Medicare
Basics
Basics
This form of Medicare is a combination of both Parts A and B and most of the time contains part D
Part C or Medicare Advantage
What are you asking for when Obtaining HIPAA?
Full Name
Date of Birth
This is the job aid that can explain all the quality measures
Quality Guidelines
Your applicant has two election periods available to them, AEP and IEP. Which would you use?
IEP, this will provide them with coverage before AEP will.
An applicant has LIS Level 1 but does not have Medicaid. Can you enroll this member?
No, LIS Level 1, 2 or 3 MUST be transferred.
When an applicant enrolls in a MA plan during AEP. When will the plan become Effective
January 1st
When in enrolling a member into a PDP. They must have these parts of Medicare.
Parts A and / or B
What score do you need to pass quality?
Agents are expected to achieve at least 96% compliance on each Quality evaluation
Loss of EGHP.
When looking at medications, this is our Source of Truth.
RxWeb
Normally Medicare is provided at Age 65. Can a member have Medicare before 65? If So How?
They have a qualifying disability
You are in the middle of collecting an applicant's provider information. You notice 2 out of 3 of the doctors are not in network. What step in the call flow do you explain this to the member?
The Solutions Presentation
If you provide medical information to a caller before Obtaining HIPAA, this is a __________ point deduction.
High
If a member does not have any election periods but you have a 5 star plan they are interested in. How can you enroll them?
The 5-Star SEP
What are the different types of SNPs?
DSNP, CSNP, ISNP
An applicant is complaining about their LEP. Explain to the applicant what this is and why they are receiving it.
This is a Late Enrollment that you receive because you did not have credible prescription drug coverage. This will travel with you for the rest of your time on Medicare.
You just finished the Plan Determination step. How long should this take?
8 - 12 mins
How many Quality Measures are there?
34
If a member has LIS when can they NOT use the LIS Maintaining?
A member is enrolling into a PPO plan and their primary care doctor is OUT OF NETWORK, and they want to keep them as PCP. How do you assign this provider?
Use the Generic PCP number.
Someone is turning 65 in August. What is there window to enroll into Medicare.
May - November
3 Months Before, Month of, 3 Months After
What are the three things you must say in order for a Member Save to count?
Based on What we discussed. I recommend staying with your current plan.
This plan is still a good fit for you
You don't need to do anything else for this year
If an agent does not all medication Utilization Management, is this a high or low point error?
Low
Question 10 Quality Guidelines
A member was disenrolled from their plan because of a move. After finding out the member never moved and this was a mistake. Can you enroll them and if so what Election Period can you use?
Yes, Invol. Loss of Creditable Cvg
A member has Medicaid in New Jersey. When you look at their plans there is no DSNP's available. How do you handle this member.
If the member has any form of Medicaid, you transfer this member.