systems
which system is used when starting the call
SYNC
which step do we ask if consumer has diabetes?
opening
no premium
For when you go to the hospital, get automatically. original Medicare- hospital insurance aka; in patient, skilled nursing, or, hospice, recovery services, some medical services
Medicare Part A
A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service. Goes towards deductible.
Co-pay
allows MA consumers to change from one MA plan to another or disenroll into OG Medicare
MA-OEP
which system for gathering consumer information?
shopper profile
which step do we obtain PCP/specialist/facilities?
needs assessment
drug coverage, can purchase or get with part c
Can get if having part a or b one or the other
Part D
Someone who receives health services or treatments, but does not stay overnight at a hospital; when the patient does not stay in the hospital.
outpatient
Takes place each year from Oct 15 to DEC 7
AEP/OEP
Which system is used when you need to reach out for help?
Teams
after narrowing to one plan, which step is next?
Solution presentation
annual deductible- optional must buy- when you go to dr, routine care. Original Medicare; medical insurance- out patient care, x rays, lab tests, have to sign up, monthly premium, can be deducted from SS, dr visits, er, dme, some preventative care- (based off income) BH when outpatient
Part B
A federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with end-stage renal disease
Medicare
allows to change plans due to circumstance like moving, change of jobs
SEP (special election period)
where can we find job aids?
knowledge central
which step do we obtain HIPAA?
opening> Gather consumer information
dental, vision (Medicare advantage) - specialists, hearing, alternative. Annual deductible- pay co pay or coinsurance for the services you use. Wellness benefits; yearly oop max, all benefits of original Medicare, often includes drug coverage. Have to pay part b fee to HAVE part C (not based off income)
Have to have part a and b; rx has an annual deductible
part C
fee added to your monthly Medicare Part D premium if you did not enroll in a Part D plan when you were first eligible and did not have other creditable prescription drug coverage for 63 or more consecutive days
LEP/late enrollment penalty
Depends on when application is submitted. If before they are eligible for Medicare, then it will the same as their Medicare effective date; otherwise, it is the first of the following month
IEP/Initial enrollment period
which system do we open to get to sync?
citrix
which step is the plan positioning?
determine outcome
offered by private companies, helps cover some or all costs deductibles or co insurance, let you choose your dr or provider and moves with you across the US, does not cover drugs
Covers what a and b doesn’t cover-- covers the 20% that the consumer would be liable to pay- no deductible
Medigap/Supplemental
(cheapest) Must see INN providers, plans may require referral, no OON coverage
HMO/Health maintenance organization
how many months total do consumers have to use the ICEP?
7