Flashcards
SEP 101
Cards in this deck (16)
- 1What is DST SEP?DST SEP is an SEP extension, to be used when a beneficiary missed an SEP due to a CMS-confirmed disaster. It may not be used as a standalone SEP.
- 2When can the LIS SEP be used? When can it not be used?It can be used 1x/quater for the first three quarters of the year (Jan - Mar, Apr - Jun , Jul - Sept). It can NOT be used any time between Oct - Dec (last quarter).
- 3A member received notice that they were passively enrolled into a drug plan on Jan 1. The letter did not arrive until Jan 15. What is the latest they may use the DIF SEP?May 15th. The SEP may be used up to 3 calendar months after the enrollment or notification, whichever is later.
- 4What is the "Rule of Three"?It is the term used to describe the typical time frame given to use an SEP
- 5What is the INC SEP?An SEP for individuals recently released from incarceration. The SEP begins on the date of release & continues for 2 calendar months. MARX has a release date tool.
Note: If "INC" is not available, select "MOV" - 6What is the time frame allowed to use DIF SEP?Either 3 months from the date of passive enrollment into the plan, or date of notification of enrollment, whichever is later
- 7A member has been dropped from their Medicare PDP because they couldn't afford & therefore didn't pay their monthly premiums. What SEP should be used to put them in a less expensive plan?Trick question!
If a client is dropped from Medicare Advantage or Prescription drug plan for non-payment, they do not get an SEP. - 8When can you use the OCC SEP?When a veteran who is enrolled in a PDP or MAPD elects to switch to an MA-only plan for the first time.
If disenrolling from a MA-PFFS/PDP combination, the member will have to contact the PDP to disenroll. - 9When can you use CSNP SEP?Once per calendar year if an individual has a condition that meets the plan's enrollment requirements, & has an MD that can later testify to the existence of that condition.
- 10When can a beneficiary use the 5-star SEP?They may use it once per calendar year to enroll in a five-star plan.
- 11What is IEP2?Beneficiaries who had Medicare prior to age 65 have a 2nd 7-month window (same as IEP) to enroll in MAPD/PDP when they turn 65.
If they didn't have creditable coverage prior to adding it for IEP2, they will not pay the penalty as long as they keep cred coverage. - 12When can you use SPAP SEP?Once per calendar year, if the individual is enrolled in a State Pharmaceutical Assistance Program that is listed on the Medicare.com registry
- 13Explain when you should use the Move SEPWhen a beneficiary moves (zip code OR county MUST change) they're eligible to select a plan in their new service area. The SEP may be used up to a month before the move, & ends 2 months after the move.
Coverage can start the month of the change of address or up to 3 months after. - 14A member tells you that they're considering dropping their retirement benefits for an MAPD. They don't know much about their retirement benefits, but like that the MAPD offers dental. What SEP should you use?BEFORE proceeding to enroll this customer, have them to speak to their benefits advisor to go over any changes that might arise from a new enrollment. Once they're satisfied the MAPD will not negatively impact them, use the SEP that applies to loss of employer/group coverage.
- 15A member moved out of their plan's service area 2 years ago but never notified the plan or Medicare. Can you still use Move SEP?Yes - the SEP may be used up to three months after the move or whenever the member notifies of the move, whichever is later.
- 16A beneficiary used their LIS/Medicaid SEP already but they received a letter stating that their LIS/Medicaid level is changing. Can you use this as an SEP?Yes - change of LIS or Medicaid level is an SEP & can even be used in the same month as the "continuing LIS/Medicaid" SEP.