Scenario
Today is April 18th, 2022. Mr. Jones calls in stating he currently has Medicare Part A and Part B (due to disability). He said he also has a WellCare HMO plan. He tells you he wants a plan that offers transportation. He also tells you he is turning 65 on June 4th, 2022. Based off the information we have; can we help him enroll into an MA plan?
If so, when would we make the MA plan effective?
Yes, we can help him using IEP2, since he had Medicare due to disability and is now turning 65.
We would make the plan effective the 1st of his 65th birthday month (June)
Today is January 9th, 2022. Mr. Fulkerson calls in stating he has Medicare Part A and just recently got his Medicare Part B. When he reads his Medicare card off to us, it says:
A- 08/01/2019 B- 02/01/2022
Can we use ICEP (delayed part B) to get him enrolled into an MA plan?
Yes, we can help him using ICEP. ICEP timeframe is 3-0-0. He would have 3 months before his Part B effective date (Nov, Dec, and Jan).
Today is February 2nd, 2022. Mr. Wackerly calls in stating he is getting Medicare Part A and Part B. He said his Part A and Part B both start on March 1st, 2022. He tells you that in he already enrolled into a WellCare HMO plan. The WellCare plan goes into effect on March 1st, 2022.
Can we use IEP to help him get into a different MA plan?
Yes! We can still help him by using his IEP election since the WellCare plan hasn’t gone into effect yet. We should tell the customer to call and cancel the WellCare plan.
Today is 07/20/2022, Mrs. Benitez calls in stating she has Medicaid and Medicare. She said she had an Anthem HMO plan but was recently able to change to a Humana HMO plan that started on 07/01/2022. Assuming the agent used MDE on the application, which quarter was the MDE election used in (Quarter 2 or Quarter 3)?
Would she be able to use MDE again today to enroll into another MA plan?
The MDE election would have been used in quarter two. The application date determines which quarter the election was used in. If the policy went into effect on 07/01/2022, we know the application had to have been written in the month of June.
Yes, we can use MDE to help her today, since she has not yet used her 3rd quarter MDE election yet.
Today is February 2nd, 2022. Mrs. Griffith calls in stating she currently has Medicare Part A and Part B and that she also has a Humana PDP. She is unhappy with her PDP plan because 1 of her prescriptions is not covered on the plan's formulary.
Can she use OEP-A to get an MA plan?
No. She cannot use OEP-A because you must have an MA plan in place in order to use OEP.
Today is June 22nd, 2022. Mr. Johnson calls in wanting to change his MA plan. His Medicare Part A and B both started on 03/01/2022. He enrolled in an Anthem MA plan (in March) that started on April 1st, 2022. He tells you that his cardiologist isn't in the plans network.
Can we use OEP-N to get him into a new MA plan?
No, we CANNOT use OEP-N because its outside of the OEP-N timeframe.
He only has the month of March and 2 months after (April and May) to use OEP-N.
Today is April 21st, 2022. Mrs. Wackerly calls in stating she needs a new plan because she will be moving from South Carolina to Michigan. She tells you that her and her family are moving on May 8th, 2022.
Can we enroll her using the MOV election? If so, when would we make the MA plan effective?
Yes, we can help her with the MOV election since she is moving to a new service area.
We would have to make the plan effective June 1st, 2022. We cannot make the plan effective on May 1st, 2022, because the effective date always has to be AFTER the move date.
Today is February 1st, 2022. Mr. Johnson calls in stating he just got his Medicare Part B. When you ask him his effective dates, he says:
Part A- 07/01/2018 Part B- 02/01/2022
He is looking for an MAPD plan that offers him additional benefits like OTC and a fitness membership. Can we use ICEP (delayed Part B) to help him get enrolled into an MAPD plan?
If so, what would the MA plan effective date be?
No, we cannot help him using ICEP.
ICEP timeframe is 3-0-0.
He would ONLY have the 3 months before his Part B to use ICEP (Nov/Dec/Jan)
Today is May 5th, 2022. Mr. Jones calls in stating he has Medicare Part A and Part B. He said he also has an Anthem MAPD HMO plan. He said he pays $23.00 a month for the plan. He also tells you that he utilizes the VA for all his prescription medications. He is wanting to save money on his monthly premium, because the $23.00 per month is getting hard for him to afford.
Based on the information we have; do we have a possible election available? If so, what would the election be?
We could help him enroll in an MAO using the OCC election
Today is February 4th, 2022. Mrs. Johnson calls in stating she has Medicare Part A and Part B. She also states that she has a Humana HMO plan. She wants a PPO plan because she wants the flexibility of using the doctors/hospitals of her own choice.
Based on the information we have; do we have a possible election available?
Yes! We can help her go from her HMO to a PPO using OEP-A
Today is June 7th, 2022. Mrs. Jones calls in stating she has Medicare Part A and Part B. She reads you her Medicare card and it says:
Part A- 03/01/2022 Part B- 03/01/2022
She enrolled in a MAPD with WellCare on June 3rd, 2022. That plan is going to go into effect on July 1st, 2022.
Does she have a possible election? If so, what is the election and when would be make the plan effective?
Yes, she has her IEP election still available since her WellCare plan has not yet gone into effect.
We will need to instruct her to call WellCare and cancel the application before we start/submit our application.
The MA plan effective date would be July 1st, 2022.
Today is April 3rd, 2022. Mr. Reed calls in stating he has Medicare Part A and Part B. When he reads his Medicare card to you, it says:
Part A- 01/01/2022 Part B-01/01/2022
He said he also has an Anthem HMO plan that’s just started on April 1st, 2022. He wants to switch to another plan because 2 of his prescriptions are not covered on the plan's formulary.
Can we use OEP-N to help get him a new MA plan?
No, we cannot use OEP-N.
OEP-N timeframe is 0-1-2 so he would only have the month of January and two months after (Feb and March) to use OEP-N.
Today is May 22nd, 2022. Mrs. Reed calls in stating she has Medicare Part A and Part B. She said she also has a Silver Script PDP plan. She tells you she recently got a letter in the mail stating that her Extra help level would be changing. She said she currently has full extra help, but the letter stated that she will now be receiving 75% extra help instead of full extra help.
Based on the information we have; does she have a possible election? If so, what would the election be?
Yes, her election would be NLS
Today is July 23rd, 2022. Mrs. Williams calls in stating she has Medicare part A and part B. She said she also has a Humana DSNP plan and Medicaid from the state. She said she just got her Humana DSNP plan. She said it started on July 1st, 2022. She now wants to change to another DSNP plan because her doctor is not in the network.
Can we use the MDE election to help her get enrolled into another MA plan?
Yes, we can use MDE to help her get enrolled into a new MA plan.
Based off the information we have, her MDE election has not yet been used this quarter.
Today is April 4th, 2021. Mrs. Shaw calls in stating she needs help getting an MAPD plan. She said her Medicare Part B just started on April 1st, 2021 and she hasn’t chosen any other type of coverage yet. Her Part A effective date was 10/01/2019.
Can we use ICEP to enroll her?
No! ICEP is only 3 months BEFORE. She gets no month of, and no months after.