2022 OVERVIEW of MEDICARE PROGRAM BASICS: CHOICE, ELIGIBILTY, AND BENEFITS
MARKETING MEDICARE ADVANTAGE AND PART D PLANS
PART 4
1. Medicare health plans establish provisions in marketing representative contracts to ensure
compliance with applicable laws and policies. If non-compliance occurs, CMS can penalize a plan in
which of the following ways?
a. CMS requires the dismissal of senior plan management. Incorrect
b. CMS requires plan sponsors to create and complete a corrective action plan and may terminate a
sponsor’s contract. Correct
c. CMS cannot penalize the plan sponsor for marketing representative non-compliance. That is the role
of the state. Incorrect
d. CMS requires plan sponsors to publish in local newspapers the names and misdeeds of the marketing
representatives who have not complied with the terms of their contracts, so that potential clients can
know whom to avoid. Incorrect
2. ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' protected
health information (PHI) to market non-health related products such as life insurance and annuities. To
do so it must obtain authorization from the enrollees. Which statement best describes the authorization
process?
a. It is not necessary for ABC to obtain an authorization to simply explain pending state or federal
legislation since there is no anticipation of selling a non-health related product in these circumstances.
Incorrect
b. Authorization may be obtained by directing a beneficiary to a website to provide consent as long as
the website includes a mechanism for an electronic signature that is valid under applicable law. Correct
c. The request for authorization may include a brief synopsis of non-health related content. Incorrect
d. Once a plan sends out a written request for consent, a beneficiary can authorize consent by simply
failing to reply within 21 days. Incorrect
3. Mr. Lynn, an agent for Acme Insurance, Inc. thinks that, since state laws are preempted with
regard to the marketing of Medicare health plans, he doesn't have much to worry about. What might
you, as his colleague, advise him concerning the type of scrutiny he will be under?
a. The state sets most requirements for marketing Medicare health plans, but each plan has different
policies that he must adhere to. Incorrect
b. Organizations sponsoring Medicare health plans are responsible for the behavior of their contracted
representatives and will be conducting monitoring activities to ensure compliance with all applicable
Federal law and guidance and plan policies. Furthermore, state agent licensure laws are not preempted
and he must abide by their requirements. Correct
c. Organizations sponsoring Medicare health plans are not responsible for enforcing compliance with
applicable law and guidance. This job belongs solely to the Medicare agency. Incorrect
, d. The Medicare agency conducts only complaint-based oversight and he can market the products he
represents as he sees fit, as long as he does so in a manner that would be considered ethical by a
reasonable lay person. Incorrect
MARKETING MEDICARE ADVANTAGE AND PART D PLANS
PART 4
1. Medicare health plans establish provisions in marketing representative contracts to ensure
compliance with applicable laws and policies. If non-compliance occurs, CMS can penalize a plan in
which of the following ways?
a. CMS requires the dismissal of senior plan management. Incorrect
b. CMS requires plan sponsors to create and complete a corrective action plan and may terminate a
sponsor’s contract. Correct
c. CMS cannot penalize the plan sponsor for marketing representative non-compliance. That is the role
of the state. Incorrect
d. CMS requires plan sponsors to publish in local newspapers the names and misdeeds of the marketing
representatives who have not complied with the terms of their contracts, so that potential clients can
know whom to avoid. Incorrect
2. ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' protected
health information (PHI) to market non-health related products such as life insurance and annuities. To
do so it must obtain authorization from the enrollees. Which statement best describes the authorization
process?
a. It is not necessary for ABC to obtain an authorization to simply explain pending state or federal
legislation since there is no anticipation of selling a non-health related product in these circumstances.
Incorrect
b. Authorization may be obtained by directing a beneficiary to a website to provide consent as long as
the website includes a mechanism for an electronic signature that is valid under applicable law. Correct
c. The request for authorization may include a brief synopsis of non-health related content. Incorrect
d. Once a plan sends out a written request for consent, a beneficiary can authorize consent by simply
failing to reply within 21 days. Incorrect
3. Mr. Lynn, an agent for Acme Insurance, Inc. thinks that, since state laws are preempted with
regard to the marketing of Medicare health plans, he doesn't have much to worry about. What might
you, as his colleague, advise him concerning the type of scrutiny he will be under?
a. The state sets most requirements for marketing Medicare health plans, but each plan has different
policies that he must adhere to. Incorrect
b. Organizations sponsoring Medicare health plans are responsible for the behavior of their contracted
representatives and will be conducting monitoring activities to ensure compliance with all applicable
Federal law and guidance and plan policies. Furthermore, state agent licensure laws are not preempted
and he must abide by their requirements. Correct
c. Organizations sponsoring Medicare health plans are not responsible for enforcing compliance with
applicable law and guidance. This job belongs solely to the Medicare agency. Incorrect
, d. The Medicare agency conducts only complaint-based oversight and he can market the products he
represents as he sees fit, as long as he does so in a manner that would be considered ethical by a
reasonable lay person. Incorrect
