2025 Highmark MA Certification ExamBy Brian Platte / July 28, 2024 Highmark offers MA/MA-PD/PDP products in: Pennsylvania, West Virginia, Delaware and Virginia Maryland, Pennsylvania, West Virginia, and Virginia Pennsylvania, West Virginia, New York and Delaware New Jersey, Pennsylvania, and West Virginia All of the above Dual Special Needs Plan (D-SNP) Diamond plan refers to which beneficiaries? Those with Diabetes Those with two chronic conditions Those who need drug benefits Those with Medicare and Medicaid Highmark Wholecare offers its Diamond and Ruby plans in 2025 in the following state(s): Pennsylvania and Delaware New York and Pennsylvania Delaware and West Virginia Pennsylvania In 2025, Highmark Health Options Duals Diamond plan is available in which state? Pennsylvania New York Delaware West Virginia Highmark Health Options Duals Diamond plan is a Full Dual plan. True False The annual Part D out-of-pocket threshold for 2025 will be capped at: $1,000 $2,000 $3,000 $4,000 There is extra assistance available for Medicare beneficiaries who have low incomes. Producers should educate the Medicare beneficiary to contact the Social Security Administration regarding low-income assistance. True False The member is responsible for the emergency care copayment regardless of whether they are admitted to the hospital or not. True False Highmark does not have a mail order prescription drug plan. True False All of the following are examples of drug utilization management tools except: Prior Authorization Quantity Limits Step Therapy Generic Substitution Pharmacist Monitoring Highmark will generally cover the drugs listed in the Formulary as long as: The drug is medically necessary The drug is used for its FDA-approved purpose The prescription is filled at a network pharmacy or mail order service Other coverage rules are followed All of the answer listed Highmark Members can contact Member Services for any of the following except: General inquiries regarding their plan benefits. Concerns or problems getting services they believe are covered. To get directions to their doctor's office. Concerns or problems getting their Part D prescription benefits. The amount that a member pays for a prescription depends only on the type of drug that a member is purchasing. True False Producers can begin accepting enrollment applications for the Annual Enrollment Period starting October 1st. True False The requirements to enroll in an MA-PD are: Must be entitled to Medicare Part A Continue paying the monthly Part B premium Must live within the plan's service area Must complete the enrollment form during an applicable enrollment period All of the answers listed Producers must submit all enrollment forms within 48 hours of their receipt of the application. True False What documents are included in the post-enrollment package that is mailed to the member after their enrollment is processed? Member's Plan ID Card An Acknowledgment Letter Evidence of Coverage Mail Order Pharmacy Forms All of the answers listed Commissions will not be paid on enrollment forms submitted without the correct agent NPN and Name. True False Producers should encourage Members to let Highmark know right away if they have questions, concerns, or problems related to their covered services or the care received. True False During the Annual Enrollment Period, what is the first date producers can accept and submit enrollment applications to Highmark? October 1 October 15 October 30 December 7 A Special Election Period form should be completed for and submitted with all enrollment applications with the exception of enrollments that qualify for the Annual Enrollment Period. True False Producers are required to retain Scope of Appointment documentation for a period of ____________. 10 years plus the contract year 7 years 2 years plus the contract year 6 months Which of the following is true about taking online enrollment applications? Online enrollment applications can be completed during a face to face meeting. Producers can enter completed paper enrollment applications into the online enrollment tool. Online enrollment applications cannot be completed via telephone. All of the above are true. Producers are not allowed to distribute materials and training tools that have not been approved by CMS to beneficiaries. True False PPO Plans include coverage for Out of Network benefits. True False Producers are allowed to alter CMS approved marketing materials. True False What is the last day that a producer can submit an enrollment application to a plan during AEP? October 15 November 30 December 7 December 31 Producers are required to take the Medicare and plan specific training: Annually Only at the time of appointment Every other year Which of the following is not a requirement for DSNP enrollment eligibility? Required to live in a service area Entitled to Medicare Part A and enrolled in Part B Enrolled in a State Medicaid Program Under the age of 18 Medigap Policies typically help lower a beneficiary's Out-of-Pocket Costs. True False Generally, it is illegal to sell a Medigap Policy to a beneficiary in which of the following situations: Beneficiary is in a Medicare Advantage plan Beneficiary has Medicaid Beneficiary already has a Medigap policy All of the above Medigap Policies are only standardized in 3 states. True False Medigap Premiums vary by plan letter and organization. True False What is the naming convention used for standardized Medigap Plans? Determined by the Organization Letters (A, B, C) Platinum, Gold, Silver & Bronze None of the above Vision care, dental care, hearing aids, and private-duty nursing are usually benefits that are __________ in Medigap Plans. Included Not Included There is a 6-month Medigap Open Enrollment Period (OEP) when insurance companies must allow beneficiaries to purchase plans. True False Which of the following is a true statement? A beneficiary in an MA-PD can also enroll in a stand-alone Prescription Drug Plan All Medigap policies cost the same Medicare Advantage members don't need a Medigap policy None of the above Medicare eligibles over the age of 65 can purchase any Medigap Plan they want at any time. True False Under federal law, it is a beneficiary's right to switch Medigap Plans: During the Medigap open enrollment period If they have a guaranteed issue right If they move out of their Medigap SELECT service area All of the above If the appointment did not result in a sale, the producer does not need to retain a copy of the Scope of Appointment document. True False What are the enrollment periods for D-SNP? IEP and AEP IEP, AEP, and SEP AEP SEP ResultsVote
