Interpreter Bulletin 470

Interpreter Bulletin: 2024 CMS Mystery Shoppers - Humana
Issue 470 (All Languages): April 5, 2024
Overview
Humana is a leading health insurance company dedicated to improving the health of every
person they serve. They are one of our health insurance clients that receives Mystery
Shopper calls.
To help prepare us for their Mystery Shopper calls, Humana has shared helpful information
and a list of questions they anticipate Mystery Shoppers will ask.
Identifying a CMS Test Call

All of Humana’s Mystery Shopper calls start the same way:
“Are you the right person to answer questions about ….?”
For example, “Are you the right person to answer questions about <PLAN NAME>?”
When you receive a Humana Mystery Shopper call, the most important part to
interpret is “Are you the right person to answer questions about...”
Make sure you interpret this statement as soon as you hear it on a call!
Part C or Part D?
Humana determines if a Mystery Shopper call is about Part C or Part D to track and score
test calls more accurately. Humana identifies Part C or Part D calls when a Mystery Shopper
asks “are you the right person to answer questions about…”
• For Part C, a Mystery Shopper will ask:
“Are you the right person to answer questions about the medical/health
benefits of plan H1234-567?”
Keywords: medical or health
• For Part D, CMS will ask:

“Are you the right person to answer questions about the prescription drug
benefits of plan H1234-567?”
Keywords: prescription or drug
Accessibility is Key
CMS Test Calls measure 2 items:

1. Accessibility is measured by: Responding YES to the question “are you the right
person?”
2. Accuracy is measured by: Correct responses to plan benefits and costs.
Interpreter Bulletin: 2024 CMS Mystery Shoppers - Humana (All Languages) Page 1 of 7
© 2024 CyraCom International, Inc. All rights reserved. (04.04.2024)
CMS Mystery Shoppers – Humana
Calls will vary in length and content. Below is a list of questions “Mystery Shoppers” may ask
regarding Humana.
English Translation
Q: Are you the right person to answer
questions about the
health/medical/prescription benefits for plan
H1234-567?
Q: Can I enroll in your plan if I live in

<COUNTY NAME>?
A: Yes, you can enroll in our plan if you live

in <COUNTY NAME>.
Q: What is the monthly premium for <PLAN

NAME>?
A: The monthly premium for <PLAN NAME>

is $$.
Q: What is the cost for Flu shots?
A: Flu shots are offered at no cost.
Q: Can a MediGap policy be used to pay for

a Medicare Advantage Plan’s out-of-pocket
costs like co-pays?
A: No, a Medigap policy cannot be used to

pay for the out-of-pocket costs of a
Medicare Advantage plan.
Q: How many days do you cover for skilled
nursing facility on <PLAN NAME>?
A: Skilled Nursing is covered for 100 days

on <PLAN NAME>.
Q: Does <PLAN NAME> require a referral for
Transfusion/Blood Lab Services?
A: Yes or No, this plan [does or does not]

require a referral for Outpatient Lab
Services.
Q: Does <PLAN NAME> affect my Part B

premium?
A: The <PLAN NAME> [does or does not]

affect your part B premium.
Q: What is the most I would pay out-of-
pocket In-Network for the year for <PLAN
NAME>?
A: The In-Network maximum out-of-pocket

limit for <PLAN NAME> is $$.
Q: In <PLAN NAME>, would I be covered if I
went to an Out-of-Network Doctor for
routine covered services?
A: Yes or No.
Q: What is the overall STARS rating for
<PLAN NAME>?
A: The <PLAN NAME> has a rating of #

STARS. Please refer to Medicare.gov for
further information.
Q: I’m not sure my Primary Care Physician

will stay on my plan. Will your plan send
notification if he leaves the plan?
A: Yes, we will notify you if your doctor

leaves the plan.
Q: Does <PLAN NAME> cover routine eye

exams?
A: Yes. Routine eye exams are covered.
Q: Are the (summary of benefits/provider

directory) available in larger font?
A: Yes, this document is available in other

formats such as Braille and large print.
Q: If my mother is goes to the emergency
Room, will the copay be waived if she is
admitted to the hospital within a certain
amount of time?
A: Under <plan name> the ER cost share is

<waived/not waived> if admitted within 24
hours.
Q: My Mom is blind can she get a (member
handbook/provider directory/summary of
benefits) in (braille/audio)?
A: Yes, it is available in alternate formats.

Q: If my mom is smoking right now and she
wants to quit smoking will the <Plan Name>
provide service and consultation to quit
smoking?
A: Yes.
Q: Are hearing aids covered on the <Plan

Name>?
A: <Yes/No>, hearing aids are/are not

covered on the <Plan Name>.
Q: If my mother joins your plan, does she
have the option to go back to Original
Medicare during next year's open enrollment
period?
A: Yes. She does.

Q: Where can I get information about the
Privacy Notice for <PLAN NAME>?
A: You can access it at

<humana.com/careplushealthplans.com>
Q: If my mother enrolls in your plan, is
there a form that she can sign to have me
represent her?
A: Yes. There are 3 options. Option 1. She

can mail or fax the form. Option 2. Call
customer service. Option 3. Submit online
under her 'MyHumana/MyCarePlus' account.
Q: Is the Summary of Benefits available on
your website?
A: Yes, you can also access it on

<myhumana.com/careplushealthplans.com>
Q: If it is cheaper to buy some prescriptions

at Walmart and pay $4.00 for a generic drug
instead of using my insurance. If I enroll in
your plan, do I have to show my plan card
and buy my drugs through your plan or can
I continue to pay for drugs on my own?
A: Yes, you can continue to purchase

medications at Walmart. You do not have to
buy your drugs through our plan.
Q: If I join your plan, and one of my

medications is not covered by your plan, can
I at least get a one-time, temporary supply
of my medicine within the first 90 days of
my enrollment in the plan?
A: Yes, you can get a one-time, temporary

supply of your medication within the first 90
days of your enrollment in the plan.
Q: Would a copy of a Medicaid card that
includes the name and eligibility date or a
copy of a letter from Social Security
Administration showing my mom receives
Supplemental Security Income be
acceptable as best available evidence for
low-income subsidy?
A: Yes.
Q: Is Wegovy covered in your plan?
A: No.
Q: What is the cost of the AREXVY Vaccine

on <Plan Name>?
A: No cost, $0.
Q: Is the yellow fever vaccine YF-VAX
covered?
A: Yes.
Q: Is Krazati covered in your plan?
A: Yes, Krazati is covered with prior

authorization from your doctor.
Q: Is COPAXONE covered?
A: Yes, Copaxone is covered.
Q: Does VIRACEPT require prior

authorization?
A: No.
Q: Sometimes my Doctor wants me to try
out a drug but only for a few days, not the
full 30 days. In this case, do I have to pay
the full 30 day copay amount?
A: No.
Q: My mom needs to move in the middle of

the year, she will eventually need to change
her plan. If she selects your plan, will your
plan be made aware of her drug payments
she made into her old plan?
A: Yes, the amount that you have paid into

your Coverage Gap (or) Deductible will carry
over to your new plan.
Q: My Mother heard about a Medication
Management Therapy program on your plan
that she will be asked to set an appointment
with a pharmacist. The question is, if she
does not want to set that appointment, will
she still be able to join your plan?
A: Yes.
Q: Is your formulary on the plan's website?
A: Yes.
Q: My mom’s doctor stated she needs to
take her medication everyday but the
pharmacy says there is a quantity limit of
one tablet per day. Does that mean her
Doctor has to contact the <Plan> before the
it covers more than 1 tablet of her
medication?
A: YES, you, your representative or your

doctor will need to contact us and ask for an
exception.
Q: Sometimes my Doctor wants me to try

out a drug but only for a few days, not the
full 30 days. In this case, do I have to pay
the full 30 day copay amount?
A: No.
Q: My mom needs to move in the middle of

the year, she will eventually need to change
her plan. If she selects your plan, will your
plan be made aware of her drug payments
she made into her old plan?
A: Yes, the amount that you have paid into

your Coverage Gap (or) Deductible will carry
over to your new plan.
Q: My Mother heard about a Medication

Management Therapy program on your plan
that she will be asked to set an appointment
with a pharmacist. The question is, if she
does not want to set that appointment, will
she still be able to join your plan?
A: Yes.
Q: Is your formulary on the plan's website?
A: Yes.
Q: My mom’s doctor stated she needs to

take her medication everyday but the
pharmacy says there is a quantity limit of
one tablet per day. Does that mean her
Doctor has to contact the <Plan> before the
it covers more than 1 tablet of her
medication?
A: YES, you, your representative or your

doctor will need to contact us and ask for an
exception.
Terminology: Humana
1. Review the terms below and translate the ones you know.
2. Using your resources, look up the translation for the terms that you do not know.
3. Add all unknown terms to your personal glossary.
English Translation
admitted
blind
braille
copay
drug
eligibility
font
formulary
handbook
in-network
Medication Management Therapy Program
Medigap policy
open enrollment period
out-of-network
out-of-pocket costs
premium
prescription
prior authorization
privacy notice
quantity limits
quit
referral
routine
skilled nursing facility
STARS ratings
subsidy
summary of benefits
Supplemental Security Income
tablet
temporary supply
transfusion/blood lab services
waived

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Interpreter Bulletin: 2024 CMS Mystery Shoppers - Humana

Issue 470 (All Languages): April 5, 2024

Identifying a CMS Test Call

• For Part D, CMS will ask:

CMS Test Calls measure 2 items:

Q: Can I enroll in your plan if I live in

A: Yes, you can enroll in our plan if you live

Q: What is the monthly premium for <PLAN

A: The monthly premium for <PLAN NAME>

A: Flu shots are offered at no cost.

Q: Can a MediGap policy be used to pay for

A: No, a Medigap policy cannot be used to

A: Skilled Nursing is covered for 100 days

A: Yes or No, this plan [does or does not]

Q: Does <PLAN NAME> affect my Part B

A: The <PLAN NAME> [does or does not]

A: The In-Network maximum out-of-pocket

A: The <PLAN NAME> has a rating of #

Q: I’m not sure my Primary Care Physician

A: Yes, we will notify you if your doctor

Q: Does <PLAN NAME> cover routine eye

A: Yes. Routine eye exams are covered.

Q: Are the (summary of benefits/provider

A: Yes, this document is available in other

A: Under <plan name> the ER cost share is

A: Yes, it is available in alternate formats.

Q: Are hearing aids covered on the <Plan

A: <Yes/No>, hearing aids are/are not

A: Yes. She does.

A: You can access it at

A: Yes. There are 3 options. Option 1. She

A: Yes, you can also access it on

Q: If it is cheaper to buy some prescriptions

A: Yes, you can continue to purchase

Q: If I join your plan, and one of my

A: Yes, you can get a one-time, temporary

Q: What is the cost of the AREXVY Vaccine

A: Yes, Krazati is covered with prior

A: Yes, Copaxone is covered.

Q: Does VIRACEPT require prior

Q: My mom needs to move in the middle of

A: Yes, the amount that you have paid into

Q: Is your formulary on the plan's website?

A: YES, you, your representative or your

Q: Sometimes my Doctor wants me to try

Q: My mom needs to move in the middle of

A: Yes, the amount that you have paid into

Q: My Mother heard about a Medication

Q: Is your formulary on the plan's website?

Q: My mom’s doctor stated she needs to

A: YES, you, your representative or your

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