Election Periods
When is AEP
October 15- December 7
What job aid would you use to access a specific plans formulary on RX Web
PCE
What are the 3 drug coverage stages we must disclose to consumers in shopper profile
Initial coverage stage, coverage gap, catastrophic coverage.
What are all the parts of Medicare and what do they cover?
Part A: Hospital
Part B: Medical
Part C: Medicare Advantage
Part D: Drugs
If you don't qualify for a free premium Part A, how much does Part A cost?
People who buy Part A will pay a premium of either $274 or $499 each month in 2022 depending on how long they or their spouse worked and paid Medicare taxes.
A consumer calls and is turning 65 but has had Medicare for several years. What election period can we use to enroll them into a plan
IEP2
A third party is calling on behalf of a prospect who is also present. What information do you need in order to proceed with the call? (Hint, there are 7 things)
Obtain from Third Party:
1.)Third Party’s Full Name
2.) Third Party relationship to prospect.
Agent: “ I’ll need to get one-time permission from <prospect>, can you please put them on the phone? Prospect comes on phone and provides:
1. Full Name
2. Date of Birth
3. Full Address or MBI
4. Agent asks Prospect: “Do you authorize us to speak with “Third Party/First Name_Last Name>, And can we share information with that individual as part of our conversation?”
To be compliant with quality, what are the three things you must share with a consumer about their medications?
The name, copays, and any utilization management.
In 2021, what is the standard premium for Part B?
$170.10 each month
A consumer calls in and you see that they have LIS Level 2, where should you send them in Genesys?
SNP/LIS Agent Transfer
Bobby just got a letter in the mail that his plan has been terminated because he has moved out of his plans service area, however he never actually moved. What election period can we use to get him into a new plan?
Invol. Loss of Creditable Coverage
If my mom ran out of her prescription a week early, wouldshe be able to get a refill a little bit early?
Yes. In general, you may refill a prescription when a minimum of seventy-five percent (75%) of the quantity is consumed based on the days supply.
In the zip code 55340, under the AARP Medicare Advantage Headwaters PPO, is there a utilization management for Metformin hcl tab of 500MG and what is it?
Quantity limit of 150 Tabs every 30 days.
There are three main reasons why an individual may be eligible for Medicare. What are they?
Ageing in at the age of 65, Being on disability for 24 months, End stage renal disease.
A consumer calls you wanting to add a dental rider to their plan 4 months after the plan has been in effect, where should we send this caller?
NO WHERE. They cannot add the dental rider because it is past 3 months of the plans effective date.
SPAP Enrollee and this can be used once a year
Within our Renew Active Program, how many gyms are avalible in the zip code 55414, within 10 miles?
157
In the zip code 51510 in the AARP Medicare Advantage Choice Plan 2 (PPO) plan, is doctor Teresa Dowling in or out of network?
In network
There are five main things that Medicare part A cover. What are they?
In-patient hospitalization, skilled nursing facility care, In home care, hospice services, and blood.
Consumers with Tricare should be enrolled in what type if plan? A consumer with VA benefits?
Tricare: MA ONLY
VA Benefits: MAPD or MA ONLY
A consumer recently got out of prison and wants to enroll in a plan, do we have an election period?
Yes, SEP change in res
A consumer calls and has a plan code H2001-001-000, they are calling to reach customer service about their hearing benefits, what is the number you would connect them to?
1-800-643-4845
In the zip code 90210, what are the copays for the acupuncture for the AARP Medicare Advantage SecureHorizons Premier (HMO) plan?
$0 copay; 20 acupuncture visits per year
Ted turns age 65 on June 1st, he called on March 3rd to enroll in a Medicare Advantage plan, when will his coverage start?
May 1st
When filing your individual tax return if it is between $91,000 up to $114,000, what will you pay each month for Part D
$12.40 + your plan premium