Grace Periods
What grace period does a Medicare member have?
Medicare members have a rolling 60-day grace period.
What does RRB stand for?
Railroad Retirement Board
When do changes made during AEP go into effect?
January 1st
How do we verify the Agent of Record?
The AOR is verified in Select Health Link for Medicare policies.
Where can we find the PCP?
WACC/CTICSS
Subscriber/Family > Members > PCP
How does a Medicare member have their pharmacy holds removed?
Medicare plans do not have a benefit hold placed when they are in a grace period.
Where can we view the LIS level and the plan the member is on?
Eligibility Inquiry
Can Medicare policies be cancelled at any time?
No. Medicare policies may only be canceled during an approved enrollment period.
What is Medicare?
Medicare is Federal Health Insurance for people over the age of 65 and certain people under the age of 65 with disabilities.
What is a PCP?
A Primary Care Provider (PCP) is a healthcare provider who manages a member’s overall health, provides routine checkups, diagnoses and treats common illnesses, and helps manage chronic conditions.
A member is paid through 8/31. They haven't paid for September or October. Their monthly premium is $59.00. How much do they need to pay and when do they need to pay by to avoid termination?
They must pay one month's premium ($59.00) by 10/31 to avoid termination.
True or False: Medicare members are charged an NSF fee for Insufficient Funds returns.
False. Medicare members are not charged an NSF fee.
What is AEP and what are the dates?
Annual Election Period
October 15th through December 7th
What is M3P?
A payment plan that allows Medicare Part D and Medicare Advantage plan enrollees to pay out-of-pocket prescription drug costs in the form of monthly payments over the course of the plan year, rather than all at once at the pharmacy.
There are multiple lines that are the same with the same address. How do we find the correct provider?
Check the Address Effective Date and select the most recent effective date.
Member's grace period was 8/1-9/30. They call in 10/1 to make a payment for August, September, and October. Can we take the payment?
No, we cannot take the payment for October. The policy will be manually terminated as of 9/30 for nonpayment.
When do Social Security payments post to members' accounts?
At the end of the month for that month.
What is the difference between AEP and MA OEP?
AEP is the Annual Election Period from October 15th - Dec 7th each year. Members may enroll, change plans, or disenroll for the upcoming year.
MA OEP is the Open Enrollment Period from January 1st - March 31st each year. Members can make a one-time election to disenroll from the MA plan they chose during AEP and enroll in a different Advantage plan or proceed with Original Medicare only.
A Medicare member passes away on 9/9/2025. When will their policy terminate?
9/30/2025. Medicare policies are only terminated as of the end of the month.
What does the error "The PCP does not have any relationships with the member's product" mean and how do we proceed?
The provider is out-of-network or the location selected is out-of-network for that provider. Transfer to Advocates for further assistance.
Member has a premium of $4.30. They are paid current through August 31st. They have not paid for September or October. When will their grace period start?
Their grace period will not start until the member's owe more than $10. Late letters will be sent once the balance exceeds $10.
A member wants to cancel their SSA deductions for November. When is the last day they can make the request?
10/1/2025 - Friday, September 5th
11/1/2025 - Friday, October 3rd
12/1/2025 - Friday, November 7th
Friday, October 3rd for November
Aside from AEP, when can members enroll or change policies?
MA OEP - Medicare Advantage Open Enrollment Period
SEP - Special Enrollment Period
ICEP - Initial Coverage Election Period
True or False: All Select Health Medicare plans include Part D coverage.
False. We offer a couple No Rx plans.
What does the error "The PCP is not accepting patients" mean and how do we proceed?
The provider's panel is full. If the member is an existing patient with the provider, we can override this. Send the Issue Template to SH Enroll PCP for review.