5-23-22 Medicare Trivia You Should Know

Internal process improvements and Objections - What Clients are Saying See meeting notes under the video: AGENDA Hannah Interoffice Chat - remember these are work accounts and should be used for work. We shouldn’t have side-group chats that are regularly used. If we need a new group chat, for a segment of people with a common project, please include me so I can stay up to date. Conflict - please remember it is always better to talk to each other than about each other when we have a conflict. If I need to help facilitate that conversation, all you have to do is ask. The best resolution for conflict is to tackle it together. Don’t let conflict come between you and being successful at your job. You are all here because you are a valuable part of this team. If you need help overcoming an issue, please let me know. Admin Training - will be doing shortly bi-weekly group training to help nail down some of the details of tasks. If you have requests on which ones you’d like help with, please let us know. Trivia! What are the two types of Trial Right? 1st year on Medicare; straight into MAPD → can choose any med supp (O/E) . Part A date must be same as MAPD start date for this to work. Not 1st year on Medicare but 1st time in an MAPD (less than a year) → can go back to the Med Supp they dropped to join the MAPD (Or GI into another plan if the original is no longer available) How does the Missouri Anniversary Rule work? Within 30 days of the policy anniversary - switch to the same plan through another carrier Washington state open enrollment law on Medicare Supplement? Change from one Med Supp to any other Med Supp at any time. No health questions. Must already have a Med Supp to qualify. Group (retiree) Supplements do NOT count if they do not have a standardized plan letter. A client calls in because he got a bill from his doctor. What are the first two questions we ask? Have you met your deductible? Was the service covered by Medicare? Someone moves from NC to FL. They have Plan N and a PDP through us. They call us to update their address and to see if they need to change plans. What do we tell them? Supp will follow you- would have to healthy qualify (through Underwriting) to change. (May want to schedule an appt to see if the new state has lower rates.) Will need to change PDPs Someone is currently employed and covered by their group insurance. They want to know if they need to enroll in Medicare this year when they turn 65. What do we need to know to give them the correct answer? Employer size (20 or more employees?) Chris Medicare.gov has been re-designed. It now has a tiny link on the main page for “Medigap”. The research results look horrible and provide very little information, then tell them to call the insurance company directly if they wish to enroll. American Hospital Association Lashes Out on Medicare Advantage: “While the numbers alone tell a distressing story, the report also describes the harrowing human impact of these MA plans’ behavior. Just consider the following few examples described in the report: A 72-year-old woman presented with a cancerous breast tumor. The MA plan denied her breast reconstruction surgery, stating “that the service was not covered.”6 That decision was reversed only after the HHS-OIG requested data from the insurer. A MA plan refused to admit a 67-year-old patient to an inpatient rehabilitation facility, even though he presented with an “acute right-sided ischemic stroke and seen at the emergency department with new onset slurred speech.”7 “The beneficiary had difficulty swallowing, was at significant risk of aspiration and fluid penetration, at high risk for pneumonia, and, therefore,” according to the Medicare Benefit Policy Manual, “should have been under the frequent supervision of a rehabilitation physician.” A MA plan refused to pay $150 a month for a hospital bed with rails, even though a 93-year-old patient had a history of epilepsy, early onset Alzheimer’s, rheumatoid arthritis, chronic back pain, knee, and joint stiffness, and limited range of motion.9 HHS-OIG’s medical experts determined, however, that this bed request was medically necessary “due to the beneficiary’s chronic conditions and movement limitations.” American Medical Association on Prior Authorization:

Recent Posts