MEDICARE 101
Who is required to have drug coverage on Medicare?
Everyone
After clocking in on workday, what should you log into?
Five9
When gathering a list of medications, what 4 things must be verbalized/confirmed
Name, Strength, Form and Quantity
What 3 things are needed to run a medicaid report in Jarvis?
Name
DOB
Zipcode
What 4 chronic conditions would qualify someone for a CSNP plan?
Cardiovascular (Heart) condition
Pulmonary (Lung) condition
Diabetes
ESRD
What two things should you confirm before reading the Medicare Disclaimer?
Confirm zipcode and a&b
If a client cannot give you a full list of drugs, what question must be asked before moving forward?
Is it okay to move forward without guaranteeing coverage for your prescriptions on this new plan?
List the 3 benefits of Medicaid
Pays part b premium
Qualifies you for a dsnp
Cost share protection for those with full caid
Who would qualify for a plan without drug coverage?
Anyone with drug coverage outside of Medicare (ie, VA and Native Tribe beneficiaries)
If a client has VA benefits, what two questions should you ask?
Do you see any civilian doctors?
Do you get all of your meds through the VA?
If a doctor is not showing as covered in Sunfire, where can you double check?
The carrier provider search portal
What are the 3 stages of drug coverage? (in order)
1) Deductible
2) Initial Coverage
3) Catastrophic Coverage
Would someone with Medicaid receive a part b giveback? Why or why not?
No because people on medicaid do not pay the part b premium in the first place
Name 3 ways an HMO network differs from a PPO network
must have a pcp
must get referrals
must remain in network
If a client has one of these 3 types of coverage, you should not put them on a Medicare advantage plan because it could affect their current coverage.
If they have Tricare, ChampVA or a retirement/employer plan
What 2 portals do we use to run a Medicaid report and why?
Jarvis and Humana
Jarvis gives you the medicaid number which you need to get the level from the Humana portal
If a client has LIS, what 3 things must you state the cost of both with and without LIS during a SOB presentation
Monthly premium
Tier costs
drug deductible
What would you notice on a SOB for a DSNP that accepts all levels of Medicaid
There will be copays/coinsurances listed for hospital and medical services
Ex: $0 or $20
$0-20%
What are 3 differences between a Humana food card and UHC food card?
Humana rolls over and covers:
personal care items (deoderant, shampoo/conditioner)
cleaning supplies
rideshares (uber/lyft)
Paper towels/plates
List 5 individual things an MAPD plan cover that original medicare does not
Dental
Vision
Hearing
Drug coverage
OTC/Food
Transportation
Any additional benefits listed also accepted
What 6 portals do you want open and ready to use at the start of your call?
Sunfire
Salesforce
CMS
Medicare.gov
Jarvis
Humana
What are the 4 benefits LIS provide
Eliminates drug deductible
Lowers monthly premium
Eliminates Late Enrollment Penalty
What levels of medicaid represent full medicaid(4) vs partial medicaid(2)
Full caid: fbde, qmb, qmb+,slmb+
Partial caid: slmb and qi1
What would you see on a CMS report that would indicate your client may be on a supplemental plan?
You would see they are on a PDP only plan