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ANSWERSHEET2024 AHIP Study Guide
Directions: Log into the AHIP Medicare Training Link using this link
https://www.ahipmedicaretraining.com/clients/hpone/internal . The top right corner of your screen should
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In this document click the ‘ctrl’ and ‘f’ (ctrl + f) key at the same time on your keyboard. It will bring up a
search box. Type out a unique key word or phrase in each AHIP question to verify if the answer is in the study
guide. (Ex. Duarte)
If the question is not in the study guide, you will need to find the answer in the applicable Module. Best
practice is to first identify what Module the answer may be found in based off the subject of the question.
(Ex. If question is about Medicare eligibility, Module 1 would be the most appropriate location from the
Training Roadmap outlined below) Once in the Module, review the order of the Training Roadmap to quickly
determine where the question might be referenced in the pages. Note: you can (ctrl + f) in the Modules
Use chart below for Module reference:
AHIP Modules: Training Roadmap:
Module 1 – Overview Medicare • Medicare Program Basics
Program Basics (60 slides) • Original Medicare: Eligibility, Enrollment, Entitlement, and Premiums
• Help for Individuals with Limited Income
• Medicare Part A Benefits and Original Medicare Cost Sharing
• Original Medicare and Part D
• Original Medicare Beneficiary Protections
• Medigap Coverage
Module 2 – Part C and Other Medicare • Medicare Advantage Plans
Health Plans (58 slides) • MA Plan Types: Coordinated Care Plans
• Special Needs Plans
• MA Plan Types: Private Fee-for-Service (PFFS) Plans
• MA Plan Types: Medical Savings Account (MSA) Plans
• Medicare Advantage Employer/Union Plans
• Medicare Advantage: Eligibility, Costs, and Benefits
• Medicare Advantage Plans and Dual Eligible Beneficiaries
• Medicare Advantage and Prescription Drugs
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• Other Type of Medicare Health Plans
Module 3 – Medicare Part D • Medicare Part D Basics Eligibility
Prescription Drug Coverage (54 slides) • Covered Drugs
• Part D Standard and Alternative Benefits
• “True Out-of-Pocket” Costs (TrOOP)
• Part D Premiums and Late Enrollment Penalties
• Part D Drug Management Tools and Formulary Requirements
• Part D Enrollee Rights
• Part D Assistance Programs
Module 4 – Communications and • New rules for marketing 2024 products
Marketing Rules for Medicare • Applicability of rules concerning marketing and communications
Advantage and Part D Plans (102 slides) • Marketing Representatives: agents/brokers and third party marketing
organizations
• Key terms and general background information
• Regulation of communications activities and materials
• Marketing communications – contacting beneficiaries
• Rules related to sales and educational events
• Marketing at individual appointments
• Use of social media to market
• Required practices
• Accessing and using certain plan materials
• Plan ratings and call recordings
• Prohibited activities
• Marketing during the open enrollment period
• Marketing in healthcare settings
• Plan oversight and enforcement of marketing requirements
• Marketing Representative Compensation
• Frequently asked questions
Module 5 – Enrollment Guidance • Enrollment periods
Medicare Advantage and Part D Plans • Election periods
(72 slides) • Enrollment Periods MA Open Enrollment Period
• Special Election Periods (SEPs)
• Open Enrollment Period for Institutionalized Individuals
• Enrollment requests
• Beneficiary acknowledgements and enrollee discrimination
prohibitions
• Post-enrollment activities and rules
• Disenrollment
Study Guide Questions
Note: the questions below are not in test order
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Questions Answers
Mrs. Gonzalez is enrolled in Original Medicare and has a ✓ Mrs. Gonzalez cannot purchase a Medigap plan that covers
Medigap policy as well, but it provides no drug coverage. drugs, but she could keep her Medigap policy and enroll in a
She would like to keep the coverage she has but replace her Part D prescription drug plan.
existing Medigap plan with one that provides drug
coverage. What should you tell her?
Edward IP suffered from serious kidney disease. As a result. ✓ Individuals eligible for Medicare based on ESRD generally
Edward became eligible for Medicare coverage due to end- lose eligibility 36 months after the month in which the
stage renal disease (ESRD). A close relative donated their individual receives a kidney transplant unless they are
kidney and Edward successfully underwent transplant eligible for Medicare on another basis such as age or
surgery 12 months ago. Edward is now age 50 and asks you disability. Edward may, however, remain enrolled in Part B
but solely for coverage of immunosuppressive drugs if he has
if his Medicare coverage will continue, what should you
no other health care coverage that would cover the drugs.
say?
Ms. Moore plans to retire when she turns 65 in a few ✓ Medicare is a program for people age 65 or older and those
months. She is in excellent health and will have under age 65 with certain disabilities, end-stage renal
considerable income when she retires. She is concerned disease, and Lou Gehrig’s disease so she will be eligible for
that her income will make it impossible for her to qualify for Medicare.
Medicare. What could you tell her to address her concern?
Ms. Henderson believes that she will qualify for Medicare ✓ To obtain Part B coverage, she must pay a standard monthly
Coverage when she turns 65, without paying any premiums, premium, though it is higher for individuals with higher
because she has been working for 40 years and paying incomes.
Medicare taxes. What should you tell her?
Anthony Boniface turned 65 in 2023. He was not receiving ✓ Anthony is eligible for a special enrollment period (SEP)
Social Security or Railroad Retirement Benefits on his because he missed an enrollment period due to the impact
65th birthday. He was interested in obtaining Medicare of the Federally declared disaster. This SEP will allow
coverage and is eligible for premium-free Part A. Before he Anthony to enroll in Part B up to six months after the end of
could enroll in Medicare, his entire area was impacted by a the emergency declaration. Anthony may enroll in premium-
free Part A at any time and his Part A coverage will be
hurricane causing massive flooding and severe wind
retroactive for up to 6 months.
damage. The Federal government declared this to be a
natural disaster which has recently ended. During this
period Anthony’s initial enrollment period expired. Anthony
asks you how he can now obtain Medicare coverage. What
should you say?
Mrs. Peňa is 66 years old, has coverage under an employer ✓ She may enroll at any time while she is covered under her
plan, and will retire next year. She heard she must enroll in employer plan, but she will have a special eight-month
Part B at the beginning of the year to ensure no gap in enrollment period after the last month on her employer plan
coverage. What can you tell her? that differs from the standard general enrollment period,
during which she may enroll in Medicare Part B.
Mr. Moy's wife has a Medicare Advantage plan, but he ✓ Medicare Supplemental Insurance would help cover his Part
wants to understand what coverage Medicare A and Part B deductibles or coinsurance in Original Fee-for-
Supplemental Insurance provides since his health care Service (FFS) Medicare as well as possibly some services that
needs are different from his wife’s needs. What could you Medicare does not cover.
tell Mr. Moy?
Shirly Thomas was enrolled in Medicaid during the Public ✓ Shirley is eligible for a Special Enrollment Period (SEP) for up
Health Emergency (PHE). This coverage has recently been to six months after the termination of her Medicaid
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terminated due to the end of the PHE. While Shirley was coverage. Under this SEP, Shirley can choose retroactive
enrolled in Medicaid, she missed an opportunity to enroll in coverage back to the date of termination from Medicaid or
Medicare and now wants Part B. Which of the following coverage beginning the month after the month of
statements best describes Shirley’s ability to now enroll in enrollment.
Medicare Part B?
Mr. Diaz continued working with his company and was ✓ Mr. Diaz will not pay any penalty because he had continuous
insured under his employer’s group plan until he reached coverage under his employer’s plan.
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?
Mr. Davis is 52 years old and has recently been diagnosed ✓ He may sign-up for Medicare at any time however coverage
with end-stage renal disease (ESRD) and will soon begin usually begins on the fourth month after dialysis treatments
dialysis. He is wondering if he can obtain coverage under start.
Medicare. What should you tell him?
Madeline Martinez was widowed several years ago. Her ✓ You should tell Madeline that she will be able to enroll in
husband worked for many years and contributed into the Medicare Part A without paying monthly premiums due to
Medicare system. He also left a substantial estate which her husband’s long work record and participation in the
provides Madeline with an annual income of approximately Medicare system. You should also tell Madeline that she will
$130,000. Madeline, who has only worked part-time for the pay Part B premiums at more than the standard lowest rate
last three years, will soon turn age 65 and hopes to enroll in but less than the highest rate due her substantial income.
Original Medicare. She comes to you for advice. What
should you tell her?
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed ✓ She should contact her state Medicaid agency to see if she
income. What could you tell Mrs. Park that might be of qualifies for one of several programs that can help with
assistance? Medicare costs for which she is responsible.
Mr. Wu is eligible for Medicare. He has limited financial ✓ Mr. Wu may still qualify for help in paying Part D costs
resources but failed to qualify for the Part D low-income through his State Pharmaceutical Assistance Program.
subsidy. Where might he turn for help with his prescription
drug costs?
Agent John Miller is meeting with Jerry Smith, a new ✓ Tell prospect Jerry Smith that he should consider adding a
prospect. Jerry is currently enrolled in Medicare Parts A and standalone Part D prescription drug coverage policy to his
B. Jerry has also purchased a Medicare Supplement present coverage.
(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. Schmidt would like to plan for retirement and has asked ✓ Part A, which covers hospital, skilled nursing facility, hospice,
you what is covered under Original Fee-for-Service (FFS) and home health services and Part B, which covers
Medicare. What could you tell him? professional services such as those provided by a doctor are
covered under Original Medicare.
Mr. Bauer is 49 years old, but eighteen months ago he was ✓ After receiving such disability payments for 24 months, he
declared disabled by the Social Security Administration and will be automatically enrolled in Medicare, regardless of age.
has been receiving disability payments. He is wondering
whether he can obtain coverage under Medicare. What
should you tell him?
Mr. Xi will soon turn age 65 and has come to you for advice ✓ Beneficiaries under Original Medicare have no cost-sharing
as to what services are provided under Original Medicare. for most preventive services which include immunizations
What should you tell Mr. Xi that best describes the health such as annual flu shots.
coverage provided to Medicare beneficiaries?
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Mildred Savage enrolled in Allcare Medicare Advantage plan ✓ Mildred may remain enrolled in Allcare and make a hospice
several years ago. Mildred recently learned that she is election. Hospice benefits will be paid for by Original
suffering from inoperable cancer and has just a few months Medicare under Part A and Allcare will continue to pay for
to live. She would like to spend these final months in any non-hospice services.
hospice care. Mildred’s family asks you whether hospice
benefits will be paid for under the Allcare Medicare
Advantage plan. What should you say?
Mrs. Chen will be 65 soon, has been a citizen for twelve ✓ Most individuals who are citizens and age 65 or over are
years, has been employed full time, and paid taxes during covered under Part A by virtue of having paid Medicare taxes
that entire period. She is concerned that she will not qualify while working, though some may be covered as a result of
for coverage under part A because she was not born in the paying monthly premiums
United States. What should you tell her?
Mr. Capadona would like to purchase a Medicare Advantage ✓ It is illegal for you to sell Mr. Capadona a Medigap plan if he
(MA) plan and a Medigap plan to pick up costs not covered is enrolled in an MA plan, and besides, Medigap only works
by that plan. What should you tell him? with Original Medicare.
Mr. Kumar is considering a Medicare Advantage HMO and ✓ In most Medicare Advantage HMOs, Mr. Kumar must
has questions about his ability to access providers. What generally obtain his services only from providers within the
should you tell him? plan's network (except in an emergency or where care is
unavailable within the network).
Mrs. Burton is a retiree with substantial income. She is ✓ She could file a grievance with her plan to complain about
enrolled in an MA-PD plan and was disappointed with the the lack of timeliness in getting an appointment.
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?
Juan Hernandez is turning 65 next month, Juan legally ✓ Juan is eligible to enroll in a Medicare Advantage as long as
entered the United States over twenty years ago but is not a he is entitled to Part A and enrolled in Part B. Juan should go
citizen. Since his entry into the country, Juan has worked at to the Social Security website to enroll in Medicare Part A
Smallcap Incorporated and contributed to the Medicare and B if he has not done so already. Once he is enrolled, he
system. Juan suffers from diabetes. He will soon retire and can choose a Medicare Advantage plan.
asks you if he can enroll in a Medicare Advantage plan that
you represent. How would you respond?
Mrs. Wang wants to know generally how the benefits under ✓ Medicare Advantage Plans may offer extra benefits that
Original Medicare might compare to the benefits package of Original Medicare does not offer such as vision, hearing, and
a Medicare Advantage Plan before she starts looking at dental services. It must include a maximum out-of-pocket
specific plans. What could you tell her? limit on Part A and Part B services.
Which of the following statement(s) is/are correct about a ✓ I. MSAs may have either a partial network, full network, or
Medicare Savings Account (MSA) Plans? no network of providers.
✓ II. MSA plans cover Part A and Part B benefits but not Part D
I. MSAs may have either a partial network, full network, or prescription drug benefits.
no network of providers. ✓ IV. Non-network providers must accept the same amount
II. MSA plans cover Part A and Part B benefits but not Part that Original Medicare would pay them as payment in full.
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.
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Mr. Romero is 64, retiring soon, and considering enrollment ✓ He should compare the benefits in his employer-sponsored
in his employer-sponsored retiree group health plan that retiree group health plan with the benefits in his neighbor’s
includes drug coverage with nominal copays. He heard MA-PD plan to determine which one will provide sufficient
about a neighbor’s MA-PD plan that you represent and coverage for his prescription needs.
because he takes numerous prescription drugs, he is
considering signing up for it. What should you tell him?
Mrs. Ramos is considering a Medicare Advantage PPO and ✓ Mrs. Ramos can obtain care from any provider who
has questions about which providers she can go to for her participates in Original Medicare, but generally will have a
health care. What should you tell her? higher cost-sharing amount if she sees a provider who/that is
not a part of the PPO network.
Mrs. Lyons is in good health, uses a single prescription, and ✓ All MSAs cover Part A and Part B benefits, but not Part D
lives independently in her own home. She is attracted by prescription drug benefits, which could be obtained by also
the idea of maintaining control over a Medical Savings enrolling in a separate prescription drug plan.
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?
Mr. Barker enjoys a comfortable retirement income. He ✓ You can offer to review the plans appeal process to help him
recently had surgery and expected that he would have ask the plan to review the coverage decision.
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. Wells is trying to understand the difference between ✓ Medicare Advantage is a way of covering all the Original
Original Medicare and Medicare Advantage. What would be Medicare benefits through private health insurance
the correct description? companies.
Mr. Greco is in excellent health, lives in his own home, and ✓ SNPs limit enrollment to certain subpopulations of
has a sizeable income from his investments. He has a friend beneficiaries. Given his current situation, he is unlikely to
enrolled in a Medicare Advantage Special Needs Plan (SNP). qualify and would not be able to enroll in the 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?
Dr. Elizabeth Brennan does not contract with the ABC PFFS ✓ Dr. Brennan can charge Mary Rogers no more than the cost
plan but accepts the plan’s terms and conditions for sharing specified in the PFFS plan’s terms and condition of
payment. Mary Rodgers sees Dr. Brennan for treatment. payment which may include balance billing up to 15%of the
How much may Dr. Brennan charge? Medicare rate.
Mrs. Radford asks whether there are any special eligibility ✓ Mrs. Radford must be entitled to Part A and enrolled in Part
requirements for Medicare Advantage. What should you tell B to enroll in Medicare Advantage.
her?
Mr. Sinclair has diabetes and heart trouble and is generally ✓ SNPs have special programs for enrollees with chronic
satisfied with the care he has received under Original conditions, like Mr. Sinclair, and they provide prescription
Medicare, but he would like to know more about Medicare drug coverage that could be very helpful as well.
Advantage Special Needs Plans (SNPs). What could you tell
him?
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Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan ✓ He may receive health care services from any doctor allowed
available in his area has an attractive premium. He wants to to bill Medicare, as long as he shows the doctor the plan’s
know if he must use doctors in a network as his current identification card and the doctor agrees to accept the PFFS
HMO plan requires him to do. What should you tell him? plan’s payment terms and conditions, which could include
balance billing.
Mr. Kelly wants to know whether he is eligible to sign up for ✓ You would need to ask Mr. Kelly if he is entitled to Part A,
a Private fee-for-service (PFFS) plan. What questions would enrolled in Part B, and if he lives in the PFFS plan’s service
you need to ask to determine his eligibility? area.
Ms. Gibson recently lost her employer group health and ✓ She can enroll in the PPO, but she will not be able to
drug coverage and now she wants to enroll in a PPO that purchase a stand-alone Medicare Part D prescription drug
does not include drug coverage. What should you tell her plan.
about obtaining drug coverage?
Mrs. Chi is age 75 and enjoys a comfortable but not ✓ Mrs. Chi may enroll in a MA MSA plan and remain in her
extremely high-income level. She wishes to enroll in a MA current standalone Part D prescription drug plan.
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?
Mr. Castillo, a naturalized citizen, previously enrolled in ✓ He is not eligible to enroll in a Medicare Advantage plan until
Medicare Part B but has recently stopped paying his Part B he re-enrolls in Medicare 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?
Daniel is a middle-income Medicare beneficiary. He has ✓ CSNP
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?
Which of the following statements about Medicare Part D ✓ I. Part D plans must enroll any eligible beneficiary who
are correct? applies regardless of health status except in limited
circumstances.
I. Part D plans must enroll any eligible beneficiary who ✓ II. Private fee-for-service (PFFS) plans are not required to
applies regardless of health status except in limited use a pharmacy network but may choose to have one.
circumstances. ✓ III. Beneficiaries enrolled in a MA-Medical Savings Account
(MSA) plan may only obtain Part D benefits through a
II. Private fee-for-service (PFFS) plans are not required to standalone PDP.
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.
Mrs. Lopez is enrolled in a cost plan for her Medicare ✓ If a Part D benefit is offered through her plan she may
benefits. She has recently lost creditable coverage choose to enroll in that plan or a standalone PDP.
previously available through her husband’s employer. She is
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interested in enrolling in a Medicare Part D prescription
drug plan (PDP). What should you tell her?
Mr. Bickford did not quite qualify for the extra help low- ✓ He could check with the manufacturers of his medications to
income subsidy under the Medicare Part D Prescription see if they offer an assistance program to help people with
Drug program and he is wondering if there is any other limited means to obtain the medications they need.
option he has for obtaining help with his considerable drug Alternatively, he could check to see whether his state has a
costs. What should you tell him? pharmacy assistance program to help him with his expenses.
Mrs. Quinn has just turned 65, is in excellent health and has ✓ If she does not sign up for a Medicare prescription drug plan
a relatively high income. She uses no medications and sees as soon as she is eligible to do so, and if she does sign up at a
no reason to spend money on a Medicare prescription drug later date, her premium will be permanently increased by 1%
plan if she does not need the coverage. She currently does of the national average premium for every month that she
not have creditable coverage. What could you tell her about was not covered.
the implications of such a decision?
Mrs. Fiore is a retired federal worker with coverage under a ✓ She could compare the coverage to see if the Medicare Part
Federal Employee Health Benefits (FEHB) plan that includes D plan offers better benefits and coverage than the FEHB
creditable drug coverage. She is ready to turn 65 and plan for the specific medications she needs and whether any
become Medicare eligible for the first time. What issues additional benefits are worth the Part D premium costs on
might she consider about whether to enroll in a Medicare top of her FEHB contribution.
prescription drug plan?
Mrs. Imelda Diaz is a Medicare beneficiary enrolled in a MA- ✓ Yes, there is no cost sharing for the shingles vaccine even in
PD plan you represent. Her neighbor recently suffered from the deductible phase of her prescription drug plan because it
a painful case of shingles. Mrs. Diaz hopes to avoid such an is an adult vaccine recommended by the Advisory Committee
illness through vaccination. She asks you whether the cost on Immunization Practices (AICP).
of shingles vaccination will be covered under the plan you
represent. What should you say?
Mrs. McIntire is enrolled in her state’s Medicaid plan and ✓ Unless she chooses a Medicare Part D prescription drug plan
has just become eligible for Medicare as well. What can she on her own, she will be automatically enrolled in one
expect will happen to her drug coverage? available in her area.
Mr. Hutchinson has drug coverage through his former ✓ If the drug coverage he has is not expected to pay, on
employer’s retiree plan. He is concerned about the Part D average, at least as much as Medicare’s standard Part D
premium penalty if he does not enroll in a Medicare coverage expects to pay, then he will need to enroll in
prescription drug plan, but does not want to purchase extra Medicare Part D during his initial eligibility period to avoid
coverage that he will not need. What should you tell him? the late enrollment penalty.
Mrs. Roberts has Original Medicare and would like to enroll ✓ A Medicare Advantage Prescription Drug (MA-PD) PFFS plan
in a Private Fee-for-Service (PFFS) plan. All types of PFFS that combines medical benefits and Part D prescription drug
plans are available in her area. Which options could Mrs. coverage, a PFFS plan offering only medical benefits, or a
Roberts consider before selecting a PFFS plan? PFFS plan in combination with a stand-alone prescription
drug plan.
Mr. Schultz was still working when he first qualified for ✓ Mr. Schultz should enroll in a Part D plan before he has a 63-
Medicare. At that time, he had employer group coverage day break in coverage in order to avoid a premium penalty.
that was creditable. During his initial Part D eligibility
period, he decided not to enroll because he was satisfied
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with his drug coverage. It is now a year later and Mr. Schultz
has lost his employer group coverage within the last two
weeks. How would you advise him?
Charles McCarthy is a Medicare beneficiary who suffers ✓ Mr. McCarthy’s insulin costs for a one-month supply cannot
from diabetes. Mr. McCarthy is considering enrollment in a be more than $35 in any coverage phase under the
MA-PD plan that you represent. He asks you whether his prescription drug plan beginning in 2023.
insulin costs will be covered. What should you say?
Which of the following individuals is most likely to be ✓ Jose, a grandfather who was granted asylum and has worked
eligible to enroll in a Part D Plan? in the United States for many years.
Mr. Shapiro gets by on a very small amount of fixed income. ✓ The extra help is available to beneficiaries whose income and
He has heard there may be extra help paying for Part D assets do not exceed annual limits specified by the
prescription drugs for Medicare beneficiaries with limited government.
income. He wants to know whether he might qualify. What
should you tell him?
Mrs. Fields wants to know whether applying for the Part D ✓ The Part D low-income subsidy could substantially lower her
low-income subsidy will be worth the time to fill out the overall costs. She can apply by contacting her state Medicaid
paperwork. What could you tell her? office or calling the Social Security Administration.
Mrs. Walters is entitled to Part A and has medical coverage ✓ Yes. Mrs. Walters must be entitled to Part A and/or enrolled
without drug coverage through an employer retiree plan. in Part B to be eligible for coverage under the Medicare
She is not enrolled in Part B. Since the employer plan does prescription drug program.
not cover prescription drugs, she wants to enroll in a
Medicare prescription drug plan. Will she be able to?
Mr. Jacob understands that there is a standard Medicare ✓ Medicare Part D drug plans may have different benefit
Part D prescription drug benefit, but when he looks at structures, but on average, they must all be at least as good
information on various plans available in his area, he sees a as the standard model established by the government.
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 ✓ Mr. Carlini can stay with Original Medicare and also enroll in
are only offered through private companies under a a Medicare prescription drug plan through a private
program known as Medicare Advantage (MA), not by the company that has contracted with the government to
government. He likes Original Medicare and does not want provide only such drug coverage to eligible Medicare
to sign up for an MA product, but he also wants prescription beneficiaries.
drug coverage. What should you tell him?
Mrs. Cantwell is enrolled in a prescription drug plan. She ✓ I. Her annual PDP deductible
has heard about something called True-Out-Pocket costs ✓ A drug manufacturer’s discount for brand name drugs after
or “TrOOP” and asks you if any of the following count her initial coverage period
toward reaching the catastrophic coverage phase. What do
you say?
I. Her annual PDP deductible
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II. A drug manufacturer’s discount for brand name drugs
after her initial coverage period
III. The off formulary drug her doctor prescribed but she
pays for because the plan denied her exception request
IV. Her over-the-counter (OTC) allergy medication.
Mrs. Berkowitz wants to enroll in a Medicare Advantage ✓ If the Medicare Advantage plan is a Private Fee-for-Service
plan that does not include drug coverage and also enroll in a (PFFS) plan that does not offer drug coverage or a Medical
stand-alone Medicare prescription drug plan. Under what Savings Account plan, Mrs. Berkowitz can do this.
circumstances can she do this?
Mr. Torres has a small savings account. He would like to pay ✓ In general, he must select a single Part D premium payment
for his monthly Part D premiums with an automatic monthly mechanism that will be used throughout the year.
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?
Agent Martinez wishes to solicit Medicare Advantage ✓ Marketing representatives may initiate electronic contact
prospects through e-mail and asks you for advice as to through e-mail but an opt-out process must be provided.
whether this is possible. What should you tell her?
Your friend’s mother just moved to an assisted living facility ✓ You appreciate the opportunity and would be happy to
and he asked if you could present a program for the schedule an appointment with anyone at their request.
residents about the MA-PD plans you market. What could
you tell him?
Hector Hernandez is an independent agent. Hector sells ✓ During the first minute of a sales call, Hector must use a
plans on behalf of three Medicare Advantage organizations disclaimer that says “I do not represent every plan available
that offer a total of 10 plans but does not represent all in your area. I represent 3 organizations that offer 10 plans in
Medicare Advantage organizations offering plans that are your area. Please contact Medicare.gov, 1-800-MEDICARE, or
available in his area. Which of the following statements best your local State Health Insurance Program to get information
on all your options.”
describes any steps Hector is required to take?
You are working several plans and community organizations ✓ You must ensure that the advertisements indicate it is an
to sponsor an educational event. When putting together educational event, otherwise it will be considered a
advertisements for this event, what should you do? marketing event.
You have been providing a pre-Thanksgiving meal during ✓ You may provide light snacks, but a Thanksgiving style meal
sales presentations in November for many years and your would be prohibited, regardless of who provides or pays for
clients look forward to attending this annual event. When the meal.
marketing Medicare Advantage and Part D plans, what are
you permitted to do with respect to meals?
Sal D’Angelo is new to the Medicare marketplace having ✓ Sal should conduct the education seminar as an early
previously been focused on life insurance and disability morning meeting and the marketing meeting on the
income protection products. He intends to conduct an following day in the late afternoon so that there are at least
educational seminar during the AEP at a local hotel and 12 hours between the two meetings.
then invite those who attend to a subsequent marketing
Page 10 of 16 July 6, 2023
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