SEPs
I live in Rutherford County, NC and missed OEP because of a wildfires in the area, am I qualified to switch my MAPD plan?
Yes, FEMA sep
State your call introduction
Hello my name is __,__ licensed agent with Aetna Medicare
My medicaid went from FBDE -> QMB PLUS on 2/1/2025, I would like to enroll in a different DSNP plan
Change in medicaid status SEP
State your call closing
Thank you for calling Aetna medicare
Phone #, HOOP
I am dropping my PACE plan and would like to enroll into MAPD for the first time
Pace switcher sep
If your member does not have their medicare # and would like you to provide it to them, what is the the expectation?
Refer them to call medicare directly for a new card
I am new to Medicare A&B as of 7/1/2025, would like to enroll today into a MAPD, can I do that? What would my effective date be?
Yes, valid SEP as they have 3 months prior to enroll, but effective date will be 7/1/25
When providing dental, vision, and hearing benefits what must be covered in order to meet compliance?
Embedded/OSB
Copays (in and out of network)
Allowance/Reimbursement
Any Applicable Network
I am a part of SeniorCare program, and would like to switch my plan.
SPAP sep
What are proper hold and transfer procedures?
I have been on Medigap and PDP plan since starting Medicare back in 2020, on 1/1/25 I decided to try MAPD plan for the first time, can I enroll back into my PDP/Medigap plans?
Yes, Trial Period SEP
In your application, how do you know something needs to be read verbatim?
White agent script box
I loss my Medicaid on 6/1/2024, my DSNP plan is ending on 4/30/2025 and would like to enroll into MAPD plan.
Loss of Snp Status SEP
Provide an example of how you would set expectations with a caller who is not authorized representative, but member has moved and needs a plan change.
You are more than welcome to stay on the line to assist the member throughout this process, however I will need the member to come on the line to verify some information and hear the medicare required statements and plan information, are you able to place the phone on speaker?
I have a chronic condition and would like to enroll into the DSNP plan in my area
No SEP, chronic condition SEP is only for enrollment into CSNP plans
State your reason and commitment for a caller that just moved to a new state...
Restate reason for call
Ask questions, identify needs, provide solutions, get protected today.. how does that sound?
I have had Medicare Part A since 2020, but I was enrolled into Part B due to exceptional situation on 3/1/25, I would like to enroll into MAPD product
If your member uses a LTC pharmacy, how can you advise of network status? If in network, what pricing do we quote?
LTC pharmacy hyperlink on the pharmacy look up tool, then quote standard network pricing
I have SLMB only (no recent changes on LIS or medicaid), live in KY and would like to enroll into H0628-012
No SEP
On an outbound call (call drops during enrollment), what items need to be covered to meet compliance?
Full introduction (identifying as licensed agent)
Recorded line
Verify HIPPA (have caller state their name and phone# or member ID)