SEP
I am moving to one state another
YES
I moved to a new address that's outside of my current plan's service area or I recently moved and this plan is a new option for me.
I don't want to make any changes
I understand. Even if you're happy, it is smart to review your plan each year since benefits and costs can change
When does OEP Start
Jan 1-March 31
This federal agency oversees Medicare marketing rules and requires agents to follow strict compliance guidelines
What is Centers for Medicare & Medicaid Services
Medicaid often helps cover costs that Medicare may not fully pay, including this type of long-term care
What is nursing home care
I lost my medicaid
YES
I recently had a change in my Medicaid(newly got medicaid, had a change in my level of Medicaid, or lost Medicaid)
I already have coverage
That's great but you may still qualify for extra benefits or savings. Let's do a quick review to make sure you're maximizing everything available
What qualifies you for Part A and B
Age 65 older, Disabled, End-Stage Renal Disease
This is the first opportunity you will have to request the caller's MBI number
After you read the Scope of Appointment and the caller agrees
This benefit helps members who cannot drive or access transportation easily
What is non-emergency medical transportation
My employer coverage is ending 5/30
I left coverage from my employer or union (including COBRA coverage)
I don't want to pay more
I understand, but health needs can change unexpectedly, and enrolling now helps avoid penalties later
What is the standard Medicare Part B monthly premium
$202.90
When gathering medication details, this information must be confirmed to ensure accurate pricing
Medication name
Form (tablet, capsule)
Release type (extended release, delayed release)
Dosage (mg, mcg)
Quantity (How many do you take per day?)
Frequency (How often do you refill – every 30 or 90 days?)
This Medicaid pathway allows individuals with income above the limit to still qualify by reducing excess income through medical expenses.
What is Medicaid spend down (medically needy program)
I am new to medicare and my new plan started 4/1/26 and want to switch to a different plan.
Part A and B started 3/1/26
YES
I'm in a MAPD and have had Medicare for less than 3 months. I want to make a change
I am not on any medications, so I don't need Part D
Even if you're not taking medications now, enrolling helps you avoid future penalties and ensures you're covered if your needs change.
Does Part A cover Long-Term Care (Custodial care)
No
This needs assessment question helps identify gaps or dissatisfaction in a client's existing plan.
Are you satisfied with your current costs and benefits?
Many states include this type of care, helping individuals remain in their homes instead of institutions
What is home and community-based services (HCBS
I dropped my Medigap/Supp plan two years ago and would like to go back to original medicare and medigap policy
NO
The trial period ends less than 12months
A prospect/member is frustrated about reduced benefits in their plan.
I understand your frustration. Plans can change each year due to regulations but often adjustments are made to create savings or improvements in other areas.
What are the 3 enrollment periods
Initial Enrollment Period IEP, Open Enrollment Period (OEP) and Special Enrollment Period (SEP)
When completing a CSNP enrollment application, this information must be collected
Diagnosis
Physician's name, provider ID, phone number and full address
What is the Dual Status Level for Code 4
SLMB+
Specified Low‑Income Medicare Beneficiary Plus