Daily Knowledge Check
What are some things we are required to tell the beneficiary when we are completing an enrollment?
Recorded line, licensed agent in your state, Medicare A &B, SOA, post enrollment scripting, welcome packet and ID cards, PPO: in/out of network
Drugs(tiers), scripting about Rx: cost sharing, formulary coverage,
Will not be automatically enrolled, policy will not be changed without consent
MA(PD)/PDP will auto cancel after new one selected
Pharmacy in the network!
Drugs entered accurately
Daily Knowledge Check
What states have state specific rules for Medicare Supplement?
CALIFORNIA: year-round
OREGON: “birthday rule”
NEW YORK: year-round
MASS: only Medicare Core Plan, Medicare Supplement 1 and 1A
MISSOURI: “anniversary rule”
CONNECTICUT: year-round enrollment
Daily Knowledge Check
What is OEP N (OEP New) and how does it work?
OEP new is to ICEP/IEP as OEP is to AEP
Period of 3 months following start date of ICEP/IEP enrollment to use OEP-N
Allows the same lock-in period for ICEP/IEP enrollees that are available to AEP
enrollees
Daily Knowledge Check
What do we put in the notes?
Details about what happened on the call.
Who you called what information you gave.
What they were looking for
Daily Knowledge Check
If someone has an app status that can’t be verified, how do we find out more information?
Call the carrier.
Check the notes. (the enrollment team leaves notes about app status.)
Check in MARx.
Ask the beneficiary
Daily Knowledge Check
If the MBI is unavailable on the plates what are some other ways we can find information about a beneficiary?
Call the beneficiary.
Ask for SSI to look them up in MARx. “would you feel comfortable giving me your social security number?”
Do you have your medicare red white and blue card?
Call the carrier for Lis levels.
Partial MBI with name and DOB.
Daily Knowledge Check
Can you have Champ VA and prescription drug coverage?
Yes you can!
Medicare advantage pays first, then champ VA will pick up the rest.
Daily Knowledge Check
How long is the medicare supplement open enrollment period?
6 months from the first day of the month you turn 65 and are enrolled in Part B.
Daily Knowledge Check
What is not covered in Medigap plan G?
Part B deductible.
Plan N?
Part B deductible
Most things are covered, 80/20 coinsurance.
Plan A?
Part B Deductible
Part A deductible
Foreign travel
Coinsurance for SNF
Part B excess charges
Daily Knowledge Check
Generally speaking, what is the cheapest way someone can get their prescriptions?
Mail order.
PREFERRED pharmacy
Daily Knowledge Check:
What are some prohibited sales practices for Medicare Advantage plans?
Cold calling.
Offering gift cards or something of monetary value, to enroll in a plan.
Market with something costing more than 15 dollars individually.
Can’t say we represent medicare, or medicare endorses the plan.
Must have verbal permission to enroll.
Must have verbal permission to discuss medicare plans.
Can’t say a plan is the best plan for them.
Can’t sell it saying it’s a supplement policy.
No Cross selling.
No misrepresentation.
On PPOs, Make sure the doctor TAKES THE INSURANCE.
Never say “free”, no definite statments.
(read everything, check everything, and take your time)
Daily Knowledge Check:
Where can you find plan information if you don’t see it in the dialer or blaze?
Carrier website
Google the plan name (Medicare QI plan presentation)
MARx With the Medicare number
Confluence (ACA Carriers have instructions)
Daily Knowledge Check:
How do you determine D-SNP eligibility for all of the carriers?
Anthem – Anthem D-SNP Eligibility Tool
Aetna – Call the D-SNP eligibility line. (can give you medicaid levels)
UHC – UHC Jarvis. (can verify Medicaid levels without Medicaid number)
Humana – D-SNP Verification Portal
Wellcare – Wellcare D-SNP Verification Line.
Daily Knowledge Check:
How can we help someone that only has PDPs or limited selection of MAPDs in their area?
Look into supplement plans.
Check the CMS website for plans that we don’t sell.
They want dental hearing or vision. Ancillary plans would be an option for them.
Daily Knowledge Check:
How can someone verify they had other coverage to avoid the late enrollment penalty?
Request documentation from previous carrier.
Provide that documentation to medicare.
Medicaid doesn’t have to pay the penalties.
LIS and FBDE do not pay the part D penalty.
Daily Knowledge Check:
How do you send a canned email in front, and it what situations would you use it?
Click the little paper with the lightning bolt.
Low rating, Cancellation request.
Daily Knowledge:
Check What are some common application statuses we see and what do they mean?
Sent to carrier: Application was sent to the carrier, not active yet.
Withdrawn Duplicate Submission: Enrolled in the same plan they already had.
Pending CMS Review: CMS is verifying the BFC has Medicare.
Pending Proof of Medicaid: D-SNP, waiting for verification from the state. Or, Beneficiary did not provide a medicaid number when the app was submitted. Wellcare can be submitted without medicaid verifcation.
Withdrawn Voluntary: BFC volunatrily canceled the plan.
Withdrawn Closed: There was an open issue with the app, that was never resolved.
Pending Invalid Election Type: AOR used an incorrect SEP.
Daily Knowledge Check:
What can you do when you become eligible for medicare?
Sign up for medicare parts a and b. (or just A if you have employer coverage)
Enroll into a pdp
Enroll into medicare advantage.
Enroll in medicare supplement coverage.
Daily Knowledge Check:
What can you do if someone calls in and you don’t see a profile for them in CCE?
Try an alternate method of looking them up.
Create a new lead, leave good notes.
Ask for their MBI and look them up in MARx.
Ask if they have an ID card, you can look up the name of the plan.
Daily Knowledge Check:
Who pays first with a medicare supplement?
Medicare!
Who pays first with Medicare Advantage?
Medicare Advantage
Who pays first with Dual Eligible Beneficiaries?
Medicare Advantage
medicare and medicaid – medicare pays first.
Who pays first with VA Tricare and Medicare Advantage?
Medicare Advantage.
Daily Knowledge Check:
How do you qualify for Medicaid or LIS?
Through the state.
Federal poverty level.
Spend down to the poverty level.
Medically needy, still involves a spend down.
Daily Knowledge Check:
What does someone need to qualify for a C-SNP plan?
A qualifying Chronic condition: Heart disease, Diabetes, Cancer, Kidney disease, COPD.
SEP CHR, one time a year to enroll in a C-SNP.
Daily Knowledge Check:
What are the different Medicaid levels and what do they mean?
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In the resource center under medicare resources, QMB categories explained.
Daily Knowledge Check:
What is covered under medicaid?
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The goal of today’s daily knowledge check is to point out that for someone who enrolled in an MA(PD) -rather than a D-SNP that they might be eligible for-it may be better for them to stay in that MA(PD) (where they can use medicaid to still get D-SNP things), then for them to revert back into Original Medicare-especially since that would most likely leave them without a PDP. We can use this as a way to overcome objections and guide our benfs into the situation that most addresses their needs.
Daily Knowledge Check:
In what states can you get a Medigap guaranteed issue all year?
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Keep these three states in mind for when we are selling Medigap!
Daily Knowledge Check:
How can you check for SEP DST and how does it work?
Extends a valid enrollment period.
Medicare advantage plan active in CMS.
FEMA website to check for SEP time periods.
Daily Knowledge Check:
Where are three places that can you find someone’s personal info (name, address, phone number, MBI etc.) on the Dialer?
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Request a formulary exception
Good Rx discounts, coupons
Request a change to a generic option with their doctor
Make sure they are using in network pharmacies (if they thought it was out of formulary but they were actually using the wrong pharmacy)
Check with doctor for alternate meds
See if they can apply for LIS or extra help for their prescriptions
Daily Knowledge Check:
How would you sell a Medigap to someone who is only familiar with Medicare Advantage?
More choices for providers.
Less money for people that see the doctor a lot.
No copays or cost sharing (on most medigaps)
Pay the premium and don’t have to worry about much else.
Good for people that don’t want to pay for something they don’t need.
Good for people that travel a lot.
Easier to understand, Just picks up where medicare left off.
Daily Knowledge Check
How would you sell a Medicare Advantage policy to someone who is used to a Medigap?
Med Adv has hearing vision and dental.
Overall cost.
Sell it with the prescription drug coverage included instead of adding it on.
Additional benefits: OTC, Fitness, Transportation, Meal benefit.
Lower Max out of pocket, vs N and K.
Flex card for costs out of pocket.
Higher populated areas won’t be affected by the network of doctors.
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Daily Knowledge Check:
How
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Look into supplement plans.
Check the cms website for plans that we don’t sell.
They want dental hearing or vision. Ancillary plans would be an option for them.
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would you explain Medicare Supplement (Medigap) to a beneficiary?
Fills in the gaps of original medicare.
Not funded by medicare or the government.
No.
Daily Knowledge Check:
What are some common application statuses we see and what do they mean?
Sent to carrier: Application was sent to the carrier, not active yet.
Withdrawn Duplicate Submission: Enrolled in the same plan they already had.
Pending CMS Review: CMS is verifying the BFC has Medicare.
Pending Proof of Medicaid: D-SNP, waiting for verification from the state. Or, Beneficiary did not provide a medicaid number when the app was submitted. Wellcare can be submitted without medicaid verification.
Withdrawn Voluntary: BFC volunatrily canceled the plan.
Withdrawn Closed: There was an open issue with the app, that was never resolved.
Pending Invalid Election Type: AOR used an incorrect SEP.
Do you need to stay in network if you have a PFFS plan?
No you do not.
The physician has to accept the terms of the plan.
Can charge the excess charge of up to 15%.
Daily Knowledge Check:
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Sign up for medicare parts a and b. (or just A if you have employer coverage)
Enroll into a PDP
Enroll into medicare advantage.
Enroll in medicare supplement coverage.
Daily Knowledge Check:
How do we prevent Fraud, Waste, and Abuse?
Report it when you see it!
Reporting hotline
Reporting email
CMS form on medicare.gov.