CMS Medicare Specialist Coverage Planning Options 2 — Questions and Answers
Question 1: A Medicare beneficiary with End-Stage Renal Disease (ESRD) wants to enroll in a Medicare Advantage plan. Which statement is most accurate?
- ESRD patients cannot enroll in any Medicare Advantage plan
- ESRD patients may enroll in Medicare Advantage plans that specifically serve ESRD patients (Correct answer)
- ESRD patients are automatically enrolled in Medicare Advantage
- ESRD patients must wait 24 months before enrolling in Medicare Advantage
Correct answer: ESRD patients may enroll in Medicare Advantage plans that specifically serve ESRD patients
Since 2021, individuals with ESRD may enroll in any Medicare Advantage plan available in their area, ending the prior restriction.
Question 2: When comparing Medicare Supplement Plan G and Plan N for a client, what is the key difference in cost-sharing?
- Plan G covers the Part A deductible while Plan N does not
- Plan N requires copays for office visits and emergency room visits while Plan G does not (Correct answer)
- Plan G includes foreign travel emergency coverage while Plan N does not
- Plan N has a lower Part B deductible than Plan G
Correct answer: Plan N requires copays for office visits and emergency room visits while Plan G does not
Plan N requires copays up to $20 for office visits and up to $50 for emergency room visits that don't result in inpatient admission, whereas Plan G has no such copays.
Question 3: A client is enrolled in a Medicare Advantage plan and moves permanently to another state where their plan has no network. What is their best option?
- They must stay in the plan until the next Annual Enrollment Period
- They qualify for a Special Enrollment Period to switch plans or return to Original Medicare (Correct answer)
- They are automatically disenrolled and placed in Original Medicare
- They must pay out-of-network rates until the plan year ends
Correct answer: They qualify for a Special Enrollment Period to switch plans or return to Original Medicare
A permanent move outside a Medicare Advantage plan's service area triggers a Special Enrollment Period, allowing the beneficiary to change plans.
Question 4: Medicare Part D's 'creditable coverage' concept is most important for which planning scenario?
- Determining eligibility for Low Income Subsidy
- Avoiding the Part D late enrollment penalty when delaying enrollment (Correct answer)
- Calculating the True Out-of-Pocket (TrOOP) threshold
- Selecting formulary tiers for specialty drugs
Correct answer: Avoiding the Part D late enrollment penalty when delaying enrollment
Drug coverage is 'creditable' if it's at least as good as standard Medicare Part D, and having it allows beneficiaries to delay Part D enrollment without incurring a late penalty.
Question 5: Which Medicare coverage option allows beneficiaries to see any provider who accepts Medicare without referrals?
- Medicare Advantage HMO
- Medicare Advantage PPO
- Original Medicare (Parts A and B) (Correct answer)
- Medicare Advantage PFFS
Correct answer: Original Medicare (Parts A and B)
Original Medicare allows beneficiaries to visit any provider nationwide who accepts Medicare assignment without needing referrals or network restrictions.
Question 6: A 67-year-old client has been working and covered by employer group health insurance. She retires and loses coverage. How long does she have to enroll in Medicare Part B without penalty?
- 60 days from the date of retirement
- 6 months from the date of retirement
- 8 months from the loss of employer coverage (Correct answer)
- 3 months before and after her birthday month
Correct answer: 8 months from the loss of employer coverage
The Special Enrollment Period for losing employer coverage is 8 months from the date employment ends or employer coverage ends, whichever comes first.
Question 7: When does the Medicare Advantage Annual Enrollment Period (AEP) occur, and what can beneficiaries do during this time?
- January 1–March 31; switch MA plans only
- October 15–December 7; switch between any Medicare coverage options (Correct answer)
- November 1–December 15; enroll in Part D only
- April 1–June 30; enroll in Medicare Supplement plans
Correct answer: October 15–December 7; switch between any Medicare coverage options
The AEP runs October 15 through December 7 each year, during which beneficiaries can join, switch, or drop Medicare Advantage or Part D plans, with changes effective January 1.
