Medicare Basics
What are the two parts of Original Medicare?
Part A & Part B
What part of Medicare is a MA plan?
Part C
Rating Method
Attained Age, Issue Age, Community Rated
Late Enrollment Penalty
1% for each month x national average premium. (2019 $33.19)
MOV
Special Election Code for a move
What do Part A & Part B cover
Part A) Inpatient care (Acute hospital, Blood, SNF, Hospice, Home Health care)
Part B) Outpatient care (Outpatient surgery, Labs, DME, Doctors visits)
MAPD
Medicare Advantage with Prescription drug coverage
How much is the copay for doctors visits under Plan N?
Up to $20
TROOP
True Out of Pocket ($5100)
Can you enroll someone in a MA only and a stand alone PDP.
NO!!!! Don't do it EVA!!!! Except PFFS.
When was Medicare created and who administers Original Medicare
1965 & CMS
When is OEP?
January 1st-March 31st
Does Plan F cover your Part B Premium?
NO!!!
Catastrophic Coinsurance/Copay
The greater of 5% or $3.40 (generic) and $8.50 (Brand name)
4 buckets of Medicaid
QMB, SLMB, QDWI, FBDE
1364
Part A deductible
MOOP
$6,700 in network and $10,000 out of network
Issue Rights
Underwritten, Guaranteed Issue, Open Enrollment
LIS
Low Income Subsidy
What does the Grey Medicaid letter mean?
Loss of Eligibility
Late enrollment penalty for Part B and how long do you pay it?
10% for every 12 months past eligibility. You pay as long as you're enrolled in Part B.
HMO, PPO, PFFS, SNP
Health Maintenance Organization, Preferred Provider Organization, Private Fee For service, Special Needs Plan
Three states standardized in different ways.
WI, MN, MA
Phases of Part D
1) Deductible 2) Initial Coverage 3) Coverage Gap (Donut Hole) 4) Catastrophic Coverage
PA, QL, ST
Prior Authorization, Quantity Limits, Step Therapy