Enrollment Periods
7 Month Window: 3 months before birthday month, birthday month, and 3 months after birthday month
Initial Enrollment Period (IEP)
How many quarters or years does it take to qualify for Medicare Part A ($0 premium)?
40 Quarters or 10 Years
Zip Code or County
What are the two types of Medicare Advantage plans?
Hint: Not HMO or PPO
Medicare Advantage Prescription Drug (MAPD) plan
and
Medicare Advantage Only (MA) plan
What is the "comprehensive plan" and the "value plan" that we offer to our clients?
Plan G + Plan N
Triggering Event to enroll into Medicare (i.e., Loss of Group Coverage)
Special Enrollment Period (SEP)
What determines the Medicare Part B premium?
Income Related Monthly Adjustment Amount (IRMAA)
What is the Part D standard deductible?
$545/annual
What type of MAPD/MA plan can someone on Medicare and Medicaid get?
Hint: Not the acronym
Dual-Special Needs Plan (D-SNP)
What are the co-pays for Plan N?
Up to:
$20/PCM
$50/ER + Specialists
Missed Initial Enrollment Period (IEP), only other time you can sign up for Part A + B. Jan-Mar 31.
What waives the 10% per year Part B penalty if they do not take Medicare Part B at 65 and enroll later down the line during a Special Enrollment Period (SEP)?
Prove that they had "credible coverage" that is defined by Medicare (i.e., group coverage, COBRA for 8 months)
What is the maximum out of pocket starting in 2025?
$2,000
What is the term that MAPD/MA plans use to describe the most an insured will ever have to pay in a single year?
Max Out of Pocket (MOOP)
How early can we sign up a client for a Medicare Supplement Plan with Washington National?
Up to 9 months before they start their Medicare Part A + B.
Change Medicare Advantage (Part C) plan or Prescription Drug (Part D) plan. Oct 15-Dec 7.
Annual Enrollment/Election Period (AEP)
Client: "I'm turning 65 in a couple of months, why did I automatically get enrolled into Medicare Part A + B?" "I didn't do anything, my card just came in the mail!"
Why is this?
Receiving Social Security payments already.
How much is one month supply of Part D covered insulin?
$35
First 12-Months in a MAPD/MA plan where you can switch back to Original Medicare and get a Medicare Supplement Plan.
"Trial Right"
Case Study: Client is hospitalized for 50 days and then is moved to a SNF for 40 days and getting better health wise. What will they pay out of pocket if they have a Plan G and met their Part B deductible?
$0
Switch to another Medicare Advantage Plan or Disenroll from MA plan and go back to Original Medicare. Jan-Mar 31.
Open Enrollment Period (OEP)
Client enrolled into Part B 31 months late. What is the Part B penalty?
Hint: Percentage
Full 12 months = 10%
31 months = 20% Penalty
Client signed up for Medicare Part D 28 months late. What is the Part D penalty (%) that will be assessed and formula?
Hint: "National base beneficiary premium" ($34.70 in 2024).
Plan Premium + $9.70 = Part D Premium
Name the four Medicare Advantage companies we are able to sell?
Humana, Aetna, Cigna, and United Health Care
What is the Foreign Emergency Travel coverage?
Hint: 3 Factors. 2 out of 3 gets the question correct.
First 60 days out of country. Meet $500 deductible. Reimburse up to 80% after deductible up to $50,000