MidTerm

True or False: During OE and GI the client is not required to go through medical underwriting and must be accepted for all Medigap plans.

False, the client must be accepted only during OE for ALL Medigap plans. GI is A, B, C, F, K, & L

True or False: The client must always pass medical underwriting in order to qualify for any Medigap Plan. Why true or why false?

False, the client sometimes will have to go through medical underwriting but not during OE or GI window (for certain plans).

True or False: During AEP a client is considered G.I.

False, they are only GI if they have a qualifying circumstance. AEP does not apply to Medigap plans.

Medicare is health insurance for: Check all that apply.

-People 65 years old and over -People under 65 with certain disabilities -People of any age with End Stage Renal Disease

Select the statements that are true below: Check all that apply

-Plan F is the most comprehensive Medigap Plan -There are 10 different Medigap Plans -Medigap Plans supplement Original Medicare -Medigap Plans work to fill in the gaps found in Original Medicare

Which of the following items does a Full Extra Help subsidy pay for? Select all that apply.

-Reduces copays -Part D Premium -Deductibles (if applicable)

What are some Features of SQS? Check all that apply

-Represents 25 of the top A-rated carriers in the US -Has an A+ Rating with the Better Business Bureau -Agents are commission agnostic

Which of the following statements are true?

-The Benefit Periods in a Medicare Drug Plan are based on the calendar year -The client will pay 35% of the retail cost for brand name drugs while in the Coverage Gap -All drug plans have a premium

Which of the following are circumstances that create an SEP for Medicare Advantage Plans? Check all that apply

-Voluntary Loss of Creditable Coverage -Eligible for Extra Help and/or Medicaid -Involuntary loss of creditable coverage -Moving / change of residence -Loss of Medicaid

List 3 circumstances that a client must potentially qualify for in order to sign up for an MA/MAPD/ or PDP during SEP.

-You move to an area that makes new plan options available to you -Loss of creditable coverage -You are eligible for or lose Medicaid (dual-eligible clients qualify for year around enrollment) -You qualify for Extra Help with PDP costs

How long are MAPD's contracted for?

1 calendar year; January 1st-December 31st

In order to understand election periods what two resources can you turn to?

1) The election period chapter in the Training Manual 2) UHC's Election Period Booklet

What two things do election periods tell you?

1)Who can sign up 2) The time period of when the client can sign up

What is the total number of Medigap plans?

10 Medigap Plans (11 plans counting HF, not required to mention)

When do Medicare Advantage plans take effect?

1st day of the month

Vered is 73 and has had Part A and B since 2009 and just lost her employer drug plan. How long does Vered have to get a Part D plan?

2 months

How long must you be on disability to become eligible for Medicare?

24 months

If a person wants to enroll in an MAPD during the IEP (Initial Election Period), when is the earliest they can do this?

3 months before they turn 65

When is IEP? How does a client qualify for IEP

3-1-3 & when the client is first turning 65 or first eligible for A and B

What percentages does Sarah pay for brand name drugs in the Coverage Gap?

35%

When is the Medigap Open Enrollment and how long is it?

6 month period that starts the first month Part B becomes effective

How long is the Open Enrollment time frame for Supplements?

6 months

Dominic is losing employer coverage and qualifies for a Guaranteed Issue window. He already has Part B of Medicare. What timeframe does he have to receive certain Medigap plans and what plans are those?

60 days before and 63 days after losing creditable coverage. A, B, C, F, K, & L.

During the Guaranteed Issue window when can a client enroll in a Medigap plan?

60 days before and 63 days after qualifying event

When is the Guaranteed Issue window time period for supplements?

60 days before and 63 days after qualifying event

What is the Part A deductible benefit period?

60 days post discharge

Jean is 73 and already has Part A. She retired and is losing group coverage and now has the option to enroll in Medicare Part B. How long does she have?

8 months

What is the time period for a client to sign up for Part B in their SEP?

8 months after qualifying event

3-1-3 means you can sign up for Part B: 2 months before you turn 65 and 5 months after you turn 65

False

A person can enroll in a standalone drug plan with an MAPD PPO.

False

Abdul lives in Utah and voluntarily leaves his retiree coverage and gets a Plan F Guaranteed Issue

False

All MAPD plans are network based.

False

All MAPD plans offer additional benefits (ie: dental, vision, health club membership).

False

Creditable coverage describes a non-Medicare health plan that isn't as good as the coverage offered by Original Medicare.

False

During Catastrophic Coverage the client will either pay $3.35 for generic drugs and $8.35 for brand drugs

False

During Catastrophic Coverage the client will pay the lesser of 5% coinsurance or $3.35 for generics and $8.35 for brand drugs.

False

Each value proposition should be exactly the same.

False

Everyone qualifies for Medigap Plans.

False

Hector can leave his MAPD in the middle of the year to join a Plan F if he passes medical underwriting

False

If you are enrolled in an HMO plan and you go to a doctor's office out-of-network, you are responsible for the Part B 20% coinsurance. Is this statement true or false?

False

In both Trial Right #1 and Trial Right #2 the client's time frame is: 60 calendar days before their prior coverage ends and no later than 60 calendar days after that.

False

Is the following statement possible? Joan has worked the required 40 quarters and is turning 65 years old, but is not collecting Social Security. She is automatically enrolled into Part B when she turns 65.

False

James turns 65 November 1st, and his Part A will begin November 1st

False

Joan recently moved and she used an SEP to enroll in an MAPD. The MAPD became effective last week, but she is still in the SEP window. Joan can get a new MAPD under her SEP.

False

Joel is not collecting Social Security when he turns 65, and is automatically enrolled in Part A and Part B of Original Medicare

False

MAPD/MA plans supplement Medicare

False

Medicare Part B is an 80/20 split and there is a maximum out-of-pocket of $1,340.00

False

Medicare will not penalize you if you do not sign up for your Part B when you are first turning 65, and do not have creditable coverage.

False

Medigap Plans cover dental services.

False

Original Medicare is Part A, B, and D.

False

PPOs have both in and out-of-network services; the client will pay less for out-of-network services.

False

Part B of Medicare covers inpatient hospital care

False

Part D/Medicare Prescription Drug plans are Medicare programs that provide prescription drug coverage regulated and provided by Medicare.

False

Regardless of when or how you enroll into Medicare, Parts A and B can only take effect at the end of the month.

False

SelectQuote Senior agents typically advise clients to purchase Plans F, G, or L.

False

Some Medigap plans include prescription drug coverage.

False

T/F: The Annual Enrollment Period applies to Medigap plans

False

The Case Specialist team sells our ancillary products.

False

The PFFS is always a network-based plan.

False

The Part B premium is $134 for all Americans who are on Medicare.

False

The most common Medigap Plans that we sell are Part F, Part G, and Part N.

False

The only way to obtain Part D coverage is to purchase a standalone drug plan.

False

The value proposition should only come at the start of the phone call.

False

There is a maximum out-of-pocket expense for the client on Original Medicare

False

True or False: When a client signs up for an MAPD during IEP the client can still switch to another MAPD even if the plan is already effective and they are still in the IEP window

False

Value Props should be 30-40 seconds long.

False

You must have Medicare Part B to be eligible for Medicare Part D.

False

You only have 2 months to enroll in Part B after your creditable coverage ends.

False

You should only use value props to explain who SQS is to your client when you start talking with a client

False

When does a plan take effect when signed up for during AEP?

January 1st

When is Disenrollment Period?

January 1st - February 14th

When is the Disenrollment Period?

January 1st - February 14th

When is the General Enrollment Period and for which part of Medicare does it apply to?

January 1st - March 31st, Part B

What parts of Medicare must you have in order to join a Medigap plan?

Medicare Parts A & B

Michael has Medicare Part A, but not Part B. He wants to join a Medigap plan. Is he able to do so?

No, you must have Medicare Part A and B to join a Medigap plan. Michael will have to enroll in Part B before getting a Medigap plan.

Joan is moving in two weeks and used an SEP to get a new MAPD plan effective in two weeks. She received the plan materials and decided she wants to enroll in a new MAPD. Joan can enroll in a new MAPD under her SEP.

True

John turns 65 November 1st, and his Part A will begin October 1st.

True

LIS/Full Extra Help recipients can change their MAPD/PDP plan as many times as they would like in the year.

True

LIS=Low Income Subsidy

True

Medicare Advantage Plans replace Original Medicare.

True

Medicare Advantage plans are also called Medicare Part C.

True

Medigap Plans help pay for some or all of the services provided under Original Medicare

True

On every call, we should introduce ourselves twice.

True

Plan L and Plan K are the only two Medigap plans with out-of-pocket limits.

True

Premium: A monthly payment that enables the individual to receive insurance coverage

True

The National Base Beneficiary Premium is $35.02 in 2018.

True

The cost of the Part A deductible in 2018 is $1,340.

True

The value proposition explains: The benefit of working with SQS versus any other company and how that APPLIES PERSONALLY to the client.

True

There is no charge for SelectQuote Senior's service.

True

To join Medicare when under 65 years old, you must be legally declared disabled for 24 consecutive months or have ESRD.

True

True or False: The client can change their Medigap policy as many times as they want as long as they still are in OE

True

T/F Medicare Advantage plans are supplemental coverage

FALSE. Medicare Advantage plans REPLACE Original Medicare.

Which two disclosures should be included in the Introduction of the phone call, before you discuss the client's personal information?

"I am a licensed sales agent in the state of (state)" "This is (your name) on a recorded line."

What is the 2018 Part B Annual Deductible?

$183

What expenses are associated with Medicare Part B? Select all that apply

$183 annual deductible 20% coinsurance

What is the FH deductible amount for 2018?

$2240

What $ amount causes the client to enter Catastrophic Coverage and what will the beneficiary pay while in Catastrophic Coverage?

$5,000. The greater amount of 5% of the retail price OR $3.35 for generic drugs and $8.35 for brand name drugs

The client will pay no more than what $ amount for brand-name drugs when on Full Extra Help?

$8.35

What will the beneficiary pay in the Coverage Gap? Select all that apply

-35% of the retail cost for brand name drugs -44% of the retail cost for generic drugs

If a client wants to drop a MAPD plan and switch to a Medigap plan, what enrollment period(s) must they be in?

-AEP October 15-Dec. 7 -Disenrollment Period Jan. 1 st - Feb. 14

The monthly premiums of Medigap plans can depend on: Select all that apply.

-Age -Tobacco Use -County -Height and Weight -Gender

Prescription Drug plan costs the customer pays are: Select all that apply

-Annual Deductibles(if applicable) -Copays -Premium

Prior to discussing Medicare Advantage or Prescription Drug Plans, you MUST say the following disclaimers:

-Can I have your permission to discuss Medicare Advantage plans with you? -Before we continue please be aware that you are not required to provide any information you don't want to, and that any information you do provide during this call will not affect your ability to request enrollment or affect your plan membership. -Have you been diagnosed with End Stage Renal disease or are you receiving renal dialysis? (MAPD only)

How does one qualify for an MAPD? (check all that apply) Check all that apply

-Cannot have End Stage Renal Disease (ESRD) -Must pay your MA/MAPD Plan Premium (if applicable) -Must continue to pay Part B Premium (if applicable) -Must be eligible for Medicare

Which of the following resources can you find on the carrier info drive? Select all that apply

-Carrier Height and Weight Limitations Chart -CA/OR/MO Rules -Carriers' Health Questions

Features of SQS: Select all that apply

-Compares 25 companies -Unbiased sales agents -Re-shop clients rates

What does not count towards the Coverage Gap? Check all that apply. Hint: Requires critical thinking!

-Dispensing fees -Drugs that are not on the plan's formulary -Drug Plan Premium -Part B Drugs

Which of the following services are covered by Medicare Part B?

-Durable Medical Equipment (DME) -Diagnostic Tests -Occupational Therapy

Brenda has a MAPD and is moving from Nebraska to North Carolina, she will lose her MAPD when she moves. What election period(s) is Brenda in and what can she enroll in? Give the timeframes for which she can enroll.

-GI Window -A, B, C, F, K, & L -60 days before and 63 days after -SEP -MA/MAPD/PDP -up to 2 months after.

Jan is 68 years old, lives in Texas, and has a Plan F. What can she do with the Plan F? Check all that apply

-Go to any doctor that accepts Original Medicare -Can see a specialist in New York that accepts Original Medicare

Which of the following carriers do we NOT represent for Part D?

-Heartland National -Gerber -Mutual of Omaha

The following are important points to make in Value Propositions: Select all that apply.

-Highlights Features, Advantages, and Benefits -Highlights company's points of difference over competitors

Which of the following are Benefit Periods of a Part D Plan? Mark all that apply

-Initial Coverage -Coverage Gap -Catastrophic Coverage

Gary is on Original Medicare only and is moving from NY to FL in two weeks Which of the following can Gary do? Select all that apply.

-Join a Medicare Advantage Plan -Join a Part D Plan -Join a Plan G by successfully going through medical underwriting -Join a Plan F by successfully going through medical underwriting

What are the two disclosures you must give on every phone call?

-Licensed sales agent in the state of _______ -Call is being recorded for quality assurance

Which are advantages of MAPD/MA plans over Original Medicare? Select all that apply

-Maximum out-of-pocket limit -Might include dental, vision, and drug coverage

Select the products that SQS sells. Check all that apply.

-Medicare Supplements -Prescription Drug Plans -Hospital Indemnity Plans -Medicare Advantage Plans -Critical Illness Plans

What are the possible factors that cause the Part A premium to be $0. Check all the apply.

-Must have worked 40 quarters -Been married for 10 years to a spouse that worked the required quarters

To qualify for a Medigap plan: Check all that apply

-Must pay the Part B Premium -Must pay the Medigap Premium -You must have Medicare Part A and Part B

Which of the following dates represent an enrollment period that happens each year? Select all that apply

-October 15-December 7 -January 1-March 31 -January 1-February 14

Medicare is health insurance for:

-People 65 years old and over -People under 65 with certain disabilities -People of any age with ESRD

What are the Four Parts to a Sales Call (in order)?

Introduction, Information Gathering, Pitch, Close

A premium is:

A payment to insurance plan that enables the individual to receive coverage

James is in a Guaranteed Issue Window, what plans can he get Guaranteed Issue? Select all that apply.

A, B, C, F, K, & L

What plans can a client join during Guaranteed Issue Window without answering health questions?

A, B, C, F, K, & L

What Medigap plan(s) is/are a client Guaranteed Issue for when in a Guaranteed Issue Window?

A, B, C, F, K, L

Which Medigap Plans do NOT cover the Part B deductible? Select all that apply

A, B, D, G, K, L, M, & N

What is the enrollment period from Oct 15 - Dec 7th?

AEP

Which Medigap carriers are underwritten by MOO? Select all that apply

Assured Life Association, Gerber Life, GPM Life

James Jones is turning 65 on August 21st. When will his Part A begin?

August 1st

What two plans cover the Part B deductible?

C & F

What are the 8 states that Part B Excess Charges are not allowed?

CT, MA, MN, NY, OH, PA, RI, and VT.

What states have open enrollments for Supplement Policy holders each year based on birthday?

California & Oregon

We sell the following carrier's DSNPs: Mark all that apply

Cigna, Humana, United Healthcare

A fixed percentage paid by the beneficiary for the services provided:

Coinsurance

An insurance company will set rates for a certain area and charge the same for everyone, regardless of age Which Medigap Rating Method does this describe?

Community-Rated Policy

A fixed dollar amount paid by the beneficiary for the services rendered:

Copay

Sarah takes lisinopril, levothyroxine sodium, atorvastatin, and Xanax. By the middle of the year her copays increase from $4 / $4/ $4/ $20 respectfully to $5/ $7/ $7 and $75. What drug plan Benefit Period has Sarah likely entered by mid-year?

Coverage Gap (Donut Hole)

What type of plan is generally "best" to put a cost-share protected member on?

D-SNP

The amount you must pay for health care before Medicare begins to pay. These amounts can change every year.

Deductible

What health questions are asked when enrolling in an MA/MAPD?

ESRD

Which of the following health consideration(s) keep you from getting a MA/MAPD?

ESRD

Elizabeth is eligible for both Medicare and Medicaid. What does this allow her to do?

Elizabeth is Dual-Eligible so she can join, switch, or drop a MA/MAPD/PDP. This gives her a year-round SEP.

A list of certain drugs and their proper dosages for which a drug plan will cover What term is the definition describing?

Formulary

Harry missed his window to sign up for Part B, when can he sign up?

General Enrollment Period

Lorenzo Martinez turned 65 years old February 20, 2017 and his Part A started February 1, 2017. He now wants to enroll in Part B and has not had any insurance coverage since 2010. It is June 9, 2018, what is the next enrollment period available for Lorenzo to get Part B?

General Enrollment Period

Gerald would like to sign up for additional coverage, but does not want to switch or drop his PDP under any circumstance. He has had A, B, and D for 4 years now. It is AEP, what options are available to him?

He can sign up for a Medigap plan by undergoing underwriting or an MA only-PFFS plan.

It is May 16 th and Bill is going to be turning 65 next month and joining Part A and B of Medicare. He has ESRD so he knows that he is not eligible for many plans. What would you advise Bill to do?

He is in his Open Enrollment so he is actually eligible to sign up for whatever Medigap plan he likes without having to go through medical underwriting. He cannot get an MAPD, though.

What are the four key parts to a sales call?

Introduction, Information Gathering, Pitch, Close

Bob has Medicare Part A coverage and he enrolled in Medicare Part B during the Part B General Enrollment Period (January 1- March 31). It is May 2, 2018 what Election Period is Bob in to join a MAPD plan, and when must the MAPD become effective?

ICEP. The MAPD must become effective July 1st , matching the Part B effective date.

Which MAPD Election Period(s) follows the 3-1-3 rule? Select all that apply

IEP

How does a client qualify for IEP 2? How does IEP 2 work and what plans can they get?

If the client was already in Medicare before age 65 and is now turning 65, they function just like the IEP and can get any MA/MAPD/PDP. During this time, the client is also eligible to get any Supplement and has OE all over again.

What makes a client Dual-Eligible & what advantages come with being Dual-Eligible?

If they qualify for both Medicare & Medicaid, they are Dual-Eligible. Possible Advantages: This opens them up for a year round enrollment period for MAPDs & PDPs, lower cost-sharing, broadens their networks, give them managed care, etc.

Chao Nyguen has been on disability for almost 2 years now. He was notified by the Social Security Administration that his Part A would automatically begin December 1, 2018 after he has been legally declared disabled for 24 months. He was told he will need to sign up for Part B to be enrolled in it. It is October 7, 2018, what enrollment period does Chao qualify for to get Part B?

Initial Enrollment Period

Jesse just turned 65 on April 2, 2018. His Part A and Part B began April 1, 2018. He is interested in a Medicare Advantage Plan. It is July 13, 2018. What election period, if any, is Jesse in to enroll in an MAPD plan? And when will the MAPD become effective?

Initial Enrollment Period (7 months- 3 months before you turn 65, month you turn 65, and the month after). MAPD effective date: August 1, 2018.

Ben is retiring from his company in Utah on April 16th, after his 67th bday. His employer coverage ends April 30th. He enrolled into Medicare Part B which is going to begin May 1. What is the last date possible for him to enroll in his PDP plan and when does it have to take effect based off the choices given?

June 30th/July 1st

What does KISS stand for, as defined in your manual?

Keep It Successfully Simple

Lauren turned 65 on November 7th , 2010 and lives in California. During this time she signed up for a MAPD, but now she is noticing that she is visiting the doctors more frequently and would like to switch her plan. It is November 1, 2018; what enrollment period does Lauren qualify for?

Lauren would qualify for AEP. Not the Birthday Rule because that is only for Medigap Plans.

Which Part C Plan includes prescription drug coverage?

MAPD

Select what Medicare Pays, Plan F Pays, and what the Client Pays in the given scenario: Bob has a Plan F. He has an outpatient knee replacement surgery for a total cost of $5,600. What does Medicare Pay, Plan F Pay, and what does Bob pay for this service? (not factoring in the Part B Deductible)

Medicare pays 80%, Plan F pays 20%, Bob pay $0

A PFFS is a "hybrid" of what?

Medigap & Medicare Advantage Plans

NO OE = ?

NO G!

Kim is on Medicaid and Medicare. She recently joined a DSNP with Humana. Can Kim go to a doctor that accepts Medicaid only and not the DSNP?

No

What amounts will a client pay for their prescriptions when on Full Extra Help?

No more than $3.35 for generic, $8.35 for brand name.

Josh turns 65 in December and was born December 1, 1953. When will his Part A begin?

November 1st, 2018

When is Annual Enrollment Period?

October 15th - December 7th

Annual Enrollment Period (AEP) is:

October 15th-December 7th

OE stands for:

Open Enrollment

Which enrollment period(s) do(es) not require medical underwriting for Medigap Plan(s) and for which plan(s)?

Open Enrollment Period -- all Medigap Plans Guaranteed Issue Window -- A, B, C, F, K, L

Jerry had creditable coverage when he turned 65, so he decided to defer his Part B. He is now turning 68 and losing his creditable coverage in March. His Part B will begin April 1st . What enrollment period is Jerry eligible for Medigap Plans and when is the last date he can sign up?

Open Enrollment, September 31st

You can add standalone PDP plans to which of the following MA Plans? Select all that apply

PFFS

We sell which of the following: Check all that apply.

PFFS, HMO, HMO-POS, SNP, PPO

Which MA/MAPD plan(s) does SQS sell? Check all that apply

PFFS, SNP, PPO, HMO, HMO-POS

What Parts of Medicare must you have to be eligible for a MA/MAPD

Part A & Part B

Which Part of Medicare covers occupational therapy?

Part B

What event triggers the client's Open Enrollment for Medigap?

Part B effective month

What are you eligible to enroll in during your IEP, the 3-1-3 window?

Part B, MA/MAPDs (Part C), and PDPs (Part D)

Select the correct statements:

Part C = Medicare Advantage Part D = Prescription Drug Insurance

Patrick joined a MAPD in December during Annual Enrollment. It is January 8th and he is not happy with his plan and no longer wants to be enrolled in it. Can he disenroll at this time and how long does he have to drop his plan? Will he get a Part D penalty if he does this?

Patrick can drop his plan because he is in the Disenrollment Period, which goes from January 1st-February 14th . He will only receive a Part D penalty if he does not join a PDP during this timeframe.

Jerry is 68 years old and retired January 1, 2018. When he retired, he lost his employer coverage. He has been very busy and forgot to enroll in Part B when he first retired. It is June 2, 2018, what enrollment period does Jerry qualify for to get Part B?

Special Enrollment Period

Which 2 plans cover Part B Excess Charges?

Plan F & G

Attained-Age-Rated policies premiums are based on which of the following?

Premiums are based on current age

List three things that are not covered by any Medicare Supplement plan?

Prescriptions, Long Term Care, Dental, Vision

Francois turned 65 and was still covered under his employer insurance. He didn't enroll in Part B or Part D then. Now Francois is retiring at age 72 and enrolling in Part B. What election period will allow him to enroll in an PDP?

SEP

Janice is moving from Oregon to Colorado and has a Plan G. What enrollment period(s) is Janice eligible for and what plan(s) could Janice switch to?

SEP for MAPD's. She is not GI for Supplements, because Medigap Plans travel with you. She can apply for another supplement, but she will have to go through medical underwriting.

When a client only has Original Medicare and moves to a new area what enrollment period(s) are they in and what can they get?

SEP, MA/MAPD/PDP. They can only get a Supplement by going through underwriting.

Shelly is 69 and unhappy with her MAPD plan that she signed up for when she was 65. It is now July and even though the year is not up, she is eligible to switch her plan because she has year-round enrollment. Under what circumstance would this be possible?

Shelly is Dual-eligible or receiving Extra Help on her prescriptions.

Read the following Scenario and pick the most applicable Election Period for Part B Maria Chavoya is 68 years old and retired January 1, 2018. When she retired, she lost her employer coverage. She has been very busy and forgot to enroll in Part B when she first retired. It is June 2, 2018, what enrollment period does Maria qualify for to get Part B?

Special Enrollment Period

When do Medicare plans take effect?

The 1st day of the month

What triggers the Open Enrollment period and how long does it last?

The OE is triggered Medicare Part B effective date; it is a 6-month period that starts the first month they are enrolled in Part B ( Part B effective month + the following five months)

A deductible is:

The amount you pay before Medicare begins to pay

What are Part B Excess Charges?

The amounts that doctors are allowed to charge above the Medicare contracted allowable amount, up to 15%, if they do not accept Medicare Assignment.

Read the following Scenario and pick the most applicable Election Period for Part B It is July 9th, 2018 Mike Manny has been on disability for almost 2 years now. He was notified by the Social Security Administration that his Part A would automatically begin December 1, 2018 after he has been legally declared disabled for 24 months. What enrollment period does Mike qualify for to get Part B as of today?

There is no enrollment period

Read the following Scenario and pick the most applicable Election Period for Part B It is May 9, 2018 and Sarah Smith is 64 years old and would like to sign up for Part B. She is still working, but wants to make sure she has everything ready for when she retires at age 65. She will be turning 65 December 2, 2018. What enrollment period does Sarah qualify for to get Part B as of today?

There is no enrollment period

Cindy turned 67 in September. She has had a Plan F for two years, but is interested in switching to a different plan. She is interested in the Plan G because she heard it saves more money. It is October 30, 2018. Is Cindy able to change her plan and if so, what enrollment period is this? Would Cindy have to go through medical underwriting?

There is no enrollment period; however Cindy is able to change her plan because you can change for Medigap plan anytime throughout the year, as long as you pass underwriting. Cindy will have to go through medical underwriting.

If a client misses OE for a Medigap Plan when is the next time they will be eligible to enroll?

They can purchase a Medigap plan anytime, but they will be subject to underwriting unless they have a qualifying event giving them GI window

A client can obtain their prescriptions through the mail.

True

Creditable coverage describes a non-Medicare health plan that is considered to be as good as the coverage offered by Original Medicare

True

Durable Medical Equipment is covered under Part B of Medicare.

True

During AEP the client can drop a PDP and only have Original Medicare.

True

During the disenrollment period, Joan can drop her MAPD and join a PDP.

True

ESRD is kidney failure.

True

Each value proposition should be personal and different.

True

For most Americans, there is no monthly premium for Medicare Part A. This is if you have worked 40 quarters, paying into Medicare or if you are married for 10 years to a spouse that worked the required 40 quarters.

True

IEP=Initial Enrollment Period

True

If the PFFS plan is an MA (medical only), you can pair it with a PDP.

True

In October 2018, John entered into the Coverage Gap and stayed in it for the remainder of the year. Is this statement possible?

True

Initial Enrollment Period (IEP) entitles you to a 7-month window to sign up for Part B.

True

Jamie lives in Missouri and leaves her employer coverage voluntarily to join a Plan F Guaranteed Issue Hint: check your manual.

True

True or false? To have a Medigap plan you must be enrolled in Part A and B

True

When the beneficiary has Full Extra Help, most clients will pay no more than $3.35 for generics and $8.35 for brand name medicines

True

When you are first eligible for Medicare, you have a 7-month window to sign up for Part B. This includes the 3 months before you turn 65, the month you turn 65, and the 3 months after you turn 65

True

You have an 8-month Special Enrollment Period to sign up for Part B that starts the month after your employment ends or your group health plan insurance ends, whichever happens first

True

You possibly could be eligible for Medicare at age 3.

True

AEP applies for MA/MAPD/PDP plans only.

True, AEP doesn't apply to Medigap plans

True or False? A client cannot switch to a Medigap mid-year if they are already in an MAPD plan even if they are willing to go through medical underwriting. Why true or why false?

True, because MAPD's are a year long contract

We sell the following carrier's CSNPs: Mark all that apply

United Healthcare, Cigna, Humana

It is February 1 st and Betty wants to purchase a Medigap Plan F, but she is currently enrolled in a MAPD. How long does Betty have to switch plans, assuming she would pass underwriting?

Until February 14th

During you sales call, it is important to create a sense of ___________________

Urgency

How does one qualify for a GI window for a Medigap plan?

When a client involuntarily loses coverage and already has Part B. If they did not have Part B and chose to enroll in it, they would be in the OE.

Tom signed up for a MAPD when he turned 65 on December 23rd , 2017. It is now July 15, 2018 and Tom is not happy with his MAPD and wants to switch to a Supplement plan. Can Tom switch and change his plan effective August 1?

Yes. He is eligible for Trial right 1, which states that the client has the right to switch from a MAPD plan if they are 65 years of age and are within the first year that they signed up for their MA/MAPD to ANY Medigap Plan (including Plan G).

James has a Part B effective date of July 1, 2018. He also joined a Plan N that began on July 1, 2018. He has Prostate Cancer and wants more comprehensive coverage, like a Plan G. It is August 1, 2018. Can James join the Plan G, why or why not?

Yes. James qualifies for Open Enrollment because it is the Part B enrollment period + the following five months. He will not have to undergo medical underwriting. He can change in his Medigap as many times as he would like during this period.

The consumer will stop paying the Part B late enrollment penalty after 10 years.

false