Election periods Hierarchy
What is the number 1 election period to use on the Hierarchy table
What is Initial election period
You received a call today from a BFC who switched into a different MAPD as of 2/1/2023. He has been on Medicare for 4 years. he would like to change to a different plan. It is OEP. Can you use OEP to enroll him? Why?
.no. plan must start 1/1/2023 or earlier.
You are having a hard time finding an SEP for this beneficiary to change them to a new plan. You noticed in Marx that their address is different from what they gave you. Upon confirmation they tell you they had moved to a neighboring town last month. They do however still live in the same county. Can you use SEP-MOV to change their plan? Explain your answer.
No you cannot because they live in the same county so the service area is the same.
For chronic plans you must have the chronic condition that is specified in the chronic plan to be eligible. You found a chronic plan in the beneficiary’s area that is only for people with diabetes. Your beneficiary does take Lantus and is a diabetic. What Sep do you use? How many times can you use that sep?
SEP-CSN, once per chronic condition
No. He has trial right 2.
What is the number 2 election period to use in the hierarchy table?
What is MA open enrollment period
Today is 03/22/2023 you received a call from a beneficiary who needs to find a plan that covers his doctors. He started his current MAPD plan on 02/01/2022 using IEP since his part A and part B just started on 02/01/2022. He wants to switch to a different MAPD plan. He is not low income. Can you change to a new MAPD plan for 04/01/2023? If so what election period can you use and why?
MAPD OEP Period 2 , OEP. They are within 3 of months of their part a and part b effective date, used IEP and are currently in an mapd plan
You receive a call on May 15 from a BFC who enrolled into an mapd plan for the first time since being on Medicare this year 01/01/2023. He had a medicare supplement prior to that and would like to go back to being on that medicare plan. What election can we use to enroll him into a pdp plan to go along with his medicare supplement plan and when would it take effect
SEP-12G June 1
Today’s date is April 8th and you received a call from a BFC who enrolled into their part b as of 03/01/2023 and their part A on 11/01/2021. She has not signed up for any plan as she didn’t realize she had to do that. She really wants to get into a Medicare plan however she has had no medical coverage for the last year and there was no specific reason the part b effective date was delayed like that. She did just receive her letter of approval and card on 03/15/2023. Can she still enroll into an mapd based on this information? If so what is the election period?
SEP-RET retro activate determination, yes can enroll.
Today is 05/01/2023 and you receive a call from a BFC living in Arizona who would like to now enroll into a Medicare Supplement plan as he only has original Medicare. His Medicare A and B started on 01/01/2023. Does he have to go through UW? Explain
No as he is still within his OEP.
What is the 3rd election period to use in the hierarchy table?
What is Special election period
Today is 03/22/2023 you get a call from a lady in NY and she is currently on a pdp plan only and wants an mapd plan. She cannot afford a med sup. She has had Medicare for years and lived in the same house for 30 years. She has Epic but does not have lis or Medicaid. Does not live in a disaster area. Does she qualify to enroll into an MAPD based on this information? IF so what SEP?
SEP SPAP,
You are talking to someone on April 20th who just received a letter that their UHC Medicare Gold Chronic PPO plan they just enrolled into as of March 1 is going to be ending due to the fact the doctor said he does not have qualifying condition of heart problems or diabetes to have the plan. What SEP can you use?
SEP-SNP
Today is Feb 6 and you are speaking to someone who wants an mapd plan but they missed AEP. They currently only have a pdp and no obvious SEP's apply. They live in Maui and would like to get into a humana MAPD plan. Can they? What SEP?
DST. missed election period of AEP. Found this in our DST sharepoint.
You are speaking to a BFC in Texas who had Medicare, Medicaid and pdp. She recently lost her Medicaid within the last 63 days and would like to enroll into a Medicare Supplement plan. Does she had GI or will she need go through UW?
GI within 90 days of losing Medicaid
What is the last election period to use on the hierarchy Table?
What is Annual Election period
You receive a call on 03/23/2023 and find a better plan for the person you are speaking too. His current plan started 02/01/2023 and he has had Medicare A & B since 01/01/2018. He does have Medicaid and Extra help for several years and there has been no recent change to his lis and Medicaid Status. When you look in Marx you notice it says QTR LIS SEP used 1/19/2023. Based on it being OEP right now and the information you have is he eligible to change plans right now? If so what election period do you use? Explain your answer.
Not able to change plans unless find a different SEP. MDE already used and cannot use until next quarter and cannot use OEP. Pipeline for April to change plans during the next quarter
Today’s date is Feb 15th and a BFC calls to change mapd plans. The Beneficiary just started Medicaid on 01/01/2023 and was enrolled into a dual plan starting 02/01/2023 using SEP-MDE however the doctors are not covered and needs to get a plan that includes them. Can the BFC enroll for a March 1 effective date, or does he have to wait until the next quarter? Explain your answer.
SEP – MCD can be used for gaining Medicaid. Doesn’t follow quarter limitation. So yes can enroll.
No. ICEP delayed part B would have had to been used prior to the part B starting Feb 1. Will need to do SEP digging.
You are speaking to a beneficiary who currently lives in Vermont. The BFC only has original Medicare and pdp. They have been on Medicare for five years and was in good health up until now, so she never needed coverage. Does this person qualify for GI or will she be underwritten?
Vermont has continuous OEP
You are speaking to a BFC who has an SEP due to moving this month. He has had the same MAPD plan through Humana since 1/1/2020. What election period do you use?
What is MA open enrollment period.
Today’s date is 03/01/2023 and you received a call from a beneficiary who had been changed to a new plan on 02/1/2023 using SEP-MDE due to them having Extra help. The beneficiary needs to go back to his plan he had prior to this plan. Upon looking in MARX you notice that this year he had a change in his level of extra help from LIS level 3 to lis level 2 as of 01/01/2023. Based on this information can he change plans? If so what election period and what is the timeframe to use that election period?
SEP-NLS within 3 months of notification
You receive a call from Harry on April 15. He is currently enrolled into the Humana Gold plus HMO MAPD plan. He really wanted to be able to get the part b give back. He hasn’t moved, doesn’t have medicaid or lis, or any other basic election period. He did inform you though that he is also a vetern and does use the VA. He gets all of his rx through the VA and never uses an outside pharamcy. Is there anything you can do for him? If so what election period would use?
Yes, can use SEP-CDC to enroll into an MA only plan.
Beneficiary calls in on March 3 and currently has Medicare, Medicaid and they believe they have a UHC dual complete plan that started on 02/01/2023 using SEP-MDE. You notice in Marx that it is showing Medicare-Medicaid which is an MMP mapd plan that they were enrolled into for March 1 2023. They never enrolled into this plan on their own. You found a better plan for them. Can you enroll them into a different plan for 04/01/2021? If yes what election period will you use?
Yes, sep-dif as MMP plans as beneficiary was more than likely passively enrolled into the MMP plan.
A beneficiary calls you on April 20th because their mapd plan had termed on 03/31/2023 due to them moving from the service area. They no longer wish to have an mapd and would like to join a Medicare supplement plan because the beneficiary was diagnosed with Cancer and is undergoing chemotherapy treatment. Are they able to get a Medicare Supplement plan? If so would the BFC have to go through UW?
No, They have GI up to 63 days after the MAPD plan ends.