OEP
True or False...
OEP is strictly for Medicare beneficiaries enrolled in a Medicare Advantage plan to make a one-time change during the period?
TRUE!
To enroll in a different MA/MAPD from a MA/MAPD or MAPD to Original Medicare with a PDP
Ms. Chopp is calling on June 22nd. Her Part A and Part B began on May 1st of the same year, and she has not made an election yet. She is interested in a Medicare Advantage plan with prescription coverage.
IEP
If a POA calls on behalf of the person they care for to enroll, what should you ask?
Are they present and able to make their own healthcare decisions?
Mr. Spencer is calling on May 27th. He put an application in for a CC-SNP Diabetes and Heart plan but, during post-enrollment verification, was found to not have the qualifying heart condition.
CHR
Humana started in Louisville, back in 1961, as a nursing home company (called Extendicare), but in what year did Humana enter the MAPD market?
Humana has a long history in providing Commercial and Medicare Advantage health plans. They offered their first private Medicare Advantage plans in 1985.
True or False...
If MARX shows OEP has been used or not used, we can assume this is correct?
False. It depends on when the applications or the cancellations were submitted to CMS. MARX will reflect “used” as long as the app has been submitted and processed. If it is showing “unused”, it may be wrong if app has not been processed yet. Because of this, an agent should proactively ask enrollee if they used the OEP prior, within the OEP timeframe.
Ms. Coburn is calling on May 4th. Her Part A started in March, but she has delayed her Part B to begin July 1st and is interested in a Medicare Advantage plan.
ICEP
When are you supposed to say the HIPPA Disclosure?
EVERY CALL!
You are not required to give any health related information; unless the information is needed to determine your eligibility to enroll in the [plan/program]. If you choose not to provide the health information that is necessary to determine enrollment eligibility, then you may not be able to enroll in the [plan/program].
Ms. Green is calling on June 14th. She applied for and was granted Medicaid status last month
MCD
True or False....
Those beneficiaries on Original Medicare (with or without a prescription drug plan) or other Medicare health plan types, such as cost plans, can make changes?
FALSE!
CANNOT make changes during the annual Medicare Advantage OEP like they can during AEP.
Mr. Arthur is calling on May 30th. He was released two weeks ago from a skilled nursing facility after residing there for 3 months and is looking for an MAPD plan
OEP-I NOT LTC that's to enroll in PDP only
The Compliance question C11/ "Did the agent offer to review"......
Name FOUR out of FIVE areas agents most commonly miss when offering to review.......
1. PCP AND SPECIALIST NETWORK STATUS
2. CURRENT PRESCRITIONS
3. PHARMACY NETWORK STATUS
4. HOSPITAL NETWORK STATUS
5. FACILITY NETWORK STATUS
Ms. Hoeffer is calling on April 15th. Her Part A and Part B started on April 1st, but she had already called in March and used her IEP to sign up for a Medicare Advantage Plan. She wants to choose a different MAPD option.
OEP-New
Betty became eligible for Parts A and B in May and enrolled in a MAPD for an effective date of June 1st. She wants to make a plan one time change in August. Can we use OEP-NEW?
No!
The one-time election begins the month of entitlement (effective date) to Part A and Part B and for two additional months.
Ms. Timmons is calling on December 21st. She did not enroll during AEP and her current plan is terminating due to non-renewal at the end of the year.
EOC
What does CTM stand for?
Complaint's Tracking Module
What is the last resort SEP to use and closely monitored?
SEP - DST
Do you know the Enrollment Hierarchy? Name the 5 in order ?
1. ICEP-IEP
2.OEP/OEP-NEW
3. SEP
4.AEP
5.OEP-I
Mr. Trenchik is calling on July 28th. He lost his LIS status this month and wants to change plans.
NLS
****Daily Double*****
Reviewing "More Benefits with your plan", at the end of the SOB, which benefits are we REQUIRED to review?
1.Healthy Options Allowance or FLEX Allowance
2. Humana Spending Account Card
3.OTC
We must offer to expand if they would like: Routine foot care, Meal Programs, GO 365, Silver Sneakers, and Personal Home Care
Ms. Mader is calling on August 16th. She currently has Part A but decided to delay her Part B until August 1. It’s been over 1 year since she has had an Employer Health plan. She is interested in enrolling in a Medicare Advantage plan.
No SEP available