Eligibility Exam Study Guide with Complete Solutions

Eligibility Exam Study Guide with Complete Solutions Entitled to Medicare Part A and enrolled in Part B - Answer-Part A: Hospital Insurance -Age 65 or older -Disabled individuals -Patients with End-Stage Renal Disease (ESRD) Part B: General Medical -Age 65 or older -Disabled individuals -Patients with End-Stage Renal Disease (ESRD) Part D: Prescription Drugs -Must be enrolled in Medicare Part A and/or B Applicant does not have ESRD prior to completing enrollment - Answer-End Stage Renal Disease (ESRD) EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER, 2024 Page 2/7 -Irreversible kidney impairment -Requires dialysis or kidney transplant -Individuals are assigned "ESRD Status" per their attending physicians attestation to CMS that ongoing treatment is necessary to sustain life -Those with ESRD are generally not eligible to enroll in a Medicare Advantage plan End Stage Renal Disease Exceptions -An applicant may elect an MA plan if ESRD was diagnosed after the enrollment form was signed -A beneficiary may remain enrolled if ESRD was diagnosed after the enrollment became effective -A beneficiary may elect another MA plan within the same organization, but may not enroll in a different organization's MA plan -An applicant may elect an MA plan within the same organization if prior commercial coverage existed within the same organization -An application making an election through an employer group plan may be eligible if the group meets certain criteria Additional Notes on ESRD - Answer--If regular dialysis is no longer required due to improved kidney function or a successful transplant, the individual is not considered to have ESRD EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER, 2024 Page 3/7 -A beneficiary who is eligible for Medicare solely based on an ESRD diagnosis in only eligible for enrollment in an MA plan for the duration of their Medicare eligibility -Plans must deny enrollment to those with ESRD who do not meet any of the qualifying exceptions -If the application is submitted to CMS, the enrollment will be rejected. Individual resides in the plan's service area - Answer--Applicant are eligible if they permanently reside in the plan's service area -Applicants are not eligible if they only temporarily reside the plan's service area or are incarcerated Permanent Address -The primary residence of the individual -The plan may request validation in the form of tax records, voter registration, utility bills, and/or driver's license -Homeless individuals may use a Post Office Box, the address of a shelter, or the address where the individual receives mail Mailing Address EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER, 2024 Page 4/7 -An alternate address used for mailing purposes -Oftentimes the address is of a relative or a post office box -Has no effect on the individual's eligibility Address exception -members may add a temporary or seasonal address if the plan offers a visitor/travelers program -If the plan does not offer the visitor/trav