MEDICARE 101
Who is required to have drug coverage on Medicare?
Everyone
After clocking in on workday, what else should you log into?
Five9
What 4 things must be verbalized/confirmed for every medication?
What 3 things are needed to run a medicaid report in Jarvis?
Name 3 ways an HMO differs from a PPO
must have a pcp, must get referrals, must remain in network
What 2 things should you confirm before accepting a call?
The clients zipcode and that they have medicare parts a and b
If a client cannot give you a full list of drugs, what question must be asked before moving forward?
Is it okay to move forward without guaranteeing coverage for your prescriptions on this new plan?
List the 3 benefits of Medicaid
pays part b premium, qualifies you for a dsnp, cost share protection for those with full caid
Who is eligible for a guaranteed issue HI policy?
People ages 60-74
What 2 questions should you ask someone with VA benefits?
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
What are the 3 stages of Part D? (in order)
Deductible, Initial Coverage, Catastrophic Coverage
What levels of Medicaid are cost share protected(4) vs non-cost share protected(2)
csp: fbde, qmb, qmb+,slmb+
non csp: slmb and qi1
What 4 chronic conditions qualifies someone for a CSNP?
cardiovascular disease, diabetes, lung disease, ESRD
What are the 3 situations in which we would never enroll a client into an MAPD plan?
If they have Tricare, ChampVA or a retirement/employer plan
What 2 portals do we use to run a Medicaid report?
Jarvis and Humana
What are 4 benefits of LIS
lowers tier costs, lowers monthly premium, eliminates part d deductible, eliminates late enrollment penalty
Can you put someone with Medicaid on a part b giveback plan? Why or why not?
You cannot because people on medicaid do not pay the part b premium in the first place
List 3 ways a Humana D-SNP otc card differs from a UHC D-SNP otc card
Rolls over, covers personal care items, covers cleaning supplies, covers rideshares
List 5 things an MAPD plan cover that original medicare does not
Dental
Vision
Hearing
Drug coverage
OTC/Food
Transportation
Any additional benefits listed also accepted
List 4 things you should check on a cms report to find an SEP
DOB
Address/state
A and B start dates
LIS
During the SOB, what 4 things must you verbalize in regards to meds?
Drug deductible, tier costs, tiers of clients current drugs, restrictions of clients current drugs
What is a sign that a D-SNP plan takes both full and partial caid?
There will be copays/coinsurances listed for hospital and medical services (docs, er, urgent care)
Name 4 ways a Supplement plan differs from a medicare advantage plan
higher monthly premium, no copays, freedom to choose docs, doesn’t cover routine/additional services, doesn’t offer drug coverage, client covered anywhere in US