SEP
The consumer is turning 65 on May 1st 2022, and is looking for a Medicare Advantage Plan, when can the consumer enroll and what is the election period?
3 months before and 3 months after plus their birth month (7 months total), What is IEP?
I am doing plan comparisons. I see a plan that is in medicare.gov and I want to sell it. I looked in Connecture it is not there...what can I do to sell it?
You CANNOT sell from medicare.gov...you can only sell to what is in Connecture
I want to use a FEMA Special Election Period for a consumer? What are the requirements?
Consumer must have missed a valid election period and you MUST call the carrier to validate that they will accept the FEMA SEP...
The consumer is receiving Medicare and Medicaid and other LIS-Eligible....What SEP is this?
What is Dual Eligible? MDE
VA member called in on April 22, 2022 and she stated she is currently on dialysis. Customer is receiving extra help. Can she enroll into a MA/ MAPD?
What is YES
ESRD doesn't disqualify the member, You can use OCC for a MA Only plan or LIS as the SEP for a MAPD based on needs
The customer recently received Part B on Feb 1st after having Part A already for years. The customer enrolled into an MAPD that became effective March 1st using ICEP. The customer calls you in May, not happy with current plan. The consumer does not have LIS or Medicaid. What SEP can you use?
What is OEP- NEW?
OEP new is to change plan within 3 months of 1st time signing up for a MA/MAPD
Agent is speaking to a VA/Medicare beneficiary. The VA PCP is not found under the MA Honor or Patriot plan. Can I enroll the consumer and will he still be able to see the VA PCP?
Yes. Assign a PCP that is participating with the plan.
The consumer can see the VA PCP at the VA and they can see the civilian PCP...and take advantage of the additional benefits.
I received a notice from my employer that they are reducing my coverage and it will no longer be consider creditable coverage. What SEP can I use to enroll into a MAPD Plan?
What is involuntary loss of Prescription Drug Coverage? (LCC)
Some people have too much income to qualify for Medicaid. This amount is called excess income. Some of these people may qualify for Medicaid if they spend the excess income on medical bills. This is called?
What is Spend down
I received a letter from my carrier that my plan contract is terminating on May 31, 2022, what is the SEP for this enrollment?
What is contract non-renewal (NON)
During AEP the consumer enrolled in a PDP. It is now April 3 and the consumer would like to change their plan...Can they enroll and if so what is the SEP?
IF the consumer has LIS or Medicaid, YES you can change the plan using a unspent Quarter. IF they do not you will need to find a different SEP.
Consumer has VA and is Medicare/Medicaid, can they get a dual plan DSNP?
Yes.
The drug portion will not affect their benefits.
NO TRICARE
Consumer wants to enroll in a plan. Part A is 4/1/2022 part B is effective 5/1/2022. What is the election period.
SEP is ICEP/Delayed Part B because you are enrolling before the effective date of PART B.
*If they are enrolling after the part B effective date... you need to use LCC for Loss of Creditable coverage.
I changed my plan in MA-OEP. I lost my QMB status on Jan 3rd, 2022 and I received a letter from my carrier that my DSNP HMO Plan will be terminated as of April 30, 2022, what SEP can I use to enroll the customer?
What is loss of Medicaid (MCD)
I am a disabled veteran, with Medicare Part A and I am currently using the VA for my medical services, I applied for Part B when will I be eligible?
What is the Part B effective date?
I want to look at a new plan. I have lived in my same home for 15 years in Mississippi. I don't have Medicaid, extra help or any of that. The only thing I really have to help is Mississippi ADAP. That is a nice program but I need help to lower my costs at the doctor. I’m tired of paying so much. What is the SEP?
What is State Pharmaceutical Assistance Program (SPAP)
Can I enroll a Consumer with QMB+ into a Standard MAPD PPO plan with full cost share protection (no DSNP in the area)?
Yes, but the consumer will NOT be cost share protected on the out of network benefits.
Consumer is only cost share protected if the plan is a DSNP PPO. Consumer needs to take the Plan card as well as the Medicaid card.
This level of Medicaid covers the Beneficiary’s Part B premium and offers Partial Medicaid Benefits without Cost share Protection
What is SLMB?
Beneficiary has Medicare & Medicaid with LIS and enrolled into Humana DSNP HMO Plan in March for April 1st start date. The customer calls back in May and wants to change her plan, can the consumer change plan?
Yes, what is the New Quarter?
The consumer enrolled into a dual PPO plan using Medicaid Maintaining in Quarter 1 and lost Medicaid eligibility due to income during the next quarter, what SEP can the agent use to enroll the consumer into another plan?
Loss of Medicaid (MCD)
Agent ask consumer if they moved during SEP probing... Consumer states No, they didn't move...agent verifies that the address in Marx doesn't match the address they currently live a... Is there an SEP?/What is the SEP
Yes> SEP: Move with today’s date
Consumer states that her doctors are no longer in the network and wants to change the plan? Can you assist?
Yes! Find an SEP for the consumer
The consumer has Medicare and Medicaid and is interested in enrolling into Humana Plan which Carrier Portal do I go to validate the consumer Medicaid level?
What is Vantage Portal? (Humana)
Customer enrolled in Medicare Part B in the General Medicare Enrollment Period Between January 1 - March 31, what is the coverage start date?
What is July 1st effective?
They can enroll in April, May and June...for July 1 effective date
What Contract code will you see in Marx when there has been a passive enrollment?
X0001
you could also see
Point of Service Contract or Medicare-Medicaid HMO