Podcast
Questions and Answers
On the date of the call, what can Gene do about his coverage?
On the date of the call, what can Gene do about his coverage?
He can enroll in a different Medicare Advantage plan with an effective date of March 1.
Where can Mrs. Violet find the Star Rating for the plan?
Where can Mrs. Violet find the Star Rating for the plan?
On Medicare.gov or in the Enrollment Guide.
Which of the following is not considered unsolicited contact with a Medicare eligible consumer according to CMS regulations and UnitedHealthcare's rules?
Which of the following is not considered unsolicited contact with a Medicare eligible consumer according to CMS regulations and UnitedHealthcare's rules?
What must the agent accurately and completely disclose before discussing benefits with the consumer?
What must the agent accurately and completely disclose before discussing benefits with the consumer?
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What should Jeff do if a consumer does not have an email address while using LEAN?
What should Jeff do if a consumer does not have an email address while using LEAN?
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What is the purpose of the Statement of Understanding?
What is the purpose of the Statement of Understanding?
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What is Scope of Appointment?
What is Scope of Appointment?
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What should Jane do if Albert is confused about a Prescription Drug plan?
What should Jane do if Albert is confused about a Prescription Drug plan?
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Under what condition may the Medicare Advantage organization disenroll a member?
Under what condition may the Medicare Advantage organization disenroll a member?
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What option is available to Dennis if he wants to keep his current coverage and add prescription drug coverage?
What option is available to Dennis if he wants to keep his current coverage and add prescription drug coverage?
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Agents have an obligation to enroll a consumer in a product that is suitable for what?
Agents have an obligation to enroll a consumer in a product that is suitable for what?
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What statement is true regarding the Star Rating system used for Medicare plans?
What statement is true regarding the Star Rating system used for Medicare plans?
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What benefit information are agents required to provide before starting an enrollment?
What benefit information are agents required to provide before starting an enrollment?
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Whose email address can the agent enter in the applicant information section of the LEAN enrollment application?
Whose email address can the agent enter in the applicant information section of the LEAN enrollment application?
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The __________ ensures that consumers acknowledge their plan enrollment during telephonic enrollment.
The __________ ensures that consumers acknowledge their plan enrollment during telephonic enrollment.
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What option is available to Aries who wants to add additional medical coverage?
What option is available to Aries who wants to add additional medical coverage?
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What type of information must the agent provide when presenting a plan to avoid confusing the consumer? (Select 3)
What type of information must the agent provide when presenting a plan to avoid confusing the consumer? (Select 3)
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What should Josh tell Janine about changing her plan to a 5-star plan?
What should Josh tell Janine about changing her plan to a 5-star plan?
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Why must an agent present accurate, complete, and factual plan information to consumers? (Select 3)
Why must an agent present accurate, complete, and factual plan information to consumers? (Select 3)
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Which election period runs from October 15 to December 7 allowing changes to Medicare plans?
Which election period runs from October 15 to December 7 allowing changes to Medicare plans?
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A one-on-one marketing appointment requires the consumer's _____ agreement prior to the appointment.
A one-on-one marketing appointment requires the consumer's _____ agreement prior to the appointment.
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What authority must an individual have to complete an Enrollment Application on behalf of a consumer?
What authority must an individual have to complete an Enrollment Application on behalf of a consumer?
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Why is an agent prohibited from entering their own email address in LEAN?
Why is an agent prohibited from entering their own email address in LEAN?
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By agreeing to the Statement of Understanding, what does the consumer acknowledge?
By agreeing to the Statement of Understanding, what does the consumer acknowledge?
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What option is available to Rosanna who wants to add prescription drug coverage while in a MA-Only PFFS plan?
What option is available to Rosanna who wants to add prescription drug coverage while in a MA-Only PFFS plan?
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Study Notes
Enrollment and Coverage Changes
- Gene can change his Medicare Advantage plan during a call in February, with coverage effective March 1.
- Premiums must be paid timely; failure to do so may lead to disenrollment from the plan.
Medicare Plan Ratings and Resources
- Star Ratings for Medicare plans can be found on Medicare.gov or in the Enrollment Guide.
- Medicare uses a 5-star rating system to evaluate plan performance and quality.
Compliance and Communication
- Mailing marketing brochures is not classified as unsolicited contact under CMS regulations.
- Agents must accurately disclose benefits and any provider/pharmacy network limitations before enrollment.
- The information provided during a plan presentation must be factual, accurate, and complete to avoid consumer confusion.
Application Processes and Requirements
- If a consumer lacks an email address, that field can remain blank in the LEAN application.
- The Statement of Understanding confirms consumer comprehension of their enrollment and plan details.
- A Scope of Appointment is required before one-on-one marketing appointments to outline the products that can be discussed.
Consumer Options and Decisions
- Dennis can maintain his Original Medicare and Medicare Supplement while enrolling in a stand-alone Prescription Drug Plan (PDP).
- Aries can switch from a stand-alone PDP to a Medicare Advantage Plan that includes drug coverage.
- Rosanna can keep her MA-Only PFFS plan while adding a stand-alone PDP.
Agent Obligations and Ethical Practices
- Agents are obligated to enroll consumers in plans that suit their needs and financial abilities.
- Consent for telephonic enrollment encompasses acknowledging plan details and standard disclosures.
- Agents should assess if a consumer needs assistance understanding plan details, especially if confusion is evident.
Important Enrollment Periods
- The Annual Election Period (AEP) runs from October 15 to December 7, allowing changes to Medicare Advantage Plans.
- Agents must not use their own email addresses in the consumer's email field to ensure proper correspondence delivery.
Understanding Consumer Agreements
- Agreeing to the Statement of Understanding indicates that consumers recognize the specifics of their enrollment in a plan.
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Description
Test your knowledge on UHC Ethics & Compliance with this quiz. Focused on Medicare regulations, it will help you understand patient coverage options and compliance requirements for 2022. Perfect for healthcare agents and compliance professionals.
