1. 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?: Medicare does not cover acupuncture, or, in general, glasses or dentures.
2. 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?: 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.
3. 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?: 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.
4. 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?: In general, he must
select a single Part D premium payment mechanism that will be used throughout
the year.
5. 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?: Yes. When an event has been advertised as
"educational," discussing plan-specific premiums is impermissible.
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, 6. 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?: 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.
7. 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?: 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.
8. 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?: 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. 9. 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?: Agent Armstrong needs to be licensed and appointed in every state
in which beneficiaries to whom he markets ABC MA plans are located.
10. Mr. Schmidt would like to plan for retirement and has asked you what is
covered under Original Fee-for-Service (FFS) Medicare? What could you tell
him?: Part A, which covers hospital, skilled nursing facility, hospice and home
health services and Part B, which covers professional services such as those
provided by a doctor are covered under Original Medicare.
11. You are seeking to represent an individual Medicare Advantage plan and
an individual Part D plan in your state. You have completed the required
training for each plan, but you did not achieve a passing score on the tests
that came after the training. What can you do in this situation?: You will not be
able to represent any Medicare Advantage or Part D plan until you complete the
training and achieve an adequate score, although you will not have to take a test if
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relief from arthritis through acupuncture. She is concerned about whether
or not Medicare will cover these items and services. What should you tell
her?: Medicare does not cover acupuncture, or, in general, glasses or dentures.
2. 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?: 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.
3. 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?: 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.
4. 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?: In general, he must
select a single Part D premium payment mechanism that will be used throughout
the year.
5. 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?: Yes. When an event has been advertised as
"educational," discussing plan-specific premiums is impermissible.
1/8
, 6. 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?: 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.
7. 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?: 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.
8. 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?: 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. 9. 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?: Agent Armstrong needs to be licensed and appointed in every state
in which beneficiaries to whom he markets ABC MA plans are located.
10. Mr. Schmidt would like to plan for retirement and has asked you what is
covered under Original Fee-for-Service (FFS) Medicare? What could you tell
him?: Part A, which covers hospital, skilled nursing facility, hospice and home
health services and Part B, which covers professional services such as those
provided by a doctor are covered under Original Medicare.
11. You are seeking to represent an individual Medicare Advantage plan and
an individual Part D plan in your state. You have completed the required
training for each plan, but you did not achieve a passing score on the tests
that came after the training. What can you do in this situation?: You will not be
able to represent any Medicare Advantage or Part D plan until you complete the
training and achieve an adequate score, although you will not have to take a test if
2/8
