Eligibility
Who is eligible for Medicare?
Persons that are:
1. 65 or older
2. Under 65 with certain disabilities
3. Anyone with End Stage Renal Disease (ESRD)
What are the 2 types of plan that we have?
HMO and PPO
What does the abbreviation SPAP means?
State Pharmaceutical Assistance Program
What system do we use for Premium payment?
PNC Biller
What benefit would you quote for a Cardiologist?
Specialist
What are the Parts of Medicare?
Part A, B, C, D
During which period can a member join, drop or switch from a plan?
Annual Enrollment Period (AEP)
What does the abbreviation BAE means?
Best Available Evidence
When is a premium considered late?
After the 10th of the month
Does Cataract Surgery require a Precertification?
Yes it does
List 3 things that shows on the Medicare Card (Red, White and Blue card)
2. Medicare Number
3. Part of Medicare that the member has
4. Coverage date for Part of Medicare
List 3 types of Enrollment/Election Period
1. Annual Enrollment Period
2. Open Enrollment Period
3. Initial Enrollment Period
4. Special Enrollment Period
What does LIS/SPAP help with?
Prescription Drugs and Part D Premium
When are the funds withdrawn from a member's account when they are set up on Electronic Funds Transfer (EFT)?
Between the 10th and 15th of the month
What benefit would Foot Orthotics be covered under?
Durable Medical Equipment (DME)
This Part of Medicare is also known as the "All in one"
Part C
List the 4 ways someone can sign up for a plan
1. Call in by phone
2. Broker
3. Paper application
4. Online
What are the 3 Rights and Protections offered to our Medicare beneficiary?
1. Coverage Decision
2. Appeals and Reconsideration
3. Grievances and CTMs
What 3 things can affect a member's premium?
Optional Supplemental Benefits (OSB), Late Enrollment Penalty (LEP) and Low Income Subsidy (LIS)
Routine Physicals are unlimited for all Aetna Members
True
What is Late Enrollment Penalty (LEP)?
Continuous period of 63 days or more that the beneficiary did not have Medicare or another creditable coverage.
What is the name of the system we use to view Enrollment information for a member?
Market Prominence
What is the only way a member can get rid of Late Enrollment Penalty (LEP)?
By getting Extra Help/Low Income Subsidy (LIS)
What is the Payment Name when enrolling a member for automatic payments in PNC Biller?
My Auto Debit
If a member is inquiring about Surgery, what benefit would you quote?
1. Ambulatory Surgical Center (ASC)
2. Outpatient Hospital Services
3. Inpatient Hospital Services