Purple
When is AEP?
October 15 - December 7
What is the time frame for OEP enrollments?
90 days before & 6 months after
How long is the Initial Election Period?
3 months before, month of, 3 months after
If someone enrolls in Part B during the GEP, when is the Part B effective?
July 1
For a medigap underwritten, when can a beneficiary over 65 enroll?
ANYTIME
Sylvia calls you on Oct. 27th. She has a purple letter in her hand.
You enroll her in a new PDP plan effective...
November 1st
Joshua has a UHC PPO in effect. He moved from Indiana to Texas four months ago. He got a notice yesterday from UHC saying he's bein disenrolled from the plan as of 10/31/2020.
He wants to try out a Plan G from Aetna.
Can he enroll? What code?
Yes - GI
Part A: 10/01/2020
Part B: 10/01/2020
You enroll bene into a Humana PPO MA-Only plan starting Nov 1
ICEP
Part A: 11/01/2017
Part B: 01/01/2021
Joseph is retiring and losing Employer coverage 12/31/2020
You enrolled him in Plan G with MOO, + PDP with Humana
List codes used for each plan
G: OEP
PDP: SEP
Name all the Enrollment periods for Gaps.
OEP
GI
UW
Mr. Smithers recently exited a rehabilitation facility on Jun 18, 2020.
It's July 9, 2020. He wants a new MA-only plan (since he gets his meds from the VA).
What code? When is it effective?
SEP - August 1
Frank lives in Dallas, TX.
He lost medicaid last month.
Gap? How?
MAPD? How?
Yes, GI in TX
Yes, SEP loss of medicaid
Part A: 11/01/2011
Part B: 12/01/2020
Enrolled in an Aetna HMO MAPD plan on Oct 13.
List the code AND the effective date
ICEP
12/01/2020
Susan has been on medicare since 2007 from a work injury. She has also been on medicaid as a QMB since 2007 as well.
Her great Aunt Ethel died and left her a house, a small farm, 6 goats, two llamas, 11 chickens and $78,000.
What will most likely happen to Susan? Will she have an opportunity to change her plan?
She will lose medicaid and have an SEP to change
Milton has medicare
Part A 02/01/2010
Part B 04/01/2012
He had Full LIS until last month. Then he got a grey letter in the mail.
He heard Medicaps were great plans. Does he have an SEP?
Does he have GI?
He has an SEP loss of LIS
He does NOT have a GI
Part A 05/01/2018
Part B 10/01/2019
You enroll on November 5
Code and effective date
AEP
01/01/2021
Name all the Election Codes for MAs and PDPs
IEP - ICEP - SEP - AEP - MA-OEP
Judy chose the Aetna Medicare Value PPO during AEP. She just found out the hospital copays is $475 per day for the first 5 days. She cannot afford this and wants to go back to her Humana Choice PPO.
It's January 16, 2021
What election? Effective date?
MA-OEP
02/01/2021
Your beneficiary says they have diabetes. They want a supp plan. What question can you ask to see if they could pass UW?
Are you insulin-dependent? How many units p day?
Janice lives in New Hartfordshire, CT. It's May 17, 2021
She has OM + PDP currently. On medicare for 4 years. She was just diagnosed with ESRD stage 3 and wants a plan to help mitigate future health costs. She lives comfortably in her own home.
What are you enrolling her in? What code is used?
Gap -- GI
Robert lives in Beaver, OR. He got medicare the month he turned 65, A&B: 05/01/2018.
Today is April 11, 2021.
He has a Plan C but it's getting too expensive.
What plan(s) can he enroll in and what code is used?
Plans A B C G K L M N
GI FOR BDAY RULE
List the three reasons a beneficiary would have OEP
Aging in to Medicare A/B same time
Turning 65 after having medicare prior
Delayed Part B
Susan missed her Initial Enrollment Window.
She can't remember when her medicare will start but she knows she wants the Humana Gold Plus HMO.
When does her Part B start and when can she enroll in the HGP HMO?
July 1
Apr 1 - Jun 30
Steven got Part A: 05/01/2014
He's been laid-off from his job with 3 days of notice.
He only has Part A. It's Oct 18, 2020. How long does Steven have to choose Part B? When is his last day to enroll?
8 months, starting the month after his employment ends (November)
Last day to enroll Jun 30
Rhoda's Part A started 06/01/2017
Part B started 09/01/2020. (She lost employer coverage in May, she used her SEP to enroll in B) Today is October 17, 2020.
She calls you today to enroll in the Aetna Plan N and a Humana Walmart PDP
What code for each + effective date
Plan N: OEP -- 11/01/2020
PDP: AEP -- 01/01/2021
Her SEP for the PDP is LONG past expired and is unusable