MSA, after the annual deductible is met, the MSA plan generally pays 75% of covered services. d. All beneficiaries enrolled in an MSA pay a plan premium in addition to their Part B premium. Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. She is attracted by the idea of maintaining control over a Medical Savings Account (MSA) but is not sure if the plan associated with the account will fit her needs. What specific piece of information about a Medicare MSA plan would it be important for her to know, prior to enrolling in such a plan? 27 Marks: 1 Choose one answer. a. MA plans are only available to those who have been enrolled in a Medigap plan for at least six months. Therefore, before enrolling in an MA plan, she must first use a Medigap plan to supplement her Original Medicare coverage. b. She must first enroll in a Medicare Part D plan, before enrolling in a Medicare Advantage plan. c. She must have previously been enrolled in Original Fee-for-Service Medicare for at least one year before she may enroll in an MA plan. d. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. Mrs. Kendrick is six months away from turning 65. She wants to know what she will have to do to enroll in a Medicare Advantage (MA) plan as soon as possible. What could you tell her? 28 Marks: 1 Choose one answer. a. When an MSA Medicare health plan is combined with a PDP, initial and renewal year(s) compensation is paid only for the MSA enrollment in order to recompense CMS for contributions made to the enrollee’s MSA account. b. This situation is considered a “dual enrollment,” and CMS compensation rules are applied to the two plans at once and independently of each other. c. MSA Medicare health plans are subject to special rules limiting initial year 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? 10/13/ Final Exam: Final Exam compensation to 50 percent of the fair market value (FMV) published annually by CMS. Regular initial year enrollment rules apply to the PDP. d. Regular CMS and renewal compensation rules apply to the PDP enrollment, but compensation is limited to $100 for the MSA health plan enrollment in order to recompense CMS for contributions made to the enrollee’s MSA account. 29 Marks: 1 Choose one answer. a. 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. c. 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. 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. 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? 30 Marks: 1 Choose one answer. a. Ms. Davis who recently turned age 65 and is eligible for Part A and has just enrolled in Part B. b. Ms. Adams, a healthy early retiree who has just begun to collect Social Security at age 62. c. Ms. Bradley is currently living abroad for a multi-year job assignment. d. Mr. Charles, an undocumented immigrant, entered the country illegally. Who is most likely to be eligible to enroll in a Part D prescription drug plan? 31 Marks: 1 Choose one answer. a. The doctor may only collect the amount allowable under Medicare plus 15 percent balance billing. b. The doctor may only collect the amount allowable under Medicare plus 25 percent balance billing. c. The doctor may only collect the amount allowable under Medicare Advantage (MA) PPO plan cost sharing for non-QMB enrollees. d. The doctor may only collect from Mr. Rivera the cost sharing allowable under the state’s Medicaid program. Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he sees an out-of-network doctor to receive a Medicare covered service. How much may the doctor collect from Mr. Rivera? 32 Marks: 1 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 enrollment in a Part D plan. She asked you when she should have her daughter plan to visit. What could you tell her? 10/13/ Final Exam: Final Exam Choose one answer. a. Her daughter should come during the three-month period that begins on the first day of her birthday month and runs for three full months. b. Her daughter should come in November. c. Her daughter should come sometime between January 1 and March 31. d. Her daughter should come by September 1. 33 Marks: 1 Choose one answer. a. He can do this because the estimated number of attendees is based on the venue size and response rate and the value of the gift does not exceed $15. b. He can do this because the gift is not a cash gift and is not readily converted to cash. c. He cannot do this because the total value of the gift exceeds the maximum $15 retail gift value. d. He can do this because the ads for the event are distributed both to enrollees and nonenrollees, so no restrictions apply Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled a marketing event and expects about 40 people to attend. He has hired a magician at a cost of $200 to entertain attendees. Can he do this in a way that complies with guidance from the Medicare agency? 34 Marks: 1 Choose one answer. a. Mrs. Valentino must remain enrolled in the Medicare Cost plan until the next AEP. b. Mrs. Valentino can submit a written request to Medicare to be disenrolled from the Cost plan and enroll in Original Medicare. c. Mrs. Valentino qualifies for a special enrollment period, which will allow her to immediately enroll in a MA-PD plan of her choice. d. Mrs. Valentino can call Medicare, request to be disenrolled from the Cost plan, and enroll in Original Medicare. Mrs. Valentino is currently enrolled in a Medicare Cost plan. This plan is no longer meeting her needs, but it is now mid-year and past the annual election period (AEP). What would you say to Mrs. Valentino regarding her options? 35 Marks: 1 Choose one answer. a. When the Part D plan can demonstrate to CMS that no enrollee has accessed the medication in the past six months, generally the plan can remove the drug from its formulary within the first 60 days of the year. b. If the Medicare prescription drug plan can show that reducing coverage early in the year will result in savings for the Part D plan and the Medicare program, generally the plan may make such a change. c. Under no conditions can a Medicare Part D prescription drug plan reduce its coverage for a given drug at any point during the year. d. When a formulary change is in response to a drug’s removal from the market. Under what conditions can a Medicare prescription drug plan reduce its coverage for a given drug during the first 60 days of the year? 36 Marks: 1 10/13/ Final Exam: Final Exam Choose one answer. a. Part D prescription drug plans use networks of pharmacies within their service areas. She could look for a plan that maintains a network in both states. b. Part D prescription drug plans focus almost entirely on mail order with fairly limited access to retail pharmacies, so as long as she orders all of her medications through the mail, she will be fine. c. Part D prescription drug plans are restricted to local service areas. She will have to use mail order to fill all of her prescriptions. d. Part D prescription drug plans generally contract with every pharmacy in the country, so she should be able to obtain her drugs in both states with no problem. 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? 37 Marks: 1 Choose one answer. a. Enrollment in Cost plans offering Part D coverage is available only during enrollment periods under the Part D program, and Cost plans must accept enrollments during these periods. b. Enrollment in Cost plans offering Part D coverage is generally available only 30 days per year, because of the more generous benefits of these plans. c. Enrollment in Cost plans offering Part D prescription drug coverage is not necessary because Cost plans offer more generous Part B benefits. d. Enrollment in Cost plans offering Part D coverage is generally available year-round, so she can immediately enroll and have prescription drug coverage. Mrs. Pierce would like to enroll in a Medicare Cost plan that offers Part D prescription drug coverage. She comes to you for advice about when she can enroll in a plan you have previously discussed. What should you tell her? 38 Marks: 1 Choose one answer. a. Yes, he can execute the enrollment for her. He can do so because he is an immediate family member. No power of attorney is necessary. b. Yes, he can execute the enrollment for her. A financial power of attorney is sufficient. c. No, he cannot execute the enrollment for her. Only Ms. Duarte can sign the form, regardless of her mental capacities. d. No, he cannot execute the enrollment for her. He must have a legal authorization, under state law that explicitly allows him to make health care decisions for his mother. You are doing a sales presentation for Ms. Duarte and her son. Ms. Duarte has some cognitive impairment and her son informs you that he has power of attorney to make financial decisions for her. Can he execute the enrollment for her? 39 Marks: 1 Choose one answer. a. She is likely to qualify for a SEP. She can choose an effective date of up to three months after the month in which the enrollment form is received by the new plan, but the effective date may not be earlier than the date of her permanent move. b. She is unlikely to qualify for a SEP and should remain on her current plan, relying on her current plan’s out-of-network benefits. c. She is unlikely to qualify for a SEP but will be automatically covered by Original Medicare and a standalone Part D prescription drug plan. 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 coverage. What would you say to her in regard to a special enrollment period (SEP)? 10/13/ Final Exam: Final Exam d. She is likely to qualify for a SEP. She can choose an effective date of up to six months after the month in which the enrollment form is received by the new plan, but the effective date may not be earlier than 30 days prior to the date of her move. 40 Marks: 1 Choose one answer. a. Ms. Lopez is considered a marketing representative of BestCare but is exempt from the marketing rules regarding approved call scripts because she works directly for MarketCo. b. Ms. Lopez needs to maintain state licensure, but because she is working for a thirdparty marketing organization she is exempt from CMS training requirements that apply to BestCare captive agents. c. Ms. Lopez no longer needs to be concerned about state licensure since she is marketing an MA product subject to federal rules. d. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to comply with CMS marketing requirements, including those regarding using only approved call scripts. Ms. Lopez is an independent agent under contract with MarketCo, a third-party marketing organization. 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? 41 Marks: 1 Choose one answer. a. You may leave enrollment kits for several MA plans and offer to discuss a Medigap and Part D prescription drug plan she might like. b. You may leave an enrollment kit and discuss a new life insurance product she might like. c. You may begin her enrollment application and require her to provide names of any of friends who may be interested in enrolling before completing her application. d. You may provide her with the required enrollment materials and take her completed enrollment application. 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 form and meet with you on October 15. During the appointment, what are you permitted to do? 42 Marks: 1 Choose one answer. a. 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. b. 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. c. 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. d. The government allows Part D plans to adopt any benefit structure as long as the list of covered drugs meets their approval. 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? 10/13/ Final Exam: Final Exam 43 Marks: 1 Choose one answer. a. It allows enrollees to choose whether to receive Medicare service by going to plan network providers and paying plan cost-sharing, or receiving services from non-network providers and paying cost-sharing due under Original Medicare. b. It includes comprehensive medical and social service delivery systems using an interdisciplinary team approach in an adult day health center, supplemented by in-home and referral services. c. It is an all-inclusive Medicare plan widely available throughout the United States. d. It is an all-inclusive publicly sponsored Medicaid plan for the elderly. Which statement best describes PACE plans? 44 Marks: 1 Choose one answer. a. He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. b. He generally would pay only a monthly premium. Medicare covers all other costs. c. He generally would pay only a monthly premium and deductible. Medicare covers all other costs. d. He generally would pay only a per-prescription co-payment. Medicare covers all other costs. Mr. Alonso receives some help paying for his two generic prescription drugs from his employer’s retiree 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 enrolling into a standard Medicare Part D prescription drug plan. What should you tell him? 45 Marks: 1 Choose one answer. a. She will have to obtain a job and work enough years to qualify for Medicare Part A. b. Since her husband paid Medicare taxes during the entire time he was working, she will automatically qualify for Medicare Part A without having to pay any premiums. c. She will have to pay the monthly Part A premium in order to obtain the coverage. d. Because her husband paid Medicare taxes, and she rarely did, she will have to pay Part A premiums but will do so at a reduced rate. Mrs. Wu was primarily a homemaker and employed in jobs that provided taxable income only sporadically. 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? 46 Marks: 1 Choose one answer. a. Medicare permits plans that have the highest quality services to reduce their premiums below the standard amount in order to increase their market share. This accounts for the variation in premium amounts. b. Some prescription drug plans may have higher operating costs and/or may offer enhanced coverage in return for an additional premium amount. He could look at plan designs to see if one of the enhanced plans would serve his needs better than a plan based on the standard design. c. All drug plans must offer exactly the same coverage model. The difference in premium is a result of the differing financial estimates of the companies offering the plans. Mr. Decaro has looked at Medicare prescription drug plans available in his area and noted a wide range in premiums. He thought that all the drug plans were required to offer the same standard benefits and would like you to explain why there is such a range in premiums. What should you tell him? 10/13/ Final Exam: Final Exam d. The premiums differ because some plans intend to market to sicker beneficiaries and have set their premiums to reflect expected greater costs. 47 Marks: 1 Choose one answer. a. Medicaid will cover his cost-sharing, regardless of from which physician or hospital he receives his Medicare-covered services. b. For Medicaid beneficiaries, Medicare reduces its cost-sharing amounts to match those charged by the state Medicaid program so there will be no change in his cost-sharing amounts. c. Medicaid will no longer pay any cost sharing once he is eligible for Medicare, so he will need to rely only on Medicare providers. d. He should know that Medicaid will pay cost sharing only for services provided by Medicaid participating providers. 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-sharing. What should you tell him? 48 Marks: 1 Choose one answer. a. Part C, which always covers dental and vision 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 D, which covers prescription drug services, is covered under Original Medicare. d. Part A, which covers long term custodial care services, is covered under Original Medicare. 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? 49 Marks: 1 Choose one answer. a. 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. b. 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. c. 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. d. Mr. Singh must leave Original Medicare to receive drug coverage. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What should you tell him? 50 Marks: 1 Choose one answer. a. Indicate that in order participate attendees must provide their contact information. b. Discuss plan specific information such as premiums and benefits. Agent Chan is conducting a sales presentation on senior issues where he hopes to enroll some attendees in the Medicare Advantage (MA) plans he represents. What action(s) may Agent Chan take during the event? 10/13/ Final Exam: Final Exam c. Sell personal information obtained as part of a raffle to a third-party marketeer. d. Conduct free health screenings as part of the event. Submit all and finish AHIP©2019. All rights reserved. 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