AHIP North Carolina 2 — Questions and Answers
Question 1: In North Carolina, which state agency is primarily responsible for regulating Medicare Advantage plans?
- North Carolina Department of Health and Human Services
- North Carolina Department of Insurance (Correct answer)
- North Carolina Division of Medical Assistance
- North Carolina State Health Plan
Correct answer: North Carolina Department of Insurance
The North Carolina Department of Insurance (NCDOI) regulates insurance products including Medicare Advantage plans sold in the state.
Question 2: A North Carolina beneficiary enrolled in a Medicare Advantage plan wants to switch to Original Medicare. Which enrollment period allows this outside of AEP?
- Open Enrollment Period (OEP) from January 1 to March 31 (Correct answer)
- Special Enrollment Period triggered by moving
- Initial Coverage Election Period only
- There is no such period; AEP is the only option
Correct answer: Open Enrollment Period (OEP) from January 1 to March 31
The Medicare Advantage Open Enrollment Period (OEP), January 1–March 31, allows MA enrollees to switch to Original Medicare or a different MA plan once.
Question 3: Which document must North Carolina agents provide to Medicare beneficiaries before discussing plan options at a sales appointment?
- Summary of Benefits
- Evidence of Coverage
- Scope of Appointment form (Correct answer)
- Annual Notice of Change
Correct answer: Scope of Appointment form
A Scope of Appointment (SOA) form must be completed before a sales appointment to document the topics the beneficiary agreed to discuss.
Question 4: Under North Carolina law, what is the 'free look' period that allows a new Medicare Supplement policyholder to cancel and receive a full refund?
- 10 days
- 30 days (Correct answer)
- 60 days
- 90 days
Correct answer: 30 days
North Carolina requires a 30-day free look period for Medicare Supplement (Medigap) policies, giving buyers time to review and return the policy for a full refund.
Question 5: A North Carolina resident turns 65 and enrolls in Medicare Part B. How long is their guaranteed issue window for a Medicare Supplement plan?
- 30 days
- 3 months
- 6 months (Correct answer)
- 12 months
Correct answer: 6 months
Federal law grants a 6-month Medigap Open Enrollment Period beginning the month a beneficiary is 65+ and enrolled in Part B, during which insurers cannot use medical underwriting.
Question 6: A North Carolina Medicare Advantage plan must provide emergency care coverage at which locations?
- Only within the plan's network
- Only within North Carolina
- Anywhere in the United States (Correct answer)
- Anywhere in the world
Correct answer: Anywhere in the United States
CMS requires all Medicare Advantage plans to cover emergency and urgently needed care anywhere in the United States, regardless of network.
Question 7: Which Part D cost-sharing feature protects North Carolina beneficiaries from catastrophic out-of-pocket drug spending each year?
- Initial coverage limit
- Coverage gap (donut hole)
- Catastrophic coverage threshold (Correct answer)
- Low Income Subsidy (LIS)
Correct answer: Catastrophic coverage threshold
Once a beneficiary's true out-of-pocket drug costs reach the catastrophic threshold, they pay minimal cost-sharing for the remainder of the year.
AHIP North Carolina 2
In North Carolina, which state agency is primarily responsible for regulating Medicare Advantage plans?