2025 BayCarePlus Medicare Certification ExamBy Brian Platte / August 19, 2024 1) True or False. BayCarePlus is serving the following counties in 2025: Pasco, Pinellas, Polk, and Hillsborough. True False 2) True or False. All BayCarePlus Plans have Pharmacy Deductibles. True False 3) True or false. To prevent misleading beneficiaries, the Centers for Medicare and Medicaid Services (CMS) is limiting the use the Medicare card image in marketing and communication materials and is requiring all third-party marketing organizations and agents to send an email to CMS requesting approval to use the Medicare card image prior to use. Failure to attain approval could result in penalty. True False 4) True or false. A member tells a producer that she takes a 10 mg capsule. On the formulary it says only tablets are covered. Should the producer advise the member that her specific medication and dosage is covered? Yes No 5) If you receive notice that a member has filed a complaint against you, what would be the best action for you to take if that member calls you while it is under investigation? A) Refuse the call B) Answer and tell the member you cannot speak to them. C) Answer and tell them to call customer service D) Answer the call, listen to the member inquiry, and three-way call Customer Service for the inquiry to be handled. Do not mention anything regarding the complaint 6) True or False. Every enrollment submission requires a Scope of Appointment and Agent Checklist. These documents can be attached to electronic applications or mailed directly to headquarters using the prepaid postage in the back of the enrollment kit. True False 7) While Mrs. Gonzalez is visiting her daughter in California. She has chest pains and is admitted to a hospital. Her daughter calls you and asks if her mom is covered even though she is out of network. What do you tell her? A) Yes, she is covered at any emergency room worldwide B) No, she is not C) Her mother must drop her plan and pick up Medicare so that she is covered D) Her mother must return to her home region to receive care. 8) True or False. BayCarePlus plans have a preferred pharmacy. True False 9) BayCarePlus has an annual voluntary retention rate of what? A) Less than 60% B) Between 60% and 70% C) Between 70% and 80% D) Close to 90% 10) True or False. Insulin is covered under the medical benefit (Part B) when it is given through a durable medical equipment pump. True False 11) When a member asks a producer whether a physician is a participating provider (in network provider), what is the best action for a producer to take? A) Check the Provider website B) Call the Provider office C) Ask the Member D) Review the most up-to-date online Provider Directory available on BayCarePlus.org 12) When an existing member asks their producer when they can opt-in to the optional supplemental benefit for comprehensive dental, what should the producer say? A) Call producer support B) Call the Provider office C) Call 1-800-MEDICARE D) Existing members can only enroll during the Annual Enrollment Period 13) Mr. Barwick normally gets 180 pills in a bottle from his previous plan. He switched to BayCarePlus and is now being told he can only get 90 pills per fill. You checked to make sure the medicine is on the formulary. What could be the issue? A) Medicine is too expensive, so the plan lowered the quantity automatically B) Medicine is covered but has a Quantity Limit (QL) restriction that requires documentation from his PCP before he can get a larger quantity. C) Plan requires his PCP to submit his previous medical records to get the old amount filled D) Plan does not work with this pharmacy, and he must use another pharmacy to get the full amount 14) True or False. BayCarePlus implemented a new enrollment portal for AEP 2024. Producers and members will continue to enroll for AEP 2025 new policies using the same EvolveNXT portal. True False 15) True or false. BayCare Medical Group (BMG) primary care physicians will call their new patients to schedule their first appointment within 14 days of their enrollment date. True False 16) If a member asks the producer which type of plan BayCarePlus carries, the producer should say: A) Medicare Advantage HMO Plans B) Medicare Supplement plans C) Original Medicare D) A government endorsed plan 17) When filling out the application, what resource should a producer use to check the correct spelling of a member’s name? A) Whatever the member says is the spelling of his/her full name B) The spelling of their name on their red, white, and blue Medicare card C) The spelling of the members name per the Member spouse D) The spelling on the member driver’s license 18) If a producer wants to register a sales event with the health plan, what should they do? A) Tell their upline B) Email the health plan manager with the date/time/location of event for approval C) Do not tell anyone D) Call producer support 19) True or False. BayCarePlus’ 2024 CMS STAR Rating is 4.0 STARS. True False 20) Agents have access to an online storefront where they can download application forms, order enrollment kits, and order approved customizable materials (T65 Letters, 5-STAR flyers, post cards, etc). True False 21) What is the BayCare Bucks™ debit card? A) A debit card that allows members to pay for their utilities. B) A debit card with money preloaded that allows members to pay for the over-the-counter and grocery products, via the S3 network. C) A debit card that allows members to buy Starbucks®. D) A debit card that allows members to pay their medical bills. 22) True or False: Continuing in 2025, BayCarePlus will pay producers for completing an HRA with new members. True False 23) All agents are required to discuss which of the following when beginning the enrollment process? A) What kind of health plan the beneficiary wishes to enroll in. B) Check to see if the beneficiaries’ providers are in network and prescription drugs are on the formulary. C) Review premiums, including the Part B premium, copays and cost-shares. D) All of the above, plus other CMS requirements. 24) True/False: BayCarePlus has a zero-tolerance policy around sales agents using profanity, aggressive or hostile behavior to team members (customer service, producer support, or BayCarePlus members). Producers understand that their annual contract and appointment with BayCarePlus can be terminated for unprofessional behavior. True False 25) As a representative of BayCarePlus, which of the following BayCare values are you responsible for upholding? A) Trust B) Dignity C) Respect D) Responsibility E) Excellence F) All of the above ResultsVote
