Practice Test Geeks(CMS) Certified Medicare Specialist Practice Test
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Medicare Specialist Enrollment & Eligibility Guidelines Flashcards

7 cards from real CMS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Medicare Specialist Enrollment & Eligibility Guidelines flashcards as text

  1. A 64-year-old individual with ALS (Lou Gehrig's disease) is diagnosed in March. When does Medicare eligibility begin?

    Answer: Immediately upon ALS diagnosis

    Individuals diagnosed with ALS are automatically enrolled in Medicare the month their Social Security disability benefits begin, with no waiting period.

  2. Which of the following individuals qualifies for a Special Enrollment Period (SEP) to enroll in Medicare Part B without a late enrollment penalty?

    Answer: An employee who had employer group health plan coverage and retired at age 67

    Employees who delayed Part B while covered under an employer Group Health Plan (GHP) qualify for an SEP without penalty when that coverage ends.

  3. What is the General Enrollment Period (GEP) for Medicare Part B, and when does coverage become effective?

    Answer: January 1–March 31; coverage begins July 1 of that year

    The GEP runs January 1–March 31 each year, and Part B coverage obtained during this period begins July 1.

  4. A beneficiary is enrolled in Medicare Part A and Part B. They want to join a Medicare Advantage plan. Which enrollment period allows them to switch from one MA plan to another MA plan between January 1 and March 31?

    Answer: Medicare Advantage Open Enrollment Period (MA OEP)

    The Medicare Advantage Open Enrollment Period (MA OEP), January 1–March 31, allows MA enrollees to switch to a different MA plan or return to Original Medicare once.

  5. How long does a newly Medicare-eligible individual have to enroll in a Medicare Advantage plan for the first time through their Initial Coverage Election Period (ICEP)?

    Answer: 3 months before through the end of the month they become entitled to Part A and Part B

    The ICEP runs from 3 months before through the last day of the month an individual first becomes entitled to both Part A and Part B.

  6. A beneficiary moves out of their Medicare Advantage plan's service area permanently. Which type of enrollment period do they qualify for?

    Answer: Special Enrollment Period

    Permanently moving out of a plan's service area triggers a Special Enrollment Period, allowing the beneficiary to switch plans or return to Original Medicare.

  7. Under Medicare's coordination of benefits rules, when a Medicare beneficiary is an active employee covered by a small employer group health plan (fewer than 20 employees), which payer is primary?

    Answer: Medicare

    For employers with fewer than 20 employees, Medicare is primary and the small group health plan is secondary.