Medicare
This is the part of medicare that covers DME such as wheelchairs.
What is Part B?
These types of plans usually include prescription drug coverage at no additional premium.
What are Advantage (MAPD) plans?
This is a Medicare program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance.
What is Extra Help (LIS)?
This type of SEP is available each year beginning on December 8 and may be used once through November 30 of the following year.
What is 5-Star Plan SEP?
These type of Advantage plans generally make members get their care and services from doctors, other health care providers, or hospitals in the plan’s network (except for emergency care, out-of-area urgent care, or temporary out-of-area dialysis) in order for the member to be covered by the plan.
What are Health Maintenance Organization (HMO) plans?
This part of Medicare helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.
What is Medicare Part A?
The late enrollment penalty is an amount that can be added to the Medicare drug coverage premium. The beneficiary may have to pay a late enrollment penalty if at any time after their Initial Enrollment Period is over, there's a period of ______ in a row when they don't have Medicare drug coverage or other creditable prescription drug coverage. They will generally have to pay the penalty for as long as they have Medicare drug coverage.
What is 63 days?
FBDE, _____, and SLMB+ are cost share protected Medicaid levels.
What is QMB+?
The first opportunity the consumer will have to enroll in Medicare is called _____________. This is a seven-month window of time. It begins three months before they turn 65, their birthday month, and then three months after.
What is the “Initial Enrollment Period,” or IEP?
Consumers who have specific severe or disabling chronic conditions (like diabetes, End-Stage Renal Disease (ESRD), HIV/AIDS, chronic heart failure, or dementia) may benefit from enrolling in this type of plan.
What are chronic condition special needs plans or C-SNPs?
This is extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare.
What is a Medicare Supplement (MediGap)?
This coverage occurs when the out-of-pocket spending in 2024 reaches $8,000, the beneficiary will not have to pay a copayment or coinsurance for covered Part D drugs for the rest of the calendar year.
What is catastrophic coverage?
Consumers on Medicaid are not eligible for these type of Advantage plans since they do not pay a Part B premium.
What are giveback or Part B reimbursement plans?
This SEP code is for consumers that have both Medicare and Medicaid (or their state helps pay for their Medicare premiums) or they get Extra Help paying for their Medicare prescription drug coverage, but have not had a change.
What is MDE?
This ___________ gives the consumer details about what the plan covers, how much they will pay for certain services, and more in the next year. The carrier makes sure to send the member this out every year by October 15, either a printed copy or a notice on how they can access it electronically.
What is the evidence of coverage?
The Part A deductible for each time the beneficiary is admitted to the hospital per benefit period, before Original Medicare starts to pay.
What is $1,632?
This is when the beneficiary may need to try one or more similar, lower-cost drugs before the plan will cover the prescribed drug.
What is step therapy?
Not everyone that has Medicaid will qualify for this type of Advantage plan, it is based on their level.
What is a DSNP?
Consumers enrolled in Original Medicare only can not use this SEP during 1/1 - 3/31, it is for those beneficiaries who are already in an Advantage plan and would like to make one change during this time.
What is the Open Enrollment Period (OEP)?
This report we can pull to let us know what current plan the consumer is on and if they have LIS, we must always ask permission from the consumer to access it first.
What is Marx?
_____________ means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services.
What is assignment?
These certain types of Advantage plans do not include Medicare drug coverage and the beneficiary can join a separate Medicare drug plan.
What are Medical Savings Account (MSA) Plans and some Private Fee-for-Service (PFFS) Plans?
This Medicaid level has Medicaid paying only their Medicare Part B premiums (have income of greater than 100% FPL, but less than 120% FPL) and may not always qualify for a special needs plan.
What is Specified Low-Income Medicare Beneficiaries (SLMB)?
If you have to pay for Part A but don’t sign up for it and/or don’t sign up for Part B (for which you must pay premiums) during your Initial Enrollment Period, and you don’t qualify for a Special Enrollment Period, you can sign up during the _________________ from January 1–March 31 each year.
What is the General Enrollment Period?
_______ is a Medicare and Medicaid program offered in many states that allows people who otherwise need a nursing home-level of care to remain in the community, like a home, apartment, or other appropriate setting.
What is PACE?