That's my type
type of Medicare offered by a private company that contracts with Medicare to provide all Part A & Part B benefits, with most offering prescription drug coverage (Part D).
Medicare advantage plans
the maximum amount the patient should pay for medical costs during one calendar/benefit year
MOOP- Maximum Out Of Pocket
The annual enrollment period is from...
Oct 15th - Dec 7th
This person offers objective fact-based education and cannot recommend any specific plans. They are here to help the patient understand their insurance options so they can make an informed decision about their Medicare insurance for 2021.
Benefits Navigator
These type of plans can’t be used to pay Medicare Advantage plan premiums, copayments or deductibles. Therefore, Medicare suggests those who join a MA plan consider dropping their _______ plans.
Medigap/supplemental
This plan type does not need a referral for specialist but there is no out of network coverage
EPO-Exclusive Provider Organization
amount patient must pay in medical costs before the insurance will began to cover medical costs; the ______ amount is typically included in the OOP max
Deductible
"what questions do you have"
"who helps you with your insurance decisions"
"What resources or information would be helpful for you"
Are all examples of what kind of questions
Open ended questions
This resource lists all of the available plans in your area from different health insurance companies, along with details on costs, benefits, provider network, and how to enroll.
Medicare.gov/Plan Finder
If a patient decides to drop their supplemental plan they have a _____ month trial right. That means, if they change their mind and decide they want to switch back to a Medicare + Medigap/supplemental policy they have the right to do so within ______ months
12 months
The most restricted plan type that does not have out of network coverage and that you need a referral for specialist
HMO- Health Maintenance Organization
A specific cost for the patient's portion for a specific medical service; typically accumulates into the MOOP, but not the deductible.
Copay
If a patient is enrolled in a part D plan currently and they are looking at a MA plan that includes part D, Do they have to enroll in the part D with the MA plan
Yes
3rd party resources that can research and help enroll
plan provider websites, brokers, eHealth/Chapter
If a patient were to disenroll from their supplemental plan, are they able to switch back to the same plan if they do not like the MA plan they enrolled in
They may be able to get the same policy back if the company still sells it. If it isn’t available, they can buy another Medigap policy.
For this plan type you must select a PCP and you need a referral in order to see a specialist
-Must have referral
-Can treat OON
-Cost more
POS- Point of Service
percentage share-of-cost between insurance carrier and patient.
Co insurance
If a patient enrolls in a MA plan and they are not happy with it when can they switch back to original Medicare
OEP: Jan 1- March 31 enrollment period.
Patients cannot switch from Original Medicare to an MA plan at this time
Can Resources and flier be sent via email after reading through the alt communication email consent disclosure if a patient states "I agree" on the recorded line or do we have to wait for the signed doc to be returned
If we get the verbal agreement we can send the resources to the patient following the proper procedure. Reach out to your leaders if you need assistance
If a patient enrolled in MA, they could choose to keep their ______as a secondary plan. Their ______should coordinate with the MA plan similarly to how it coordinates with Original Medicare.
EGHP/commercial
This is the least restrictive plan type but has the higher premium. No need for a referral with this one.
-OON
-No referral
PPO- Preferred provider Organization
Amount the patient pays for the plan (per month)
Premium
Patient can make changes to their Medicare Advantage and Medicare prescription drug coverage when certain events happen in their life, like if they move or they lose other insurance coverage. These chances to make changes are called _____________
Special Enrollment Periods
When should call transfer be offered to patient
On any interested call. If a patient is not interested at this time or is not ready we still want to mention that this is an option
What are the options available for patients experiencing financial hardships
AKF and PFE are options available for patients but should only be talked about if the patient is expressing this financial hardship