RENAL DISEASE EXAM QUESTIONS WITH ANSWERS
Mrs. Jenkins is enrolled in both Part A and Part B of Medicare. She has
recently also become eligible for Medicaid and would like to enroll in a MA-
PD plan. Since this is her first experience with Medicare Advantage, she is
concerned that she will be locked into a plan and unable to make any
coverage changes for at least a year if not longer. What should you tell
her?correct Ans Since Mrs. Jenkins has Medicare Part A and Part B and
receives Medicaid, she has a special election period (SEP) that will allow
her to enroll or disenroll from an MA or MA-PD plan during the first 9
months of each calendar year.
Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't
sufficiently cover his prescription drug needs. He is interested in changing
plans during the upcoming MA Open Enrollment Period. What are his
options during the MA OEP?correct AnsHe can switch to a MA-PD plan.
Mr. Ford enrolled in an MA-only plan in mid-November during the Annual
Election Period (AEP). On December 1, he calls you up and says that he
has changed his mind and would like to enroll into a MA-PD plan. What
enrollment rules would apply in this case?correct Ans He can make as
many enrollment changes as he likes during the Annual Election
Period and the last choice made prior to the end of the period will
be the effective one as of January 1.
Mr. Liu turns 65 on June 19. He has never previously qualified for Medicare
so his first Medicare eligibility date will be by June 1. Mr. Liu's ICEP and
Part D IEP begin March 1 and end on September 30. He wants prescription
drug coverage with his Part A and Part B benefits. What advice can you
provide him?correct Ans He can enroll in a MA-PD as long as he
enrolls in Part B and is entitled to Part A.
, Ms. Claggett is sixty-six (66) years old. She has been covered under
Original Medicare for the last six years due to her disability and has never
been enrolled in a Medicare Advantage or a Part D plan before. She wants
to enroll in a Part D plan. She knows that there is such a thing as the "Part
D Initial Enrollment Period" (IEP) and has concluded that, since she has
never enrolled in such a plan before, she should be eligible to enroll under
this period. What should you tell her about how the Part D Initial
Enrollment Period applies to her situation?correct AnsMs. Claggett has
had two IEPs and missed them both. The first occurred three
months before and three months after the month when she was
first entitled to Part A OR enrolled in Part B. Because she was
eligible for Medicare before age 65, Ms. Claggett had a second IEP
based on turning age 65, which has also expired.
Ms. O'Donnell learned about a new MA-PD plan that her neighbor
suggested and that you represent. She plans to switch from her old MA
HMO plan to the new MA-PD plan during the Annual Election Period.
However, she wants to make sure she does not end up paying premiums
for two plans. What can you tell her?correct Ans She only needs to
enroll in the new MA-PD plan and she will automatically be
disenrolled from her old MA plan.
You work for Caring Health, a Medicare Advantage (MA) plan sponsor.
Recently, Mrs. Garcia has completed an enrollment application for a plan
offered by Caring Health, which is waiting for a reply from CMS indicating
whether or not Mrs. Garcia's enrollment has been accepted. Once CMS
replies, how long does Caring Health have to notify Mrs. Garcia that her
enrollment has been accepted and in what format?correct AnsThe plan
has 10 calendar days to notify Mrs. Garcia in writing.
Mrs. Kendrick is in good health, has worked for many years and 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?correct Ans She may enroll in an MA plan beginning
three months immediately before her first entitlement to both
Medicare Part A and Part B.
Mrs. Reynolds is in her Medicare initial coverage election period (ICEP) and
the date of her entitlement to Part A and B has already occurred. Mrs.
Reynolds has just signed up for a Medicare Advantage plan on the second
of the month. She is leaving for vacation in two weeks and wants to know
if her new coverage will start before she leaves. What should you tell her?
correct AnsTypically, her coverage would begin on the first day of
the next month, so she should not expect her coverage to begin
before she leaves.
Mr. Robinson was quite ill recently and forgot to pay his monthly premium
for his MA-PD plan. He is worried that he will lose his coverage now when
he needs it the most. He is certain his plan will disenroll him because that
is what happened to a friend of his in a similar type of plan. What can you
tell Mr. Robinson about his situation?correct AnsPlan sponsors have the
option to do nothing when a plan member does not pay their
premiums or disenroll the member after a grace period and notice.
Mrs. Johnson calls to tell you she has not received her new plan ID card
yet, but she needs to see a doctor. What can she expect to receive from
the plan after the plan has received her enrollment form?correct
AnsEvidence of plan membership, information on how to obtain
services, and the effective date of coverage.
Mr. Anderson is a very organized individual and has filled out and brought
to you an enrollment form on October 10 for a new plan available January 1
next year. He is currently enrolled in Original Medicare. What should you
do?correct AnsTell Mr. Anderson that you cannot accept any
enrollment forms until the annual election period begins.
Mr. Wendt suffers from diabetes which has gotten progressively worse
, during the last year. He is currently enrolled in Original Medicare (Parts A
and B) and a Part D prescription drug plan and did not enroll in a Medicare
Advantage (MA) plan during the last annual open enrollment period (AEP)
which has just closed. Mr. Wendt has heard certain MA plans might provide
him with more specialized coverage for his diabetes and wants to know if
he must wait until the next annual open enrollment period (AEP) before
enrolling in such a plan. What should you tell him?correct Ans If there is a
special needs plan (SNP) in Mr. Wendt's area that specializes in
caring for individuals with diabetes, he may enroll in the SNP at
any time under a special election period (SEP)
You would like to offer gifts of nominal value to potential enrollees who call
for more information about a plan you represent. You would then like to
offer additional gifts if they come to a marketing event. Each of the gifts
meets the CMS definition of nominal value, but together, the gifts are more
than the nominal value. Is this permissible?correct AnsNo, the total value
of the gifts given to an enrollee in a year cannot exceed the CMS definition
of nominal value.
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 only make financial not health care decisions for her. Can he
execute the enrollment for her?correct Ans 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.
Agent Willis had several clients who disenrolled from the plans he
represents during the AEP to enroll in Medicare Advantage plans that are
competitors of his. Agent Willis believes that the choices they made are
not ideal for them and would like to get their business back during the
Medicare Advantage Open Enrollment Period (MA-OEP).
What can agent Willis do?correct Ans He can call them to let them
know that if they do not like their new plans, they can change
Mrs. Jenkins is enrolled in both Part A and Part B of Medicare. She has
recently also become eligible for Medicaid and would like to enroll in a MA-
PD plan. Since this is her first experience with Medicare Advantage, she is
concerned that she will be locked into a plan and unable to make any
coverage changes for at least a year if not longer. What should you tell
her?correct Ans Since Mrs. Jenkins has Medicare Part A and Part B and
receives Medicaid, she has a special election period (SEP) that will allow
her to enroll or disenroll from an MA or MA-PD plan during the first 9
months of each calendar year.
Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't
sufficiently cover his prescription drug needs. He is interested in changing
plans during the upcoming MA Open Enrollment Period. What are his
options during the MA OEP?correct AnsHe can switch to a MA-PD plan.
Mr. Ford enrolled in an MA-only plan in mid-November during the Annual
Election Period (AEP). On December 1, he calls you up and says that he
has changed his mind and would like to enroll into a MA-PD plan. What
enrollment rules would apply in this case?correct Ans He can make as
many enrollment changes as he likes during the Annual Election
Period and the last choice made prior to the end of the period will
be the effective one as of January 1.
Mr. Liu turns 65 on June 19. He has never previously qualified for Medicare
so his first Medicare eligibility date will be by June 1. Mr. Liu's ICEP and
Part D IEP begin March 1 and end on September 30. He wants prescription
drug coverage with his Part A and Part B benefits. What advice can you
provide him?correct Ans He can enroll in a MA-PD as long as he
enrolls in Part B and is entitled to Part A.
, Ms. Claggett is sixty-six (66) years old. She has been covered under
Original Medicare for the last six years due to her disability and has never
been enrolled in a Medicare Advantage or a Part D plan before. She wants
to enroll in a Part D plan. She knows that there is such a thing as the "Part
D Initial Enrollment Period" (IEP) and has concluded that, since she has
never enrolled in such a plan before, she should be eligible to enroll under
this period. What should you tell her about how the Part D Initial
Enrollment Period applies to her situation?correct AnsMs. Claggett has
had two IEPs and missed them both. The first occurred three
months before and three months after the month when she was
first entitled to Part A OR enrolled in Part B. Because she was
eligible for Medicare before age 65, Ms. Claggett had a second IEP
based on turning age 65, which has also expired.
Ms. O'Donnell learned about a new MA-PD plan that her neighbor
suggested and that you represent. She plans to switch from her old MA
HMO plan to the new MA-PD plan during the Annual Election Period.
However, she wants to make sure she does not end up paying premiums
for two plans. What can you tell her?correct Ans She only needs to
enroll in the new MA-PD plan and she will automatically be
disenrolled from her old MA plan.
You work for Caring Health, a Medicare Advantage (MA) plan sponsor.
Recently, Mrs. Garcia has completed an enrollment application for a plan
offered by Caring Health, which is waiting for a reply from CMS indicating
whether or not Mrs. Garcia's enrollment has been accepted. Once CMS
replies, how long does Caring Health have to notify Mrs. Garcia that her
enrollment has been accepted and in what format?correct AnsThe plan
has 10 calendar days to notify Mrs. Garcia in writing.
Mrs. Kendrick is in good health, has worked for many years and 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?correct Ans She may enroll in an MA plan beginning
three months immediately before her first entitlement to both
Medicare Part A and Part B.
Mrs. Reynolds is in her Medicare initial coverage election period (ICEP) and
the date of her entitlement to Part A and B has already occurred. Mrs.
Reynolds has just signed up for a Medicare Advantage plan on the second
of the month. She is leaving for vacation in two weeks and wants to know
if her new coverage will start before she leaves. What should you tell her?
correct AnsTypically, her coverage would begin on the first day of
the next month, so she should not expect her coverage to begin
before she leaves.
Mr. Robinson was quite ill recently and forgot to pay his monthly premium
for his MA-PD plan. He is worried that he will lose his coverage now when
he needs it the most. He is certain his plan will disenroll him because that
is what happened to a friend of his in a similar type of plan. What can you
tell Mr. Robinson about his situation?correct AnsPlan sponsors have the
option to do nothing when a plan member does not pay their
premiums or disenroll the member after a grace period and notice.
Mrs. Johnson calls to tell you she has not received her new plan ID card
yet, but she needs to see a doctor. What can she expect to receive from
the plan after the plan has received her enrollment form?correct
AnsEvidence of plan membership, information on how to obtain
services, and the effective date of coverage.
Mr. Anderson is a very organized individual and has filled out and brought
to you an enrollment form on October 10 for a new plan available January 1
next year. He is currently enrolled in Original Medicare. What should you
do?correct AnsTell Mr. Anderson that you cannot accept any
enrollment forms until the annual election period begins.
Mr. Wendt suffers from diabetes which has gotten progressively worse
, during the last year. He is currently enrolled in Original Medicare (Parts A
and B) and a Part D prescription drug plan and did not enroll in a Medicare
Advantage (MA) plan during the last annual open enrollment period (AEP)
which has just closed. Mr. Wendt has heard certain MA plans might provide
him with more specialized coverage for his diabetes and wants to know if
he must wait until the next annual open enrollment period (AEP) before
enrolling in such a plan. What should you tell him?correct Ans If there is a
special needs plan (SNP) in Mr. Wendt's area that specializes in
caring for individuals with diabetes, he may enroll in the SNP at
any time under a special election period (SEP)
You would like to offer gifts of nominal value to potential enrollees who call
for more information about a plan you represent. You would then like to
offer additional gifts if they come to a marketing event. Each of the gifts
meets the CMS definition of nominal value, but together, the gifts are more
than the nominal value. Is this permissible?correct AnsNo, the total value
of the gifts given to an enrollee in a year cannot exceed the CMS definition
of nominal value.
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 only make financial not health care decisions for her. Can he
execute the enrollment for her?correct Ans 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.
Agent Willis had several clients who disenrolled from the plans he
represents during the AEP to enroll in Medicare Advantage plans that are
competitors of his. Agent Willis believes that the choices they made are
not ideal for them and would like to get their business back during the
Medicare Advantage Open Enrollment Period (MA-OEP).
What can agent Willis do?correct Ans He can call them to let them
know that if they do not like their new plans, they can change
