Medicare Advantage
What part of Medicare helps cover hospital stays?
What is Part A?
What is the government program that helps low-income individuals pay for medical care?
What is Medicaid?
What does IEP stand for?
What is Initial Enrollment Period?
This document/statement must be obtained before discussing plan benefits with a client.
What is the Scope of Appointment (SOA)?
This term describes the max number of times a client can switch plans during MA OEP.
What is once?
What is the name of the period from January 1 to March 31 when someone on a Medicare Advantage plan can make a one-time switch?
What is the Medicare Advantage Open Enrollment Period (OEP)?
What program/plan(s) helps people who qualify for both Medicare and Medicaid?
What is a Dual Special Needs Plan (D-SNP)?
What doe AEP stand for?
What is the Annual Enrollment Period?
Finish this required phrase: “We do not offer every plan available in your area…”
Please contact Medicare.gov, 1800 Medicare, or your local State Health Insurance Program to get information on all your options.
These partial dual levels pay some costs but not all; name at least one.
What is SLMB or QI?
Name two benefits that some Medicare Advantage plans offer that Original Medicare does not.
What are dental and vision? (Other acceptable answers: hearing, gym memberships, transportation, OTC cards)
What does QMB only cover for eligible beneficiaries?
What are Medicare Part A and B premiums, deductibles, coinsurance, and copayments? (Fully Cost Covered)
This type of plan is designed for beneficiaries with certain qualifying health conditions (like diabetes, CHF, or COPD) and allows them to enroll or switch plans year-round if they meet the condition criteria.
What is CSN? (Chronic Special Needs plan)
Failing to provide a disclaimer or misrepresenting plan details could lead to this type of CMS file.
What is a CTM (Complaint To Medicare)?
True or False: People with QMB level Medicaid can be billed by providers for Medicare cost-sharing.
What is False?
This plan type covers a specific county or service area and requires members to stay in-network for most services.
What is an HMO plan?
This government agency oversees Medicaid at the federal level.
What is CMS (Centers for Medicare & Medicaid Services)
A client calls in and says, “I just got a letter that my state Medicaid benefits were terminated last month.”
You verify they lost eligibility on Sept 15th.
Which SEP would you use to enroll them in a new Medicare Advantage plan, and how long do they have to use it?
What is MCD (Loss of Medicaid)? - 2 full months after loss of eligibility to make a change.
True or False: You can incentivize a client with a $50 gift card to complete an appointment.
What is False?
A client has full Medicaid and Original Medicare but no MAPD plan. What type of plan would you recommend first?
What is a D-SNP plan?
This election period is the only time during the year, outside of SEPs, when anyone can enroll, disenroll, or switch plans.
What is AEP (Annual Enrollment Period)?
These two main factors determine Medicaid eligibility.
What are income and assets/resources?
A client enrolled in a new Medicare Advantage plan during AEP with a January 1 effective date.
On February 10, they call and say:
“I hate this plan. My doctors aren’t in-network, and I want to switch.”
They do not have LIS, Medicaid, or a qualifying chronic condition.
Which SEP can you use, and what are the rules around when they can make this change?
What is OEP?
Rule: They can make one switch to another MA/MAPD plan or go back to Original Medicare + PDP.
During a sales call, the client asks you to explain the difference between a Medicare Advantage HMO and PPO.
You accidentally say, “The PPO is the best plan in your area — everyone prefers it.”
What compliance rule have you violated, and why?
What is the use of superlatives or steering?
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