Mrs. West wears glasses and dentures and has enjoyed considerable
pain relief from arthritis through acupuncture. She is concerned about
whether or not Medicare will cover these items and services. What
should you tell her?
Correct Answer: Medicare does not cover acupuncture, or, in general, glasses or dentures.
Mr. Bickford did not quite qualify for the extra help low-income subsidy
under the Medicare Part D Prescription Drug program and he is
wondering if there is any other option he has for obtaining help with
his considerable drug costs. What should you tell him?
Correct Answer: He could check with the manufacturers of his medications to see if they
offer an assistance program to help people with limited means obtain the medications they
need. Alternatively, he could check to see whether his state has a pharmacy assistance
program to help him with his expenses.
,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?
Correct Answer: 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 MA-only PPO plan and a stand-alone prescription drug plan.
Mr. Torres has a small savings account. He would like to pay for his
monthly Part D premiums with an automatic monthly withdrawal from
his savings account until it is exhausted, and then have his premiums
withheld from his Social Security check. What should you tell him?
Correct Answer: In general, he must select a single Part D premium payment mechanism
that will be used throughout the year.
,Agent 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?
Correct Answer: Yes. When an event has been advertised as "educational," discussing plan-
specific premiums is impermissible.
Mrs. Mulcahy is concerned that she may not qualify for enrollment in a
Medicare prescription drug plan because, although she is entitled to
Part A, she is not enrolled under Medicare Part B. What should you tell
her?
Correct Answer: Everyone who is entitled to Part A or enrolled under Part B is eligible to
enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she
does not need to enroll under Part B before enrolling in a prescription drug plan.
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?
, Correct Answer: 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.
Ms. Moore plans to retire when she turns 65 in a few months. She is in
excellent health and will have considerable income when she retires.
She is concerned that her income will make it impossible for her to
qualify for Medicare. What could you tell her to address her concern?
Correct Answer: Medicare is a program for people age 65 or older and those under age 65
with certain disabilities, end stage renal disease or Lou Gehrig's disease, so she will be
eligible for Medicare.
Agent Armstrong is employed by XYZ Agency, which is under contract
with ABC Health Plan, a Medicare Advantage (MA) plan that offers
plans in multiple states. XYZ Agency maintains a website marketing the
MA plans with which it has contracts. Agent Armstrong follows up with
individuals who request more information about ABC MA plans via the
website and tries to persuade them to enroll in ABC plans. What
statement best describes the marketing and compliance rules that
apply to Agent Armstrong?
Correct Answer: Agent Armstrong needs to be licensed and appointed in every state in
which beneficiaries to whom he markets ABC MA plans are located.
pain relief from arthritis through acupuncture. She is concerned about
whether or not Medicare will cover these items and services. What
should you tell her?
Correct Answer: Medicare does not cover acupuncture, or, in general, glasses or dentures.
Mr. Bickford did not quite qualify for the extra help low-income subsidy
under the Medicare Part D Prescription Drug program and he is
wondering if there is any other option he has for obtaining help with
his considerable drug costs. What should you tell him?
Correct Answer: He could check with the manufacturers of his medications to see if they
offer an assistance program to help people with limited means obtain the medications they
need. Alternatively, he could check to see whether his state has a pharmacy assistance
program to help him with his expenses.
,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?
Correct Answer: 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 MA-only PPO plan and a stand-alone prescription drug plan.
Mr. Torres has a small savings account. He would like to pay for his
monthly Part D premiums with an automatic monthly withdrawal from
his savings account until it is exhausted, and then have his premiums
withheld from his Social Security check. What should you tell him?
Correct Answer: In general, he must select a single Part D premium payment mechanism
that will be used throughout the year.
,Agent 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?
Correct Answer: Yes. When an event has been advertised as "educational," discussing plan-
specific premiums is impermissible.
Mrs. Mulcahy is concerned that she may not qualify for enrollment in a
Medicare prescription drug plan because, although she is entitled to
Part A, she is not enrolled under Medicare Part B. What should you tell
her?
Correct Answer: Everyone who is entitled to Part A or enrolled under Part B is eligible to
enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she
does not need to enroll under Part B before enrolling in a prescription drug plan.
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?
, Correct Answer: 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.
Ms. Moore plans to retire when she turns 65 in a few months. She is in
excellent health and will have considerable income when she retires.
She is concerned that her income will make it impossible for her to
qualify for Medicare. What could you tell her to address her concern?
Correct Answer: Medicare is a program for people age 65 or older and those under age 65
with certain disabilities, end stage renal disease or Lou Gehrig's disease, so she will be
eligible for Medicare.
Agent Armstrong is employed by XYZ Agency, which is under contract
with ABC Health Plan, a Medicare Advantage (MA) plan that offers
plans in multiple states. XYZ Agency maintains a website marketing the
MA plans with which it has contracts. Agent Armstrong follows up with
individuals who request more information about ABC MA plans via the
website and tries to persuade them to enroll in ABC plans. What
statement best describes the marketing and compliance rules that
apply to Agent Armstrong?
Correct Answer: Agent Armstrong needs to be licensed and appointed in every state in
which beneficiaries to whom he markets ABC MA plans are located.
