Broker Certification Exam


1 Private-Fee-for-Service (PFFS) plans differ from HMOs or PPOs in which of the following ways?

a) The member appeals process
b) There is no provider network
c) PFFS plans cannot charge deductible amounts
d) All of the above

2 PFFS plans are subject to the same eligibility requirements as other Medicare Advantage plans.
a) True
b) False

3 PFFS plans are subject to the same enrollment guidelines as other Medicare Advantage plans.
a) True
b) False

4 Which of the following are highlights of Health Net's Private-Fee-for-Service Pearl plan?
a) Pearl PFFS gives members freedom of choice—no provider network, no prior treatment authorization, no primary care physician designation, no physician referrals required
b) There is virtually no claims paperwork for the member
c) Members receive full benefits when they are traveling throughout the US. The PFFS plan benefits do not provide Worldwide coverage
d) All of the above

5 Which of the following are highlights of Health Net's Private-Fee-for-Service Pearl plan?
a) A dedicated Customer Service line
b) 2 plan designs, depending on service area
c) Can be offered to individuals and/or group retirees
d) All of the above

6 Physicians who accept Medicare assignment are permitted to charge PFFS members up to 15% over the amount paid by the plan.
a) True
b) False

7 Health Net Pearl members are not covered for outpatient prescription drugs unless they select a Health Net Orange plan, another PDP plan, or have other creditable coverage.
a) True
b) False

8 Employers who want to offer the Pearl plan to retirees can do so without restriction.
a) True
b) False

9 In 2007, Health Net will offer two Health Net Pearl, PFFS plan designs, an HMO and a Medicare Supplement look-alike (plan design availability is determined on a per county basis).
a) True
b) False

10 Independent producers who sell Health Net's Pearl plan will have a dedicated toll free phone number to call for service questions and needs.
a) True
b) False

11 When choosing a Part D Prescription Drug plan, beneficiaries have the option of choosing an MAPD or a stand alone PDP.

a) True
b) False

12 Which of the following are NOT Part D Prescription Drug plan eligibility requirements?

a) Have an income greater than 20,000 but less than 80,000
b) Must be eligible for Medicare Part A and/or Part B
c) Must reside in the plan's service area
d) B and C

13 Enrollment in a Prescription Drug plan is

a) Voluntary
b) Open to all Medicare eligible persons
c) Is restricted to those 65 years of age or older
d) A and B

14 “True Out of Pocket Costs,” TrOOP, includes

a) Any costs for drugs normally covered under the Medicare Prescription Drug Program, for which the member pays directly, and for which they are not reimbursed
b) Any amounts the member pays, but for which they are reimbursed by someone else, e.g. an employer

15 Some of the highlights of Health Net's Prescription Drug plans include

a) Small neighborhood pharmacy retailers and national chains
b) Home Infusion, Indian/Tribal/Urban (I/T/U) and long term care pharmacies
c) Mail order services through Express Scripts
d) All of the above

16 Some of the highlights of Health Net's Prescription Drug plans include

a) A robust pharmacy network
b) A dedicated Customer Service line
c) Multiple ways for a member to acquire their TrOOP
d) All of the above

17 Which of the following is NOT a choice of coverage for Medicare eligible persons?

a) MAPD and a stand alone PDP
b) MAPD
c) PDP
d) MA or Medigap and a stand alone PDP

18 At a minimum, private insurance companies offering Prescription Drug plans must

a) Must offer the standard benefits defined by CMS
b) May offer benefits that are as good as or better than the standard benefits defined by CMS
c) May integrate medical coverage with the drug benefit as a MAPD plan
d) All of the above

19 Medicare beneficiaries who do not meet the requirements for any special election periods may change plans how many times each year following the annual election period?

a) As many times as they want but only once per month
b) Twice between January 1 and May 15
c) Once between January 1 and March 31
d) None

20 Medicare is a national health insurance program for

a) Individuals age 65 or older
b) Individuals under age 65 who have been declared disabled
c) Individuals with End-Stage Renal Disease (ESRD)
d) All of the above

21 The correct definition(s) of Medicare is (are):

a) A federal health insurance program for the elderly, disabled, and persons diagnosed with ESRD.
b) A state funded program for the poor and medically indigent.
c) A health insurance program established by Congress.
d) Both A and C

22 Medicare Part C is the Medicare Advantage (MA) option, formerly Medicare + Choice, created by the Balanced Budget Act of 1997 to provide Medicare beneficiaries more health care options.

a) True
b) False

23 The Medicare Modernization Act (MMA), 2003

a) Established a regional PPO option beginning in 2006 (MA Regional plans)
b) Added a Part D prescription drug benefit allowing comprehensive drug coverage (Medicare Part D plans) for beneficiaries through private insurers
c) Renamed Part C from Medicare+Choice to Medicare Advantage (MA) beginning in 2004
d) All of the above

24 What does the term “Medicare Advantage (MA) Plans” mean?

a) Hospital Insurance
b) Medical Insurance
c) Medicare HMO, PPO, POS and PFFS plans
d) Plans which help fill in gaps in Medicare coverage

25 What does the term “Medigap Plans” mean?

a) Hospital Insurance
b) Medical Insurance
c) Medicare HMO, PPO, POS and PFFS plans
d) Plans which help fill in gaps in Medicare coverage

26 What does the term “Medicare Part A” mean?

a) Hospital Insurance
b) Medical Insurance
c) Medicare HMO, PPO, POS and PFFS plans
d) Plans which help fill in gaps in Medicare coverage

27 What does the term “Medicare Part B” mean?

a) Hospital Insurance
b) Medical Insurance
c) Medicare HMO, PPO, POS and PFFS plans
d) Plans which help fill in gaps in Medicare coverage

28 CMS stands for:

a) Central Medicare Standards
b) Consumer and Medicare Science
c) Centers for Medicare & Medicaid Services
d) Care Management System

29 When do Medicare benefits become available?

a) Medicare benefits become available at the beginning of the month in which the individual reaches age 65. This is true even if the individual is still working
b) Medicare benefits become available when the individual applies for Medicare and is approved by CMS
c) Medicare benefits become available once the person can no longer afford to pay for insurance on their own
d) Medicare benefits become available when an employer pays for Medicare benefits

30 Beneficiaries eligible to enroll in a Medicare Advantage Plan include:

a) The individual has Medicare Parts A and B
b) The individual lives in the health plan's service area
c) The individual has not been medically determined to have ESRD prior to enrollment
d) All of the above

31 How can an individual enroll in Medicare?

a) The individual will be automatically enrolled and will be notified 3 months prior to the individual's 65th birthday
b) If the individual is not eligible for Medicare, the individual can apply to Medicare by contacting their local Social Security Administration office and completing the necessary paperwork
c) Both A and B
d) None of the above

32 The Part D component of the MMA replaced the Drug Discount Card program in 1/1/2006

a) True
b) False

33 Medicare Private-Fee-for-Service, Medicare Advantage, Medigap, Health Savings Accounts are

a) Some of the options available to Medicare eligible individuals if offered in the area where the individual resides
b) Medicare Assistance programs
c) Were developed as part of the Part D component added in 1965
d) All of the above

34 Medicare only covers about half of typical health care costs

a) True
b) False

35 If an individual does not enroll in Part B during their Initial Enrollment period, they will have to wait until the next General Enrollment period to enroll.

a) True
b) False

36 Failure to enroll in Part B coverage when eligible may result in a 10% increase in Part B premium for each 12 month period the individual could have been enrolled but did not take it.

a) True
b) False

37 The General Enrollment periods for Medicare are held __________________ and Part B coverage starts on __________ of that year.

a) December 1st through February 28th; July 1st
b) January 1st through March 31st; July 1st
c) November 15th through January 1st; July 1st
d) October 1st through December 31st, July 1st

38 MA plans

a) Must cover at least the same benefits covered under Medicare Part A and Part B
b) Eliminate the need for Medigap plans as they generally cover many of the same benefits that a Medigap policy would cover
c) Automatically include a drug benefit
d) Both A and B

39 Medicaid is:

a) Only provided in California
b) Only covers immunizations for the elderly
c) Is a federal program that provides health insurance for categories of the poor and medically indigent
d) Only provided to wealthy beneficiaries

40 Identify the Medicare programs/plans that may be available to help beneficiaries with low-incomes, pay for prescription drugs and other benefits.

a) Limited Income Subsidy Program
b) State Pharmaceutical Assistance Programs
c) Special Needs Plans
d) All of the Above

41 PFFS (Private-Fee-for-Service) plans

a) Require the individual only see certain doctors or hospitals within their service area
b) Do not require the individual to have Medicare Part A and Part B to enroll
c) Allow a beneficiary to go to any doctor or hospital they want, as long as the provider they see agrees to accept the plan's pre-set fees, terms and conditions
d) Require the primary care physician determine when the individual can see a specialist

42 All privately insured MA plans may offer benefits in addition to those provided by Original Medicare.

a) True
b) False

43 All marketing materials for Medicare beneficiaries must be reviewed and approved by CMS prior to use.

a) True
b) False

44 Representatives can provide a clear understanding of the MA Plan by

a) Giving a complete presentation
b) Tailoring each presentation to each individual
c) Probing to ensure the enrollee understands the presentation
d) All of the above

45 Which of the following activities are NOT identified by CMS as “prohibited” marketing activities?

a) Discriminatory activities
b) Door-to-door solicitation
c) Probing to ensure the enrollee understands the presentation
d) Activities that misrepresent the MAO and or it's offerings

46 Medicare required marketing activities include

a) Offer the plan to all Medicare beneficiaries eligible to enroll
b) Provide Medicare beneficiaries interested in enrolling adequate written description of the organization's rules and other information necessary to make an informed decision
c) Use only marketing materials that have been approved by CMS
d) All of the above

47 Federal Regulation Disclosure requirements stipulate that all MA plans provide adequate written descriptions upon request on which of the following subjects?

a) Benefits under Original Medicare
b) Premiums in the service area
c) Benefits in the service area
d) All of the above

48 Claiming recommendation or endorsement by CMS of the MAOs plan or claiming the CMS recommends that beneficiaries enroll in the particular plan is

a) An acceptable marketing activity if done during a door-to-door solicitation
b) A prohibited activity because it misrepresents the MAO and CMS to the beneficiary
c) A prohibited activity because it discriminates against unknowing beneficiaries
d) An acceptable marketing activity to induce enrollment

49 It is allowable to make overstatements about the Plan's coverage provided it was intended to induce enrollment

a) True
b) False

50 Introducing the option to “cancel or disenroll if not fully satisfied” or “enroll on a trial basis” as a selling/closing technique

a) Is an acceptable activity
b) Is an acceptable activity if later followed by full disclosure
c) Is considered an activity meant to mislead, confuse, or misrepresent
d) None of the above

51 CMS allows plans to give Medicare beneficiaries nominal value gifts, provided that the plan offers these gifts whether or not the beneficiary enrolls in the plan. Nominal value is defined by CMS as an item having little or no resale value and which cannot be readily converted to cash. Generally nominal value gifts are worth $15.00 or less.

a) True
b) False
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