Compliance
True or False: If an application is submitted with an invalid election period, it will be approved by CMS.
False
What are the dates for the MA-OEP?
January 1-March 31st
Sean is turning 65 in March and called Social Security to get signed up for Original Medicare. The SSA informs Sean that his Parts A and B do not go into effect until the first of the March. On February 7th, Sean calls in and asks to enroll into a Medicare Advantage plan. Can Sean apply for a plan yet?
Yes
Skylar tells her trusted insurance agent that she can’t enroll in a Medicare Supplement plan because it is not the AEP. Why is this incorrect?
Medicare Supplement plans do not require an SEP.
You can qualify for a PACE program even if you don’t have Medicaid/Medicare. What is the minimum age someone would need to be to qualify for a PACE program?
55
Phil receives a call on October 14, and the prospect is interested in enrolling. Phil knows that the AEP starts on October 15th. What should Phil’s next step be?
Ask all of the SEP questions to see if the prospect qualifies to enroll today.
What does OEPI stand for?
Open Enrollment Period of Institutionalized Individuals
Myranda has a Medicare Supplement policy and is interested in enrolling in a Medicare Advantage plan. She calls on January 13th, hoping to use the MA-OEP. Does Myranda Qualify for the MA-OEP?
No
Anthony stayed in Italy for 4 weeks while on vacation. When he returned, he realized he missed the end of AEP and didn’t get to select a new plan for the new year. While being asked qualifying questions by a broker, Anthony tells the broker that he had just flown in from Italy and was a U.S. citizen. The broker submits an application, and 1 week later, Anthony receives a letter stating his application was denied. Why did the application not go through?
Anthony was not permanently living outside of the United States- he was just there for vacation, so the SEP was invalid.
COBRA is a federal law that may let you keep your employer group health plan coverage for a limited time after your employment ends. COBRA stands for ____.
Consolidated Omnibus Budget Reconciliation Act
Election periods are typically considered used once ___________.
An election takes effect/plan becomes effective
Aside from the MA-OEP and OEPI, what other election period is often referred to as an “open election period”?
AEP
Bonesta has been living in an assisted-living facility for the last year and is interested in making a plan change. She is currently enrolled in an MAPD with Humana. On December 15th, she calls in to make a plan change. What SEP would she qualify for?
No SEP has been verified. We will continue looking for an SEP.
Jeremy posts a rant to his friends saying that he is upset because he didn’t know there would be a penalty for not having drug coverage. One of his friends informs him that if he has low-income, he will not have to pay the penalty. Jeremy contacts the SSA and tells them that he has a low-income and should not have to pay the penalty. He states that the SSA representative helped him fill out paperwork, and he’s not sure what it was all for, but now he doesn’t have a penalty. Based on this information, what SEP might Jeremy qualify for?
Change in Medicare/LIS Status SEP (New to Medicaid/LIS)
Someone who belongs to an SPAP would receive assistance paying cost sharing and/or ____________, and they get a one-time SEP for this every ___________.
Premiums / calendar year
James opens his calls on April 1st by telling each caller that it is the MA-OEP and they can enroll today to have coverage start tomorrow. There are 3 things that James did incorrectly. What were they?
Incorrect MA-OEP date/Guaranteeing eligibility before verifying they qualify/the plan wouldn’t take effect until the 1st of the following month if the SEP was valid.
Once institutionalized, how long does a prospect have to make a plan change using OEPI?
Unlimited time. This election period is continuous for institutionalized individuals and ends 2 months after the month they move out of the institution.
Jeff didn’t know he had to sign up for Part B and missed his IEP. He calls during the General Enrollment Period and signs up for Part B. What is the earliest date Jeff could apply for a plan?
January 1st
Megan really wanted to enroll into a PPO plan that had great benefits, but she didn’t have an SEP. To overcome this, Megan opens a P.O. box so she can start listing a new address that is one county over. To her surprise, she still does not qualify to enroll, despite her having a new address. Why does Megan not qualify?
The Change in Residence SEP is based on residential addresses and not mailing addresses.
What are the qualifications to use the Government Entity-Declared Disaster SEP?
1) Resided in the declared disaster area/Relied on help from family or friends living in the disaster area
2) Had a valid election period during the time of the disaster that was not used
Name the correct order for the election period hierarchy. (Hint – This includes: SEP, OEPI, AEP, ICEP, IEP-D, MA-OEP. )
IEP-D, ICEP, MA-OEP, SEP, AEP, OEPI
Name 3 of the 6 institutions that would qualify a prospect for the OEPI
Individuals living in: Skilled Nursing Facility, Nursing Home, Psychiatric Hospital, Rehabilitation Hospital, Long-term Care Hospital, Sing-bed hospital
Thomas moved from Indiana to Kentucky on June 1st. Six months later, he receives a letter stating he is being disenrolled from his Indiana MAPD plan. Based on this information, name 2 election periods Thomas would qualify for at this time to get a new MAPD in Kentucky.
Outside Plan’s Service Area over 6 months SEP / AEP
Alec went online and switched himself from an MAPD to a stand-alone PDP on June 4th. On July 15th, Alec realizes he is very unhappy with this change because he has a low-income and he thought his previous MAPD had better coverage for his needs. Alec knows that he has a monthly SEP due to being an LIS recipient, but when he tries to switch back to his previous MAPD, his application is rejected. Why is Alec’s application being rejected?
The monthly LIS/Medicaid SEP Alec is using is specifically for enrolling into PDP’s and does NOT permit enrollment into an MAPD.
CMS or State Medicaid programs may auto-enroll persons into a new or different plan under certain circumstances. Name 3 of these circumstances.
Dual Eligible, LIS, Low Star Rating, Plan Termination (Non-Renewal)