Does Original Medicare typically cover prescription Drugs?
No
Medicare Advantage is also known as?
Medicare Part C
Do members need Part A and Part B to sign up for a supplement plan?
Yes
What four things do you need to sign up for a part D drug plan?
Part A OR Part B, Live in the plans service area, Have a current enrollment period
What enrollment period gives the beneficiary a 7-month window to enroll?
IEP (Initial Enrollment Period)
What are the two parts of Original Medicare?
Hospital (Part A) and Medical (Part B)
What parts of Medicare does a Medicare Advantage Plan usually cover?
A, B, and D
Do Medigap plans come with dental, or vision coverage?
No, while you can get discounts, it doesn’t come with coverage.
What is a Medicare program that helps with Drug costs and premiums?
Extra Help (LIS)
If a member has multiple enrollment periods how would you know which one to use?
Use the Enrollment Period Hierarchy
How long do members need to be on disability to be eligible for Medicare?
24 Months (2 Years)
What 4 things do you need to be eligible for a Medicare Advantage plan?
Part A, Part B, Live in the plans service area, Have a current enrollment period
When is the best time to sign up for a medigap plan?
During their Open Enrollment Period (6 month time frame from Medicare effective date)
I have a Supplemental Plan G, can I get a PDP with that?
Yes, Medicare Supplement plans do NOT include prescription coverage so you will need one.
When Does the Annual Enrollment Period (AEP) occur?
Every year from October 15th – December 7th
What 4 things Does Part A cover?
Hospital Care
Skilled Nursing Facility Care (SNF)
Home Health Services
Hospice
What are four major types of Medicare Advantage plans?
HMOs, PPOs, POSs, and SNPs
If you sign up for a supplement plan what else do you need to sign up for in order to not get a penalty through Medicare?
Part D, Drug coverage
Are there any limiting health factors of Prescription Drug Plans in order to get one?
No, No underwriting or health questions.
What is the enrollment period Hierarchy in order.
Initial Enrollment Period (IEP/ICEP)
Special Enrollment Period (SEP)
Annual Enrollment Period (AEP)
Open Enrollment Period Institutionalized (OEPI)
What 5 things does Part B cover?
Doctor Visits,
Outpatient medical services,
Emergency room services (outpatient)
Mental health care
Laboratory services
If a member is dual eligible what does that mean?
They have both Medicare and Medicaid. Eligible for a SNP plan if one is in their area.
What would most likely happen if someone signs up for a medigap plan outside of their Open Enrollment period.
They would have to go through a Health assessment (AKA Underwriting)
When would your coverage begin if you signed up for a PDP during AEP?
January 1st of the next year
Name 4 of the most common Special enrollment periods.
Moving, Change to Medicaid, Change to Extra Help (LIS), Losing Employer Group Health Coverage