Enrollment Periods
Mr. Tito just got his Medicare card in the mail his entitlement dates read:
A 11/01/2022
B 11/01/2022
What enrollment type can he use?
What is IEP?
Ms. Jackson will be moving to New York to Texas next month. What enrollment type would you use?
What is SEP MOVE ?
(30 days prior, 60 days after)
Ms. Hawks wants a plan where she doesn't need referrals to visit any specialist.
What is PPO?
Federal and State program that helps with healthcare costs for some people with limited income and resources
What is Medicaid?
Always 20% regardless what MAPD plan beneficiaries are on. (Excluding dual beneficiaries)
What is DME?
(Durable Medical Equipment) like c-pap, oxygen tank, wheelchair.
In addition Infusion and chemo drugs are also 20%
From January 1 - March 31 beneficiaries can change from MAPD to MAPD, MAPD to PDP, or MAPD to OG Medicare.
What is OEP?
Mr. Kelly will be losing his creditable coverage in September, he has 30 days prior and 60 days after to enroll in a plan, what is his enrollment type?
What is SEP LOCC?
I lost non Medicare prescription drug coverage that’s as good as Medicares prescriptions drug coverage...
Mrs. Roberts has a PCP and only see's one specialist. She wants low copays, which plan type typically has lower copays?
What is an HMO?
Can a beneficiary have LIS without Medicaid?
What is yes
During this timeframe, members are usually responsible for paying a greater portion of the drug cost than they did in the Initial Coverage Phase.
What is coverage gap AKA Donut hole
From October 15 - December 7 anyone on Medicare can enroll or make a change to their plan.
What is AEP?
Mr. Perry has had Medicare for several years. He will be turning 65 next month. What will be his enrollment period?
What is 2nd IEP?
Your speaking with Mrs. Starks and she is interested in getting a plan with a low premium. She doesn't qualify for extra help. She lives in a rural area and the only MAPD has a premium of $90, she expresses that's too expensive. What option would you suggest?
What is Original Medicare with PDP?
One plan change per quarter for the first three quarters of each year
What is SEP LIS/Full Dual
Reduces Copays for Part D to
$1.35 Generic
$4.00 Brand
Pays Part D deductible and Plan premium if Applicable
What is LIS LVL 2
Enrollment period that is out of their initial enrollment period.
What is SEP?
Your client qualifies for a D-SNP plan, but they are out of IEP? What enrollment will you use?
What is SEP FULL DUAL?
I have both Medicare and Medicaid (or my state helps pay for my Medicare premiums)or I get extra Help paying for prescription drugs, and I havent had a change.
What HMO plan lets you have some out of the network coverage?
What is HMO-POS?
(still requires a referral from PCP)
What information do you need to have to be able to check SNP Eligibility Medicaid Status?
What is Name, DOB, and Social Security?
Mr. Moore’s Medicare was effective 08/22. He started an MAPD plan Aug 1 and wants to change to another MAPD. What enrollment type would you use to get mr. Moore into a new Mapd?
What is OEP NEW
This one-time election begins the month of entitlement (effective date) to Part A and Part B and for two additional months. (Cannot be used with Retro dates)
Ms. Edwards has a MAPD and wants to go back to original Medicare on February 22. What SEP could you use?
What is OEP?
Mrs. Hills received notice of award with the following dates
A 02/01/2019
B 02/01/2019
Decision date 08/12/2022
What is the enrollment type?
What is SEP Retro?
I am new to medicare, and I was notified about getting Medicare after my Part A and/or Part B coverage started.
Mr. Strange has Badger Care and is new to Medicare what plan type would you look into for Mr. Strange?
What is D-SNP?
Medicare beneficiaries enrolled in this program have no legal obligation to pay Medicare Part A OR B deductibles, coinsurances, or copays for any Medicare-covered items and services.
What is QMB (Qualified Medicare Beneficiary)
2022 Monthly income and resource Limits
Individual $1,153
Married Couple $1,546
occurs when a member submits a request to the plan to make a decision on whether to cover a drug or to allow a lower member cost-share for a formulary drug.
What is Drug exception