Medicare Parts
How many parts of Medicare are their ?
4
How many Election Periods are their ?
Six Types
What does QUEST stand for ?
Quality , Understanding , Empathy , Sensitivity and Trust
What is another name for Part C ?
Medicare Advantage Plans
What does the P stand for ?
Paraphrase
Medicare Part A is ?
Hospitalization
T/F
IEP time frame is from Oct 15th - Dec 7th
FALSE
Is using probing questions apart of QUEST ?
YES !
SPU stands for ______.
Only procedures that involves _____ are covered.
Short Procedure Unit
All outpatient procedures that involve anesthesia are covered.
T/F
Addressing a members concern is apart of PEAS
What three parts of Medicare can have private insurance companies ?
1. Part B
2. Part C
3. Part D
If a member calls in and they have just moved how long do they have to enroll into a plan and what election period will they qualify for ?
1/1/YY - 12/31/YY
SEP (Special Election Period)
What are the plans offered for Aetna Medicare?
HMO, PPO, OA HMO, ESA PPO
Medicare is health insurance for people who ...
1. Are 65 or older
2.Certain disabilities
3.Any age with End - Stage Renal Disease
*permanent kidney failure requiring dialysis or kidney transplant
When should PEAS be used?
EVERY CALL!!
What part of Medicare can a member automatically receive benefits ?
Part A
What are the names & Abbreviations of the Election Periods ?
- Annual Election Period (AEP)
-Initial Coverage Election Period (ICEP)
-Special Election Period (SEP)
-Medicare Advantage Open Enrollment Period (MA OEP)
-Initial Election Period (IEP)
T/F
All plans require a precertification. . .
FALSE.
ESA PPO plans do not require a precertification but it is requested.
When members are required to stay in a facility for a extended period of time it is called a ______.
Skilled Nursing Facility
What does the E stand for ?
-Explain what it means and give visual example
Empathize : understand and share the feelings of another.
If a member has Part B and signs up through Original Medicare and then decides that they would also like Part D , can they enroll inside of a Part C plan ?
No , because the member does not have Part A . To receive Part C you must have Part A & B .
A beneficiary who becomes eligible for medicare have a ______ for Part D that is the 7 month period surrounding medicare , what election period would the member qualify for ?
IEP : For Part D ONLY , a beneficiary is entitled to Part A or enrolled in part B and permanently resides in the service area of a Part D plan . (3 months before and 3 months after)
T/F
OA HMO members are required to stay in network but require a referral.
FALSE.
OA HMO members are required to follow Aetna Medicare Network for coverage and does not require a referral.
When are emergencies covered?
ALWAYS
If a member spouse calls in stating that her husband passed away would you empathize or use a sympathetic statement ?
A- Empathize
B. BOTH
C.Sympathetic
D. Neither