1. 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?: a. Cost plan enrollees can choose to receive Medicare covered services
under the plan's benefits by going to plan network providers and paying plan cost
sharing, or may receive services from non-network providers and pay cost-sharing
due under Original Medicare.
2. b. 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.: 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?
a. 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.
b. 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.
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.
3. 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 at a cost of $200 to entertain attendees. Can he do this in
a way that complies with guidance from the Medicare agency?: a. He can do
this because the estimated number of attendees is based on the venue size and
response rate and the value of the gift does not exceed $15.
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4. 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?: b. Mrs. Ramos can obtain care from any provider who participates in
Original Medicare, but generally will have a higher cost-sharing amount if she sees
a provider who/that is not a part of the PPO network.
5. 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?: 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.
6. 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 muchThe doctor may only collect from Mr.
Rivera the cost sharing allowable under the state's Medicaid program.may
the doctor collect from Mr. Rivera?: The doctor may only collect from Mr. Rivera
the cost sharing allowable under the state's Medicaid program.
7. 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?:
8. Choose one answer.:
9. : a. A PFFS plan is a type of Medicare Supplement plan and she may enroll in
one if it is available in her area.
10. : b. 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.
11. : c. 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.
12. : d. 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.
13. Question8:
14. Marks: 1:
15. During an appointment scheduled to discuss a Medicare Advantage
Prescription Drug plan (MA-PD), Mr. Peters asked his agent to describe a
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stand-alone prescription drug plan (Part D plan) that his neighbor told him
about. What should his agent do?:
16. : a. Since Mr. Peters requested a description of the Part D plan, his agent must
leave the Part D plan brochure, but not an enrollment form, and would have to
schedule another appointment after at least 48 hours have passed to discuss the
Part D plan with Mr. Peters.
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