MEDICARE 101
Which medicare beneficiaries are required to have drug coverage?
Everyone (unless they get drug coverage outside of medicare ie VA or Tribal Benefits)
After clocking in on workday, what should you log into?
Five9
When gathering a list of medications, which 4 things must be verbalized?
Name, Strength/Dose, Form, Quantity
On a DSNP plan, what would be required in order to use the OTC card for food and other amenities?
A chronic condition (SSBCI)
What 4 chronic conditions would qualify someone for a CSNP plan?
Cardiovascular (Heart) condition
Pulmonary (Lung) condition
Diabetes
ESRD
Before reading the medicare disclaimer, what 2 things should you confirm with your client?
Confirm zipcode and a&b
If a client cannot give you a full list of drugs, what question must be asked before you can compliantly move forward.
Is it okay to move forward without guaranteeing coverage for your prescriptions on this new plan?
If you see this for Inpatient hospital copay, what does that say about which levels of Medicaid are accepted for that specific D-SNP: “Inpatient Hospital Copay: $0 copay per stay OR $1975 copay per stay”
The plan accepts both Full and Partial Medicaid levels
Who would qualify for a plan without drug coverage?
Anyone with drug coverage outside of Medicare (ie, VA and Native Tribe beneficiaries)
If a client uses the VA, what 2 fact finding questions should you ask?
Do you see any civilian doctors?
Do you get all of your meds through the VA?
If a doctor is not showing as covered in Sunfire, where can you double check?
The carrier provider search portal
DAILY DOUBLE
What are the 3 stages of drug coverage? (in order)
1) Deductible
2) Initial Coverage
3) Catastrophic Coverage
Would someone with Medicaid receive a part b giveback? Why or why not?
No because people on medicaid do not pay the part b premium in the first place
How would you describe a Hospital Indemnity policy to someone who has never heard of one?
Its a policy that pays a cash benefit in the event of a hospitalization or emergency room visit.
DAILY DOUBLE
If a client has any of these 3 types of coverage, you should not put them on a Medicare advantage plan because it would be considered a compliance risk (list all 3)
If they have Tricare, ChampVA or a retirement/employer plan
DAILY DOUBLE
List 3 portals that can be used to run a Medicaid report.
Jarvis
Wellcare
ThinkAgent(Aetna)
When going over a Summary of Benefits presentation with a member, if they have LIS, what 3 things must you state the cost of with and without LIS?
Plan premium
Drug tier costs
Drug Deductible
List the 3 benefits of Medicaid:
Pays part b premium
Qualifies you for a dsnp
Cost share protection for those with full caid
Name the 3 ways an HMO network differs from a PPO network
must have a pcp
must get referrals
must remain in network
List 5 individual things Part C offers that original medicare does not
Dental
Vision
Hearing
Drug coverage
OTC/Food
Transportation
Fitness benefit
Any additional benefits listed also accepted
List 5 portals you will use throughout your call process.
Sunfire
Salesforce
CMS
Medicare.gov
Medicaid portal
Provider portal
Five9
What are the 4 benefits of LIS coverage?
Lowers tier cost
Eliminates drug deductible
Lowers monthly premium
Eliminates Late Enrollment Penalty
DAILY DOUBLE
What levels of medicaid represent full medicaid(4) vs partial medicaid(2)
Full caid: fbde, qmb, qmb+,slmb+
Partial caid: slmb and qi
DAILY DOUBLE
What would you see on a CMS report that would indicate your client may be on a supplemental plan?
You would see they are on a PDP only plan