Test Bank For AHIP Multi – Versions Latest Updated 2024
Mr. Albert has heard about something called the Star Rating system for Medicare Advantage
... [Show More] 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? - correct answers??????
Beneficiaries who live in the service area of a 5-star plan and are enrolled in an MA or PDP plan, or beginning in 2013, a Cost plan
Beneficiaries who live in the service area of a 5-star plan, are enrolled in Original Medicare, and meet the eligibility requirements for Medicare Advantage or Part D plans
The SEP is available each year beginning on December 8 and may be used once through November 30 of the following year. For example, the SEP for calendar year 2018 can be
used from December 8, 2017 through November 30, 2018.
Disenroll from an MA plan, PDP or Cost plan or
leave Original Medicare
Enroll in a 5-star MA plan, PDP or Cost plan
Eligible individuals may enroll in a 5-star plan
through 1-800-MEDICARE, Medicare.gov, or
directly through the 5-star plan.
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? - correct answersCost 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.
Last year Agent Melanie Meyers marketed and enrolled several clients in Medicare Advantage (MA) health plans. This year she has decided to focus on non-MA products. What advice would you give Melanie if she wishes to continue to receive renewal fees? - correct answers
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)? - correct answers
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? - correct answersHe should know that Medicaid will pay cost sharing only for services provided by Medicaid participating providers.
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? - correct answersFormularies must be developed with input from pharmacists,doctors, and other experts.
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? - correct answersA meal cannot be provided, but light
snacks would be permitted.
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 answers
Ms. Levi is considering enrollment in a Medicare Advantage HMO plan offered in her area. Ms. Levi often travels to visit relatives and is concerned that she may need emergency care outside of her plan's service area. What should you tell her about coverage of emergency care? - correct answersPlans are required to cover out-of network emergency care.
Which of the following individuals are likely to qualify for a special enrollment period (SEP) for both MA and Part D due to a change of residence?
I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area.
II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service area.
III. Gilbert moves into a plan service area where there is now a Part D plan available to him from a service area where no Part D plan was available.
IV. Henry makes a permanent move providing him with new MA and Part D options. - correct answersII, III, and IV only
Mr. Lynn, an agent for Acme Insurance, Inc. thinks that, since state laws are preempted with regard to the marketing of Medicare health plans, he doesn't have much to worry about. What might you, as his colleague, advise him concerning the type of scrutiny he will be under? - correct answersOrganizations sponsoring Medicare
health plans are responsible for the behavior of their contracted representatives and will be conducting
monitoring activities to ensure compliance with all applicable Federal
law and guidance and plan policies.
Furthermore, state agent licensure laws are not preempted and he must abide by their requirements.
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)? - correct answersMrs. Wellington is eligible for a SEP
that may be used once until November 30 to enroll in the fivestar plan. [Show Less]
