Election Periods
When is the Open Enrollment Period (OEP)?
January 1st - March 31st
What makes up Medicare Advantage/Medicare Part C?
Medicare Part A benefits + Part B benefits and usually a few added perks (that can include prescription drug coverage) = Part C or Medicare Advantage
What are the two disclosures you must give on every phone call?
Call is being recorded for quality assurance
Licensed sales agent in the state of _______
What is the total number of Medigap plans?
10 Medigap Plans (11 plans counting HF, not required to mention)
A PFFS is a "hybrid" of what?
A Medigap and Medicare Advantage plan
What parts of Medicare must you have in order to join a Medigap plan?
Medicare Parts A and B
T/F: Medicare Advantage Plans replace Original Medicare, so beneficiaries may lose out on certain Part A or Part B benefits. Why True/False?
False. All Medicare Advantage plans are required to cover at least all of the same benefits covered by Original Medicare.
During your sales call, it is important to create a sense of ___________________
URGENCY!
List three things are not covered by any Medicare Supplement plan.
Prescriptions, Long Term Care, Dental, Vision.....
Medicare is health insurance for:
People 65 years old and older
People under 65 with certain disabilities
People of any age with End Stage Renal Disease (ESRD) (or Lou Gehrig's Disease - not required to mention)
What triggers the Open Enrollment (OE) period and how long does it last?
The OE is triggered by the Medicare Part B effective date; it is a 6-month period that starts the first month they are enrolled in Part B (Part B effective month + the following five months)
An HMO-POS is a hybrid of what?
An HMO and PPO
What purpose does the Value Proposition serve?
Shows the client the VALUE in doing business with our company (and you as the agent) over doing business with our competitors.
What two plans cover the Part B deductible?
Plans C and F
Josh turns 65 in December and was born December 1, 1954. When will his Part A begin?
November 1, 2019
T/F: The Annual Enrollment Period applies to Medigap plans. Why True/False?
FALSE. The AEP does not apply to Medigap plans- AEP alone does not make a client GI for a Medigap plan. AEP applies to Part C and D of Medicare.
Which Medicare Advantage plan generally is not network-based?
PFFS (Private Fee For Service)
What are the four key parts to a sales call (in order)?
Introduction, Information Gathering, Pitch, and Close
What is the Guaranteed Issue window time period for supplements?
60 days before, 63 days after qualifying event.
T/F: Medicare Advantage plans are supplemental coverage. Why True/False?
FALSE. Medicare Advantage plans REPLACE (the benefit structure of) Original Medicare.
Which enrollment period(s) do(es) not require medical underwriting for Medigap Plan(s) and for which plan(s)?
Open Enrollment Period -- all Medigap Plans
Guaranteed Issue Window -- ABCFKL
When is OEP? During this timeframe, what changes can a customer make?
Jan 1 - March 31.
Leave MAPD and go to Original Medicare and a PDP
Switch their MA/MAPD to another MA/MAPD
Prior to discussing Medicare Advantage or Prescription Drug Plans, you MUST say the following disclaimers:
Can I have your permission to discuss Medicare Advantage plans with you?
Before we continue please be aware that you are not required to provide any information you don't want to, and that any information you do provide during this call will not affect your ability to request enrollment or affect your plan membership.
Have you been diagnosed with End Stage Renal disease or are you receiving renal dialysis? (MAPD only)
How many states are Part B Excess Charges not allowable in? (Name two)
If a customer lives in this state and travels outside of the state, are they subject to Part B Excess Charges?
8 states. CT, MA, MN, NY, OH, PA, RI, and VT.
Yes
What $ amount causes the client to enter Catastrophic Coverage and what will the beneficiary pay while in Catastrophic Coverage?
$5,100.
The greater amount of 5% of the retail price OR $3.40 for generic drugs and $8.50 for brand name drugs.