28093188
Description
Flashcards by Martha Navarro, updated more than 1 year ago
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Created by Martha Navarro
over 3 years ago
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| Question | Answer |
| What is OEP? | The time (Jan 1 - Mar 31) when beneficiaries who are unhappy with their Advantage plan may make a one-time change to another plan, including dropping the plan to go to Original Medicare. |
| Is OEP the same as OEP-New? | No. OEP & OEP-New are both opt-out periods, but OEP happens between Jan 1 & Mar 31, for anyone in an Advantage plan. OEP-New is a similar period given to new Medicare beneficiaries in their first advantage plan. |
| When does the plan become effective when using OEP? | The first of the month following the date the enrollment application was received. |
| A member states that they are not happy with their Medicare Advantage plan, but they didn't enroll in their plan during AEP. Can you still use OEP to switch the member? | Yes. A member does not have to have added their current plan during AEP to be able to switch during OEP. As long as the member has a Medicare Advantage plan, they are able to use OEP. |
| An MAPD member calls during OEP. You help them switch to a five-star MAPD. Should you use the OEP SEP code or the five-star? | OEP. The enrollment period that expires first, should be used first. Five-star SEP can be used at any time of year. |
| Is OEP-I the same as OEP? | No, OEP-I is one of the codes used when an individual has an SEP from moving into, living in, or moving out of a defined "institution". |
| What SEP code should you use when switching someone from an MAPD to a PDP (Original Medicare)? | OEP |
| An MAPD-enrolled member calls in & says they're just shopping around for AEP because they don't think they can change this time of year anyway. Are you allowed to open by telling them about OEP? | No. You can help the member look into plans & suggest that if they want to chance, you can find an SEP, but you are not allowed to bring up OEP first. |
| A member wants to return to Original Medicare during OEP. Does this give the member guaranteed issue into a supplement plan? | No, it does not. |
| A member with LIS calls in during OEP; they are unhappy with their current plan due to the lack of benefit their PDP has. Which SEP should you use, OEP or Continuing LIS? | Use the LIS/Extra Help SEP. Members who have only a PDP are not allowed to make changes using OEP. |
| A member is moving on March 30th, & is calling you to make the switch. Should you select OEP or MOVE on the application? | OEP, since it is due to run out first. The MOVE SEP can be used up to two months after the change of address. |
| A beneficiary calls in on March 1st to shop around & they say they're unhappy with their Advantage plan! What election period should you use? | OEP |
| A member calls in looking to change their plan during OEP. They have Medicaid but no LIS, & are on a standalone drug plan. Can you help them enroll into another plan? | Yes - but not using OEP. The beneficiary still has Medicaid, which gives them an SEP to change 1x per quarter for the first nine months of the year. |
| A beneficiary calls during OEP. He has a supplement, & is looking to enroll into another supplement. Are you able to help him? | Yes - but not using OEP. Supplements do not require SEPs, & are open for enrollment year-round. The member will still need to pass the supp's underwriting, unless they have Guaranteed Issue. |
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