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ANSWERS LATEST UPDATE 2022
What impact, if any, will the Medicare Access and CHIP Reauthorization
Act of 2015 (MACRA) have upon Medigap plans?
a.The Part A deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. b. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. c.The Part A deductible is no longer covered under Medigap plans for all enrollees staring January 1, 2020. d. MACRA provides funding to help individuals age 59 and above enroll in Medigap plans.
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?
a.All three are treated as independent agents under CMS compensation rules. b. Baker and Charles are subject to CMS compensation rules because they are paid by third parties. Able is not bec he is paid directly by a health plan. c.Able is subject to CMS compensation rules because he is paid directly by a health
ANSWERS LATEST UPDATE 2022
plan. Agents Baker and Charle not because they are paid by third parties. d. Charles is subject to CMS compliance rules because he works for a TMO and CMS applies an extra layer of scru such organizations. Able and Baker are not.
Mr. and Mrs. Nunez attended one of your sales presentations. They’ve asked
you to come to their home to clear up a few questions. During the
presentation, Mrs. Nunez feels tired and tells you that her husband can finish
things up. She goes to bed. At the end of your discussion, Mr. Nunez says
that he wants to enroll both himself and his wife. What should you do?
a. You should sign the form for Mrs. Nunez yourself, since she informed you, as the plan’s representative, that she w to enroll. b. As long as she is able to do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will have to wake up to sign her form or do so at another time. c.Legal spouses can sign enrollment forms for one another under federal law. You may enroll both Mr. and Mrs. Nun as long as her husband signs on her behalf d. You can countersign Mrs. Nunez’ application, along with her husband, indicating that she approved this choice ver This witness signature is sufficient to make the enrollment valid.
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?
a. As long as he fills out the paperwork to begin withholding from his Social Security check at least 63 days before su withholding should begin, he can change his
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reduce their premiums below the standard amount in order to increase their market share. This accounts for the variation in premium amounts.
Which of the following statement is correct about Medicare Savings Account
(MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug
benefits.
III. An individual who is eligible for health care benefits through the
Veteran's Administration may enroll in an MSA.
IV. Non-network providers must accept the same amount that Original
Medicare would pay them as payment in full.
a. II and III only b. I, II, and III only c. I, II, and IV only d. I and II only
Mr. James has end stage renal disease (ESRD). He has been covered under Original
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Medicare but would like to know if he can enroll in a Medicare Advantage plan. What
should you tell him?
a. Individuals with end stage renal disease may enroll in a Medicare Advantage plan, but only if they are willing to pa extra premium to do so. b. Individuals with end stage renal disease can only enroll in a Medicare Advantage plan after they have been on dia for 12 months. c.Individuals with end stage renal disease can enroll in any Medicare Advantage plan that they choose without payin extra premium. d. He will not be able to enroll in a Medicare Advantage plan because he has end stage renal disease, unless a spec needs plan for beneficiaries with ESRD is available in his service area.
Ms. Jensen has heard about “Original Fee-for-Service Medicare” and “Private Fee-
for-Service” plans. She wants to know what the difference is, if any. What should
you tell her?
a. Original Medicare and PFFS plans are essentially the same thing. b. PFFS plans are a type of Medicare Advantage plan offered by private companies. c.PFFS plans primarily cover drugs that Original FFS Medicare does not cover. d. PFFS is a form of supplemental coverage that fills in the gaps where Original Medicare leaves off.
Agent Herman works in the senior marketplace and depends on referrals and leads
to grow and maintain his business. Which of the following situations may Agent
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d. MA plans are only available to those who have been enrolled in a Medigap plan for at least six months. Therefor before enrolling in an MA plan, she must first use a Medigap plan to supplement her Original Medicare coverage .
15. 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?
a.You can make unsolicited contacts but you cannot cross-sell other products. b. You do not need to take an annual test, but you must not provide potential enrollees with more than light snacks at presentations. c.You are not required to submit copies of disseminated materials to CMS at the time of use, but CMS may reques and review copies if employee complaints occur. d. You do not need to complete a scope of appointment, but CMS can ask you to reconstruct one if there is a subsequent employee complaint.
16. 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?
a. Part D covers prescription drugs and she should look at her premiums, formulary, and cost sharing among other to see if they have changed. b. Part D covers physician and non-physician practitioner services and the deductible has not changed this year, b physician charges may go up.
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c. Part D covers long-term care services and she shouldn’t worry because there has been no change in coverage. d. Part D covers hospital and home health services and the cost sharing has changed this year.
17. Mr. Rice has coverage for medical services and medications through his
employer’s retiree plan. He is considering switching to a Medicare prescription
drug plan because his retiree plan does not cover two important medications.
What should he consider before making a change?
a. Mr. Rice’s retiree plan is required to take him back if, within 63 days of having voluntarily quit the employer’s pla he decides that he prefers it to his Medicare Part D plan. b. Mr. Rice can only receive his prescription drug coverage through a Medicare Advantage prescription drug plan so he should drop his employer coverage. c. If his drug coverage through the retiree plan is “creditable” he should not switch, even though it is possible to do d. If Mr. Rice drops his drug coverage through the retiree plan, he may not be able to get it back and he also may l his medical health coverage.
18. Winthrop Brokerage wishes to place an advertisement in the local
newspaper that says: "We offer Medicare Advantage plans offered by AB
Health and Top Choice Health. Contact us if you would like to learn more."
Which of the following best describes the obligation(s) of Winthrop
Brokerage regarding the advertisement?
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services and items covered by the plan with minimal out-of-pocket costs
because his MA-PD coverage has been very good. However, when he
received the bill, he was surprised to see large charges in excess of his
maximum out-of-pocket limit that included a number of services and items
he thought would be fully covered. He called you to ask what he could do?
What could you tell him?
a.You could remind him that he cannot do anything until the next Annual Election Period when he will have an opportunity to change plans. b. You could reassure him that such charges are typical, but if he needs assistance in paying, he should apply to the state. c.You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. d. You could suggest he call the doctor who performed the surgery to complain about the costs and ask for a discount on the charges.
21. Eleanor takes several high cost prescription drugs. She would like to enroll
in a standalone Part D prescription drug plan that is available in her area. In
what type of Medicare Health Plan can she enroll if she also wishes to enroll
in the standalone Part D plan?
a.A MA PPO plan only if it does not offer drug coverage. b. A Cost Plan that does not offer drug coverage or a Cost Plan that does offer drug coverage if she chooses not to enroll in it.
b. Ms. Davis who recently turned age 65 and is eligible for Part A and has just enrolled in Part B.
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c.A Cost Plan only if it does not offer drug coverage. d. A MA PPO plan that offers drug coverage if she chooses not to enroll in it.
22. Who is most likely to be eligible to enroll in a Part D prescription drug plan?
a. Mr. Charles, an undocumented immigrant, entered the country illegally. c. Ms. Bradley is currently living abroad for a multi-year job assignment. d. Mr. Adams, a healthy early retiree who has just begun to collect Social Security at age 62.
23. 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?
a. All that she needs to do is meet state licensure requirements moving forward.
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letter informing her that she has been automatically enrolled in Medicare Part B.
She wants to understand what this means. What should you tell Mrs. Quinn?
a. Part B primarily covers physician services. She will be paying a monthly premium and, with the exception of many prevent and screening tests, generally will have 20% co- payments for these services, in addition to an annual deductible. b. She will need to pay no premiums for Part B as she qualifies for premium free coverage due to the number of quarters sh has worked. c. She should disenroll if she does not want to pay the monthly premiums. There is no disadvantage to doing so. d. Part B will cover her dental and vision needs.
26.Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is
being successfully treated for tha 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?
a. Medicare will cover Mrs. Shields' skilled nursing services provided during the first 20 days of her stay, after which she would have a coinsurance until she has been in the facility for 100 days. b. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields' long-term care costs. c.Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered because Medicare does not provide such a benefit. d. Medicare will cover an unlimited number of days in a skilled-nursing facility, as long as a physician certifies that such care is needed.
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27.Which of the following individuals are likely to qualify for a special enrollment period
(SEP) for both MA and
Part D due to a change of residence?
I. Edward (enrolled in MA and Part D) moves to a new home within the same
neighborhood in his existing plan's service area.
II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing
plan's service area.
III. Gilbert moves into a plan service area where there is now a Part D plan available to
him from a service area where no Part D plan was available.
IV. Henry makes a permanent move providing him with new MA and Part D options.
a. II and III only b. I, II, III and IV c.I and II only d. II, III, and IV only
28.Mary Samuels recently suffered a stroke while visiting her daughter and
grandchildren. As a result, Mary has been admitted to a rehabilitation hospital
where she is expected to reside for several months. The rehabilitation hospital is
located outside the geographic area served by her current Medicare Advantage
(MA) plan. What options are available to Mary regarding her health plan
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institutionalized individuals. d. Mary’s only option in this situation is to return to Original Medicare.
29.Mr. McTaggert notes that a Private Fee-for-Service (PFFS) plan available in his
area has an attractive premium. He wants to Mr know what makes them different
from an HMO or a PPO. What should you tell him?
a.PFFS plans are the same as Medicare supplement plans and he may obtain care from any provider in the U.S. b. Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts Original Medicare, as long as the provider has a reasonable opportunity to access the plan’s terms and conditions and agrees to accept them. c.If a PFFS enrollee shows his/her card when obtaining services from a provider who participates in Original Medicare, t that provider is required to accept the plan’s terms and conditions. d. If offered, beneficiaries can select a stand-alone Part D prescription drug plan (PDP) with an HMO or a PPO, but not w PFFS plan.
30.You are mailing invitations to new Medicare beneficiaries for a marketing
event. You want an idea of how many people to expect, so you would like to
request RSVPs. What should you keep in mind?
a.You may request RSVPs, but you are not permitted to require contact information. b. You are not permitted to request RSVPs, so you will need to find a different way to estimate how many people are com
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c.You may require RSVPs and an e-mail address so you can follow up in the event of a cancellation. d. You may not require RSVPs, but when people arrive, you may require completion of contact information on a sign-up s
31.Wendy Park becomes eligible for Medicare for the first time in July. With the
help of Agent James Chan, she enrolls in FeelBetter Medicare Advantage plan with
an effective date of July 1st. Which statement best describes how Agent Chan may
be compensated under CMS rules?
a.FeelBetter will pay Agent Chan initial year compensation for the period July 1 through October 15th -(the date open enrollment begins). If Ms. Park remains enrolled in the plan, renewal amounts will be paid. b. FeelBetter will pay Agent Chan initial year compensation for the 12 months of July through July. Renewal amount will b paid thereafter if Ms. Park remains enrolled. c.FeelBetter will pay Agent Chan a bonus equal to three months initial year compensation since he has successfully enro Ms. Park in a MA plan when she is both first eligible and a younger, and likely healthier, enrollee. d. FeelBetter will pay Agent Chan initial year compensation for the months July through December. Renewal amounts wil be paid starting in January if Ms. Park remains enrolled the following year.
32. 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?
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should you tell her?
a. During the MA Open Enrollment Period, from January 1 – March 31, she may disenroll from the MA-PD plan into Origin Medicare and also may add a stand-alone prescription drug plan. b. During the MA Open Enrollment Period, from January 1 – March 31, she may only disenroll from a MA or MA-PD plan, but cannot enroll in a stand-alone Part D plan. c.During the MA Open Enrollment Period, from January 1 – March 31, she may drop a MA or MA-PD plan and go back to Original Medicare, but she may only enroll in a stand-alone prescription drug plan if she also purchases a Medigap policy d. During the MA Open Enrollment Period, from January 1 – March 31, she may only add or drop Part D coverage, so she cannot switch back to Original Medicare.
35.Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her?
a. Mrs. Radford must apply to the Medicare Advantage plan, which will include a medical review, prior to being accepted enrolled. b. Mrs. Radford can enroll in any Medicare Advantage plan that operates within the United States. c. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. d. Even if Mrs. Radford has end stage renal disease, she will be able to enroll in any Medicare Advantage plan in her serv area.
36.Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years
ago. Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD).
What options does Mrs. Billings have in regard to her MA plan during the next
d. She should remain in Original Medicare until the annual election period running from October 15 to December 7, durin which she
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open enrollment season?
a. She must remain enrolled in her ABC MA plan unless the plan terminates. b. She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one available in her area. c.She must immediately drop her ABC MA plan and enroll in Original Medicare. d. She must immediately drop her ABC MA plan and enroll in a Special Needs Plan (SNP) for individuals suffering from E if one is available in her area.
37.When Myra first became eligible for Medicare, she enrolled in Original
Medicare (Parts A and B). She is now 67 and will turn 68 on July 1. She would
now like to enroll in a Medicare Advantage (MA) plan and approaches you about
her options. What advice would you give her?
a. She should wait until the new year to disenroll from Original Medicare and select an MA plan between January 1 and M 31. b. She could enroll in an MA plan during the period including the three months before, the month of, and up to three mont after turning 68. c.She could immediately enroll in MA plan based on the one-time special enrollment period available to those 70 and you
38.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?
