Next week you will be participating in your first "educational event" for prospective
enrollees. To be sure that you do not violate any of the applicable guidelines, in what
activities should you plan to engage?
Give this one a try later!
You should plan to ensure that the educational event is informative and
must not conduct a sales presentation or distribute or accept enrollment
forms at the event.
Mr. Zachow has a condition for which three drugs are available. He has tried two but
had an allergic reaction to them. Only the third drug works for him and it is not on his
Part D plan's formulary. What could you tell him to do?
Give this one a try later!
, Mr. Zachow has a right to request a formulary exception to obtain coverage
for his Part D drug. He or his physician could obtain the standardized
request form on the plan's website, fill it out, and submit it to his plan.
Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-service
(PFFS) plan. What questions would you need to ask to determine his eligibility?
Give this one a try later!
You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B,
and if he lives in the PFFS plan's service area.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed
her Medicare Summary Notice (MSN) and disagrees with a determination that
partially denied one of her claims for services. What advice would you give her?
Give this one a try later!
Mrs. Duarte should file an appeal of this initial determination within 120 days
of the date she received the MSN in the mail.
Able, Baker, and Charles are engaged in the marketing to and enrollment of
beneficiaries into Medicare health plans. Mr. Able is an independent agent paid
directly by a health plan. Ms. Baker is an independent agent paid through a field
marketing organization (FMO). Mr. Charles is an independent agent paid for his work
by a third-party marketing organization (TMO). How do the CMS compensation rules
apply to these three agents?
Give this one a try later!
, Baker and Charles are subject to CMS compensation rules because they
are paid by third parties. Able is not because he is paid directly by a health
plan.
Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may
be extra help paying for Part D prescription drugs for Medicare beneficiaries with
limited income. He wants to know whether he might qualify. What should you tell him?
Give this one a try later!
The extra help is available to beneficiaries whose income and assets do not
exceed annual limits specified by the government.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are
provided under Original Medicare. What should you tell Mr. Xi that best describes the
health coverage provided to Medicare beneficiaries?
Give this one a try later!
Beneficiaries under Original Medicare have no cost-sharing for most
preventive services.
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?
Give this one a try later!
enrollees. To be sure that you do not violate any of the applicable guidelines, in what
activities should you plan to engage?
Give this one a try later!
You should plan to ensure that the educational event is informative and
must not conduct a sales presentation or distribute or accept enrollment
forms at the event.
Mr. Zachow has a condition for which three drugs are available. He has tried two but
had an allergic reaction to them. Only the third drug works for him and it is not on his
Part D plan's formulary. What could you tell him to do?
Give this one a try later!
, Mr. Zachow has a right to request a formulary exception to obtain coverage
for his Part D drug. He or his physician could obtain the standardized
request form on the plan's website, fill it out, and submit it to his plan.
Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-service
(PFFS) plan. What questions would you need to ask to determine his eligibility?
Give this one a try later!
You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B,
and if he lives in the PFFS plan's service area.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed
her Medicare Summary Notice (MSN) and disagrees with a determination that
partially denied one of her claims for services. What advice would you give her?
Give this one a try later!
Mrs. Duarte should file an appeal of this initial determination within 120 days
of the date she received the MSN in the mail.
Able, Baker, and Charles are engaged in the marketing to and enrollment of
beneficiaries into Medicare health plans. Mr. Able is an independent agent paid
directly by a health plan. Ms. Baker is an independent agent paid through a field
marketing organization (FMO). Mr. Charles is an independent agent paid for his work
by a third-party marketing organization (TMO). How do the CMS compensation rules
apply to these three agents?
Give this one a try later!
, Baker and Charles are subject to CMS compensation rules because they
are paid by third parties. Able is not because he is paid directly by a health
plan.
Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may
be extra help paying for Part D prescription drugs for Medicare beneficiaries with
limited income. He wants to know whether he might qualify. What should you tell him?
Give this one a try later!
The extra help is available to beneficiaries whose income and assets do not
exceed annual limits specified by the government.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are
provided under Original Medicare. What should you tell Mr. Xi that best describes the
health coverage provided to Medicare beneficiaries?
Give this one a try later!
Beneficiaries under Original Medicare have no cost-sharing for most
preventive services.
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?
Give this one a try later!
