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Medicare Basics
| Question | Answer |
|---|---|
| True or False: You can have a Medicare Advantage and Medicare Supplement at the same time? | False |
| What enrollment period is for those with diabetes and heart conditions? | SEP: CSN - Chronic |
| What dates are the Annual Enrollment Period? (AEP) | October 15th - December 7th |
| What dates are the Open Enrollment Period? (OEP) *oops | January 1st - March 31st |
| When can I expect to use OEP-NEW? (Different from OEP) | When someone has USED their IEP already- The one-time election begins the month of entitlement (effective date) to Part A and Part B and for two additional months. |
| What is a PDP? | Prescription Drug Plan |
| What is a MAPD? | Medicare Advantage Prescription Drug Plan |
| What is “Dual-Eligible?” | Someone who has Medicare and Medicaid- would be eligible for a DE-SNP plan. |
| What SEP would I use for someone who told me their Medicaid ended and so did their DSNP plan? | SEP- MCD |
| What is LIS? | Low Income Subsidy- provided by the federal government for folks below a certain income. |
| What enrollment period can I use if this caller just got LIS started last month? | SEP-NLS |
| What is another term for LIS? | Extra Help |
| What can someone use if their plan ended, they have LIS, but no drug coverage until next month? | Li-Net |
| What enrollment period would I use for someone who was just released from prison/jail? | SEP-INC Make sure you check MARx has a release date populated before placing an application |
| What enrollment period would you use for someone who is not a US citizen but just became a lawfully present? | SEP-LAW |
| When would you use SEP-LEC? | Loss of Employer Coverage |
| What enrollment period would I use for someone who lost creditable prescription drug coverage? | SEP-LCC |
| What enrollment period would I use for someone who lost their CSNP plan due to not having the correct CSNP condition to enroll into a regular plan? (Missed their 60-day verification window and now lost coverage.) | SEP-CSN or an honorable mention: SEP-SNP |
| What enrollment period would I use for someone who lost their plan due the contract not renewing? | SEP- EOC |
| What enrollment period can I use to CHANGE someone’s plan that they didn’t enroll into themselves and now wants to choose their own plan? (Passive Enrollment) | SEP-DIFF |
| What does SPAP stand for? | State Pharmaceutical Assistance Program |
| True or False: Every state has an SPAP program. | FALSE |
| What does FBDE stand for? | Full Benefit Dual Eligible |
| What does QMB and QMB+ stand for? | Qualified Medicare Beneficiary (Plus) |
| What does QI stand for? | Qualified Individual |
| What does SLMB and SLMB+ stand for? | Specified Low Income Medicare Beneficiary (Plus) |
| What does QDWI stand for? | Qualified Disabled Working Individual |
| These levels of Medicaid are always cost share protected as it pertains to Medicare: | QMB and QMB+ |
| These Medicaid levels can likely be cost share protected as it pertains to Medicare, but you would need to double check the state to make sure: | FBDE and SLMB+ |
| These levels of Medicaid are NOT cost share protected as it pertains to Medicare: | SLMB, QI, QWDI |
| Where do you go to login to Vantage? | Humana.com + “Log In” on the top right corner |
| Where do I go to get my call script? | Go/TKC |
| What demographics do I gather in the beginning of the call? | Name → Preferred Name Phone # and Type Address and Verify the County Email Veteran Status |
| Fill in the script blank: “Good Morning, you’re speaking with Sarah and I’m a licensed agent. I’m grateful you chose Humana. How ___________________________________________________________________________?” | “How can I care for you today?” |
| What options do Medicare beneficiaries have in addition to Original Medicare A and B? | 1. Prescription Drug Plan only 2. Medicare Supplement + Drug Plan 3. Medicare Advantage (HMO, PPO, PFFS) |
| After we gather demographics during our call, what is our next step? | 1st. Switch Lead from “New” to “Working” in SF. 2nd. Ask Qualifier questions |
| I am enrolling my client into a plan that has no provider networks so they can see ANY doctor that accepts Medicare. What type of plan am I enrolling my client into? | Medicare Supplement Plan |
| This client isn’t sure what plan she has but explained she shows both her Medicare Card and her Medical card to the doctor. She explains that she knows Medicare pays first and her plan pays second- what type of plan does this client have? | Medicare Supplement Plan |
| What are some primary differences between Medicare Supplement Plans and Medicare Advantage Plans? | No networks of doctors with Medicare Supplement Medicare Supplement higher premiums but lower OOP costs Medicare Advantage considered “all-in-one” plan - medical, prescription, dental, vision etc- Medicare Supplement is ONLY Medical. |
| True or False: Medicare covers LTC (Long Term Care) services | FALSE. |
| What can I change during OEP? (Jan-March) | IF you have a MA/MAPD plan you can change to another MA/MAPD plan ONE TIME |
Created by:
mckenziestoll