Initial Enrollment
If turning 65 on December 15th, earliest date eligible to start Medicare benefits (due to age)
What is December 1st
October 15 through December 7
What are the dates for Annual Open Enrollment
Every month
What is how often required to close intakes
Centers for Medicare & Medicaid Services (CMS)
Who is the agency responsible for implementation of Medicare
Dates that a beneficiary who currently has a MA plan and can switch from MA to another MA or to back to OM. (Not SEP, LIS, or MediCal)
What is October 15-December 7 and January 1-March 31
Six months after the effective date of Part B
The length of time an individual can enroll in a Medigap without medical underwriting.
January 1st effective date
What is when drug and MA plans coverage begins if changes made during annual open enrollment.
The 10th of the following month.
What is when Counselors should have all intakes entered and closed in SHARP for the month.
Most dental and vision coverage
What is services not covered by Original Medicare
Original Medicare coverage option with both Part A and Part B required
What is a Medigap plan
January 1 - March 31st each year for those not yet enrolled in Medicare
What is General Annual Enrollment
Switch from one Medicare Advantage Plan to another Medicare Advantage Plan OR back to Original Medicare without a SEP
What are changes a beneficiary can make during Annual Open Enrollment and Medicare Advantage Open Enrollment Period.
01/01/1957
What you type into a SHARP intake if you do not know the client's birthday but you know they are 65 or over.
Payer of last resort
What is Medicaid/MediCal.
Term referring to the maximum an insurance plan requires a person to pay, after which the plan will pay 100% of covered expenses up to the policy limit?
What is Maximum Out of Pocket limit
Employer coverage/spouse employer coverage and 20 or more employees
What are two requirements to properly defer Part B without a penalty.
The process of removing insulin as a drug listed and then adding $420 back into the results for each insulin drug.
What is how to complete a 2023 PDP search for a client with one or more insulin drugs.
Entry that must be included in the basic demographics section of SHARP to ensure complete distribution of information (even if you estimate it)
What is the birthdate
Beneficiary receives this before appealing a Medicare coverage decision.
What is a Notice of Denial from Medicare
Typically, more expensive and less restrictive vs less expensive and more restrictive
What is the difference between Original Medicare and Medicare Advantage plans
What Inpatient requirement to qualify for rehabilitation benefits after a hospital stay is required for Original Medicare but not necessarily for Medicare Advantage
What is the Three Midnight Rule
One time during the first quarter, one time during the second quarter, one time during the third quarter and/or during annual open enrollment
Fraud checked on intake topics covered and SMP checked on intake closing
What are two boxes that must be checked on SHARP intakes to obtain Senior Medicare Patrol (SMP) credit
After receiving 24 months of Social Security disability benefits.
What is Medicare eligibility for those who are under age 65.
After enrolling in MA plan, ability to return to Original Medicare within 12 months and re-enroll in previous Medigap plan with guaranteed issue after age 65
What is Trial Period #2