Medicare Specialist Enrollment & Eligibility Guidelines Flashcards

A 68-year-old beneficiary has been enrolled in Medicare Part A only and wants to add Part B. They never had employer coverage as the reason for delay. What penalty applies?

Answer: 10% for each 12-month period they could have had Part B but didn't enroll

The Part B late enrollment penalty is 10% of the standard Part B premium for each 12-month period the beneficiary was eligible but did not enroll without a qualifying exception.

What is the maximum number of months a Medicare Advantage enrollee can use the MA Open Enrollment Period (MA OEP) to make a plan change in a calendar year?

Answer: One change between January 1 and March 31

During the MA OEP (January 1–March 31), an enrollee may make only one plan change — either to another MA plan or back to Original Medicare.

Which of the following individuals is eligible to enroll in Medicare Part A at no premium cost?

Answer: A 65-year-old whose spouse worked 40 quarters in Medicare-covered employment

Premium-free Part A is available to a 65-year-old whose current or former spouse has at least 40 quarters of Medicare-covered work, even if the beneficiary did not work those quarters personally.

A Medicare beneficiary is involuntarily disenrolled from their Medicare Advantage plan because the plan exits their service area. What enrollment rights do they have?

Answer: They receive a Special Enrollment Period to join another MA plan or return to Original Medicare

When a Medicare Advantage plan terminates or exits an area, affected enrollees receive an SEP to select a new MA plan or return to Original Medicare.

What happens to a beneficiary's Medicare coverage if they become incarcerated?

Answer: Medicare eligibility is retained but benefits are not payable for inmate care covered by correctional facilities

Incarcerated individuals remain eligible for Medicare, but Medicare does not pay for services provided to inmates that are the responsibility of the correctional facility.

A beneficiary's Initial Enrollment Period for Medicare begins three months before they turn 65. If they enroll in the third month after their birthday month, when does Part B coverage begin?

Answer: Three months after the month of enrollment

Enrolling in the 3rd month after the birthday month results in a 3-month delay, so Part B coverage begins 3 months after that enrollment month.

Which of the following best describes 'creditable coverage' as it pertains to Medicare Part D?

Answer: Drug coverage expected to pay, on average, at least as much as the standard Medicare Part D benefit

Creditable coverage for Part D is drug coverage that is expected to pay, on average, at least as much as the standard Medicare prescription drug benefit.