SCENARIOS
Today is May 2nd, 2021.Mr. Lopez calls in stating he has Medicare Part A and Part B. He said his Part A and Part B both started on February 1st, 2022.He tells you that in February he enrolled into a CarePlus HMO plan.The plan went into effect on March 1st, 2022.He tells you he is unsatisfied with his current plan because it doesn’t accept his PCP.Can we use OEP-New to help him get into a new MA plan?
No, we cannot use OEP- New. He missed his OEP- New election opportunity.
Today is April 9th, 2022. Mr. Silvia calls in stating he has Medicare Part A and Part B. He said he also has VA coverage. After doing some digging, you determine he also has an Anthem MAPD plan. During the call Mr. Silvia tells you he pays about $22.00 a month for his Anthem plan. He said he only utilizes the gym membership and the OTC allowance. He said he goes to all VA doctors and gets all his prescriptions from the VA. Based off the information Mr. Silvia gave us, does he have a possible election?If so, what election would it be?
We can use OCC to take him out of his MAPD plan and enroll him into a MAO.
What is defined as an “institution”?
A skilled nursing facility, nursing home, intermediate care facility for the mentally disabled, psychiatric hospital, rehabilitation hospital or long term care hospital (it does NOT include assisted living facilities or residential homes).
Today is 06/01/2022. Mrs. Lopez calls in stating she just got Medicare Part B on 04/01/2022. She said her Part A started on 03/01/2022. She has not yet chosen any type of coverage. Can we help her enroll into a plan using ICEP?
No, we cannot use ICEP. ICEP delayed Part B timeframe is 3-0-0
This is an open and unlimited use enrollment period for Medicare beneficiaries residing in an institution lasting for up to two (2) months after leaving the facility.
OEP-I -Open Enrollment Institutional
Today is 04/04/2022. Mrs. Gomez calls in stating she currently has Medicare Part A and Part B. She said she also has a United Health Care HMO plan. She tells you she wants a plan that offers more additional benefits like D/V/H. She also tells you she is turning 65 on May 4th, 2022.Based off the information we have; can we help her enroll into an MA plan?
IF so, when would we make the MA plan effective?
Yes, we can help her using IEP2, since she had Medicare due to disability and is now turning 65.
Today is 04/07/2022. Mr. Contreras calls in stating he just got his Medicare Part A and Part B on 03/01/2022. He tells you that he enrolled into a PDP with Silver Scripts on March 9th, 2022. The PDP went into effect on April 1st, 2022.He said he is unsatisfied with his current plan because 2 of his prescriptions aren't covered on the formulary. Can we use OEP-New to help him get into an MA plan?
No, we cannot use OEP-New since he doesn’t currently have an MA plan in effect.
Today is April 12th, 2022. Mr. Ortega calls in stating he has Medicare Part A and Part B. He said he also has a Humana HMO plan. He tells you he currently lives in Ohio, but will be moving to Miami-Dade, Florida on May 22nd, 2022. He already bought a house there and has his new address! Based off the information we have, does Mr. Miller have an election?If so, what is the election and when would we make his new MA plan effective?
Yes, he has a MOV election. We would have to make the plan effective June 1st, 2022. We cannot make the plan effective on May 1st, because the MA plan must start the 1st of the month AFTER the move.