Group Health, PPACA, Senior Health Products & California Rules Common to L&H: CA-LH practice questions

Group Health, PPACA, Senior Health Products & California Rules Common to L&H CA-LH-07-453

A licensed agent is conducting a marketing event for Medicare Advantage plans. During the presentation, the agent mentions that the plan is 'endorsed by Medicare.' According to CMS marketing compliance rules, what is the status of this statement?

This is allowed only if the agent is a captive agent for that specific carrier. This is permitted if the plan holds a 5-star quality rating from CMS. This is acceptable as long as the agent gives the beneficiary a written disclaimer. This is prohibited, because Medicare does not endorse private plans.

Show the answer

The answer is D: This is prohibited, because Medicare does not endorse private plans.

CMS prohibits plans and agents from claiming that a plan is recommended or endorsed by CMS, Medicare, the Secretary or HHS (42 CFR 422.2262(a)(1)(ix)). Medicare does not endorse any private plan, so the statement is a violation however it is qualified.

Source: 42 CFR 422.2262

Report a problem with this question

Group Health, PPACA, Senior Health Products & California Rules Common to L&H CA-LH-07-488

An agent at a third-party marketing organization (TPMO) that sells for some, but not all, of the Medicare Advantage organizations in the area is running a marketing event for Medicare Advantage plans. The TPMO disclaimer must be included in the marketing materials. What is the purpose of this disclaimer?

To tell the beneficiary the agent is a government employee paid by Medicare. To guarantee the beneficiary that the plan presented is the best one available. To give the beneficiary the agent's license number and personal contact details. To tell the beneficiary the TPMO does not offer every plan in the area.

Show the answer

The answer is D: To tell the beneficiary the TPMO does not offer every plan in the area.

The TPMO disclaimer tells beneficiaries that the organization does not offer every plan available in their area and points them to Medicare.gov or 1-800-MEDICARE for all of their options (42 CFR 422.2267(e)(41)). It must appear in marketing materials, on websites and in electronic communications, and be stated on sales calls.

Source: 42 CFR 422.2267

Report a problem with this question

Group Health, PPACA, Senior Health Products & California Rules Common to L&H CA-LH-07-502

An agent is marketing a Medicare Advantage plan and wants to use the term 'Medicare-approved' in their advertisement. What is the requirement?

The term is banned from all Medicare Advantage advertising in every circumstance. It may describe benefits or services, but may not claim Medicare endorses the plan. They must first get written permission from the local Social Security office. They must hold Medicare broker certification for at least five years first.

Show the answer

The answer is B: It may describe benefits or services, but may not claim Medicare endorses the plan.

CMS marketing rules let Medicare Advantage organizations and agents use the term 'Medicare-approved' to describe benefits or services, and to say they are approved to participate in Medicare. They may not claim that CMS, Medicare, the Secretary or HHS recommends or endorses the plan (42 CFR 422.2262). No Social Security approval, certification period or outright ban applies, and the rules do not require a 'not endorsed by Medicare' disclaimer.

Source: 42 CFR 422.2262

Report a problem with this question

Group Health, PPACA, Senior Health Products & California Rules Common to L&H CA-LH-07-506

What is the role of the 'Scope of Appointment' (SOA) form in Medicare marketing?

To verify the client's income and subsidy eligibility for the plan. To document which Medicare products the client agreed to discuss. To authorize the agent to access the client's medical records. To serve as the client's Medicare Advantage enrollment application.

Show the answer

The answer is B: To document which Medicare products the client agreed to discuss.

Before a personal marketing appointment, the plan or agent must agree on and record the Scope of Appointment with the beneficiary, in writing for in-person appointments. It documents which products the beneficiary agreed to discuss, and products beyond that scope cannot be marketed without a new SOA (42 CFR 422.2264(c)(3)). The current rule requires the SOA to be agreed and recorded before the appointment, and it sets no waiting period between the two. A signed SOA, business reply card or request for information is valid for 12 months.

Source: 42 CFR 422.2264

Report a problem with this question