Which statement is correct regarding enrollment in Medicare Advantage (MA) plans?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Medicare Advantage plans must accept any Medicare beneficiary who is eligible for the plan's service area, regardless of health status, and may not charge higher premiums because of health conditions or preexisting conditions. This guaranteed acceptance is a hallmark of MA enrollment. Premiums may vary by plan design and benefits, but not by an individual beneficiary's health. No medical underwriting or examination is required to enroll in an MA plan. Medicare Advantage enrollment is guaranteed regardless of health status for anyone entitled to Part A and enrolled in Part B, living in the plan's service area. Plans instead compete on benefits, cost sharing, provider networks, and quality ratings, while Medicare pays them a risk-adjusted amount tied to the enrollee's risk score.
Why the other options are wrong
- C) Denying enrollment based on chronic illness would violate the rule that MA plans accept beneficiaries without regard to health status. MA plans cannot exclude beneficiaries with chronic illnesses; enrollment is guaranteed regardless of health status for those who meet basic eligibility.
- D) MA premiums are not health-rated for individual beneficiaries; plan premiums do not increase because of a person's age within the plan. MA plans may not charge higher premiums based on age within the plan; Medicare risk-adjusts payments to the plan rather than allowing health- or age-based pricing.
- A) MA enrollment does not require a medical examination; plans accept all eligible Medicare beneficiaries. No medical examination is permitted; MA enrollment requires eligibility, not underwriting or a health assessment.
Memory hook
Medicare Advantage opens its doors to every eligible beneficiary, no health history screening.