AHIP Final Exam Answers (All Verified)

AHIP Test Answers (Correct)

AHIP final exam answers

AHIP Final Exam Questions and Answers

Mr. Davis is 52 years old and has recently been diagnosed with end-stage
renal disease (ESRD) and will soon begin dialysis. He is wondering if he can
obtain coverage under Medicare. What should you tell him?:

Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. Juan is a
naturalized citizen and has contributed to the Medicare system for over 20
years. Juan asks you if he will be entitled to Medicare and if he enrolls how
that will impact his employer-sponsored healthcare coverage. How would
you respond?:

Mr. Moy’s wife has a Medicare Advantage plan, but he wants to understand
what coverage Medicare Supplemental Insurance provides since his health
care needs are different from his wife’s needs. What could you tell Mr.
Moy?:

Mrs. PeHa is 66 years old, has coverage under an employer plan, and will
retire next year. She heard she must enroll in Part B at the beginning of the
year to ensure no gap in coverage. What can you tell her?:

Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been
employed full time, and paid taxes during that entire period. She is concerned
that she will not qualify for coverage under part A because she was not
born in the United States. What should you tell her?:

Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as
well, but it provides no drug coverage. She would like to keep the coverage

she has but replace her existing Medigap plan with one that provides drug
coverage. What should you tell her?:

Mrs. West wears glasses and dentures and has enjoyed considerable
pain relief from arthritis through massage therapy. She is concerned about
whether or not Medicare will cover these items and services. What should
you tell her?:

Mr. Patel is in good health and is preparing a budget in anticipation of his
retirement when he turns 66. He wants to understand the health care costs
he might be exposed to under Medicare if he were to require hospitalization
as a result of an illness. In general terms, what could you tell him about his
costs for inpatient hospital services
under Original Medicare?:

Ms. Henderson believes that she will qualify for Medicare Coverage when
she turns 65, without paying any premiums, because she has been working
for 40 years and paying Medicare taxes. What should you tell her?:

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 MedicarePart D prescription drug plan. What should you tell him?:

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?:

Mr. Xi will soon turn age 65 and has come to you for advice as to what
services are provided under Original Medicare. What should you tell Mr. Xi
that best describes the health coverage provided to Medicare beneficiaries?-
:

Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees with
a determination that partially denied one of her claims for services. What
advice would you give her?:

Mr. Capadona would like to purchase a Medicare Advantage (MA) plan
and a Medigap plan to pick up costs not covered by that plan.
What should you tell him?:

Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What
could you tell Mrs. Park that might be of assistance?:

Mr. Rainey is experiencing paranoid delusions and his physician feels
that he should be hospitalized. What should you tell Mr. Rainey (or his
representative) about the length of an inpatient psychiatric hospital stay
that Medicare will cover?:

Mr. Schmidt would like to plan for retirement and has asked you what is
covered under Original Fee-for-Service (FFS) Medicare? What could you tell
him?:

Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is
currently enrolled in Medicare Parts A and B. Jerry has also purchased a
Medicare Supplement (Medigap) plan which he has had for several years.
However, the plan does not provide drug benefits. How would you advise
Agent John Miller to proceed?:

Mr. Bauer is 49 years old, but eighteen months ago he was declared
disabled by the Social Security Administration and has been receiving disability payments. He is wondering whether he can obtain coverage under Medicare. What should you tell him?:

Mr. Buck has several family members who died from different cancers. He
wants to know if Medicare covers cancer screening.
What should you tell him?:

Which of the following statement is/are correct about a Medicare Savings
Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of
providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription
drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal
deductible of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original
Medicare would pay them as payment in full.:

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 a
stand-alone Medicare prescription drug plan. What should you tell him about
this situation?:

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?:

Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group health plan that includes drug coverage

with nominal copays. He heard about a neighbor’s MA-PD plan that you
represent and because he takes numerous prescription drugs, he is considering signing up for it. What should you tell him?:

Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but
accepts the plan’s terms and conditions for payment. Mary Rodgers sees Dr.
Brennan for treatment. How much may Dr. Brennan charge?:

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 must use doctors
in a network as his current HMO plan requires him to do. What should you
tell him?:

Mr. Wells is trying to understand the difference between Original Medicare
and Medicare Advantage. What would be the correct description?:

Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in a MA MSA plan that she heard about from
her neighbor. She also wants to have prescription drug coverage since her
doctor recently prescribed several expensive medications. Currently, she is
enrolled in Original Medicare and a standalone Part D plan. How would you
advise Mrs. Chi?:

Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no problems
functioning. Which type of SNP is likely to be most appropriate for him?:

Mrs. Burton is a retiree with substantial income. She is enrolled in an
MA-PD plan and was disappointed with the service she received from her
primary care physician because she was told she would have to wait five

weeks to get an appointment when she was feeling ill. She called you to ask
what she could do so she would not have to put up with such poor access
to care. What could you tell her?:

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?:

Mrs. Radford asks whether there are any special eligibility requirements
for Medicare Advantage. What should you tell her?:

Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might
affect her access to services since she receives some assistance for her
health care costs from the State. What should you tell her?:

Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part
B but has recently stopped paying his Part B premium. Mr. Castillo is still
covered by Part A. He would like to enroll in a Medicare Advantage (MA) plan
and is still covered by Part A. What should you tell him?:

Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. In mid-February of 2021, her doctor confirms a diagnosis
of end-stage renal disease (ESRD). What options will Mrs. Davenport have
regarding her MA plan during the next open enrollment season?:

Mr. Kumar is considering a Medicare Advantage HMO and has questions
about his ability to access providers. What should you tell him?:

Mr. Barker enjoys a comfortable retirement income. He recently had
surgery and expected that he would have certain services and items covered
by the plan with minimal out-of-pocket costs because his MA-PD coverage
has been very good. However, when he received the bill, he was surprised to
see large charges in excess of his maximum out-of-pocket limit that included
some services and items he thought would be fully covered. He called you
to ask what he could do? What could you tell him?:

Mr. Sinclair has diabetes and heart trouble and is generally satisfied with
the care he has received under Original Medicare, but he would like to know
more about Medicare Advantage Special Needs Plans (SNPs). What could
you tell him?:

Mr. Lopez has heard that he can sign up for a product called “Medicare
Advantage” but is not sure about what type of plan designs are available
through this program. What should you tell him about the types of health
plans that are available through the Medicare Advantage program?:

Mr. Sanchez has just turned 65 and is entitled to Part A but has not
enrolled in Part B because he has coverage through an employer plan. If he
wants to enroll in a Medicare Advantage plan, what will he have to do?:

Mr. Zachow has a condition for which three drugs are available. He has
tried two but had an allergic reaction to them. Only the third drug works for
him and it is not on his Part D plan’s formulary. What could you tell him to
do?:

Mr. Bickford did not quite qualify for the extra help low-income subsidy
under the Medicare Part D Prescription Drug program and he is wondering
if there is any other option he has for obtaining help with his considerable
drug costs. What should you tell him?:

Mr. and Mrs. Vaughn both take a specialized multivitamin prescription
each day. Mr. Vaughn takes a prescription for helping to regrow his hair.
They are anxious to have their Medicare prescription drug plan cover these
drug needs. What should you tell them?:

Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of
your clients. In addition to drugs on his plan’s formulary he takes several
other medications. These include a prescription drug not on his plan’s formulary, over-the-counter medications for colds and allergies, vitamins, and
drugs from an Internet-based Canadian pharmacy to promote hair growth
and reduce joint swelling. His neighbor recently told him about a concept
called TrOOP and he asks you if any of his other medications could count
toward TrOOP should he ever reach the Part D catastrophic limit. What should
you say?:

Ms. Edwards is enrolled in a Medicare Advantage plan that includes
prescription drug plan (PDP) coverage. She is traveling and wishes to fill
two of the prescriptions that she has lost. How would you advise her?:

Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has
recently lost creditable coverage previously available through her husband’s
employer. She is interested in enrolling in a Medicare Part D prescription
drug plan (PDP). What should you tell her?:

Mrs. Allen has a rare condition for which two different brand name drugs
are the only available treatment. She is concerned that since no generic
prescription drug is available and these drugs are very high cost, she will not
be able to find a Medicare Part D prescription drug plan that covers either
one of them. What should you tell her?:

Mrs. Quinn has just turned 65, is in excellent health and has a relatively
high income. She uses no medications and sees no reason to spend money
on a Medicare prescription drug plan if she does not need the coverage. She

currently does not have creditable coverage. What could you tell her about
the implications of such a decision?:

Mr. Shultz was still working when he first qualified for Medicare. At that
time, he had employer group coverage that was creditable. During his initial
Part D eligibility period, he decided not to enroll because he was satisfied
with his drug coverage. It is now a year later and Mr. Shultz has lost his
employer group coverage within the last two weeks. How would you advise
him?:

Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollment
in a Medicare prescription drug plan because, although she is entitled to Part
A, she is not enrolled under Medicare Part B. What should you tell her?:

What types of tools can Medicare Part D prescription drug plans use that
affect the way their enrollees can access medications?:

All plans must cover at least the standard Part D coverage or its actuarial
equivalent. Which of the following statements best describes some of the
costs a beneficiary would incur for prescription drugs under the standard
coverage?:

Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he looks at information on various plans available
in his area, he sees a wide range in what they charge for deductibles,
premiums, and cost sharing. How can you explain this to him?:

Mr. Carlini has heard that Medicare prescription drug plans are only
offered through private companies under a program known as Medicare
Advantage (MA), not by the government. He likes Original Medicare and does
not want to sign up for an MA product, but he also wants prescription drug
coverage. What should you tell him?:

Which of the following individuals is most likely to be eligible to enroll in
a Part D Plan?:

Mr. Hutchinson has drug coverage through his former employer’s retiree
plan. He is concerned about the Part D premium penalty if he does not enroll
in a Medicare prescription drug plan, but does not want to purchase extra
coverage that he will not need. What should you tell him?:

Mrs. McIntire is enrolled in her state’s Medicaid plan and has just become
eligible for Medicare as well. What can she expect will happen to her drug
coverage?:

Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not
include drug coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this?:

Which of the following statements about Medicare Part D are correct?
I. Part D plans must enroll any eligible beneficiary who applies regardless of
health status except in limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy
network but may choose to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may
only obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan.:

Mr. Torres has a small savings account. He would like to pay for his
monthly Part D premiums with an automatic monthly withdrawal from his
savings account until it is exhausted, and then have his premiums withheld
from his Social Security check. What should you tell him?:

You will be holding a sales event soon, at which you would like to offer
door prizes to attendees. Under guidelines from the Medicare agency, what
types of gifts or prizes would not be allowed in this situation?:

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 marketing requirements as the plans themselves.
How should you respond to such a statement?:

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 on October 15. During the appointment, what are you
permitted to do?:

One of your colleagues argues that it is better to focus your time and
energy exclusively in neighborhoods with single-family homes. He further
argues that their older owners are more likely to have higher incomes and
purchase the Medicare Advantage products you represent compared to
those living in apartment complexes. How should you respond?:

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?:

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?:

Melissa Meadows is a marketing representative for Best Care which
has recently introduced a Medicare Advantage plan offering comprehensive
dental benefits for $15 per month. Best Care has not submitted any potential
posts to CMS for approval. Melissa would like to use the power of social
media to reach potential prospects. What advice would you give her?:

Agent Jennings makes a presentation on Medicare advertised as an
educational event. Agent Jennings distributes materials that are solely educational. However, she gives a brief presentation that mentions plan-specific
premiums. Is this a prohibited activity at an event that has been advertised
as educational?:

Agent Martinez wishes to solicit Medicare Advantage prospects through
e-mail and asks you for advice as to whether this is possible. What should
you tell her?:

Miguel Sanchez is a relatively new agent who has come to you for advice
as to what he can do during the Medicare Advantage Open Enrollment
Period (MA-OEP). What advice should you give Miguel?:

ABC is a Medicare Advantage (MA) plan sponsor. It would like to use
its enrollees’ information to market non-health related products such as life
insurance and annuities. Which statement best describes ABC’s obligation
to its enrollees regarding marketing such products?:

You have approached a hospital administrator about marketing in her
facility. The administrator is uncomfortable with the suggestion. How could
you address her concerns?:

During a sales presentation, your client asks you whether the Medicare
agency recommends that she sign up for your plan or stay in Original
Medicare. What should you tell her?:

Agent Armstrong is employed by XYZ Agency, which is under contract
with ABC Health Plan, a Medicare Advantage (MA) plan that offers plans in
multiple states. XYZ Agency maintains a website marketing the MA plans
with which it has contracts. Agent Armstrong follows up with individuals
who request more information about ABC MA plans via the website and tries
to persuade them to enroll in ABC plans. What statement best describes
the marketing and compliance rules that apply to Agent Armstrong?:

You have been providing a pre-Thanksgiving meal during sales presentations in November for many years and your clients look forward to attending
this annual event. When marketing Medicare Advantage and Part D plans,
what are you permitted to do with respect to meals?:

Next week you will be participating in your first “educational event” for
prospective enrollees. To be sure that you do not violate any of the applicable
guidelines, in what activities should you plan to engage?:

You are working several plans and community organizations to sponsor
an educational event. When putting together advertisements for this event,
what should you do?:

Another agent you know has engaged in misconduct that has been verified by the plan she represented. What sort of penalty might the plan impose
on this individual?:

You are seeking to represent an individual Medicare Advantage plan and
an individual Part D plan in your state. You have completed the required
training for each plan, but you did not achieve a passing score on the tests
that came after the training. What can you do in this situation?:

Plan sponsors may undertake the following marketing activities with
current Medicare Advantage plan members?:

Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work and is covered by an employer health plan, he has not enrolled
in Part B or Part D. He receives a notice on June 1 that his employer is cutting
back on prescription drug benefits and that as of July 1 his coverage will
no longer be creditable. He has come to you for advice. What advice would
you give Mr. Rockwell about special election periods (SEPs)?:

Mrs. Young is currently enrolled in Original Medicare (Parts A and B),
but she has been working with Agent Neil Adams in the selection of a
Medicare Advantage (MA) plan. It is mid-September, and Mrs. Young is going
on vacation. Agent Adams is considering suggesting that he and Mrs. Young
complete the application together before she leaves. He will then submit
the paper application before the start of the annual enrollment period (AEP).
What would you say If you were advising Agent Adams?:

Mr. Block is currently enrolled in a Medicare Advantage plan that includes
drug coverage. He found a stand-alone Medicare prescription drug plan in
his area that offers better coverage than that available through his MA-PD
plan and in addition, has a low premium. It won’t cost him much more and,
because he has the means to do so, he wishes to enroll in the stand-alone
prescription drug plan in addition to his MA-PD plan. What should you tell
him?:

Mrs. Reeves is newly eligible to enroll in a Medicare Advantage plan and
her MA Initial Coverage Election Period (ICEP) has just begun. Which of the
following can she not do during the ICEP?:

Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part
D low-income subsidy. How does that affect his ability to enroll or disenroll
in a Part D plan?:

Mr. Yoo’s employer has recently dropped comprehensive creditable prescription drug coverage that was offered to company retirees. The company
told Mr. Yoo that, because he was affected by this change, he would qualify for
a Special election period. Mr. Yoo contacted you to find out more about what
this means. What can you tell him?:

Mrs. Schmidt is moving and a friend told her she might qualify for a
“Special election period” to enroll in a new Medicare Advantage plan. She
contacted you to ask what a special election period is. What could you tell
her?:

Mrs. Margolis contacts you in August because she will become eligible for
Medicare for the first time in November. She would like to meet and discuss
plan choices with you. What advice should you give her?:

Mr. Chen 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?:

Mrs. Kumar would like her daughter, who lives in another state, to meet
with you during the Annual Election Period to help her complete her enrollment in a Part D plan. She asked you when she should have her daughter
plan to visit. What could you tell her?:

Mr. Roberts is enrolled in an MA plan. He recently suffered complications
following hip replacement surgery. As a result, he has spent the last three
months in Resthaven, a skilled nursing facility. Mr. Roberts is about to be
discharged. What advice would you give him regarding his health coverage
options?:

Mr. White has Medicare Parts A and B with a Part D plan. Last year, he
received a notice that his plan sponsor identified him as a “potential at-risk”

beneficiary. This month, he started receiving assistance from Medicaid. He
wants to find a different Part D plan that’s more suitable to his current
prescription drug needs. He believes he’s entitled to a SEP since he is now
a dual eligible. Is he able to change to a different Part D plan during a SEP
for dual eligible individuals?:

Mr. Ziegler is turning 65 next month and has asked you what he can do,
and when he must do it, with respect to enrolling in Part D. What could you
tell him?:

A client wants to give you an enrollment application on October 1 before
the beginning of the Annual Election Period because he is leaving on vacation for two weeks and does not want to forget about turning it in. What
should you tell him?:

Mr. Garrett has just entered his MA Initial Coverage Election Period
(ICEP). What action could you help him take during this time?:

You are meeting with Ms. Berlin 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?:

You have come to Mrs. Midler’s home for a sales presentation. At the
beginning of the presentation, Mrs. Midler tells you that she has a copy of her
medical records available because she thinks this will help you understand
her needs. She suggests that you will know which questions to ask her about
her health status in order to best assist her in selecting a plan. What should
you do?:

Mr. and Mrs. Nunez attended one of your sales presentations. They’ve
asked you to come to their home to clear up a few questions. During the
presentation, Mrs. Nunez feels tired and tells you that her husband can finish

things up. She goes to bed. At the end of your discussion, Mr. Nunez says
that he wants to enroll both himself and his wife. What should you do?:

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?:

Mr. Wendt suffers from diabetes which has gotten progressively worse
during the last year. He is currently enrolled in Original Medicare (Parts A
and B) and a Part D prescription drug plan and did not enroll in a Medicare
Advantage (MA) plan during the last annual open enrollment period (AEP)
which has just closed. Mr. Wendt has heard certain MA plans might provide
him with more specialized coverage for his diabetes and wants to know if he
must wait until the next annual open enrollment period (AEP) before enrolling
in such a plan. What should you tell him?:

Since 2004 Ms. Eisenberg has had a Medigap plan that provides some
drug coverage. She has recently 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?:

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?:

Mrs. Wu was primarily a homemaker and 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?:

Mr. Perry is entitled to Medicare Part A but has not yet enrolled in Part B,
even though he is 69 years old. He would like to enroll in a Medicare Part D
prescription drug plan but is concerned that he will have to sign up for Part
B as well in order to qualify for enrollment in a Part D plan. What should you
tell him?:

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?:

ACA Section 1557 rules for disability concern:

Under ACA Section 1557, a health plan premium sold through a state
exchange may, based on an individual’s age,:

Which of the following statements best describes Section 1557 of the
Affordable Care Act (ACA)?:

Which Medicare programs are covered by ACA Section 1557?:

As a result of violations of ACA Section 1557 nondiscrimination rules,:

Which of the following statements best describes the scope of operations subject to Section 1557 under the 2020 Final Rule?:

Section 1557 of the Affordable Care Act applies to:

Under Section 1557, 2020 Final Rule issued during the Trump Administration sex was initially defined____________:

Which of the following would be considered permissible under Section
1557 and the 2020 Final Rule?:

Auxiliary aids and services must be provided to individuals with disabilities, such as those suffering from vision or hearing impairments, free of
charge, and in a timely manner. Auxiliary aids and services include which of
the following:
I. large print materials
II. qualified sign language interpreters
III. braille materials and displays
IV. screen reader software:

Which entity enforces Section 1557 for programs that receive funding
from on are administered by HHS?:

Which of these actions is most likely to be permitted in dealing with
a person with limited English proficiency?:

Under ACA Section 1557, a health plan:

For a health plan, what are the possible consequences of violations of
ACA Section 1557?:

Which of the following is NOT potentially a penalty for violation of a law
or regulation prohibiting fraud, waste, and abuse (FWA)?:

Which of the following requires intent to obtain payment and the knowledge the actions are wrong?:

You are performing a regular inventory of the controlled substances in
the pharmacy. You discover a minor inventory discrepancy. What should you
do?:

Your job is to submit a risk diagnosis to the Centers for Medicare &
Medicaid Services (CMS) for the purpose of payment. As part of this job,
you use a process to verify the data is accurate. Your immediate supervisor
tells you to ignore the Sponsor’s process and to adjust or add risk diagnosis
codes for certain individuals. What should you do?:

You are in charge of paying claims submitted by providers. You notice
a certain diagnostic provider (“Doe Diagnostics”) requested a substantial

payment for a large number of members. Many of these claims are for a certain procedure. You review the same type of procedure for other diagnostic
providers and realize Doe Diagnostics’ claims far exceed any other provider
you reviewed. What should you do?:

A person drops off a prescription for a beneficiary who is a “regular”
customer. The prescription is for a controlled substance with a quantity of
160. This beneficiary normally receives a quantity of 60, not 160. You review
the prescription and have concerns about possible forgery. What is your next
step?:

Waste includes any misuse of resources, such as the overuse of services or other practices that directly or indirectly result in unnecessary costs
to the Medicare Program.:

Bribes or kickbacks of any kind for services that are paid under a
Federal health care program (which includes Medicare) constitute fraud by
the person making as well as the person receiving them.:

These are examples of issues that should be reported to a Compliance
Department: suspected fraud, waste, and abuse (FWA); potential health privacy violation, unethical behavior, and employee misconduct.:

Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly or intentionally
misrepresented facts to obtain payment.:

Ways to report potential fraud, waste, and abuse (FWA) include:
a. Mail drops
b. Special Investigative Units (SIUs)
c. Tekephone hotlines
d. All of the above
e. In-person reporting to the compliance department/supervisor:

Once a corrective action plan is started, the corrective action plan must
be monitored annually to ensure they are effective.:

What are some of the penalties for violating fraud, waste, and abuse
(FWA) laws?
a.Civil Monetary Penalties
b.Imprisonment

c.All of the above
d.Exclusion from participation in all Federal health care programs:

Any person who knowingly submits false claims to the Government is
liable for five times the Government’s damages caused by the violator plus
a penalty.:

Some of the laws governing Medicare Part C and D fraud, waste, and
abuse (FWA) include the Health Insurance Portability and Accountability Act
(HIPAA), the False Claims Act the Anti-Kickback Statute, and the Health Care
Fraud Statute.:

You can help prevent fraud, waste, and abuse (FWA) by doing all the
following:
Look for suspicious activity
Conduct yourself in an ethical manner
Ensure accurate and timely data and billing
Ensure you coordinate with other payers
Keep up to date with FWA policies and procedures, standards of conduct,
laws, regulations, and the Centers for Medicare & Medicaid Services (CMS)
guidance
Verify all information provided to you:

You work for a Sponsor. Last month, while reviewing a Centers for
Medicare & Medicaid Services (CMS) monthly report, you identified multiple
individuals not enrolled in the plan but for whom the Sponsor is paid. You
spoke to your supervisor who said don’t worry about it. This month, you identify the same enrollees on the report again. What should you do?:

You discover an unattended email address or fax machine in your office
receiving beneficiary appeals requests. You suspect no one is processing
the appeals. What should you do?:

A sales agent, employed by the Sponsor’s first-tier, downstream, or
related entity (FDR), submitted an application for processing and requested
two things: 1) to back-date the enrollment date by one month, and 2) to waive
all monthly premiums for the beneficiary. What should you do?:

Ways to report a compliance issue include:
a.In-person reporting to the compliance department/supervisor
b.Report on the Sponsor’s website
c.Telephone hotlines
d.All of the above:

Compliance is the responsibility of the Compliance Officer, Compliance
Committee, and Upper Management only.:

What is the policy of non-retaliation?:

Medicare Parts C and D sponsors are not required to have a compliance
program.:

At a minimum, an effective compliance program includes four core
requirements.:

Correcting non-compliance________:

These are examples of issues that can be reported to a Compliance Department: suspected fraud, waste, and abuse (FWA), potential health privacy
violation, and unethical behavior/employee misconduct.:

Once a corrective action plan begins addressing non-compliance for
fraud, waste, and abuse (FWA) committed by a Sponsor’s employee or
first-tier, downstream, or related entity’s (FDR’s) employee, ongoing monitoring of the corrective actions is not necessary.:

Standards of Conduct are the same for every Medicare Parts C and D
sponsor.:

What are some of the consequences for non-compliance, fraudulent, or
unethical behavior?
a.Exclusion from participating kin all Federal health care programs
b.Termination of employment
c.Disciplinary action
d.All of the above:

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?:

Ms. Morris will turn 65 on June 10th. She has never previously qualified
for Medicare. She is entitled to Medicare Part A and intends to enroll in Part
B. She wants to know if she is eligible to enroll in a Medicare Advantage plan
that includes prescription drug coverage. What do you tell her?:

Agent Marvin Millner wants to reach out to his current clients for referrals. What advice would you give to Marvin?:

Mr. Chen has heard about a Medical Savings Account (MSA) but wants
to know if it is just about saving money, or if he will get insurance coverage
for his health care expenditures as well. What should you tell him?:

Ms. Lewis understands that Medicare prescription drug plans may use
various methods to control the use of specific drugs. She has heard about
a technique called “step therapy” and is wondering if you can explain what
that is. What should you tell her?:

Ms. Stuart 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 coverage for prescription drugs. Would she be able to obtain
drug coverage if she enrolled in the SNP?:

Agent Roderick enrolls retiree Mrs. Martinez in a medical savings account (MSA) Medicare health plan. The MSA plan does not offer prescription
drug coverage, so Agent Roderick also enrolls Mrs. Martinez in a standalone
prescription drug plan (PDP). What CMS compensation rules apply to this
situation?:

Mr. Olsen is concerned that a Medicare Advantage plan will not cover the
same range of services that would be covered under Original fee-for-service
Medicare. What should you tell him?:

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)?:

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 enrollment guidelines,
when could she do this?:

Mr. Lopez, who is fairly well-off financially, would like to enroll in a
Medicare prescription drug plan you represent and simply give you a check
to cover his premiums for the entire year. What should you tell him?:

Ms. Jensen 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?:

Ms. Bushman has two homes in different states and is concerned about
restrictions on where she can get her medications. What should you tell
her?:

Who is most likely to be eligible to enroll in a Part D prescription drug
plan?:

Mr. Lopez takes several high-cost prescription drugs. He would like
to enroll in a standalone Part D prescription drug plan that is available

in his area. In what type of Medicare Health Plan can he enroll?:

If a beneficiary is enrolled in a stand-alone prescription drug plan
and wants to keep that plan, what type of Medicare health plan could the
individual also enroll in, without being automatically disenrolled from the
stand-alone prescription drug plan?:

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?:

Which of the following is/are most likely to be characterized as an
involuntary disenrollment from a Medicare Advantage (MA) plan?
I. The enrollee dies.
II. An SNP enrollee loses special needs status due to substantially improved
health.
III. It is determined that the member is not lawfully present in the United
States.
IV. The member enrolls in another plan during the Annual Open Enrollment
period.:

Mr. Singh would like drug coverage but does not want to be enrolled in
a Medicare Advantage plan. What should you tell him:

Madeline Martinez was widowed several years ago. Her husband worked
for many years and contributed into the Medicare system. He also left a
substantial estate which provides Madeline with an annual income of approximately $130,000. Madeline, who has only worked part-time for the last three
years, will soon turn age 65 and hopes to enroll in Original Medicare. She
comes to you for advice. What should you tell her?:

Mr. Wu is eligible for Medicare. He has limited financial resources but
failed to qualify for the Part D low-income subsidy. Where might he turn for
help with his prescription drug costs?:

Mrs. Geisler’s neighbor told her she should look at her Part D options
during the annual Medicare enrollment period because features of Part D
might have changed. Mrs. Geisler can’t remember what Part D is so she
called you to ask what her neighbor was talking about. What could you tell
her?:

Mr. Diaz continued working with his company and was insured under
his employer’s group plan until he reached age 68. He has heard that there
is a premium penalty for those who did not sign up for Part B when first
eligible and wants to know how much he will have to pay. What should you
tell him?:

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?:

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?:

Anita Magri will turn age 65 in August 2022. Anita intends to enroll
in Original Medicare Part A and Part B. She would also like to enroll in a
Medicare Supplement (Medigap) plan. Anita’s older neighbor Mel has told
her about the Medigap Part F plan in which he is enrolled. It not only provides foreign travel emergency benefits but also covers his Medicare Part B
deductible. Anita comes to you for advice. What should you tell her?:

Mrs. Quinn recently turned 66 and decided after many years of work
to begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn
received a letter informing her that she has been automatically enrolled in
Medicare Part B. She wants to understand what this means. What should you

tell Mrs. Quinn?:

What impact, if any, have recent regulatory changes had upon Medigap
plans?:

Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treated for that condition. However, she and
her physicians feel that after her lengthy hospital stay she will need a month
or two of nursing and rehabilitative care. What should you tell them about
Original Medicare’s coverage of care in a skilled nursing facility?:

Mrs. Willard wants to know generally how the benefits under Original
Medicare might compare to the benefits package of a Medicare Advantage
Plan before she starts looking at specific plans. What could you tell her?-
:

Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might
affect her access to services since she receives some assistance for her
health care costs from the State. What should you tell her?:

Mrs. Walters is enrolled in her state’s Medicaid program in addition
to Medicare. What should she be aware of when considering enrollment
in a Medicare Advantage (MA) plan?:

Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B.
She is considering enrollment in a Medicare Advantage plan (Part C). What
should you advise her to do before she will be able to enroll in a Medicare
Advantage plan?:

Ms. Gibson recently lost her employer group health and drug coverage
and now she wants to enroll in a PPO that does not include drug coverage.
What should you tell her about obtaining drug coverage?:

Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her
area that does not include drug coverage. She wants to enroll in the plan and
enroll in a stand-alone prescription drug plan. What should you tell her?:

Mrs. Lyons is in good health, uses a single prescription, and lives
independently in her own home. She is attracted by the idea of maintaining
control over a Medical Savings Account (MSA) but is not sure if the plan
associated with the account will fit her needs. What specific piece of information about a Medicare MSA plan would it be important for her to know,
prior to enrolling in such a plan?:

Mrs. Fiore is a retired federal worker with coverage under a Federal Employee Health Benefits (FEHB) plan that includes creditable drug coverage.
She is ready to turn 65 and become Medicare eligible for the first time. What
issues might she consider about whether to enroll in a Medicare prescription
drug plan?:

Mrs. Roswell is a new Medicare beneficiary who has just retired from
retail work. She is interested in selecting a Medicare Part D prescription drug
plan. She takes a number of medications and is concerned that she has not
been able to identify a plan that covers all of her medications. She does not
want to make an abrupt change to new drugs that would be covered and
asks what she should do. What should you tell her?:

Mrs. Roberts has Original Medicare and would like to enroll in a Private
Fee-for-Service (PFFS) plan. All types of PFFS plans are available in her area.
Which options could Mrs. Roberts consider before selecting a PFFS plan?:

Mrs. Walters is entitled to Part A and has medical coverage without drug
coverage through an employer retiree plan. She is not enrolled in Part B.
Since the employer plan does not cover prescription drugs, she wants to
enroll in a Medicare prescription drug plan. Will she be able to?:

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?:

One of your clients, Lauren Nichols, has heard about a Medicare concept
from one of her neighbors called TrOOP. She asks you to explain it. What
do you say?:

Mr. Shapiro gets by on a very small amount of 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?:

Mr. Rice is 68, actively working and has coverage for medical services
and medications through his employer’s group health plan. He is entitled to
premium free Part A and thinking of enrolling in Part B and switching to an
MA-PD because he is paying a very large part of his group coverage premium
and it does not provide coverage for a number of his medications. Which of
the following is NOT a consideration when making the change?:

This year you have decided to focus your efforts on marketing to employer group plans. One employer provides you with a list of their retirees
and asks you to contact them to explain the characteristics of the plan they
have selected. What should you do?:

Alice is a marketing representative employed by a health plan. Betty is a
captive agent of a health plan who markets to multiple plans and sponsors.
Carl is a captive agent who markets to only one plan/sponsor. Denise is an
independent agent who markets to different types of groups. Edward is an
independent agent who markets only to employer and union groups. CMS
marketing representative compensation rules generally apply to::

During a sales presentation to Ms. Daley for a Medicare Advantage
plan that has a 5-star rating in customer service and care coordination, and
received an overall plan performance rating of a 4-star, which of the following
would be the best statement to say to her?:

BestCare Health Plan has received a request from a state insurance
department in connection with the investigation of several marketing representatives licensed by the state who sell Medicare Advantage plans. What
action(s) should BestCare take in response?:

You are mailing invitations to new Medicare beneficiaries for a marketing
event. You want an idea of how many people to expect, so you would like to
request RSVPs. What should you keep in mind?:

You market many different types of insurance and ordinarily you spend
time each evening calling potential clients. To comply with requirements
for marketing Medicare Advantage and Part D plans, what must you do
about contacting potential clients to market those plans?:

Monica is an agent focused on serving seniors eligible for Medicare. As
she reviews her records, she is trying to determine which of the following
items are considered compensation. What do you tell her?
I. Commissions
II. Bonuses
III. Mileage reimbursement
IV. Awards:

Your colleague works at a third-party marketing organization (TMO) and
she said she did not need to take the Medicare training for brokers and
agents or pass a test to market Medicare plans since her contract is with the
TMO, not the plans that have the products she sells. What could you say to
her?:

Mr. Lynn, an agent for Acme Insurance, Inc. thinks that, since state
laws are preempted concerning 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?:

You have set up an appointment for an in-home sales presentation with
Mrs. Fernandez, who expressed interest in the Medicare plans you represent.
In preparation for the sales presentation, what must you do?:

You are meeting with Mrs. Hall in her home. On her scope of appointment
form, she asked to discuss Medicare Advantage plans. During the meeting,
she asks to discuss a stand-alone prescription drug plan. She is leaving the
next day to visit her family for a week in another state, so it is important
for her to make a decision before she leaves. What must happen before that
additional discussion can take place?:

Agent Harriet Walker has recently begun marketing Medicare Advantage
and related products aimed at meeting the needs of senior citizens. Client
Mildred Jones has expressed interest in a Medicare Advantage plan. It is
now the beginning of September. If you were in Agent Walker’s position,
what would you do?:

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?:

By contacting plans available in your area, you have learned that the
plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefits
package. What should you do to make sure your clients know about these
pieces of information?:

When you market Medicare Advantage and Part D plans, what may you
offer as a gift to induce enrollment in a plan?:

You are scheduled to give a sales presentation at a local senior center at
which a drawing will be held for a prize. At the beginning of the presentation,
which of the following must you do?:

Winthrop Brokerage wishes to place an advertisement in the local newspaper that says: “We offer Medicare Advantage plans offered by AB Health
and Top Choice Health. Contact us if you would like to learn more.” Which
of the following best describes the obligation(s) of Winthrop Brokerage
regarding the advertisement?:

If you are to comply with Medicare’s guidance regarding educational
events, which of the following would be acceptable activities?:

While making an appointment to discuss Medicare Advantage (MA) and
Part D plans with a potential enrollee, you are asked to describe other types
of insurance products that your client might wish to purchase. What additional types of insurance can you present during the MA and Part D marketing

appointment?:

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 for $200 to entertain attendees. Can he do this in
a way that complies with guidance from the Medicare agency?:

Willard works as a representative focused on the senior marketplace.
What would be considered prohibited activity by Willard?:

Which of the following individuals has enrolled in a plan based on a fixed
enrollment period?:

Mr. Wilcox has been enrolled in Lexington Private Fee-for-Service (PFFS)
Medicare Advantage Health Plan (Lexington) for several years. Recently, Mr.
Wilcox decided to spend time with his children who live in another state that
is not in Lexington’s service area. In the future, he may relocate near his
children permanently. How does this move to another service area impact his
PFFS MA coverage?:

Miles is a licensed agent who represents Colgate Health and its
Medicare Advantage (MA) plans. Miles has several clients who have recently
come to him for help. They are in their initial coverage periods) (ICEP) and
are interested in enrolling in one of Colgate Health’s MA plans. Adam will
soon turn 68 and has decided to retire. Betty is about to turn 65 and has
also decided to retire. Adam and Betty both currently have coverage through
Colgate Health. Charles had health coverage through Colgate but dropped
the coverage when he retired early to travel to Europe. Charles has just
turned age 65 and is now back in the United States. Diedre, who will turn
65 next month, currently has coverage through Ditmas Health – a company
that Miles also represents. Who qualifies for the opt-in simplified enrollment
mechanism?:

Mr. Fitzgerald is selling his home to permanently move into a retirement
facility near his daughter in a neighboring state before the Annual Election
Period. 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?:

Mrs. Jenkins is enrolled in both Part A and Part B of Medicare. She
has recently also become eligible for Medicaid and would like to enroll in
a MA-PD plan. Since this is her first experience with Medicare Advantage,
she is concerned that she will be locked into a plan and unable to make
any coverage changes for at least a year if not longer. What should you tell
her?:

Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn’t
sufficiently cover his prescription drug needs. He is interested in changing
plans during the upcoming MA Open Enrollment Period. What are his options
during the MA OEP?:

Mrs. Parker likes to handle most of her business matters through telephone calls. She currently is enrolled in Original Medicare Parts A and B but
has heard about a Medicare Advantage plan offered by Senior Health from a
neighbor. Mrs. Parker asks you whether she can enroll in Senior Health’s MA
plan over the telephone. What can tell her?
I. Enrollment requests can only be made in face-to-face interviews or by mail.
II. Telephone enrollment request calls must be recorded.
III. Telephonic enrollments must include all required elements necessary to
complete an enrollment.
IV. The signature element must be completed via certified mail.:

Mr. Ford enrolled in an MA-only plan in mid-November during the Annual
Election Period (AEP). On December 1, he calls you up and says that he has
changed his mind and would like to enroll into a MA-PD plan. What enrollment
rules would apply in this case?:

Ms. Thomas has worked for many years and is turning 68 in June. She
is eligible for Medicare Part A and did not enroll for Part B when first eligible
because she has insurance through her employer – Coffee Brew, Inc. She

also did not enroll in Part D because she had creditable coverage. She would
like to retire in June and enroll in a Medicare Advantage plan. She has been
informed that her group coverage will end on her retirement effective date.
How would you advise Ms. Thomas?:

Mr. Liu turns 65 on June 19. He has never previously qualified for
Medicare so his first Medicare eligibility date will be by June 1. Mr. Liu’s
ICEP and Part D IEP begin March 1 and end on September 30. He wants
prescription drug coverage with his Part A and Part B benefits. What advice
can you provide him?:

Ms. Claggett is sixty-six (66) years old. She has been covered under
Original Medicare for the last six years due to her disability and has never
been enrolled in a Medicare Advantage or a Part D plan before. She wants
to enroll in a Part D plan. She knows that there is such a thing as the “Part
D Initial Enrollment Period” (IEP) and has concluded that, since she has
never enrolled in such a plan before, she should be eligible to enroll under
this period. What should you tell her about how the Part D Initial Enrollment
Period applies to her situation?:

Ms. O’Donnell learned about a new MA-PD plan that her neighbor suggested and that you represent. She plans to switch from her old MA HMO
plan to the new MA-PD plan during the Annual Election Period. However, she
wants to make sure she does not end up paying premiums for two plans.
What can you tell her?:

You work for Caring Health, a Medicare Advantage (MA) plan sponsor.
Recently, Mrs. Garcia has completed an enrollment application for a plan
offered by Caring Health, which is waiting for a reply from CMS indicating
whether or not Mrs. Garcia’s enrollment has been accepted. Once CMS
replies, how long does Caring Health have to notify Mrs. Garcia that her
enrollment has been accepted and in what format?:

Mrs. Kendrick is in good health, has worked for many years and is six
months away from turning 65. She wants to know what she will have to do to
enroll in a Medicare Advantage (MA) plan as soon as possible. What could
you tell her?:

Mrs. Reynolds is in her Medicare initial coverage election period (ICEP)
and the date of her entitlement to Part A and B has already occurred. Mrs.
Reynolds has just signed up for a Medicare Advantage plan on the second of
the month. She is leaving for vacation in two weeks and wants to know if her
new coverage will start before she leaves. What should you tell her?:

Mr. Robinson was quite ill recently and forgot to pay his monthly premium for his MA-PD plan. He is worried that he will lose his coverage now when
he needs it the most. He is certain his plan will disenroll him because that is
what happened to a friend of his in a similar type of plan. What can you tell
Mr. Robinson about his situation?:

Mrs. Johnson calls to tell you she has not received her new plan ID
card yet, but she needs to see a doctor. What can she expect to receive
from the plan after the plan has received her enrollment form?:

Mr. Anderson is a very organized individual and has filled out and
brought to you an enrollment form on October 10 for a new plan available
January 1 next year. He is currently enrolled in Original Medicare. What
should you do?:

Richard is a licensed agent who represents Spartan Health Plan and
its Medicare Advantage (MA) plans. Richard has several clients who have
recently come to him for help who are in their initial coverage election period
(ICEP) and are interested in enrolling in one of Spartan Health Plan’s MA
plans. Alice will soon turn 65 and retire. Alice has coverage through Spartan
Health Plan offered by her employer. Bob had health coverage through Spartan but dropped the coverage when he retired early to travel overseas. Bob,
who has just turned age 65, is now back in the United States. Charlotte, who
will turn 65 next month, has coverage through Athena Health plan – a company Richard also represents. Who qualifies for the opt-in simplified enrollment
mechanism?:

You would like to offer gifts of nominal value to potential enrollees who
call for more information about a plan you represent. You would then like
to offer additional gifts if they come to a marketing event. Each of the gifts
meets the CMS definition of nominal value, but together, the gifts are more
than the nominal value. Is this permissible?:

You are doing a sales presentation for Ms. Duarte and her son. Ms.
Duarte has some cognitive impairment and her son informs you that he has
power of attorney to only make financial not health care decisions for her.
Can he execute the enrollment for her?:

Agent Willis had several clients who disenrolled from the plans he
represents during the AEP to enroll in Medicare Advantage plans that are
competitors of his. Agent Willis believes that the choices they made are not
ideal for them and would like to get their business back during the Medicare
Advantage Open Enrollment Period (MA-OEP). What can agent Willis do?:

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?:

Mrs. Sanchez lives in a state located near Canada. She has recently
become eligible for Medicare and is considering enrollment in Part D prescription drug coverage. One of her friends has told her that she needs to be
aware of something called TrOOP. What should you tell her when she asks
you about TrOOP?:

Mr. Polanski likes the cost of an HMO plan available in his area but would
like to be able to visit one or two doctors who aren’t participating providers.
He wants to know if the Point of Service (POS) option available with some
HMOs will be of any help in this situation. What should you tell him?:

Mr. Landry is approaching his 65th birthday. He has signed up for
Medicare Part A, but he did not enroll in Part B because he has employer-sponsored coverage and intends to keep working for several more years.
But he is considering enrolling in Part D prescription drug coverage because
he believes it is superior to his employer plan. How would you advise
him?:

You have decided to focus on doing in-home presentations to market
the Medicare Advantage (MA) plans you represent. Before you conduct such
sales presentations, what must you do?:

This year you decide to focus your efforts on marketing to employer and
union groups. Which of the following statements best describes what you
can and cannot do in order to stay in compliance?:

Agent Chan is conducting a sales presentation on senior issues where
he hopes to enroll some attendees in the Medicare Advantage (MA) plans he

represents. What action(s) may Agent Chan take during the event?:

Ms. Hernandez 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?:

Mr. Lee was intending to enroll in MaxCare’s Medicare Advantage plan
this year. However, due to his current medical condition, his daughter Debbie
has been appointed as his legal representative over both health and financial
matters. Debbie would like to ensure that her father is still able to enroll
in MaxCare’s plan, but she is unsure what her role is to help with his
enrollment request. What advice can you give her?:

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?:

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)?: