Plan Information
Probing Questions
Acronyms
Transfer? Not to Transfer?
AEP/SEP/IEP
100

If a caller states that they currently have a Plan F and wants to get an HMO plan. Can they have/add the HMO plan? 

No. They cannot have both a Med supp and MAPD, only one or the other. This is double medical coverage and is considered illegal. 

If the caller wants MAPD, they will need to let go of their Plan F to avoid double medical coverage. As well as needing an SEP to switch into  a MAPD. 

100

Someone called in saying they saw an ad on the bus and wants a plan. What are some probing questions to ask the caller? 

  • Are you disabled or 65+? 
  • Do you have Medicare parts A and B? 
  • Are you currently a HS member? 
100

What does MAPD stand for? 

Medicare Advantage + Prescrition Drug Plan 

100

John calls in stating he got bill on his monthly premium and is higher than it should be. Do we transfer this caller? If yes, where to? 

Yes, to MSO

100

Caller states they moved last week to a different zipcode. What enrollment period do they qualify for? 

SEP- Moved

200

Caller is asking what is involved in a MAPD. What are somethings you can tell them to educate them on plans before an agent? 

  • They have both Medical and Prescription coverage 
  • Some plans have extra benefits such as OTC, Dental, Vision, etc. 
  • Plans are based on state, zipcode and county 
  • There are a few options, HMO, PPO, and if they have Medicaid they can also be qualified for a DSNP 
200

A woman called in stating their neighbor has a really good OTC benefit and she wants in on it too. What are some probing questions we can ask her?

  • Do you have Medicare parts A and B? 
  • Does your neighbor have a HealthSpring plan? 
  • What HealthSpring plan is your neighbor on? 
200

What does PCP stand for? 

Primary Care Physician

200

Janice has called in to report her spouse has passed. Does this caller get transferred? If yes, who does this caller get transferred to?

(50 Bonus Points: What is the disposition needed for this call?)

Yes, MSO 


(BP: Deceased)

200

Caller states they turn 65 in 50 days. What enrollment period do they qualify for? 

IEP- Aged into Medicare (within the 7month period) 

300

These are plans that have very high premiums but are accepted anywhere medicare is accepted.

Medicare Supplements / Medigap

300

Elise is calling in as she just got her red white and blue card and wants to go over plans in her area. What are some probing questions we can ask her?

  • When is your effective dates on the red white and blue card? 
  • Does it reflect BOTH A and B on the card? 
  • When do you turn 65? 
300

What does CID stand for? 

(50 Bonus points: What is it used for?) 

Customer ID 

(BP: CID is the number given to the Licesned Agent to pull up the Landscape lead)

300

Amaya called in stating she was told she now has Medicare and has received the red white and blue card and she was told to call to get a plan. Does this caller get transferred? If yes, who does this caller get transferred to? 

Yes, to a LHA- Licensed Health Agent 

300

Caller calling in on behalf of themselves and spouse to explore plans on November 19. What enrollment period do they qualify for? 

AEP- Within October 15th - December 7th 

400

This is a plan that let's customers see a specialist without a referral. 

(Hint: It's a type of MAPD) 

PPO- Preferred Provider Organization

400

Andrew is an experienced caller and this is his 4th AEP. He knows exactly what he wants already and just needs to get to an enrollment. What are some probing questions we can ask him? 

  • Do you have your red white and blue card? 
  • What plan are you looking into? 
  • Do you have an agent you are already working with? 
400

What does HMO and PPO stand for? 

HMO- Health Maintenance Organization

PPO- Preferred Provider Organization 

400

Caller calls in stating they just got Medicare Part A and doesn't have Part B but is wanting to look over MAPD. Does this caller get transferred? If yes, who does this caller get transferred to? 

No, provide Medicare phone number to check if eligible for Part B 

400

Caller stating they got let go from their job and lost their employer coverage. What enrollment period do they qualify for? 

SEP- Loss of Employer coverage 

500

What are some differences between a Supplemental/Medigap plan and a MAPD?

  • Prescription/Drugs included in MAPD not Medigap
  • Medigap you can use with generally any Doctor/hospital that accepts Medicare. MAPD Must use plans in network (Especially HMOs) 
  • Medigap generally a referral is not needed. MAPD may require referrals depending on plan 
  • MAPD has extra benefits such as dental, vision, hearing, OTC, fitness, transportation, etc. (depending on the plan. Generally all Medigaps are limited to only medical- everything else is separate cost and needs add on. 
  • Medigap may need medical underwriting outside certain protected enrollment periods. MAPD does not need medical underwriting to join. 
500

These type of plans are only available to certain customers. They have extra benefits like food cards, quarterly allowances for utilities and have a 0 copay for most if not all services.What should you ask to see if the customer qualifies for this plan?

Do you have medicare and Medicaid?

500

What does MSO stand for? 
What does MS stand for? 

MSO= Member Services Operations 

MS= Medigap Supplement 

500

Caller states they are a current member and moved 2 weeks ago and got a letter stating to call and update their address. Does this caller get transferred? If yes, who does this caller get transferred to? 

Yes, to a LHA for a plan change due to a move SEP 


(50 BP if mentioned: Also provide MSO number for them to update address with them directly after LHA enrollment) 

500

Caller states they have extra help and would like to change their PDP plan. He is calling on July 12th. What enrollment period do they qualify for? 

SEP- LIS (Lowincome Subsidy/ Medicaid) 

M
e
n
u