Ms. Gardner is currently enrolled in an MA-PD plan. However, she wants to
disenroll from the MAPD 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? -CORRECT
ANSWER– : 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).
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? -CORRECT ANSWER– Answer: Agent
Lopez’s entire compensation must be recouped because Ralph
disenrolled within 3 months of enrollment.
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?
-CORRECT ANSWER– She should remain in Original Medicare until the annual
election period
running from October 15 to December 7, during which she can select an MA
plan.
Mr. Jenkins is interested in enrolling in a Medicare cost plan and has sought
your advice. What
would you tell him? -CORRECT ANSWER– 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.
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? -CORRECT ANSWER– 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.
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? -CORRECT ANSWER– Mary may make an unlimited number of MA
enrollment requests and may
disenroll from her current MA plan.
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? –
CORRECT ANSWER– Medicare will cover an annual wellness visit, even if he
has no illnesses or
injuries.
Mr. Wells is trying to understand the difference between Original Medicare
and Medicare
Advantage. What would be a correct description? -CORRECT ANSWER–
Medicare Advantage is a way of covering all the Original Medicare benefits
through private health insurance companies.
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\u0002pocket costs. What
could you tell him? -CORRECT ANSWER– Because he reached the coverage
gap last year, he will probably reach it
again this year close to the same time.
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? -CORRECT ANSWER– SNPs
limit enrollment to certain sub-populations of beneficiaries. Given his
current situation, he is unlikely to qualify and would not be able to enroll in the
SNP.
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 -CORRECT ANSWER– He can give away more than
one gift during a single event, but the
aggregate retail value cannot exceed $15
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? -CORRECT ANSWER– 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
Since 2004 Ms. Eisenberg has had a Medigap plan that provides some drug
coverage. She has
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? -CORRECT
ANSWER– The letter is to inform her that the drug coverage offered through her
Medigap plan does not offer drug coverage that is at least comparable to that
provided under the Medicare Part D prescription drug program. If she does
not have such creditable coverage during periods when she is eligible for the
Part D program, she will face a premium penalty if she enrolls in a Part D plan
at a later date.
Mrs. Pierce would like to enroll in a Medicare Cost plan that offers Part D
prescription drug coverage.
She comes to you for advice about when she can enroll in a plan you have
previously discussed.
What should you tell her? -CORRECT ANSWER– Enrollment in Cost plans
offering Part D coverage is available only during
enrollment periods under the Part D program, and Cost plans must accept
enrollments during these periods.
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
October 15. During the
appointment, what are you permitted to do? -CORRECT ANSWER– You may
provide her with the required enrollment materials and take her
completed enrollment application.
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? -CORRECT
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<\/p>\n\n\n\n