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Types of Inhalers
Diabetes Medications

Glimepriride

Glipizide

Metformin

Humulin

Novolin

FlexTouch

Humalog

Insulin

Tresidba

Levemir

Basaglar

Lantus

Toujeo

Tradjenta

Jardiance

Januvia

Janumet

Trulicity

Ozempic

Mounjaro
Cardiovascular Disease

Arrhythmias

Propranolol

Atenolol

Metoprolol

Pacemaker

Stent placements

bypass surgeries

Xarelto

Warfarin

Eliquis

Angioplasty treatment

Bypass surgery

Clopidogrel

Nitroglycerin
Pulmonary Disease

Bronchodilators

Short-Acting Inhalers

Long-Acting Inhalers

Combination Inhalers

Corticosteroid Inhalers

Prednisone

Roflumilast (Daliresp)

Theophylline

Azithromycin

Doxycycline

Mucolytics

Acetylcysteine

Oxygen Therapy

Pneumococcal

Medicare Election Periods

IEP - Initial Enrollment Period
A/B dates are the same. 3 months prior to the A/B date, the month of, and 3 following months is their IEP window for a total of 7 months.

ICEP - Initial Coverage Election Period
If Part B date is delayed and hasn’t started yet, you can use ICEP to enroll 3 months PRIOR to the Part B start date.

OEP-NEW - Open Enrollment Period for New Beneficiaries
Beneficiary enrolled into an advantage plan using their IEP/ICEP and has an ACTIVE plan. They have 3 months from their A/B start date to make one plan change. If their B date is delayed and they used ICEP to enroll into their current plan, they have 3 months from their B start date to use OEP-NEW to make a plan change.

P-SEP IC - eligible FIDE SNPs, HIDE SNPs, and AIPs
full-benefit dually eligible individuals may use the integrated care SEP to enroll, once per month, into a fully integrated dual eligible special needs plan (FIDE SNP), highly integrated dual eligible special needs plan (HIDE SNP), or applicable integrated plan (AIP).

MCD - Medicaid
If they lost their Medicaid or had a change in Medicaid level, they can use MCD to enroll into a new plan. 3 months after loss or change in level is the window.

NLS - Extra Help/LIS
If they lost their Extra Help LIS or had a change in level, they can use NLS to enroll into a new plan. 3 months is the window. If the client is under the income limit and you help APPLY for the LIS for the client, that DOES NOT trigger NLS. They must be approved before using NLS. See the LIS 2025 Section for Income Limitations & The Link to Apply.

MOV - Move
“Have you recently moved in the last year?” If yes and the new address isn’t reflected in Marx, then you can use MOV code to enroll, regardless of how many months passed. If address is already reflected in Marx, 2 months is the window after they moved. Must be a new zip code OR county.

LEC - Loss of Employer Coverage
A/B dates are different. If you see they just got their Part B added within the last few months, it will usually indicate they lost their employer coverage or are retiring and going to start using their Medicare. This will trigger an enrollment period (loss of employer coverage). 3 months after their B start date is the window for LEC.

5STAR - 5-Star Plan
Filter the plans to show 5-star plans. Getting a client into a 5-star plan is an enrollment code. Must enroll into the 5-star plan and not a different plan. Valid from 12/8 to 11/30.

LCC - Loss of Creditable Coverage
Involuntary loss of creditable coverage, including a reduction in the level of coverage so that it is no longer creditable. Does NOT include any loss or reduction due to a failure to pay premiums. 3 months is the window.

CHR/CSN - Chronic Condition
This SEP is for those individuals with a chronic condition to enroll in a CSNP plan. The individual must have the qualifying chronic condition to enroll into the CSNP plan. Check the SOB or EOC to see what chronic condition is required; Cardiovascular Disorders, Chronic Heart Failure, and Diabetes. If the client is currently in a CSNP plan, enrolling into a different CSNP with a different carrier will usually go through.

OCC - MA-Only
To enroll into MA-only. Individuals who currently have a MAPD or PDP-only may disenroll if they have other creditable drug coverage (such as TriCare or VA coverage) by using this SEP to enroll into a MA-only plan. For example: MAPD to MA-Only, or PDP to MA-Only.

MDE - Double Eligible & LIS SEP No longer in effect
Individuals with a low-income subsidy (LIS) who are not enrolled in Medicaid can no longer switch Medicare Advantage plans quarterly. They must wait until Open Enrollment, an initial enrollment period, or meet the requirements for another SEP option.

DST - Disaster (NO LONGER IN EFFECT AS OF 4/1)

Medicaid Levels

Level	Name	Description
FBDE	Full Benefits Dual Eligible	Full Medicaid benefits; generally 0% cost share unless not covered by Medicaid
QMB+	Qualified Medicare Beneficiary Plus	Eligible for full Medicaid benefits; may pay prescription drug copays
SLMB+	Specified Low-Income Beneficiary Plus	Eligible for full Medicaid benefits; may pay prescription drug copays
SLMB	Specified Low-Income Beneficiary	Part B premium paid only
QMB	Qualified Medicare Beneficiary	Pay Part D drug copays
QDWI	Qualified Disabled & Working Individual	Pays your Part A
QI	Qualifying Individual	Part B premium paid only

LIS (Low-Income Subsidy) 2025

Level	Deductible	Copayment
Level 1	$0	$4.90 or $12.15
Level 2	$0	$1.60 or $4.80
Level 3	$0	$0 or $0

LIS helps reduce prescription costs for individuals with limited income and resources.

Note: The out-of-pocket threshold is $2,000. There is no cost-sharing for covered Part D drugs above the annual out-of-pocket threshold.

Requirements to Achieve LIS

Criteria	Single	Married
Annual Income	Below $22,590	Below $30,660
Monthly Income	Below $1,882.50	Below $2,555
Resources	Below $17,220	Below $34,360
Other Requirements	Enrolled in Medicare and reside in one of the 50 states or the District of Columbia

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Participants:

Humana

UHC

Wellcare

Aetna

Cigna

Devoted

Anthem

Zing

Molina

Types of Inhalers

Medicare Election Periods

Medicaid Levels

LIS (Low-Income Subsidy) 2025

Requirements to Achieve LIS

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NOTE!! 2024 to 2025 Plan Crosswalk (Use H###_### or H####-### Format)

Humana

UHC

Wellcare

Aetna

Cigna

Devoted

Anthem

Zing

Molina

Types of Inhalers

Diabetes Medications

Cardiovascular Disease

Pulmonary Disease

Medicare Election Periods

Medicaid Levels

LIS (Low-Income Subsidy) 2025

Requirements to Achieve LIS

Reset Your Password