AHIP North Carolina 3 — Questions and Answers
Question 1: A North Carolina agent is compensated for helping a beneficiary switch from one Medicare Advantage plan to another. Which compensation rule applies?
- The agent receives a new initial enrollment commission
- The agent receives a renewal commission rate for the switch (Correct answer)
- The agent receives no compensation for plan-to-plan switches
- Compensation is determined solely by the state of North Carolina
Correct answer: The agent receives a renewal commission rate for the switch
CMS rules require that plan-to-plan switches (internal or external) be compensated at the renewal rate, not the higher initial enrollment rate.
Question 2: What is the primary purpose of North Carolina's SHIIP (Seniors' Health Insurance Information Program)?
- To sell Medicare Advantage plans to seniors
- To provide free, unbiased Medicare counseling to beneficiaries (Correct answer)
- To regulate agent licensing in the state
- To administer the state Medicaid program
Correct answer: To provide free, unbiased Medicare counseling to beneficiaries
SHIIP is a free state program staffed by trained volunteers who provide objective Medicare and health insurance counseling to North Carolina seniors.
Question 3: A North Carolina Medicare beneficiary is dual-eligible (Medicare and Medicaid). Which plan type is specifically designed to coordinate their benefits?
- Medicare Supplement Plan G
- Dual Eligible Special Needs Plan (D-SNP) (Correct answer)
- Part D stand-alone prescription drug plan
- Medicare Savings Account (MSA) plan
Correct answer: Dual Eligible Special Needs Plan (D-SNP)
Dual Eligible Special Needs Plans (D-SNPs) are designed to coordinate Medicare and Medicaid benefits for beneficiaries who qualify for both programs.
Question 4: Under North Carolina regulations, how must a Medicare Advantage agent document a telephonic enrollment?
- No documentation is required for phone enrollments
- The agent must record the call with the beneficiary's verbal consent (Correct answer)
- The agent must mail a paper SOA within 3 days
- The agent must submit a written attestation only
Correct answer: The agent must record the call with the beneficiary's verbal consent
For telephonic enrollments, CMS requires a recorded call confirming the beneficiary's enrollment request, with the recording retained as documentation.
Question 5: A North Carolina beneficiary loses employer group health coverage mid-year. What type of Medicare enrollment period does this trigger?
- Annual Enrollment Period
- Open Enrollment Period
- Special Enrollment Period (Correct answer)
- Initial Enrollment Period
Correct answer: Special Enrollment Period
Losing employer group health coverage is a qualifying life event that triggers a Special Enrollment Period (SEP) allowing Medicare enrollment outside standard windows.
Question 6: Which statement about Medicare Supplement Plan N in North Carolina is accurate?
- Plan N covers 100% of Medicare Part B excess charges
- Plan N requires copays for some office and emergency room visits (Correct answer)
- Plan N is only available to beneficiaries under age 65 with disabilities
- Plan N includes routine dental and vision coverage
Correct answer: Plan N requires copays for some office and emergency room visits
Medigap Plan N has cost-sharing in the form of copays for physician office visits (up to $20) and ER visits (up to $50 if not admitted), and does not cover Part B excess charges.
Question 7: What is the maximum number of consecutive months a North Carolina beneficiary can be enrolled in a Medicare Medical Savings Account (MSA) plan before they must re-enroll?
- 12 months
- 24 months
- 36 months
- MSA plans have no re-enrollment requirement; enrollment continues automatically (Correct answer)
Correct answer: MSA plans have no re-enrollment requirement; enrollment continues automatically
Medicare MSA plan enrollment continues automatically year to year unless the beneficiary actively disenrolls or switches during an enrollment period.
AHIP North Carolina 3
A North Carolina agent is compensated for helping a beneficiary switch from one Medicare Advantage plan to another.
Which compensation rule applies?