Johns Hopkins Medicare Certification ExamBy Brian Platte / August 2, 2024 You meet with Mrs. Carmen who is aging into Medicare and currently has an employer plan. She wants to enroll in the Advantage MD PPO plan. She asks you if it is the same as a Medicare Supplement plan. What should you do? Let her know Medicare Advantage plans are almost identical to Medicare Supplement plans so she will not know the difference. Let her know that Medicare Advantage plans are not the same as Medicare Supplement plans and go over the differences with her. Tell Mrs. Carmen that Medicare Advantage plans are the best and she does not need to worry about her other options. Your prospect is requesting to enroll in the Advantage MD supplemental dental rider. They ask if there is a waiting period for the benefits to begin. What should you tell them? There is no waiting period. Advantage MD has a three-month waiting period. There is a one-time six-month waiting period for the benefits to kick in. You are providing a Sales Seminar at the public library and while explaining the PPO plan you tell the audience the the carrier's plan is the "highest rated" plan in the county. Since this is the only plan in the area are you compliant in this statement? Yes No You are giving a presentation to Mr. and Mrs. Thompson. They are both physically and mentally able to sign the enrollment application. Mrs. Thompson gets up during your presentation because she is tired and goes to bed. Mr. Thompson says it is ok he will sign for his wife. What should you do? Ask to come back when both parties are available and able to sign and you can do another presentation. Let Mr. Thompson sign the enrollment application since he is Mrs. Thompson legal spouse. Tell Mr. Thompson to sign as Power of Attorney for Mrs. Thompson. You meet with Mr. Simmons on Dec. 10 because he was unable to meet with you during the Annual Enrollment Period due to a death in the family. He really wants the PPO plan you represent. What should you do? Since it was due to a death in the family, ask for proof and enroll him in the requested plan. Do not enroll Mr. Simmons at this time unless he has a Special Election Period available to him. Ask Mr. Simmons to write a hardship letter and then enroll him in the plan you represent. You meet with Mrs. Magellan and she is deciding between Advantage MD's two PPO plans. She wants to know which plan gives her the most prescription drug coverage. She hit the donut hole last year in July and does not want to hit it in 2025. There has been no change in her medications. What can you tell her? You tell her that both plans are so rich in benefits that she will not enter into the donut hole in 2025. You should tell her that the donut hole is going away in 2025. The higher priced PPO gives her more retail drug coverage and therefore will keep out of the donut hole. Mr. Stevens loves the Advantage MD PPO plans you represent. He needs to get dentures in the next 8 months. He wants to sign up for a plan that will help in some of the costs associated with that procedure. What should you tell him? Explain to Mr. Stevens that PPO does cover dentures with an embedded comprehensive dental allowance of $1,000. Also, mention that the PPO Plus plan does not offer comprehensive dental coverage but does offer an optional supplemental dental rider with denture coverage. Let Mr. Stevens know the Advantage MD PPO Plus Plan will cover 50% of the cost up to a maximum amount of $1,000. Explain to Mr. Stevens that the Advantage MD Plan will not cover this expense unless his dentist gets prior authorization first. A new Medicare beneficiary wants to enroll in your plan when she turns 65 in October. She currently has coverage through her employer. She calls you in August and says she is retiring at the end of September. You meet with her on Sept. 15 and enroll her in a plan with an effective date of Oct. 1. Which election period should you use? ICEP - Initial Coverage Election Period AEP - Annual Election Period IEP - Initial Election Period You normally give a thank you gift to your clients after they enroll in one of your plans. What type of gift are you allowed to give to a Medicare beneficiary for enrolling in a plan with you? A $15 gift card to Best Buy Minor League baseball tickets No gifts are allowed as an inducement to enroll in Medicare Advantage plans. You are told by your manager to set up a Facebook page advertising Medicare Advantage so you can get some leads from prospective clients. When is the practice allowed by Johns Hopkins Health Plans? With prior authorization from Johns Hopkins Health Plans. It is never allowed to advertise on social media. As long as your manager says it is ok you can go ahead and do it. CMS guidelines dictate how to handle when two election periods overlap. Ms. White has diabetes, a chronic condition, and is turning 65 next month (November). Which election period should be used in this example? SEP ICEP AEP You are planning on scheduling two sales seminars during AEP and have cleared them through your FMO. You are going to discuss the Advantage MD PPO plans in the seminar. When is this allowed? As long as you have prior authorization from Johns Hopkins Health Plans, this will be ok. You only need your FMO's approval and you can go ahead and conduct the seminar. Never. Johns Hopkins Health Plans does not authorize any external agents to conduct sales seminars. You are meeting with a Medicare beneficiary on Oct. 15. They are turning 65 in January and need to enroll in a plan for Jan. 1. Which election period should you choose? AEP ICEP/IEP OEPI You go to a member's home to conduct a 1 to 1 sales presentation and have a Scope of Appointment completed ahead of time. When you arrive, you noticed the member has invited two of her friends to sit in on the presentation because they also need coverage. What must you do? Nothing. Because you have a scope for your potential member, you can go ahead and do your sales presentation to all of the attendees. You must have them all sign Scope of Appointment forms and reschedule your appointment for later in the week. You must have each of the other two guests sign a Scope of Appointment and list them as walk-ins. You can conduct your presentation to all parties at that point. Your potential member wants to enroll in one of your Advantage MD PPO plans and says she needs dentures. Which plan can she enroll in that will give coverage for this? The Advantage MD PPO Plus plan. PPO plan offers embedded comprehensive dental coverage and dentures are covered. PPO Plus plan with the full dental rider will provide coverage for dentures. Neither Plan offers denture coverage. Your client opts to enroll in the Advantage MD HMO plan. They ask if referrals are required every time they see a specialist. What should you tell them? No referrals are required Referrals are only required if the specialist is out of network. Referrals are required for all specialty visits. How does Advantage MD treat observation stays? Observation stays are treated as in-patient hospital stays. They are treated as partial hospital stays They are treated as outpatient services and the copay would vary based on the Advantage MD plan that the member has. You are presenting the Johns Hopkins Advantage MD plans to a prospect and they ask "What do I do if one of my medications is not covered by the plan?" What should you tell your client? Just pay cash for the medications. Tell your doctor to prescribe something else. The plan is required to cover your medication for 30 days while you and your doctor file an exception with the plan to get the medication covered or seek other medication options. Your prospect is interested in the HMO plan and they ask: "If I choose to go out of network, can I use my Medicare card for the service?" Yes, but you would need to make sure you pay your Part B deductible first. No, you could not use your Medicare card, and you would be responsible for the cost of the visit and any services they completed at the visit. If my prospect tells me their doctor is affiliated with a Hopkins hospital, does that mean they are in network? Yes, all providers that have hospital privileges with Hopkins are in network. No, not all providers who have rights at Hopkins are in network. You should look the provider up at www.hopkinsmedicare.com. ResultsVote
