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Withdrawn Duplicate Submission: Enrolled in the same plan they already had.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Withdrawn Voluntary: BFC volunatrily canceled the plan.
Withdrawn Closed: There was an open issue with the app, that was never resolved.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?
FBDE
QMB
QMB+
SLMB
SLMB+
QI
QDWI
In the resource center under medicare resources, QMB categories explained.
Daily Knowledge Check:
What is covered under medicaid?
Inpatient services
outpatient services
Skilled Nursing Facility
Home healthcare
Physician services
Rural health clinic services.
Doctor’s that accept medicaid.
Lab and X-ray.
Family planning
Nurse/midwife services.
Transportation.
Tobacco cessation.
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?
Washington State, New York, and Connecticut.
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?
Advanced tab
Profile
Plates
Daily Knowledge Check
What can a beneficiary do during AEP?
Switch plans
Unlimited selections
The last one before Dec 7 at 11:59:59 is the policy they will have January 1st.
Daily Knowledge Check:
Can you use the LIS SEP during AEP?
You cannot.
AEP for an earlier effective date.
Daily Knowledge Check
How do we find what a prescription should cost for a beneficiary?
Check the plans formulary
Check blaze
Prescription benefits in navigation on the plates.
Daily Knowledge Check:
What can we do for someone that was denied for a D-SNP plan?
See if they had an SEP, to enroll in another plan.
Determine their eligibility. There might be another D-SNP they qualify for.
Check for LIS, that would qualify them for an SEP.
Daily Knowledge Check:
When do you qualify for Medicare if you are receiving disability benefits from
social security?
After 24 months.
You are automatically enrolled.
Daily Knowledge Check:
If someone’s application was an invalid SEP for using IEP or ICEP what might be a valid election period you can use? (delayed part b start date)
Loss of employer coverage.
Daily Knowledge Check:
What can you do for someone if their medication is not covered or not part of a plan formulary?
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.