Medicare 101
Federal program for eligible beneficiaries.
What is Medicare?
This is the first thing you do after a warm handoff from a Sales Agent
What is introduce yourself and set expectations?
If you’re unsure about an SEP code, you should do this.
What is escalate to the Licensed Member Care Team?
This document is used to confirm Medicaid level eligibility for Dual Special Needs Plans.
What is the Summary of Benefits (SOB)?
This model should be used when a member expresses hesitancy about completing the HRA.
What is the CARE model?
Those over 65 having worked 40 quarters or under 65 and is receiving SSD for over 2 years.
Individuals with ALS
Individuals with ESRD
Who is Eligible for Medicare?
This section confirms the member understands their current plan will end and when the new one begins.
What is the Intent section?
This process links the member on the line with the correct case in CUY.
What is "Matching a Lead"?
This benefit helps members save on groceries, OTC items, or utilities.
What is the Spending Card Allowance?
This must be confirmed for each medication during pre-registration to ensure accuracy.
What is the prescriber?
Medicare coverage for Hospital
What is Medicare Part A?
This part of the script ensures the member’s doctor is in-network.
What is Provider Look-up?
This software must be launched after logging into CUY to enable audio.
What is GATO (softphone)?
This benefit provides convenience and cost savings on medications.
What is Mail Order Pharmacy?
This tab in SunFire is where you go if benefit activations don’t appear automatically.
What is the Opportunities tab?
This enrollment period happens every year from October 15 to December 7.
What is the Annual Enrollment Period (AEP)?
This sub-status is used when an application is submitted.
What is WTP-Pending?
This tool is used to verify if a provider is in-network.
What are Carrier Portals?
This benefit helps members get to their doctor appointments.
What is Transportation?
Name one situation where you should NOT offer to send the confirmation text a second time.
What is when the member says they don’t know how to use text or messaging is turned off?
This condition allows someone under 65 to qualify for Medicare.
What is Social Security Disability for 24 months, ALS, or ESRD?
This is something you should never include in call notes.
What is personal or sensitive member information?
An online MCR resource library
What is FOCA?
This is the best way to search for an application in SunFire.
What is using the Enrollment Code from CUY?
This part of CARE involves showing empathy and repeating or summarizing the member’s concern.
What is Acknowledge?