CMS Medicare Specialist Enrollment & Eligibility Guidelines 2 — Questions and Answers
Question 1: A 64-year-old individual with ALS (Lou Gehrig's disease) is diagnosed in March. When does Medicare eligibility begin?
- Immediately upon ALS diagnosis (Correct answer)
- After a 24-month waiting period
- At age 65
- After a 5-month Social Security disability waiting period
Correct 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.
Question 2: Which of the following individuals qualifies for a Special Enrollment Period (SEP) to enroll in Medicare Part B without a late enrollment penalty?
- A retiree who delayed Part B enrollment for 18 months with no employer coverage
- An employee who had employer group health plan coverage and retired at age 67 (Correct answer)
- A beneficiary who simply forgot to enroll during their Initial Enrollment Period
- A person who dropped Part B voluntarily 2 years ago
Correct 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.
Question 3: What is the General Enrollment Period (GEP) for Medicare Part B, and when does coverage become effective?
- January 1–March 31; coverage begins July 1 of that year (Correct answer)
- October 15–December 7; coverage begins January 1
- January 1–March 31; coverage begins April 1
- November 1–January 31; coverage begins February 1
Correct 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.
Question 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?
- Annual Enrollment Period (AEP)
- Medicare Advantage Open Enrollment Period (MA OEP) (Correct answer)
- Special Enrollment Period (SEP)
- Initial Coverage Election Period (ICEP)
Correct 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.
Question 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)?
- 3 months before and 3 months after the Part B effective date
- Only the month they turn 65
- 3 months before through the end of the month they become entitled to Part A and Part B (Correct answer)
- 6 months centered on the Medicare effective date
Correct 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.
Question 6: A beneficiary moves out of their Medicare Advantage plan's service area permanently. Which type of enrollment period do they qualify for?
- Annual Enrollment Period only
- Special Enrollment Period (Correct answer)
- General Enrollment Period
- Initial Enrollment Period
Correct 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.
Question 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?
- The employer group health plan
- Medicare (Correct answer)
- The plan that processed the claim first
- Medicaid if the individual is dual-eligible
Correct answer: Medicare
For employers with fewer than 20 employees, Medicare is primary and the small group health plan is secondary.
CMS Medicare Specialist Enrollment & Eligibility Guidelines 2
A 64-year-old individual with ALS (Lou Gehrig's disease) is diagnosed in March.
When does Medicare eligibility begin?