Sales Integrity Education for External Partner Agents - Humana | Quizlet

If a beneficiary is going into, leaving or residing in a nursing home and wishes to enroll in a MAPD plan, they would use which enrollment period?

OEP-I

If a newly eligible beneficiary wants to enroll in a MA only Plan, what enrollment period can they use?

ICEP

When a beneficiary is first eligible for a drug plan and wishes to enroll in a MAPD or PDP plan, which enrollment period would they use?

IEP

Mr. Bencomo tells you that he has not been eligible for Medicaid for a month now and wants to change his MAPD plan today. Can he do this and if yes, what enrollment period would he use?

SEP

The SEP for beneficiaries with a chronic condition...

Allows a beneficiary with severe or disabling chronic conditions to enroll in a SNP designed to serve beneficiaries with those conditions

The SEP for employer group health can be used when...

All of the above

It is July 15 and you are speaking with Mrs. Ingram who is turning 65 on August 15. She asks you about her options to have drug coverage. What options will Mrs. Ingram have to enroll in Part D drug coverage?

All answers above are correct

Mr. Mendes celebrated his birthday in June and selected a MAPD plan with a competitor using his IEP for an August 1st effective date. It is now September and he would like to enroll in Humana's MAPD plan. Can he do this? If so, which election period would you use?

He can't enroll now. He will have to wait until the next AEP unless he qualifies for an SEP

If a beneficiary is disenrolled from a MAPD because they stopped paying their Part B premium, they can...

Use the SEP for individuals involuntarily disenrolled from a MAPD plan due to loss of Part B to enroll in a stand-alone PDP plan

It is January 22 and you are speaking with Mrs. Wilson who wants to disenroll from her MAPD plan. What could the MA Annual OEP allow her to do?

Disenroll from MAPD, return to Original Medicare or she can enroll in a different Medicare Advantage plan

Mr. Christian tells you he has a Part D but he never uses it as he always gets his prescriptions from the VA(Veterans Administration). How would you guide Mr. Christian?

Let him know that he has a special opportunity to disenroll from his Part D plan to maintain other credible coverage

Mrs. Lewis turned 65 in May and enrolled in a MAPD plan with a competitor effective May 1. On August 2, she tells you she is not thrilled with her plan and wants to disenroll and enroll in a Humana plan. She does not qualify for an SEP at this time. Can she do that? If yes, what enrollment period would you use?

No, Mrs. Lewis will have to wait until the next AEP

What is the correct hierarchy for the enrollment periods as outlined by CMS?

ICEP/IEP, MA Annual OEP/MA OEP New, SEP, AEP, OEP-I

Mrs. Ford is turning 65 on April 22. She calls in on February 28 and would like to enroll in a MAPD plan. What is Mrs. Ford's proposed effective date?

April 1st

Mrs. Kent turned 65 on June 21. She is calling on July 7 and would like to enroll in an MA-only plan. What is Mrs. Kent's proposed effective date?

August 1st

Mr. Packard is calling on October 23. He would like to change his plan from a competitor to a Humana MAPD plan. He does not qualify for an SEP. What is Mr. Packard's proposed effective date?

January 1st

Mrs. Spring is calling on May 15 to inform us that she will be moving from Florida to Texas at the end of May. What would Mrs. Spring's proposed effective date be?

June 1st

Mr. Evans is calling on March 15. He turned 65 on January 14. He would like to enroll in an MAPD plan. What is Mr. Evan's proposed effective date?

April 1st

Mrs. Pearl is calling on November 22. She turned 65 on October 30 and would like to enroll in a MAPD plan. What is Mrs. Pearl's proposed effective date?

December 1st

Mr. Post calls on November 12 during AEP. He states that he is moving on December 1 to another state. What would Mr. Post's proposed effective date be?

December 1st

A newly eligible Medicare beneficiary who has the same effective date for both Part A and Part B wants to enroll into a MA plan without prescription coverage. Which enrollment period would they use?

ICEP

Which enrollment period allows a beneficiary to choose how they will receive benefits for the coming year?

AEP

If a newly eligible beneficiary wants to enroll in a Part D plan only, when can the beneficiary use their IEP?

7 Months surrounding their Medicare effective date

If a beneficiary is going into, leaving or residing in a nursing home and wishes to enroll in a PDP plan, which election period would they use?

SEP

Mr. Minderman tells you that he has not been eligible for Medicaid for a month now and wants to change his MAPD plan today. Can he do this and if yes, what election period would you use?

Yes. He can use the SEP for loss of Medicaid eligibility for enrollment into an MA/MAPD or PDP

Mr. Quezada celebrated his birthday in June and selected a MAPD plan with a competitor using his IEP for an August 1st effective date. It is now September, and he would like to disenroll from the MAPD and return to Original Medicare as well as enroll in a Humana stand-alone PDP plan. Can he do this? If so, which special election period would you use?

Mr. Quezada can use the SEP for individuals who enrolled in an MAPD during their IEP at 65 and are dropping MAPD within the first 12 months to choose PDP

Mr. Bencomo was enrolled in one of our competitor's Chronic Condition SNP plans for Asthma. He was just diagnosed as having Diabetes and has several expensive Diabetes medications prescribed for him. Mr. Bencomo wants to switch from him current plan to Humana's Diabetic Chronic Condition SNP plan. Can he do so? If so, which enrollment period would he use?

Yes. He can enroll using the SEP for Chronic Condition

Mr. Campbell has has Medicare Part A & Part B since 2005 due to disability. During the last AEP, several months ago, he had enrolled in a MAPD plan. He is turning 65 next month, in August, and he wants to enroll in a Medicare Supplement plan and a Part D plan. If he can enroll in a PDP plan, which enrollment period can be used?

IEP

You are speaking with Mr. Szilagyi on March 4th. He is retiring and leaving his group coverage. He got Medicare Part A several years ago but delayed his Part B until now, as he was covered under a group plan. His Part B went into effect on March 1 and now he wants to enroll in a MAPD plan. Which enrollment period would you use?

SEP for Employer Group Health Plan

It's July and Mrs. Wilson will celebrate her 65th birthday on August 15. She qualifies for Premium-free Part A. Ms. Wilson will also elect to have Part B coverage. What options will she have to enroll in Part D coverage?

All answers are correct

You are speaking with Mrs. Lewis on March 17th. She was just informed that she has been disenrolled from her MAPD plan because she could no longer pay her Medicare Part B premium. She still has Medicare Part A. She is worried about her prescription costs and requests to enroll into a Humana PDP today. Can she do this and if so, which election period is available to her?

Yes. She can enroll today using a SEP for individuals who were disenrolled from a MAPD plan due to loss of Part B

You are speaking with Mrs. Mendez on June 25th. She was eligible for Medicare Part A several years ago but delayed her Part B until now, as she was covered under a group plan. She as enrolled in Medicare Part B and it will become effective on August 1st. She is requesting to enroll in a MAPD plan effective August 1st. Which enrollment period would you use?

ICEP for delayed Part B

You are speaking with Mrs. Bartus on April 5th. She tells you that she canceled her Medicare Supplement plan during the last AEP to enroll in an MAPD plan for the first time. She is now requesting to drop her MAPD plan, revert back to Original Medicare and enroll in a stand-alone PDP. Can Mrs. Bartus make this change now? If so, what election period would you use?

Yes, Mrs. Bartus can enroll in a PDP using the SEP for individuals who dropped a Medicare Supplement Policy when they enrolled for the first time in a MA plan

It is Valentine's Day and Mrs. Ewing who is currently enrolled in Original Medicare, requests to enroll in a Humana MAPD. Can Mrs. Ewing do this, and if so, which enrollment period would you use?

No, unless she has an SEP that we have not yet discovered

You are speaking with Mrs. St. Clair on December 5th. She has Medical POA for her husband who has just been admitted to a nursing home. He has dementia and can no longer make decisions for himself. He needs a MAPD plan with an effective date of January 1. He currently has Medicare A & B and a Part D plan with a competitor. Can he enroll in our MAPD plan? If so, which enrollment period would you use?

AEP

In October Mr. McCaw received a letter from ACME Company informing him that his current PDP Plan with them will not be renewing for the next plan year. What would you tell Mr. McCaw about his options to enroll into a Humana PDP?

Both answers A & B are correct

It is February 21st and you are speaking with Mrs. Imperatrice. She just received a letter advising her that she is eligible for Medicaid in her state. She is asking you to explain her Medicare plan options. What would you tell Mrs. Imperatrice?

She has a SEP to enroll into any PA/MAPD or PDP plan in her service area

Ms. Ingram moved from Florida to New York 7 months ago. She forgot to contact Humana to inform them of her address change. She went to the pharmacy yesterday and was told that she no longer had Humana coverage. She phoned customer service and found out that she had been disenrolled from our plan because she had moved out of the area. Can she enroll in a Humana plan and if so what SEP would she use?

Yes, she can enroll using the SEP for New Move