North Carolina Flashcards
7 cards from real AHIP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 North Carolina flashcards as text
A North Carolina agent hosts a Medicare educational event at a local library. Which activity turns this into a sales event requiring additional CMS compliance steps?
Answer: Distributing plan-specific brochures with premium information
Distributing plan-specific materials with benefit or premium details at what was announced as an educational event converts it into a sales/marketing event subject to CMS sales event rules.
North Carolina's Medicaid managed care program that coordinates services for dually eligible Medicare beneficiaries is known as:
Answer: Carolina Complete Health
Carolina Complete Health is one of the NC Medicaid managed care organizations that may serve dually eligible beneficiaries in North Carolina.
Which CMS marketing rule applies when a North Carolina agent wants to send a mailer promoting a Medicare Advantage plan to prospective enrollees?
Answer: Agents may not use unsolicited door-to-door marketing but may send mailers
CMS prohibits unsolicited door-to-door marketing and cold-call telemarketing but permits direct mail to prospective beneficiaries without prior permission.
A North Carolina beneficiary enrolled in a PDP (stand-alone Part D plan) asks about the Extra Help program. What does Extra Help primarily assist with?
Answer: Prescription drug costs including premiums, deductibles, and copays
Extra Help (Low Income Subsidy) reduces or eliminates Part D premiums, deductibles, and copays for qualifying low-income beneficiaries.
Under CMS rules, what must a North Carolina Medicare Advantage organization do if it terminates a provider from its network mid-year?
Answer: Notify affected enrollees within 30 days and provide a list of alternative providers
When a network provider is terminated, the MA organization must notify affected enrollees within 30 calendar days and offer assistance finding alternative in-network providers.
Which situation qualifies a North Carolina Medicare beneficiary for a Special Enrollment Period to enroll in a Part D drug plan outside of AEP?
Answer: Losing creditable prescription drug coverage involuntarily
Involuntary loss of creditable prescription drug coverage is a qualifying event that triggers a Part D SEP, allowing enrollment in a PDP or MA-PD plan.
A North Carolina beneficiary with End-Stage Renal Disease (ESRD) diagnosed before 2021 wants to join a Medicare Advantage plan. What rule applies?
Answer: They are generally prohibited from enrolling in MA plans and must use Original Medicare
Before the 21st Century Cures Act took full effect (2021), most beneficiaries with ESRD diagnosed prior to 2021 were excluded from standard MA plan enrollment; however, post-2021 law now allows ESRD patients to enroll in any MA plan.