Anthem Medicare Advantage Certification Practice Exam

These questions are part of the practice quiz. Start practicing

• During the Open Enrollment Period, which group is NOT eligible to make changes?
• Can beneficiaries who are dually eligible switch to Original Medicare using a SEP?
• What is the role of the Centers for Medicare and Medicaid Services (CMS) in relation to Medicare Advantage plans?
• What does it imply if a Medicare Advantage plan has a limited network?
• What is generally included in prescription drug coverage under Medicare Advantage plans?
• What distinguishes fraud, waste, and abuse in healthcare?
• In terms of cost, what is true of some Medicare Advantage plans?
• What does the “Star Rating” system signify for Medicare Advantage plans?
• How can a member understand the benefits available to them in their Medicare Advantage plan?
• What does the term “capitation” refer to in healthcare payment models?
• How does the service area of a Medicare Advantage plan affect member eligibility?
• What is one advantage of choosing a Medicare Advantage plan over Original Medicare?
• When is the general enrollment period for Medicare Advantage?
• True or False: Members of Medicare Advantage plans can see any doctor without restrictions.
• What is the proper method for verifying the primary care physician (PCP) indicator information?
• How often can members change their Medicare Advantage plan?
• Which statement about rules on rates is NOT true?
• How does a cancellation differ from a disenrollment?
• Which of the following may be considered extra benefits provided by MA-PD plans that are not covered by traditional Medicare?
• What do prior authorization requirements in Anthem Medicare Advantage plans signify?
• What is the purpose of the “Annual Election Period” in Medicare Advantage?
• Are agents or brokers allowed to offer gifts as a condition of enrollment?
• Which statement about drug tiers is true?
• At a Sales event, what is prohibited regarding enrollment applications for the Annual Enrollment Period (AEP)?
• Can individuals switch back to traditional Medicare from a Medicare Advantage plan?
• In case of a sales misrepresentation inquiry, what is essential to address?
• What type of coverage do Medicare Advantage plans provide in comparison to traditional Medicare?
• What might individuals be required to pay if they miss the Medicare Advantage enrollment period?
• What type of services may require prior authorization in Anthem Medicare Advantage plans?
• What is true regarding plans with narrow or select networks?
• What type of events should avoid requiring contact information from beneficiaries?
• Which of the following is a characteristic of the Coverage Gap phase?
• How can individuals verify if their doctors are in-network for an Anthem Medicare Advantage plan?
• To be eligible for a Stand alone Part D plan, which of the following must the enrollee satisfy?
• What should agents and brokers prioritize before organizing events?
• How does prescription drug coverage function in most Anthem Medicare Advantage plans?
• What is typically included in a Medicare Advantage plan?
• Which of the following statements about creditable prescription drug coverage is true?
• What distinguishes Medicare Part C from the other parts of Medicare?
• In order to be eligible for the HMO plan, what must the beneficiary continue to pay?
• How often are qualifications for low-income assistance for Part D plans reviewed?
• What factor can influence the premium costs of a Medicare Advantage plan?
• What type of plans are Special Needs Plans (SNPs)?
• What defines a “restrictive network” in Medicare Advantage plans?
• Beneficiaries must agree to terms before enrolling in any Medicare plan. True or False?
• Prior to making an enrollment decision, what must beneficiaries do?
• What type of services might be included in a Medicare Advantage plan?
• Which event type requires that materials include plan-specific information?
• Which of the following preventative services are typically covered by Anthem Medicare Advantage plans?
• Which statement describes actions at an Educational Event?
• Which option best describes the flexibility of using preferred vs. non-preferred providers in a PPO plan?
• Members may have reduced cost-share amounts on certain formulary tiers when utilizing preferred pharmacies. Is this statement true or false?
• What is required in terms of notifying beneficiaries of event changes?
• Do FEMA disaster SEPs only apply if members missed a valid enrollment period?
• What does the term “in-network” imply for members of Anthem Medicare Advantage plans?
• What does the term “inpatient services” generally imply within the scope of Medicare?
• Does the plan deductible need to be satisfied before preventive services are covered by the plan?
• Who is eligible for enrollment in Institutional Special Needs Plans (ISNPs)?
• Who primarily provides primary care services in Anthem Medicare Advantage plans?
• Do PPO plans typically include Part D prescription coverage?
• What role do nurse practitioners play in Anthem Medicare Advantage plans?
• What is the impact of late enrollment in a Medicare Advantage plan?
• What must be verified when a beneficiary has drug coverage through another carrier?
• True or False: Medicare Advantage plans must cover all the services that Original Medicare covers.
• What is one key eligibility requirement for enrolling in an Anthem Medicare Advantage plan?
• During the Annual Election Period (AEP), what can a member do regarding prescription drug coverage?
• What must beneficiaries qualify for to enroll in a Dual Special Needs Plan (DSNP)?
• The Late Enrollment Penalty (LEP) does not apply to Low-Income Subsidy (LIS) members or members with creditable coverage. Is this statement true or false?
• Was a new monthly integrated care Special Enrollment Period (SEP) created for CY2025?
• True or False: All Medicare Advantage plans require referrals to see specialists.
• How does Anthem Medicare Advantage promote preventive care?
• What does a special needs individual need to qualify for Medicare Parts A and B?
• What is the primary distinction between “inpatient” and “outpatient” services under Medicare?
• What is required for a member to receive preventive care without costs in an HMO plan?
• What action can members take if they are dissatisfied with their Medicare Advantage plan's performance?
• What is required for Third-Party Marketing Organizations to share a beneficiary's data?
• What might a member expect during a wellness visit under Anthem Medicare Advantage?
• Which of the following is NOT considered a preventive benefit?
• Which of the following is true about the coverage of prescription drugs in Medicare Advantage?
• What are events designed to steer potential enrollees toward a specific plan called?
• Are agents eligible for commission payments on plans sold before completing necessary licensing and certification?
• What happens if a beneficiary enrolled in a MA-only HMO also signs up for a PDP plan?
• What does 'co-payment' refer to in healthcare?
• What does enrolling in a Medicare Advantage plan typically provide?
• Which of the following benefits is usually part of an Anthem Medicare Advantage plan?
• What can beneficiaries expect pertaining to the costs of preventive services under the Medicare Advantage program?
• Do enrollees need a referral to see an out-of-network provider under Medicare Advantage?
• What action is required if a beneficiary wants to change their plan during the SEP?
• When does the SEP for Enrollment into a Chronic Care SNP apply?
• What is the required development for each Special Needs Plan?
• In terms of cost-sharing, how do preventive services function in Medicare Advantage plans?
• Does enrollment in a Medicare Supplement plan automatically disenroll a beneficiary from a Medicare Advantage Plan?
• Which choice is not a drug tier option addressed in the presentation?
• What is the focus of a chronic condition management program in Anthem Medicare Advantage?
• What is required for an individual to be considered qualified or "ready to sell" in Medicare?
• How can beneficiaries contest decisions made by their Anthem Medicare Advantage plan?
• How do Medicare Advantage plans compare to Original Medicare?
• Catastrophic Coverage in Part D begins once the member reaches which threshold?
• What is one common requirement for participation in a Medicare Advantage plan?
• What is one benefit of enrolling in a Medicare Advantage plan?
• What is a distinguishing feature of a PPO plan?
• What is a flexible spending account (FSA) in relation to Anthem Medicare Advantage?
• What should be done if an educational event is cancelled?
• Which of the following are types of Special Needs Plans (SNPs)?
• What does the Summary of Benefits typically include?
• What is a potential consequence of choosing an out-of-network provider?
• Which type of plan requires members to have a primary care physician?
• What is a defining feature of SNPs regarding provider networks?
• What does Medicare Advantage typically require for specialist visits?
• Which of the following statements is true regarding SNPs?
• Which statement is NOT true about Low Income Assistance for Part D plans?
• Which aspect of plan benefits does a MA plan typically not cover?
• Which statement is true regarding the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and Medigap plans?
• What is an example of an action that might be considered marketing misrepresentation?
• If a member obtains preventive care from out-of-network providers, who is responsible for the costs?
• Who is responsible for the administration of Medicare Advantage plans?
• In the context of Medicare Advantage plans, what does the term "network" refer to?
• The Medicare Advantage Program combines coverage for which parts of Medicare?
• What must the agent confirm regarding providers for beneficiaries considering enrollment into a plan?
• What is the primary reason for needing express written consent from beneficiaries under TPMOs?
• What is the purpose of the Late Enrollment Penalty (LEP)?
• How should beneficiaries be notified of cancellations or modifications of events?
• What is generally required for a beneficiary to receive treatment from a specialist in an HMO plan?
• Beneficiaries can opt out of their Medicare Supplement plan without consequences. True or False?
• Which statement is true regarding the eligibility of plans for commission payments?
• If a beneficiary has an appointment to discuss a PDP product, what can an agent discuss during that meeting?
• Carriers may not pay for prescriptions if members use an Out-Of-Network pharmacy. Which choice does not represent a certain case that would allow for Out-Of-Network reimbursement?
• Which statement is true regarding Medicare Advantage and its administration?
• Is there a dedicated phone line for Anthem Medicare Advantage members?
• How do enrollees typically pay for services received from out-of-network providers under a PPO?
• What does it mean when a plan is “Medicare-certified”?
• How often must Chronic SNPs (CSNPs) reconfirm a beneficiary's eligibility?
• What does an HMO plan typically require regarding healthcare providers?
• When is it typically necessary for a member to obtain prior authorization?
• What does "ANOC" stand for in the context of Medicare?
• Why is it important to confirm coverage and copayments for formularies each year?
• When responding to a sales misrepresentation inquiry, what must be included in the response?
• When should members enroll in a Part D plan to avoid the Late Enrollment Penalty?
• What materials are included in the Medicare Advantage or Part D marketing materials/sales kit?
• What do Fully Integrated Dual Eligible (FIDE) plans provide?
• What happens if a member lives outside the defined service area of a Medicare Advantage plan?
• Do HMO and PPO plans share any common characteristics?
• Which of the following does not represent a drug exception option?
• How do Medicare Advantage plans approach coverage for emergency services?
• What is allowed at sales and marketing events concerning enrollment?
• When must sales event cancellations and modifications be reported?
• Which of the following is a characteristic of a Special Needs Plan (SNP)?
• Which of the following is NOT a valid reason for involuntary disenrollment?
• What is defined as "when you believe that your health is in serious danger"?
• What does "network adequacy" signify in Anthem Medicare Advantage plans?
• Is emergency care always considered to be in-network for Medicare Advantage plans?
• What is a Special Needs Plan (SNP) offered by Anthem?
• What does the term “network tier” indicate in Medicare Advantage plans?
• Which of the following statements is true regarding Medicare Advantage plans?
• What should be explained regarding the Part D late enrollment penalty?
• What should members do if they plan to travel and require healthcare under their Anthem plan?
• Which statement about disenrollment is NOT true?
• What may result from repeated occurrences of late reporting or event cancellations?
• True or False: Members must pay a premium for all Medicare Advantage plans.
• What is the purpose of the Evidence of Coverage document?
• What is the primary purpose of Anthem Medicare Advantage plans?
• How often do Medicare Advantage members typically receive a health assessment?
• What is prohibited within 12 hours of an educational event in the same location?
• Which of the following would NOT be classified as marketing misrepresentation?
• How does telehealth fit into the services offered by Anthem Medicare Advantage plans?
• What should be done if a member wishes to cancel their enrollment before the effective date?
• Which of the following statements about eligibility criteria for Medicare Advantage HMO plans is accurate?
• What is an example of a supplemental benefit that Medicare Advantage plans might offer?
• What is a common consequence of failing to confirm changes to plan coverage each year?
• What type of individuals do SNPs target?
• What does the term 'formulary' mean in Medicare Advantage plans?
• If reviewing an existing member's plan needs, what document should you consider?
• What is the purpose of a Summary of Benefits document in Medicare Advantage plans?
• Which of the following scenarios is most likely to lead to corrective action?
• Which statement is false regarding the payment of Medicare Part B premiums?
• What does the monthly integrated care SEP beginning Calendar Year 2025 allow for full dual eligible individuals?
• What additional benefits do Medicare Advantage plans often include beyond medical coverage?
• What does coordinated care refer to in the context of Anthem Medicare Advantage plans?
• Why is the assessment of “Star Ratings” important for Medicare Advantage plans?
• What defines a "special needs individual"?
• What types of assessments are typically included in the wellness visit by Anthem Medicare Advantage plans?
• What type of plan is Medicare Advantage classified as?
• What is the maximum out-of-pocket limit in Medicare Advantage plans?
• What is a characteristic requirement for patients under CSNPs?
• What is the Special Election Period (SEP) for Dual Eligible and Other LIS Eligible Individuals replaced with beginning Calendar Year 2025?
• What is defined as “urgently needed care”?
• What may happen if an individual does not enroll in a Medicare Advantage plan during the election period?
• What is the definition of coinsurance?
• What is an essential advantage of choosing a Medicare Advantage plan?
• What type of services does a beneficiary generally have to pay more for if they go out-of-network?
• Which Part D benefit phase was eliminated starting with Calendar Year 2025?
• What should be done with incomplete or incorrect applications that contain beneficiary information?
• During which period can members make changes to their Medicare Advantage plans besides the Annual Election Period?
• What does “premier provider” network mean in Medicare Advantage?
• In the context of Anthem’s Medicare Advantage plan, what does "referral" mean?
• What type of coverage is NOT typically included in Medicare Advantage plans?
• What exception allows a beneficiary to enroll in a plan with prescription drug coverage after choosing an MA-only plan?
• What must agents and brokers do regarding events before advertising them?
• What is the main difference between HMO and PPO plans in Medicare Advantage?
• What must a PPO plan inform clients regarding non-emergent eligible services outside of the network?
• How should documents containing beneficiary information be disposed of?
• Do prescription drug costs under Part D apply to the medical out-of-pocket maximum?
• Who is the Open Election Period (OEP) designed for?