front 1 What are the 3 types of advantage plans? | back 1
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front 2 What advantage plan can you have a stand alone PDP plan with? | back 2 PFFS ONLY! |
front 3 Can I add a PDP plan in addition to my MA - only plan? | back 3 NO *only exception is with a MA-only PFFS plan* |
front 4 What are the core benefits that need to be discussed with prospect before enrolling? | back 4
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front 5 What parts do MAPD cover? | back 5
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front 6 Who contracts with Humana to provide MA plans? | back 6 CMS |
front 7 What program makes sure you pay no more than $35 / month from an in-network provider for select insulins? | back 7 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** |
front 8 What PDP plan offers ISP (insulin savings program)? | back 8 Premier Rx PDP plan |
front 9 How are insulin pumps covered under and MAPD? | back 9 Part B |
front 10 What plan am I not allowed to see out of network doctors? | back 10 HMO |
front 11 I want to see any doctor anywhere, anytime and I travel full time?? | back 11 PFFS |
front 12 I would like to see doctors when I visit my family out of state, what plan should I enroll into potentially? | back 12 PPO |
front 13 What MAPD is most similar to Original Medicare? | back 13 PFFS |
front 14 This type of plan almost always requires a referral.. | back 14 HMO |
front 15 What benefit puts money back on my Part B premium | back 15 Part B Giveback *no additional paperwork *reduce $ member pays for Part B *SoB will show you if / what is offered |
front 16 What requirements are there for a C-SNP plan? | back 16 *varies by plan*
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front 17 What is the difference between Medicare and Medicaid? (simplified) | back 17 Medicare is Federal, Medicaid is State specific. Y |
front 18 When do you qualify for Medicare? | back 18 Age 65 or Collecting SS disability for at least 2 years ( 24 months ) |
front 19 When do you qualify for Medicaid? | back 19 Based on your state's income requirements, if you are below a certain income. |
front 20 Who handles and dispurses Extra Help (LIS- Low Income Subsidies)? | back 20 Social Security |
front 21 What election period is MDE? | back 21 Those with Extra Help can change once per quarter during the first 3 qtr's of the year: Jan-March April-June Jul-Sept |
front 22 What election period is MCD? | back 22 Lose, Gain, or change of Medicaid status |
front 23 What election period is NLS? | back 23 Gain, Lose, or Change of LIS status (extra help) |
front 24 What election period is DIF? | back 24 CMs and State-Initiated enrollments (passive enrollments) ** auto enrollment or reassignment and want to leave that plan for a new one. |
front 25 What election period is LTC? | back 25 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 |
front 26 GEP is what election period? | back 26 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 |
front 27 LAW is what election period? | back 27 Non- U.S. citizens who become Lawfully present begins the month the lawful presence starts and continues for 2 months |
front 28 OTH is what election period? | back 28 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. |
front 29 5ST is what election period? | back 29 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 |
front 30 What is DST for an election period? | back 30 Those affected by a disaster and that disaster caused them to miss a valid election period. |
front 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? | back 31 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 |
front 32 ICEP is used when? | back 32 Delayed Part B or their inital election period into an MA-only plan |
front 33 MOV is what election period? | back 33 When they moved out of service area and needs to change plans |
front 34 SEP-LEC is what? | back 34 Lose of employer coverage |
front 35 SEP-CHR? | back 35 CHRONIC |
front 36 SEP-PAP | back 36 STATE PHARMACUTICAL PROGRAM |
front 37 OEP-New | back 37 first 3 months into their IEP enrollment, they have the ability to enroll into a different MAPD plan. |
front 38 To enroll into a dual plan the prospect needs what? | back 38 A qualifying level of Medicaid in addition to their Parts A and B of original Medicare. |
front 39 What does a SNP plan offer? | back 39
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front 40 When can you add an OSB a members plan? | back 40 Any time-- no election period |
front 41 Can they have 2 OSBs at the same time? | back 41 Yes-- however they would have to be different OSBs.. for example; one hearing and one dental OSB, cannot have 2 dental or 2 hearing. |
front 42 If they disenroll from their MAPD will they be able to keep their OSBs? | back 42 NO. OSBs cancel when the MAPD plan cancels. |