ANTHEM - 2026 CERTIFICATIONS
EXAM QUESTIONS AND CORRECT
ANSWERS. VERIFIED 2025/2026.
The Special Election Period (SEP) for Dual Eligible and Other LIS Eligible Individuals previously
allowed one time per-calendar-quarter during the first nine months of the year was replaced
beginning Calendar Year 2025 with a monthly SEP to enroll in a standalone PDP. Eligible
beneficiaries can switch PDPs or leave a MA/MAPD plan for Original Medicare plus a standalone
PDP. - ANS True
Which of the following statements is NOT true about a disenrollment? - ANS Disenrollment
requests can be taken verbally
How does a cancellation differ from a disenrollment? - ANS Both A and B are correct
A. A cancellation applies if a request is received prior to a member's effective date or by the
date on the Outbound Enrollment Verification (OEV) letter
B. Cancellation requests are initiated by the member and can be received either verbally or in
writing
FEMA disaster SEPs can only be used if members missed a valid enrollment period. -
ANS True
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, A monthly integrated care SEP beginning calendar year 2025 allows full dual eligible individuals
to elect an integrated Dual Eligible Special Needs Plan (D-SNP) (for example, Fully Integrated
Dual Eligible (FIDE), Highly Integrated Dual Eligible (HIDE), and Applicable Integrated Plan (AIP)).
This SEP is allowed only when the individual receives Medicaid through an affiliated managed
care plan. - ANS True
A member can add or drop prescription drug coverage during the Annual Election Period (AEP).
- ANS True
If a beneficiary has agreed to an in-home appointment to discuss a PDP product, an agent can
discuss an HMO product with them during that same meeting, if the beneficiary requests it and
a new scope of appointment form is completed. - ANS True
The Open Election Period (OEP) is for beneficiaries who are enrolled in a MA-only or MA-PD
plan, or those who are enrolled in Original Medicare, including those enrolled in stand-alone
PDPs. - ANS False
Which of the following is not a valid reason for involuntary disenrollment? - ANS Moving to a
new address in the same plan service area
Prior to making an enrollment decision, beneficiaries must review and complete the pre-
enrollment checklist. - ANS True
If a beneficiary currently has drug coverage through another carrier, you must verify their
prescriptions would be covered under our plan's formulary, too. The drugs that are actually
covered may vary from one carrier to another or one plan to another. - ANS True
You MUST tell your PPO plan clients they will have to pay more when seeking non-emergent
eligible services outside of the network. - ANS True
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
EXAM QUESTIONS AND CORRECT
ANSWERS. VERIFIED 2025/2026.
The Special Election Period (SEP) for Dual Eligible and Other LIS Eligible Individuals previously
allowed one time per-calendar-quarter during the first nine months of the year was replaced
beginning Calendar Year 2025 with a monthly SEP to enroll in a standalone PDP. Eligible
beneficiaries can switch PDPs or leave a MA/MAPD plan for Original Medicare plus a standalone
PDP. - ANS True
Which of the following statements is NOT true about a disenrollment? - ANS Disenrollment
requests can be taken verbally
How does a cancellation differ from a disenrollment? - ANS Both A and B are correct
A. A cancellation applies if a request is received prior to a member's effective date or by the
date on the Outbound Enrollment Verification (OEV) letter
B. Cancellation requests are initiated by the member and can be received either verbally or in
writing
FEMA disaster SEPs can only be used if members missed a valid enrollment period. -
ANS True
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, A monthly integrated care SEP beginning calendar year 2025 allows full dual eligible individuals
to elect an integrated Dual Eligible Special Needs Plan (D-SNP) (for example, Fully Integrated
Dual Eligible (FIDE), Highly Integrated Dual Eligible (HIDE), and Applicable Integrated Plan (AIP)).
This SEP is allowed only when the individual receives Medicaid through an affiliated managed
care plan. - ANS True
A member can add or drop prescription drug coverage during the Annual Election Period (AEP).
- ANS True
If a beneficiary has agreed to an in-home appointment to discuss a PDP product, an agent can
discuss an HMO product with them during that same meeting, if the beneficiary requests it and
a new scope of appointment form is completed. - ANS True
The Open Election Period (OEP) is for beneficiaries who are enrolled in a MA-only or MA-PD
plan, or those who are enrolled in Original Medicare, including those enrolled in stand-alone
PDPs. - ANS False
Which of the following is not a valid reason for involuntary disenrollment? - ANS Moving to a
new address in the same plan service area
Prior to making an enrollment decision, beneficiaries must review and complete the pre-
enrollment checklist. - ANS True
If a beneficiary currently has drug coverage through another carrier, you must verify their
prescriptions would be covered under our plan's formulary, too. The drugs that are actually
covered may vary from one carrier to another or one plan to another. - ANS True
You MUST tell your PPO plan clients they will have to pay more when seeking non-emergent
eligible services outside of the network. - ANS True
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
