AHIP North Carolina 4 — Questions and Answers
Question 1: 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?
- Distributing plan-specific brochures with premium information (Correct answer)
- Handing out general Medicare fact sheets
- Displaying the plan's logo on a banner
- Providing a sign-in sheet for attendees
Correct 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.
Question 2: North Carolina's Medicaid managed care program that coordinates services for dually eligible Medicare beneficiaries is known as:
- NC Health Choice
- Carolina Complete Health (Correct answer)
- Healthy Connections
- NC Medicaid Direct
Correct 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.
Question 3: Which CMS marketing rule applies when a North Carolina agent wants to send a mailer promoting a Medicare Advantage plan to prospective enrollees?
- Mailers require prior written permission from each recipient
- Mailers must be submitted to CMS for approval before distribution
- Mailers are prohibited within 30 days of AEP
- Agents may not use unsolicited door-to-door marketing but may send mailers (Correct answer)
Correct 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.
Question 4: 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?
- Medicare Part A hospital deductibles
- Medicare Part B premiums only
- Prescription drug costs including premiums, deductibles, and copays (Correct answer)
- Long-term care facility costs
Correct 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.
Question 5: Under CMS rules, what must a North Carolina Medicare Advantage organization do if it terminates a provider from its network mid-year?
- Immediately remove the provider from the plan directory without notice
- Notify affected enrollees within 30 days and provide a list of alternative providers (Correct answer)
- Cancel coverage for all enrollees who used that provider
- Terminate the plan's contract with CMS
Correct 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.
Question 6: Which situation qualifies a North Carolina Medicare beneficiary for a Special Enrollment Period to enroll in a Part D drug plan outside of AEP?
- Voluntarily dropping prior creditable coverage
- Moving to a new address within the same county
- Losing creditable prescription drug coverage involuntarily (Correct answer)
- Deciding Original Medicare no longer meets their needs
Correct 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.
Question 7: A North Carolina beneficiary with End-Stage Renal Disease (ESRD) diagnosed before 2021 wants to join a Medicare Advantage plan. What rule applies?
- They may enroll in any MA plan without restriction
- They are generally prohibited from enrolling in MA plans and must use Original Medicare (Correct answer)
- They may only enroll in a Special Needs Plan (SNP) for ESRD
- They must first obtain a waiver from the North Carolina Department of Insurance
Correct 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.
AHIP North Carolina 4
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?