AHIP North Carolina 5

Question 1

A North Carolina agent receives a $50 gift card offer from a Medicare Advantage plan to give to any beneficiary who enrolls. What should the agent do?

Accepted Answer

Decline; CMS prohibits giving cash or gifts of more than nominal value to induce enrollment

Answer

CMS strictly prohibits offering cash or items of more than nominal value ($15 per item, $75 per year) to influence a beneficiary's plan selection.

Question 2

Which Medicare Supplement plan is the most comprehensive and covers virtually all out-of-pocket costs, but is only available to North Carolina beneficiaries who became eligible for Medicare before January 1, 2020?

Accepted Answer

Plan F

Answer

Medigap Plan F is the most comprehensive plan but was closed to newly eligible Medicare beneficiaries as of January 1, 2020; only those eligible before that date may purchase it.

Question 3

A North Carolina Medicare Advantage enrollee disputes a plan's denial of a medical service. What is the first formal step in the appeals process?

Accepted Answer

File a redetermination request with the MA plan

Answer

The first level of the MA appeals process is a redetermination, which is a formal review of the coverage denial conducted by the MA plan itself.

Question 4

Under CMS rules, within how many calendar days must a North Carolina Medicare Advantage plan respond to a standard (non-expedited) prior authorization request?

Accepted Answer

14 calendar days

Answer

CMS requires MA plans to respond to standard prior authorization requests within 14 calendar days of receiving the request.

Question 5

A North Carolina beneficiary is considering a Medicare Advantage MSA plan. Which statement about MSA plans is correct?

Accepted Answer

The plan deposits money into the beneficiary's savings account and has a high deductible

Answer

Medicare MSA plans combine a high-deductible health plan with a medical savings account funded by the plan, which the beneficiary can use for qualified medical expenses.

AHIP - America's Health Insurance Plans Practice Test

AHIP - America's Health Insurance Plans Practice Test

AHIP North Carolina 5