Medicare Agent and Broker Training Exam In accordance with the Centers for Medicare & Medicaid Services (CMS) CMS’ Medicare Managed Care Manual (MMCM), CMS’ Medicare Prescription Drug Benefit Manual (MPDBM), Medicare Communications and Marketing Guidelines (MCMG), and regulations at Title 42 of the Code of Federal Regulations, Parts 417, 422, and 423), Community First Health Plans, Inc. (Community First) requires training and testing for all agents and brokers. Community First must ensure that all agents and brokers (including employed, subcontracted, downstream, and/or delegated entities) that sell Community First Medicare products are trained and tested annually on Medicare rules and regulations and on the specific plan types our agents and brokers sell.Medicare Training and Plan Overview 2025 SlidesYou have unlimited attempts to take this exam.To pass this exam, you must receive a grade of 85% or higher.Before you begin the exam, please provide your agent information.Broker InformationName(Required) First Last National Producer Number(Required)Name of Upline Agency(Required)Agent Telephone Number(Required)Agent Email Address Part I: Medicare Basics1) A prospective beneficiary asks an agent if plan XYZ has an urgent care benefit and if so, what the benefit includes. Where would the agent find this information for plan XYZ?(Required) Summary of Benefits Provider Directory Evidence of Coverage None of the above 2) If a beneficiary enrolled in an MA HMO tells you that she wants to see a specialist, you should tell her:(Required) You will likely need a referral from your primary care physician (PCP) to see a specialist. If you see your specialist without this referral, the plan may not pay for your visit. Call and make an appointment You do not need to see a specialist All of the above 3) True or False? Once a beneficiary is enrolled in an MA plan and has paid his plan-specific monthly premium, he no longer needs to pay his Part B premium.(Required) True False 4) Match the Medicare Part with the correct description.1. Physician services, outpatient hospital care, lab tests, mental health services, some preventatives services, and medical equipment considered medically necessary to treat a disease or condition 2. Prescription Drug Benefit3. Hospital inpatient care, some SNF care, and home health and hospice care.4. An option for beneficiaries to receive Parts A and B benefits from an MA Plan offered by a private company that has a contract with Medicare.Which description correctly describes Medicare Part A?(Required) 1 2 3 4 Which description correctly describes Medicare Part B?(Required) 1 2 3 4 Which description correctly describes Medicare Part C?(Required) 1 2 3 4 Which description correctly describes Medicare Part D?(Required) 1 2 3 4 Part II: Enrollment and Disenrollment5) Mrs. Doe will turn 65 at the end of March and signed up for an MA plan in January during her Initial Coverage Election Period (ICEP). When will her coverage begin?(Required) On February 1 On March 1 On April 1 On May 1 6) Which of the following periods provide an opportunity for a beneficiary to move from Original Medicare to an MA plan?(Required) October 15 through December 7 January 1 through April 15 January 1 through March 31 Between six and twelve months after losing employer group coverage All of the above 7) Which of the following conditions would qualify an MA plan member to switch plans during a Special Enrollment Period (SEP) (more than one may be correct)?(Required) The member recently moved into a nursing home The member’s plan was terminated The member does not like his/her doctor The member is not satisfied with the plan The member has a change in permanent residence The member was recently admitted into the hospital 8) During a formal sales event held on October 5, an agent tells attendees, “You can enroll in Acme’s Gold Medicare Advantage HMO plan between October 15 and December 7, but the plan will not take effect until January 1. However, if you do not like the plan after you enroll, you have until March 31 to switch back to Original Medicare.” Following the presentation, the agent assists a couple in filling out an enrollment form for Acme’s Gold HMO plan and tells the couple that she will” hold on to it” until the October 15 enrollment date. Which of the following statements are true (more than one may be true)?(Required) The agent is not allowed to assist beneficiaries in completing their enrollment form The presenter provided incorrect Annual Election Period (AEP) information The agent is not allowed to accept an enrollment prior to October 15 The presenter provided incorrect Medicare Advantage Open Enrollment Period (MA-OEP) information. 9) True or False: Plans are expected to submit beneficiary responses to the race and ethnicity fields on all MA and Part D enrollments.(Required) True False Part III: Beneficiary Protections10) Mrs. Doe has decided to file a grievance because she feels that she was treated with disrespect while communicating with a plan’s customer services representative (CSR). What is the first step Mrs. Doe should take to file a grievance?(Required) File an appeal with the plan File an appeal with an Administrative Law Judge Contact the plans in writing or by telephone to file a grievance None of the above 11) For all MA plans, a dually eligible beneficiary will not have to pay cost-sharing for Medicare Part A and B services if they are in which of the categories below?(Required) QMB Full Benefit Dual Eligible (full Medicaid benefits) SLMB only QI QMB and Full Benefit Dual Eligible (full Medicaid benefits) onlyonly All of the above 12) For all MA plans, an enrollee that chooses to join a PDP will be automatically disenrolled from his/her current plan.(Required) True False 13) A Medicare beneficiary is eligible for a dual-eligible special needs plan (D-SNP) if:(Required) The individual is enrolled in any Medicaid category The individual has full Medicaid benefits The individual receives the Part D low-income subsidy (Extra Help) The individual meets the D-SNP specific eligibility criteria, including limits on categories of dual eligibility, enrollment in an affiliated Medicaid plan, and/or age restriction 14) A plan may end an enrollee’s membership if:(Required) The enrollee is away from the service area for more than 6 months and the plan doesn’t have a visitor/travel benefit The enrollee is no longer entitled to Medicare Part A or enrolled in Part B benefits For individuals enrolled in SNPs, the enrollee no longer meets the special needs status of the SNP (or deemed continued eligibility, if applicable) All of the above 15) When can a full-benefit dually eligible individual elect a HIDE SNP?(Required) Only during AEP During AEP or OEP In any month In any month, if they are currently enrolled or in the process of enrolling in the HIDE SNP’s affiliated Medicaid MCO Part IV: Communication and Marketing Regulations and Materials for Sales Agents/Brokers16) True or False: A state insurance department would like to investigate a sales agent that they suspect is violating Medicare communication and marketing regulations. The plan does not need to provide information because the agent is licensed and has followed the guidelines to date.(Required) True False 17) Which of the following is NOT considered a Third-Party Marketing Organization (TPMO)?(Required) A state licensed independent agent/broker A lead generated organization A member of the plan who speaks highly of the plan A marketing agency that develops content for multiple MA plans 18) True or False: CMS requires plans to record the names of all attendees attending their plan sponsored marketing/sales events.(Required) True False Part V: Agent and Broker Compensation19) A beneficiary enrolled into Acme Health Plan in November 2024 as an initial enrollment. Assuming the beneficiary remains enrolled in the plan in 2025, in what month does their first renewal cycle begin?(Required) December 2024 January 2025 November 2025 December 2025 20) If a beneficiary who is a member of an MA plan enrolls in a different MA plan offered by another organization during the middle of an enrollment year, and the new organization does not use agent and brokers, which of the following statements are true?(Required) The new organization would continue to make payments to the enrolling agent from the previous organization. The initial organization would continue to pay the enrolling agent for one full renewal cycle. The new organization will not pay compensation to any agent or broker for the new enrollment and the organization offering the prior plan would have to recoup for the number of months the member was not in the plan. None of the above Part VI: Medicare Marketing Activities21) Mr. Smith, an agent with ACME Health Plan, is giving a sales presentation and wants to provide some food for his guests. What can Mr. Smith provide?(Required) A sit-down meal offered in a separate room, before or after the promotional portion of the event A buffet dinner Snacks such as cheese and crackers None of the above 22) In which of these situations must a Scope of Appointment form be collected at least 48 hours prior to the interaction between the agent and the individual with Medicare?(Required) A formal marketing event that a beneficiary did not pre-register to attend A one-on-one appointment occurring in the beneficiary’s home on November 3rd An unscheduled meeting with a beneficiary who arrives at an agent’s office without an appointment and requests information A person with Medicare calling in to a sales agent for the first time Both a formal marketing event that a beneficiary did not pre-register to attend and a person with Medicare calling in to a sales agent for the first time All of the above scenarios require a Scope of Appointment form be collected 23) All individual sales/marketing and enrollment calls between TPMOs and beneficiaries are required to be recorded.(Required) True False Part VII: Community First Medicare Advantage Plan24) What is the name of the Community First Plan?(Required) Bluebonnet Lone Star Alamo Mission 25) Community First Medicare Advantage Alamo D-SNP HMO Plan is offered in how many counties?(Required) 5 1 8 3 26) What year was Community First Medicare Advantage Plan established?(Required) 2018 2019 2020 2021 27) Community First Medicare Advantage Plan utilizes Envolve third-party vendor for dental and vision benefits?(Required) True False Δ
