Medicare Agent & Broker Certification (All agents and
brokers that sell Medicare products are trained and tested
annually on Medicare rules and regulations, and details
specific to the plan products they are selling) Questions
With 100% Correct Answers.
A prospective beneficiary asks an agent if plan XYZ has an urgent care benefit
and if so, what the benefit includes. Where would the agent find this information
for plan XYZ?
Evidence of Coverage
Because the beneficiary asked if plan XYZ has an urgent care benefit and what the
benefit includes.
If the beneficiary only wanted to know if plan XYZ has an urgent care benefit, the
answer would be Summary of Benefits & Evidence of Coverage.
If a beneficiary who is enrolled in an HMO tells you that she wants to see a
specialist, you should tell her:
You will likely need a referral from your primary care physician (PCP) to see a
specialist. If you see your specialist without this referral, the plan may not pay for your
visit.
Because the beneficiary is enrolled in an HMO, she should work with her PCP prior to
seeing a specialist (except in an emergency).
True or False?
Once a beneficiary is enrolled in an MA plan and has paid his plan-specific
monthly premium, he no longer needs to pay his Part B premium.
False
Beneficiaries are required to continue paying their Part B premium (unless they receive
Extra Help) in addition to any plan-specific premium.
Define: Medicare Part A
Part A of Medicare covers hospital inpatient care, some SNF care, and home health and
hospice care
Define: Medicare Part B
Part B of Medicare covers physician services, outpatient hospital care, lab tests, mental
health services, some preventative services, and medical equipment considered
medically necessary to treat a disease or condition
Define: Medicare Part C
Part C of Medicare provides an option for beneficiaries to receive private health plan
coverage in lieu of Original Medicare
Define: Medicare Part D
Part D of Medicare provides prescription drug benefit
Mrs. Doe will turn 65 at the end of March and signed up for an MA plan in January
during her Initial Coverage Election Period (ICEP). When will her coverage begin?
, On March 1
The ICEP coverage begins the first day of the month of entitlement to Medicare Part A
and Part B, OR the first of the month following the month the enrollment request was
made (if after entitlement has occurred).
What enrollment period provides an opportunity for a beneficiary to move from
Original Medicare to an MA plan?
The Annual Election Period (AEP) for enrolling in an MA Plan is October 15 through
December 7.
The beneficiary is already enrolled in Original Medicare, so there is no Initial Coverage
Election Period (ICEP) that is applicable.
What is the enrollment period for enrolling in an MADP?
January 1 through February 14
This period only allows a beneficiary to change from an MA plan to Original Medicare
(with/without a stand-alone PDP).
Which conditions would qualify an MA plan member to switch plans during a
Special Enrollment Period?
The member recently moved into a nursing home
The member's plan was terminated
The member has moved to another state
If an individual moves into, resides in, or moves out of a long-term care facility, such as
a nursing home, he or she is eligible for a SEP. He/She would also be eligible for an
SEP as a result of moving out of the plan's service area or if his/her current plan is
terminated.
During a formal sales event held on October 5, an agent tells attendees, "You can
enroll in Acme's Traditional Medicare Advantage HMO plan between October 15
and December 7, but the plan won't take effect until January 1. However, if you
don't like the plan after you enroll, you have until March 1 to switch back to
Original Medicare." Following the presentation, the agent assists a couple in
filling out an enrollment form for Acme's Traditional HMO plan, and tells the
couple that she will "hold on to it" until the October 15 enrollment date.
What is inaccurate?
The agent is not allowed to accept an enrollment prior to October 15
The presenter provided incorrect Medicare Advantage Disenrollment Period (MADP)
information
Although agents may assist beneficiaries in completing their forms, an agent may not
accept, collect, or take possession of completed enrollment forms before October 15
and may not encourage beneficiaries to mail the enrollment form to the plan prior to
October 15. Further, although the agent provided the correct dates for the AEP (October
15 - December 7), she misstated the window for which a beneficiary may disenroll and
revert back to Original Medicare. In 2015, the MADP is January 1 - February 14.
brokers that sell Medicare products are trained and tested
annually on Medicare rules and regulations, and details
specific to the plan products they are selling) Questions
With 100% Correct Answers.
A prospective beneficiary asks an agent if plan XYZ has an urgent care benefit
and if so, what the benefit includes. Where would the agent find this information
for plan XYZ?
Evidence of Coverage
Because the beneficiary asked if plan XYZ has an urgent care benefit and what the
benefit includes.
If the beneficiary only wanted to know if plan XYZ has an urgent care benefit, the
answer would be Summary of Benefits & Evidence of Coverage.
If a beneficiary who is enrolled in an HMO tells you that she wants to see a
specialist, you should tell her:
You will likely need a referral from your primary care physician (PCP) to see a
specialist. If you see your specialist without this referral, the plan may not pay for your
visit.
Because the beneficiary is enrolled in an HMO, she should work with her PCP prior to
seeing a specialist (except in an emergency).
True or False?
Once a beneficiary is enrolled in an MA plan and has paid his plan-specific
monthly premium, he no longer needs to pay his Part B premium.
False
Beneficiaries are required to continue paying their Part B premium (unless they receive
Extra Help) in addition to any plan-specific premium.
Define: Medicare Part A
Part A of Medicare covers hospital inpatient care, some SNF care, and home health and
hospice care
Define: Medicare Part B
Part B of Medicare covers physician services, outpatient hospital care, lab tests, mental
health services, some preventative services, and medical equipment considered
medically necessary to treat a disease or condition
Define: Medicare Part C
Part C of Medicare provides an option for beneficiaries to receive private health plan
coverage in lieu of Original Medicare
Define: Medicare Part D
Part D of Medicare provides prescription drug benefit
Mrs. Doe will turn 65 at the end of March and signed up for an MA plan in January
during her Initial Coverage Election Period (ICEP). When will her coverage begin?
, On March 1
The ICEP coverage begins the first day of the month of entitlement to Medicare Part A
and Part B, OR the first of the month following the month the enrollment request was
made (if after entitlement has occurred).
What enrollment period provides an opportunity for a beneficiary to move from
Original Medicare to an MA plan?
The Annual Election Period (AEP) for enrolling in an MA Plan is October 15 through
December 7.
The beneficiary is already enrolled in Original Medicare, so there is no Initial Coverage
Election Period (ICEP) that is applicable.
What is the enrollment period for enrolling in an MADP?
January 1 through February 14
This period only allows a beneficiary to change from an MA plan to Original Medicare
(with/without a stand-alone PDP).
Which conditions would qualify an MA plan member to switch plans during a
Special Enrollment Period?
The member recently moved into a nursing home
The member's plan was terminated
The member has moved to another state
If an individual moves into, resides in, or moves out of a long-term care facility, such as
a nursing home, he or she is eligible for a SEP. He/She would also be eligible for an
SEP as a result of moving out of the plan's service area or if his/her current plan is
terminated.
During a formal sales event held on October 5, an agent tells attendees, "You can
enroll in Acme's Traditional Medicare Advantage HMO plan between October 15
and December 7, but the plan won't take effect until January 1. However, if you
don't like the plan after you enroll, you have until March 1 to switch back to
Original Medicare." Following the presentation, the agent assists a couple in
filling out an enrollment form for Acme's Traditional HMO plan, and tells the
couple that she will "hold on to it" until the October 15 enrollment date.
What is inaccurate?
The agent is not allowed to accept an enrollment prior to October 15
The presenter provided incorrect Medicare Advantage Disenrollment Period (MADP)
information
Although agents may assist beneficiaries in completing their forms, an agent may not
accept, collect, or take possession of completed enrollment forms before October 15
and may not encourage beneficiaries to mail the enrollment form to the plan prior to
October 15. Further, although the agent provided the correct dates for the AEP (October
15 - December 7), she misstated the window for which a beneficiary may disenroll and
revert back to Original Medicare. In 2015, the MADP is January 1 - February 14.
