Medicare Basics
Medicare Part A is for _______________ ___________.
What is Hospital Insurance.
Julie is turning 65 on April 12th. When will her Medicare become effective?
What is April 1st.
When does the MA OEP take place?
What is January 1st - March 31st
The two types of disability enrollments are _____________ and _________________.
What are Prospective and Retroactive
What does ESRD stand for?
What is End Stage Renal Disease
Medicare Part B is for _______________ __________________.
What is Medical Insurance
Neil turns 65 on May 7th. He is actively working for the State and is not planning on retiring until next year. What plans will be he eligible for when he ages into Medicare?
What is the BCBS 70/30 and the BCBS 80/20 as he is actively working. His Medicare is secondary to his SHP insurance until he retires!
If Sarah is enrolled in the Humana Base plan effective 1/1/2021, what changes can she make during the MA OEP?
What is Sarah can change to the Humana Enhanced or the BCBS 70/30 MA plan OR she can enroll in an outside individual MAPD, individual MA plan, or individual Prescription Drug plan.
When a member is awarded Medicare due to disability, they receive an award letter from ___________ __________ ____________.
What is Social Security Administration
The Coordination Period where Medicare is Secondary to their State Health Plan insurance is ______ months.
What is 30 months
Medicare Part C is for ____________ ____________ ________.
What is Medicare Advantage Plan.
Desiree ages into Medicare effective September 1st. Upon reviewing her account, you notice she has been auto-enrolled into the Humana Base plan, which she intends on keeping. What should you do next?
What is review the Humana Checklist w/ the member: verify Medicare information and make sure they have both Parts A and B, verify we have a correct physical address on file, advise they cannot have an outside MAPD or Part D which could result in a drop, ask if they have outside coverage (i.e. through a spouse), advise Medigap/Supplemental plans will not work with Humana plans ; advise on last day to make changes - which would be Aug. 1st.
How many changes do members enrolled in a Medicare Advantage plan effective 1/1/2021 get during the MA OEP?
What is one change - all changes are final!
On 12/15/2020, Norah received an award letter stating she has been awarded Medicare due to disability effective 2/1/2021. What type of enrollment is this? What plans would she be eligible for?
What is Prospective; she is eligible for the Humana Base, the Humana Enhanced, and the BCBS 70/30 MA plans
Rachelle was awarded Medicare due to ESRD as of 8/1/2018. On 2/1/2021, what happens to her Medicare? Will she still be eligible for the BCBS 80/20 plan?
What is her Medicare will change from secondary to primary. She will only be eligible for the 80/20 plan IF she is still actively working; if she is not actively working, then she will be eligible for the 70/30 MA plan or one of the Humana plans effective 2/1/2021.
Medicare Part D is for _______________ __________.
What is Prescription Drugs.
Abigail turns 65 on June 1st. She gets auto-enrolled into the Humana Base plan. What is her last day to make changes to this plan?
What is March 31st - as her Medicare effective date is May 1st (since her birthday falls on the first of June).
An SHP member wants to switch from the Humana Enhanced to the Humana Base. They call in February. When will this change become effective?
What is March 1st.
On 10/13/2020, Adam received a letter from SSA stating he has been awarded Medicare due to disability. In the letter, it states his Hospital Insurance has been backdated to 6/1/2019. What type of enrollment is this? What plans is he eligible for?
What is retroactive enrollment; He is ONLY eligible for the BCBS 70/30 MA plan for the remainder of 2020, but can elect a Humana plan for 2021.
Mariah was awarded Medicare due to ESRD but is still in her coordination period so her Medicare is secondary to her SHP insurance. Her coordination period will end on November 12, 2021. However, she is aging into Medicare on June 1st, 2021. Does this change anything in regards to Medicare becoming primary?
What is NO - ESRD trumps aging into Medicare since her ESRD came first. Medicare will still be secondary until the 30 month coordination period ends.
Which parts of Medicare make up Original Medicare?
What is Part A and Part B
Justin calls in because his wife was dropped from their Humana coverage. After verifying that his wife has both Part A and B, has a physical address on file, and no outside coverage, you call Humana. The Humana rep states there's an "incomplete application." What should you do next?
What is ask the representative at Humana more probing questions to see if they can find out more information as this might not be due to the actual application. If the representative is unable to, reach out to a manager.
Mike is enrolled in the BCBS 70/30 MA plan eff. 1/1/2021. He states he has an outside MAPD. How did you assist?
What is redirect him to SHP directly at ppo.inquiries@nctreasurer.com
Joseph received his award letter on 9/23/2020, and in the letter it states his Hospital insurance will be backdated to 2/1/2018. The letter states he has the option of backdating his Medical insurance but will have to pay the arrears. What would you say to him when he asks what the benefits of backdating his Medical (Part B) are?
What is explain that any claims between 2/1/2018 and now would be reprocessed with Medicare as Primary and BCBS as secondary, so he may be responsible for out of pocket medical costs for whatever Part B would have covered if he chooses not to backdate it. You would also explain that his premiums for his plan that he was enrolled in prior to receiving this award would be reimbursed to him (i.e. premiums for 80/20).
Harry was awarded Medicare due to ESRD. He is undergoing a kidney transplant next week. When will his Medicare coverage end?
What is 36 months after the month the member receives his kidney transplant.