Medicaid / Extra Help
This bene has Medicare and Medicaid (or gets Extra Help) and wants to switch to a different Medicare drug plan
OR
wants to drop MAPD and return to Original Medicare and join a separate Medicare drug plan
So you should use this SEP:
SEP-DEP
The bene was discharged from a Long-Term Care Facility 1 month ago. The agent used this code
SEP-LTC
The bene is changing from Group Medicare plan to an Individual Medicare plan, so the agent used this code
SEP-LEC
This is what CSNP stands for
Chronic Special Needs Plan
Has Medicare and gets full Medicaid benefits. Wants to join or switch to a plan that coordinates coverage between their Medicare and Medicaid managed care plans. The agent should use this code
SEP-INT
SEP-INT should be used for a bene in this situation
Has Medicare and gets full Medicaid benefits. Wants to join or switch to a plan that coordinates coverage between their Medicare and Medicaid managed care plans (DSNP)
The bene currently resides in a long term care facility, but will be discharged tomorrow. The agent used this code
SEP-LT2
The bene is retiring and has lost employer coverage 3 months ago. This code is outside of the timeframe to be used.
SEP-LEC
A bene was recently disenrolled from a Special Needs Plan because they lost Special Needs status, so this code was used
SEP-SNP
This Sep cannot be used from Dec. 1st to Dec. 7th
SEP-5ST
A bene calls in because they recently became eligible for Medicaid.
The agent should use this SEP/BOSE code
SEP-MCD
SEP-IIP was used for this situation and plan type
The bene lives in a Long-Term Care Facility and enrolled in a PDP
The bene plans to move in a month. What code can the agent use
What is SEP-MOV
(how can we CYA in this situation? What additional information do we need)
The verbiage used in the script to clarify if the bene has a chronic condition
"Looks like there's a plan available in your area that is only for people with certain medical conditions, and based on the information you provided it sounds like you may qualify but I'd like to confirm.
Your ability to enroll will be based on verification that you have a qualifying specific condition."
Are you currently enrolled in a qualified State Pharmaceutical Assistance Program is a sample question used to determine if this SEP can be used
SEP-PAP
A bene calls in because they received notice that they will be losing Extra Help. The letter is dated today, but the changes will into not go into effect for 6 months.
Can we use SEP-NLS?
No
[Allowed 1 opportunity to make an election within 3 months of any of the changes, or notification of a change, whichever is later]
This code's time frame begins: the date of discharge
and ends: 2 months after discharge
SEP-LTC
The bene recently lost VA Rx benefits (this month) and so the agent used this code to get them Rx coverage
SEP-LCC
These are common types of CSNP chronic conditions (name 3)
Diabetes
Chronic Heart Failure
Chronic Heart Conditions
Chronic Kidney Disease
etc
The excel sheet for SEP-DST is organized by this category
State
This SEP is only for PDP and the bene has to have Medicare and Medicaid (or Extra Help)
SEP-DEP
This code is only for PDP and begins when individual moves into or out of an institution, continues while residing in institution
SEP-IND
The bene has been on an MAPD plan for the last 2 months. When checking MARx the agent found they were auto-enrolled, so they used this code to get a new MAPD for the bene
SEP-DIF
The bene is in a CSNP for their heart condition, however there is a plan from the same carrier that offers coverage for their heart Dr to be in-network. The agent should be careful to avoid this
enrolling using SEP-CSN
This is the SEP-INC time frame
Begins: 1 month before the release
Ends: 2 months after the release