Practice Test Geeks(CEC) Certified Enrollment Counselor Practice Test
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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

  1. A beneficiary was enrolled in a Medicare Advantage plan that is terminating its contract with CMS. What SEP are they entitled to?

    Answer: They receive a Special Enrollment Period to choose a new plan before coverage ends

    When a Medicare Advantage plan loses its CMS contract, affected enrollees receive a Special Enrollment Period to choose a new MA plan or return to Original Medicare.

  2. What is the maximum number of times a beneficiary enrolled in a Medicare Advantage plan can use the MA Open Enrollment Period per calendar year?

    Answer: Once per calendar year

    The Medicare Advantage Open Enrollment Period (January 1–March 31) allows currently enrolled MA beneficiaries to make one plan change per calendar year.

  3. An enrollment counselor is helping a client understand their rights to appeal a plan's coverage denial. What is the first level of the Medicare appeals process?

    Answer: Redetermination by the plan

    The first level of the Medicare appeals process is a redetermination, where the plan reviews its own initial coverage denial decision.

  4. A beneficiary complains that their Medicare Advantage plan did not process a claim correctly. What is the difference between a grievance and an appeal in this context?

    Answer: A grievance addresses dissatisfaction with plan services or quality; an appeal contests a coverage or payment denial

    A grievance addresses complaints about quality of care, service, or plan conduct, while an appeal specifically contests a plan's decision to deny, reduce, or terminate coverage or payment.

  5. Which of the following situations would allow a beneficiary to use the Five-Star Special Enrollment Period?

    Answer: They want to switch to a Medicare Advantage plan that has a 5-star CMS quality rating

    The Five-Star SEP allows beneficiaries to switch once per calendar year (outside AEP) to a Medicare Advantage plan or Part D plan that holds a 5-star CMS quality rating.

  6. A Medicare beneficiary is hospitalized and their Medicare Advantage plan issues a Notice of Medicare Non-Coverage (NOMNC). What does this document inform the beneficiary?

    Answer: That the plan intends to terminate a covered inpatient or skilled nursing stay

    The Notice of Medicare Non-Coverage (NOMNC) informs a beneficiary that the plan will stop covering a Medicare-covered service (such as inpatient hospital or SNF care) and explains their right to appeal.

  7. A beneficiary moving into a nursing home asks about Medicare coverage for skilled nursing facility care. What is required for Medicare Part A to cover SNF care?

    Answer: A qualifying 3-day inpatient hospital stay and a skilled care need

    Medicare Part A covers SNF care only after a qualifying 3-consecutive-day inpatient hospital stay and only when skilled nursing or therapy services are medically necessary.