Ahip Medicare Test

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  1. Ms. Gardner is currently enrolled in an MA-PD plan. However,she wants to disenroll from the MA-PD plan and instead enroll in a Part D only plan and go back to Original Medicare. According to Medicare's enrollmentguidelines, when could she do this?
    She may do it only during the MA Disenrollment Period, which runs from January 1 to February 14 of each year.
  2. You have finished a sales presentation with Mrs. Slade, who chose to enroll into a Part D plan you represent. At the end of the presentation, she asks you to stay in contact to ensure that she is being well served by the plan. How would Medicare's guidelines for making contact with Mrs. Slade apply in this situation?
    You may initiate a call to Mrs. Slade to conduct normal business related to her enrollment in the Part D plan and to discuss other products her plan sponsor offers.
  3. Several agents you work with are planning sales events in your area.  One plans on giving door prizes worth $5, refreshments valued at $8 per anticipated attendee, and coupon books with discounts worth $10.  Since no gift or prize exceeds the $15 limit he believes his plan is acceptable.  What should you tell them?
    He can give away more than one gift during a single event,but the aggregate retail value cannot exceed $15.
  4. Mr. Yu is concerned that his neighbor, Gladys, has not scheduled an appointment to review Medicare Advantage plan options for this year, even though she sent you a reply card requesting a call from you. You have not yet been successful in reaching Gladys and Mr. Yu would like to see what happen, so that her needs can be well served. What could you offer to do?
    You could continue calling Gladys until you reach her and offer to either schedule an in-home presentation to explain the plans youre present or provide her with the plan enrollment kit to review herself.
  5. Mr.Bush 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?
    No, he cannot purchase a Medicare Advantage or Part D policy because he has not received Social Security or Railroad Retirement disability benefits for 24 months.
  6. You are accustomed to obtaining names and contact information through a variety of means, and then calling potential clients in an attempt to set up a sales appointment. Under the rules applicable to marketing Medicare Advantage and Part D plans, what sorts of activities can you engage in with respect to beneficiaries who have not previously given you permission to contact them?
    You may not make any unsolicited call or visit to any beneficiary, unless explicit permission was given by the beneficiary for a call or visit.
  7. 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 astand-alone Medicare prescription drug plan. What should you tell him about this situation?
    He could enroll in one of the MA plans that include prescription drug coverage or a Medigap plan and a stand-alone prescription drug plan, but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan.
  8. 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?
    • 1. 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. 
    • 2. He should know that Medicaid will pay cost sharing only for services provided by Medicaid participating providers.              
    • 3.Medicaid will cover his cost-sharing, regardless of from which physician orhospital he receives his Medicare-covered services.   4.Medicaid will no longer pay any cost sharing once he is eligible for Medicare,so he will need to rely only on Medicare providers.
  9. Ms. Deboy was a homemaker and was 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?
  10. Since her husband paid Medicare taxes during the entire time he was working, she will automatically qualify for Medicare Part A without having to pay any premiums.
  11. 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?
    The Part D low income subsidy could substantially lower her overall costs. She can apply by contacting her state Medicaid office, or calling the Social Security Administration.
  12. You have scheduled a sales event at a local shopping center,targeting individual enrollees. Unfortunately, the marketing materials from the plan have not arrived in time for the event. Other agents suggest that you create your own materials and give you some suggestions for what sorts of things work. What should you do?
  13. You may develop and use your own materials, as long as they are generic, refer only to the types of Medicare plans you represent, and do not misrepresent any material facts.
  14. Mr. Mayhew accepted an invitation to present information onthe MA plans he represents for a local Chamber of Commerce. The Chamber advertised the event in their monthly newsletter and asked anyone interested to call to RSVP. The sales event is now five days away, only three people responded, and the Chamber decided to cancel the event. What should Mr. Mayhew do?
  15. Mr. Mayhew should report the cancellation to the plan with which he contracts immediately, and he must make sure everyone who responded is called to inform them of the cancellation.
  16. You are meeting with Ms. Blum 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?
  17. You may correct this information as long as you add your initials and date next to the correction
  18. Ms. Jefferson 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?
  19. PFFS plans are a type of Medicare Advantage plan offered by private companies.
  20. 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?
  21. Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, end stage renal disease, Lou Gehrig’s disease, or exposed to certain environmental hazards, so she will be eligible for Medicare.
  22. Ms. Bass lives on a limited fixed income and is concerned about the cost of healthcare. What should you tell her about the sort of help available to low income individuals under the Medicare program?
  23. As a Medicare beneficiary with limited income and resources she may contact her state Medicaid agency to apply for assistance paying for the Part B premium and cost sharing and Part D prescription drug coverage.
  24. While marketing Medicare Advantage and Part D plans, you collected a large number of scope of appointment forms from your clients,where in 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?
  25. The scope of appointment forms must be retained for a period of ten (10) years.
  26. 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?
  27. Prescription drugs she purchases on her own that are not on her Part D plan’s formulary.
  28. 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?
  29. You appreciate the opportunity and would just need to complete scope of appointment forms on behalf of all the residents who would like to attend.
  30. 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?
  31. You will have to avoid calling any potential client, unles she or she initiates contact with you and specifically asks that you give him orher a call.
  32. 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?
  33. Original Medicare covers ambulance services.
  34. 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?
  35. If Mr. Rice drops his drug coverage through the retiree plan, he may not be able to get it back and he also may lose his medical health coverage.
  36. Medicare health plans establish provisions in marketing representative contracts to ensure compliance with applicable laws and policies. If non-compliance occurs, CMS can penalize a plan in which of the following ways?
  37. CMS requires plan sponsors to create and complete a corrective action plan and may terminate a sponsor’s contract.
  38. Ms. McCutcheon 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 coveragefor prescription drugs.  Would she beable to obtain drug coverage if she enrolled in the SNP?
  39. Yes. All SNPs are required to provide Part D coverage forprescription drugs.
  40. Mrs. Murphy 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?
  41. There is no limit on the expenses a plan can incur on behalf of any one beneficiary and a plan sponsor may not end a member’s enrollment just because of high costs, so she should not be concerned.
  42. Mrs. Reid requested that you call her to discuss a Part D plan she is interested in learning about to determine if she wants to enroll.  However, she is concerned about identity theft and does not want to give you her Social Security number.  What should you tell her?
  43. When you call her, you should indicate that she is not required to provide any information to you, and failure to do so will not affect her membership in the plan.
  44. 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 requirements as the plans themselves. How should you respond to such a statement?
  45. Your co worker 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.
  46. 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?
  47. You should tell your colleague no because participation in an educational event may not include a sales presentation.
  48. 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?
  49. You must have her sign a scope of appointment form, indicating which products she wishes to discuss, and note on the form that she is a “walk in.” You may then proceed with the discussion.
  50. 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?
  51. Medigap plans help beneficiaries cover coinsurance,co-payments, and/or deductibles for medically necessary services.
  52. 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?
  53. He generally would pay a monthly premium, annual deductible,and per-prescription cost sharing.
  54. 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?
  55. He might qualify for help with Part D prescription drug costs and help paying Part A and/or Part B premiums, deductibles, and/or cost sharing.
  56. A large physician group in your area contracts with the plans you represent. You have an opportunity to work with them to market the plans, but want to be sure you follow the CMS requirements. What can you askthe physician group to do?
  57. Provide names of the plans they contract with along with information from the CMS website.
  58. Mr. Cotter 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?
  59. Mr. Cotter can dis enroll from his employer-sponsored coverage to elect a Medicare Advantage or Part D plan within 2 months of his disenrollment, but he should reevaluate if he really wants to drop his employer coverage.
  60. Ms. Lowman 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?
  61. Materials for marketing Medicare health plans to individualsare 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.
  62. While you market Medicare Advantage and Medicare Prescription Drug plans, which activity must you do?
  63. You must ensure that only those who have an equal opportunity to enroll receive incentive gifts for enrolling.
  64. Mr. Mattison 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?
  65.  Formularies be developed with input from pharmacists, doctors, and other experts
  66. Mrs. Toma has a low, fixed income. What could you tell herthat might be of assistance?
  67. She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help with Medicare costs for which she is responsible.
  68. Under what conditions can a Medicare prescription drug plan reduce its coverage for a given drug mid-way through the year?
  69. When a new generic drug for the same condition becomes available or when the FDA or manufacturer withdraws the drug from the market, a brand name drug can be replaced
  70. During an appointment scheduled to discuss a Medicare Advantage-Prescription Drug plan (MA-PD), Mr. Polise 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?
  71. Since Mr. Polise requested a description of the Part D plan, his agent must have Mr.Polise sign a new scope of appointment form that includes Part D, and then the agent may discuss the Part D plan so Mr. Polise can compare plans and make an informed enrollment choice during the appointment.
  72. Mr. Fera is selling his home to move into a retirement facility near his daughter in a neighboring state. 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?
  73. Because he is moving outside of the service area, the plan must automatically disenroll him. He will have a special election period to select a new plan.
  74. 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?
  75. Some prescription drug plans may have higher operating costs and/or may offer enhanced coverage in return for an additional premium amount. He could look at plan designs to see if one of the enhanced plans would serve his needs better than a plan based on the standard design.
  76. 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 mustuse doctors in a network like his current HMO plan requires him to do. What should you tell him?
  77. 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.
  78. You are preparing for a marketing presentation and have created a checklist of tips so you are sure to do a good job of marketing and at the same time be in compliance with all requirements. Which of the following should you include on your tip list?
  79. Use only plan materials that have been approved by the Medicare agency and the plan you represent.
  80. Mr. Shapiro gets by on a very small 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?
  81. The extra help is available only to Medicare beneficiaries who are enrolled in Medicaid. He should apply for coverage under his state’s Medicaid program to access the extra help with his drug costs.
  82. Mr. Zachow has a condition for which three drugs are available. He has tried two, but had an allergic reaction to them. Only thethird drug works for him and it is not on his Part D plan's formulary. What could you tell him to do?
  83. Mr. Zachow has aright to request a formulary exception to obtain coverage for his Part D drug.He or his physician could obtain the standardized request form on the plan’swebsite, fill it out, and submit it to his plan.
  84. After a sales presentation, Mr. Buffet announces that he is ready to enroll in the plan you represent. He would like to know if he can havehis plan premiums deducted from his Social Security check. What should you tell him?
  85. He may choose with holding from his Social Security when he completes the enrollment form.
  86. 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 thephone or in small brochures.  How should you respond to this argument?
  87. This is correct. Infact, the Medicare agency requires potential enrollees to meet face-to-face with an agent, plan representative, or State Health Insurance AssistanceProgram representative before permitting a beneficiary to enroll in a MA orPart D plan.
  88. Ms. Townsend wants to understand the relationship between your Medicare Advantage plan and Original Medicare. Which of the following is an example of a statement that you could make to explain the relationship?
  89. If a physician accepts Medicare, s/he must accept the MAplan
  90. You are doing a sales presentation for Ms. Tranchida and herson.  Ms. Tranchida 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?
  91. Yes, he can execute the enrollment for her. A financial power of attorney is sufficient.
Card Set:
Ahip Medicare Test
2015-08-27 13:16:10
medicare exam prescription drugs

Ahip Medicare exam flash cards
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