CMS Medicare Specialist Enrollment & Eligibility Guidelines 5

Question 1

A beneficiary turns 65 in June. They enroll in Medicare Part B during the month of June (their birthday month). When does their Part B coverage begin?

Accepted Answer

June 1

Answer

Enrolling in the birthday month results in Part B coverage beginning on the first day of the birthday month itself.

Question 2

Which enrollment period allows a beneficiary who recently lost Medicaid coverage to enroll in or change a Medicare Advantage or Part D plan?

Accepted Answer

Special Enrollment Period due to loss of Medicaid

Answer

Loss of Medicaid coverage qualifies as a Special Enrollment Period trigger, allowing the beneficiary to enroll in or change an MA or Part D plan.

Question 3

Under the Medicare Secondary Payer rules, when does Medicare become primary payer for a beneficiary aged 65 or older who is actively employed at a company with 25 employees?

Accepted Answer

The employer plan is primary; Medicare is secondary for active employees at employers with 20+ employees

Answer

For active employees age 65+ at employers with 20 or more employees, the employer Group Health Plan is primary and Medicare is secondary.

Question 4

A Medicare beneficiary who has Original Medicare and a Medigap policy wants to switch to a Medicare Advantage plan. What should a Medicare Specialist advise regarding their Medigap policy?

Accepted Answer

Medigap policies cannot be used with Medicare Advantage and they should be aware they may not be able to get the same Medigap policy back if they later leave MA

Answer

Medigap cannot be used with Medicare Advantage, and beneficiaries may lose guaranteed issue rights if they later want to return to Original Medicare with a Medigap policy.

Question 5

What is the enrollment window for a beneficiary who qualifies for Medicare due to ESRD and wants to enroll in a Medicare Advantage ESRD plan?

Accepted Answer

During a specific ESRD enrollment period available since January 2021, allowing ESRD patients to enroll in MA plans

Answer

Since January 2021, ESRD patients may enroll in Medicare Advantage plans, and they have specific enrollment periods available to them throughout the year.

(CMS) Certified Medicare Specialist Practice Test

(CMS) Certified Medicare Specialist Practice Test

CMS Medicare Specialist Enrollment & Eligibility Guidelines 5