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
... [Show More] care. What should you tell him about how a
Medicare Cost Plan might fit his needs? Correct Answer: 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.
b. Ms. Lopez is considered a marketing representative of Best Care and thus is obligated to comply
with CMS marketing requirements, including those regarding using only approved call scripts. Correct
Answer: Ms. Lopez is an independent agent under contract with Market Co, a third-party marketing
organization. Markets has a contract with Best Care 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 Markets in response to its mailers promoting Best Care health
plan. Which of the following best describes the responsibilities of Ms. Lopez?
a. Ms. Lopez is considered a marketing representative of Best Care but is exempt from the marketing
rules regarding approved call scripts because she works directly for Market Co.
b. Ms. Lopez is considered a marketing representative of Best Care 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.
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? Correct
Answer: 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.
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? Correct Answer: b. Mrs. Ramos can obtain
care from any provider who participates in Original Medicare, but generally will have a higher costsharing amount if she sees a provider who/that is not a part of the PPO network.
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? Correct Answer: 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.
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 [Show Less]