PLAHI - Pennsylvania Life Accident and Health Insurance Exam

Question 21: A Pennsylvania resident is approaching her sixty-fifth birthday and wants to know the window during which she may first sign up for Medicare Part B without any penalty. Which of the following correctly describes that initial enrollment period?

The full calendar year of the birthday

The birthday month only

Three months before through three months after

Six months after the birthday only

Question 22: A Pennsylvania beneficiary compares what she pays under Medicare Part B with what she used to pay under her former employer's major medical plan. Which of the following correctly describes Part B cost sharing after the annual deductible?

Full coverage with no coinsurance

About twenty percent coinsurance, no stop-loss

About twenty percent coinsurance with stop-loss

A flat copayment for every service

Question 23: A Pennsylvania beneficiary enrolled in both Part A and Part B chooses to receive all of her Medicare benefits through a private plan that contracts with the federal program and may add drug coverage. Which of the following has she joined?

A Medicare Advantage plan under Part C

A Medicare supplement policy

A Medicaid managed care plan

A long-term care partnership policy

Question 24: A Pennsylvania retiree wants outpatient prescription drug coverage under Medicare and asks her producer who actually issues the plan and who ultimately pays the pharmacy counter. Which of the following correctly describes how Part D coverage is delivered to her?

Medicare issues the plan and pays pharmacies

The state issues it; Medicare reimburses

A private company issues it and pays

The employer issues it; Medicare reimburses

Question 25: A Pennsylvania beneficiary asks her producer which everyday services original Medicare will not pay for, so that she can budget for those costs herself. Which of the following combinations most correctly lists the services that original Medicare excludes?

Inpatient hospital care and hospice care

Routine vision, dental, hearing, private-duty nursing

Skilled nursing after hospitalization and home health

Physician services and diagnostic laboratory tests

Question 26: A Pennsylvania worker who is over sixty-five stays on the job at a company with more than twenty employees and is also enrolled in Medicare. Which of the following describes which coverage pays first for her active employment?

Medicare always pays first after sixty-five

Neither pays until the other denies

The employer group plan pays first

The two split every claim evenly

Question 27: A Pennsylvania insurer sells several of the standardized Medicare supplement plans and must make one particular plan available to consumers if it sells any of them at all. Which of the following describes that mandatory plan and its benefits?

Plan A, containing the core benefits

The plan with the richest benefits

A plan covering both Medicare deductibles

Any plan the insurer chooses to designate

Question 28: A Pennsylvania beneficiary wants a Medicare supplement policy and asks her producer when an insurer may not deny coverage or charge her more because of her health. Which of the following describes the Commonwealth's Medigap open enrollment period?

Sixty days beginning at retirement

One year beginning at age sixty-five

Ninety days beginning at Part A enrollment

Six months beginning with Part B enrollment

Question 29: A Pennsylvania resident who is under sixty-five becomes entitled to Medicare because of a long-term disability and enrolls in Part B. She then applies for a Medicare supplement policy. Which of the following describes her open enrollment rights?

She receives the same six-month open enrollment

She must wait until she reaches sixty-five

She may be charged a health-based rate

She has no open enrollment protection

Question 30: A Pennsylvania beneficiary loses her employer retiree health plan and becomes an eligible person entitled to buy a Medicare supplement policy without any health screening. Which of the following states the guaranteed issue window the Commonwealth provides to her?

Thirty days

Forty-five days

Six months

Sixty-three days

Question 31: A Pennsylvania producer delivers a Medicare supplement policy and must point out the prominent notice printed on its first page describing the buyer's right to return it for a refund. Which of the following states that return period in Pennsylvania?

Ten days for agent sales

Thirty days for all standardized policies

Twenty days if replacing coverage

Forty-five days for direct response sales

Question 32: A Pennsylvania producer meets a prospect to complete a Medicare supplement application and must hand over two documents at that meeting. Which of the following correctly identifies what the Commonwealth requires be delivered at the time of application?

An outline of coverage and buyer's guide

A conditional receipt and a policy summary

A replacement notice and a delivery receipt

A shopper's guide and an inflation graph

Question 33: A Pennsylvania beneficiary replaces her existing Medicare supplement policy with a new one from another insurer, having already satisfied every waiting period under the old contract. Which of the following describes what the replacing insurer may lawfully impose?

A full new preexisting condition period

No new waiting periods for satisfied benefits

A six-month waiting period on all benefits

A permanent exclusion for prior conditions

Question 34: A Pennsylvania producer runs an advertisement that conceals its true purpose and is designed simply to generate names of prospects, without disclosing that insurance will be solicited. Which of the following describes that practice under the Medigap marketing standards?

Permitted if the producer later discloses

Permitted for direct response sales

Prohibited cold lead advertising

Required as a consumer disclosure

Question 35: A Pennsylvania producer proposes selling a second Medicare supplement policy to a beneficiary who already owns one that remains in force and is paid current. Which of the following describes how the Commonwealth's appropriateness standards treat that proposal?

Permitted if the beneficiary signs a waiver

Permitted whenever the second plan differs

Required whenever benefits are incomplete

Presumptively excessive coverage

Question 36: A Pennsylvania insurer designs the commission schedule for its Medicare supplement line and asks its counsel what limits apply to first-year and to renewal compensation. Which of the following correctly states the Commonwealth's permitted compensation rules for that line?

Twice renewal; renewals level five years

First year uncapped; renewals may vary freely

First year capped at half of renewal

No compensation permitted after the first year

Question 37: A Pennsylvania beneficiary buys a Medicare supplement policy that costs less than comparable plans because she agrees to use a specified network of hospitals and providers for all nonemergency care. Which of the following describes what she purchased?

A Medicare Advantage plan

A long-term care partnership policy

A hospital indemnity policy

A Medicare Select policy

Question 38: A Pennsylvania producer explains a program funded jointly by the state and federal governments that covers health care for people with limited income and resources, regardless of their age or work history. Which of the following programs is she describing?

Medicare Part A

The Children's Health Insurance Program

Medicaid

Social Security disability insurance

Question 39: A Pennsylvania family earns too much to qualify for Medicaid but cannot afford private coverage for their teenage son. A producer explains a Commonwealth program with free, low-cost and full-cost tiers. Which of the following programs is he describing?

Medicare Part C