Module 4 - Communications & Marketing Rules for Medicare Advantage and Part D Plans Review Questions

Question 1

You have been providing a pre-Thanksgiving meal during sales presentations in November for many years and your clients look forward to attending this annual event. When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals?

Answer 1

You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal.

Question 2

Hector Hernandez is an independent agent. Hector sells plans on behalf of three Medicare Advantage organizations that offer a total of 10 plans but does not represent all Medicare Advantage organizations offering plans that are available in his area. Which of the following statements best describes any steps Hector is required to take?

Answer 2

During the first minute of a sales call, Hector must use a disclaimer that says “I do not represent every plan available in your area. I represent 3 organizations that offer 10 plans in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all your options.”

Question 3

Evan Marsh is a newly appointed agent. Evan intends to conduct an educational session on Medicare at a senior citizens center near his home. He has advertised the session as an educational event. Evan asks you what is permissible at such an event. What should you say?

Answer 3

Evan may provide a meal as long as its value is $15 or less per attendee and he may make available business reply cards (BRCs).

Question 4

You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. You have completed the required training for each plan, but you did not achieve a passing score on the tests that came after the training. What can you do in this situation?

Answer 4

You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score. However, you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing.

This is because the guidelines specify that agents and brokers must pass the tests following their training in order to represent the plans12. If they do not achieve a passing score, they cannot represent the plans until they do so. However, if they are marketing employer/union group plans and the companies do not require testing, they may not need to take a test.

Question 5

Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. She agreed to sign a scope of appointment form and meet with you on October 15. During the appointment, what are you permitted to do?

Answer 5

You may provide her with the required enrollment materials and take her completed enrollment application.

Question 6

Linda Sanchez is conducting a previously agreed upon appointment with client, Maria Gomez about a MA-Part D plan she represents. Before an enrollment form is completed, Linda needs to provide Maria with information about ____

Answer 6

I. whether or not Maria’s primary care provider is in the plan’s network.
II. whether Maria’s current prescriptions are covered by the plan.
III. the monthly premium cost(s).

The life insurance products that Linda also sells (IV) are not relevant to the MA-Part D plan Maria is considering. Therefore, they do not need to be discussed before completing the enrollment form.

Question 7

Your client, Alexis Jones, calls you on December 4th about changing her Medicare Advantage plan during the annual election period which ends December 7th. What should you do?

Answer 7

Complete a scope of appointment (SOA) during the call and indicate that they will meet to discuss Medicare Advantage plans during an appointment the following day.

During the annual election period, a client can change their Medicare Advantage plan. If Alexis calls on December 4th and the annual election period ends on December 7th, there is still time to make changes. You should complete a scope of appointment (SOA) during the call and schedule a meeting for the following day to discuss the Medicare Advantage plans. There’s no need to wait for a “cooling off” period or until the next year’s open enrollment period.

Question 8

Wendy Park becomes eligible for Medicare for the first time in July. With the help of Agent James Chan, she enrolls in FeelBetter Medicare Advantage plan with an effective date of July 1st. Which statement best describes how Agent Chan may be compensated under CMS rules?

Answer 8

FeelBetter will pay Agent Chan initial year compensation for July through December. The renewal amounts will be paid starting in January if Ms. Park remains enrolled the following year.

Question 9

You have approached a hospital administrator about marketing in her facility. The administrator is uncomfortable with the suggestion. How could you address her concerns?

Answer 9

Tell her that Medicare guidelines allow you to conduct marketing activities in common areas of a provider’s facility.

Question 10

ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees’ information to market non-health related products such as life insurance and annuities. Which statement best describes ABC’s obligation to its enrollees regarding marketing such products?

Answer 10

It must obtain a HIPAA compliant authorization from an enrollee that indicates the plan or plan sponsor may use their information for marketing purposes.

According to Medicare’s marketing rules, a Medicare Advantage plan sponsor cannot use its enrollees’ information to market non-health related products such as life insurance and annuities without obtaining a HIPAA compliant authorization. This ensures that the privacy and personal information of the enrollees are protected. The other options do not align with the rules and regulations set by Medicare.

Question 11

Sal D’Angelo is new to the Medicare marketplace having previously been focused on life insurance and disability income protection products. He intends to conduct an educational seminar during the AEP at a local hotel and then invite those who attend to a subsequent marketing meeting to discuss the benefits of next year’s plans. How would you advise Sal?

Answer 11

Sal should conduct the education seminar as an early morning meeting and the marketing meeting on the following day in the late afternoon so that there are at least 12 hours between the two meetings.

Based on the Medicare Marketing Guidelines, Sal should ensure there is a clear distinction between the educational event and the marketing event. The guidelines state that providers should not conduct marketing activities during educational events.

Sal should conduct the education seminar as an early morning meeting and the marketing meeting on the following day in the late afternoon so that there are at least 12 hours between the two meetings. This would help ensure that the educational event and the marketing event are clearly separate. However, Sal should also check with local regulations and guidelines to ensure compliance.

Question 12

Another agent you know has engaged in misconduct that has been verified by the plan she represented. What sort of penalty might the plan impose on this individual?

Answer 12

The plan may withhold commission, require retraining, report the misconduct to a state department of insurance or terminate the contract.

Question 13

You are working with several plans and community organizations to sponsor an educational event. When putting together advertisements for this event, what should you do?

Answer 13

You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event.
This is important to maintain transparency and ensure that the audience understands the nature of the event. It also helps to distinguish between educational events and marketing events, which have different goals and regulations. Remember, the key is to provide clear and accurate information to the public.

Question 14

Your friend’s mother just moved to an assisted living facility and he asked if you could present a program for the residents about the MA-PD plans you market. What could you tell him?

Answer 14

You appreciate the opportunity and would be happy to schedule an appointment with anyone at their request.

This is because it’s important to respect the privacy and individual needs of each resident. Providing a program about the MA-PD plans you market should be done in a way that allows residents to opt-in to learn more, rather than assuming interest or distributing materials unsolicited. It’s also crucial to ensure that any marketing activities comply with the rules and regulations of the Medicare program.

Question 15

Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. What should you tell her?

Answer 15

Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided.

Based on the Medicare Communications and Marketing Guidelines (MCMG), marketing representatives may initiate electronic contact through e-mail12. However, they must provide a way for the enrollee to opt out of electronic communications3. The content of any unsolicited email cannot intend to steer a recipient into choosing or retaining a plan4.

Question 16

Another agent working for your agency claims that because you are not employed by the Medicare Advantage plans that you represent, you are not subject to the same marketing requirements as the plans themselves. How should you respond to such a statement?

Answer 16

Your coworker is not correct. Marketing on behalf of a plan is considered marketing by the plan and requires that all contracted and employed agents comply with all Medicare marketing rules.

This is because when you’re marketing on behalf of a plan, you’re essentially acting as a representative of that plan. Therefore, you’re required to follow the same marketing rules as the plan itself. This ensures that all information provided to potential enrollees is accurate, clear, and not misleading. It also helps maintain the integrity and reputation of the Medicare Advantage plans.

Question 17

Melissa Meadows is a marketing representative for Best Care which has recently introduced a Medicare Advantage plan offering comprehensive dental benefits for $15 per month. Best Care has not submitted any potential posts to CMS for approval. Melissa would like to use the power of social media to reach potential prospects. What advice would you give her?

Answer 17

as soon as CMS approves Best Care’s social media posts, Agent Meadows could post a tweet stating that “Best Care offers an array of Medicare Advantage benefit packages. One might be right for you. Call me to find out more!”

This is because it’s important to have all marketing materials, including social media posts, approved by CMS to ensure they are compliant with Medicare marketing guidelines. It’s also crucial to avoid sharing plan-specific information until the potential customer has expressed interest in learning more. This approach helps ensure that all information provided is accurate and not misleading.

Question 18

Miguel Sanchez is a relatively new agent who has come to you for advice as to what he can do during the Medicare Advantage Open Enrollment Period (MA-OEP). What advice should you give Miguel?

Answer 18

During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings.

This is because unsolicited marketing activities are generally not permitted during the MA-OEP. However, if a beneficiary has requested a meeting, it is acceptable for Miguel to provide them with information about different plans. It’s important for Miguel to ensure that all his marketing activities are compliant with Medicare marketing guidelines.

Question 19

You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. The hospital administration expresses some hesitation about allowing marketing in a health care facility. What should you tell them?

Answer 19

Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving health care services.

his approach respects the primary purpose of the hospital, which is to provide health care services, while still allowing for marketing activities in appropriate areas. It’s important to ensure that marketing practices do not interfere with patient care or exploit vulnerable individuals. Common areas like gift shops and cafeterias are typically separate from areas where health care services are provided, making them more suitable for marketing activities. However, it’s crucial to always consider the ethical implications and potential impact on patients when planning marketing strategies in a health care setting.

Question 20

Agent Daniel Webber has properly set up a sales appointment to meet with client Edward Young at Agent Webber’s office. At the agreed upon appointment time, Mr. Young arrives with his elderly neighbor – Clara Burton, who wants to learn about her Medicare Advantage options. What should Agent Daniel Webber do?

Answer 20

After executing a scope of appointment (SOA) with Clara Burton, meet with Edward Young and Clara Burton to discuss their Medicare Advantage options.

This is because Clara’s unexpected arrival at the office provides an exception to the rule requiring at least 48 hours to pass between the execution of a SOA and a marketing appointment.