Questions - PASS THE AHIP EXAM

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Question #1
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?
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Question #2
Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period (AEP). On December 1, he calls you up and says that he has changed his mind and would like to enroll into a MA-PD plan. What enrollment rules would apply in this case?
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Question #3
Which of the following individuals has enrolled in a plan based on a fixed enrollment period?
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Question #4
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without paying any premiums, because she has been working for 40 years and paying Medicare taxes. What should you tell her?
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Question #5
When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan?
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Question #6
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?
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Question #7
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through massage therapy. She is concerned about whether or not Medicare will cover these items and services. What should you tell her?
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Question #8
You are meeting with Mrs. Hall in her home. On her scope of appointment form, she asked to discuss Medicare Advantage plans. During the meeting, she asks to discuss a stand-alone prescription drug plan. She is leaving the next day to visit her family for a week in another state, so it is important for her to make a decision before she leaves. What must happen before that additional discussion can take place?
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Question #9
Mrs. Parker likes to handle most of her business matters through telephone calls. She currently is enrolled in Original Medicare Parts A and B but has heard about a Medicare Advantage plan offered by Senior Health from a neighbor. Mrs. Parker asks you whether she can enroll in Senior Health’s MA plan over the telephone. What can you tell her?

I. Enrollment requests can only be made in face-to-face interviews or by mail.
II. Telephone enrollment request calls must be recorded.
III. Telephonic enrollments must include all required elements necessary to complete an enrollment.
IV. The signature element must be completed via certified mail.

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Question #10
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?
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Question #11
This year you have decided to focus your efforts on marketing to employer group plans. One employer provides you with a list of their retirees and asks you to contact them to explain the characteristics of the plan they have selected. What should you do?
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Question #12
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?
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Question #13
Which of the following statements about Medicare Part D are correct?

I. Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP.

Answer:
I, II, and III only
(Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. Also, private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. Additionally, beneficiaries enrolled in an MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP.)

Question #14
Mr. Lee was intending to enroll in MaxCare’s Medicare Advantage plan this year. However, due to his current medical condition, his daughter Debbie has been appointed as his legal representative over both health and financial matters. Debbie would like to ensure that her father is still able to enroll in MaxCare’s plan, but she is unsure what her role is to help with his enrollment request. What advice can you give her?
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Question #15
Ms. Claggett is sixty-six (66) years old. She has been covered under Original Medicare for the last six years due to her disability and has never been enrolled in a Medicare Advantage or a Part D plan before. She wants to enroll in a Part D plan. She knows that there is such a thing as the “Part D Initial Enrollment Period” (IEP) and has concluded that, since she has never enrolled in such a plan before, she should be eligible to enroll under this period. What should you tell her about how the Part D Initial Enrollment Period applies to her situation?
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Question #16
You plan to participate in an educational event sponsored by a large regional health care system. One of your colleagues suggests that you do a presentation on one of the Medicare Health plans you market and modify it to include information about preventive screening tests showcased at the event. How should you respond to your colleague’s suggestion?
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Question #17
Mr. Lynn, an agent for Acme Insurance, Inc. thinks that, since state laws are preempted concerning the marketing of Medicare health plans, he doesn't have much to worry about. What might you, as his colleague, advise him concerning the type of scrutiny he will be under?
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Question #18
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do?
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Question #19
Mr. Robinson was quite ill recently and forgot to pay his monthly premium for his MA-PD plan. He is worried that he will lose his coverage now when he needs it the most. He is certain his plan will disenroll him because that is what happened to a friend of his in a similar type of plan. What can you tell Mr. Robinson about his situation?
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Question #20
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. He wants to understand the health care costs he might be exposed to under Medicare if he were to require hospitalization as a result of an illness. In general terms, what could you tell him about his costs for inpatient hospital services under Original Medicare?
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Question #21
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?
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Question #22
Which of the following statement(s) is/are correct about a 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.
IV. Non-network providers must accept the same amount that Original Medicare would pay them as payment in full.
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Question #23
Mrs. Johnson calls to tell you she has not received her new plan ID card yet, but she needs to see a doctor. What can she expect to receive from the plan after the plan has received her enrollment form?
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Question #24
Madeline Martinez was widowed several years ago. Her husband worked for many years and contributed into the Medicare system. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. She comes to you for advice. What should you tell her?
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Question #25
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrollment in a Medicare Advantage plan (Part C). What should you advise her to do before she will be able to enroll in a Medicare Advantage plan?
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Question #26
Mr. Schultz was still working when he first qualified for Medicare. At that time, he had employer group coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. It is now a year later and Mr. Schultz has lost his employer group coverage within the last two weeks. How would you advise him?
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Question #27
Mrs. Peňa is 66 years old, has coverage under an employer plan, and will retire next year. She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell her?
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Question #28
Mrs. Walters is enrolled in her state’s Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare Advantage (MA) plan?
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Question #29
Which of the following is/are most likely to be characterized as an involuntary disenrollment from a Medicare Advantage (MA) plan?
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Question #30a
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group health plan that includes drug coverage with nominal copays. He heard about a neighbor’s MA-PD plan that you represent and because he takes numerous prescription drugs, he is considering signing up for it. What should you tell him?
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Question #30b
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group health plan that includes drug coverage with nominal copays. He heard about a neighbor’s MA-PD plan that you represent and because he takes numerous prescription drugs, he is considering signing up for it. What should you tell him?
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Question #31 (Similar to 260)
Mrs. Mulcahy, age 65, 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?
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Question #32
Mrs. Reynolds is in her Medicare initial coverage election period (ICEP) and the date of her entitlement to Part A and B has already occurred. Mrs. Reynolds has just signed up for a Medicare Advantage plan on the second of the month. She is leaving for vacation in two weeks and wants to know if her new coverage will start before she leaves. What should you tell her?
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Question #33 (Similar to 133)
Mrs. Chou likes a Private Fee-for-Service (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?
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Question #34
Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. What can you tell her about Medigap as an option to address this concern?
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Question #35
Mrs. Turner is comparing her employer’s retiree insurance to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are met? What could you tell her?
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Question #36
Ms. O’Donnell learned about a new MA-PD plan that her neighbor suggested and that you represent. She plans to switch from her old MA HMO plan to the new MA-PD plan during the Annual Election Period. However, she wants to make sure she does not end up paying premiums for two plans. What can you tell her?
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Question #37
Agent Harriet Walker has recently begun marketing Medicare Advantage and related products aimed at meeting the needs of senior citizens. Client Mildred Jones has expressed interest in a Medicare Advantage plan. It is now the beginning of September. If you were in Agent Walker’s position, what would you do?
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Question #38
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan’s terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge?
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Question #39
While making an appointment to discuss Medicare Advantage (MA) and Part D plans with a potential enrollee, you are asked to describe other types of insurance products that your client might wish to purchase. What additional types of insurance can you present during the MA and Part D marketing appointment?
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Question #40
Agent Roderick enrolls retiree Mrs. Martinez in a medical savings account (MSA) Medicare health plan. The MSA plan does not offer prescription drug coverage, so Agent Roderick also enrolls Mrs. Martinez in a standalone prescription drug plan (PDP). What CMS compensation rules apply to this situation?
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Question #41
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?
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Question #42
Ms. Morris will turn 65 on June 10th. She has never previously qualified for Medicare. She is entitled to Medicare Part A and intends to enroll in Part B. She wants to know if she is eligible to enroll in a Medicare Advantage plan that includes prescription drug coverage. What do you tell her?
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Question #43
Monica is an agent focused on serving seniors eligible for Medicare. As she reviews her records, she is trying to determine which of the following items are considered compensation. What do you tell her?
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Question #44
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?
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Question #45
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be of assistance?
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Question #46
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?
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Question #47
BestCare Health Plan has received a request from a state insurance department in connection with the investigation of several marketing representatives licensed by the state who sell Medicare Advantage plans. What action(s) should BestCare take in response?
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Question #48
Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. In addition to drugs on his plan’s formulary he takes several other medications. These include a prescription drug not on his plan’s formulary, over-the-counter medications for colds and allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to promote hair growth and reduce joint swelling. His neighbor recently told him about a concept called TrOOP and he asks you if any of his other medications could count toward TrOOP should he ever reach the Part D catastrophic limit. What should you say?
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Question #49
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug coverage since her doctor recently prescribed several expensive medications. Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi?
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Question #50
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?
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Question #51
Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans. What could you tell her?
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Question #52
Mr. Diaz continued working with his company and was insured under his employer’s group plan until he reached age 68. He has heard that there is a premium penalty for those who did not sign up for Part B when first eligible and wants to know how much he will have to pay. What should you tell him?
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Question #53
Mr. Albert has heard about something called the Star Rating system for Medicare Advantage plans. He asks you to explain it to him since he is interested in enrolling in a plan that is newly available in his area. After you explain that it is the way for consumers to judge plan performance, what else would you say?
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Question #54
By contacting plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefits package. What should you do to make sure your clients know about these pieces of information?
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Question #55
You work for Caring Health, a Medicare Advantage (MA) plan sponsor. Recently, Mrs. Garcia has completed an enrollment application for a plan offered by Caring Health, which is waiting for a reply from CMS indicating whether or not Mrs. Garcia’s enrollment has been accepted. Once CMS replies, how long does Caring Health have to notify Mrs. Garcia that her enrollment has been accepted and in what format?
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Question #56
Alice is a marketing representative employed by a health plan. Betty is a captive agent of a health plan who markets to multiple plans and sponsors. Carl is a captive agent who markets to only one plan/sponsor. Denise is an independent agent who markets to different types of groups. Edward is an independent agent who markets only to employer and union groups. CMS marketing representative compensation rules generally apply to:
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Alice is a Full Dual-Eligible receiving full cost sharing from the state. What should her agent remind her about
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Question #57
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?
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Question #58
Mr. Decaro has looked at Medicare prescription drug plans available in his area and noted a wide range in premiums. He thought that all the drug plans were required to offer the same standard benefits and would like you to explain why there is such a range in premiums. What should you tell him?
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Question #59
Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. She is interested in selecting a Medicare Part D prescription drug plan. She takes a number of medications and is concerned that she has not been able to identify a plan that covers all of her medications. She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. What should you tell her?
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Question #60
Mrs. Fiore is a retired federal worker with coverage under a Federal Employee Health Benefits (FEHB) plan that includes creditable drug coverage. She is ready to turn 65 and become Medicare eligible for the first time. What issues might she consider about whether to enroll in a Medicare prescription drug plan?
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Question #61
What impact, if any, have recent regulatory changes had upon Medigap plans?
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Question #62
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?
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Question #63
If a beneficiary is enrolled in a stand-alone prescription drug plan and wants to keep that plan, what type of Medicare health plan could the individual also enroll in, without being automatically disenrolled from the stand-alone prescription drug plan?
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Question #64
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). What could you tell him?
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Question #65
Your colleague works at a third-party marketing organization (TMO) and she said she did not need to take the Medicare training for brokers and agents or pass a test to market Medicare plans since her contract is with the TMO, not the plans that have the products she sells. What could you say to her?
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Question #66
You are scheduled to give a sales presentation at a local senior center at which a drawing will be held for a prize. At the beginning of the presentation, which of the following must you do?
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Question #67
Mr. Rice is 68, actively working and has coverage for medical services and medications through his employer’s group health plan. He is entitled to premium free Part A and thinking of enrolling in Part B and switching to an MA-PD because he is paying a very large part of his group coverage premium and it does not provide coverage for a number of his medications. Which of the following is NOT a consideration when making the change?
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Question #68
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?
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Question #69
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?
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Question #70
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What should you tell him?
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Question #71
Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. She is traveling and wishes to fill two of the prescriptions that she has lost. How would you advise her?
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Question #72
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?
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Question #73
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?
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Question #74
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?
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Question #75
Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her?
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Question #76
Mr. Wendt suffers from diabetes which has gotten progressively worse during the last year. He is currently enrolled in Original Medicare (Parts A and B) and a Part D prescription drug plan and did not enroll in a Medicare Advantage (MA) plan during the last annual open enrollment period (AEP) which has just closed. Mr. Wendt has heard certain MA plans might provide him with more specialized coverage for his diabetes and wants to know if he must wait until the next annual open enrollment period (AEP) before enrolling in such a plan. What should you tell him?
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Question #77
Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. How would you respond?
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Question #78
Willard works as a representative focused on the senior marketplace. What would be considered prohibited activity by Willard?
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Question #79
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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Question #80
Mr. Wilcox has been enrolled in Lexington Private Fee-for-Service (PFFS) Medicare Advantage Health Plan (Lexington) for several years. Recently, Mr. Wilcox decided to spend time with his children who live in another state that is not in Lexington’s service area. In the future, he may relocate near his children permanently. How does this move to another service area impact his PFFS MA coverage?
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Question #81
Ms. Thomas has worked for many years and is turning 68 in June. She is eligible for Medicare Part A and did not enroll for Part B when first eligible because she has insurance through her employer - Coffee Brew, Inc. She also did not enroll in Part D because she had creditable coverage. She would like to retire in June and enroll in a Medicare Advantage plan. She has been informed that her group coverage will end on her retirement effective date. How would you advise Ms. Thomas?
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Question #82
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?
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Question #83
Who is most likely to be eligible to enroll in a Part D prescription drug plan?
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Question #84
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)?
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Question #85
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him?
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Question #86
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?
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Question #87
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?
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Question #88
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?
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Question #89
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. She asks you to explain it. What do you say?
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Question #90
If you are to comply with Medicare’s guidance regarding educational events, which of the following would be acceptable activities?
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Question #91
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?
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Question #92
Mr. Liu turns 65 on June 19. He has never previously qualified for Medicare so his first Medicare eligibility date will be by June 1. Mr. Liu’s ICEP and Part D IEP begin March 1 and end on September 30. He wants prescription drug coverage with his Part A and Part B benefits. What advice can you provide him?
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Question #93
Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled a marketing event and expects about 40 people to attend. He has hired a magician for $200 to entertain attendees. Can he do this in a way that complies with guidance from the Medicare agency?
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Question #94
Mrs. Kendrick is in good health, has worked for many years and is six months away from turning 65. She wants to know what she will have to do to enroll in a Medicare Advantage (MA) plan as soon as possible. What could you tell her?
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Question #95 (similar to 238)
During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a 5-star rating in customer service and care coordination, and received an overall plan performance rating of a 4-star, which of the following would be the best statement to say to her?
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Question #96
Mr. Anderson is a very organized individual and has filled out and brought to you an enrollment form on October 10 for a new plan available January 1 next year. He is currently enrolled in Original Medicare. What should you do?
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Question #97
Mr. Fitzgerald is selling his home to permanently move into a retirement facility near his daughter in a neighboring state before the Annual Election Period. He has a stand-alone prescription drug plan and has learned it is not available where he is moving. He doesn’t know what he should do. What can you tell him?
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Question #98
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. She is attracted by the idea of maintaining control over a Medical Savings Account (MSA) but is not sure if the plan associated with the account will fit her needs. What specific piece of information about a Medicare MSA plan would it be important for her to know, prior to enrolling in such a plan?
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Question #99
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?
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Question #100
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay that Medicare will cover?
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Question #101
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?
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Question #102
Mr. Lopez has heard that he can sign up for a product called “Medicare Advantage” but is not sure about what type of plan designs are available through this program. What should you tell him about the types of health plans that are available through the Medicare Advantage program?
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Question #103
Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to?
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Question #104
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. What should you tell him?
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Question #105
Miles is a licensed agent who represents Colgate Health and its Medicare Advantage (MA) plans. Miles has several clients who have recently come to him for help. They are in their initial coverage periods) (ICEP) and are interested in enrolling in one of Colgate Health’s MA plans. Adam will soon turn 68 and has decided to retire. Betty is about to turn 65 and has also decided to retire. Adam and Betty both currently have coverage through Colgate Health. Charles had health coverage through Colgate but dropped the coverage when he retired early to travel to Europe. Charles has just turned age 65 and is now back in the United States. Diedre, who will turn 65 next month, currently has coverage through Ditmas Health – a company that Miles also represents. Who qualifies for the opt-in simplified enrollment mechanism?
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Question #106
Agent Marvin Millner wants to reach out to his current clients for referrals. What advice would you give to Marvin?
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Question #107
Mr. Cole has been a Medicaid beneficiary for some time, and recently qualified for Medicare as well. He is concerned about changes in his cost-sharing. What should you tell him?
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Question #108
During an appointment scheduled to discuss a Medicare Advantage Prescription Drug plan (MA-PD), Mr. Peters asked his agent to describe a stand-alone prescription drug plan (Part D plan) that his neighbor told him about. What should his agent do?
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Question #109
Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a 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?
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Question #110
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?
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Question #111
Mrs. Jenkins is enrolled in both Part A and Part B of Medicare. She has recently also become eligible for Medicaid and would like to enroll in a MA-PD plan. Since this is her first experience with Medicare Advantage, she is concerned that she will be locked into a plan and unable to make any coverage changes for at least a year if not longer. What should you tell her?
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Question #112
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?
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Question #113
Mrs. Tanner is enrolled in a Medicare Advantage HMO that offers a point of service option. This allows Mrs. Tanner to do which of the following?
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Question #114
You have decided to focus on doing in-home presentations to market the Medicare Advantage (MA) plans you represent. Before you conduct such sales presentations, what must you do?
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Question #115
Anita Magri will turn age 65 in August 2022. Anita intends to enroll in Original Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita’s older neighbor Mel has told her about the Medigap Plan F in which he is enrolled. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. What should you tell her?
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Question #116
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Where might he turn for help with his prescription drug costs?
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Question #117
What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) have upon Medigap plans?
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Question #118
Mr. Hutchinson has drug coverage through his former employer’s retiree plan. He is concerned about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to purchase extra coverage that he will not need. What should you tell him?
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Question #119
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs. What could you tell Mr. Moy?
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Question #120
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. He is wondering whether he can obtain coverage under Medicare. What should you tell him?
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Question #121
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?
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Question #122
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?
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Question #123
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?
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Question #124
What impact, if any, will recent regulatory changes have upon Medigap plans?
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Question #125
A client wants to give you an enrollment application on October 1 prior to the beginning of the Annual Election Period because he is leaving on vacation for two weeks and does not want to forget about turning it in. What should you tell him?
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Question #126
Mr. Lopez takes several high-cost prescription drugs. He would like to enroll in a standalone Part D prescription drug plan that is available in his area. In what type of Medicare Health Plan can he enroll?
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Question #127
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?
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Question #128
Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan, but does not want to be limited in terms of where he obtains his care. What should you tell him about how a Medicare Cost Plan might fit his needs?
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Question #129
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him?
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Question #130
You would like to market an MA plan at a neighborhood pharmacy. What should you keep in mind to comply with the marketing requirements for MA plans?
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Question #131
Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage (MA) and Part D plans that Agent Smith sells at the regular Tuesday brunch the neighbors have for senior citizens. What should Agent Tom Smith tell Mr. Moreno about the kinds of food that can be provided to potential enrollees who attend the sales presentation?
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Question #132
Mr. Jenkins is interested in enrolling in a Medicare cost plan and has sought your advice. What would you tell him?
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Question #133 (Similar to 33)
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?
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Question #134
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?
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Question #135
Mr. Perry is entitled to Medicare Part A but has not yet enrolled in Part B, even though he is 69 years old. He would like to enroll in a Medicare Part D prescription drug plan but is concerned that he will have to sign up for Part B as well in order to qualify for enrollment in a Part D plan. What should you tell him?
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Question #136
Another agent you know has engaged in misconduct that has been verified by the plan she represented. What sort of penalty might the plan impose on this individual?
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Question #137
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently lost creditable coverage previously available through her husband's employer. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). What should you tell her?
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Question #138
Mr. Nguyen understands that Medicare prescription drug plans can use a formulary or list of covered drugs. He is suspicious about how plans establish these formularies. What should you tell him?
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Question #139
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?
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Question #140
Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA), not by the government. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. What should you tell him?
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Question #141
Mrs. Wu was primarily a homemaker and employed in jobs that provided taxable income only sporadically. Her husband worked full-time throughout his long career. She has heard that to qualify for Medicare Part A she has to have worked and paid Medicare taxes for a sufficient time. What should you tell her?
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Question #142
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?
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Question #143
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?
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Question #144
Ms. Levi is considering enrollment in a Medicare Advantage HMO plan offered in her area. Ms. Levi often travels to visit relatives and is concerned that she may need emergency care outside of her plan’s service area. What should you tell her about coverage of emergency care?
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Question #145
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?
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Question #146
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)?
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Question #147
Mr. James has end-stage renal disease (ESRD). He has been covered under Original Medicare but would like to know if he can enroll in a Medicare Advantage plan. What should you tell him?
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Question #148
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?
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Question #149
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?
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Question #150
Mrs. Schneider has Original Medicare Parts A and B and has just qualified for her state’s Medicaid program, so the state is now paying her Part B premium and she is considered a dual eligible. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan?
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Question #151
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?
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Question #152
Ms. Stuart has heard about a special needs plan (SNP) that one of her friends is enrolled in and is interested in that product. She wants to be sure she also has coverage for prescription drugs. Would she be able to obtain drug coverage if she enrolled in the SNP?
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Question #153
You are meeting with Ms. Berlin and she has completed an enrollment form for a MA-PD plan you represent. You notice that her handwriting is illegible and as a result, the spelling of her street looks incorrect. She asks you to fill in the corrected street name. What should you do?

Answer:
You may correct this information as long as you add your initials and date next to the correction

Question #154
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?
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Question #155
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?
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Question #156
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?
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Question #157
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?
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Question #158
Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period. On December 1, he calls you up and says that he has changed his mind and would like to enroll into a MA-PD plan. What enrollment rules would apply in this case?
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Question #159
You have been providing a pre-Thanksgiving meal during sales presentations in November for many years and your clients look forward to attending this annual event. When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals?
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Question #160
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.
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Question #161
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?
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Question #162
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?
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Question #163
Mr. Polanski likes the cost of an HMO plan available in his area but would like to be able to visit one or two doctors who aren’t participating providers. He wants to know if the Point of Service (POS) option available with some HMOs will be of any help in this situation. What should you tell him?
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Question #164
Mr.Chan is one of your clients and in excellent health. He is enrolled in a Medicare prescription drug plan that you represent. He recently heard about a Medication Therapy Management (MTM) program in which his friend is enrolled. What should you tell him?
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Question #165
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxes during that entire period. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. What should you tell her?
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Question #166
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?
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Question #167
Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the Annual Open Enrollment Period. Ralph's effective enrollment date is January 1st. Ralph disenrolls on February 12th because he did not understand that the plan did not cover services furnished by several of his longtime providers. Which of the following statements best describes the impact of Ralph's action upon Agent Lopez's compensation?
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Question #168
Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. She currently does not have creditable coverage. What could you tell her about the implications of such a
decision?
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Question #169
Mrs. Roberts has just received a new Medicare identity card in the mail. She is concerned that it is a forgery since it does not have her Social Security number on it. What should you tell her?
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Question #170
Mrs. Disraeli is enrolled in Original Medicare (Parts A and B) and a standalone Part D prescription drug plan. She has recently developed diabetes and has suffered from heart disease for several years. She has also recently learned that her area is served by a SNP for individuals suffering from such a combination of chronic diseases (C-SNP). Mrs. Disraeli is concerned however, that she will have few rights or protections if she enrolls in a C-SNP. How would you respond?
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Question #171
You are completing a PFFS plan sale to Mr. West who is new to Medicare and prefers to be contacted by telephone. As you are finishing up, what should you tell him about next steps in the enrollment process?
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Question #172 (Similar to 259)
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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Question #173
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?
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Question #174
Mrs. Reynolds just signed up for a Medicare Advantage plan on the second of the month. She is leaving for vacation in two weeks and wants to know if her new coverage will start before she leaves. What should you tell her?
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Question #175
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him?
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Question #176
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?
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Question #177
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?
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Question #178
Mrs. Kendrick is six months away from turning 65. She wants to know what she will have to do to enroll in a Medicare Advantage (MA) plan as soon as possible. What could you tell her?
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Question #179
Mr. Ziegler is turning 65 next month and has asked you what he can do, and when he must do it, with respect to enrolling in Part D. What could you tell him?
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Question #180 (similar to 181)
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?
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Question #181 (similar to 180)
During a sales presentation in Ms. Sully's home, she tell you that she has hard about a type of Medicare health plan known as PFFS. She wants to know if this would be available for her.
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Question #182 (Similar to 211)
All plans must cover at least the standard Part D coverage or its actuarial equivalent. What costs would a beneficiary incur for Rx in 2016 under the standard coverage?
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Question #183
Andrews was preparing a budget for next year because she takes quite a few Rx drugs, she will reach the coverage gap, and wants to be sure she has enough money set aside for those months. She received assistance calculating her projected expenses from her daughter who is a pharmacist. She doesn't think the calculations are correct because her out of pocket expenses would be lower than last year.
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Question #184
Mr. Barker had surgery recently and expected that he would have certain 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?
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Question #185
Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-Service (PFFS) plan. As part of that discussion, what should you be sure to tell her?
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Question #186
Mr. Olsen is concerned that a Medicare Advantage plan will not cover the same range of services that would be covered under Original fee-for-service Medicare. What should you tell him?
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Question #187
Ordinarily, you obtain referrals from a third party that initiates contact with potential clients and usually sets up appts. for you. How would the guidelines for marketing MA and Part D plans apply to this practice?
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Question #188
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be a correct description?
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Question #189
Under what conditions can a Medicare prescription drug plan reduce its coverage for a given drug during the first 60 days of the year?
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Question #190
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?
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Question #191
Mr. Sanchez is entitled to Part A, but has not enrolled in Part B because he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do?
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Question #192 (Same question )
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?
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Question #193
Mr. Gonzalez is entitled to Part A, but has not yet enrolled in Part B. If he wants to enroll in a Private Fee-for-Service (PFFS) plan, what will he have to do?
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Question #194
Mr. Gonzalez is entitled to Part A, but has not yet enrolled in Part B. If he wants to enroll in a Medicare Advantage (MA) plan, what will he have to do?
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Question #195
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this?
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Question #196a
Which of the following individuals is most likely to be eligible to enroll in a Medicare Advantage or Part D Plan?
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Question #196b
Which of the following individuals is most likely to be eligible to enroll in a Part D Plan?
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Question #197
Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could you help him take during this time?
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Question #198
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?
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Question #199
Mrs. Kumar would like her daughter, who lives in another state, to meet with you during the Annual Election Period to help her complete her enrollment in a Part D plan. She asked you when she should have her daughter plan to visit. What could you tell her?
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Question #200
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?
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Question #201
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years. However, the plan does not provide drug benefits. How would you advise Agent John Miller to proceed?
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Question #202
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?
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Question #203
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and was disappointed with the service she received from her primary care physician because she was told she would have to wait five weeks to get an appointment when she was feeling ill. She called you to ask what she could do so she would not have to put up with such poor access to care. What could you tell her?
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Question #204
Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. What should you tell him?
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Question #205
Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. In mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD). What options will Mrs. Davenport have regarding her MA plan during the next open enrollment season?
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Question #206
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would have certain 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 some services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him?
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Question #207
Mr. Shultz was still working when he first qualified for Medicare. At that time, he had employer group coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. It is now a year later and Mr. Shultz has lost his employer group coverage within the last two weeks. How would you advise him?
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Question #208
What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications?
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Question #209
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?
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Question #210
Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access to services since she receives some assistance for her health care costs from the State. What should you tell her?
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Question #211 (Similar to 182)
All plans must cover at least the standard Part D coverage or its actuarial equivalent. Which of the following statements best describes some of the costs a beneficiary would incur for prescription drugs under the standard coverage?
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Question #212
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?
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Question #213
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He would like to know his options since he has decided to drop his retiree coverage and is eligible for Medicare. What should you tell him?
CLICK HERE: (AHIP ANSWERS)

Question #214
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' information to market non-health related products such as life insurance and annuities. Which statement best describes ABC's obligation to its enrollees regarding marketing such products?
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Question #215
Mr. Yoo's employer has recently dropped comprehensive creditable prescription drug coverage that was offered to company retirees. The company told Mr. Yoo that, because he was affected by this change, he would qualify for a Special election period. Mr. Yoo contacted you to find out more about what this means. What can you tell him?
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Question #216
You have approached a hospital administrator about marketing in her facility. The administrator is uncomfortable with the suggestion. How could you address her concern
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Question #217
You are working several plans and community organizations to sponsor an educational event. When putting together advertisements for this event, what should you do?

Answer:
You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event.
(Educational events must be explicitly advertised as educational)

Question #218
Which of the following statement is/are correct about a 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.
IV. Non-network providers must accept the same amount that Original Medicare would pay them as payment in full.

Answer:
I, II, and IV
(MSAs may not have a network or may have a full or partial network of providers. MSAs cover Part A and Part B benefits after the deductible. All non-network providers must accept the same amount that Original Medicare would pay them as payment in full. This is the amount the enrollee will pay the provider before the deductible is met.)

Question #219
You have come to Mrs. Midler’s home for a sales presentation. At the beginning of the presentation, Mrs. Midler tells you that she has a copy of her medical records available because she thinks this will help you understand her needs. She suggests that you will know which questions to ask her about her health status in order to best assist her in selecting a plan. What should you do?

Answer:
You can only ask Mrs. Midler questions about conditions that affect eligibility, specifically, whether she has one of the conditions that would qualify her for a special needs plan.
(Marketing representatives may ask health screening questions during the completion of an enrollment request if they are necessary to determine eligibility to enroll in a SNP.)

Question #220
Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-income subsidy. How does that affect his ability to enroll or disenroll in a Part D plan?

Answer:
He qualifies for a special election period and can enroll in or disenroll from a Part D plan once during that period.
(He is not prohibited from enrolling in a different plan. Because he is entitled to Medicare Part A and Part B and has a change in his low income subsidy status, he is eligible for a special election period. During the SEP, he can enroll in or disenroll from a Part D plan once.)

Question #221
Another agent working for your agency claims that because you are not employed by the Medicare Advantage plans that you represent, you are not subject to the same marketing requirements as the plans themselves. How should you respond to such a statement?

Answer:
Your coworker is not correct. Marketing on behalf of a plan is considered marketing by the plan and requires that all contracted and employed agents comply with all Medicare marketing rules.
(Plan marketing representatives are subject to the same requirements related to marketing and communications as the plans.)

Question #222
Plan sponsors may undertake the following marketing activities with current Medicare Advantage plan members?
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Question #223
One of your colleagues argues that it is better to focus your time and energy exclusively in neighborhoods with single-family homes. He further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. How should you respond?
CLICK HERE: (AHIP ANSWERS)

Question #224
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. What should you tell him?

Answer:
It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original Medicare.
(The purpose of Medigap plans is to supplement Original Medicare benefits. Medigap plans do not work with Medicare Advantage plans. It is illegal to sell a Medigap plan to someone already in a Medicare Advantage health plan.)

Question #225
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 election periods (SEPs)?

Answer:
Mr. Rockwell is eligible for a SEP due to his involuntary loss of creditable drug coverage; the SEP begins in June and ends on September 1- two months after the loss of creditable coverage.
(He is eligible for a SEP. However, the SEP takes place the month he was advised of the loss of coverage (i.e. June), and it ends 2 months after the loss of creditable coverage (i.e. September)

Question #226
A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. Before engaging in such a discussion, what should you do?
CLICK HERE: (AHIP ANSWERS)

Question #227
Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. What should you tell him?
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Question #228
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug coverage. She would like to keep the coverage she has but replace her existing Medigap plan with one that provides drug coverage. What should you tell her?

Answer:
Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug plan.
(Individuals who are enrolled in Medigap plans may only obtain Medicare drug coverage (Part D) through a stand-alone prescription drug plan.)

Question #229
Mrs. McIntire is enrolled in her state's Medicaid plan and has just become eligible for Medicare as well. What can she expect will happen to her drug coverage?
CLICK HERE: (AHIP ANSWERS)

Question #230
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. What should you tell her?

Answer:
Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided.
(A marketing representative may initiate electronic contact through e-mail since that is now considered general audience marketing similar to print media. Rules regarding unsolicited contact do not apply to marketing through these materials. However, use of electronic media must provide an opt-out process.

Use of general audience e-mail to solicit Medicare Advantage prospects (without providing plan-specific information) is permitted. These general audience marketing materials do not require prior CMS approval but must provide an opt-out process. While a marketing representative may use e-mail to initiate contact, they may not follow-up with unsolicited telephone calls.)

Question #231
Melissa Meadows is a marketing representative for Best Care which has recently introduced a Medicare Advantage plan offering comprehensive dental benefits for $15 per month. Best Care has not submitted any potential posts to CMS for approval. Melissa would like to use the power of social media to reach potential prospects. What advice would you give her?

Answer:
As soon as CMS approves Best Care's social media posts, Agent Meadows could post a tweet stating that "Best Care offers an array of Medicare Advantage benefit packages. One might be right for you. Call me to find out more!"
(Best Care must submit marketing materials, including social media posts to CMS for approval before the plan or its agents may begin posting such marketing content.

Agent Meadow cannot post any content that either has not been approved by CMS)

Question #232
Miguel Sanchez is a relatively new agent who has come to you for advice as to what he can do during the Medicare Advantage Open Enrollment Period (MA-OEP). What advice should you give Miguel?

Answer:
During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings
(During the MA-OEP, those enrolled in a Medicare Advantage plan have the opportunity to change plans or enroll in Original Medicare. Marketing representatives may respond to beneficiary requests for one-on-one meetings.)

Question #233
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings distributes materials that are solely educational. 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?
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Question #234
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?
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Question #235
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?
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Question #236
You will be holding a sales event soon, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation?
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Question #237
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?

Answer:
You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score. However, you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing.
(You are required to pass the test in order to represent any Medicare Advantage or Part D plans. There is no testing requirement for agents/brokers that only market employer/union group plans.)

Question #238 (similar to 95)
During a sales presentation, your client asks you whether the Medicare agency recommends that she sign up for your plan or stay in Original Medicare. What should you tell her?
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Question #239
Your friend's mother just moved to an assisted living facility and he asked if you could present a program for the residents about the MA-PD plans you market. What could you tell him?
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Question #240
Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. She agreed to sign a scope of appointment form and meet with you on October 15. During the appointment, what are you permitted to do?

Answer:
You may provide her with the required enrollment materials and take her completed enrollment application.
(Because you are meeting for an individual marketing appointment, you are permitted to distribute plan materials and accept enrollment forms. You may not make the completion of Mrs. Lu’s application dependent upon her providing you with her friends’ names.)

Question #241
Mrs. Schmidt is moving and a friend told her she might qualify for a "Special election period" to enroll in a new Medicare Advantage plan. She contacted you to ask what a special election period is. What could you tell her?
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Question #242
You are meeting with Ms. Berlin and she has completed an enrollment form for a MA-PD plan you represent. You notice that her handwriting is illegible and as a result, the spelling of her street looks incorrect. She asks you to fill in the corrected street name. What should you do?
CLICK HERE: (pass your exam)

Question #243
Mrs. Young is currently enrolled in Original Medicare (Parts A and B), but she has been working with Agent Neil Adams in the selection of a Medicare Advantage (MA) plan. It is mid-September, and Mrs. Young is going on vacation. Agent Adams is considering suggesting that he and Mrs. Young complete the application together before she leaves. He will then submit the paper application before the start of the annual enrollment period (AEP). What would you say If you were advising Agent Adams?
CLICK HERE: (pass your exam)

Question #244
Mr. Roberts is enrolled in an MA plan. He recently suffered complications following hip replacement surgery. As a result, he has spent the last three months in Resthaven, a skilled nursing facility. Mr. Roberts is about to be discharged. What advice would you give him regarding his health coverage options?

Answer:
His open enrollment period as an institutionalized individual will continue for two months after the month he moves out of the facility.
(The open enrollment period (OEPI) for institutionalized individuals is a continuous open enrollment period as long as an individual is in an institution. The OEPI ends two months after the month the individual moves out of the institution. An institutionalized individual, such as Mr. Roberts, does not have to return to Original Medicare within two months of discharge. He may make a Medicare Advantage enrollment request or at his option return to Original Medicare and enroll in Part D.)

Question #245
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?
CLICK HERE: (AHIP ANSWERS)

Question #246
Mrs. Margolis contacts you in August because she will become eligible for Medicare for the first time in November. She would like to meet and discuss plan choices with you. What advice should you give her?

Answer:
Tell her to wait until October to discuss plan choices with you so that you can share plan benefits for the current year as well as any changes for the following year that may impact her choice.
(You are not permitted to discuss the following year’s plan options in August. Marketing representatives are permitted to simultaneously market plans for the current and prospective years starting on October 1, provided marketing materials indicate what plan year is being discussed.)

Question #247
Mr. White has Medicare Parts A and B with a Part D plan. Last year, he received a notice that his plan sponsor identified him as a "potential at-risk" beneficiary. This month, he started receiving assistance from Medicaid. He wants to find a different Part D plan that's more suitable to his current prescription drug needs. He believes he's entitled to a SEP since he is now a dual eligible. Is he able to change to a different Part D plan during a SEP for dual eligible individuals?

Answer:
No. Once he is identified by the plan sponsor as a "potential at-risk" beneficiary, he cannot use the dual eligible SEP to change plans while this designation is in place.
(Typically, an individual with Medicare Parts A and B that receives Medicaid assistance receives a SEP during the first 9 months of each calendar year. However, once an individual is identified by the plan sponsor as a “potential at-risk” or “at-risk” beneficiary and the plan sponsor has sent written notice to the individual, he or she cannot use this SEP to change plans while this designation is in place.)

Question #248
Mrs. Reeves is newly eligible to enroll in a Medicare Advantage plan and her MA Initial Coverage Election Period (ICEP) has just begun. Which of the following can she not do during the ICEP?

Answer:
She can enroll in a Medigap plan to supplement the benefits of the MA plan that she's also enrolling in.
(MA ICEP is not an opportunity to enroll in a Medigap plan. Also, Medigap does not supplement MA plan benefits; it is meant to supplement Original Medicare. During the ICEP, an individual may choose an MA-PD when the Part D IEP and MA ICEP occur at the same time.)

Question #249
Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug coverage. He found a stand-alone Medicare prescription drug plan in his area that offers better coverage than that available through his MA-PD plan and in addition, has a low premium. It won't cost him much more and, because he has the means to do so, he wishes to enroll in the stand-alone prescription drug plan in addition to his MA-PD plan. What should you tell him?
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Question #250
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 open enrollment season?
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Question #251
Mr. Davis is 49 years old and has been receiving disability benefits from the Social Security Administration for 12 months. Can you sell him a Medicare Advantage or Part D Prescription Drug policy?
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Question #252
Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is considering enrollment in a Medicare health plan. What should you advise her to do before she will be able to enroll into a Medicare health plan?

Answer:
In order to join a Medicare health plan, she also must enroll in Part B

Question #253
Mr. Yu has limited income and resources so you have encouraged him to see if he qualifies for some type of financial assistance. Mr. Yu is not sure it is worth the trouble to apply and wants to know what the assistance could do for him if he qualifies. What could you tell him?
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Question #254
Mrs. Wolf 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?
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Question #255
Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few weeks. She concerned about having prescription drug coverage. Which of the following statements provides the best advice?
CLICK HERE: (pass your exam)

Question #256
Mr. Meoni's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs. What could you tell Mr.Meoni?
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Question #257
If Dr. Elizabeth Brennan does not contract with the PFFS plan, but accepts the plan's terms and conditions for payment, how will she be paid?
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Question #258
Which statement best describes PACE plans?
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Question #259 (similar to 172)
Mr. Rivera has QMB-Plus eligibility and is thus covered by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) plan. Later in the year, Mr. Rivera needs dentures, a service only covered under Medicaid. What action would you recommend he take in order to have this cost covered?
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Question #260 (Similar to 31)
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?
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Question #261
Under what conditions can a Medicare prescription drug plan reduce its coverage for a given drug mid-way through the year?
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Question #262
Mr. Katz reached the Part D coverage gap in August last year. His prescriptions have not changed, he is keeping the same Part D plan and the benefits, cost-sharing, and coverage of his drugs are all the same as last year. He asked what to expect for this year about his out-of-pocket costs. What could you tell him?
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Question #263
Mrs. Grant uses several very expensive drugs and anticipates that she will enter catastrophic coverage at some point during the year. To help her determine when she is likely to qualify for catastrophic coverage, she asked which expenses count toward the out-of-pocket limit that qualifies her for catastrophic coverage. Which one of the following would count?
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Question #264
Mrs. Fiore was in the Army for 35 years and is now retired. She has drug coverage through the VA. What issues might she consider with regard to whether to enroll in a Medicare prescription drug plan?
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Question #265
Mr. Jenkins 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?
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Question #266
Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for Medicare & Medicaid Services' Marketing Guidelines to ensure he is compliant for which type of products?
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Question #267
You work for a company that has marketed Medigap products for many years. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. What do you need to do with your materials before using them for marketing purposes?
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Question #268
Which of the following is a correct statement about state laws as they pertain to marketing representatives?
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Question #269
Agent Antonio is preparing for a presentation on Medicare and Medicare Advantage before a local senior citizen civic group where he hopes to enroll some attendees. Which of the following steps should he take in order to be in compliance with Medicare marketing rules?
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Question #270
While marketing Medicare Advantage and Part D plans, you collected a large number of scope of appointment forms from your clients, wherein they indicated their interest in specific products and their wish for you to provide information on those products in their homes. What should you do with those forms?
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Question #271
Which of the following statements best describes how business reply cards (BRCs) may be employed in the marketing of Medicare Advantage products?
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Question #272
You have received an advertisement from a vendor who says they can provide you with an extensive list of publicly available e-mail addresses for individuals who are Medicare beneficiaries. In addition, one of your Medicare Advantage clients offered to share her e-mail address book with you so you could contact her Medicare-eligible friends. In considering these sources of leads, what rules must you be sure to abide by?
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Question #273
Agent Mark Andrews would like to employ technology to facilitate the growth of his Medicare Advantage (MA) practice. What step(s) would you recommend that Mark take?
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Question #274
Mr. Valesquez asked if the Private Fee-for-Service plan you have discussed is like Original Medicare or a Medigap supplement plan. What should you say about a Private Fee-for-Service (PFFS) plan to explain it to Mr. Valesquez?
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Question #275
Ajax Agency is targeting potential enrollees for MSA plans. Which of the following statements best describes the rules that apply to the MSA materials it distributes?
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Question #276
Ordinarily, you provide clients who purchase various types of insurance products from you with a gift when they enroll and you let them know that they will receive it after their enrollment is complete. When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan?
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Question #277
One of your colleagues argues that face-to-face meetings with potential enrollees should be required because they cannot make an appropriate decision with the minimal information that can be provided over the phone or in small brochures. How should you respond to this argument?
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Question #278
Mrs. Valentino is currently enrolled in a Medicare Cost plan. This plan is no longer meeting her needs, but it is now mid-year and past the annual election period (AEP). What would you say to Mrs. Valentino regarding her options?
CLICK HERE: (AHIP ANSWERS)

Question #279
Mrs. Murdock has been very ill and has been in the hospital multiple times this year. She is concerned that her expenses have reached the maximum out-of-pocket costs and now her special needs plan (SNP) will disenroll her. What can you tell her?
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Question #280
Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits. How does she enroll in Original Medicare?
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Question #281
Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a Medicare Supplement Insurance Plan?
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Question #282
Being 65 or older, being under 65 years of age with certain disabilities for more than 24 months, and being any age with ESRD or ALS are each eligibility requirements for which program?
CLICK HERE: (pass your exam)

Question #283
Which of the following defines a Medicare Advantage (MA) Plan? (Select 2)
CLICK HERE: (AHIP ANSWERS)

Question #284
Janice wants to enroll in a Medicare Advantage plan. Which of the following is NOT an eligibility requirement?
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Question #285
Which of the following statements is correct about HMO MA Plans?
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Question #286
Which of the following are MA Plans that focus on using network providers to maximize the benefits and reduce out-of-network expenses?
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Question #287
Which is true about Medicare Supplement Open Enrollment?
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Question #288
Roger wants to know what counts toward the Out-of-Pocket Maximum on the Medicare Advantage Plan he is considering. Which statement is accurate?
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Question #289
Which of the following statements is true about a Medicare Supplement Insurance Plan member who wants to enroll in an MA Plan?
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Question #290
Which of the following best defines Medicare Part D?
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Question #291
There are ___ LIS copay categories that could be assigned to a member, depending on the level of need.
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Question #292
Which of the following is a fact about Medicare Prescription Drug Plans?
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Question #293
What are two options for Medicare consumers to get Part D prescription drug coverage (assuming they meet all eligibility requirements)? (Select 2)
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Question #294
Which of the following statements is NOT true about the Coverage Gap?
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Question #295
Step Therapy, Prior Authorization, Quantity Limit, 7-day limit, Dispensing Limit and Limited Access are all examples of what?
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Question #296
A consumer may have to pay a Late Enrollment Penalty (LEP) if they did NOT enroll in a Medicare Advantage plan with Part D benefits or stand-alone prescription drug plan when they were first eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for ______________.
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Question #297
Through which means is financial assistance offered to a consumer who qualifies for Low Income Subsidy for their part of Medicare Part D costs?
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Question #298
Formulary is defined as:
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Question #299a
Which of the following is true about Medicare Supplement Insurance underwriting criteria in states where underwriting applies?
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Question #299a
In states where Medicare Supplement Insurance underwriting criteria can apply, all of the following underwriting criteria apply EXCEPT
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Question #300
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which went into effect January 1, 2020, applies to all carriers offering Medicare supplement plans.
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Question #301
Which of the following is NOT true of Medicare Supplement Insurance Plans?
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Question #302
Cynthia is turning 65 on July 5. Her Medicare Part A and Part B will be effective on July 1. Using her Initial Election Period (IEP), when can she submit an application for a Medicare Advantage or Prescription Drug plan?
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Question #303
Janine, currently enrolled in a 3-star plan, discovers there is 5-star plan available where she lives. She asks her agent, Josh, to enroll her in the 5-star plan. Josh can advise Janine of each of the following except:
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Question #304
An agent is explaining Medicare Advantage plan options to a consumer. During the conversation, the agent explains that Medicare gives each plan a Star Rating. Which statement is true?
CLICK HERE: (pass your exam)

Question #305
An agent is explaining Medicare Advantage plan options to a consumer. During the conversation, the agent explains that Medicare gives each plan a Star Rating. Which statement is true?
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Question #306a
What is the purpose of the Statement of Understanding?
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Question #306b

The __________ensures that when consumers provide their verbal agreement during the telephonic enrollment, they acknowledge and understand they are actually enrolling, in which plan they are enrolling, as well as the standard disclosures.
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Question #307
Which statement is true about discussing benefits with the consumer before an enrollment?
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Question #308
When completing an enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address?
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Question #309
When must the Scope of Appointment be obtained for an in-person or telephonic sales presentation?
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Question #310 (similar to #349)
To complete an Enrollment Application on behalf of a consumer, what authority must the individual have?
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Question #311
Melanie is currently enrolled in a MAPD, and she is interested in enrolling in a PDP. Which statement is true?

Answer:
An election period is required to enroll in a new plan.

Question #312
Medicare Advantage (MA) organization must disenroll a member from an MA plan in which situation?
CLICK HERE: (AHIP ANSWERS)

Question #313
Rosanna is enrolled in a Medicare Advantage Only (MA-Only) Private Fee-for-Service (PFFS) Plan. The plan is suitable for her needs and service area. She has decided she wants to add prescription drug coverage. Which option is available to Rosanna (assuming she is in a valid election period)?
CLICK HERE: (AHIP ANSWERS)

Question #314
An agent should only enroll a consumer in a product:

Answer:
That is suitable for the consumer's needs, goals and financial resources.

Question #315
What are Dual Special Needs Plans (DSNP)?
CLICK HERE: (AHIP ANSWERS)

Question #316
Dual Special Needs Plans (D-SNP) are defined as which of the following:
CLICK HERE: (AHIP ANSWERS)

Question #317
Which statement is true about how the loss of Medicaid affects a member's enrollment in a D-SNP?
CLICK HERE: (AHIP ANSWERS)

Question #318
Which statement describes the primary characteristic of a consumer who may benefit from a D-SNP?
CLICK HERE: (AHIP ANSWERS)

Question #319
What program is available to support C-SNP and D-SNP members who may have unique health care needs?
CLICK HERE: (AHIP ANSWERS)

Question #320
Which statement is true about C-SNPs, D-SNPs, and prescription drug coverage?
CLICK HERE: (AHIP ANSWERS)

Question #321
When selling D-SNPs, agents must:
CLICK HERE: (AHIP ANSWERS)

Question #322
The consumer states they currently pay a percentage of charges when they receive medical care. This means:
CLICK HERE: (AHIP ANSWERS)

Question #323
The following is a characteristic of consumers for whom a C-SNP may be most appropriate:
CLICK HERE: (AHIP ANSWERS)

Question #324
On May 10, Michael meets with an agent and says he is enrolled in another carrier's C-SNP due to his diabetes. When can Michael enroll in a different C-SNP that also covers diabetes (his only chronic condition), assuming he has not moved out of his current plan's service area?
CLICK HERE: (AHIP ANSWERS)

Question #325
Which is a service provided to a C-SNP or D-SNP member placed in the low to moderate care management risk level?

Initial Health Assessment
Interdisciplinary Care Team
Ongoing reassessment of risk level for status changes
Individualized plan of care
CLICK HERE: (AHIP ANSWERS)

Question #326
It is very important for consumers enrolling in a C-SNP to know the following about accessing providers:
CLICK HERE: (AHIP ANSWERS)

Question #327
Which statement is true about the Medicaid program?
CLICK HERE: (AHIP ANSWERS)

Question #328
Alice is Full Dual Eligible and is enrolling in a D-SNP. What should her agent remind her about?
CLICK HERE: (AHIP ANSWERS)

Question #329
Using the post-enrollment method, when will a new member be disenrolled from their C-SNP if a qualifying condition cannot be verified?
CLICK HERE: (AHIP ANSWERS)

Question #330
Members who lose their eligibility for the D-SNP due to a change or loss of Medicaid status are responsible for what cost sharing?
CLICK HERE: (AHIP ANSWERS)

Question #331
Which of the following consumers are eligible for Medicare if other eligibility requirements are met?
CLICK HERE: (AHIP ANSWERS)

Question #332
Which type of MA Plan is an HMO plan that also covers some benefits out-of-network, generally at a higher cost?
CLICK HERE: (AHIP ANSWERS)

Question #333
When is Mary's Medicare Supplement Open Enrollment period if she turns 65 on September 23, 2022, and her Medicare Part B effective date is September 1, 2022?
CLICK HERE: (AHIP ANSWERS)

Question #334
Margaret currently has an MAPD Plan. What would happen if you enrolled her into a stand-alone PDP?
CLICK HERE: (AHIP ANSWERS)

Question #335
What is Medicare Part D?
CLICK HERE: (AHIP ANSWERS)

Question #336
Which consumer is eligible for a stand-alone Medicare Prescription Drug Plan?
CLICK HERE: (AHIP ANSWERS)

Question #337
Aside from a stand-alone Medicare Prescription Drug Plan, how else could a Medicare-eligible consumer get Part D prescription drug coverage?
CLICK HERE: (AHIP ANSWERS)

Question #338
Which of the following statements does NOT correctly define prescription drug stages?
CLICK HERE: (pass your exam)

Question #339
Which of these statements is true about the drug utilization management (UM) rules?
CLICK HERE: (pass your exam)

Question #340
When is a Medicare Supplement Insurance consumer subject to underwriting and screened for eligibility?
CLICK HERE: (pass your exam)

Question #341
Which of the following is true about Medicare Supplement Insurance Plans?
CLICK HERE: (AHIP ANSWERS)

Question #342
On October 20, Aries decides to switch his PDP to a Medicare Advantage plan. Aries would like this change to be effective November 1. Which statement is true for Aries?
CLICK HERE: (AHIP ANSWERS)

Question #343
Which election period runs from October 15 to December 7 and allows consumers to elect to join a Medicare Advantage Plan or switch to a different plan?
CLICK HERE: (AHIP ANSWERS)

Question #344
How should agent Erin respond when consumer Mrs. Rose notices that the presented MA Plan has a Star Rating of 2 stars?
CLICK HERE: (AHIP ANSWERS)

Question #345
In which of the following situations can telephonic contact be made with a Medicare eligible consumer?
CLICK HERE: (AHIP ANSWERS)

Question #346
Before starting an enrollment, what benefit information are agents required to provide to the consumer?
CLICK HERE: (AHIP ANSWERS)

Question #347
Whose email address may the agent enter into the LEAN enrollment application?
CLICK HERE: (AHIP ANSWERS)

Question #348
A one-on-one marketing appointment, whether in-person or telephonic, is always considered a marketing/sales event, but it is not reported to UnitedHealthcare or CMS; instead the consumer must provide ___________________agreement prior to the start of the appointment.
CLICK HERE: (AHIP ANSWERS)

Question #349 (similar to #310)
To complete an Enrollment Application on behalf of a consumer, what authority must the individual have?
CLICK HERE: (AHIP ANSWERS)

Question #350
Melanie is currently enrolled in a Medicare Supplement Insurance Plan and a PDP. Assuming she has a valid election period, what would happen if she enrolled in an HMO MAPD plan?
CLICK HERE: (AHIP ANSWERS)

Question #351
In which situation must the Medicare Advantage (MA) organization disenroll a member from an MA plan?
CLICK HERE: (AHIP ANSWERS)

Question #352
Dennis, a consumer, is currently enrolled in Original Medicare plus a Medicare Supplement Plan. His current plan is suitable for his medical needs, but he would like to add prescription drug coverage only. Since Dennis wants to keep his current coverage, which option is available to Dennis (assuming he is in a valid election period)?
CLICK HERE: (AHIP ANSWERS))

Question #353
Why must an agent present accurate, complete, and factual plan information to consumers? (Select 3)
CLICK HERE: (AHIP ANSWERS)

Question #354
Do consumers have to be an AARP member to enroll in an AARP-branded plan with UnitedHealthcare?
CLICK HERE: (AHIP ANSWERS)

Question #355
According to AARP, there are how many individual AARP members?
CLICK HERE: (AHIP ANSWERS)

Question #356
Which consumer might benefit the most by enrolling in a D-SNP?
CLICK HERE: (AHIP ANSWERS)

Question #357
Which statement is true about the Medicaid program?
CLICK HERE: (AHIP ANSWERS)

Question #358
You must advise consumers enrolling in a D-SNP that:
CLICK HERE: (AHIP ANSWERS)

Question #359
Ginny just enrolled in a C-SNP that uses the post-enrollment verification method. When will the plan send her a termination notification letter if it has not yet been able to verify a qualifying chronic condition?
CLICK HERE: (AHIP ANSWERS)

Question #360
A D-SNP member loses his eligibility due to a change or loss of Medicaid status. What cost sharing is he responsible for while in the grace period?
CLICK HERE: (AHIP ANSWERS)

Question #361
ACA Section 1557 rules for disability concern
CLICK HERE: (AHIP ANSWERS)

Question #362
Under ACA Section 1557, a health plan premium sold through a state exchange may, based on an individual's age,
CLICK HERE: (AHIP ANSWERS)

Question #363
Which of the following statements best describes Section 1557 of the Affordable Care Act (ACA)?
CLICK HERE: (AHIP ANSWERS)

Question #364
Which Medicare programs are covered by ACA Section 1557?
CLICK HERE: (AHIP ANSWERS)

Question #365
As a result of violations of ACA Section 1557 nondiscrimination rules,
CLICK HERE: (AHIP ANSWERS)

Question #366
Which of the following statements best describes the scope of operations subject to Section 1557 under the 2020 Final Rule?
CLICK HERE: (AHIP ANSWERS)

Question #367
Section 1557 of the Affordable Care Act applies to
CLICK HERE: (AHIP ANSWERS)

Question #368
Under Section 1557, 2020 Final Rule issued during the Trump Administration sex was initially defined____________
CLICK HERE: (AHIP ANSWERS)

Question #369
Which of the following would be considered permissible under Section 1557 and the 2020 Final Rule?
CLICK HERE: (AHIP ANSWERS)

Question #370
Auxiliary aids and services must be provided to individuals with disabilities, such as those suffering from vision or hearing impairments, free of charge, and in a timely manner. Auxiliary aids and services include which of the following:
CLICK HERE: (AHIP ANSWERS)

Question #371
Which entity enforces Section 1557 for programs that receive funding from on are administered by HHS?
CLICK HERE: (AHIP ANSWERS)

Question #372
You discover an unattended email address or fax machine in your office receiving beneficiary appeals requests. You suspect no one is processing the appeals. What should you do?
CLICK HERE: (AHIP ANSWERS)

Question #373
You work for a Sponsor. Last month, while reviewing a Centers for Medicare & Medicaid Services (CMS) monthly report, you identified multiple individuals not enrolled in the plan but for whom the Sponsor is paid. You spoke to your supervisor who said don't worry about it. This month, you identify the same enrollees on the report again. What should you do?
CLICK HERE: (AHIP ANSWERS)

Question #374
A sales agent, employed by the Sponsor's first-tier, downstream, or related entity (FDR), submitted an application for processing and requested two things: 1) to back-date the enrollment date by one month, and 2) to waive all monthly premiums for the beneficiary. What should you do?
CLICK HERE: (AHIP ANSWERS)

Question #375
Which of these actions is most likely to be permitted in dealing with a person with limited English proficiency?
CLICK HERE: (AHIP ANSWERS)

Question #376
Under ACA Section 1557, a health plan
CLICK HERE: (AHIP ANSWERS)

Question #377
For a health plan, what are the possible consequences of violations of ACA Section 1557?
CLICK HERE: (AHIP ANSWERS)

Question #378
Which of the following is NOT potentially a penalty for violation of a law or regulation prohibiting fraud, waste, and abuse (FWA)?
CLICK HERE: (AHIP ANSWERS)

Question #379
Which of the following requires intent to obtain payment and the knowledge the actions are wrong?
CLICK HERE: (AHIP ANSWERS)

Question #380
You are performing a regular inventory of the controlled substances in the pharmacy. You discover a minor inventory discrepancy. What should you do?
CLICK HERE: (AHIP ANSWERS)

Question #381
Your job is to submit a risk diagnosis to the Centers for Medicare & Medicaid Services (CMS) for the purpose of payment. As part of this job, you use a process to verify the data is accurate. Your immediate supervisor tells you to ignore the Sponsor's process and to adjust or add risk diagnosis codes for certain individuals. What should you do?

Answer:
Report the incident to the compliance department (via compliance hotline or other mechanism)

Question #382
You are in charge of paying claims submitted by providers. You notice a certain diagnostic provider ("Doe Diagnostics") requested a substantial payment for a large number of members. Many of these claims are for a certain procedure. You review the same type of procedure for other diagnostic providers and realize Doe Diagnostics' claims far exceed any other provider you reviewed. What should you do?
CLICK HERE: (AHIP ANSWERS)

Question #383
A person drops off a prescription for a beneficiary who is a "regular" customer. The prescription is for a controlled substance with a quantity of 160. This beneficiary normally receives a quantity of 60, not 160. You review the prescription and have concerns about possible forgery. What is your next step?
CLICK HERE: (AHIP ANSWERS)

Question #384
Waste includes any misuse of resources, such as the overuse of services or other practices that directly or indirectly result in unnecessary costs to the Medicare Program.
CLICK HERE: (AHIP ANSWERS)

Question #385
Bribes or kickbacks of any kind for services that are paid under a Federal health care program (which includes Medicare) constitute fraud by the person making as well as the person receiving them.
CLICK HERE: (AHIP ANSWERS)

Question #386
These are examples of issues that should be reported to a Compliance Department: suspected fraud, waste, and abuse (FWA); potential health privacy violation, unethical behavior, and employee misconduct.
CLICK HERE: (AHIP ANSWERS)

Question #387
You can help prevent fraud, waste, and abuse (FWA) by doing all the following:
Look for suspicious activity
Conduct yourself in an ethical manner
Ensure accurate and timely data and billing
Ensure you coordinate with other payers
Keep up to date with FWA policies and procedures, standards of conduct, laws, regulations, and the Centers for Medicare & Medicaid Services (CMS) guidance
Verify all information provided to you
CLICK HERE: (AHIP ANSWERS)

Question #388
Once a corrective action plan is started, the corrective action plan must be monitored annually to ensure they are effective.
CLICK HERE: (AHIP ANSWERS)

Question #389
Once a corrective action plan begins addressing non-compliance for fraud, waste, and abuse (FWA) committed by a Sponsor's employee or first-tier, downstream, or related entity's (FDR's) employee, ongoing monitoring of the corrective actions is not necessary.
CLICK HERE: (AHIP ANSWERS)

Question #390
Any person who knowingly submits false claims to the Government is liable for five times the Government's damages caused by the violator plus a penalty.
CLICK HERE: (AHIP ANSWERS)

Question #391
Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly or intentionally misrepresented facts to obtain payment.
CLICK HERE: (AHIP ANSWERS)

Question #392
Some of the laws governing Medicare Part C and D fraud, waste, and abuse (FWA) include the Health Insurance Portability and Accountability Act (HIPAA), the False Claims Act the Anti-Kickback Statute, and the Health Care Fraud Statute.
CLICK HERE: (AHIP ANSWERS)

Question #393
Medicare Parts C and D sponsors are not required to have a compliance program.
CLICK HERE: (AHIP ANSWERS)

Question #394
Correcting non-compliance________
CLICK HERE: (AHIP ANSWERS)

Question #395
Ways to report a compliance issue include:
CLICK HERE: (AHIP ANSWERS)

Question #396
Compliance is the responsibility of the Compliance Officer, Compliance Committee, and Upper Management only.
CLICK HERE: (AHIP ANSWERS)

Question #397
What is the policy of non-retaliation?
CLICK HERE: (AHIP ANSWERS)

Question #398
At a minimum, an effective compliance program includes four core requirements.
CLICK HERE: (AHIP ANSWERS)

Question #399
Ways to report a compliance issue include:
CLICK HERE: (AHIP ANSWERS)

Question #400
What are some of the consequences for non-compliance, fraudulent, or unethical behavior?
CLICK HERE: (pass your exam)

Question #401
What are some of the penalties for violating fraud, waste, and abuse (FWA) laws?
CLICK HERE: (AHIP ANSWERS)

Question #402
Ways to report potential fraud, waste, and abuse (FWA) include:
CLICK HERE: (AHIP ANSWERS)

Question #403
Under ACA Section 1557, a health plan
CLICK HERE: (AHIP ANSWERS)

Question #404
Which of the following defines a Medicare Advantage (MA) Plan? (Select 3)
CLICK HERE: (AHIP ANSWERS)

Question #405
Which of the following is NOT an eligibility requirement for enrollment in a Medicare Advantage Plan?
CLICK HERE: (AHIP ANSWERS)

Question #406
Which statement best describes a care management program that varies depending upon the level of the member's health risk?
CLICK HERE: (AHIP ANSWERS)

Question #407
Which statement best describes a D-SNP?
CLICK HERE: (pass your exam)

Question #408
Melanie wants to enroll in a D-SNP. Which of the following must her agent do?
CLICK HERE: (AHIP ANSWERS)

Question #409
Which of the following consumer characteristics demonstrates a good fit for a C-SNP?
CLICK HERE: (AHIP ANSWERS)

Question #410
On July 19, each of the following consumers met with an agent. Based on the information provided, which consumer must wait until the Annual Election Period (AEP) or Open Enrollment Period (OEP) to enroll?
CLICK HERE: (AHIP ANSWERS)

Question #411
Which service will a C-SNP or D-SNP member in the high risk care management category receive?
CLICK HERE: (AHIP ANSWERS)

Question #412
What is the purpose of the Chronic Condition Verification form?
CLICK HERE: (AHIP ANSWERS)

Question #413
Which statement is true about members of a Medicare Advantage (MA) Plan who want to enroll in a Medicare Supplement Insurance Plan?
CLICK HERE: (AHIP ANSWERS)

Question #414
Which AARP-branded Medicare products does UnitedHealthcare offer? (Select 3)
CLICK HERE: (AHIP ANSWERS)

Question #415
The value proposition for the AARP brand is seen in what kinds of benefits for the members? (Select 3)
CLICK HERE: (AHIP ANSWERS)

Question #416
Which of the following is TRUE about the production requirement for the Authorized to Offer Elite status?
CLICK HERE: (pass your exam)

Question #417
Which of the following statements about AARP are TRUE? (Select 2)
CLICK HERE: (AHIP ANSWERS)

Question #418
According to AARP, there are how many individual AARP members?
CLICK HERE: (AHIP ANSWERS)

Question #419
How many status levels are in the Authorized to Offer Program?
CLICK HERE: (AHIP ANSWERS)

Question #420
Do consumers have to be an AARP member to enroll in an AARP-branded plan with UnitedHealthcare?
CLICK HERE: (AHIP ANSWERS)

Question #421
Which of the following are part of being straightforward when servicing a customer? (Select 3)
CLICK HERE: (AHIP ANSWERS)

Question #422
AARP expects agents offering AARP-branded products to demonstrate five key behaviors when interacting with customers. AARP wants customers we work with to feel their relationship with AARP is _____________.
CLICK HERE: (AHIP ANSWERS)

Question #423
Which of the following is NOT true about UnitedHealthcare Medicare plans carrying the AARP name?
CLICK HERE: (AHIP ANSWERS)

Question #424
Which of the following describes Permission to Contact guidelines?
CLICK HERE: (AHIP ANSWERS)

Question #425
During an appointment, you may not discuss any products not agreed to in advance by the beneficiary.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #426
Wellcare offers a range of Medicare plans to provide members with affordable access to:
CLICK HERE: (AHIP ANSWERS)

Question #427
Wellcare must receive notice of an event change or cancellation as soon as possible, but no later than 30 minutes after the event start time.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #428
Beneficiary-facing content that includes generic or plan-specific product or benefit information must be submitted for review and CMS submission, as well as acceptance or approval, prior to distribution.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #429
Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activity?
CLICK HERE: (AHIP ANSWERS)

Question #430
Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy. Wellcare's quality focus consists of six drivers. Which of the following is not a Wellcare quality driver?
CLICK HERE: (AHIP ANSWERS)

Question #431
A broker/agent may be terminated for cause if they fail to comply with a compliance investigation, encourage others to avoid the compliance interview process, or fail to provide truthful or complete information.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #432
Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts SOAs in which of the following methods?
CLICK HERE: (AHIP ANSWERS)

Question #433
What are some examples of steps that can be taken when safeguarding and securing PHI and PII?
(Select all that apply.)
CLICK HERE: (AHIP ANSWERS)

Question #434
A Health Risk Assessment (HRA):

a. Provides physicians with an overview of a member's health status.
b. Ensures members are able to access care and receive services that meet their needs.
c. Is an important part of our quality initiative, directly impacting our Star Ratings.
CLICK HERE: (AHIP ANSWERS)

Question #435
Health plan fax numbers vary for health plans that offer fax enrollment submissions.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #436
Which option is the preferred method to submit enrollment?
CLICK HERE: (AHIP ANSWERS)

Question #437
By selecting the correct provider during the enrollment process, you can:

CLICK HERE: (AHIP ANSWERS)

Question #438
Key areas you as a broker/agent have control over and impact upon regarding Star Ratings for quality are:
CLICK HERE: (AHIP ANSWERS)

Question #439
Brokers/Agents must meet all required contracting, training, and certification requirements to be eligible to sell Wellcare's Medicare Products.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #440
______ events are designed to inform the people that attend about Medicare Advantage, Prescription Drug, or other Medicare programs without going into the specifics of a particular carrier.
CLICK HERE: (AHIP ANSWERS)

Question #441
A Health Risk Assessment (HRA) can be completed for C-SNP and D-SNP plans only, before the enrollment application process in Ascend through the Value Based Enrollment (VBE) portal.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #442
Centene continues to expand its reach by offering more products in a wider geography. ____ new Wellcare and Ascension Complete plans are going to market.
CLICK HERE: (AHIP ANSWERS)

Question #443
All PDPs will feature a $0 tier 1 benefit when filled at preferred pharmacies.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #444
For PDP Medication Home Delivery, the ____ plan will continue to offer a discount for 90-day tier 2, tier 3 and tier 6 prescriptions.
CLICK HERE: (AHIP ANSWERS)

Question #445
The Wellcare preferred pharmacy network includes Walgreens, CVS, and many grocery chains in 2023.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #446
Centene has new PPO D-SNP product expansion in CT, IN, KS, KY, MS, OH, OK, PA, SC, and a new HMO D-SNP in LA.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #447
Wellcare added ___ counties to their footprint for 2023.
CLICK HERE: (AHIP ANSWERS)

Question #448
Centene's 2023 product expansion represents a __% increase from 2022.
CLICK HERE: (AHIP ANSWERS)

Question #449
For 2023, Ascension Complete added 27 new counties to their footprint.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #450
Brokers/Agents may be investigated after being suspected of noncompliant activity reported through a:
(Select all that apply.)

CLICK HERE: (AHIP ANSWERS)

Question #451
Which elements are available as part of Wellcare's sales support model?
CLICK HERE: (AHIP ANSWERS)

Question #452
Any request or distribution of PHI should contain only the minimum amount of PHI required to complete the intended task.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #453
The information contained within ACT will equip brokers/agents to certify, market, and sell which health plans?

CLICK HERE: (AHIP ANSWERS)

Question #454
Wellcare does not need to be informed of all marketing/sales events at which plans or materials will be presented or distributed (Formal & Informal).
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #455
From October 1st to October 14th, which activity is not permissible by brokers/agents?
CLICK HERE: (AHIP ANSWERS)

Question #456
Failure to inform a beneficiary that a trusted provider is out-of-network or is not available in the newly selected plan can cause a sales allegation.
Select one:

CLICK HERE: (AHIP ANSWERS)

Question #457
What are some examples of what can trigger a beneficiary complaint?
(Select all that apply.)

CLICK HERE: (pass your exam)

Question #458
Which option is the preferred method to submit enrollment?
CLICK HERE: (AHIP ANSWERS)

Question #459
When a paper SOA form is used, it must be completed __________ hosting the sales presentation.
CLICK HERE: (AHIP ANSWERS)

Question #460
Enrollments through Ascend offer the following unique benefits:
(Select all that apply.)

CLICK HERE: (AHIP ANSWERS)

Question #461
Which of the following is not an example of Protected Health Information (PHI)?
CLICK HERE: (AHIP ANSWERS)

Question #462
A broker/agent may be terminated for cause if they fail to comply with a compliance investigation, encourage others to avoid the compliance interview process, or fail to provide truthful or complete information.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #463
There are ___ LIS copay categories that could be assigned to a member, depending on the level of need.
CLICK HERE: (AHIP ANSWERS)

Question #464
The Part D Senior Savings Model (SSM), which reduces member spending on insulin, will be offered on all Value Script, Value Plus PDPs, and select Wellcare MAPD plans.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #465
All PDPs will feature a $0 tier 1 benefit when filled at preferred pharmacies.
Select one:

CLICK HERE: (AHIP ANSWERS)

Question #466
Value Script and Value Plus PDP products have a ___-tier formulary structure for 2023.
CLICK HERE: (AHIP ANSWERS)

Question #467
___ PDPs will be offered across all 50 U.S. states and Washington, D.C.

CLICK HERE: (AHIP ANSWERS)

Question #468
All PDPs will continue to offer $0 tier 1 preferred cost-sharing through CVS Medication Home Delivery (Mail Order).
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #469
The Wellcare preferred pharmacy network includes Walgreens, CVS, and many grocery chains in 2023.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #470
Which standalone Prescription Drug Plan is best for a dual-eligible chooser?
CLICK HERE: (AHIP ANSWERS)



Question #471
The _________ plan is expected to have one of the lowest premiums in the country!

CLICK HERE: (AHIP ANSWERS)

Question #472
For PDP Medication Home Delivery, the ____ plan will continue to offer a discount for 90-day tier 2, tier 3 and tier 6 prescriptions.
CLICK HERE: (AHIP ANSWERS)


Question #473
A broker/agent who has never had any verbal warnings cannot be issued a Corrective Action Plan.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #474
Which resources are available for download from the Shared Resources section found within Centene Workbench?

CLICK HERE: (pass your exam)

Question #475
Once the enrollment is completed, you can save a copy of the application for your reference.
CLICK HERE: (AHIP ANSWERS)

Question #476
Prior to completing the enrollment form, you should always confirm the beneficiary’s primary care physician (PCP) and/or specialists.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #477
The NEW online Centene Workbench self-service portal enables you to:

CLICK HERE: (AHIP ANSWERS)

Question #478
Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing.
CLICK HERE: (AHIP ANSWERS)

Question #479
What type of inquiries can Wellcare's Corporate Sales Support team assist with?

CLICK HERE: (AHIP ANSWERS)

Question #480
When discussing prescription drug coverage, you should:
(Select all that apply.)

CLICK HERE: (AHIP ANSWERS)

Question #481
Brokers/Agents can submit a support ticket online through their Centene Workbench portal.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #482
A grievance request, or any evidence concerning a grievance, must be filed orally or in writing no later than _____ calendar days from the date of the event or the date the member is made aware of the issue
CLICK HERE: (AHIP ANSWERS)

Question #483
Centene requires all contracted brokers/agents to read, understand, and agree to Centene's Business Ethics and Code of Conduct Policy.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #484
Ascend is a fast, easy, and compliant way for brokers/agents to submit agent-assisted electronic enrollments.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #485
Melanie is currently enrolled in an HMO MAPD, and she is talking to sales agent Brenda about enrolling in a Medicare Supplement Insurance Plan. What should Brenda tell Melanie?
CLICK HERE: (AHIP ANSWERS)

Question #486
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?
CLICK HERE: (AHIP ANSWERS)

Question #487
Gene got Medicare before he turned 65 and enrolled into a Medicare Advantage plan. He calls in February the month before his 65th birthday and is unhappy with his current plan. On the date of the call, what can Gene do about his coverage?
CLICK HERE: (AHIP ANSWERS)


Question #488
John has Power of Attorney to act on behalf of his mother. What does that mean when it comes to his mother enrolling in a Medicare Advantage Plan?
CLICK HERE: (AHIP ANSWERS)

Question #489
To avoid confusing or misleading a consumer, what type of information must the agent provide when presenting a plan? (Select 3)
CLICK HERE: (AHIP ANSWERS)

Question #490
Which statement is true of D-SNP members?
CLICK HERE: (AHIP ANSWERS)

Question #491
What report(s) are available on Aetna Producer World

a. Medicare Book of Business Report
b. Commission Reports
c. Licensing Report
d. Pending Application Report
e. All of the above
CLICK HERE: (AHIP ANSWERS)

Question #492
How long are you required to maintain Scope of Appointment (SOA) documentation?
CLICK HERE: (AHIP ANSWERS)

Question #493
When obtaining a Scope of Appointment, you may NOT:

a. Discuss plan options not agreed to by the beneficiary
b. Ask for referrals
c. Market non-health care products, such as annuities or life insurance (cross selling)
d. All of the above
CLICK HERE: (AHIP ANSWERS)

Question #494
Annual Election Period is from:
CLICK HERE: (AHIP ANSWERS)

Question #495
What are the requirements you need to complete in order to be ready to sell?

a. Pass the Aetna Individual Medicare certification process for the product(s) you intend to sell
b. New producers need to complete contracting when onboarding
c. Current producers need to maintain their licenses and meet our requirements
d. You must actively verify your RTS status
e. All of the above
CLICK HERE: (AHIP ANSWERS)

Question #496
To report compliance or fraud, waste, and abuse concerns to Aetna you should:

a. Make an anonymous call to Ethics Line® (1-877-287-2040)
b. Visit Ethics Line® on the web at www.CVSHealth.com/EthicsLine.
c. Fax the information to the closest Social Security office.
d. Mail your concerns in writing to David Falkowski, CVS Chief Compliance Officer
e. A, B, and D
CLICK HERE: (AHIP ANSWERS)

Question #497
Agent Oversight routinely monitors agent performance against CMS and internal standards. We monitor:

a. Cancellation and rapid disenrollment rates
b. Enrollment application turnaround time
c. Scope of Appointment (SOA) forms
d. Third party secret shopper surveillance program of formal and informal marketing/sales events
e. Complaints and marketing incidents
f. All of the above
CLICK HERE: (AHIP ANSWERS)

Question #498
Our Agent Oversight team will implement corrective action when there are CMS infractions and prohibited tactics.
Disciplinary or corrective action may include:
a. Focused training or monitoring sessions
b. Verbal or written warnings
c. Full retraining and re-testing
d. Placement on an agent “watch list”
e. Suspension or probationary period, with or without commissions
f. Contract and appointment termination, with or without cause
g. All of the above
CLICK HERE: (AHIP ANSWERS)

Question #499
A prohibited marketing activity is:
a. Conducting health screenings that give the impression of “cherry picking”
b. Requiring beneficiaries to provide contact information as a prerequisite for attending an event
c. Asking a beneficiary for a referral
d. Using superlative language, such as “the best”, “one of the best”, or “rated number 1”, unless substantiated by data provided by CMS
e. Claiming you are recommended or endorsed by CMS
f. All of the above
CLICK HERE: (AHIP ANSWERS)

Question #500
If a beneficiary requests to discuss other products not originally documented on the SOA, you must document a second SOA for the additional product type before the appointment may continue.
CLICK HERE: (AHIP ANSWERS)

Question #501
The Permission to Contact form is used by Aetna sales representatives and external agents to contact beneficiaries and must be completed prior to conducting an outbound call to a Medicare prospect
CLICK HERE: (AHIP ANSWERS)

Question #502
If a prospect calls to RSVP for a meeting, a Permission to Contact form is not required for that meeting but would be required for a representative to place a follow-up call to a meeting attendee.
CLICK HERE: (AHIP ANSWERS)

Question #503
You may make unsolicited calls to prospective enrollees.
CLICK HERE: (AHIP ANSWERS)

Question #504
Producers may only use CMS and Aetna-approved marketing materials that have been created by our marketing team, approved by us and filed with CMS by us when discussing Aetna Individual Medicare plans
CLICK HERE: (AHIP ANSWERS)

Question #505
Use the appropriate CMS-approved consumer sales presentation from beginning to end, read the presentation notes or talking points, and, if/when you use the MA/MAPD/PDP sales video, it should be in conjunction with the approved sales presentation.
CLICK HERE: (AHIP ANSWERS)

Question #506
To order enrollment kits for Aetna Medicare products, you must be Ready to Sell (RTS) and access Aetna branded kits through a single point of entry, using your NPN to log in.
CLICK HERE: (AHIP ANSWERS)

Question #507
A signed Medicare enrollment application must reach us within two (2) calendar days of when you receive it from the beneficiary.
CLICK HERE: (AHIP ANSWERS)

Question #508
For Aetna MA/MAPD, DSNP and Allina enrollment, you can upload images, fax or email.
CLICK HERE: (AHIP ANSWERS)

Question #509
It’s not necessary to verify that the consumer has Medicare Parts A and B at the time of enrollment.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #510
You are prohibited from soliciting referral clients through cold calling, door-to-door visits, or other actions prohibited under state or federal law.
CLICK HERE: (AHIP ANSWERS)

Question #511
Following enrollment, the client will hear from us within approximately 14 days of his/her acceptance into the plan.
CLICK HERE: (AHIP ANSWERS)

Question #512
You must direct all requests to cancel, withdraw, or terminate enrollment applications to the same location where the application was originally submitted or call the Member Services number on the member ID card.
CLICK HERE: (AHIP ANSWERS)

Question #513
There are three ways to verify your ready-to-sell status.
CLICK HERE: (AHIP ANSWERS)

Question #514
Failure to respond within the required timeframe to Aetna or CMS requests for information may result in suspension or termination of an agent, broker or producer’s ability to market, sell and receive commissions.
CLICK HERE: (AHIP ANSWERS)

Question #515
You can receive commission for any sale that results from an unreported marketing/sales event.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #516
Once submitted, who can cancel an enrollment application before the effective date?
CLICK HERE: (AHIP ANSWERS)

Question #517
An Electronic Scope of Appointment (eSOA) valid for ___________.
CLICK HERE: (AHIP ANSWERS)

Question #518
If you receive an Enrollment Process Exception Notice, your immediate action will be required in order to avoid any disciplinary actions, which may include___________________.

a. Forfeited commission
b. Suspension of your contract
c. Termination of your contract
d. All of the above
CLICK HERE: (AHIP ANSWERS)

Question #519
The cost estimates displayed on most pricing tools, such as Medicare.com, SilverScript.com, AetnaMedicare.com and most third-party websites, will typically reflect __________________ pricing.

a. Retail
b. LTC pharmacy
c. Mail order
d. Both A and C
e. All of the above
CLICK HERE: (AHIP ANSWERS)

Question #520
Agents must submit the original documentation for enrollment within 24 hours after the application data has been entered into the agent portal.
CLICK HERE: (AHIP ANSWERS)

Question #521
If a member is assessed a Part D Income Related Monthly Adjustment Amount (Part D-IRMAA), the member will be notified by the Social Security Administration. Part D‐IRMAA is paid directly to Medicare.
CLICK HERE: (AHIP ANSWERS)

Question #522
The Application Date is the date you received the completed enrollment form from the beneficiary
CLICK HERE: (AHIP ANSWERS)

Question #523
If your client receives a letter from SilverScript requesting proof of Creditable Coverage, and the client has already submitted proof of creditable coverage with the enrollment application, they can ignore the letter.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #524
If a beneficiary had a break in Medicare prescription drug coverage or other creditable coverage of 63 days in a row, they may be subject to a late enrollment penalty.
CLICK HERE: (AHIP ANSWERS)

Question #525
During IEP, the effective date is either the first of the month the member becomes eligible OR the first of the month following the month the enrollment form is submitted, whichever is later.
CLICK HERE: (AHIP ANSWERS)

Question #526
Members can pay their monthly premium at the register of CVS retail locations.
CLICK HERE: (AHIP ANSWERS)

Question #527
SilverScript stand-alone prescription drug plans are sponsored by Aetna Medicare Solutions, a CVS Health company.
CLICK HERE: (AHIP ANSWERS)

Question #528
Mail order prescription drug services are not available for SilverScript PDP plans.
Select one:
CLICK HERE: (AHIP ANSWERS)

Question #529
The three types of Special Needs Plans are:
CLICK HERE: (AHIP ANSWERS)

Question #530
Meredith, a DSNP member, loses Medicaid eligibility. What impact does this have on her DSNP enrollment?
CLICK HERE: (AHIP ANSWERS)

Question #531
John, 68, is currently enrolled in a Medicare Supplement Plan with a stand-alone Prescription Drug Plan. Newly diagnosed with a chronic condition, he calls agent Charles on May 3 to ask if there are plans that will help him manage his condition. Can John enroll in a Chronic Special Needs Plan (C-SNP) that covers his chronic condition?
CLICK HERE: (AHIP ANSWERS)

Question #532
By contacting plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefits package. What should you do to make sure your clients know about these pieces of information?
CLICK HERE: (AHIP ANSWERS)

Question #533
Which statement is true of D-SNP members?
CLICK HERE: (AHIP ANSWERS)

Question #534
Which program is available to support the unique health care needs of C-SNP and D-SNP members?
CLICK HERE: (AHIP ANSWERS)

Question #535
Which of the following are eligibility requirements for enrollment in a Medicare Advantage (MA) Plan? (Select 3)
CLICK HERE: (AHIP ANSWERS)

Question #536
Which of the following is a correct statement about in-network provider services?
CLICK HERE: (AHIP ANSWERS)

Question #537
What costs count toward the out-of-pocket maximum for Medicare Advantage (MA) Plans?
CLICK HERE: (AHIP ANSWERS)

Question #538
Which of the following best describes eligibility to enroll in a stand-alone Prescription Drug Plan?
CLICK HERE: (AHIP ANSWERS)

Question #539
Which of the following statements accurately describes a prescription drug stage?
CLICK HERE: (AHIP ANSWERS)

Question #540
Formulary is defined as
CLICK HERE: (AHIP ANSWERS)

Question #541
What kind of financial assistance does a consumer receive who qualifies for Low Income Subsidy?
CLICK HERE: (AHIP ANSWERS)

Question #542
Which is true about Medicare Supplement Open Enrollment?
CLICK HERE: (AHIP ANSWERS)

Question #543
Which of the following statements is true about election periods?
CLICK HERE: (AHIP ANSWERS)

Question #544
Which statement regarding Star Ratings is true?
CLICK HERE: (AHIP ANSWERS)

Question #545
Which of the following is not considered unsolicited contact with a Medicare eligible consumer according to CMS regulations and UnitedHealthcare's rules, policies, and procedures?
CLICK HERE: (AHIP ANSWERS)

Question #546
Which of the following are examples of what an agent must review with a consumer prior to completing an enrollment application?
CLICK HERE: (AHIP ANSWERS)

Question #547
What is Scope of Appointment?
CLICK HERE: (AHIP ANSWERS)

Question #548
Which statement is accurate when a consumer has a Power of Attorney (POA)?
CLICK HERE: (AHIP ANSWERS)

Question #549
When must an MA Plan or stand-alone PDP disenroll a member?
CLICK HERE: (AHIP ANSWERS)

Question #550
Which of the following is true about UnitedHealthcare Medicare plans carrying the AARP name?
CLICK HERE: (AHIP ANSWERS)

Question #551
What type of event is an agent conducting when they present plan information that includes benefits and cost sharing in an audience-presenter format?
CLICK HERE: (AHIP ANSWERS)

Question #552
What event advertisement or invitation must include this disclaimer: “For accommodation of persons with special needs at meetings, call ”?
CLICK HERE: (AHIP ANSWERS)

Question #553
Select the TWO UnitedHealthcare event reporting rules that are accurate. (Select 2)
CLICK HERE: (AHIP ANSWERS)

Question #554
Which of the following giveaways is not permitted at an educational or marketing/sales event (assume nominal retail value rule is met)?
CLICK HERE: (AHIP ANSWERS)

Question #555
Which of the following activities is a provider participating in an agent’s marketing/sales event permitted to do?
CLICK HERE: (AHIP ANSWERS)

Question #556
When conducting an informal marketing/sales events, agents may ________________
CLICK HERE: (AHIP ANSWERS)

Question #557
Meredith, a D-SNP member, loses Medicaid eligibility. What impact does this have on her D-SNP enrollment?
CLICK HERE: (AHIP ANSWERS)

Question #558
How is a C-SNP or D-SNP member's care management health risk levels determined initially?
CLICK HERE: (AHIP ANSWERS)

Question #559
Select the statement that best describes a feature of D-SNP?
CLICK HERE: (AHIP ANSWERS)

Question #560
When selling D-SNPs, agents must:
CLICK HERE: (AHIP ANSWERS)

Question #561
John, 68, is currently enrolled in a Medicare Supplement Plan with a stand-alone Prescription Drug Plan. Newly diagnosed with a chronic condition, he calls agent Charles on May 3 to ask if there are plans that will help him manage his condition. Can John enroll in a Chronic Special Needs Plan (C-SNP) that covers his chronic condition?
CLICK HERE: (AHIP ANSWERS)

Question #562
It is very important for consumers enrolling in a C-SNP to know the following about accessing providers:
CLICK HERE: (AHIP ANSWERS)

Question #563
Which statement is true about the Medicaid program?
CLICK HERE: (AHIP ANSWERS)

Question #564
You must advise consumers enrolling in a D-SNP that:
CLICK HERE: (AHIP ANSWERS)

Question #565
How long do plans using the C-SNP pre-enrollment verification process have to verify the qualifying chronic condition until they must deny the enrollment request
CLICK HERE: (AHIP ANSWERS)

Question #566
In which two parts of Medicare is enrollment generally automatic for eligible consumers who are receiving Social Security benefits, UNLESS they choose to delay their coverage?
CLICK HERE: (AHIP ANSWERS)

Question #567
To be eligible for this plan type, consumers must meet the following requirements: be entitled to Medicare Part A and enrolled in Part B, and reside in the plan's service area. Which plan is being described?

Answer:

Question #568
Which of the following statements is correct about HMO MA Plans?
CLICK HERE: (AHIP ANSWERS)

Question #569
Which type of MA Plan is an HMO plan that also covers certain benefits out-of-network, generally at a higher cost
CLICK HERE: (AHIP ANSWERS)

Question #570
When does Medicare Supplement Open Enrollment take place?
CLICK HERE: (AHIP ANSWERS)

Question #571
Which statement is true about Medicare Supplement Open Enrollment?

CLICK HERE: (AHIP ANSWERS)

Question #572
Jennifer is enrolling into a Medicare Advantage (MA) plan and wants to know what counts toward the Out-of-Pocket Maximum. Which of the following is accurate?
CLICK HERE: (AHIP ANSWERS)

Question #573
A consumer with only Part A residing in the plan’s service area can enroll in which plan type to get Part D coverage?
CLICK HERE: (AHIP ANSWERS)

Question #574
Which of the following statements is true about the Coverage Gap?
CLICK HERE: (AHIP ANSWERS)

Question #575
Which of the following statements is NOT true about the Coverage Gap?
CLICK HERE: (AHIP ANSWERS)

Question #576
How does a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of Medicare Part D costs?
CLICK HERE: (AHIP ANSWERS)

Question #577
Which of the following is NOT true about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) impact to Plans C and F?
CLICK HERE: (AHIP ANSWERS)

Question #578
Which of the following are true about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Plans and the impact to Plans C and F? (Select 2)
CLICK HERE: (AHIP ANSWERS)

Question #579
Which statement is true of Medicare Supplement Insurance Plans?
CLICK HERE: (AHIP ANSWERS)

Question #580
Which of the following statements is true about using a 5-Star Special Enrollment Period (SEP)?
CLICK HERE: (AHIP ANSWERS)

Question #581
By agreeing to the Statement of Understanding, the consumer:
CLICK HERE: (AHIP ANSWERS)

Question #582
Which of the following must an agent obtain from the consumer no less than 48 hours (unless an exception applies) before an in-person, online, or telephonic marketing appointment?
CLICK HERE: (AHIP ANSWERS)

Question #583
To complete an Enrollment Application on behalf of a consumer, what authority must the individual have?
CLICK HERE: (AHIP ANSWERS)

Question #584
What happens on the plan effective date when a member enrolled in a Medicare Supplement Insurance Plan and stand-alone PDP enrolls in a Medicare Advantage plan that includes drug coverage?
CLICK HERE: (AHIP ANSWERS)

Question #585
In which situation MAY the Medicare Advantage (MA) organization decide to disenroll a member from an MA plan?
CLICK HERE: (AHIP ANSWERS)

Question #586
In what product should agents enroll consumers?
CLICK HERE: (AHIP ANSWERS)

Question #587
To live up to the five Consumer Commitment Standards, agents offering AARP-branded products should help their customers feel their relationship with AARP is ____________________
CLICK HERE: (AHIP ANSWERS)

Question #588
Which of the following are part of being straightforward when servicing a customer? (Select 3)
CLICK HERE: (AHIP ANSWERS)

Question #589
Do consumers have to be an AARP member to enroll in an AARP-branded plan with UnitedHealthcare?
CLICK HERE: (AHIP ANSWERS)

Question #590
Which of the following statements is FALSE?
CLICK HERE: (AHIP ANSWERS)

Question #591
Which of the following statements are true about AARP?
CLICK HERE: (AHIP ANSWERS)

Question #592
Which of the following statements are True? (Choose 3)
CLICK HERE: (AHIP ANSWERS)

Question #593
According to AARP, there are how many individual AARP members?
CLICK HERE: (AHIP ANSWERS)

Question #594
Which of the following statements about AARP are TRUE? (Select 2)
CLICK HERE: (AHIP ANSWERS)

Question #595
Where can agents find the Authorized to Offer Guidelines?
CLICK HERE: (AHIP ANSWERS)

Question #596
The value proposition for the AARP brand is seen in what kinds of benefits for the members? (Select 3)
CLICK HERE: (AHIP ANSWERS)

Question #597
Which AARP-branded Medicare products does UnitedHealthcare offer? (Select 3)
CLICK HERE: (AHIP ANSWERS)

Question #598
Dual Special Needs Plans (D-SNP) are defined as:
CLICK HERE: (AHIP ANSWERS)

Question #599
A D-SNP might be in the best interest of which of these consumers?
CLICK HERE: (AHIP ANSWERS)

Question #600
Which program is available to support the unique health care needs of C-SNP and D-SNP members?
CLICK HERE: (AHIP ANSWERS)

Question #601
Confirming the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Medicare Part B is a requirement of:
CLICK HERE: (AHIP ANSWERS)

Question #602
A C-SNP may be most appropriate for:
CLICK HERE: (AHIP ANSWERS)

Question #603
Which of the following are Care Management Plan components provided to a C-SNP or D-SNP member placed in the low to moderate Care Management risk level?
CLICK HERE: (AHIP ANSWERS)

Question #604
Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE). This coverage has recently been terminated due to the end of the PHE. While Shirley was enrolled in Medicaid, she missed an opportunity to enroll in Medicare and now wants Part B. Which of the following statements best describes Shirley’s ability to now enroll in Medicare Part B?
CLICK HERE: (AHIP ANSWERS)

Question #605
Edward IP suffered from serious kidney disease. As a result. Edward became eligible for Medicare coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and Edward successfully underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his Medicare coverage will continue, what should you say?
CLICK HERE: (AHIP ANSWERS)

Question #606
Anthony Boniface turned 65 in 2023. He was not receiving Social Security or Railroad Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and is eligible for premium-free Part A. Before he could enroll in Medicare, his entire area was impacted by a hurricane causing massive flooding and severe wind damage. The Federal government declared this to be a natural disaster which has recently ended. During this period Anthony’s initial enrollment period expired. Anthony asks you how he can now obtain Medicare coverage. What should you say?
CLICK HERE: (AHIP ANSWERS)

Question #607
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred recently learned that she is suffering from inoperable cancer and has just a few months to live. She would like to spend these final months in hospice care. Mildred’s family asks you whether hospice benefits will be paid for under the Allcare Medicare Advantage plan. What should you say?
CLICK HERE: (AHIP ANSWERS)

Question #608
Mrs. Wang wants to know generally how the benefits under Original Medicare might compare to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans. What could you tell her?
CLICK HERE: (AHIP ANSWERS)

Question #609
Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty years ago but is not a citizen. Since his entry into the country, Juan has worked at Smallcap Incorporated and contributed to the Medicare system. Juan suffers from diabetes. He will soon retire and asks you if he can enroll in a Medicare Advantage plan that you represent. How would you respond?
CLICK HERE: (AHIP ANSWERS)

Question #610
Mrs. Imelda Diaz is a Medicare beneficiary enrolled in a MA-PD plan you represent. Her neighbor recently suffered from a painful case of shingles. Mrs. Diaz hopes to avoid such an illness through vaccination. She asks you whether the cost of shingles vaccination will be covered under the plan you represent. What should you say?
CLICK HERE: (AHIP ANSWERS)

Question #611
Mrs. McIntire is enrolled in her state’s Medicaid plan and has just become eligible for Medicare as well. What can she expect will happen to her drug coverage?
CLICK HERE: (AHIP ANSWERS)

Question #612
Mrs. Cantwell is enrolled in a prescription drug plan. She has heard about something called True-Out-Pocket costs or “TrOOP” and asks you if any of the following count toward reaching the catastrophic coverage phase. What do you say?
CLICK HERE: (AHIP ANSWERS)

Question #613
Charles McCarthy is a Medicare beneficiary who suffers from diabetes. Mr. McCarthy is considering enrollment in a MA-PD plan that you represent. He asks you whether his insulin costs will be covered. What should you say?
CLICK HERE: (AHIP ANSWERS)

Question #614
Mr. Hutchinson has drug coverage through his former employer’s retiree plan. He is concerned about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to purchase extra coverage that he will not need. What should you tell him?
CLICK HERE: (AHIP ANSWERS)

Question #615
Which of the following individuals is most likely to be eligible to enroll in a Part D Plan?
CLICK HERE: (AHIP ANSWERS)

Question #616
Evan Marsh is a newly appointed agent. Evan intends to conduct an educational session on Medicare at a senior citizens center near his home. He has advertised the session as an educational event. Evan asks you what is permissible at such an event. What should you say?
CLICK HERE: (AHIP ANSWERS)

Question #617
Linda Sanchez is conducting a previously agreed upon appointment with client, Maria Gomez about a MA-Part D plan she represents. Before an enrollment form is completed, Linda needs to provide Maria with information about ____

I. whether or not Maria’s primary care provider is in the plan’s network.
II. whether Maria’s current prescriptions are covered by the plan.
III. the monthly premium cost(s).
IV. the life insurance products that Linda also sells
CLICK HERE: (AHIP ANSWERS)

Question #618
Agent Daniel Webber has properly set up a sales appointment to meet with client Edward Young at Agent Webber’s office. At the agreed upon appointment time, Mr. Young arrives with his elderly neighbor – Clara Burton, who wants to learn about her Medicare Advantage options. What should Agent Daniel Webber do?
CLICK HERE: (AHIP ANSWERS)

Question #619
Your client, Alexis Jones, calls you on December 4th about changing her Medicare Advantage plan during the annual election period which ends December 7th. What should you do?
CLICK HERE: (AHIP ANSWERS)

Question #620
Your friend’s mother just moved to an assisted living facility and he asked if you could present a program for the residents about the MA-PD plans you market. What could you tell him?
CLICK HERE: (AHIP ANSWERS)

Question #621
Hector Hernandez is an independent agent. Hector sells plans on behalf of three Medicare Advantage organizations that offer a total of 10 plans but does not represent all Medicare Advantage organizations offering plans that are available in his area. Which of the following statements best describes any steps Hector is required to take?
CLICK HERE: (AHIP ANSWERS)

Question #622
Sal D’Angelo is new to the Medicare marketplace having previously been focused on life insurance and disability income protection products. He intends to conduct an educational seminar during the AEP at a local hotel and then invite those who attend to a subsequent marketing meeting to discuss the benefits of next year’s plans. How would you advise Sal?
CLICK HERE: (AHIP ANSWERS)

Question #623
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?
CLICK HERE: (AHIP ANSWERS)

Question #624
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?
CLICK HERE: (AHIP ANSWERS)

Question #625
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?
CLICK HERE: (AHIP ANSWERS)

Question #626
Torie Jones is a new marketing representative. Torie asks you for advice as to what topics must be discussed with a Medicare beneficiary prior to enrollment in a Medicare Advantage (MA-PD) plan. What should you say?
CLICK HERE: (AHIP ANSWERS)

Question #627
You are visiting with Mr. Tully and his daughter at her request. He has advanced Alzheimer’s and is incapable of understanding the implications of choosing a Medicare Advantage or prescription drug plan. Can his daughter fill out the enrollment form and sign it for him?
CLICK HERE: (AHIP ANSWERS)

Question #628
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 coverage?
CLICK HERE: (AHIP ANSWERS)

Question #629
Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area that has suffered from major flooding that has been declared a major disaster by both the Federal government and her state. As a result of dealing with the flooding issues and being evacuated from her home, Edna missed her chance to enroll in MA during her Initial Coverage Election Period. Felix lives in an area with a Medicare Advantage plan with a 4-star rating that he would like to join. George dropped his Medigap policy six months ago when he first enrolled in a Medicare Advantage plan. He now wants to return to Original Medicare. Harriet has recently developed diabetes and would like to enroll in a Medicare Advantage plan that focuses on care for those with that disease. Which, if any, of these individuals would qualify for a special election period (SEP)?
CLICK HERE: (AHIP ANSWERS)

Question #630
You are doing a sales presentation for Mrs. Pearson. You know that Medicare marketing guidelines prohibit certain types of statements. Apply those guidelines to the following statements and identify which would be prohibited.
CLICK HERE: (AHIP ANSWERS)

Question #631
Select the option that accurately represents MA Plan network characteristics (non-emergency care)
CLICK HERE: (AHIP ANSWERS)

Question #632
Which of the following is an eligibility requirement for enrollment in a Medicare Advantage Plan?
CLICK HERE: (AHIP ANSWERS)

Question #633
Which of the following is an eligibility requirement for enrollment in a Medicare Advantage Plan?
CLICK HERE: (AHIP ANSWERS)

Question #634
In what order do the four prescription drug coverage stages occur?

CLICK HERE: (AHIP ANSWERS)

Question #635
Which of the following best describes the Late Enrollment Penalty
(LEP)?
CLICK HERE: (AHIP ANSWERS)

Question #636
Annual Election Period (AEP) is a time when:
CLICK HERE: (AHIP ANSWERS)

Question #637
Annual Election Period (AEP) is a time when. . .
CLICK HERE: (AHIP ANSWERS)

Question #638
Mrs. Violet asks agent Bob where she can find the Star Rating for the plan he has been presenting. Which statement is correct?
CLICK HERE: (AHIP ANSWERS)

Question #639
Which statement about discussing benefits with the consumer before enrollment is true?
CLICK HERE: (AHIP ANSWERS)

Question #640
Which statements about discussing benefits with the consumer before an enrollment is (not) true?
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Question #641
While using LEAN to complete an enrollment application with a consumer, Agent Jeff learns the consumer does not have an email address. What should Jeff do?
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Question #642
Albert seems confused and is struggling to understand the information Jane is explaining. Which option should Jane consider.
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Question #643
Where can agents find the Authorized to Offer Guidelines?
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Question #644
When does the Special Election Period for Dual/LIS Change in Status begin for D-SNP members that lose Medicaid eligibility?
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Question #645
What type of event must an agent conduct when they want to be able to collect consumer information, schedule future appointments, and accept enrollment applications?
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Question #646
Which of the following activities must agents do when conducting an informal marketing/sales event?
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Question #647
Which of the following activities is a provider participating in an agent’s marketing/sales event permitted to do?
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Question #648
What type of event must an agent conduct when they want to be able to collect consumer information, schedule future appointments, and accept enrollment applications?
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Question #649
What type of event is an agent conducting when they inform Medicare consumers about Original Medicare, Medicare Advantage, Prescription Drug, or other Medicare programs?
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Question #650
From the following options, select the THREE actions an agent must take when they need to cancel a reported formal marketing/sales event that was supposed to occur in three weeks. Note: The only advertising was a flyer posted at the event venue. (Select 3)?
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Question #651
What activities can an agent engage in at an educational event?
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Question #652
Which of the following TWO statements are true related to offering food items at events? (Select 2)?
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Question #653
An agent is advertising a formal marketing/sales event in the local paper. The advertisement will not contain any mention of a gift, prize, or drawing. Which of the following disclaimers must the agent include in the advertisement
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Question #654
A client wants to give you an enrollment application on October 1 before the beginning of the Annual Election Period because he is leaving on vacation for two weeks and does not want to forget about turning it in. What should you tell him?
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Question #655
Which of these statements is NOT true about the drug utilization management (UM) rules?CLICK HERE: (AHIP ANSWERS)

Question #656
Which of these statements are true about the drug utilization management (UM) rules?
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Question #657
Which of the following lists drug tiers from least expensive cost share to most expensive cost share?
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Question #658
Aries is currently a member of a stand-alone PDP. Aries would like to have additional medical coverage. A thorough needs analysis indicates a Medicare Advantage Plan would be a good fit, there are plans available in his area, and he is in a valid election period. Which option is available to Aries?
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Question #659
Agent Willis had several clients who disenrolled from the plans he represents during the AEP to enroll in Medicare Advantage plans that are competitors of his. 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?
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Question #660
As an agent, you have an obligation to only enroll a consumer in a product:
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Question #661
Dino, an agent, received a phone call on September 29 from a consumer interested in Medicare Advantage plans for the new plan year. Dino proceeded to verify the consumer's Medicare eligibility, describe the costs and benefit coverage of the plan, and explained that he could not accept an enrollment application until October 15. What did Dino do that was NOT compliant?
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Question #662
With which of these consumers might you want to explore the possibility of a D-SNP enrollment
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Question #663
Which Medicare programs are covered by ACA Section 1557 under the Biden Administration’s Proposed Rule?
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Question #664
Which of the following would be considered permissible under Section 1557?
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Question #665
Which of the following would be considered permissible under Section 1557 and the 2020 Final Rule?
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Question #667
Keep ETLU
Under Section 1557, the 2020 Final Rule issued during the Trump Administration sex was initially defined____________
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Question #668
Which of the following statements best describes the scope of operations subject to Section 1557 under the Proposed Rule of the Biden Administration?
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Question #669
These are examples of issues that can be reported to a Compliance Department: suspected fraud, waste, and abuse (FWA), potential health privacy violation, and unethical behavior/employee misconduct.
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Question #670
You would like to offer gifts of nominal value to potential enrollees who call for more information about a plan you represent. You would then like to offer additional gifts if they come to a marketing event. Each of the gifts meets the CMS definition of nominal value, but together, the gifts are more than the nominal value. Is this permissible?
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Question #671
Which statement is true about how the loss of Medicaid affects a member's enrollment in a D-SNP?
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Question #672
Standards of Conduct are the same for every Medicare Parts C and D sponsor.
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AHIP Answers