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SSD Flashcards

(48 cards)

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1
Q

SSD

A

SSD = social services department

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2
Q

QMB

A

QMB = Qualified Medicare Beneficiary

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3
Q

CSC

A

CSC = Customer Service Center

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4
Q

What is social service process?

A

Complete QMB Questionaire with member
Application processed by enrollment
social services rep contacts our member

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5
Q

CP999 New referral process

A

Complete QMB
Warm Transfer
document either cp999 or cp609
social services

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6
Q

CP609

A

Warm Transfer Member

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7
Q

SLMB

A

Specified Low-Income medicare Benefiicary

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8
Q

QI

A

Qualifying Individual

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9
Q

QDWI

A

Qualified Disabled and Working Individuals

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10
Q

4 kinds of Medicare Savings Programs

A

QMB - qualified medicare beneficiary
SLMB - specified low-income medicare beneficiary
QI - Qualifying Individual
SSI - supplemental security insurance

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11
Q

MSP

A

Medicare Savings Programs - help pay premiums, deductibles, coinsurance, copayments, etc

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12
Q

LTC

A

Long-term care

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13
Q

LIS

A

Low Income Subsidy (financial aid from government)

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14
Q

DCF

A

Department of Children and Families

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15
Q

DH

A

donut hole

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16
Q

Donut Hole

A

Part D coverage gap:
Most plans with Medicare prescription drug coverage (Part D) have a coverage gap (called a “donut hole”). This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Once you have spent up to the yearly limit, your coverage gap ends and your drug plan helps pay for covered drugs again.

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17
Q

SFP

A

Full Service Center for Federal/State Benefits

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18
Q

CPHP

A

Center for Public Health Practice

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19
Q

CPHP Outreach Program

A

Federal Assistance and State Assistance.
Fed Assistance = Extra help with MPDP cost (LIS), SSI Referrals, SafeLink
State Assistance = Care Program Referral, CPHP DCF access processing center

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20
Q

What acronym for Extra Help?

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A

LIS - low income subsidy
part D - prescription drug costs
If lowest income level, then no premiums or deductibles
No coverage gap (DH) or Late Enrollment Penalty

21
Q

What requirements to receive Extra Help for prescription plans?

Study These Flashcards
A

Ben enrolled in Medicare
Live in USA
meet income of the subsidy program.

members automatically qualify if:
Medicaid coverage
SSI - supplemental security income
help from Medicaid paying Part B premium

22
Q

SSI

Study These Flashcards
A

Supplemental Security Income

It is designed to help aged, blind, and disabled people, who have little or no income;
and It provides cash to meet basic needs for food, clothing, and shelter.

23
Q

What are the 3 LIS re-determinations

Study These Flashcards
A
  1. Initial - outreach in Aug - Sep
  2. Cyclical - random selection
  3. Subsidy changing event (update from marriage, death, divorce, change in income
24
Q

Social security doesn’t count what things?

Study These Flashcards
A

home you live
life insurance policies less than 1500
your car
burial plots

25
SSI Referrals eligibility standards
income single $753, couple $1120 assets: single $2000, couple $3000
26
MBR needs to live in Florida how long to be eligible for SafeLink Wireless?
live for 6 months
27
Safelink Wireless Eligibility -
federal public housing, food stamps, SSI, Medicaid. The Lifeline program is available to eligible consumers in selected states. Actual requirements vary by state, but in general to qualify for Lifeline, subscribers must either have an income that is at or below 135% of the federal Poverty Guidelines
28
State Programs Eligibility
``` Medicare Part A have income levels specified in program have assets levels specified FL resident US citizen or qualified alien ```
29
LTC
Long term care (Cares Program) For 65 and older that are Medicaid eligible helps members stay at home while improving quality of life
30
Can member reside in nursing home receive LTC?
Yes
31
What does a member need if not 65 and older but disabled to get LTC?
Disabled Adult Waiver
32
SEP
Special Enrollment Period A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child. If you qualify for an SEP, you usually have up to 60 days following the event to enroll in a plan. If you miss that window, you have to wait until the next Open Enrollment Period to apply. You can enroll in Medicaid and the Children’s Health Insurance Plan (CHIP) any time of year, whether you qualify for a Special Enrollment Period or not.
33
What doesnt count for personal assets
First home, first car, furniture
34
HEC
Home Equity Conversion HEC plans
35
Transfer Line for En and SP?
SP 1500016 | En 1500061
36
Medicaid programs - member benefits
Savings up to 1608 exempt from the donut hole have SEP - special election period can enroll in Care Needs/Careneeds Plus plans
37
Prescreening for Medicare Savings Programs (QMB,SLMB,QI1)
Is your monthly gross income less than $1361 or couple $1828? Is your savings less than 7280 or couple with 10930
38
Prescreening for Extra help (LIS)
Is your monthly gross income less than 1485 or couple $2002? Assets less than 13820 or couple less than 27600
39
Does social security include HEC?
No it doesn't include HEC - home equity conversion plans
40
Gross income includes what
wages social security benefits, pensions,veterans benefits workers comp, child support, unemployment compensation, annuities/rent
41
Personal assets includes what
cash, savings,bonds, CDs, trust funds, life insurance, 2nd car, real estate (except your homestead)
42
If member makes more than $8890 they are eligible for what?
LIS - Extra help medicare part D
43
What order of assistance categories for eligibility by income and assets
``` From lowest income to highest: SSI QMB SLMB QI1 Extra Help LIS ```
44
Cares Program (LTC) eligibility
enrolled in Medicare Parts A and B eligible for ICP income levels enrolled in medicaid waiver Also if in nursing home and has assisted living waiver Disabled and have A/DA waiver (aged and disabled adult)
45
What are normal LTC eligibility requirements?
65 and older and on medicaid
46
ICP
Institutional Care Program income and assets levels
47
How many levels in LIS standard drug benefit
there are 4 levels for co-payments 4 partial extra help 1 full extra help
48
Requirements to receive Extra help for drug plans
enrolled in medicare live in US meet income of the subsidy program Note: members automatically qualify if: medicaid coverage SSI help from medicaid paying Part B premium

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