2014 - SST - SST Assessment

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2014 - SST - SST Assessment - Quiz

Questions and Answers
  • 1. 

    Use the following information to answer questions 6-9:There are three types of storage facilities: regular, warehouse and specialty. Listed below are the rules for deciding which type of storage to use. 
    • Regular or warehouse should be used for items that do not need special handling.
    • Special storage should be used for items that need special handling.
    • Warehouse storage should be used for items weighing over 200 pounds.
    • Regular storage should be used items weighing less than 200 pounds.
    • Special storage should always be used for storing hazardous materials.

  • 2. 

    Use the following information to answer questions 10-13:PLEASE MAKE SURE THE EMPLOYEES ARE PAID CORRECTLY:George Winters640-58-2253…. Kalispell, MT……. $42,102Louise Hamel324-72-2663……Croydon, PA……$37,700Is everything correct in “List to be checked”? Verify per column: List to be checked   NameSocial Security NumberAddressCommission1. George Witners640-58-7253Kalispell, MT$42,1202. Louise Hamel324-72-2663Croydon, PA$37,700

  • 3. 

    Essay Question: Give an example of a work situation where you have felt stress and were able to overcome it:

  • 4. 

    Use the following information to answer questions 33-35:Home health servicesHow often is it covered?Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) covers eligible home health services like intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and more. Usually, a home health care agency coordinates the services your doctor orders for you.Medicare doesn't pay for: 
    • 24-hour-a-day care at home
    • Meals delivered to your home
    • Homemaker services
    • Personal care
    Who's eligible?All people with Medicare who meet all of these conditions are covered: 
    • You must be under the care of a doctor, and you must be getting services under a plan of care established and reviewed regularly by a doctor.
    • You must need, and a doctor must certify that you need, one or more of these:
      • Intermittent skilled nursing care (other than just drawing blood)
      • Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally-predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition.
    • The home health agency caring for you must be Medicare-certified.
    • Your must be homebound, and a doctor must certify that you're homebound.
    You're not eligible for the home health benefit if you need more than part-time or "intermittent" skilled nursing care.You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.Note: Home health services may also include medical social services, part-time or intermittent home health aide services, medical supplies for use at home, durable medical equipment, or injectable osteoporosis drugs.Your costs in Original Medicare 
    • $0 for home health care services.
    • 20% of the Medicare-approved amount for durable medical equipment.
    Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren't covered by Medicare, and how much you'll have to pay for them. This should be explained by both talking with you and in writing. The home health agency should give you a notice called the "Home Health Advance Beneficiary Notice" (HHABN) before giving you services and supplies that Medicare doesn't cover.NoteTo find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like other insurance you may have, how much your doctor charges, whether your doctor accepts assignment, the type of facility, and the location where you get your test, item, or service.NoteYour doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them. 

  • 5. 

    Disclaimer: This assessment is intended to determine how well Benefit Advisors follow instructions along with basic Medicare and OneExchange knowledge.This is an open book assessment. You may use your resources but you may not discuss the test with your peers.

  • 6. 

    A customer said he is enrolled in a MAPD (UHC PPO) outside of OneExchange and does not know the exact name of the plan. To ensure you do not re-enroll the customer into the same plan, where should you check to get the plan name?

    • A.

      Use the customer's Medicare card information to look up his current plan on Medicare.gov.

    • B.

      Tell the customer to call the carrier

    • C.

      Tell the customer you cannot enroll him into an MAPD

    • D.

      Look in the SSC to see if we have enrolled him before. If not, then we can enroll him in any plan.

    Correct Answer
    A. Use the customer's Medicare card information to look up his current plan on Medicare.gov.
    Explanation
    To ensure that the customer is not re-enrolled in the same plan, it is suggested to use the customer's Medicare card information to look up his current plan on Medicare.gov. This will provide the exact name of the plan the customer is enrolled in, allowing for accurate enrollment without duplication.

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  • 7. 

    Durable medical equipment is covered under which part of Medicare

    • A.

      Part A

    • B.

      Part B

    • C.

      Part D

    • D.

      All of the above

    Correct Answer
    B. Part B
    Explanation
    Durable medical equipment is covered under Part B of Medicare. Part B covers medically necessary services and supplies, including durable medical equipment such as wheelchairs, walkers, and oxygen equipment. Part A covers hospital stays and inpatient care, while Part D covers prescription drugs. Therefore, the correct answer is Part B.

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  • 8. 

    To be eligible for a stand-alone PDP, the customer must be entitled to Part A and/or enrolled in Part B.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    To be eligible for a stand-alone PDP (Prescription Drug Plan), the customer must meet certain criteria. One of the requirements is that the customer must be entitled to Part A and/or enrolled in Part B. This means that the customer must either be eligible for Medicare Part A or enrolled in Medicare Part B in order to qualify for a stand-alone PDP. Therefore, the statement "To be eligible for a stand-alone PDP, the customer must be entitled to Part A and/or enrolled in Part B" is true.

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  • 9. 

    David Jack is turning 64, is Medicare disabled, and would like to enroll in AARP Secure Horizon MAPD in his area during the AEP.  He can make this change:

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    David Jack can make the change to enroll in AARP Secure Horizon MAPD during the AEP because he is turning 64, is Medicare disabled, and it is stated that he would like to enroll in the plan. Therefore, the statement "True" is the correct answer.

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  • 10. 

    It is June and my employer has just advised that I am losing my employer coverage December31st.  I can enroll in a plan effective 01/01/2015 during August 2014:

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The statement is false because the individual cannot enroll in a plan effective 01/01/2015 during August 2014. The individual's employer coverage is ending on December 31st, so they would need to find alternative coverage for the period between January 1st and December 31st of the following year.

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  • 11. 

    What type of storage would be used for equipment weighing 350 pounds?

    • A.

      Special

    • B.

      Warehouse

    • C.

      Regular

    Correct Answer
    B. Warehouse
    Explanation
    Warehouse storage would be used for equipment weighing 350 pounds because a warehouse is a large space specifically designed for storing and organizing heavy and bulky items. It has the capacity to accommodate heavy equipment and provides the necessary infrastructure, such as wide aisles, high ceilings, and sturdy shelving, to handle the weight and size of the equipment effectively. This type of storage ensures that the equipment is safely stored and easily accessible when needed.

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  • 12. 

    What types of storage would be used for a 50 pound box of dynamite?

    • A.

      Special

    • B.

      Warehouse

    • C.

      Regular

    Correct Answer
    A. Special
    Explanation
    A 50 pound box of dynamite would require special storage due to its hazardous nature. Regular storage may not have the necessary safety measures to prevent accidents or explosions. A warehouse could potentially be used if it is equipped with specific storage protocols for dangerous materials, but "special" is the most appropriate answer as it explicitly indicates the need for specialized storage.

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  • 13. 

    What type of storage would you use for a 5 gallon drum needing refrigeration?

    • A.

      Special

    • B.

      Warehouse

    • C.

      Regular

    Correct Answer
    A. Special
    Explanation
    For a 5 gallon drum needing refrigeration, a special type of storage would be required. Regular storage may not have the necessary temperature control to keep the drum refrigerated. Therefore, a special storage facility equipped with refrigeration capabilities would be the appropriate choice to ensure that the drum remains at the desired temperature.

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  • 14. 

    What type of storage would be used for machinery weighing 175 pounds?

    • A.

      Special

    • B.

      Warehouse

    • C.

      Regular

    Correct Answer
    C. Regular
    Explanation
    Regular storage would be used for machinery weighing 175 pounds because regular storage is typically designed to handle average-sized items and does not have any specific requirements or limitations. Since the weight of the machinery is not exceptionally heavy, it can be safely stored in regular storage without the need for any special accommodations or considerations.

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  • 15. 

    Both Employees’ names are listed correctly:

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
  • 16. 

    Both social security numbers are listed incorrectly:

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The statement "Both social security numbers are listed incorrectly" is false. This means that at least one of the social security numbers is listed correctly.

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  • 17. 

    Both Addresses are listed correctly:

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    The given statement suggests that both addresses are listed correctly. Since the answer is "True," it implies that both addresses are indeed listed correctly.

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  • 18. 

    One employee’s commission is listed inaccurately:

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    The given answer is "True" because it states that one employee's commission is listed inaccurately. This implies that there is an error in the commission listing for at least one employee.

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  • 19. 

    A customer calls to enroll and tells you their Medicare Part A and Part B effective dates are 12/01/2014.  Their birthday is 01/01/2015. Today’s date is October 15th 2014.  Priority Health is the Medicare Supplement carrier that they choose to enroll with. They have been informed their group coverage is ending on 11/30/2014 as they will then be Medicare eligible.You would… (Hint: always check the Carrier guides) 

    • A.

      Proceed with enrollment for 01/01/2015 effective date with Priority Health

    • B.

      Proceed with enrollment for 12/01/2014 effective date with Priority Health

    • C.

      Proceed with enrollment for 12/01/2014 effective date with a different carrier.

    Correct Answer
    C. Proceed with enrollment for 12/01/2014 effective date with a different carrier.
    Explanation
    The correct answer is to proceed with enrollment for 12/01/2014 effective date with a different carrier. This is because the customer's Medicare Part A and Part B effective dates are already set for 12/01/2014, and their birthday is on 01/01/2015. Therefore, they will be eligible for Medicare on 12/01/2014 and should enroll with a different carrier for that effective date.

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  • 20. 

    Read everything before answering the question.  I have nine lives and think of myself as royalty.  Though I can be fierce, I usually let others feed and pamper me.  I can be found out in the open or even indoors.  What am I?  You can find the answer by doing the following: take the word Coalition and write down each letter that is in the word, but do not repeat any letters more than once.  Now remove the first, third, and sixth letters.  Now take the first letter and move it between the third and fourth.  What is the answer?

    Correct Answer
    Lion, lion
  • 21. 

    Carefully read each step before doing anything:
    1. On a piece of scratch paper, write today's date in the top right hand corner.
    2. Write the answer to the following multiplication problem directly underneath the date:
    3. 6 X 5 = ?
    4. Write the name of the month that begins with the letter "D”.
    5. Add 15 to the answer you got on letter b, and write this new total directly underneath your answer for letter c.
    6. In the lower left hand corner of your scratch paper, write the names of your favorite movie and musical group.
    7. Just above your answer to letter e, write "This test is very easy."
    8. In the lower right hand corner of your test paper, draw a rectangle and inside the rectangle draw a five pointed star. The size of these drawings is not important.
    9. Directly above your answer to letter g, draw a row of three small circles. Once again, size is not important.
    10. Write the name of the first president of the United States on the back of your scratch paper anywhere you choose. If you don't know who this is, write your own name instead.
    11. Write the name of any country that begins with the letter "I" directly underneath your answer to letter b.
    12. Take the number of dwarfs in the Snow White story and add it to the number of bears in the Goldilocks story. Divide by 2. Write this total in the approximate center of your scratch paper.
    13. Think of a number between 1 and 50.  Double that number.  Add 20.  Add 6.  Subtract 17. Subtract 9. Divide by 2.  Write this number on your test paper directly underneath your answer to letter k.
    14. Now that you have carefully read all of the parts so far, and you have not carried out any of the actual work, skip the next two steps and go back and only complete letter d.
    15. The name of the first president of the United States is George Washington. He was president from 1789 until 1797. Add the two dates together to see if the total is less than 5000.
    16. You should not be reading the last step before the first, but now that you are here, you have just wasted some of the time you need to complete the question.

    Correct Answer
    December, december, "December", Dec, Dec., "Dec", "Dec."
  • 22. 

    My teammate is running behind returning from lunch and emails me for help.  She requests that I sign into ADP using her username and password and clock in for her.  I am a team player so I:

    • A.

      Tell them you would be happy to clock in for them once you’re done with your call, but when they arrive, tell them you were unable to get off the phone.

    • B.

      Log into their profile and clock them in, as they were only a few minutes away.

    • C.

      Explain that it would be unethical for you to clock in on their behalf.

    • D.

      Alert your supervisor about this request.

    • E.

      Options C and D

    Correct Answer
    E. Options C and D
    Explanation
    The correct answer is options C and D because it would be unethical to sign into ADP using someone else's username and password and clock in for them. This violates security protocols and can lead to potential legal and disciplinary consequences. Alerting the supervisor about this request is the right thing to do to ensure transparency and maintain professional integrity.

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  • 23. 

    During the situation analysis segment, the retiree stated they were interested in reviewing dental and vision options.  After selecting medical and Rx options, the retiree is ready to proceed to the applications segment, forgetting to evaluate dental/vision options.  I should:

    • A.

      Proceed with the current applications, after all they are probably worn out and ready to get off the phone.

    • B.

      Proceed with the current applications and if they happen to remember the dental and vision choices, tell them they can call back in and speak to the dental and vision enrollment team.

    • C.

      Remind them that they specified the desire to discuss dental and vision options. If they were still interested, you would review those options now.

    • D.

      Remind them that they specified the desire to discuss dental and vision options, but if they were tired of being on the phone, they could just call back at a later day to complete that enrollment with the dental and vision enrollment team.

    Correct Answer
    C. Remind them that they specified the desire to discuss dental and vision options. If they were still interested, you would review those options now.
    Explanation
    The retiree expressed interest in reviewing dental and vision options during the situation analysis segment. However, they forgot to evaluate these options after selecting medical and Rx options. The correct answer suggests reminding the retiree about their initial desire to discuss dental and vision options and offering to review those options now. This ensures that the retiree's preferences are addressed and allows them to make an informed decision about their dental and vision coverage.

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  • 24. 

    Mrs. Drake has called in to complete her enrollment into an Rx plan.  She takes a couple of drugs that are not on any plan’s formulary.  You ask her what she currently pays for the drugs and she responds with “I think it’s about $5.00.”  What should you do next?

    • A.

      Tell her she’ll pay a lot more this year because if the prices are not showing in your system they must be expensive drugs.

    • B.

      Go to Medicare.gov to see if the prices are listed. If they're not, explain that we do not show the price in our system and there's a possibility she will be responsible for the full cost of the drugs.

    • C.

      Tell her she will probably pay the same amount she’s been paying for the drugs. They are probably generics and since they are so inexpensive, she shouldn't worry too much about it.

    • D.

      Tell her our system has a lot of glitches but the drug is probably covered. If it's not, she can ask the pharmacy if they have a generic drug discount list so she doesn't have to pay full cost.

    Correct Answer
    B. Go to Medicare.gov to see if the prices are listed. If they're not, explain that we do not show the price in our system and there's a possibility she will be responsible for the full cost of the drugs.
    Explanation
    The correct answer is to go to Medicare.gov to see if the prices are listed. If they're not, explain that we do not show the price in our system and there's a possibility she will be responsible for the full cost of the drugs. This is the appropriate next step because checking Medicare.gov will provide accurate and up-to-date information on drug prices. If the prices are not listed, it indicates that the drugs may not be covered by any plan and the customer may have to pay the full cost. It is important to inform the customer about this possibility to manage their expectations and avoid any surprises.

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  • 25. 

    You have completed the analysis portion of the call, and recommended plans for the customer when they let you know they have to leave and won’t be able to complete the applications right now. You should:

    • A.

      Give them OneExchange’s contact information and ask that they call back as soon as possible to complete the applications and that any benefit advisor will be able to assist them

    • B.

      Give them your name and OneExchange’s contact information and ask that they call back and ask for only you to complete the applications

    • C.

      Tell them that they must complete the applications today for them to go into effect on time

    Correct Answer
    A. Give them OneExchange’s contact information and ask that they call back as soon as possible to complete the applications and that any benefit advisor will be able to assist them
    Explanation
    In this situation, the best course of action is to provide the customer with OneExchange's contact information and ask them to call back as soon as possible to complete the applications. By doing so, the customer can reach out to any benefit advisor who will be able to assist them. This ensures that the customer is aware of how to proceed and allows them to complete the applications at their convenience.

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  • 26. 

    Bob is a retiree from XYZ Corp. with $6000 (213d eligible expenses) of annual joint funding for him and his spouse. He will be losing employer group coverage on 10/31/2014. He lives in an Open Enrollment state and he is not required to enroll through OneExchange to gain his funding. Bob is also a veteran who lives 4.5 miles from the VA Hospital where he has gone for years. Bob’s wife is a retired government employee who also carries Bob on her group plan which has a $0 premium. Help him choose a plan:

    • A.

      Plan F $158 with a PDP

    • B.

      Plan N $118 with a PDP

    • C.

      High Deductible Plan F $79.00

    • D.

      PPO (MAPD) $50 with comprehensive dental and vision

    • E.

      None of the above - Advise the customer that he does not need to enroll through OneExchange

    Correct Answer
    E. None of the above - Advise the customer that he does not need to enroll through OneExchange
    Explanation
    Based on the given information, Bob is not required to enroll through OneExchange to gain his funding. Since Bob already has coverage through his wife's group plan with a $0 premium, he does not need to enroll in any of the listed plans. Therefore, the correct answer is advising Bob that he does not need to enroll through OneExchange.

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  • 27. 

    Marcel recently retired and would like to look at plan options that will meet her needs. She is in perfect health and doesn’t take any prescriptions. She’s always enjoyed having comprehensive coverage just in case she may need it. Her current plan has a $3500 deductible. She is eligible for a $900 HRA (all 213d eligible expenses). She has one doctor that she sees twice a year. Help her choose a plan:

    • A.

      Plan F $228 with a PDP

    • B.

      MAPD $20 / $2500 OOP Max

    • C.

      Cost Plan $179 (No Copays)

    Correct Answer
    B. MAPD $20 / $2500 OOP Max
    Explanation
    Marcel is in perfect health and doesn't take any prescriptions, so she may not need the comprehensive coverage provided by Plan F. The MAPD plan offers a low monthly premium of $20 and a maximum out-of-pocket limit of $2500, which means that Marcel's total expenses for the year will not exceed $2500. This plan also covers both medical and prescription drug costs. The Cost Plan has a lower premium of $179 but does not include copays, which means Marcel would have to pay for each doctor visit out-of-pocket. Therefore, the MAPD plan with a $20 premium and $2500 OOP Max seems like the best option for Marcel.

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  • 28. 

    Stress is always a bad thing:

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Stress is not always a bad thing. While chronic or excessive stress can have negative effects on both physical and mental health, some amount of stress can actually be beneficial. It can motivate individuals to perform better, increase focus and alertness, and help in dealing with challenging situations. Stress can also trigger the body's natural defense mechanisms and improve resilience. Therefore, it is incorrect to assume that stress is always a bad thing.

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  • 29. 

    Everyone feels stress at certain times:

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Stress is a natural response to various situations and can be experienced by anyone. It is a normal part of life and can be triggered by various factors such as work, relationships, or financial issues. Therefore, it is true that everyone feels stress at certain times.

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  • 30. 

    Stress affects those around you:

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Stress can have a significant impact on those around you. When you are stressed, it can affect your mood, behavior, and overall well-being, which can in turn influence the people in your environment. Your loved ones, colleagues, or friends may be affected by your stress through increased tension, irritability, or even changes in your relationships. Additionally, stress can also be contagious, meaning that if you are stressed, it may cause others to feel stressed as well. Therefore, it is important to manage stress effectively to maintain healthy relationships and promote a positive environment.

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  • 31. 

    Your stress levels would decrease if you had more effective time management:

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Having more effective time management can indeed decrease stress levels. When you manage your time effectively, you are able to prioritize tasks, set realistic goals, and allocate appropriate time for each activity. This helps in reducing the feeling of being overwhelmed and allows you to accomplish tasks in a timely manner. By having a better control over your schedule, you can also create time for relaxation and self-care, which further contributes to stress reduction. Therefore, it is true that having more effective time management can lead to decreased stress levels.

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  • 32. 

    Mrs. Martin is a retiree that has just moved from CO to TX (ZipCode: 78702) and wants to enroll into a Humana MAPD. Is her primary doctor, Dr. Patsy Jones MD, in the network with any Humana MAPD plans?

    • A.

      Yes, She accepts all Humana Plans

    • B.

      Yes, She accepts the PPO and PFFS but not the HMO

    • C.

      No, She doesn’t accept any plans with Humana

    • D.

      No, Unable to find the doctor at all

    Correct Answer
    B. Yes, She accepts the PPO and PFFS but not the HMO
    Explanation
    The correct answer is "Yes, She accepts the PPO and PFFS but not the HMO." This means that Mrs. Martin's primary doctor, Dr. Patsy Jones MD, is in the network with some Humana MAPD plans. Specifically, she accepts the Preferred Provider Organization (PPO) and Private Fee-for-Service (PFFS) plans, but not the Health Maintenance Organization (HMO) plan.

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  • 33. 

    Mr. Conner is a 64 year old retiree who just moved from FL to CA on 08/15/2014. His 65th birthday is in September and his group coverage ends 9/30/2014. Today's date is 8/25/2014. Which enrollment reason should be used to give his Medical and Rx coverage a 10/1/2014 effective date?

    • A.

      SEP – LEC

    • B.

      ICEP – Aging In

    • C.

      SEP – MOV

    • D.

      CA Birthday Rule

    Correct Answer
    A. SEP – LEC
    Explanation
    The correct answer is SEP - LEC. SEP stands for Special Enrollment Period, which allows individuals to enroll in or make changes to their health insurance plans outside of the regular enrollment period. LEC stands for Loss of Employer Coverage. In this case, Mr. Conner's group coverage ends on 9/30/2014, and since his 65th birthday is in September, he is eligible for a Special Enrollment Period due to the loss of employer coverage. This allows him to enroll in new medical and prescription drug coverage with an effective date of 10/1/2014.

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  • 34. 

    Mr. Baker called you today and he is very upset. He cannot believe that after all the years he spent working for his company they would drop his coverage like this. Not only that, but he is sick and is still receiving active treatments for his heart condition. He spoke to a local agent recommended by a friend, but there is no way he can afford the prices he was quoted.  On top of it all, now he’s going to have to pay cash for all his medications! He is eligible for a $3000 HRA if he enrolls through OneExchange. What would you tell Mr. Baker that could help him calm down and understand his options?

    • A.

      “Sir, if you just enroll in a plan F then you won’t have any out of pocket costs, and you’ll have coverage. You can continue to see your current Doctor and it won’t even cost you any more than it did before.”

    • B.

      “Sir, are you aware that you have funding from your former employer to help you defray that cost going forward? I’d like to see if we can get a plan that will meet your needs and may not cost more than you are currently paying”

    • C.

      “Sir, didn’t you know that you HAVE to enroll through us? You shouldn’t have been talking to that other agent to begin with because they can’t help you.”

    • D.

      “Sir, I’m going to need a list of all your drugs to let you know how much you will be paying for them. You have to tell me so I can make sure I quote you the right way.”

    Correct Answer
    B. “Sir, are you aware that you have funding from your former employer to help you defray that cost going forward? I’d like to see if we can get a plan that will meet your needs and may not cost more than you are currently paying”
    Explanation
    The correct answer addresses Mr. Baker's concerns about the cost of his coverage and his medications. By informing him that he has funding from his former employer to help with the costs, the answer provides a potential solution to alleviate his financial burden. Additionally, the answer suggests exploring different plans that can meet his needs without increasing his expenses. This response shows empathy towards Mr. Baker's situation and offers a proactive approach to finding a suitable solution.

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  • 35. 

    Mr. and Mrs. Smith have a variety of health concerns. They have researched extensively to find a plan that will work for them but can’t find one that covers all their doctors. They finally decided to enroll in a PPO plan so they can get at least some coverage when they are outside the network. They also notice that with this plan their drugs are very costly for Mrs. Smith, but they feel like they don’t have any other choices. What might you say to them to help them find a plan that will work for them?

    • A.

      “That plan is not a good plan, it doesn’t even cover all your doctors and you’ll be paying an arm and a leg for it. This gap plan is much better and will work for you.”

    • B.

      “I guess you can enroll in that MAPD if that’s what you want. It makes my job easy if you’ve already decided so we’ll just go with it.”

    • C.

      “Why don’t you give me a list of your drugs and doctors and I’ll check to see if there is something you missed. Maybe we can even call the carrier to see if they will cover those doctors”

    • D.

      “I know you have done a lot of research but have you looked into Medigap plans? These plans have no networks restrictions for Medicare doctors and we can select a drug plan specifically for each of you to make sure it will meet your needs.”

    Correct Answer
    D. “I know you have done a lot of research but have you looked into Medigap plans? These plans have no networks restrictions for Medicare doctors and we can select a drug plan specifically for each of you to make sure it will meet your needs.”
    Explanation
    The correct answer suggests exploring Medigap plans as an alternative. Medigap plans do not have network restrictions for Medicare doctors, which means that Mr. and Mrs. Smith can have coverage for all their doctors. Additionally, they can select a drug plan specifically for each of them to ensure that their medication needs are met. This option provides a solution to their concerns about coverage for doctors and expensive drugs, making it a more suitable plan for them.

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  • 36. 

    Mrs. Smith’s doctor recommended she hire a 24 hour nurse when she goes home from the hospital. Will Medicare cover this?

    • A.

      Yes, because his doctor is telling her that it is needed so Medicare must cover it.

    • B.

      No, because it is not part of Medicare covered services

    • C.

      They will only cover the first 72 hours, and then after that Medicare will only cover part time care

    Correct Answer
    B. No, because it is not part of Medicare covered services
    Explanation
    Medicare provides coverage for certain medical services, treatments, and supplies that are deemed medically necessary. While a doctor may recommend hiring a 24-hour nurse for Mrs. Smith, it does not necessarily mean that Medicare will cover it. Medicare coverage is limited to specific services and does not include round-the-clock nursing care unless it is provided in a skilled nursing facility or under certain circumstances. Therefore, the recommendation for a 24-hour nurse would not be covered by Medicare.

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  • 37. 

    Mr. Brown’s doctor recommended water therapy for his knee pain. Mr. Brown wants to go to the local YMCA for this. Will Medicare pay for this?

    • A.

      Yes, because his doctor recommended it.

    • B.

      Yes, because Medicare wants everyone to get to the gym more

    • C.

      No, because Medicare doesn’t cover any kind of therapy

    • D.

      No, because the YMCA is not Medicare certified

    Correct Answer
    D. No, because the YMCA is not Medicare certified
    Explanation
    Medicare only covers services provided by healthcare providers that are Medicare certified. Since the YMCA is not Medicare certified, Medicare will not pay for Mr. Brown's water therapy at the local YMCA.

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  • 38. 

    Ms. Thompson will need Home Health Care when she leaves the hospital.  She wants to be certain that Medicare will cover this expense at 100%.  Can you assure her that everything will be covered at 100%?

    • A.

      Yes, because her doctor is recommending it

    • B.

      No, because Medicare doesn’t cover Home Health Care when you leave the hospital, only when you leave a skilled nursing facility

    • C.

      No, because there may be additional doctor recommended treatments beyond what Medicare agrees to pay for

    Correct Answer
    C. No, because there may be additional doctor recommended treatments beyond what Medicare agrees to pay for
    Explanation
    The correct answer is "No, because there may be additional doctor recommended treatments beyond what Medicare agrees to pay for." This answer is based on the information provided in the question, which states that Ms. Thompson wants to be certain that Medicare will cover the expense of home health care at 100%. The answer explains that Medicare may not cover all the additional doctor-recommended treatments, implying that there may be additional costs that Ms. Thompson would have to bear.

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