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On the “Medicare Verify Coverage 2” “Verify Coverage” 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 Vantage, Jarvis, or Vantage mProducer portals to verify Medicaid eligibility.

Now that Medicaid information is verified:

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Right-Click Here and open in a new tab to view the ­2021 ­2022 LIS Table.

  • When quoting plans, the “Plan Decider Plate” should only show plans that the beneficiary qualifies for, based on the information you previously entered. You can also 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+.

Tip: Be aware that the The Routine Costs within the Plan Features section of D-SNP plans will likely indicate a 20% Dr. coinsurancecoinsurance for doctor’s visits and hospital stays.

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This is not accurate. To see the correct $0 copaycopays, 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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open the Summary of Benefits for the plan. It is advisable to open the Summary of Benefits on EVERY D-SNP plan to verify that you are providing accurate information.

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 FBDE, QMB, or QMB+ Medicaid Levels will have a $0 copay. All other levels of Medicaid can expect to pay 20% coinsurance on this plan, and may benefit more from a different D-SNP plan or regular MAPD plan.

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Tip: Be aware that the The application allows agents to indicate the participant does not have Medicaid. The agent must indicate Medicaid eligibility and enter the Medicaid number on the app for a D-SNP enrollment.

Sales Tips:

  • Utilize verbiage such as “a DSNP plan is a plan that will help coordinate your Medicare and Medicaid benefits.”

  • Focus on the extra benefits that a DSNP’s plans offer

    • Over the counter benefits

    • Dental

    • Vision

    • Hearing

    • Healthy food cards

    • Flex cards

Enrollment Reasons

Plan

Medicare Code/Reason

Dialer

Code/Reason

Uses

MA/MAPD/PDP

MDE

MDE

May be used once per quarter if shopper currently has Medicaid.

MA/MAPD/PDP

MCD

MCD

Lost Medicaid or change in Medicaid level. One time SEP for 3 months following notification or date of loss/change of coverage (whichever is later)

May be used if they had a Change to their Medicaid status this month, or within the past 2 months.

Medigap

NA

NA

It is usually illegal to sell a Medigap to a Medicaid participant