CEC Post-Enrollment and Renewals 2

Question 1

A beneficiary enrolled in a Medicare Advantage plan wants to add dental coverage mid-year. What should the enrollment counselor advise?

Accepted Answer

They must wait for the Annual Enrollment Period to switch to a plan with dental benefits

Answer

They can add dental coverage at any time during the year

Answer

They can request a Special Enrollment Period specifically for dental coverage

Answer

They should disenroll from Medicare Advantage and enroll in Original Medicare

Question 2

Which of the following is a valid reason for a Medicare beneficiary to qualify for a Special Enrollment Period after initial enrollment?

Accepted Answer

The beneficiary moved to a new address outside their plan's service area

Answer

The beneficiary simply changed their mind about their plan choice

Answer

The beneficiary wants a plan with lower premiums

Answer

The beneficiary forgot to enroll during their Initial Enrollment Period

Question 3

During the Medicare Advantage Open Enrollment Period (January 1–March 31), what changes can a beneficiary make?

Accepted Answer

Switch from one Medicare Advantage plan to another MA plan or return to Original Medicare

Answer

Enroll in any Medicare Advantage plan for the first time

Answer

Add or drop Part D drug coverage without restriction

Answer

Switch between any Part D standalone plans

Question 4

A client enrolled in a PDP (Prescription Drug Plan) notices their medication is no longer covered after the plan's Annual Notice of Change. What is the best next step?

Accepted Answer

Review the Annual Notice of Change and use the AEP to switch to a plan covering the medication

Answer

Continue using the plan and request an exception after the new year begins

Answer

File a formal grievance with CMS immediately

Answer

Request the drug be added to the formulary during the current plan year

Question 5

What document must Medicare Advantage and Part D plans send to enrollees each September?

Accepted Answer

Annual Notice of Change (ANOC)

Answer

Evidence of Coverage (EOC)

Answer

Summary of Benefits (SOB)

Answer

Medicare & You handbook

Question 6

A beneficiary disenrolls from a Medicare Advantage plan and returns to Original Medicare. When does their Part A and Part B coverage take effect?

Accepted Answer

The first day of the month following disenrollment

Answer

Immediately upon disenrollment

Answer

January 1 of the following year

Answer

60 days after disenrollment

Question 7

A newly enrolled Medicare Advantage member receives their Evidence of Coverage but does not understand the out-of-pocket maximum. What is the most accurate explanation?

Accepted Answer

It is the maximum amount the beneficiary will pay in cost-sharing for covered services in a plan year

Answer

It is the monthly premium cap the plan can charge

Answer

It is the limit on how much Medicare will pay the plan annually

Answer

It is the maximum number of prescriptions covered under the plan