Page Comparison

• Full Medicaid: Pays Medicare Part B premium and most eligible medical expenses.

• Partial Medicaid: Covers all or part of Medicare Part B premium, but covers no medical expenses.

• Usually Medicare beneficiaries with Medicaid at either level will also have Extra Help.

• Any level of Medicaid will qualify participant for an SEP (1/1 to 9/30).

Soft Verification

It helps to get a “Soft” verification earlier in the call to know what enrollment reasons and plans are likely available for the customer. Often the simplest way to verify is by simply asking: “Are you eligible for Medicaid in addition to Medicare?”

• If unsure, ask:

  • “Do you pay a monthly premium for your Medicare part B?”

  • “Do you have a Medicaid Card?”

  • “When you go to the doctor or hospital, do you ever have a copay?”

Firm Verification

A definitive verification must be obtained to complete the enrollment. For D-SNPs, the participant must qualify for Full Medicaid. This can be verified on Jarvis,

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Marx

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Jarvis Verification (UHC)

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Vantage Verification (Humana site)

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On the “Medicare Verify Coverage 2” plate:

1. Indicate if the shopper has Medicaid. If “Yes” or “Unsure,” move to step 2.

2. Proceed to “Look up Medicaid info.”

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Use either Jarvis or Vantage portals to verify Medicaid eligibility.

• Click Here for the Jarvis (UHC) step-by-step guide.

• Click Here for the Vantage (Humana) step-by-step guide.
  
  Note - It is better to use Jarvis if possible because you may enter either the Medicaid or Medicare number to verify eligibility. Vantage requires the Medicaid or Social Security number along with the Medicare number.

Now that Medicaid information is verified:

1. Select the level of Medicaid.

2. Enter the Medicaid number.

3. Click “Save & Next.”

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The next plate will indicate the customer qualifies:

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Before you read this scripting to the customer, first identify:

• We are within the first 9 months of the year (the MDE enrollment code may not be used from Oct-Dec).

• Verify they have not already used their quarterly SEP this quarter (only one MDE enrollment may be used per quarter).

  • Quarter 1: January 1 - March 31

  • Quarter 2: April 1- June 30

  • Quarter 3: July 1 - September 30

  • The enrollment quarters are based on the submission date, not the effective date. Example: If a customer submitted an application on March 15th for an April 1st effective date, this is considered a quarter 1 enrollment. The customer would still be able to change plans in quarter 2.

• If a customer has Medicaid, this means they also qualify for LIS/Extra Help. When quoting Medications, quote the non-LIS pricing as well as the LIS pricing.

  • Example: “I am now going to quote you the prescription pricing that would apply if you did not qualify for Extra Help followed by the pricing you should expect to pay as long as you remain qualified for Extra Help.”

• When quoting plans, check the Summary of Benefits (SOB) to verify what levels of Medicaid the plan accepts. Every D-SNP accepts FBDE. Use Ctrl+F to easily locate the levels of Medicaid the plan accepts within the SOB. The example below confirms this Anthem plan accepts FBDE, QMB, and QMB+.

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Tip: Be aware that the Routine Costs within the Plan Features section of D-SNP plans will likely indicate a 20% Dr. coinsurance.

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This is not accurate. To see the correct $0 copay, you may verify by using this link to open Sunfire Blaze in a new tab or navigate to the “Medical Benefits Description” plate.

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A screenshot of the Medical Benefits Description Plate is below. Notice the copay/coinsurance says either $0 or 20% depending on Medicaid level but participants with a D-SNP will have a $0 copay.

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Tip: Be aware that the application allows agents to indicate the participant does not have Medicaid

Enrollment Reasons