Enrollment Periods
Mr. Tito just got his Medicare card in the mail his entitlement dates read:
A 09/01/2023
B 09/01/2023
What enrollment type can he use?
What is IEP? or *ICEP
Ms. Jackson will be moving to New York to Texas next month. What enrollment type would you use?
What is SEP MOVE ?
(30 days prior, 60 days after)
Ms. Hawks wants a plan where she doesn't need referrals to visit any specialist.
What is PPO?
Federal and State program that helps with healthcare costs for some people with limited income and resources
What is Medicaid?
Always 20% regardless what MAPD plan beneficiaries are on. (Excluding dual beneficiaries)
What is DME?
(Durable Medical Equipment) like c-pap, oxygen tank, wheelchair.
In addition Infusion and chemo drugs are also 20%
From January 1 - March 31 beneficiaries can change from MAPD to MAPD, MAPD to PDP, or MAPD to OG Medicare.
What is OEP?
Mr. Kelly will be losing his creditable coverage in September, he has 30 days prior and 60 days after to enroll in a plan, what is his enrollment type?
What is LOCC?
I lost non Medicare prescription drug coverage that’s as good as Medicares prescriptions drug coverage...
Mrs. Roberts has a PCP and only see's one specialist. She wants low copays, which plan type typically has lower copays?
What is an HMO?
Can a beneficiary have LIS without Medicaid?
What is yes
During this timeframe, members are usually responsible for paying a greater portion of the drug cost than they did in the Initial Coverage Phase.
What is coverage gap AKA Donut hole
From October 15 - December 7 anyone on Medicare can enroll or make a change to their plan.
What is AEP?
Mr. Perry has had Medicare for several years. He will be turning 65 next month. What will be his enrollment period?
What is 2nd IEP?
Your speaking with Mrs. Starks and she is interested in getting a plan with a low premium. She doesn't qualify for extra help. She lives in a rural area and the only MAPD has a premium of $90, she expresses that's too expensive. What option would you suggest?
What is Original Medicare with PDP?
One plan change per quarter for the first three quarters of each year
What is SEP LIS/Full Dual
Reduces Copays for Part D to
$1.45 Generic
$4.300 Brand
Pays Part D deductible and Plan premium if Applicable
What is LIS LVL 2
Enrollment period that is out of their initial enrollment period.
What is SEP?
Your client qualifies for a D-SNP plan, but they are out of IEP? What enrollment will you use?
What is MCD
I have both Medicare and Medicaid (or my state helps pay for my Medicare premiums)or I get extra Help paying for prescription drugs, and I haven't had a change.
What HMO plan lets you have some out of the network coverage?
What is HMO-POS?
(still requires a referral from PCP)
What information do you need to have to be able to check SNP Eligibility Medicaid Status?
What is Name, DOB, Social Security/Medicaid # and MBI #?
Who said Mrs. Marsha I have all my equipment set and ready to go at home?
Who is Jim Kaufman
Ms. Edwards has a MAPD and wants to go back to original Medicare on February 22. What SEP could you use?
What is OEP?
Mrs. Hills enrolled in
Part A 10/01/2010
And
Part B 10/1/2023
What is the enrollment type?
What is ICEP?
I have Medicare, and I decided to enroll in Medicare after my Part A and/or Part B coverage started.
Mr. Strange has Medicaid and is new to Medicare what plan type would you look into for Mr. Strange?
What is D-SNP?
Medicare beneficiaries enrolled in this program have no legal obligation to pay Medicare Part A OR B deductibles, coinsurances, or copays for any Medicare-covered items and services.
What is QMB (Qualified Medicare Beneficiary)
When I am talking to much my mom say ZIP IT!
Who is Mark