Easy Peasy Questions
Two sections where I can find SEP resource documents on the Vault Medicare Training page
What are the Daily Resources and General Resources sections?
When someone needs a plan or a plan change, these resources help to identify an Enrollment Period to achieve this goal.
A couple years ago, caller went back to work and dropped their MAPD plan for employer group coverage. Recently employment ended, and they lost that group coverage. You look up the enrollment code to help them enroll in an MAPD plan.
Note: Include both UHC and Humana Guide codes in answer
What is
UHC - Code: SEP | Reason: Loss of EGHP Coverage – pages 12 & 17
Humana Code: LEC – page 6
Today is June 30th. Caller has been on an MAPD for years, turns 65 on July 15th. Enrollment codes for both UHC and Humana…
Note: Include in answer both UHC and Humana guide codes
What is IEP2 for UHC and IEP for MAPD/PDP for Humana.
They have a another 7 month window: April 1st – October 30th to make changes.
UHC SEP Code: IEP2 pages 11 & 14 (For MAPD or PDP, not for MA-only)
Humana Code: MRD for MA-only – page 8 | IEP for MAPD/PDP – page 3
“I need the phone number for <carrier> to update my address.”
Note: What SEP/Type of SEP do you think might work?
What is MOV SEP? (or some type of Move SEP)
Moving
Note: Write a question you would possibly ask. No “What” is required in the answer.
Did you recently move?
“yes”- When did you move?/When did you notify Social Security that you moved? If they haven't notified Social Security yet, or if it's within the first 63 days of them notifying SS, use the Move SEP
Page number of the Humana SEP guide where you find the Election Period Hierarchy
What is page 4?
NOTE: CMS will deny applications with the wrong enrollment/election. It is imperative to choose the correct enrollment/election period.
Caller has MAPD plan with limited dental, wants better dental coverage. They qualify for Extra Help/LIS but not for Medicaid. SEP code to get an MAPD plan now with more dental coverage…
NOTE: Include both UHC and Humana Guide codes in answer
What is
UHC: Code: SEP | Reason: Dual/LIS maintaining – pages 11 & 16
Humana Code: MDE – pages 1 & 9
Caller saw ad that says there’s a plan with 5 stars in their area. Their current plan has only 3 stars. Codes and date range this SEP can be used …
Note: Include both UHC and Humana guide codes in answer
What is
UHC SEP Reason – 5 Star - Election from 12/8 through 11/30, pages 13 & 21
Humana Code: 5ST - page 11
“I am finally retiring at the end of the next month. I got my part A and part B Medicare at the beginning of last year when I originally thought I was retiring. Now I am ready to get an Advantage plan. Can I get enrolled in one?”
Note: Name the SEP
What is LEC – Losing Employer Group Coverage
Extra Help
Note: Write a question you would possibly ask. No “What” is required in the answer.
Did you receive a yellow or green letter in the mail from Medicare stating you qualified for Low Income Subsidy assistance or Extra Help?
“yes”- if they received a letter stating they qualified for Extra Help, you can help them enroll with the LIS SEP
“no”-move on to the next question
**REMEMBER: There are different levels of Extra Help that they can qualify for. Even if they make over the limit, they may still qualify if they take care of a dependent or have a job that puts them over the limit.
SEP resource that has hyperlinks on page 2 to different SEPs within the same document
What is the Humana SEP Guide?
Caller will soon be moving in with family a few miles from her current home – same city, same zip code, but different county. She wants a plan with OTC benefits. No plans in her current area have OTC. Can you help her now?
Note: Include both UHC and Humana Guide codes in answer
What is “Yes if there is a plan available to her in the new area that is not available in her current area”?
UHC SEP Reason: SEP - Change in Residence – pages 12 & 17
Humana Code: MOV - page 5
I belong to a pharmaceutical assistance program provided by my state
Note: Include both UHC and Humana guide codes in answer
What is SPAP
UHC SEP Reason: SPAP Enrollee – pages 12 & 19
Humana Code: PAP – page 7
(Today is April 1st) “I have part A and I am newly enrolled in my state Medicaid program, but I didn’t sign up for Part B when I was first eligible. I would like to sign up for Medicare Advantage plan. When can I do that?
Note: What is the date?
Once they sign up for Part B first during the General Enrollment Period between January 1st – March 31st by calling the Social Security office, we can get them signed up for a MA plan.
Medicaid
Note: Write a question you would possibly ask. No “What” is required in the answer.
Do you get any help through your state Medicaid program?
“yes”- use SEP receiving/maintaining Medicaid or help on part B premium
“no”- move on to the next question
**REMEMBER: There are different forms of Medicaid. Ask if they get help with food stamps (if they get food stamps they are usually within the income limits to qualify for Extra Help), or if they received a letter saying they are on a spend down/share-of-cost with Medicaid, or if they have partial Medicaid.
Document and page # where I find the “Enrollment Elections Timeline”
What is page 2 of the UHC guide?
(Today is April 10th) Caller has no MAPD/PDP plan, has Part A&B since 2020, is newly eligible for Medicaid as of May 1st. How and when you can help them get enrolled in MAPD plan…
Note: Include both UHC and Humana Guide codes in answer
What is May 1st?
UHC SEP Reason – Change in Dual/LIS Status – pages 11 & 16
Humana Code: MCD – page 9
Caller left a Program of All-Inclusive Care for the Elderly
Note: Include both UHC and Humana guide codes in answer
What is PACE?
UHC: page 20 for MA/MAPD; page 28 for PDP
Humana: PAC - page 6
I do not pay anything for my Medicare coverage. I only make about $800 a month.
Note: Name the SEP
What is Dual Eligible (Medi-Medi) – Maintaining Medicaid eligibility and/or Extra Help
Loss of Current Coverage
Note: Write a question you would possibly ask. No What is required in the answer.
Did you receive a letter from your current insurance company that you no longer have coverage or that they are not offering any coverage in your area anymore?
“yes”- use SEP Loss of Creditable Coverage (LCC) or if available Loss of Employer Coverage (LEC)
“no”- move on to the next question
My effective date for Part A was last year and my effective date for delayed Part B is May 1st of this year. <date> is the last day I can sign up for an MA/MAPD plan without using an SEP Enrollment Period
What is April 30th?
ICEP with delayed Part B (different A&B effective dates)
Applies only to MA/MAPD plans
Not for PDP enrollment
Need PDP? Check for other SEP, e.g. ending group coverage, recent move, etc.
There was a HUGE storm last month, power was out for days, trees down, flooding. Caller had only until end of last month to get signed up for MAPD. Told by another agent they can’t get coverage until next year. Enrollment option…
Note: Include both UHC and Humana Guide codes in answer
What is
UHC SEP Reason: Declared Disaster/Emergency pages 13 & 21
Humana Code: DST - page 11
Declared Weather Emergency or Major Disaster – Not limited to FEMA – Could be a State, City, or County disaster.
The individual had to have missed an enrollment period as a result of the event to be eligible.
Moving into, residing in, or moving out of an institution; enrolling in MA/MAPD (hint: Not an SEP enrollment)
Note: Include both UHC and Humana guide codes in answer
What is OEP-I
UHC Code: OEP-I, pages 11 & 18
Humana Code: OEP-I, page 4
My income recently went up, and I no longer get Extra Help. I cannot afford my prescriptions anymore. Can I get a different plan that will save me more money?
What is Dual LIS (change in status) – Gain/Loss LIS/Extra Help
VA Coverage
Note: Write a question you would possibly ask. No What is required in the answer.
Do you currently have VA or Tricare (military insurance)?
“yes”- use the OCC SEP to enroll them into an MA-only plan designed with Veterans in mind, e.g. Humana Honor, Aetna Eagle, United Healthcare Patriot
(Note: if they get their Rx from VA and are disenrolling from Part D)
“no”-move on to the next SEP question or reschedule to call them back