Post-Enrollment and Renewals Flashcards
7 cards from real CEC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Post-Enrollment and Renewals flashcards as text
A beneficiary enrolled in a Medicare Advantage plan wants to add dental coverage mid-year. What should the enrollment counselor advise?
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.
Which of the following is a valid reason for a Medicare beneficiary to qualify for a Special Enrollment Period after initial enrollment?
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.
During the Medicare Advantage Open Enrollment Period (January 1–March 31), what changes can a beneficiary make?
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.
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?
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.
What document must Medicare Advantage and Part D plans send to enrollees each September?
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.
A beneficiary disenrolls from a Medicare Advantage plan and returns to Original Medicare. When does their Part A and Part B coverage take effect?
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.
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?
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.