Podcast
Questions and Answers
What is an example of a top beneficiary complaint that affects Star Ratings?
What is an example of a top beneficiary complaint that affects Star Ratings?
The beneficiary did not understand that enrolling in a Wellcare plan would change their current Medicare Advantage plan.
An SEP is a period outside of the ICEP, AEP, or MA OEP when beneficiaries can enroll based solely on life events that qualify for an SEP period.
An SEP is a period outside of the ICEP, AEP, or MA OEP when beneficiaries can enroll based solely on life events that qualify for an SEP period.
True
What specific beneficiary information must a broker/agent cover before the enrollment process?
What specific beneficiary information must a broker/agent cover before the enrollment process?
All
Which of the following is not a Wellcare quality driver?
Which of the following is not a Wellcare quality driver?
Signup and view all the answers
Once the enrollment is completed, you can save a copy of the application for your reference.
Once the enrollment is completed, you can save a copy of the application for your reference.
Signup and view all the answers
The Mastery Exam will lock for a period of 48 hours after each failed attempt.
The Mastery Exam will lock for a period of 48 hours after each failed attempt.
Signup and view all the answers
What must the TPMO disclaimer be used by any TPMO that sells plans on behalf of more than one MA plan provider?
What must the TPMO disclaimer be used by any TPMO that sells plans on behalf of more than one MA plan provider?
Signup and view all the answers
A request to the plan from a member or provider for a formal review of an Action (Denial) or Adverse Plan Determination (Medicare) is called what?
A request to the plan from a member or provider for a formal review of an Action (Denial) or Adverse Plan Determination (Medicare) is called what?
Signup and view all the answers
Which of the following statements about Scope of Appointment (SOA) is FALSE?
Which of the following statements about Scope of Appointment (SOA) is FALSE?
Signup and view all the answers
Which state did Wellcare add to its footprint for 2024?
Which state did Wellcare add to its footprint for 2024?
Signup and view all the answers
The Prescription Drug Plan (PDP) network is expected to include over how many total pharmacies?
The Prescription Drug Plan (PDP) network is expected to include over how many total pharmacies?
Signup and view all the answers
Members are no longer required to pay a partial deductible due to the Inflation Reduction Act.
Members are no longer required to pay a partial deductible due to the Inflation Reduction Act.
Signup and view all the answers
The 2024 Inflation Reduction Act (IRA) Part D Benefits include reduced insulin copays for all insulins and insulin-combination products.
The 2024 Inflation Reduction Act (IRA) Part D Benefits include reduced insulin copays for all insulins and insulin-combination products.
Signup and view all the answers
The Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024 will impact which plan(s)?
The Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024 will impact which plan(s)?
Signup and view all the answers
Wellcare has new All-Dual D-SNP products in various states.
Wellcare has new All-Dual D-SNP products in various states.
Signup and view all the answers
Members who have LIS and enroll in other plans will have a premium to pay regardless of the level of LIS the member is granted.
Members who have LIS and enroll in other plans will have a premium to pay regardless of the level of LIS the member is granted.
Signup and view all the answers
Which of the Prescription Drug Plan (PDP) products is new to the 6-tier formulary structure for 2024?
Which of the Prescription Drug Plan (PDP) products is new to the 6-tier formulary structure for 2024?
Signup and view all the answers
All Prescription Drug Plans (PDPs) will offer a $___ copay for most Part D preventive vaccines.
All Prescription Drug Plans (PDPs) will offer a $___ copay for most Part D preventive vaccines.
Signup and view all the answers
Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part D plan premiums.
Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part D plan premiums.
Signup and view all the answers
CVS Caremark Mail Order will be in-network for 2024.
CVS Caremark Mail Order will be in-network for 2024.
Signup and view all the answers
Which LIS category is assigned to members whose costs are fully subsidized and who receive the most assistance?
Which LIS category is assigned to members whose costs are fully subsidized and who receive the most assistance?
Signup and view all the answers
Study Notes
Wellcare Beneficiary Complaints
- A common beneficiary complaint affecting Star Ratings is misunderstanding that enrolling in a Wellcare plan changes their current Medicare Advantage plan.
Special Enrollment Periods (SEPs)
- Special Enrollment Periods allow beneficiaries to enroll based on qualifying life events outside of the normal enrollment periods.
Broker/Agent Requirements
- Brokers/agents must cover specific beneficiary information before the enrollment process begins.
Medicare Star Ratings
- Wellcare's quality strategy is centered around Medicare Star Ratings, driven by six key components.
- "Serving Government Customers" is not a recognized quality driver for Wellcare.
Enrollment Application
- Once enrollment is complete, saving a copy of the application for personal reference is not permitted.
Mastery Exam Policy
- The Mastery Exam does not lock for 48 hours after each failed attempt.
TPMO Disclaimer
- Any Third-Party Marketing Organization (TPMO) selling multiple Medicare Advantage (MA) plans must utilize a specific disclaimer.
Appeals Process
- A request for a formal review of an action or denial is classified as an appeal.
Scope of Appointment (SOA)
- A false statement concerning SOA is that an electronic SOA submitted in Ascend must be in Pending status before starting the appointment.
Geographical Expansion
- For 2024, Wellcare expanded its services to include Delaware.
Prescription Drug Plan (PDP) Network
- The PDP network is expected to include over 60,000 total pharmacies.
Inflation Reduction Act Impact
- Members are still required to pay a partial deductible despite the Inflation Reduction Act.
Part D Benefits under IRA
- The 2024 Inflation Reduction Act requires reduced insulin copays on formulary products, capping costs at $35 for a month's supply.
Pharmacy Benefit Manager Update
- The transition to Express Scripts as the Pharmacy Benefit Manager on 1/1/2024 will affect all plans.
New Dual-Eligible SNP Products
- Wellcare introduced new All-Dual D-SNP products in multiple states, including Alabama, Florida, and Texas, among others.
Low-Income Subsidy (LIS) Premiums
- Members with LIS who enroll in other plans will have premiums regardless of their LIS level.
PDP Formulary Structure
- "Value Script" is not a new product in the 6-tier formulary structure for 2024.
Vaccine Copayment Policy
- All Prescription Drug Plans will have a $0 copayment for most Part D preventive vaccines at any network pharmacy.
Low-Income Subsidy Misconceptions
- Low-Income Subsidy (LIS), or Extra Help, does not reduce premiums for all Part D plans.
CVS Caremark Mail Order
- CVS Caremark Mail Order will not be considered in-network for 2024.
High Assistance LIS Category
- LIS category Three is designated for members with full subsidies, receiving the maximum level of assistance.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz covers key aspects of the Wellcare enrollment process, including beneficiary complaints, special enrollment periods, and broker requirements. Gain insights into the importance of Medicare Star Ratings and the policies surrounding enrollment applications and mastery exams.
