SEPs
My Medicare coverage started last month but I already used my IEP election. What SEP can I use?
What is OEP-NEW?
OEP-New is available to new Medicare Advantage enrollees following IEP/ICEP with their Medicare entitlement. The one-time election begins the month of entitlement (effective date) to Part A and Part B and for two additional months.
How often do I have to say the TPMO disclaimer?
What is every call?
The TPMO disclaimer must be initiated within the first 60 seconds of every call.
Which levels of Medicaid provide cost share protection?
What is QMB+, QMB, SLMB+ (varies by state), and FBDE (varies by state).
I just moved out of an SNF, how long do I have to choose a new plan?
What is 2 months?
This is an open and unlimited use enrollment period for Medicare beneficiaries residing in an institution lasting for up to two (2) months after leaving the facility.
I reviewed my consumer's medications in Medicare.gov, do I have to read it again in the SOB?
Yes.
Reading prescription benefits is one of the SOB requirements for all carriers.
My consumer is a level 2 LIS and their insulin is not covered by the plan. What will they pay for their medication?
What is retail cost? Medications must be covered for a consumer to pay LIS copays.
I am new to Medicare and I have LIS. What enrollment period comes first in the hierarchy?
What is IEP/ICEP?
Hierarchy of Enrollment Periods
1. IEP/ICEP
2. (MA) OEP/OEP-New
3. SEP
4. AEP
5. OEP-I
I am enrolling my consumer in a PPO plan and their doctor is out of network. Do I have to assign an in network PCP?
Yes, PCP assignment is required for all enrollments.
I am enrolling a consumer into a Humana DSNP and the Vantage portal is down. How can I verify their Medicaid?
By calling Humana directly.
My consumer is already in enrolled in Part A and their Part B starts in two months. What is the SEP?
What is delayed Part B (ICEP)?
This SEP allows the consumer to enroll in a plan during the 3 months BEFORE their part B becomes effective.
My consumer has Medicaid and I am enrolling them in a regular HMO, do I have to read the copays?
Yes. You must read whatever costs are listed in the SOB.
The most I pay for a generic medication is $1.45, what level of LIS do I have?
What is level 2?
ICL/Gap Copays: $0-1.45 for generics and $0-4.15 for brands