CEC Post-Enrollment and Renewals 2 — Questions and Answers
Question 1: A beneficiary enrolled in a Medicare Advantage plan wants to add dental coverage mid-year. What should the enrollment counselor advise?
- They can add dental coverage at any time during the year
- They must wait for the Annual Enrollment Period to switch to a plan with dental benefits (Correct answer)
- They can request a Special Enrollment Period specifically for dental coverage
- They should disenroll from Medicare Advantage and enroll in Original Medicare
Correct answer: They must wait for the Annual Enrollment Period to switch to a plan with dental benefits
Medicare Advantage plan changes, including adding benefits like dental, generally require waiting for the Annual Enrollment Period (October 15–December 7) unless a qualifying SEP event occurs.
Question 2: Which of the following is a valid reason for a Medicare beneficiary to qualify for a Special Enrollment Period after initial enrollment?
- The beneficiary simply changed their mind about their plan choice
- The beneficiary moved to a new address outside their plan's service area (Correct answer)
- The beneficiary wants a plan with lower premiums
- The beneficiary forgot to enroll during their Initial Enrollment Period
Correct answer: The beneficiary moved to a new address outside their plan's service area
Moving out of a plan's service area is a qualifying life event that triggers a Special Enrollment Period, allowing the beneficiary to change plans.
Question 3: During the Medicare Advantage Open Enrollment Period (January 1–March 31), what changes can a beneficiary make?
- Switch from one Medicare Advantage plan to another MA plan or return to Original Medicare (Correct answer)
- Enroll in any Medicare Advantage plan for the first time
- Add or drop Part D drug coverage without restriction
- Switch between any Part D standalone plans
Correct answer: Switch from one Medicare Advantage plan to another MA plan or return to Original Medicare
The MA Open Enrollment Period allows beneficiaries already enrolled in a Medicare Advantage plan to switch to another MA plan or return to Original Medicare once.
Question 4: A client enrolled in a PDP (Prescription Drug Plan) notices their medication is no longer covered after the plan's Annual Notice of Change. What is the best next step?
- Continue using the plan and request an exception after the new year begins
- Review the Annual Notice of Change and use the AEP to switch to a plan covering the medication (Correct answer)
- File a formal grievance with CMS immediately
- Request the drug be added to the formulary during the current plan year
Correct answer: Review the Annual Notice of Change and use the AEP to switch to a plan covering the medication
The Annual Notice of Change alerts beneficiaries to plan changes, and the Annual Enrollment Period (Oct 15–Dec 7) is the time to switch to a better-fitting plan for the new year.
Question 5: What document must Medicare Advantage and Part D plans send to enrollees each September?
- Evidence of Coverage (EOC)
- Annual Notice of Change (ANOC) (Correct answer)
- Summary of Benefits (SOB)
- Medicare & You handbook
Correct answer: Annual Notice of Change (ANOC)
Plans must send the Annual Notice of Change (ANOC) by September 30 each year, informing members of any changes taking effect on January 1.
Question 6: A beneficiary disenrolls from a Medicare Advantage plan and returns to Original Medicare. When does their Part A and Part B coverage take effect?
- Immediately upon disenrollment
- The first day of the month following disenrollment (Correct answer)
- January 1 of the following year
- 60 days after disenrollment
Correct answer: The first day of the month following disenrollment
When a beneficiary disenrolls from Medicare Advantage and returns to Original Medicare, coverage takes effect the first day of the month following the disenrollment.
Question 7: A newly enrolled Medicare Advantage member receives their Evidence of Coverage but does not understand the out-of-pocket maximum. What is the most accurate explanation?
- It is the monthly premium cap the plan can charge
- It is the maximum amount the beneficiary will pay in cost-sharing for covered services in a plan year (Correct answer)
- It is the limit on how much Medicare will pay the plan annually
- It is the maximum number of prescriptions covered under the plan
Correct answer: It is the maximum amount the beneficiary will pay in cost-sharing for covered services in a plan year
The out-of-pocket maximum is the annual cap on cost-sharing (copays, coinsurance, deductibles) that a beneficiary must pay for covered in-network services.
CEC Post-Enrollment and Renewals 2
A beneficiary enrolled in a Medicare Advantage plan wants to add dental coverage mid-year.
What should the enrollment counselor advise?