CEC Post-Enrollment and Renewals 5

Question 1

A beneficiary asks about switching from a Medicare Supplement (Medigap) plan to a Medicare Advantage plan. What should the counselor advise regarding guaranteed issue rights?

Accepted Answer

They lose guaranteed issue rights when switching to MA, and may face medical underwriting if they later want to return to Medigap in most states

Answer

Switching from Medigap to a Medicare Advantage plan generally forfeits guaranteed issue protections, and returning to a Medigap plan in most states is subject to medical underwriting.

Question 2

What is the purpose of the Medicare Advantage plan's Evidence of Coverage (EOC) document?

Accepted Answer

To provide a comprehensive description of covered benefits, costs, and rules for the plan year

Answer

The Evidence of Coverage (EOC) is a detailed document that explains all covered services, costs, prior authorization requirements, and rules for the enrollee's plan during the current benefit year.

Question 3

A client enrolled in a dual-eligible Special Needs Plan (D-SNP) is confused about what additional benefits they receive. What is a key feature of D-SNPs?

Accepted Answer

They coordinate Medicare and Medicaid benefits for dual-eligible beneficiaries and may offer extra benefits

Answer

Dual-eligible Special Needs Plans (D-SNPs) are designed to coordinate Medicare and Medicaid benefits for individuals eligible for both programs, often offering additional benefits tailored to this population.

Question 4

A beneficiary enrolled in a Medicare Advantage plan is told their primary care physician (PCP) is leaving the plan's network. What should the counselor recommend?

Accepted Answer

Check if a SEP applies, review the plan's continuity of care policy, and consider plan options at the next AEP

Answer

Counselors should help the beneficiary understand their continuity of care rights, check for applicable SEPs, and plan for a potential switch during the Annual Enrollment Period if the provider change is permanent.

Question 5

What is the role of a State Health Insurance Assistance Program (SHIP) counselor in the post-enrollment process?

Accepted Answer

To provide free, unbiased Medicare counseling to help beneficiaries understand their rights and options

Answer

SHIP counselors provide free, unbiased, one-on-one assistance to Medicare beneficiaries, helping them understand coverage options, appeals rights, and post-enrollment issues.

(CEC) Certified Enrollment Counselor Practice Test

(CEC) Certified Enrollment Counselor Practice Test

CEC Post-Enrollment and Renewals 5