MetroPlus Products Sales Exam
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Name
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First Name
Last Name
Date
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Month
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Day
Year
Date
TK ID
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Please find # behind your MetroPlus ID (9 digits)
Multiple Choice
1. Which of the following population(s) qualifies for the MetroPlus Partnership in Care (PIC)? (1 Point)
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a. Individuals who are HIV positive or have AIDS
b. Homeless individuals
c. Transgender Individuals
d. All of the above
2. Pregnant Women and children under 1 years old need to be at or below ________ FPL to be eligible for Medicaid. (1 point)
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a. 138%
b. 300%
c. 223%
d. 154%
3. Which of the following benefits are EXCLUDED from Medicaid coverage? (1 point)
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a. Home Health Care
b. Personal and Comfort Items
c. Court Ordered Services
d. Inpatient Care
4. Medicaid, Child Health Plus and the Essential Plan all offer continuous coverage for (1 point)
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a. 12 months
b. 16 months
c. 18 months
d. 24 months
5. Ashlah is a 24-year-old Bronx resident that suffers from schizophrenia and alcoholism. Ashlah’s income puts her at 125% FPL. Which of the following plans is best suited for Ashlah’s situation? (1 point)
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a. Medicaid
b. Child Health Plus
c. Enhanced Plan (HARP)
d. BronzePlus
Raul is a 35-year-old lives in Brooklyn with four children: Juan, Pedro, Carolina and Elizabeth. The family recently arrived from Mexico and do not have legal permanent residency. The children are below the age of 19. Raul is interested in health coverage for his children. His household size is 5 and total annual income is $50,000 (Next 3 questions are about this family.)
6. Which plan(s) are Raul’s children eligible to receive? (1 point)
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a. Medicaid
b. Emergency Medicaid
c. QHP Child-Only
d. Child Health Plus
e. Essential Plan
7. What plan would Raul qualify for? (1 point)
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a. Medicaid
b. Emergency Medicaid
c. Child Health Plus
d. Essential Plan
8. (continued from above) Based on the family, and with a higher income to qualify for Full-Pay Premium CHP, many children would he pay for? (1 point)
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a. 1
b. 2
c. 3
d. 4
9. Pablo’s 4 children qualify for a $9 premium CHP plan. How many children will he pay the premium for?( 1 point )
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a. 1
b. 2
c. 3
d. 4
10. Ashaki is a 25-year-old Bronx resident with two children: Kinnette and Nijah. Kinnette is 13 years old and Nijah is 16 years old. Ashaki’s FPL is at 153%. She qualifies for Essential Plan 1. What do the children qualify for? (1 point)
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a. Medicaid
b. CHP
c. EP 1
d. CHP or EP 1
11. Which QHP plan has the lowest premium for an individual? (1 point)
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a. Bronze
b. Silver
c. Gold
d. Platinum
e. Catastophic (MedPlus)
12. Which QHP plan has the highest premium for an individual? (1 point)
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a. Bronze
b. Silver
c. Gold
d. Platinum
e. Catastrophic (MedPlus)
13. Which Essential Plans offer benefits that are similar to Medicaid. (1 point)
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a. EP 1 and 2
b. EP 2 and 3
c. EP 3 and 4
d. EP 1 and 4
14. What is a deductible? (1 point)
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a. The amount you must meet before insurance starts paying
b. A fixed percent you pay after meeting your deductible
c. A fixed dollar amount you pay after meeting your deductible
d. The monthly amount you pay to your health insurance for coverage
e. The most you will pay for your medical costs – after that, insurance covers 100% of the cost
15. What is a co-pay? (1 point)
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a. The amount you must meet before insurance starts paying (i.e. cost-sharing)
b. A fixed percent you pay after meeting your deductible
c. A fixed dollar amount you pay after meeting your deductible
d. The monthly amount you pay to your health insurance for coverage
e. The most you will pay for your medical costs – after that, insurance covers 100% of the cost
16. What is co-insurance? (1 point)
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a. The amount you must meet before insurance starts paying (i.e. cost-sharing)
b. A fixed percent you pay after meeting your deductible
c. A fixed dollar amount you pay after meeting your deductible
d. The monthly amount you pay to your health insurance for coverage
e. The most you will pay for your medical costs – after that, insurance covers 100% of the cost
17. What is a MOOP (Maximum Out of Pocket)? (1 Point)
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a. The amount you must meet before insurance starts paying (i.e. cost-sharing)
b. A fixed percent you pay after meeting your deductible
c. A fixed dollar amount you pay after meeting your deductible
d. The monthly amount you pay to your health insurance for coverage
e. The most you will pay for your medical costs – after that, insurance covers 100% of the cost
18. What is a premium? ? (1 point)
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a. The amount you must meet before insurance starts paying (i.e. cost-sharing)
b. A fixed percent you pay after meeting your deductible
c. A fixed dollar amount you pay after meeting your deductible
d. The monthly amount you pay to your health insurance for coverage
e. The most you will pay for your medical costs – after that, insurance covers 100% of the cost
19. What are Essential Health Benefits? (1 point)
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a. A list of 10 benefits a member can chose from to pay more or less for their premium
b. Benefits offered to only members who have EP (Essential Plan)
c. Benefits that all plans are required to offer in order to be in the Marketplace
d. A list of 10 benefits that some plans offer – you pay more money (higher premium) for additional benefits (i.e. vision, dental, etc.)
20. What is the difference between a Standard plan and a Non-Standard plan? (1 point)
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a. Non-Standard is an off-market plan that not every insurance company offers
b. Non-Standard is the name for insurance companies that don’t offer the 10 Essential Health Benefits
c. Non-Standard plan can have additional benefits (i.e Adult vision & dental)
d. Adult and pediatric vision & dental
21. Kaitlin is a 40-year-old undocumented immigrant that resides in Queens. Her FPL is 137% and she has been under PRUCOL for the last 10 years. She is considering a health insurance plan that meets her needs. Which plan does she qualify for? (1 point)
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a. Medicaid
b. EP 1 or 2
c. EP 3 or 4
d. QHP
e. MLTC
f. Medicare
Priya is a 25-year-old Brooklyn resident that lives with her 60-year-old grandmother, Sahana. Priya works as a Salesclerk at a discount store and her grandmother is unemployed. Priya’s FPL is 140% FPL (Next 3 Questions apply to this scenario.)
22. What plan would Priya qualify for? (1 point)
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a. Medicaid
b. CHP
c. EP 1 or 2
d. EP 3 or 4
e. QHP
f. MLTC
23. Later in the year, Priya becomes pregnant. She decides to continue working through her pregnancy. Her grandmother believes she qualifies for a new plan. Priya believes she doesn’t. Who is correct? (1 point)
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a. Priya
b. Her grandmother
24. If Priya qualifies for a new plan, which plan would it be? (1 point)
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a. No change (Priya was correct)
b. Medicaid
c. EP
d. QHP
25. Prya’s grandmotherSahana suffers from Chronic Obstructive Pulmonary Disease and Cancer. She difficulty speaking and has difficulty with bathing and eating. Recently, a nurse evaluated Sahana and determined that she requires at least 120 days of nursing services in the home. What is the best health insurance plan for Sahana? ? (1 point)
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a. Medicaid
b. Emergency Medicaid
c. EP
d. QHP
e. MLTC
f. Medicare
26. MetroPlus’ Marketplace plans B3, S3, G3 and P3 are: (1 point)
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a. Standard Plans
b. Non-Standard Plans
c. Child-Only Plans
d. AI/AN Standard Plans
e. AI/AN Non-Standard Plans
f. AI/AN Child-Only Plans
27. MetroPlus’ Marketplace plans B1, S1, G1, P1 and M1 are: (1 point)
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a. Standard Plans
b. Non-Standard Plans
c. Child-Only Plans
d. AI/AN Standard Plans
e. AI/AN Non-Standard Plans
f. AI/AN Child-Only Plans
28. MetroPlus’ Marketplace plans B2, S2, G2 and P2 are: (1 point)
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a. Standard Plans
b. Non-Standard Plans
c. Child-Only Plans
d. AI/AN Standard Plans
e. AI/AN Non-Standard Plans
f. AI/AN Child-Only Plans
29. Cost Sharing Reduction (CSR) levels are based on: (1 point)
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a. Federal Poverty Level
b. American Indian/Alaska Native Trive Membership
c. Age
d. Personal Preference
30. Cost Sharing Reductions (CSRs) are only available for which of the following metal level plan(s)? (1 point)
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a. Bronze
b. Silver
c. Gold
d. Platinum
e. Catastrophic (MedPlus)
f. A, B, C, D
g. A, B, C, D, E
The following questions may have 1 or more correct answers. Please select all answer(s) to the following questions.
31. Mr. Ganesh and Mr. Naser were sitting around talking about how great MetroPlus is. Mr. Ganesh has SilverPrime and Mr. Naser has SilverPlus. They visited their PCP on the same day in January because of flu-like symptoms. Mr. Ganesh paid $30 and Mr. Naser paid $230 to see the same doctor. Mr. Naser is upset because he paid more money to see the same doctor! Can you explain why Mr. Ganesh paid $30? Can you also explain why Mr. Naser paid $230? (2 points - “select all that apply”)
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a. SilverPrime costs more, has better benefits, and therefore, he has to pay less money when he goes to the doctor
b. SilverPrime covers 3 PCP appointments not subject to the deductible
c. Mr. Ganesh met his deductible
d. Mr. Naser has not yet met his deductible
32. (continued from above) In December, after multiple doctors’ visits and medications throughout the year, Mr. Naser thought he had the flu again, so he went back to his PCP. However, this time he only paid $30. Mr. Naser wants to know why he paid $230 in January and $30 in December to see the same doctor! (2 points - select all that apply)
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a. Mr. Nasar met his deductible by December
b. Mr. Nasar had paid his $30 premium
c. Mr. Nasar had to pay a co-pay
d. Mr. Nasar had to pay co-insurance
e. Mr. Nasar met his MOOP and only had to pay part of the cost
33. On December 1st, Ms. Tuma and Ms. Chowdhury were comparing their gold-crusted wheelchairs (contracted at $10,000). Ms. Tuma has BronzePlus and had to pay $5000 (50% fee) for her wheelchair. Ms. Chowdhury has PlatinumPlus and only had to pay $1000 (10% fee) for her wheelchair. Ms. Tuma is upset she had to pay so much more and wants to know why! (1 point - select all that apply)
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a. Ms. Tuma has not yet met her deductible, Ms. Chowdhury has
b. Ms. Tuma has BronzePlus and it has fewer benefits than Ms. Chowdhury who has PlatinumPlus and has better benefits
c. Ms. Chowdhury has a higher monthly premium, so she has lower out of pocket costs
34. Juan and Deepak were comparing their bills from their recent ruptured appendix surgeries on January 2. Juan has MedPlus and paid $5,000 for his surgery. Deepak has the Platinum plan and paid $100. Why is that? (2 points - select all that apply)
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a. Juan has not yet met his deductible
b. Juan has MedPlus and it has fewer benefits than Deepak who has PlatinumPlus and has better benefits
c. PlatinumPlus has a $0 deductible, so he automatically goes to co-pays
d. MedPlus has a high deductible; it was not met on January 2
35. To be eligible for MetroPlus’ Managed Long-Term Care, an individual (2 points - select all that apply)
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a. Must have Medicaid
b. Must have Medicare
c. Be at or above 21 years of age
d. Can be absent from the service area for 30 or more days
36. Which of the following are eligibility criteria for Medicare (3 points - select all that apply)
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a. 65 and over
b. 65 and over with a medical condition or disability
c. Any age with a disability for more than 24 months
d. Age 21 and over with a disability for more than 24 months
e. Age 65 and under with a disability for more than 24 months
f. End Stage Renal Disease (ESRD)
g. Any serious medical condition (i.e. diabetes, cancer, etc.)
Please answer True/False
37. Based on family size and income, a child can qualify for both CHP and Medicaid at the same time. (1 point)
True
False
38. A member can have both Medicare and Medicaid? (1 point)
True
False
39. Cosmetic surgery is one of the covered benefits for Medicaid Managed Care. (1 point)
True
False
40. Medical necessity is not considered when providing benefits to members. (1 point)
True
False
41. The Advanced Premium Tax credit can be applied towards a QHP member’s premium at the end of the year. (1 point)
True
False
42. The higher a Marketplace plan’s premium, the higher the out-of-pocket costs will be. (1 point)
True
False
43. If a Medicaid member needs transportation between their home and a doctor’s appointment, this is a covered benefit that is offered to them.. (1 point)
True
False
44. Ms. Li is 35. She was diagnosed with breast cancer and went through 6 months of chemo and radiation. While she went through treatments, she was not able to work and that makes her eligible for Medicare. (1 point)
True
False
45. Mr. Li is 36 had not been feeling well for a while. He finally went to his doctor where he found out that his kidneys are failing, and he would need a kidney transplant. He is also determined to qualify for disabilities. After 24 months, he then qualifies for Medicare. (1 point)
True
False
Total Points
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