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?
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.
Question2
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?
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. 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.
d. She will have to pay the monthly Part A premium in order to obtain the coverage.
Question3
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?
Choose one answer.
a. He should know that Medicaid will pay cost sharing only for services provided by
Medicaid participating providers.
b. Medicaid will no longer pay any cost sharing once he is eligible for Medicare, so he will
need to rely only on Medicare providers.
c. 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.
d. Medicaid will cover his cost-sharing, regardless of from which physician or hospital he
receives his Medicare-covered services.
,Question4
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?
Choose one answer.
a. Formularies are developed by a consortium of health plans.
b. Formularies must be developed with input from pharmacists, doctors, and other experts.
c. 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.
d. Plans must use a single, standard formulary developed by the Federal government to
keep costs down and quality high for beneficiaries.
Question5
Marks: 1
Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of BestCare's
efforts to facilitate electronic enrollment in its Medicare Advantage plans. In setting up the enrollment
site, which of the following must Phiona consider?
I. If a legal representative is completing an electronic enrollment request, he or she must first
upload proof of his or her authority.
II. All data elements required to complete an enrollment request must be captured.
III. The process must include a clear and distinct step that requires the applicant to activate an
"Enroll Now" or "I Agree" type of button or tool.
IV. The mechanism must capture an accurate time and date stamp at the time the applicant enters
the online site.
Choose one answer.
a. II and III only
b. II, III, and IV only
c. I and II only
d. I, II, III, and
IV Question6
Marks: 1
By contacting plans available in your area, you have learned that the plan you represent has a
significantly lower monthly premium than the others. Furthermore, you see that the plan you represent
has a unique benefits package. What should you do to make sure your clients know about these pieces
of information?
Choose one answer.
a. You have clear evidence that your plan is the best and can say so to your clients.
b. To obtain information about another plan’s benefits, you must refer clients to those other
plans, because you may not provide comparative information, regardless of the source, to
demonstrate any differences among the plans.
, c. You may create a chart that lists each plan in the beneficiary’s service area along with
the benefits of the plan you represent, compared to those of the other available plans.
d. You may make comparisons between plans if you can support them by studies or
statistical data and such comparisons are factually based.
Question7
Marks: 1
Ms. Lewis understands that Medicare prescription drug plans may use various methods to control the
use of specific drugs. She has heard about a technique called “step therapy” and is wondering if you can
explain what that is. What should you tell her?
Choose one answer.
a. Step therapy involves slow changes in the dosages of a given drug in order to discover
the correct amount.
b. Step therapy involves taking somewhat larger doses but skipping every other day, resulting
in lower overall consumption of the drug.
c. Step therapy involves using one or more lower priced drugs before trying a more
expensive drug when all are used to treat the same condition.
d. Step therapy refers to incentives plans can provide to enrollees to engage in regular walking
in order to reduce their need for medications treating heart and cholesterol problems.
Question8
Marks: 1
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?
Choose one answer.
a. 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
b. The beneficiary could only choose an 1876 Cost Plan.
c. The beneficiary could only choose 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
Question9
Marks: 1
Dr. Elizabeth Brennan does not contract with the PFFS plan but accepts the plan’s terms and conditions
for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge?
Choose one answer.
a. Dr. Brennan can charge Mary Rodgers more than the cost sharing specified in the PFFS
plan’s terms and conditions as long as she treats all beneficiaries the same.
b. Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS
plan’s terms and condition of payment which may include balance billing up to 15 percent of the
Medicare rate.
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?
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.
Question2
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?
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. 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.
d. She will have to pay the monthly Part A premium in order to obtain the coverage.
Question3
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?
Choose one answer.
a. He should know that Medicaid will pay cost sharing only for services provided by
Medicaid participating providers.
b. Medicaid will no longer pay any cost sharing once he is eligible for Medicare, so he will
need to rely only on Medicare providers.
c. 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.
d. Medicaid will cover his cost-sharing, regardless of from which physician or hospital he
receives his Medicare-covered services.
,Question4
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?
Choose one answer.
a. Formularies are developed by a consortium of health plans.
b. Formularies must be developed with input from pharmacists, doctors, and other experts.
c. 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.
d. Plans must use a single, standard formulary developed by the Federal government to
keep costs down and quality high for beneficiaries.
Question5
Marks: 1
Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of BestCare's
efforts to facilitate electronic enrollment in its Medicare Advantage plans. In setting up the enrollment
site, which of the following must Phiona consider?
I. If a legal representative is completing an electronic enrollment request, he or she must first
upload proof of his or her authority.
II. All data elements required to complete an enrollment request must be captured.
III. The process must include a clear and distinct step that requires the applicant to activate an
"Enroll Now" or "I Agree" type of button or tool.
IV. The mechanism must capture an accurate time and date stamp at the time the applicant enters
the online site.
Choose one answer.
a. II and III only
b. II, III, and IV only
c. I and II only
d. I, II, III, and
IV Question6
Marks: 1
By contacting plans available in your area, you have learned that the plan you represent has a
significantly lower monthly premium than the others. Furthermore, you see that the plan you represent
has a unique benefits package. What should you do to make sure your clients know about these pieces
of information?
Choose one answer.
a. You have clear evidence that your plan is the best and can say so to your clients.
b. To obtain information about another plan’s benefits, you must refer clients to those other
plans, because you may not provide comparative information, regardless of the source, to
demonstrate any differences among the plans.
, c. You may create a chart that lists each plan in the beneficiary’s service area along with
the benefits of the plan you represent, compared to those of the other available plans.
d. You may make comparisons between plans if you can support them by studies or
statistical data and such comparisons are factually based.
Question7
Marks: 1
Ms. Lewis understands that Medicare prescription drug plans may use various methods to control the
use of specific drugs. She has heard about a technique called “step therapy” and is wondering if you can
explain what that is. What should you tell her?
Choose one answer.
a. Step therapy involves slow changes in the dosages of a given drug in order to discover
the correct amount.
b. Step therapy involves taking somewhat larger doses but skipping every other day, resulting
in lower overall consumption of the drug.
c. Step therapy involves using one or more lower priced drugs before trying a more
expensive drug when all are used to treat the same condition.
d. Step therapy refers to incentives plans can provide to enrollees to engage in regular walking
in order to reduce their need for medications treating heart and cholesterol problems.
Question8
Marks: 1
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?
Choose one answer.
a. 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
b. The beneficiary could only choose an 1876 Cost Plan.
c. The beneficiary could only choose 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
Question9
Marks: 1
Dr. Elizabeth Brennan does not contract with the PFFS plan but accepts the plan’s terms and conditions
for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge?
Choose one answer.
a. Dr. Brennan can charge Mary Rodgers more than the cost sharing specified in the PFFS
plan’s terms and conditions as long as she treats all beneficiaries the same.
b. Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS
plan’s terms and condition of payment which may include balance billing up to 15 percent of the
Medicare rate.
