Grace Periods
What are the rules for the Medicare grace period?
Members have a 60-day rolling GP
When are monthly medicare premium payments do to avoid termination? Any exceptions?
No exceptions. payments due on last day of the month at end of 60-day grace period.
If a member has questions on their benefits who do we transfer to?
Member Services 88199
What does RRB stand for?
Railroad Retirement Board
What is Medicare?
Medicare is the federal health insurance program for people who are 65 or older and certain younger people with disabilities.
How Does A Medicare Member Remove Their Pharmacy Holds?
Medicare plans DO NOT have claims or pharmacy HOLDS once they are in their grace period.
Name one resource a member has if they need help with their premiums other than a subsidy.
My Advocate # 844-794-2296
Or they can go online to: https://secure.ssa.gov/i1020/start
It is not a guarantee they will get assistance. They will need to see if they qualify before any sort of assistance is given.
What can we tell members who have questions about an LEP?
Let them know that there is an option to appeal the LEP and you can get them over to Medicare Enrollment to discuss it.
What Screen Shows the LIS Level And The Plan The Member Is On
Eligibility Inquiry
What is Medicare Advantage?
Medicare Advantage is SelectHealth’s private health insurance policy for Medicare members. SelectHealth is an HMO (health maintenance organization) plan sponsor with a contract with Medicare. We offer all benefits of Original Medicare as well as prescription drug coverage.
True or False: Members with a LIS have a longer Grace Period than members with no LIS.
False
True or False: Medicare Members are charged an NSF fee for Insufficient funds.
False
Who determines the LIS.
Member has to call SSA in order to see if they meet the requirements for a Subsidy
How is the SSA payment setup?
Member has to call in before cutoff date to request SSA deductions. Once they request it we send an email to 2nd level to setup the SSA.
What is AEP and what are the dates?
AEP is the Annual Election Period for Medicare Members to enroll in a plan for the upcoming year. The dates are October 15 – December 7
Member's premium payment is $65.00. $0.00 dollars is for medical. $35.00 is for dental and $30.00 is for vision. the member is at the end of their grace period and wants to know what will happen if they don't make the payment. What do you tell them?
Advise member that if payment of $65.00 is not made by end of GP they will lose their OSB's but keep their Medical Benefits.
When do SSA payments post to members' accounts?
SSA/RRB will post around the end of the month for that month.
If a member wants to appeal the LEP and fills out the form; who reviews and determines a decision?
C2C is the name of the company that reviews and determines the outcome of the appeal if the member has already started an appeal, they can call C2C at 1-833-919-0198
What are the differences between Medicare billing & INDV/FFM? Give 3 differences.
Medicare 60-day GP
MED1 vs IND1
No extra days to make payment
SSA setup
Do Medicare Members have HSA accounts
There is such a thing as a Medicare Medical Saving Account (MSA) Plans. We don't offer them. If they had an HSA account, contributions have to stop 6 months prior to the start of Medicare, but of course they can still use the funds accumulated prior.
Member is paid in tolerance until 3/31/2021 they haven’t made the payment for April or May and we are in the month of May. Their monthly premium is $200.00. How much do they need to pay and by when to avoid termination?
Member would need to pay $200.00 by May 31st to avoid Termination
Member's premium is $0.00 and their LEP is $20.00 the member hasn't paid the LEP for June or July. They currently owe $40.00 will the policy terminate if we do not get the $40.00 by 7/31/2021?
If the member has a $.0.00 premium and the payment, they make every month is for the LEP, the policy will not be terminated but they will still be responsible for the payment
You receive a call from a member who is terminated. You let the member know the account is no longer active but they still owe $120 on the account. The member asks to be reinstated what are the steps?
let them know you would need to transfer them to our enrollment department to see what your options are for continuing coverage.
If a member wants to Cancel their SSA deductions for November when is the last day they can call and request it?
10/1/2021 Friday, September 10th
11/1/2021 Friday, October 8th
12/1/2021 Friday, November 5th
10/8/21
Medicare member processed a payment on the wrong account. Meant to pay their medicare policy what steps would you take to fix the issue?
Advise member it is not an issue. grab refund template and send email to SHARGOV@IMAIL.ORG