Medicare Basics
This part of Medicare covers outpatient medical services like doctor visits.
What is Part B?
his program helps lower prescription drug costs based on federal poverty guidelines.
What is Extra Help (LIS)?
The first thing you should determine before recommending plans.
What are the client's needs?
MAPD stands for this.
What is Medicare Advantage Prescription Drug Plan?
These disclosures must be read exactly as written.
What are CMS disclosures?
A beneficiary with this type of Medicare can generally see any provider that accepts Medicare.
What is Original Medicare?
QMB+ is considered this type of Medicaid.
What is Full Medicaid?
This should make up roughly 80% of your conversation with the client.
What is listening?
A beneficiary who gets all prescriptions from the VA may not need this.
What is Part D coverage?
Changing the wording of a CMS disclaimer is considered this.
What is non-compliance?
This Medicare Advantage option generally requires members to stay in-network except for emergencies.
What is an HMO?
SLMB is considered this type of Medicaid.
What is Partial Medicaid?
DOUBLE JEOPARDY!!!
This sales technique involves matching the client's communication style.
What is mirroring?
A grocery benefit should never be assumed because it depends on this.
What are plan eligibility and availability
DOUBLE JEOPARDY!!!
You should never promise this benefit unless the plan specifically includes it.
What is a food card?
This Medicare Advantage option allows members to see out-of-network providers, usually at a higher cost.
What is a PPO?
This pays Medicare Part A and B deductibles, coinsurance, and copays.
What is Full Medicaid (QMB/QMB+/FBDE/SLMB+)?
Before discussing plan recommendations, you should verify these three things.
What are providers, medications, and benefits important to the client?
DOUBLE JEOPARDY!!!
Dental and vision benefits should be tied back to this.
What are the client's needs?
DOUBLE JEOPARDY!!!
If you're unsure whether a benefit exists, you should do this instead of guessing.
What is verify it in the Summary of Benefits?
DOUBLE JEOPARDY!!!
A client asks if enrolling in a Medicare Advantage plan means they lose Medicare.
What is No—they remain enrolled in Medicare but receive benefits through a private insurance company.
A client receives all medications through the VA and doesn't need Part D coverage. Which plan type may be more appropriate?
What is an MA-Only plan?
A client only says they want a food card. What's the correct approach?
Complete a full needs analysis instead of focusing on one benefit.
A client wants dentures, hearing aids, transportation, and lower drug costs. Before recommending a plan, what should you verify?
What are providers, prescriptions, Medicaid/LIS status, and benefit eligibility?
A client asks, "Will I definitely save money?" How should you respond?
Review the plan costs and explain potential savings without guaranteeing them.