Part C
(MA/MAPD Plans)
(MA/MAPD Plans)
When can you sign up a client for an MA/MAPD plan during AEP for a January 1st, 2025 start date?
Oct 15-Dec 7
What is the cap on a monthly supply of insulin?
$35
What does D-SNP stand for and what two programs are required to be enrolled in to qualify for this type of plan?
Dual-Special Needs Plan (D-SNP)
Medicare and Medicaid
What does SOA stand for?
Scope of Appointment (SOA)
Mary, 64/F, turns 65 in June of next year and would like to enroll in an MAPD this AEP for 2025. Can she?
Yes or No
No
What additional items are typically covered with an MAPD plan that Original Medicare w/ a Med Supp does not?
(3 Items)
Dental
Vision
Rx Plan
What is the MOOP for 2025?
$2,000
What does C-SNP stand for?
Chronic-Special Needs Plan
When is an SOA needed?
48 hours prior to meeting
Client, 66/M, that you helped sign up form Medicare and a supplement plan last year calls you to discuss their options during AEP. What can you do? (2 things)
Discuss the new Part D plans if he would like to stay in Original Medicare
or
Discuss the MAPD plans that you represent
Medicare Advantage is typically cheaper in premium and lower deductible compared to Original Medicare but what causes individual's to pay more when receiving medical care?
(2 Items)
1. Higher co-pays
2. High MOOPs
Why is it important to review these new plans with your clients?
(2 reasons) Hint: Financial
1. Changes in formularies (effects co-pay tiers)
2. Changes in premium
What does I-SNP stand for?
Institutional-Special Needs Plan
What clients can you solicit for Medicare Advantage? (2)
Hint: Not phone or email or door knock
Current MA/MAPD client
Filled out lead form (Web or Direct Mailer)
Joe, 69/M, is already enrolled in Part A + B with a Medicare Supplement Plan G and an individual Part D plan. He calls you to make a switch to his Medicare Supplement plan. What should you tell him? (Two things)
1. Change PDP for 2025
or
2. Change to Medicare Advantage in 2025
You help a client sign up for an MA only plan in October and he contacts you in November to also get a Part D plan. What is your response?
You cannot have a solo Part D Plan with an MA only plan.
What are all plans required to offer to Medicare beneficiaries starting in 2025 if they cannot afford their medications all at once?
Payment plan that spreads out throughout the calendar year and does not exceed the MOOP
What D-SNP company(s) are we partnered with which can be sold in DC?
United Health Care (Sole contract with DC Government)
What is mandatory for all phone calls and virtual appointments during a sales appointment for an MA or MAPD?
Must be recorded!
A client, 69/F, thats enrolled in an MAPD already (4 years), calls you during AEP and wants to switch back to Original Medicare? What is your response.
This is not the time to do that. I can help you with that during the Medicare Advantage Disenrollment Period January 1st-February 14th.
What is some additional benefits that can possibly come with an MAPD plan?
(3 items) Hint: Not Medical
1. Gym Membership
2. Transportation to and from appointments
3. Meal delivery after hospitalization
The pharmacy will not fill a brand name (expensive) Rx for a client. They have a Part D plan. What must be the issue?
Need Prior Authorization
How many special enrollment periods (SEP) do D-SNP enrollees have?
Three.
Jan-Mar
Apr-Jun
Jul-Sep
When does the SOA time rule not apply?
Walk-in
Last 2 days of AEP
A client, 65/M, is in their first year of Medicare (2024) with a MAPD plan and calls you to switch back to Original Medicare during AEP. What is your response?
Sure we can disenroll you and switch you back to Medicare Parts A + B effective the following month utilizing the "Right-to-Try" provision.