MEDICARE 101
This is the four-letter federal health insurance program for people 65+ or with certain disabilities.
What is Medicare?
This required in-person or phone document must be signed by the beneficiary before an agent can discuss specific plan details in most cases.
What is a Scope of Appointment (SOA)?
This Medicare Savings Program pays Part A and B premiums, deductibles, coinsurance, and copays for the lowest-income tier of dual eligibles.
What is QMB (Qualified Medicare Beneficiary)?
A beneficiary turning 65 in June has this 7-month window to enroll in Part A and B, spanning 3 months before to 3 months after their birthday month.
What is the ICEP/IEP (Initial Coverage Election Period)?
A beneficiary who just moved to a new address outside their plan's service area qualifies for this type of enrollment period.
What is a SEP for a permanent move?
This part of Medicare covers hospital inpatient stays, skilled nursing, hospice, and some home health.
What is Part A?
CMS marketing rules prohibit agents from doing this to a beneficiary who hasn't requested contact, especially by phone or door-to-door.
What is unsolicited contact/cold calling?
This federal program helps pay Part D premiums, deductibles, and copays for beneficiaries with limited income and resources.
What is LIS/Extra Help?
A beneficiary who wants to switch Medicare Advantage plans or drop back to Original Medicare between January 1 and March 31 is using this period.
What is the OEP (Open Enrollment Period)?
A beneficiary who just became eligible for Medicaid/AHCCCS or lost it can use this SEP to change plans.
What is the SEP for gaining or losing Medicaid/dual-eligible status?
This part covers outpatient care, doctor visits, and preventive services, and carries a monthly premium for almost everyone.
What is Part B?
This word is banned in Medicare marketing because it implies the beneficiary hasn't already paid for the benefit through premiums or taxes.
What is "free"?
This Arizona program is the state's Medicaid agency, providing health coverage to low-income residents including many dual eligibles.
What is AHCCCS?
A beneficiary calls in October wanting to switch their Part D plan for the coming year — this is the window they're in.
What is the AEP (Annual Enrollment Period, Oct 15–Dec 7)?
Dual-eligible and LIS-eligible beneficiaries get this SEP frequency to change Part D or Medicare Advantage plans.
What is once per month (the monthly dual/LIS SEP)?
Also called Medicare Advantage, this part bundles A and B (and usually D) through private insurers.
What is Part C?
Federal law prohibits selling this type of supplemental plan to someone who is confirmed QMB, because it duplicates protections they already have.
What is a Medigap plan?
This Medicare Savings Program covers Part B premiums only, for slightly higher income than QMB.
What is SLMB (Specified Low-Income Medicare Beneficiary)?
A beneficiary who missed their Part B enrollment window and has no other coverage may face this permanent consequence if they enroll late.
What is the Part B late enrollment penalty?
A beneficiary whose current plan is dropping their doctor or pharmacy from network coverage, or is losing its contract with CMS, qualifies for this SEP type.
What is a SEP for a plan contract violation or non-renewal?
This part covers prescription drugs and is offered either as a standalone plan or bundled into an Advantage plan.
What is Part D?
This required disclaimer must be given within the first minute of a call (or in writing/electronically otherwise) and states the agent doesn't represent every plan available in the area.
What is the TPMO (Third-Party Marketing Organization) disclaimer?
This free, unbiased counseling program (not affiliated with any insurance company) helps Medicare beneficiaries compare plans and understand benefits.
What is SHIP (State Health Insurance Assistance Program)?
A beneficiary who worked past 65 with employer coverage and is now retiring has this 8-month window to enroll in Part B without penalty.
What is the SEP for loss of employer coverage?
A beneficiary can use this SEP anytime during the year to switch into a plan CMS has rated this many stars or higher.
What is the 5-star SEP?