AHIP North Carolina 4

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?

Accepted Answer

Distributing plan-specific brochures with premium information

Answer

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:

Accepted Answer

Carolina Complete Health

Answer

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?

Accepted Answer

Agents may not use unsolicited door-to-door marketing but may send mailers

Answer

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?

Accepted Answer

Prescription drug costs including premiums, deductibles, and copays

Answer

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?

Accepted Answer

Notify affected enrollees within 30 days and provide a list of alternative providers

Answer

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.

AHIP - America's Health Insurance Plans Practice Test

AHIP - America's Health Insurance Plans Practice Test

AHIP North Carolina 4