Agent Garyfrom Florida - TEST 2sent me his AHIP 2020 Test Questions and Answers.
Attached is myAHIPFinal Exam – I got a 98% on it the first time. Realize that I have been doing theseAHIPexams since 2010 and Medicare is my primary business. I am surprised I got any wrong. Not sure which answer is incorrect.Sincerely, Agent Gary
(I believe that I found the wrong answer - please comment) - Patty and Susan found the wrong answer - all 50 questions are now answered correctly.
Question 1. Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a PPO that does not include drug coverage. What should you tell her about obtaining drug coverage?
a. She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. Answer: a.She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan.
b. She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan.
c. She can enroll in the PPO and purchase drug coverage through a Medigap plan.
d. She can enroll in the PPO and if she decides that she wants drug coverage, she will be able to drop her PPO at any time in favor of a Medicare Advantage plan that includes such drug coverage.
Question 2.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?
a. Medicaid will cover his cost-sharing, regardless of from which physician or hospital he receives his Medicare-covered services.
b. He should know that Medicaid will pay cost sharing only for services provided by Medicaid participating providers.
c. For Medicaid beneficiaries, Medicare reduces its cost-sharing amounts to match those charged by the state Medicaid program so there will be no change in his cost-sharing amounts.
d. Medicaid will no longer pay any cost sharing once he is eligible for Medicare, so he will need to rely only on Medicare providers
Answer: b.He should know that Medicaid will pay cost sharing only for services provided by Medicaid participating providers.
Question 3.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? a. You must receive an invitation from the beneficiary and document the specific types of products the beneficiary wants to discuss prior to making an in-home presentation. Answer:a. You must receive an invitation from the beneficiary and document the specific types of products the beneficiary wants to discuss prior to making an in-home presentation.
b. There is no special action that you must take. If they choose, you may go to an individual’s house to provide presentations and offer assistance with enrolling in a plan.
c. You must first contact the Medicare agency to ensure that the individual is actually a Medicare beneficiary.
d. A proper introduction at the door that includes a disclaimer regarding your relationship with the plan you represent is the only required action you must take, prior to entering the beneficiary’s home.
Question 4.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? Answer d.The doctor may only collect from Mr. Rivera the cost sharing allowable under the state’s Medicaid program.
a. The doctor may only collect the amount allowable under Medicare plus 25 percent balance billing.
b. The doctor may only collect the amount allowable under Medicare Advantage (MA) PPO plan cost sharing for non-QMB enrollees.
c. The doctor may only collect the amount allowable under Medicare plus 15 percent balance billing.
d. The doctor may only collect from Mr. Rivera the cost sharing allowable under the state’s Medicaid program.
BMrs. 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? Answer d.Medicare will cover Mrs. Shields' skilled nursing services provided during the first 20 days of her stay, after which she would have a coinsurance until she has been in the facility for 100 days.
a. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields' long-term care costs.
b. Medicare will cover an unlimited number of days in a skilled-nursing facility, as long as a physician certifies that such care is needed.
c. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered because Medicare does not provide such a benefit.
d. Medicare will cover Mrs. Shields' skilled nursing services provided during the first 20 days of her stay, after which she would have a coinsurance until she has been in the facility for 100 days
Question 6.You are working with a number of plans and community organizations to sponsor an educational event. When putting together advertisements for this event, what should you do?
a. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event.
b. Plans may not participate in advertising such an event. All advertising must be done by community organizations.
c. You must state in the advertisement that it will be an educational event and that the education will consist of specific information about the participating plans.
d. You must only ensure that the advertisement is factually accurate.
Answer: a. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event.
Question 7.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? a. A signature is not necessary since Mr. Tully is not physically or mentally capable of filling out and signing the form. Answer: c.a. Mr. Tully’s daughter can do so only, if she is authorized under state law as a court-appointed legal guardian, has a durable power of attorney for health care decisions, or is authorized under state surrogate consent laws to make health decisions.
b. Mr. Tully’s daughter can do so because she is an immediate family member who has taken responsibility for her father’s care.
c. Mr. Tully’s daughter can do so only, if she is authorized under state law as a court-appointed legal guardian, has a durable power of attorney for health care decisions, or is authorized under state surrogate consent laws to make health decisions.
d. If the enrollment form is countersigned by one of Mr. Tully’s treating physicians, she can sign it for him.
Question 8.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? Answer: d.Most individuals who are citizens and over age 65 are covered under Part A by virtue of having paid Medicare taxes while working, though some may be covered as a result of paying monthly premiums.
a. All individuals who are citizens and over age 65 will be covered under Part A.
b. Most individuals who are citizens and over age 65 and are covered under Part A must pay a monthly premium for that coverage.
c. Most individuals who are citizens and over age 65 and wish to be covered under Part A must enroll in a Medicare Health Plan.
d. Most individuals who are citizens and over age 65 are covered under Part A by virtue of having paid Medicare taxes while working, though some may be covered as a result of paying monthly premiums.
Question 9.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? a. He will need to mail in his payment with his enrollment form. Answer: d.Enrollees should pay using automatic withdrawal from a bank account or credit or debit card, direct monthly billing from the plan, or deductions from their Social Security check
b. You can take his first payment, but after that, he will need to make arrangements to send his monthly premium payment to the plan.
c. This is perfectly acceptable. You will be happy to forward his payment to the plan.
d. Enrollees should pay using automatic withdrawal from a bank account or credit or debit card, direct monthly billing from the plan, or deductions from their Social Security check.
Question 10.Mrs. Patterson is a new enrollee in the HealthBest Medicare Advantage (MA-PD) plan. She is new to this type of coverage and asks you what materials, if any, she should expect to receive. How would you reply?
a. She should expect to receive Evidence of Coverage (EOC) within 21 days of confirmation of enrollment. Answer: d.She should expect either the pharmacy directory in hard copy or a distinct and separate notice (in hard copy) describing where she can find the pharmacy directory online and how to request a hard copy. Question11.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?
b. She should expect to receive hard copies of both the provider and pharmacy directories automatically within 30 days of confirmation of enrollment.
c. She should expect to receive a hard copy of the provider directory in and a separate notice describing where she can find monthly periodic updates online and how to request hardcopies.
d. She should expect either the pharmacy directory in hard copy or a distinct and separate notice (in hard copy) describing where she can find the pharmacy directory online and how to request a hard copy.
a. PFFS plans are designed to cover only prescription drugs and if that is the type of coverage she wants, she may enroll in one if it is available in her area. Answer: b.a. A PFFS plan is one of the various types of Medicare Advantage plans offered by private entities and she may enroll in one if it is available in her area.
b. A PFFS plan is one of the various types of Medicare Advantage plans offered by private entities and she may enroll in one if it is available in her area.
c. A PFFS plan is a type of Medicare Supplement plan and she may enroll in one if it is available in her area.
d. A PFFS plan is exactly the same as Original Medicare, only offered by a private entity and she may enroll in one if it is available in her area.
Question 12.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?
a. Original Medicare covers ambulance services. Answer: a.Original Medicare covers ambulance services.
b. Original Medicare covers orthopedic shoes.
c. Original Medicare covers cosmetic surgery.
d. Original Medicare covers routine foot care.
Question 13.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 inresponse to its mailers promoting BestCare health plan. Which of the following best describes the responsibilities of Ms. Lopez?
a. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to comply with CMS marketing requirements, including those regarding using only approved call scripts. Answer: a. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to comply with CMS marketing requirements, including those regarding using only approved call scripts.
b. Ms. Lopez is considered a marketing representative of BestCare but is exempt from the marketing rules regarding approved call scripts because she works directly for MarketCo.
c. Ms. Lopez no longer needs to be concerned about state licensure since she is marketing an MA product subject to federal rules.
d. Ms. Lopez needs to maintain state licensure, but because she is working for a third-party marketing organization she is exempt from CMS training requirements that apply to BestCare captive agents.
Question 14.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 plan? a. She can submit any bills she has for co-payments under Medicare to the state’s Medicaid program and they will always be fully covered. Answer:d. She can enroll in any type of Medicare Advantage (MA) plan except an MA Medical Savings Account (MSA) plan.
b. If a provider accepts her Medicare Advantage plan coverage, that provider is legally obligated to also accept her Medicaid coverage, so she does not need to worry about finding providers who participate in both Medicare and Medicaid.
c. State Medicaid programs do not coordinate any of their coverage with Medicare Advantage plans.
d. She can enroll in any type of Medicare Advantage (MA) plan except an MA Medical Savings Account (MSA) plan.
Question 15 explained by Susan
Question 15.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?
a. Tell Julia that you are happy to meet with her once this year’s open enrollment begins on October 15th. Answer: a.Tell Julia that you are happy to meet with her once this year’s open enrollment begins on October 15th.
b. Tell Julia that you will meet with her at a time of her convenience within the next week, when you can accept a completed enrollment application to be submitted after October 15th.
c. Tell Julia that you will meet with her to explain Medicare and should she be interested you can accept and submit an enrollment request, since this is an initial enrollment qualifying her for a special enrollment period.
d. Tell Julia that she must first complete a questionnaire providing her health history so that you can recommend an appropriate product before submitting an enrollment application, since she qualifies for a special enrollment period.
Question 16.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? Answer:
I. Commissions
II. Bonuses
III. Mileage reimbursement
IV. Referral fees
Question 17.All plans must cover at least the standard Part D coverage or its actuarial equivalent. What costs would a beneficiary incur for prescription drugs in 2020 under the standard coverage?
a. Standard Part D coverage would require payment of an annual deductible of $435, 25% cost-sharing between $435 and $4,020, and once through the catastrophic coverage threshold the beneficiary pays either co-pays for generic and brand name drugs or coinsurance of 5%, whichever is greater. Answer: d. Standard Part D coverage would require payment of an annual deductible, fixed per-prescription co-payments, 35% of the costs in the coverage gap, and once catastrophic coverage begins, the plan covers 100% of all costs.
b. Standard Part D coverage would require payment of fixed per-prescription co-payments and 75% of the costs in the coverage gap.
c. Standard Part D coverage would require payment of only fixed per-prescription co-payments. d. Standard Part D coverage would require payment of an annual deductible, fixed per-prescription co-payments, 35% of the costs in the coverage gap, and once catastrophic coverage begins, the plan covers 100% of all costs.
Question 18.Agent Mary Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings distributes materials that are solely educational in nature. However, she gives a brief presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that has been advertised as educational?
a. Yes. Whether or not an event has been advertised as “educational” or a “sales presentation,” discussing plan-specific information is impermissible. Answer: c.Yes. When an event has been advertised as “educational,” discussing plan-specific premiums is impermissible.
b. No. This action is permissible. Handing out enrollment forms, on the other hand, would not be permissible.
c. Yes. When an event has been advertised as “educational,” discussing plan-specific premiums is impermissible.
d. No. Attendees expect some “puffery” at any event on a product in which they may be potentially interested.
Question 19: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?
Answer: the agent did not give me this answer.
We don't have the 4 answer options here. Potential answers from Susan: He can provide snacks and gifts totalingless than $15 per person. He can provide reply cards so that potential enrollees can provide authorization for the agent to contact them. He can provide information as to star ratings, as long as he isn't misleading in his star rating statements.
Question 20.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?
a. If he enrolls in the PFFS plan and shows his card to a doctor who participates in Original Medicare, then that doctor is required to accept the plan’s terms and conditions, which could include balance billing.
b. He may receive health care services from any doctor allowed to bill Medicare, as long as he shows the doctor the plan’s identification card and the doctor agrees to accept the PFFS plan’s payment terms and conditions, which could include balance billing.
c. He may receive services from any physician, regardless of whether or not that physician participates in the plan or Original Medicare.
d. If he enrolls in the PFFS plan, he can go to any doctor anywhere as long as the doctor accepts Original Medicare.
Answer:b. He may receive health care services from any doctor allowed to bill Medicare, as long as he shows the doctor the plan’s identification card and the doctor agrees to accept the PFFS plan’s payment terms and conditions, which could include balance billing.
Question 21.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?
a. Formularies must be developed with input from pharmacists, doctors, and other experts.
b. Formularies are developed by a consortium of health plans.
c. Plans must use a single, standard formulary developed by the Federal government to keep costs down and quality high for beneficiaries.
d. Formularies are developed purely on the basis of drug costs and include the least expensive drugs to keep costs down for beneficiaries and the Medicare program.
Answer:a. Formularies must be developed with input from pharmacists, doctors, and other experts.
Question 22.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?
a. A meal cannot be provided, but light snacks would be permitted.
b. Any type of meal or food is allowed, as long as it is available to the general public and not just those who are eligible to enroll in the plans.
c. Nothing may be provided to eat or drink during the sales presentation.
d. Any meal is allowed, as long as it is valued at less than $15.
Answer: a.A meal cannot be provided, but light snacks would be permitted.
Question 23.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?
a. Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan through a private company that has contracted with the government to provide only such drug coverage to eligible Medicare beneficiaries.
b. Mr. Carlini can keep Original Medicare, but if he does not sign up for an MA plan that includes prescription drug coverage, he will only be able to obtain prescription drug coverage through a Medigap plan.
c. In order to obtain prescription drug coverage, Mr. Carlini must enroll in an MA plan. The plan will cover his Part A and Part B services, as well as provide him with the desired prescription drug coverage.
d. Mr. Carlini can obtain drug coverage through the Federal government’s fallback plans, which are designed to provide an alternative to privately sponsored Medicare Advantage plans.
Answer:a. Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan through a private company that has contracted with the government to provide only such drug coverage to eligible Medicare beneficiaries.
Question 24.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?
a. Materials need only be reviewed and approved by the company(s) she represents.
b. States often volunteer to review marketing materials on behalf of the Medicare agency. She should check with her Department of Insurance to see if such a review is available and would satisfy CMS requirements.
c. Materials for marketing Medicare health plans to individuals are subject to Medicare’s uniform national requirements. They do not need to be reviewed by the state, but the company she represents must obtain approval from the Medicare agency (CMS) for any materials she uses.
d. Obtaining approval of her materials from the State Department of Insurance is a good practice and she should continue it with materials for the Medicare health plans she represents.
Answer:c. Materials for marketing Medicare health plans to individuals are subject to Medicare’s uniform national requirements. They do not need to be reviewed by the state, but the company she represents must obtain approval from the Medicare agency (CMS) for any materials she uses.
Question 25.Mr. Wilcox has been enrolled in Lexington 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?
a. Lexington must disenroll Mr. Wilcox after 12 weeks unless he can provide proof that he is simply visiting on a temporary basis.
b. Lexington can offer an extended visitor/traveler (V/T) benefit to Mr. Wilcox for up to 15 months.
c. Lexington can allow for Mr. Wilcox’s continued enrollment for up to 12 months whether or not he is in a visitor/traveler (V/T) program.
d. Lexington must disenroll Mr. Wilcox after 6 months unless he can provide proof that he is simply visiting on a temporary basis
Answer:c. Lexington can allow for Mr. Wilcox’s continued enrollment for up to 12 months whether or not he is in a visitor/traveler (V/T) program.
Question 26:You meet with Mrs. Wilson to complete her enrollment in a Medicare Advantage plan. You tell her that there will be an enrollment verification process to confirm that she is enrolled in the plan that she requested and understands the plan features and rules. What should Mrs. Wilson expect regarding the verification process?
a. Mrs. Wilson will be contacted by you within one week for a follow-up appointment to handle the verification process.
b. Your assistant will contact Mrs. Wilson within seven calendar days to set up a joint call with the plan’s home office to verify that she has enrolled in a plan of her choice and understands its features and rules.
c. You will contact Mrs. Wilson within 10 calendar days to set up a joint call with the plan’s home office to verify that she has enrolled in a plan of her choice and understands its features and rules.
d. Mrs. Wilson will be contacted by the plan sponsor within 15 calendar days of receipt of the enrollment request.
Answer:d. Mrs. Wilson will be contacted by the plan sponsor within 15 calendar days of receipt of the enrollment request.
Question 27.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?
a. He need not be entitled to Part A or enrolled in Part B to be eligible for the Part D prescription drug benefit. He must only be aged 65 to qualify for enrollment in Part D, so he can go ahead and enroll in a Part D prescription drug plan.
b. He will have to enroll in Part B before he can enroll in a Part D prescription drug plan.
c. He does not have to enroll in Part B but, must pay a penalty for his failure to do so when he first turned 65. After that, he can enroll in a Part D prescription drug plan.
d. He is eligible for the Part D prescription drug benefit because he is entitled to Part A and he does not have to be enrolled in Part B.
Answer:d. He is eligible for the Part D prescription drug benefit because he is entitled to Part A and he does not have to be enrolled in Part B.
Question 28.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?
a. No. Mrs. Walters will have to enroll in Part B in order to qualify for enrollment into the Medicare prescription drug program.
b. Yes, but Mrs. Walters must drop the employer coverage prior to enrolling in a Medicare prescription drug plan.
c. No. As long as her employer offers coverage that is equivalent to that available through Medicare, Mrs. Walters cannot enroll in a Medicare prescription drug plan.
d. Yes. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program.
d. Yes. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program.
Question 29.If you are to be in compliance with Medicare’s guidance regarding educational events, which of the following would be acceptable activities?
a. You may discuss plan specific premiums and benefits.
b. You may have a stack of enrollment forms on the table in your booth but may only pass them out to individuals who request one.
c. You may ask passers-by to provide you with their names, addresses and phone numbers so that you could contact them later with information about the plan(s) you represent.
d. You may distribute business cards to individuals who request information on how to contact you for further details on the plan(s) you represent.
Answer: d. You may distribute business cards to individuals who request information on how to contact you for further details on the plan(s) you represent.
Question 30. Dr. Elizabeth Brennan does not contract with the 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?
a. Dr. Brennan can charge the beneficiary the same costsharing as Original Medicare as long as she sends the claim to Medicare and not the plan. Answer:c. Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan’s terms and condition of payment which may include balance billing up to 15 percent of the Medicare rate.
b. Dr. Brennan can charge Mary Rodgers more than the cost sharing specified in the PFFS plan’s terms and conditions as long as she treats all beneficiaries the same.
c. Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan’s terms and condition of payment which may include balance billing up to 15 percent of the Medicare rate.
d. Dr. Brennan can charge Mary no more than the cost sharing specified in the PFFS plan’s terms and conditions of payment which may include balance billing up to 25 percent of the Medicare rate.
Question 31.Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for Medicare & Medicaid Services’ communication and Marketing Guidelines to ensure he is compliant for which type of products?
a. Medicare Advantage (MA) and Prescription Drug (PDP) plans
b. Private long-term care policies for Medicare beneficiaries
c. Section 1332 waiver plans
d. Medigap plans.
Answer:a. Medicare Advantage (MA) and Prescription Drug (PDP) plans
Question 32.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? a. Medicare covers hospice services and they will be available for her.
b. Hospice services are currently only offered under a limited demonstration project. Whether they will eventually become available nationally depends on the outcomes of the demonstration. c. Medicare does not cover hospice services. Hospice services are only available through state Medicaid programs, if the state offers such coverage.
d. The Federal government facilitates competition between hospice programs to lower the price of their services for Medicare beneficiaries, but does not offer coverage for hospice services through the Medicare program.
Answer:a. Medicare covers hospice services and they will be available for her.
Question 33.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?
a. Medicare will cover only a one-time “Welcome to Medicare” wellness visit.
b. Medicare will cover an annual wellness visit, even if he has no illnesses or injuries.
c. He can have as many preventive physical exams as he feels that he needs. They will all be covered by Medicare.
d. Physical exams, in the absence of readily observable illness or injury, are never covered under any circumstances.
Answer:b. Medicare will cover an annual wellness visit, even if he has no illnesses or injuries.
Question 34. 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?
a. Medicare Advantage (MA) HMO-POS plan that does not include drug coverage.
b. Medicare Advantage (MA) HMO that does not include drug coverage.
c. Private Fee-for-Service (PFFS) plan that does not include drug coverage.
d. Medicare Advantage (MA) PPO that does not include drug coverage.
Answer:c. Private Fee-for-Service (PFFS) plan that does not include drug coverage.
Question 35.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?
a. New plans and Part D sponsors that do not have any Star Rating are not required to provide Star Rating information until the nextcontract year.
b. Plans must provide Star Rating information as part of the Summary of Benefits package, but they may optionally choose to provide Star Rating information on their websites.
c. CMS generally issues plan ratings in January of each year, and plan sponsors must update the rating information available to enrollees within 30 days.
d. New plans and part D sponsors must provide a projection of the Star Rating they will receive until they have been officially awarded an overall Star Rating by CMS.
Answer:a. New plans and Part D sponsors that do not have any Star Rating are not required to provide Star Rating information until the next contract year.
Question 36. 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)?
a. Mrs. Wellington is eligible for a two- month SEP that began on January 1, so she should act quickly if she wishes to enroll in the MA five-star plan.
b. Mrs. Wellington must first enroll in a standalone PDP before she is eligible for a SEP to enroll in the MA five-star plan.
c. Mrs. Wellington is eligible for a SEP that may be used once until November 30 to enroll in the five-star plan.
d. Mrs. Wellington can enroll in the five-star plan in the following October, when the next annual enrollment period (AEP) begins – not before.
Answer:c. Mrs. Wellington is eligible for a SEP that may be used once until November 30 to enroll in the five-star plan.
Question 37.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?
a. He will have to drop Part A and then will be eligible to enroll in a MA plan.
b. He will have to enroll in a Medicare prescription drug plan prior to enrolling in a MA plan.
c. He will need to do nothing. His entitlement to Part A makes him eligible to enroll in any Medicare Advantage plan.
d. He will have to enroll in Part B prior to enrolling in a MA plan.
Answer: d. He will have to enroll in Part B prior to enrolling in a MA plan.
Question 38.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?
a. Part D prescription drug plans generally contract with every pharmacy in the country, so she should be able to obtain her drugs in both states with no problem.
b. Part D prescription drug plans focus almost entirely on mail order with fairly limited access to retail pharmacies, so as long as she orders all of her medications through the mail, she will be fine.
c. Part D prescription drug plans use networks of pharmacies within their service areas. She could look for a plan that maintains a network in both states.
d. Part D prescription drug plans are restricted to local service areas. She will have to use mail order to fill all of her prescriptions.
Answer:c. Part D prescription drug plans use networks of pharmacies within their service areas. She could look for a plan that maintains a network in both states.
Question 39. 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 otheroption he has for obtaining help with his considerable drug costs. What should you tell him?
a. The only option available is to reduce his income so that he can qualify for the Part D extra help or wait until next year to see if the annual limits change.
b. He should look into the possibility of purchasing his medications through the internet from off-shore pharmacies.
c. He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means to obtain the medications they need. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses.
d. He should contact his neighbors and family members and let them know that any contributions they make toward his drug expenses will be tax deductible.
Answer: c. He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means to obtain the medications they need. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses.
Question 40. 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?
a. She may only make such a change during her “initial coverage election period,” which occurred when she first became entitled to
Medicare.
b. She may do it only during the MA Disenrollment Period, which runs from January 1 to February 14 of each year.
c. Any time that she is dissatisfied with the plan’s network coverage or customer service she may make such a change.
d. She may make such a change during the Annual Election Period that runs from Oct. 15 to December 7, or during the MA Open Enrollment Period which takes place from January 1- March 31 of each year (beginning in 2019).
Answer: d. She may make such a change during the Annual Election Period that runs from Oct. 15 to December 7, or during the MA Open Enrollment Period which takes place from January 1- March 31 of each year (beginning in 2019).
This question below was corrected by Susan and Patty- The correct answer is A and all 50 questions on this test are now correct.
Question 41. Mrs. Quinn has 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?
a. Part B primarily covers physician services. She will be paying a monthly premium and, with the exception of many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an annual deductible.
b. She will need to pay no premiums for Part B as she qualifies for premium-free coverage due to the number of quarters she has worked.
c. Part B will cover her dental and vision needs.
d. She should disenroll if she does not want to pay the monthly premiums. There is no disadvantage in doing so.
Answer:a. Part B primarily covers physician services. She will be paying a monthly premium and, with the exception of many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an annual deductible.
Question 42: 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?
a. The VA will not offer drug coverage to Mrs. Fiore once she qualifies for the Medicare Part D program.
b. The VA does not offer creditable coverage and Mrs. Fiore may incur a Part D premium penalty if she enrolls in a Medicare prescription drug plan at some point after her initial eligibility date.
c. Costs under the VA are significantly higher than those under a Medicare Part D plan.
d. She could compare the coverage to see if the Medicare Part D plan offers better benefits and coverage than the VA for the specific medications she needs and whether any additional benefits are worth the Part D premium costs.
Answer: d. She could compare the coverage to see if the Medicare Part D plan offers better benefits and coverage than the VA for the specific medications she needs and whether any additional benefits are worth the Part D premium costs.
Question 43. 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?
a. If a PFFS enrollee shows his/her card when obtaining services from a provider who participates in Original Medicare, then that
provider is required to accept the plan’s terms and conditions.
b. If offered, beneficiaries can select a stand-alone Part D prescription drug plan (PDP) with an HMO or a PPO, but not with a PFFS
plan.
c. Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts Original Medicare, as long as the provider has
a reasonable opportunity to access the plan’s terms and conditions and agrees to accept them.
d. PFFS plans are the same as Medicare supplement plans and he may obtain care from any provider in the U.S.
Answer: c. Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts Original Medicare, as long as the provider has
a reasonable opportunity to access the plan’s terms and conditions and agrees to accept them.
Question 44. Mr. Jenkins is interested in enrolling in a Medicare cost plan and has sought your advice. What would you tell him?
a. All cost plans (like other types of MA plans) are required to be open for enrollment during the MA annual election period.
b. Costs plans are required to be open to enrollment year-round, so he should select a date when he would like coverage to begin.
c. Cost plans that offer an optional supplemental Part D benefit are required to be open to enrollment at least 90 days per year in addition to accepting Part D enrollments during the annual enrollment period.
d. Cost plans are required to be open to enrollment at least 30 days per year, and many are open for enrollment all year. So open enrollment will be dependent on the plan he chooses.
Answer: d. Cost plans are required to be open to enrollment at least 30 days per year, and many are open for enrollment all year. So open enrollment will be dependent on the plan he chooses.
Question 45. 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?
a. Mrs. Tanner can go to non-plan doctors knowing that cost sharing will generally be the same as with network providers.
b. Mrs. Tanner can go to non-plan doctors without receiving prior approval for all services.
c. Mrs. Tanner can go to non-plan doctors for certain services without receiving prior approval.
d. Mr. Tanner can go to non-network doctors without worrying about a cap on the amount of out-of-network services she may receive.
Answer: c. Mrs. Tanner can go to non-plan doctors for certain services without receiving prior approval.
Question 46. Who is most likely to be eligible to enroll in a Part D prescription drug plan?
a. Mr. Charles, an undocumented immigrant, entered the country illegally.
b. Ms. Davis who recently turned age 65 and is eligible for Part A and has just enrolled in Part B.
c. Ms. Bradley is currently living abroad for a multi-year job assignment.
d. Ms. Adams, a healthy early retiree who has just begun to collect Social Security at age 62.
Answer: b. Ms. Davis who recently turned age 65 and is eligible for Part A and has just enrolled in Part B.
Question 47. 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 nogap in coverage. What can you tell her?
a. She may not enroll in Part B while covered under an employer group health plan and must wait until the standard general enrollment period after she retires.
b. She may only enroll in Part B during the general enrollment period whether she is retired or not.
c. She may enroll at any time while she is covered under her employer plan, but she will have a special eight-month enrollment period that differs from the standard general enrollment period, during which she may enroll in Medicare Part B.
d. She must wait at least 30 days after her employment terminates before she may enroll in Medicare Part B
Answer: c. She may enroll at any time while she is covered under her employer plan, but she will have a special eight-month enrollment period that differs from the standard general enrollment period, during which she may enroll in Medicare Part B.
Question 48. 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?
a. TrOOP is calculated on an annual basis and consists of an enrollee's out-of-pocket deductible plus any amounts paid on behalf of an enrollee by Medicaid.
b. TrOOP are out-of-pocket costs that count toward the annual out-of-pocket threshold to move into catastrophic coverage and generally include, in addition to the annual deductible, costs for drugs not on the Part D plan's formulary and drugs purchased outside the United States.
c. TrOOP are out-of-pocket costs that count toward the annual out-of-pocket threshold to move into catastrophic coverage and generally include the annual deductible(s) and costs for drugs on the plan's formulary purchased at a plan's participating pharmacy. In some instances, amounts not directly paid by the enrollee (like manufacturer discounts) count toward TrOOP.
d. TrOOP is calculated on a cumulative basis and consists of the sum of an enrollee's out-of-pocket deductibles from the date of his or her enrollment in Part D plus outlays for over-the-counter drugs
Answer: c. TrOOP are out-of-pocket costs that count toward the annual out-of-pocket threshold to move into catastrophic coverage and generally include the annual deductible(s) and costs for drugs on the plan's formulary purchased at a plan's participating pharmacy. In some instances, amounts not directly paid by the enrollee (like manufacturer discounts) count toward TrOOP.
Question 49. Ms. Jensen has heard about “Original Fee-for-Service Medicare” and “Private Fee-for-Service” plans. She wants to know what the difference is, if any. What should you tell her?
a. PFFS is a form of supplemental coverage that fills in the gaps where Original Medicare leaves off.
b. PFFS plans primarily cover drugs that Original FFS Medicare does not cover.
c. Original Medicare and PFFS plans are essentially the same thing.
d. PFFS plans are a type of Medicare Advantage plan offered by private companies.
Answer: d. PFFS plans are a type of Medicare Advantage plan offered by private companies.
Question 50. 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)?
a. She is likely to qualify for a SEP. She can choose an effective date of up to six months after the month in which the enrollment form is received by the new plan, but the effective date may not be earlier than 30 days prior to the date of her move.
b. She is unlikely to qualify for a SEP and should remain on her current plan, relying on her current plan’s out-of-network benefits.
c. She is likely to qualify for a SEP. She can choose an effective date of up to three months after the month in which the enrollment form is received by the new plan, but the effective date may not be earlier than the date of her permanent move.
d. She is unlikely to qualify for a SEP but will be automatically covered by Original Medicare and a standalone Part D prescription drug plan.
Answer: c. She is likely to qualify for a SEP. She can choose an effective date of up to three months after the month in which the enrollment form is received by the new plan, but the effective date may not be earlier than the date of her permanent move.