QA
How long do I have to complete my auto fail greetings?
5 minutes
I am on Medicare and recently received Medicaid benefits through my state. What is the SEP?
What is MCD?
Individuals who gain, lose, or have a change in their Medicaid status.
My most expensive medication is $4. What level of LIS am I on?
What is level 2
What does it mean to be a dually eligible beneficiary?
The consumer has both Medicare and Medicaid coverage
When do I need to state the SOA?
Before discussing plans
The consumer is on Medicare and is losing benefits through their spouse's employer. What is the SEP?
What is LEC?
The SEP ends 2 months after their employer coverage ends
My consumer is a level 2 LIS and their insulin is not covered by the plan. What will they pay for their medication?
Which Medicaid levels are cost share protected?
What is QMB+, QMB, SLMB+ (varies by state), and FBDE (varies by state).
I reviewed my consumers medications in Medicare.gov. Do I have to read it again in the SOB?
Yes, the SOB must be read verbatim
My consumer doesn't have an SEP but I have a 5 star plan available. Can I enroll them?
Yes, the 5 star SEP can be used once per calendar year.
My consumer makes $1400 a month, will they qualify for LIS?
Yes, the income limit is $1,718 per month.
I am enrolling a consumer into a Humana DSNP and my Vantage portal is down. How can I verify their Medicaid?
By calling Humana directly.
I am enrolling my consumer in a PPO plan and their doctor is out of network. Do I have to assign an in network PCP?
Yes, PCP assignment is required for all enrollments.
My consumer is already in enrolled in Part A and their Part B will not start for two more months. What is the SEP?
What is delayed Part B (ICEP)?
This SEP allows the consumer to enroll in a plan during the 3 months BEFORE their part B becomes effective.
I am filling out an Extra Help application and I need to determine if my consumer falls within the resources limits. Is their primary residence considered a resource?
No, resources are their combined savings, investments, and real estate other than their primary residence.
What does it mean to be cost share protected?
Medicaid will cover Medicare copays, coinsurances, and deductibles for medical care.
I enrolled a consumer last week and they called me today with questions about their plan. Do I have to do my auto fail greetings again?
Yes, compliance is required on every call regardless of how many times you speak with a consumer.
I am planning to move to a new state at the beginning of next month. Do I have an SEP?
Yes, the SEP is MOV.
The consumer can make a plan change the month before the move and up to two months after the move.
My plan has a small monthly premium. Will my LIS help pay for that?
Yes, depending on the state benchmark levels and the consumers premium subsidy, LIS may cover a portion or all of their premium.
My consumer has Medicaid but I don't have any DSNPs in their area. What plan can I enroll them in?
Humana Value Plus , UHC Assure, Anthem MediBlue Coordination Plus, or any HMO with a premium that will be covered by their LIS premium subsidy.