2025 BCBS of Arizona Medicare Certification Exam

Question 1

When must you state, "Currently, we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. You can always contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) for help with plan choices."?

During the enrollment process, prior to submitting an enrollment.

When a beneficiary completes the Scope of Appointment (SOA) form.

Within 60 seconds of an appointment/call.

Within 48 hrs of completing an enrollment.

Question 2

An Enrollee must notify the health plan if he/she has permanently moved out of the service area.

True

False

Question 3

Certain formulary prescriptions may be subject to limitations. These limitations include which of the following?

Step Therapy

Prior Authorization

Quantity level Limits

All of the above are types of limitations

Question 4

Joan is a snow bird and only lives in AZ 8 months at a time. Can she enroll in an AZ Blue Medicare Advantage plan?

She can if she has a permanent residence in AZ and has a home address.

Members have to live in their plan state 100% of the time they are on the plan.

The enrollee only need a PO Box to proove they reside in AZ.

Question 5

For 2025 , what is the Part D Initial Coverage Limit for all AZ Blue Medicare Advantage Plans?

3820

5030

There is no initial coverage limit and the three phases of coverage for 2025 are annual deductible, initial coverage, and catastrophic coverage

Question 6

Information, plan documents, forms and the online enrollment for can be found on all AZ Blue Medicare Advantage plans by going to AZ Blue.com/Medicare.

True

False

Question 7

In 2025, once the beneficiary's True-Out-Of-Pocket costs reach $2000, the catastrophic stage begins.

Part D Medications will no longer be covered and the beneficiary will need to purchase a free standing Prescription Drug Plan

Beneficiaries will pay full price for their Part D medications.

The beneficiary will pay $0 for the remainder of the year for Part D drugs.

Question 8

A producer may take an individual's word that he/she is the "authorized representative" and complete that portion of the enrollment request.

True

False

Question 9

A beneficiary is on a prescription drug that is not on her plan's formulary. How can she try to get this drug covered?

By submitting a request to CMS

By requesting a formulary exception

By signing up for Medication Therapy Management (MTM)

The beneficiary doesn’t have any options

Question 10

How much is the yearly Medicare Part D Deductible in 2025 for the Classic plans?

0

590

1000

800

Question 11

If a beneficiary enrolled in a AZ Blue MA HMO plan says she wants to see a specialist, you should tell her-

A referral from their PCP would be required to see a specialist.

The AZ Blue Advantage Blue Best Life Classic and Plus HMO plans DO NOT require a referral to see a specialist.

You do not need to see a specialist

ALL the above

Question 12

Which prescription drugs are not included when calculating a member's "True Out-Of-Pocket (TrOOP) cost( $2000)

Tier 1 Drugs

Tier 2 Drugs

Medicare Part D excluded Drugs

Specialty Drugs

Question 13

Lee is a 28 year old Medicare beneficiary who is disabled and wants to enroll in an AZ Blue Medicare Advantage plan. She is enrolled in Original Medicare and lives in Pima county. Which of the following makes Lee eligible to enroll in the plan.

Must be entitled In Medicare Part A

Must permanently reside in the AZ Blue Medicare Advantage service area.

Must be enrolled in Medicare part B

All of the above

Question 14

Upon receipt of the paper Enrollment form, producers have 10 days to enter and submit the information online.

True

False

Question 15

Telephonic enrollments must be recorded using a CMS-compliant script to ensure that beneficiaries understand that they are:

Being recorded and that they are completing an enrollment form

Attesting to the accuracy of required elements

Attesting to their intent to enroll

All of the above

Question 16

A Beneficiary whose MA plan terminates is entitled to choose another MA Plan?

The beneficiary whose MA Plan terminates is entitled to a special election period (SEP) that allows them to make a one-time enrollment request into a new plan.

The beneficiary is required to go back to Original Medicare until the next AEP.

The beneficiary can only change to an out of state MA plan.

The beneficiary can change as many times as they want to during the year.

Question 17

Which of the following are common errors on an enrollment request?

Missing or incorrect date of Birth

Not listing Complete Physical or Mailing address

Plan option not selected

All of the above

Question 18

When must a Scope of Appointment (SOA) form be obtained?

48 hrs prior to a scheduled appointment

Within 24 hrs of enrolling the beneficiary

Within 48 hrs of enrolling the beneficiary

Within 3 days after a scheduled appointment with a beneficiary

Question 19

A producer can get a beneficiary's permission to sign on the enrollment request if the beneficiary is not available.

True

False

Question 20

How can you check AZ Blue Medicare Advantage plan coverage for a specific drug for a beneficiary?

Go to Medicare.gov, follow the steps to enter the drugs you want to look at and then click the plan name

Go to azblue.com/Medicare

Look in the plan's printed formulary booket

All of the above

Question 21

Once a selected plan option is effective, the enrollee must remain on the plan for the remainder of the calendar year, unless they are eligible for a Special Election Period or the Medicare Advantage Open Enrollment Period (OEP).

True

False

Question 22

Enrollment in a AZ Blue Medicare Advantage, or a Cost plan or a Drug plan during a valid enrollment period automatically disenrolls the enrollee from another Medicare Advantage plan but not from a MediGap Policy.

True

False

Question 23

Roy is a beneficiary with Veterans Affairs (VA) prescription drug benefits. What advice would you provide to Roy while consulting with him?

That he should review his coverage options carefully.

Drugs covered by the VA are not eligible for additional coverage under Medicare Part D plans.

VA and employer or Union group benefits are usually considered creditable prescription drug coverage.

All of the above

Question 24

Which of the following is an enrollment application "DO"?

Hold and batch enrollment requests

Mail paper enrollment forms via the United States Postal Service (USPS) regular mail

Hold an Enrollment request for a future effective date

Keep original applications, SOA forms and a copy of all confirmation sheets (Fax, online, overnight) for the current year plus 10 years (11 years total) for verification

Question 25

What types of plans does AZ Blue offer in Maricopa and Pinal counties?

ALL of the plans

Only Classic HMO and Plus HMO plans

AZ Blue does not cover any plans in those counties

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