Post-Enrollment and Renewals Flashcards
7 cards from real CEC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Post-Enrollment and Renewals flashcards as text
A beneficiary enrolled in a Medicare Part D plan reaches the catastrophic coverage phase. What happens to their cost-sharing at this stage?
Answer: They pay a small copay or coinsurance and the plan covers the rest
In the catastrophic coverage phase, beneficiaries pay significantly reduced cost-sharing (small copay or 5% coinsurance) and the plan covers the majority of drug costs.
An enrollment counselor's client asks about the Medicare Savings Programs. Which statement is accurate?
Answer: They are federal programs that help low-income beneficiaries pay Medicare premiums and cost-sharing
Medicare Savings Programs are state-administered, federally funded programs that assist low-income beneficiaries with Medicare Part A and/or Part B premiums, deductibles, and copayments.
What is the primary purpose of the Low-Income Subsidy (LIS/Extra Help) program in relation to Medicare Part D?
Answer: To help low-income beneficiaries pay for Part D premiums, deductibles, and copayments
The Low-Income Subsidy (Extra Help) assists qualifying low-income beneficiaries by reducing or eliminating Part D premiums, deductibles, and copayments.
A beneficiary who receives Extra Help is auto-enrolled into a benchmark plan. What happens if they do not make a plan selection?
Answer: They remain enrolled in the assigned benchmark plan
Beneficiaries auto-enrolled into a benchmark Part D plan remain in that plan if they take no action, and their Extra Help subsidy continues.
A client asks why they received a late enrollment penalty for Part D. Which scenario would result in this penalty?
Answer: They went 63 or more consecutive days without creditable prescription drug coverage
A Part D late enrollment penalty applies when a beneficiary goes 63 or more consecutive days without creditable prescription drug coverage after their enrollment window closes.
Which of the following best describes a 'formulary exception' in a Medicare Part D plan?
Answer: A request for the plan to cover a drug not on the formulary or at a lower cost-sharing tier
A formulary exception is a request for the plan to cover a non-formulary drug or place a drug on a lower cost-sharing tier when the standard formulary does not meet the beneficiary's medical needs.
After a beneficiary enrolls in a new Medicare Advantage plan, when does the new coverage typically begin?
Answer: The first day of the month following the month of enrollment, if all conditions are met
Medicare Advantage enrollment generally becomes effective the first day of the month following the month of enrollment, assuming the beneficiary has Medicare Parts A and B.