Advantage Plans Review Flashcards

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1

What are the 3 types of advantage plans?

  1. PFFS
  2. PPO
  3. HMO / HMO-POS

2

What advantage plan can you have a stand alone PDP plan with?

PFFS ONLY!

3

Can I add a PDP plan in addition to my MA - only plan?

NO

*only exception is with a MA-only PFFS plan*

4

What are the core benefits that need to be discussed with prospect before enrolling?

  1. Plan name and type
  2. Monthly premium
  3. RX included.
  4. PCP copay
  5. Specialist copay
  6. Hospital (you pay)

5

What parts do MAPD cover?

  1. Part A
  2. Part B
  3. Part C (this is a mapd)
  4. Part D

6

Who contracts with Humana to provide MA plans?

CMS

7

What program makes sure you pay no more than $35 / month from an in-network provider for select insulins?

ISP- Insulin Savings Program

***SoB - Will tell you if the plan offers the program "Your plan participates in the Insulin Savings Program."

**Extra help recipients do not qualify**

8

What PDP plan offers ISP (insulin savings program)?

Premier Rx PDP plan

9

How are insulin pumps covered under and MAPD?

Part B

10

What plan am I not allowed to see out of network doctors?

HMO

11

I want to see any doctor anywhere, anytime and I travel full time??

PFFS

12

I would like to see doctors when I visit my family out of state, what plan should I enroll into potentially?

PPO

13

What MAPD is most similar to Original Medicare?

PFFS

14

This type of plan almost always requires a referral..

HMO

15

What benefit puts money back on my Part B premium

Part B Giveback

*no additional paperwork

*reduce $ member pays for Part B

*SoB will show you if / what is offered

16

What requirements are there for a C-SNP plan?

*varies by plan*

  • Congestive heart failure
  • cardiovascular disease
  • diabetes
  • chronic lung disease

17

What is the difference between Medicare and Medicaid?

(simplified)

Medicare is Federal, Medicaid is State specific.

Y

18

When do you qualify for Medicare?

Age 65 or

Collecting SS disability for at least 2 years ( 24 months )

19

When do you qualify for Medicaid?

Based on your state's income requirements, if you are below a certain income.

20

Who handles and dispurses Extra Help (LIS- Low Income Subsidies)?

Social Security

21

What election period is MDE?

Those with Extra Help can change once per quarter during the first 3 qtr's of the year:

Jan-March

April-June

Jul-Sept

22

What election period is MCD?

Lose, Gain, or change of Medicaid status

23

What election period is NLS?

Gain, Lose, or Change of LIS status (extra help)

24

What election period is DIF?

CMs and State-Initiated enrollments (passive enrollments)

** auto enrollment or reassignment and want to leave that plan for a new one.

25

What election period is LTC?

Long Term Care

individuals who moves into or resides in or moves out of a SNF , nursing facility, Intermediate Care Facility of the Mentally Ill, Psychiatric hosptial or unit, Rehab, etc.

2 calendar monthes to make the change

26

GEP is what election period?

SEP for those who are not entitled to Part A premium-free and who enroll into Part B during the GEP Jan-March. SEP begins April 1 and ends June 30 with a July 1 effective date

27

LAW is what election period?

Non- U.S. citizens who become Lawfully present

begins the month the lawful presence starts and continues for 2 months

28

OTH is what election period?

involuntarily disenrolled from MAPD due to loss of PART B (fail to pay part b premium) but who are still entitled to Part A , SEP to enroll into PDP plan.

29

5ST is what election period?

5 Start Plan avail in the area

H0292- 3 HMO Plans North KY

H1951 - 24 HMO plans in LA

H4461 - 16 HMO plans in TN

30

What is DST for an election period?

Those affected by a disaster and that disaster caused them to miss a valid election period.

31

If my birthday is 6/20/23 and I'm turning 65 and getting Medicare when does my Medicare typically start and when can I enroll?

Medicare typically will start the month of your birthday 6/1/23

You would be eligible to enroll March, April, May for a 6/1 effective.

or June for a 7/1 effective

July for a 8/1 effective

Aug for a 9/1 and Sept for a 10/1 effective

32

ICEP is used when?

Delayed Part B

or

their inital election period into an MA-only plan

33

MOV is what election period?

When they moved out of service area and needs to change plans

34

SEP-LEC is what?

Lose of employer coverage

35

SEP-CHR?

CHRONIC

36

SEP-PAP

STATE PHARMACUTICAL PROGRAM

37

OEP-New

first 3 months into their IEP enrollment, they have the ability to enroll into a different MAPD plan.

38

To enroll into a dual plan the prospect needs what?

A qualifying level of Medicaid in addition to their Parts A and B of original Medicare.

39

What does a SNP plan offer?

  • Plans that offer enriched benefits
  • May include lower costs
  • Enhanced care management
  • Dual eligible (D-SNP) (DE-SNP)
  • Chronic, severe or disabling medical conditions (C-SNP)
  • Customized benefits for unique situations
  • Offer additional benefits not covered by Original Medicare
    • Dental, vision, hearing

40

When can you add an OSB a members plan?

Any time-- no election period

41

Can they have 2 OSBs at the same time?

Yes-- however they would have to be different OSBs.. for example; one hearing and one dental OSB, cannot have 2 dental or 2 hearing.

42

If they disenroll from their MAPD will they be able to keep their OSBs?

NO. OSBs cancel when the MAPD plan cancels.