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Medicare Stack #2

All Election Key Points

Big SIX Election Reasons 1 - On Medicaid or ExtraHelp? 2 - Lose Medicaid or ExtraHelp? 3 - Move or Plan to Move? 4 - Loss of Employer Coverage? 5 - Loss of Creditable Coverage? 6 - State Pharmaceutical Assistance Program?
Less Common Election Reasons - non renewing (the plan will end) - Loss of Pace - 5 Star - Retroactive - Other Credible Coverage (VA, Tricare or IHS) - go from MAPD or PDP to MAO
What is Medicaid? - state funded and varies by state * may or may not have a medicaid card * may or may not get help with medical costs - will get help with PARTB + prescriptions - reduced drug plan premiums, deductibles and copays
Medicaid Prescription Prices $1.30 generic + $3.90 for brand name + no deductible
Extra Help (Low-Income Subsidy LIS) - only for prescriptions - reduced drug plan premiums, deductibles and copays - no id card
Extra Help Prescription Prices - $0-$89 Drug Deductible - $3.60 generics + $8.95 brand name or 15% of the drug (4 levels to the %)
How to apply for the Medicare Part D Extra Help program You can call the Social Security Administration about the Extra Help program at 1-800-772-1213
Who qualifies for Extra Help? income is below 135% of the FP - even if you don’t qualify for full LIS benefits, you could be eligible for partial LIS benefits if your income level is at or below 150% of the FPL.
Election due to Loss of Medicaid and Extra Help - bene who have change, loss or gain medicaid/extra help are eligible to make change year-round - effective date still 1st of following month * timeframe: within 3 months of notification or loss (whichever is later)
Election due to MOV - election can be used any time - eligible to enroll the month before you move + 2 months after * coverage can not start before that person lives there - move must be perm, they need to pick one
Election due to Loss of Employer Coverage - can be used any time - voluntary or involuntary - eligible during month of loss and two months after - effective date can be up to 3 months out
Election due to Loss of Creditable Coverage - election can be used at anytime - relates to prescription coverage not being as good as medicare - loss must be involuntary - eligible in that month and two months after
What is a 5 STAR program and where are they currently? rating by Medicare - highly rated program - only in counties in FL TX ME NY currently
What do we ask if the caller has VA, Tricare, or IHS? must find out if they have part D coverage in MAPD or PDP * if so, they can use this election
What are the scenarios where a caller can drop their PDP? AEP/OEP + SEPs (already have CC, enrolled in PACE, access to employer/union PDP, Medi/Medi, LIS eligible
Created by: cmazzariti
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