North Carolina Flashcards
7 cards from real AHIP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 North Carolina flashcards as text
A North Carolina agent receives a $50 gift card offer from a Medicare Advantage plan to give to any beneficiary who enrolls. What should the agent do?
Answer: Decline; CMS prohibits giving cash or gifts of more than nominal value to induce enrollment
CMS strictly prohibits offering cash or items of more than nominal value ($15 per item, $75 per year) to influence a beneficiary's plan selection.
Which Medicare Supplement plan is the most comprehensive and covers virtually all out-of-pocket costs, but is only available to North Carolina beneficiaries who became eligible for Medicare before January 1, 2020?
Answer: Plan F
Medigap Plan F is the most comprehensive plan but was closed to newly eligible Medicare beneficiaries as of January 1, 2020; only those eligible before that date may purchase it.
A North Carolina Medicare Advantage enrollee disputes a plan's denial of a medical service. What is the first formal step in the appeals process?
Answer: File a redetermination request with the MA plan
The first level of the MA appeals process is a redetermination, which is a formal review of the coverage denial conducted by the MA plan itself.
Under CMS rules, within how many calendar days must a North Carolina Medicare Advantage plan respond to a standard (non-expedited) prior authorization request?
Answer: 14 calendar days
CMS requires MA plans to respond to standard prior authorization requests within 14 calendar days of receiving the request.
A North Carolina beneficiary is considering a Medicare Advantage MSA plan. Which statement about MSA plans is correct?
Answer: The plan deposits money into the beneficiary's savings account and has a high deductible
Medicare MSA plans combine a high-deductible health plan with a medical savings account funded by the plan, which the beneficiary can use for qualified medical expenses.
Which statement accurately describes how a Medicare Advantage plan's network impacts North Carolina beneficiaries enrolled in an HMO?
Answer: HMO enrollees generally must use in-network providers except for emergencies and urgently needed care
HMO-type MA plans require members to use the plan's network for non-emergency care; emergency and urgently needed care are covered outside the network at any time.
A North Carolina Medicare Part D enrollee has not yet reached the deductible. They purchase a 90-day supply of a Tier 2 drug. How is the cost typically calculated at this stage?
Answer: They pay the full retail price until the deductible is met
Until a Part D beneficiary meets their deductible, they typically pay the full negotiated cost of non-exempt drugs; many plans exempt lower tiers, but this varies by plan.