Original Medicare
Original Medicare is made up of these two parts
What is Part A and Part B?
Also referred to as Medicare Part C.
What are Medicare Advantage plans?
A type of Medicare Advantage plan that provides extra support for people living with qualifying chronic conditions
What is a C-SNP?
Also known as Extra Help, this program assists Medicare beneficiaries with limited income and resources in paying for prescription drugs.
What is Low-Income Subsidy (LIS)?
A person legally authorized to act on behalf of another individual.
What is a Power of Attorney or POA?
Most Americans qualify premium free if they have paid Medicare taxes for at least 40 quarters (10 years).
What is Medicare Part A
Beneficiaries have access to in-network and out-of-network providers with this type of network.
What is a PPO
This must be high enough to meet the stipulation of the particular D-SNP to qualify.
What is the level of Medicaid
A joint federal and state program that helps with medical costs for some people with limited income and resources.
What is Medicaid?
When an agent pressures someone to make a decision by using threats, intimidation, or some other form of pressure that takes away their free choice without giving them a fair chance to consider their options.
What is Coersion?
People 65 years or older and people with certain disabilities, ESRD or ALS.
Who is eligible for Medicare?
A beneficiary will not lose their Medicare when they enroll in an Advantage plan as they need to maintain this to be eligible for a plan.
What is Medicare Part A and Part B?
A Medicare election period is designed for individuals with severe or disabling chronic conditions to enroll in a C-SNP designed to serve individuals with those conditions.
What is the Chronic Condition election period?
To qualify, beneficiaries typically need to have an income up to 150% of the federal poverty level and limited resources.
What is Extra Help or LIS?
Encompasses the effort to meet and exceed legal, ethical, and professional standards. It revolves around the practice of adhering to the extensive set of regulations governing the healthcare industry.
What is compliance?
These beneficiaries are automatically enrolled in Medicare Parts A and B when they turn 65.
Who are people that are already receiving Social Security or Railroad Retirement Board benefits?
In almost all cases, beneficiaries are not allowed to have this in addition to a Medicare Advantage plan. The exception would be with a PFFS MA plan.
What is a stand alone prescription drug plan (PDP)
Providers cannot bill members for any deductibles, copays or coinsurance.
What is cost-share protection?
These plans coordinate Medicare and Medicaid benefits and provide additional perks, like care coordination, specialized support, and sometimes, wellness benefits like gym memberships or over-the-counter allowances.
What are D-SNPs?
This is considered the number one way to avoid complaints.
What is to remain compliant.?
Available for specific situations like having delayed Part B due to employer coverage.
What is a Special Enrollment Period?
A 7 month window that opens 3 months before the beneficiary is Medicare eligible, the month of Medicare eligibility and 3 months after.
That is the Initial Enrollment Period (IEP)
New for 2025, this SEP allows full-benefit dual eligible individuals to align their Medicare and Medicaid benefits by enrolling into integrated plans.
What is the Integrated Special Enrollment Period?
This level of Extra Help (or LIS) qualifies the client for $0 medications, both generic and brand name.
What is Level 3?
This includes actions with intentional deceit to gain unauthorized benefits or advantages. Fraudulent behavior is characterized by a deliberate attempt to deceive or manipulate the system or beneficiaries for personal gain or to harm others.
What is Fraudulent Behavior?