Medicare Course Answers

 Medicare Course Home Transcript Question1 Marks: 1 Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for-Service (PFFS) plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts consider before selecting a PFFS plan? Choose one answer. a. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combin benefits and Part D prescription drug coverage, a PFFS plan offering only m benefits, or a PFFS plan in combination with a stand-alone prescription drug b. A stand-alone prescription drug plan in combination with a PFFS plan or a Medigap Supplemental Insurance plan. c. A PFFS plan offering only medical benefits or a PFFS Medigap Suppleme Insurance plan. d. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combin benefits and Part D prescription drug coverage, a PFFS plan offering only m benefits, or PFFS Medigap Supplemental Insurance plan. Question2 Marks: 1 Mr. Wong is a single individual. He has had a successful business career and is now able to retire with a comfortable income. Mr. Wong's taxable income is in excess of $100,000. Mr. Wong has health coverage through his employer but will sign-up Medicare Part A, Part B and Part D when he leaves the workforce. How would you advise him as he budgets for Medicare premiums? Choose one answer. a. Due to his participation in the workforce he will not have to pay premium A and he will pay the lowest monthly premium rates for Part B and Part D b. Due to his participation in the workforce he will not have to pay premium A and will pay reduced premiums for Part B and Part D. c. Due to the provisions of MACRA, his Part B and D coverage will be com covered through a low-cost Medigap policy to supplement his Part A cove d. Due to his participation in the workforce he will not have to pay premium A but he will pay higher premiums for Part B and Part D due to the amoun income. Question3 Marks: 1 Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to be most appropriate for him? Choose one answer. a. D-SNP b. C-SNP c. FIDE-SNP d. I-SNP Question4 Marks: 1 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 make financial decisions for her. Can he execute the enrollment for her? Choose one answer. a. No, he cannot execute the enrollment for her. Only Ms. Duarte can sign th regardless of her mental capacities. b. Yes, he can execute the enrollment for her. He can do so because he is a immediate family member. No power of attorney is necessary. c. Yes, he can execute the enrollment for her. A financial power of attorney i d. No, he cannot execute the enrollment for her. He must have a legal autho under state law that explicitly allows him to make health care decisions for h Question5 Marks: 1 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? Choose one answer. a. The Part D standard model’s importance is that it is the only type of plan low-income beneficiaries can enroll and still receive any extra help for which qualify. b. The government allows Part D plans to adopt any benefit structure as lon of covered drugs meets their approval. c. The government bases its payments to Part D plans on the standard ben For Part D plans to receive the full government payment, they must offer the model, however, they can take a risk and revise their benefit structure to att beneficiaries. d. Medicare Part D drug plans may have different benefit structures, but on they must all be at least as good as the standard model established by the Question6 Marks: 1 Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her? Choose one answer. a. Part D covers prescription drugs and she should look at her premiums and cost-sharing among other factors to see if they have changed. b. Part D covers long-term care services and she shouldn’t worry becaus been no change in coverage. c. Part D covers hospital and home health services and the cost sharing changed this year. d. Part D covers physician and non-physician practitioner services and th deductible has not changed this year, but the physician charges may go Question7 Marks: 1 Mr. Jackson just turned 65. He has been seeing the same general practitioner for annual check-ups for the past 15 years, likes these yearly visits, and would like to continue obtaining these services as a Medicare beneficiary. What should you tell him about annual check-ups? Choose one answer. a. Medicare will cover only a one-time “Welcome to Medicare” wellness visit. b. He can have as many preventive physical exams as he feels that he needs be covered by Medicare. c. Physical exams, in the absence of readily observable illness or injury, are ne under any circumstances. d. Medicare will cover an annual wellness visit, even if he has no illnesses or i Question8 Marks: 1 Mrs. Allen has a rare condition for which two different brand name drugs are the only available treatment. She is concerned that since no generic prescription drug is available and these drugs are very high cost, she will not be able to find a Medicare Part D prescription drug plan that covers either one of them. What should you tell her? Choose one answer. a. When medication costs exceed a certain threshold amount, which rises a Medicare prescription drug plan is permitted to exclude coverage for all least expensive of the medications in a given category. Mrs. Allen will nee encourage her physician to prescribe the least expensive of the two altern b. Medicare prescription drug plans are required to cover drugs in each th category. She should be able to enroll in a Medicare prescription drug pla covers the medications she needs. c. Medicare prescription drug plans are allowed to restrict their coverage drugs. She will need to pay for her brand name medications out of pocket d. Medicare prescription drug plans are required to include only a certain of brand name drugs among those they cover. It may be possible that pla in her area have opted not to include in their formularies the brand name needs. She may need to pay for this particular medication out of pocket. Question9 Marks: 1 Ms. Hernandez has marketed several different types of insurance products in her home state and has typically sought approval of her materials from her State Department of Insurance. What would you advise her regarding seeking such approval for materials she uses to market Medicare Advantage plans? Choose one answer. a. Materials need only be reviewed and approved by the company(s) she rep b. States often volunteer to review marketing materials on behalf of the Med agency. She should check with her Department of Insurance to see if such a available and would satisfy CMS requirements. c. Obtaining approval of her materials from the State Department of Insuranc practice and she should continue it with materials for the Medicare health pla represents. d. Materials for marketing Medicare health plans to individuals are subject to uniform national requirements. They do not need to be reviewed by the state company she represents must obtain approval from the Medicare agency (C materials she uses. Question10 Marks: 1 Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period. In mid-January of the following year, she wants to switch back to Original Medicare and enroll in a stand-alone prescription drug plan. What should you tell her? Choose one answer. a. During the MA Open Enrollment Period, from January 1 – March 31, s disenroll from the MA-PD plan into Original Medicare and also may add alone prescription drug plan. b. During the MA Open Enrollment Period, from January 1 – March 31, s only disenroll from a MA or MA-PD plan, but cannot enroll in a stand-alo plan. c. During the MA Open Enrollment Period, from January 1 – March 31, s only add or drop Part D coverage, so she cannot switch back to Original d. During the MA Open Enrollment Period, from January 1 – March 31, s drop a MA or MA-PD plan and go back to Original Medicare, but she ma in a stand-alone prescription drug plan if she also purchases a Medigap Question11 Marks: 1 Agent Willis had several clients who disenrolled from the plans he represents during the AEP to try new Medicare Advantage plans. 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? Choose one answer. a. He can send them information about the MA-OEP along with a flyer o he represents. b. He can e-mail them in January and ask them to let him know if they a happy with their new plans. c. He can wait until October and send them information about the plans represents. d. He can call them to let them know that if they do not like their new pla can change back during the MA-OEP. Question12 Marks: 1 This year you decide to focus your efforts on marketing to employer and union groups. Which of the following statements best describes what you can and cannot do in order to stay in compliance? Choose one answer. a. You can make unsolicited contacts but you cannot cross-sell other products b. You do not need to complete a scope of appointment, but CMS can ask you reconstruct one if there is a subsequent employee complaint. c. You are not required to submit communication and marketing materials spec those employer plans to CMS at the time of use, but CMS may request and re if employee complaints occur. d. You do not need to take an annual test, but you must not provide potential e more than light snacks at presentations. Question13 Marks: 1 Ms. Lewis understands that Medicare prescription drug plans may use various methods to control the use of specific drugs. She has heard about a technique called “step therapy” and is wondering if you can explain what that is. What should you tell her? Choose one answer. a. Step therapy refers to incentives plans can provide to enrollees to enga walking in order to reduce their need for medications treating heart and ch problems. b. Step therapy involves slow changes in the dosages of a given drug in or discover the correct amount. c. Step therapy involves using one or more lower priced drugs before tryin expensive drug when all are used to treat the same condition. d. Step therapy involves taking somewhat larger doses but skipping every resulting in lower overall consumption of the drug. Question14 Marks: 1 Mr. Chen has heard about a Medical Savings Account (MSA), but wants to know if it is just about saving money, or if he will get insurance coverage for his health care expenditures as well. What should you tell him? Choose one answer. a. Under the Medicare Advantage program, the MSA is only an account to pay for IRS-allowed health expenditures he may have. It does not involve h insurance of any kind. b. Under the Medicare Advantage program, the MSA plan is a form of pres coverage. c. Under the Medicare Advantage program, a MSA plan involves the comb high deductible health plan and a savings account for health expenses. Me make contributions to this savings account to help him pay his health care while in the deductible. d. Under the Medicare Advantage program, the MSA is funded by money h each year. If he does not use it all on IRS allowable health care expenditur will lose the money the following year. Question15 Marks: 1 Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the Annual Enrollment Period (AEP). At the beginning of January, her neighbor told her about the Medicare Advantage (MA) plan he selected. He also told her there was an open enrollment period that she might be able to use to enroll in a MA plan. Ms. Gonzales comes to you for advice shortly after speaking to her neighbor. What should you tell her? Choose one answer. a. There is a MA Open Enrollment Period (OEP) that takes place between Ja and March 31 and Ms. Gonzales can use it to change from Original Medicar only to a MA plan that includes prescription drug coverage. b. There is a MA Open Enrollment Period (OEP) that takes place between Ja and March 31, but Ms. Gonzales cannot use it because eligibility to use the available only to MA enrollees. c. There is a MA Open Enrollment Period (OEP) that takes place between Ja and March 31 and Ms. Gonzales can use it to change from Original Medicar to a MA or MA-PD plan. d. There is a MA Disenrollment Period that takes place between January 1 a 14 but since Ms. Gonzales enrolled in Original Medicare and Part D during t would not apply to her. Question16 Marks: 1 Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work and is covered by an employer health plan, he has not enrolled in Part B or Part D. He receives a notice on June 1 that his employer is cutting back on prescription drug benefits and that as of July 1 his coverage will no longer be creditable. He has come to you for advice. What advice would you give Mr. Rockwell about special enrollment periods (SEPs)? Choose one answer. a. Mr. Rockwell is eligible for a SEP due to his involuntary loss of credita coverage; the SEP begins in June and ends September 1 - two months a loss of creditable coverage. b. Mr. Rockwell must wait until the next annual election period (AEP) to s Part D prescription drug coverage. c. Mr. Rockwell is eligible for a SEP that begins in June and ends three m later, during which he may enroll, disenroll, and reenroll in Part D plans, selection considered binding. d. Mr. Rockwell is eligible for a SEP that begins three months before the which he receives notice of loss of creditable coverage and ends three m that month. Question17 Marks: 1 Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a PPO that does not include drug coverage. What should you tell her about obtaining drug coverage? Choose one answer. a. She can enroll in the PPO and purchase drug coverage through a Me b. She can enroll in the PPO and if she decides that she wants drug cov will be able to drop her PPO at any time in favor of a Medicare Advantag includes such drug coverage. c. She can enroll in the PPO and purchase drug coverage through a stan Medicare Part D prescription drug plan. d. She can enroll in the PPO, but she will not be able to purchase a stan Medicare Part D prescription drug plan. Question18 Marks: 1 You market many different types of insurance and ordinarily you spend time each evening calling potential clients. To be in compliance with requirements for marketing Medicare Advantage and Part D plans, what must you do about contacting potential clients to market those plans? Choose one answer. a. You only need to comply with the requirements of federal and state “Do N registries. b. Because the Medicare health plans are important federal programs for be federal law regarding the "Do Not Call" registry is waived so you will be able enroll beneficiaries over the telephone. c. You will have to avoid calling any potential client unless he or she initiate with you and specifically asks that you give him or her a call. d. As long as you market only health-related products, you can make an init any beneficiary, but then must honor "do not call again" requests. Question19 Marks: 1 Who is most likely to be eligible to enroll in a Part D prescription drug plan? Choose one answer. a. Mr. Charles, an undocumented immigrant, entered the country illegally. b. Ms. Adams, a healthy early retiree who has just begun to collect Social Sec 62. c. Ms. Davis who recently turned age 65 and is eligible for Part A and has just Part B. d. Ms. Bradley is currently living abroad for a multi-year job assignment. Question20 Marks: 1 Mr. Kelly has substantial financial means. He enrolled in Original Medicare and purchased a Medigap policy many years ago that offered prescription drug coverage. The prescription drug coverage has not been comparable to that offered by Medicare Part D for several years and despite notification, Mr. Kelly took no action. Which of the following statements best describes what will occur if Mr. Kelly now decides to enroll in Medicare Part D? Choose one answer. a. He will avoid any financial penalty or late enrollment fee under the grandfat provisions of Medicare Part D. b. He will not be able to enroll in Part D unless he decides to also enroll in a M Advantage plan. c. He will incur a one-time financial penalty equal to 30 percent of the annual premium. d. He will incur a late enrollment penalty. Question21 Marks: 1 Ms. Bushman has two homes in different states and is concerned about restrictions on where she can get her medications. What should you tell her? Choose one answer. a. Part D prescription drug plans focus almost entirely on mail order with fai access to retail pharmacies, so as long as she orders all of her medications mail, she will be fine. b. Part D prescription drug plans are restricted to local service areas. She w use mail order to fill all of her prescriptions. c. Part D prescription drug plans generally contract with every pharmacy in so she should be able to obtain her drugs in both states with no problem. d. Part D prescription drug plans use networks of pharmacies within their se She could look for a plan that maintains a network in both states. Question22 Marks: 1 Mrs. Sanchez lives in a state located near Canada. She has recently become eligible for Medicare and is considering enrollment in Part D prescription drug coverage. One of her friends has told her that she needs to be aware of something called TrOOP. What should you tell her when she asks you about TrOOP? Choose one answer. a. TrOOP are out-of-pocket costs that count toward the annual out-of-pocke to move into catastrophic coverage and generally include the annual deduc costs for drugs on the plan's formulary purchased at a plan's participating p some instances, amounts not directly paid by the enrollee (like manufacture count toward TrOOP. b. TrOOP is calculated on a cumulative basis and consists of the sum of an out-of-pocket deductibles from the date of his or her enrollment in Part D pl for over-the-counter drugs. c. TrOOP are out-of-pocket costs that count toward the annual out-of-pocke to move into catastrophic coverage and generally include, in addition to the deductible, costs for drugs not on the Part D plan's formulary and drugs pur outside the United States. d. TrOOP is calculated on an annual basis and consists of an enrollee's out deductible plus any amounts paid on behalf of an enrollee by Medicaid. Question23 Marks: 1 Alice is enrolled in a MA-PD plan. She makes a permanent move across the country and wonders what her options are for continuing MA-PD coverage. What would you say to her in regard to a special enrollment period (SEP)? Choose one answer. a. She is likely to qualify for a SEP. She can choose an effective date of up months after the month in which the enrollment form is received by the new the effective date may not be earlier than 30 days prior to the date of her m b. She is unlikely to qualify for a SEP but will be automatically covered by O Medicare and a standalone Part D prescription drug plan. c. She is unlikely to qualify for a SEP and should remain on her current plan her current plan’s out-of-network benefits. d. She is likely to qualify for a SEP. She can choose an effective date of up months after the month in which the enrollment form is received by the new the effective date may not be earlier than the date of her permanent move. Question24 Marks: 1 Which of the following is a correct statement about state laws as they pertain to marketing representatives? Choose one answer. a. State licensure laws are pre-empted and do not apply to marketing represen marketing MA and Part D plans b. Medicare health plans must comply with requests for information from state departments investigating complaints about a marketing representative. c. Plan sponsors can use any marketing representative, as long as they are lic least one state. d. Plans must contract only with marketing representatives who reside in the st they intend to work. Question25 Marks: 1 Ms. Lopez is an independent agent under contract with MarketCo, a third-party marketing organization. MarketCo has a contract with BestCare health plan, a Medicare Advantage (MA) organization, to offer marketing services through its contracted agents and agencies. Ms. Lopez returns calls to individuals who contact MarketCo in response to its mailers promoting BestCare health plan. Which of the following best describes the responsibilities of Ms. Lopez? Choose one answer. a. Ms. Lopez is considered a marketing representative of BestCare and thus to comply with CMS marketing requirements, including those regarding using approved call scripts. b. Ms. Lopez no longer needs to be concerned about state licensure since sh marketing an MA product subject to federal rules. c. Ms. Lopez needs to maintain state licensure, but because she is working fo party marketing organization she is exempt from CMS training requirements t BestCare captive agents. d. Ms. Lopez is considered a marketing representative of BestCare but is exe the marketing rules regarding approved call scripts because she works direct MarketCo. Question26 Marks: 1 Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care. What should you tell her? Choose one answer. a. In general, Mrs. Ramos will need a referral to see specialists. b. Mrs. Ramos should be aware that generally plan providers can decide case-by-case basis, whether they will treat her. c. Mrs. Ramos can obtain care from any provider who participates in Ori Medicare, but generally will have a higher cost-sharing amount if she se provider who/that is not a part of the PPO network. d. In general, Mrs. Ramos can obtain care from any provider who partici Original Medicare, but will have to pay the difference between the plan’s amount and the provider’s usual and customary charge. Question27 Marks: 1 Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the time to fill out the paperwork. What could you tell her? Choose one answer. a. The Part D low income subsidy is designed for Medicare beneficiaries who for Medicaid. If she does not qualify for Medicaid, she would likely not qualify f help and therefore should not take the time to apply. b. Those who qualify for the Part D low income subsidy pay nothing for any of medications. She should definitely apply if she believes there is any chance of qualifying. c. The Part D low income subsidy will not help her once she reaches the cove she need not take the time to apply. d. The Part D low income subsidy could substantially lower her overall costs. S apply by contacting her state Medicaid office or calling the Social Security Adm Question28 Marks: 1 Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare prescription drug plan you represent and simply give you a check to cover his premiums for the entire year. What should you tell him? Choose one answer. a. Enrollees should pay using automatic withdrawal from a bank account or c debit card, direct monthly billing from the plan, or deductions from their Socia check. b. This is perfectly acceptable. You will be happy to forward his payment to t c. You can take his first payment, but after that, he will need to make arrange send his monthly premium payment to the plan. d. He will need to mail in his payment with his enrollment form. Question29 Marks: 1 Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treated for that condition. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What should you tell them about Original Medicare’s coverage of care in a skilled nursing facility? Choose one answer. a. Medicare will cover an unlimited number of days in a skilled-nursing fac long as a physician certifies that such care is needed. b. Mrs. Shields will have to apply for Medicaid to have her skilled nursing covered because Medicare does not provide such a benefit. c. Medicare will cover Mrs. Shields' skilled nursing services provided duri 20 days of her stay, after which she would have a coinsurance until she h the facility for 100 days. d. Once she has expended her liquid assets, Medicare will cover 80% of Shields' long-term care costs. Question30 Marks: 1 You have set up an appointment for an in-home sales presentation with Mrs. Fernandez, who expressed interest in the Medicare plans you represent. In preparation for the sales presentation, what must you do? Choose one answer. a. At the time you arrive for the appointment, let her know which products y going over. b. Seven days prior to the appointment, you must notify the company(s) yo regarding which products you will be presenting, so they can report the nat meeting to the Medicare agency. c. Prior to conducting the presentation, obtain, and document having obtain permission to visit, along with her interest in the specific products you will p d. Prior to arriving at her home, request approval from CMS to use special that you developed to explain the plan benefits instead of the plan’s materi you think are confusing. Question31 Marks: 1 What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) have upon Medigap plans? Choose one answer. a. The Part A deductible is no longer covered under Medigap plans for enrollees starting January 1, 2020. b. The Part A deductible will no longer be covered for individuals newly Medicare starting January 1, 2020. c. The Part B deductible will no longer be covered for individuals newly Medicare starting January 1, 2020. d. MACRA provides funding to help individuals age 59 and above enro Medigap plans. Question32 Marks: 1 Mr. Murphy is an agent. A neighbor invited him to discuss the Medicare Advantage (MA) and Part D plans he sells at the regular Tuesday brunch the neighbors have for senior citizens. What should Mr. Murphy tell his neighbor about the kinds of food that can be provided to potential enrollees who attend the sales presentation? Choose one answer. a. Any type of meal or food is allowed, as long as it is available to the gene and not just to those who are eligible to enroll in the plans. b. The neighbors may not provide a meal, but light snacks would be permit c. Any meal is allowed, as long as it is valued at less than $15. d. The neighbors may not provide anything to either eat or drink during the presentation. Question33 Marks: 1 Julia Harris is turning 66 in July, at which time she will retire. She has contacted your office and requested a meeting so that she can learn about Medicare and the products you represent. How should you respond? Choose one answer. a. Tell Julia that you will meet with her at a time of her convenience within th week, when you can accept a completed enrollment application to be subm October 15th. b. Tell Julia that you are happy to meet with her once this year’s open enroll on October 15th. c. Tell Julia that you will meet with her to explain Medicare and should she b you can accept and submit an enrollment request, since this is an initial enro qualifying her for a special enrollment period. d. Tell Julia that she must first complete a questionnaire providing her health that you can recommend an appropriate product before submitting an enroll application, since she qualifies for a special enrollment period. Question34 Marks: 1 Which of the following statements is correct about the appeal and grievance processes? I. Enrollees have a right to obtain a review (appeal) of certain decisions about prescription drug coverage. II. The grievance process is used for reviews of coverage decisions on plan benefits. III. Plans must provide a link to the Medicare.gov website where an enrollee can enter a complaint. IV. Enrollees have a right to file complaints (sometimes called grievances) about the quality of their care. Choose one answer. a. II and IV only b. I, III, and IV only c. I and II only d. I and III only Question35 Marks: 1 Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr. Vaughn takes a prescription for helping to regrow his hair. They are anxious to have their Medicare prescription drug plan cover these drug needs. What should you tell them? Choose one answer. a. Medicare prescription drug plans are permitted to cover vitamins, but not dr cosmetic purposes. b. Mr. Vaughn’s hair growth medication would only be covered under Part D if resulted from an illness or was a side effect of a treatment such as chemother c. Medicare prescription drug plans are not permitted to cover the prescription the Vaughns are interested in under Part D coverage, however, plans may cov supplemental benefits and the Vaughn’s could look into that possibility. d. The vitamins the Vaughns are taking will be covered under Part D because physician suggested they should take vitamins, but the hair loss medication ca covered. Question36 Marks: 1 Mr. Landry is approaching his 65th birthday. He has signed up for Medicare Part A, but he did not enroll in Part B because he has employer-sponsored coverage and intends to keep working for several more years. But he is considering enrolling in Part D prescription drug coverage because he believes it is superior to his employer plan. How would you advise him? Choose one answer. a. Mr. Landry is eligible for Part D since he has Part A, and his initial e period (IEP) for Part D will continue for three months after his 65th birt b. Mr. Landry must enroll in Part B to enroll in Part D, and he still has t so. c. Mr. Landry must wait until the next annual open enrollment period b initial enrollment period for Part D lapsed when he enrolled in Part A. d. Mr. Landry must enroll in Part B to enroll in Part D, but his initial enr period for Part B lapsed when he enrolled in Part A. Question37 Marks: 1 Mrs. Wellington is enrolled in Parts A and B of Original Medicare. A friend recently told her that there is an excellent Medicare Advantage (MA) plan with a five-star rating serving her area. On January 15 she comes to you for advice as to what options, if any, she has. What should you say regarding special enrollment periods (SEPs)? Choose one answer. a. Mrs. Wellington must first enroll in a standalone PDP before she is e SEP to enroll in the MA five-star plan. b. Mrs. Wellington is eligible for a two- month SEP that began on Janua she should act quickly if she wishes to enroll in the MA five-star plan. c. Mrs. Wellington is eligible for a SEP that may be used once until Nov to enroll in the five-star plan. d. Mrs. Wellington can enroll in the five-star plan in the following Octob the next annual enrollment period (AEP) begins – not before. Question38 Marks: 1 You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. The hospital administration expresses some hesitation about allowing marketing in a health care facility. What should you tell them? Choose one answer. a. So long as the hospital or its physician staff don’t object, marketing anyw hospital is an acceptable practice. b. Marketing in health care facilities is an acceptable practice, as long as it t in common areas where patients are not receiving or waiting to receive hea c. Marketing in health care facilities is an acceptable practice, regardless of takes place. d. As long as the marketing activities are conducted in a way that does not healthy beneficiaries, it does not matter where in the hospital these activitie out. Question39 Marks: 1 Ms. Gardner is currently enrolled in an MA-PD plan. However, she wants to disenroll from the MA-PD plan and instead enroll in a Part D only plan and go back to Original Medicare. According to Medicare's enrollment guidelines, when could she do this? Choose one answer. a. Any time that she is dissatisfied with the plan’s network coverage or custo she may make such a change. b. She may only make such a change during her “initial coverage election pe occurred when she first became entitled to Medicare. c. She may make such a change during the Annual Election Period that runs 15 to December 7, or during the MA Open Enrollment Period which takes pla January 1- March 31 of each year (beginning in 2019). d. She may do it only during the MA Disenrollment Period, which runs from J February 14 of each year. Question40 Marks: 1 Since 2004 Ms. Eisenberg has had a Medigap plan that provides some drug coverage. She has recently received a letter from her Medigap carrier informing her that her drug coverage is not "creditable." She wants to know what this means. What should you tell her? Choose one answer. a. The letter is to inform her that the drug coverage offered through her Medig does not offer drug coverage that is at least comparable to that provided und Medicare Part D prescription drug program. If she does not have such credita coverage during periods when she is first eligible for the Part D program, she premium penalty if she enrolls in a Part D plan at a later date. b. The letter is to inform her that her Medigap drug coverage must be supple purchasing coverage under a Part D plan. If she does not do so within 63 day not be able to obtain Part D coverage at a later date. c. The letter is to inform her that her Medigap plan’s coverage has been dete the Federal government to be inadequate and the plan must therefore discon offering such coverage. Ms. Eisenberg will have to select a different Medigap wants drug coverage. d. The letter is to inform her that Medicare Part D prescription drug coverage but there is no need for her to change her drug coverage since it is just as go D. She may keep her current coverage through the Medigap plan. Question41 Marks: 1 Mr. Buck has several family members who died from different cancers. He wants to know if Medicare covers cancer screening. What should you tell him? Choose one answer. a. Medicare covers treatments for existing disease, injury and malformed li parts. As such, it does not cover any screening tests and these must be pa beneficiary out of pocket. b. Medicare covers all screening tests that have been approved by the FDA frequency determined by the treating physician. c. Medicare covers the periodic performance of a range of screening tests meant to provide early detection of disease. Mr. Buck will need to check sp before obtaining them to see if they will be covered. d. Medicare covers some screening tests that must be performed within the after enrollment. Beyond that point expenses for screening tests is the resp the beneficiary. Question42 Marks: 1 Agent Chan is conducting a sales presentation on senior issues where he hopes to enroll some attendees in the Medicare Advantage (MA) plans he represents. What action(s) may Agent Chan take during the event? Choose one answer. a. Sell personal information obtained as part of a raffle to a third-party m b. Conduct free health screenings as part of the event. c. Indicate that in order participate attendees must provide their contact i d. Discuss plan specific information such as premiums and benefits. Question43 Marks: 1 Ms. Brooks has an aggressive cancer and would like to know if Medicare will cover hospice services in case she needs them. What should you tell her? Choose one answer. a. Hospice services are currently only offered under a limited demonstration p Whether they will eventually become available nationally depends on the outc demonstration. b. Medicare does not cover hospice services. Hospice services are only availa state Medicaid programs, if the state offers such coverage. c. The Federal government facilitates competition between hospice programs price of their services for Medicare beneficiaries, but does not offer coverage f services through the Medicare program. d. Medicare covers hospice services and they will be available for her. Question44 Marks: 1 Last year Agent Melanie Meyers marketed and enrolled several clients in Medicare Advantage (MA) health plans. This year she has decided to focus on non-MA products. What advice would you give Melanie if she wishes to continue to receive renewal fees? Choose one answer. a. Melanie will need to do nothing to continue receiving renewal fees since th sale was made when she met all requirements. b. All that she needs to do is meet state licensure requirements moving forw c. Melanie must remain trained, tested, licensed, and appointed, regardless she is actively selling MA products. d. All that she needs to do is avoid being terminated for cause. Question45 Marks: 1 During a sales presentation in Ms. Sullivan’s home, she tells you that she has heard about a type of Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would be available to her. What should you tell her about PFFS plans? Choose one answer. a. PFFS plans are designed to cover only prescription drugs and if that is coverage she wants, she may enroll in one if it is available in her area. b. A PFFS plan is a type of Medicare Supplement plan and she may enro is available in her area. c. A PFFS plan is exactly the same as Original Medicare, only offered by entity and she may enroll in one if it is available in her area. d. A PFFS plan is one of the various types of Medicare Advantage plans private entities and she may enroll in one if it is available in her area. Question46 Marks: 1 Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he sees an out-of-network doctor to receive a Medicare covered service. How much may the doctor collect from Mr. Rivera? Choose one answer. a. The doctor may only collect the amount allowable under Medicare p percent balance billing. b. The doctor may only collect the amount allowable under Medicare p percent balance billing. c. The doctor may only collect from Mr. Rivera the cost sharing allowab the state’s Medicaid program. d. The doctor may only collect the amount allowable under Medicare A (MA) PPO plan cost sharing for non-QMB enrollees. Question47 Marks: 1 Mrs. Chou likes a PFFS plan available in her area that does not include drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What should you tell her? Choose one answer. a. She could enroll in the PFFS plan and a Medigap plan that offers drug but not in a stand-alone Medicare prescription drug plan. b. She could enroll in a PFFS plan and a stand-alone Medicare prescript plan. c. She could enroll in a PFFS plan, but not in a stand-alone drug plan. d. If she wants drug coverage and a PFFS plan, she could only enroll in plan that includes Medicare prescription drug coverage. Question48 Marks: 1 Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could you help him take during this time? Choose one answer. a. If he has a disability, he may enroll in Original Fee-for-Service Medic the MA Initial Coverage Election Period. b. He will have a three month period during which he may enroll in as m Medicare Advantage plans as he chooses, with the last enrollment bein effective one. c. He may change or drop MA plans, but may not drop drug coverage. d. He will have one opportunity to enroll in a Medicare Advantage plan. Question49 Marks: 1 Mr. McTaggert notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know what makes them different from an HMO or a PPO. What should you tell him? Choose one answer. a. PFFS plans are the same as Medicare supplement plans and he may o from any provider in the U.S. b. Enrollees in a PFFS plan can obtain care from any provider in the U.S. w Original Medicare, as long as the provider has a reasonable opportunity to plan’s terms and conditions and agrees to accept them. c. If a PFFS enrollee shows his/her card when obtaining services from a p participates in Original Medicare, then that provider is required to accept th terms and conditions. d. If offered, beneficiaries can select a stand-alone Part D prescription drug (PDP) with an HMO or a PPO, but not with a PFFS plan. Question50 Marks: 1 Richard is a licensed agent who represents Spartan Health Plan and its Medicare Advantage (MA) plans. Richard has several clients who have recently come to him for help who are in their initial coverage election period (ICEP) and are interested in enrolling in one of Spartan Health Plan's MA plans. Alice will soon turn 65 and retire. Alice has coverage through Spartan Health Plan offered by her employer. Bob had health coverage through Spartan but dropped the coverage when he retired early to travel overseas. Bob, who has just turned age 65, is now back in the United States. Charlotte, who will turn 65 next month, has coverage through Athena Health plan – a company Richard also represents. Who qualifies for the opt-in simplified enrollment mechanism? Choose one answer. a. Alice and Bob because each of them has had coverage through Spartan H b. Alice because she will not have a break between her non-Medicare and Me coverage through Spartan Health Plan. c. Alice and Charlotte because each of them currently have health coverage a initial coverage election period (ICEP). d. Alice, Bob, and Charlotte because electronic health record interoperability w Richard to access any needed information for their applications. Submit all and finish