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
What penalty applies to a Medicare beneficiary who goes 15 full months without creditable prescription drug coverage after their Part D Initial Enrollment Period ends?
Answer: 15 x 1% = 15% added to the national base beneficiary premium, paid for as long as enrolled
The Part D late enrollment penalty is 1% of the national base beneficiary premium for each uncovered month, added permanently to the Part D premium.
Which of the following is NOT a qualifying condition for Medicare eligibility based on disability before age 65?
Answer: Permanent blindness with no SSDI entitlement
Blindness alone without SSDI entitlement or ESRD/ALS diagnosis does not qualify someone for Medicare before age 65.
A beneficiary with ESRD has a 3-month waiting period before Medicare begins. In which month does Medicare coverage start if their dialysis began in April?
Answer: July
For ESRD patients on dialysis, Medicare begins the 4th month of dialysis treatment, meaning if dialysis starts in April, coverage begins in July.
A Medicare beneficiary is hospitalized on November 30. Their Medicare Advantage Annual Enrollment Period change takes effect January 1. Which plan covers the hospitalization?
Answer: Their current plan in effect on November 30
AEP changes take effect January 1, so the plan in force on the date of service (November 30) covers the hospitalization.
Which statement accurately describes Medicare Savings Programs (MSPs) in relation to Medicare enrollment?
Answer: MSPs are state Medicaid programs that help pay Medicare premiums, deductibles, and/or cost-sharing
Medicare Savings Programs are state Medicaid programs designed to assist low-income Medicare beneficiaries with their Medicare cost-sharing obligations.
When does a beneficiary who signs up for Medicare Part B during the Special Enrollment Period (SEP) following loss of employer coverage have their coverage begin?
Answer: The first day of the following month after enrollment, or any of the preceding 3 months at the beneficiary's request
During an SEP, Part B coverage can be backdated up to 3 months before the month enrollment is requested, or can begin the following month.
Which statement about Part A premium-free eligibility is correct?
Answer: A beneficiary needs 40 quarters of Medicare-covered employment for premium-free Part A
Premium-free Part A requires 40 quarters (10 years) of Medicare-covered employment by the beneficiary or their spouse.