Covered California Certified Enroller Practice Exam

What is the exception to the rule that prohibits Medicare enrollees from purchasing Covered California plans?

1. If they are low income

2. If they are not enrolled in Medicare Part A with premium

3. If they have a job-based plan

4. There are no exceptions

The correct answer is: If they are not enrolled in Medicare Part A with premium

Medicare enrollees are generally prohibited from purchasing Covered California plans because they have access to Medicare, which is designed to provide health coverage for people aged 65 and older, as well as some individuals with disabilities or specific health conditions. However, the exception that allows certain individuals to purchase a Covered California plan is if they are not enrolled in Medicare Part A (hospital insurance) with premium. When someone has not enrolled in Medicare Part A, it indicates they may not have access to the comprehensive benefits that Medicare provides, making them eligible to seek alternative coverage through Covered California. This is particularly pertinent for individuals who are eligible for Medicare but have not signed up, perhaps due to confusion about the enrollment process or decisions to delay enrollment. The other factors mentioned do not serve as exceptions for purchasing plans through Covered California. Low income does not exempt Medicare enrollees from the prohibition. Having a job-based plan also does not provide an exception because individuals with access to employer-sponsored health insurance cannot turn to Covered California for coverage. Lastly, stating that there are no exceptions is incorrect since the situation of not being enrolled in Medicare Part A does provide a pathway for enrollment into Covered California plans.