Bonus Round
What are the 3 Waiver states?
Minnesota, Wisconsin, and Massachusetts
What is the rate disclaimer?
"Rates are subject to change. Actual rates will be determined upon acceptance into the program based upon eligibility criteria and your medical conditions, if applicable."
What are the Plan N Baseline Benefits?
Part A Deductible
Part B Coinsurance/Copayment(with copay disclaimer)
No Coverage for the Part B deductible
A consumer is just turning 65, will be getting A and B starting 5/1/2022 and would like to enroll in plan G. Is this consumer considered in scope or out of scope?
In scope
Who qualifies for Open Enrollment in Texas?
Applicants qualify for Open Enrollment during the first 6 months they are enrolled into Medicare Part B. If their initial enrollment into Part B is before age 65, they have a second 6 month Open Enrollment beginning the month they turn 65.
Who is eligible for the extended basic plan in Minnesota?
If the consumer was 65 or had Medicare part A prior to 1/1/2020
These services should ONLY be disclosed if brought up by the Applicant.
Value Added Services
IE Fitness, Dental ,vision
What is the estimated monthly premium for Plan G in Nebraska(68104 zip code) for someone in their OE?
$113.49
A consumer from Pennsylvania calls saying they dont like their MAPD and would like to change to a supplement. During your needs conversation you discover they have HealthChoices. Is this consumer in scope or out of scope.
Out of scope- consumer has Medicaid
What is the 30 Day "Free Look" period?
Consumer will receive a Full refund of premiums (minus claims paid, if any) if policies are returned within 30 days of plan issuance
What Value added services are offered to a resident of Massachusetts?
NONE
Prior to enrolling what are the mandatory items agents need to read from the job aid?
Rate Disclaimer, Discounts, (Part A deductible coverage, Part B Coinsurance or Copayment, Part B deductible coverage.) Baseline Benefits
An Applicant in North Carolina is under age 65 and loses/drops a managed care plan. Does this qualify them for guaranteed issue? Medicare Part A started BEFORE 1/1/2020
Yes or NO, if so which plans are they eligible?
YES, Plans A or C
A consumer is moving from Florida to Georgia and would like to change his supplement from Plan F to Plan G. Is this consumer considered in scope or out of scope?
Out of scope- consumer wants to change AARP supplement plans-transfer to Optum CSS
Does the tobacco use surcharge apply to e-cigarettes, vapor cigarettes, nicotine patches or marijuana?
No, the tobacco surcharge will only apply if they also used tobacco products within the past 12 months.
A consumer in Massachusetts is just turning 65 as of 5/1/2022. During your needs conversation you discover they really want their Part A deductible covered. What plan should you recommend to them and why?
I recommend the Supplement 1A plan because its the only plan you're eligible for that would cover the Part A deductible.
For those applicants not in their OE or GI what would cause underwriting to deny them coverage?
Applicant is in NC
*Provide all the reasons
Applicants that are outside of their Open Enrollment and do not qualify for guaranteed issue are underwritten for eligibility and they will be denied coverage if any of the following applies:
● within the past 2 years had any kidney problems (ESRD, dialysis required dialysis, Chronic Kidney Disease),
● within the past 2 years was told by a medical professional that they may need:
● to be hospitalized as an inpatient (not including overnight outpatient observation),
● joint replacement,
● organ transplant,
● surgery for cancer,
● back or spine surgery,
● heart or vascular surgery,
● was hospitalized as an inpatient within the past 90 days (not including overnight outpatient observation),
● currently being treated or living in a nursing facility other than an assisted living facility.
PA Consumer would like to enroll in the same Plan F that her friend has. She is in her OE and her Part A started 4/1/2022. Is she eligible for Plan F?
Explain if she is or is not. if not eligible what other plan could be comparable?
She is not eligible due to her Part A effective Date. Plan G can be a viable option but consumer would need to be made aware it doesn't cover the part B deductible.
A consumer is retiring and leaving their employer group health coverage. They currently have both Medicare parts A and B, but do NOT have an active AARP membership. Is this consumer considered in scope or out of scope?
In scope- while having an AARP membership is a requirement to have an AARP supplement plan its not required in order to initially sign up. Consumer will however need to obtain membership before the plan is approved.
A consumer would like to sign up for plan G but is NOT in their OE or GI. They mention they have an irregular heartbeat. Would this consumer be allowed to enroll? Why or Why not?
Yes, consumer would be allowed to enroll at a level 2 rate.
A Wisconsin consumer in his OE would like to enroll in the Basic plan with Copay. Will this plan give him coverage for the part A Deductible and home healthcare? If not how can he get that coverage?
No, but he can get that coverage by adding on riders 1 and 4
Which Enrollment process will be used for a applicant in OHIO whos POA is calling in on their behalf?
Applicant DOB 05/02/1956
Assisted Phone Enrollment in OLE
A consumer has Plan J and was curious about a Medicare advantage plan. They do have the Trial Period SEP available- would they be able to switch to their plan J again if they dont like the MAPD?
YES/NO WHY/WHY NOT
No they wouldnt be able to go back to Plan J because that plan no longer exists. Only current members of Plan J can keep the plans benefits.
A Colorado applicant is losing they're Medicaid eligibility at the end of the month and would like to enroll into a Medicare supplement Plan G. Are they in or out of scope? Can this applicant enroll without underwriting?
In scope, Yes losing Medicaid eligibility is grounds for Guaranteed Issue which allows for no underwriting.
What notes need to left in MIRA following enrollment?
Mira Notes for Enrollments Notes must be left in Mira. This is the information needed on every Medicare Supplement enrollment:
• Assisted Phone Enrollment or Voice Signature
• Plan the application was for (ex: Plan N, Plan K..)
• Who completed the application (if it was a POA, spouse etc.)
• If completing as Voice Signiture, method of kit (Showing in COMPAS, in-hand, Access online, emailed kit)
• If completing as Assisted Phone Enrollment (App Assist), why (ex. no kit sent)
• AARP Membership Number & Expr Date (if available)
• Tobacco Use (in states where it is required): Yes or No