Medicare

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Across
  1. 5. General coinsurance for ORIGINAL MEDICARE
  2. 7. Involuntary loss of creditable coverage including a reduction in the level of coverage so that it is no longer creditable NOT including any loss or reduction due to a failure to pay premiums.
  3. 8. In this plan you can go to almost any doctor, other health providers, or hospital that accepts plan without referral.
  4. 9. State has a State declaration: Drought SEP incident dates: 07/08/2022 – Ongoing; This SEP declaration is effective: 07/08/2022 – Ongoing
  5. 11. During this enrollment period beneficiaries may choose how they receive their Medicare benefits for the upcoming year. The last election made determined by the application date will be the plan that takes effect on January 1.
  6. 12. Hierarchy of Enrollment Periods** 2.
  7. 14. You can join switch or drop a Medicare Advantage Plan or Medicare drug plan or switch to Original Medicare during this enrollment period
  8. 17. A written order from your primary care doctor for you to see a specialist or get certain medical services.
  9. 18. gaining Medicare A & B at the same time (Medical Only)
  10. 19. SEP exists for individuals affected by a weather-related emergency or major disaster who were unable to, and did not make an election during another valid election period.
  11. 21. Loss of Special Needs Status.
  12. 24. SEP for Individuals who were not eligible for a MA or PDP because they had been out of the U.S. and have now moved back
  13. 25. In most cases you must get a referral to see a specialist in HMO Plans. Certain services like yearly screening mammograms don't require a referral
  14. 29. This SEP is for those individuals with severe or disabling chronic conditions.
  15. 31. $1600 for each inpatient hospital benefit period before Original Medicare starts to pay.
  16. 34. SEP for individuals who Gain, Lose or Have a Change in their Medicaid Status
  17. 35. $0 for most people (because they or a spouse paid Medicare taxes long enough while working - generally at least 10 years). If you get Medicare earlier than age 65 you won’t pay a Part A premium.
  18. 37. state has a state declaration for Tropical Storm Ophelia; SEP incident dates: 09/23/2023 – 10/24/2023; This SEP declaration is effective: 09/23/2023 – 11/30/2023
  19. 38. Hierarchy of Enrollment Periods 1.
  20. 40. Individuals who disenroll from Part D to enroll in or maintain other creditable coverage Individuals enrolled in a PDP or MAPD who have or are enrolling in other creditable coverage such as Tricare or VA coverage may use this SEP to disenroll from the PDP or MAPD by enrolling in an MA-only plan.
  21. 41. State has a state declaration: Severe Flooding and Tropical Storm; SEP incident dates: 09/22/2023 – 10/23/2023; this SEP declaration is effective: 09/22/2023 – 11/30/2023
  22. 42. Individuals who have Medicare A and B and receive any type of Federal or State assistance from Medicaid or Low Income Subsidy (LIS).
  23. 43. Contract Not Renewed - Contract non-renewal of plan effective Jan. 1 For members of MA/MAPD/PDP/Cost Plan that will be affected by contract non-renewal (PLEX - Plan Exit) or service area reduction (plan no longer available in zip or county) for the upcoming plan year. The SEP begins December 8 and ends on the last day of February. The effective date would be the first day of the upcoming month following enrollment.
  24. 44. Recipients may have to pay an extra amount if they don’t sign up for Medicare coverage during their Initial Enrollment Period or have other coverage that’s similar in value to Medicare (like from an employer).
  25. 45. You can use any doctor or hospital that takes Medicare anywhere in the U.S.
  26. 46. state has a FEMA declaration: Hurricane Idalia SEP incident dates: 08/29/2023 – 10/21/2023;this SEP declaration is effective: 08/29/2023 – 11/30/2023
  27. 47. gaining Medicare A & B at the same time (Prescription Coverage Included)
  28. 48. SEP for individuals who Gain, Lose or Have a Change in their LIS Status
Down
  1. 1. Medicare beneficiaries may enroll in a MA/MAPD/PDP that has an overall Plan Rating of five (5) Stars. The plan effective date must be during the year in which that plan has the 5-Star rating and the enrollee must meet all other plan eligibility requirements. This SEP is a one-time use per contract year. ONLY between 12/8 - 11/30
  2. 2. Hierarchy of Enrollment periods 5.
  3. 3. For members of MA/MAPD/PDP/Cost Plan that will be affected by contract non-renewal (PLEX - Plan Exit) or service area reduction (plan no longer available in zip or county) for the upcoming plan year. The SEP begins December 8 and ends on the last day of February. The effective date would be the first day of the upcoming month following enrollment.
  4. 4. Hierarchy of Enrollment periods 4.
  5. 6. This state has a FEMA declaration for Severe Storms, Flooding, and Tornadoes SEP incident dates: 06/08/2023 – 10/20/2023 This SEP declaration is effective: 06/08/2023 – 10/31/2023; SEP incident dates: 06/08/2023 – 11/19/2023; this SEP declaration is effective: 06/08/2023 – 12/31/2023
  6. 10. The month of Medicare entitlement and for 2 additional months following IEP/ICEP enrollment into MA/MAPD.
  7. 13. $164.90 each month (or higher depending on your income). The amount can change each year. Medicare recipients pay each month even if you don’t get any Part B-covered services.
  8. 15. The doctor you see first for most health issues.
  9. 16. Once you pay the plan’s limit in Medicare Advantage the plan pays 100% of your covered health services for the rest of the calendar year.
  10. 20. state has a FEMA declaration for Severe Storms, Straight-line Winds, and Tornadoes; SEP incident dates: 06/14/2023 – 10/20/2023; this SEP declaration is effective: 06/14/2023 - 11/30/2023
  11. 22. $226 before Original Medicare starts to pay. You pay this deductible once each year.
  12. 23. Insurance for people aged 65 and older. You may be eligible to get Medicare earlier if you have a disability End-Stage Renal Disease (ESRD) or ALS (also called Lou Gehrig’s disease).
  13. 26. In many cases you can only use doctors and other providers who are in the plan’s network and service area (for non-emergency care). Some plans offer non-emergency coverage out of network but typically at a higher cost.
  14. 27. Helps cover Inpatient care in hospitals Skilled nursing facility care Hospice care/Home health care.
  15. 28. SEP exists for individuals who are losing group health coverage. Losses include the individual opting out of the Company/Group coverage during the employer’s annual benefit selection season, changes due to life events and discontinuation of employment or the Company/Group ceases to offer group health coverage. The SEP begins the month of the loss of coverage and continues for two additional months. The individual may choose a plan effective date up to 3 months after the month in which the individual completed the enrollment request.
  16. 30. state has a state declaration: Potential Tropical Cyclone (PTC) Sixteen SEP incident dates: 09/22/2023 – 11/19/2023; This SEP declaration is effective: 09/22/2023 – 12/31/2023
  17. 32. Helps cover Services from doctors and other health care providers Outpatient care Home health care.
  18. 33. Hierarchy of Enrollment periods 3.
  19. 34. state has a FEMA declaration: Severe Storms, Straight-Line Winds, Tornadoes, and Flooding SEP incident dates: 07/29/2023 – 10/20/2023 This SEP declaration is effective: 07/29/2023 – 11/30/2023
  20. 36. SEP begins on the actual date of the release of incarceration and continues for two additional months
  21. 39. Helps cover the cost of prescription drugs (including many recommended shots or vaccines).
  22. 42. state has a state declaration for Severe Weather SEP incident dates: 09/23/2023 – 10/24/2023