AHIP North Carolina 3

Question 1

A North Carolina agent is compensated for helping a beneficiary switch from one Medicare Advantage plan to another. Which compensation rule applies?

Accepted Answer

The agent receives a renewal commission rate for the switch

Answer

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)?

Accepted Answer

To provide free, unbiased Medicare counseling to beneficiaries

Answer

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?

Accepted Answer

Dual Eligible Special Needs Plan (D-SNP)

Answer

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?

Accepted Answer

The agent must record the call with the beneficiary's verbal consent

Answer

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?

Accepted Answer

Special Enrollment Period

Answer

Losing employer group health coverage is a qualifying life event that triggers a Special Enrollment Period (SEP) allowing Medicare enrollment outside standard windows.

AHIP - America's Health Insurance Plans Practice Test

AHIP - America's Health Insurance Plans Practice Test

AHIP North Carolina 3