Opting for a plan with a reduced premium usually translates to higher out-of-pocket expenses for the beneficiary. However, if you seldom need medical attention and are comfortable with occasional copays, this might work for you. Broadly speaking, Plan N mirrors Plan G in its offerings. In certain regions, the savings on premiums might render Plan N a more economical choice annually.

The uncertainty surrounding out-of-pocket expenses tied to Plan N frequently arises after visits to healthcare facilities like doctor’s offices or emergency rooms. You might be pondering, ‘Which types of office visits come with a Plan N copay, and which ones don’t? What qualifies as an office visit?’

The answer isn’t always straightforward. Whether you’re required to pay a copay hinges on the specific billing code utilized by the provider. Deciphering this can be intricate unless you’re familiar with the precise code assigned to the claim.

Every medical service you undergo corresponds to a distinct code that informs the insurance company about the procedure conducted. Clients often find themselves perplexed when confronted with copayments. At Boomer Benefits®, we have a comprehensive understanding of these codes due to our daily involvement in addressing claims matters. In this piece, I’ll elucidate this information to equip you with the knowledge needed to navigate your financial obligations confidently.

Medigap Plan N Coverage

Before delving deeper, let’s outline the key features of Medigap Plan N. Much like Plan G, Plan N entails your accountability for the annual Part B deductible. Once this deductible is met, your coverage becomes notably extensive.

Plan N assists in addressing your Part A deductible and related services, Part B coinsurance, and other facets. However, it’s important not to overlook the significance of the copays and potential Part B excess charges that could come into play.

Up to $20 Copay

If you’ve conducted an online search about Plan N, you might have come across phrases like, “You might have a copay of up to $20 under Plan N” or “There’s a possibility of excess charges.” The imprecise, open-ended wording tends to create ambiguity.

Do you pay the deductible first?

You are responsible for the deductible. You must pay this amount first before you have a copay for an office visit. This means that you will pay $226 (in 2023) for your Part B services, such as doctor visits, physical therapy, durable medical equipment, lab work, and more. Once that deductible is met for the year, you can expect copays for certain office visits.

How is the copay determined?

You might have observed that the copay isn’t a fixed figure; instead, it has an upper limit of $20. This is due to the copay being determined by the Medicare-approved amount for the particular service in question. It’s important to note that the Plan N copay can vary, with a maximum of $20, indicating that consistency isn’t guaranteed.

To illustrate, let’s consider an instance where your office visit holds a Medicare-approved amount of $460, and you’ve already met the annual deductible. Medicare covers 80%, which amounts to $368, resulting in a remaining balance of $92 to be paid to the provider. With Plan N, your copay of $20 is applicable, and your plan handles the remaining $72.

However, if the Medicare-approved amount is merely $80, Medicare Part B will cover $64, and the outstanding 20% coinsurance adds up to $16. Here, you’ll pay $16 instead of the maximum $20 copay.

What services are subject to the $20 Plan N copay?

Having covered the potential range of your copay, let’s delve into the types of visits that entail such a fee. Any visit classified as an office visit or evaluation and management visit will be subject to the $20 copay. While this might seem straightforward, there are 15 distinct codes that can trigger up to a $20 copay. If your visit is associated with any of these 15 codes, anticipate a copay.

The intricacy arises from not knowing precisely which visits will correspond to these codes until after the visit concludes. Essentially, your physician will assign the appropriate code after the visit, and the billing department will formulate the claim based on the information provided by the doctor. Subsequently, the claim is sent to Medicare.

After Medicare and your Medigap Plan N process the claim and relay it back to your healthcare provider, you’ll receive the copay bill. Additionally, you should receive an Explanation of Benefits from your Plan N provider before the bill. This document itemizes the expenses and coding associated with a visit. If the code aligns with one of the codes listed below, you’ll be accountable for the copay.

Do telehealth visits apply to the copay?

Traditionally, telehealth services were typically offered as an extra perk with Medicare Advantage plans. However, the landscape has shifted since the pandemic, with more healthcare providers extending telehealth options to patients. This can prove especially convenient for those with hectic schedules or a preference to avoid waiting rooms. If telehealth visits align with your preferences, it’s only natural to inquire whether the Plan N copay applies.

While telehealth visits can encompass virtual office visits, psychotherapy sessions, and consultation services, it’s conceivable that they might correspond to one of the relevant CPT codes. If this is the case, you should anticipate a copay bill. In the event that you ever encounter queries or uncertainties regarding a code or bill received, my team is just a phone call away.

Is the Plan N copay required for physical therapy, lab work, or X-rays?

A frequently raised question among beneficiaries while evaluating Medigap plans is whether the Plan N copay is relevant to particular services like physical therapy or lab work. It’s important to clarify that the copay is exclusively relevant to the office visit itself.

Every service conducted during the visit is assigned its own distinctive code. If these codes don’t align with the relevant copay codes, you won’t encounter a copay for those specific services.

What if you have multiple visits in one day?

If you share my inclination, you might prefer scheduling multiple appointments on the same day for efficiency. However, it’s worth noting that if you follow this approach, a copay will be incurred for each Medicare-approved visit on that particular day, provided it corresponds to one of the relevant codes. This applies regardless of whether your appointments involve various doctors within the same medical practice.

Up to $50 Copay

Recalling the outset of this article, I pointed out the possibility of encountering a copay during an emergency room visit. For such instances, the copay could reach a maximum of $50 for each relevant visit. As illustrated in the chart provided earlier, five distinct ER codes fall within the copay category. Consequently, you should anticipate a copay if your visit corresponds to any of the aforementioned codes.

Much like the office copays, this amount is calculated in relation to the Part B 20% coinsurance. In essence, it’s determined by the Medicare-approved amount designated for that specific service.

What happens if you are admitted as an inpatient?

Transitioning from an emergency room visit to being admitted as an inpatient in the hospital is not only a procedural shift but also brings about a change in your Medicare coverage. While receiving care in the emergency room falls under Part B coverage, being admitted as an inpatient result in Part A coverage governing your inpatient stay. Consequently, if you become an inpatient in the hospital following an ER visit and your care is covered by Part A, your Plan N copay will be waived.

How often do you pay the ER copay?

While the desire to make multiple visits to the emergency room in a single day is minimal, it’s a circumstance that can occur. In such a situation, if you don’t end up being admitted to the hospital as an inpatient, you will be responsible for a copay of up to $50 for each relevant emergency room visit you experience on that particular day.

Is Plan N the right plan for you?

All factors considered, Plan N offers comprehensive coverage tailored to Medicare beneficiaries seeking lower premiums or those who infrequently visit the doctor. However, as time has passed, I’ve encountered numerous individuals raising inquiries about the Plan N copays prior to enrolling. The available information hasn’t always been crystal clear. The truth is, that copayments can accumulate, making it vital to grasp which services necessitate these copays—a crucial aspect impacting one’s decisions concerning Medigap.

Should you find yourself with queries about Plan N and its cost structure, rest assured that my team is equipped with answers. You can reach us at 817-249-8600. Our assistance extends beyond mere enrollment; we’re here to provide guidance if you have concerns about copays or bills. And remember, our services come to you free of charge.

Key Takeaways

• Copays within Plan N are determined by the specific coding assigned to each visit.
• Roughly 15 doctor visits are subject to the office visit copay.
• The copay for emergency room visits is applicable to 5 distinct codes.

The post Medicare Plan N Copays: Clearing Up the Confusion appeared first on Insurance Specialists Group.

Once you register for Medicare, you’re presented with two primary options: opting for a Medicare Supplement or a Medicare Advantage plan. After settling on one of these, a plethora of further choices await.

Medicare Supplement plans act as a secondary payer to Medicare, resulting in reduced out-of-pocket expenses throughout the year. Such plans can offer you a clear-cut medical coverage framework. However, it’s crucial to grasp all the intricacies and potential benefits of Medicare Supplements. It’s also wise to explore the leading Medicare Supplement providers in your vicinity, as premium rates can differ. Before diving deep into your research, let’s touch upon some fundamental aspects of supplement plans.

What do Medicare Supplemental Policies entail?

Medicare Supplemental Policies, often known as Medigap coverage, act as auxiliary insurance, assisting beneficiaries with the residual costs not covered by Medicare. For instance, while Medicare Part B covers 80% of sanctioned outpatient procedures, the beneficiary is responsible for the other 20%. This is where Medigap coverage steps in, offering either complete or partial assistance with deductibles, copays, and coinsurance for a set monthly fee.

Unlike some plans, these supplemental policies don’t restrict you to specific networks. Thus, beneficiaries can seek medical attention from any physician nationwide who acknowledges Original Medicare.

What will be the most popular Medicare Supplement plan in 2023? 

The right plan for you comes down to your personal preferences and individual needs. However, two of the most popular supplements are Plan G and Plan N. 

Medicare Supplement Plan G 

Over time, Plan G has gained traction owing to its extensive health benefits. Those enrolled in Plan G cover the yearly Part B deductible, and subsequently, all their Medicare-sanctioned treatments for the year are fully catered for.

Medicare Supplement Plan N 

Plan N stands out as another favored Medigap option, bearing resemblance to Plan G. Generally, Plan N features more affordable monthly premiums compared to Plan G, though it comes with increased out-of-pocket costs. Under Plan N, beneficiaries cover the annual Part B deductible, any surplus charges, and copayments for visits to doctors and emergency rooms. Apart from these distinctions, Plans N and G offer similar benefits.

It’s crucial for those on Medicare to understand that the medical benefits of a Medigap policy, like Plan G, remain consistent regardless of the insurance provider. For instance, a Plan G from Aetna will encompass the same benefits as one from Mutual of Omaha. The primary variation lies in the cost.

How much do Supplement plans cost? 

While the healthcare benefits are clear-cut, determining the expense of a Supplement plan is more nuanced. Monthly fees are influenced by aspects such as your age, gender, residential area, smoking habits, and the specific insurance provider.

Given these variables, the price tag of a Supplement plan can differ for each individual. Moreover, the costs can shift based on the extent of coverage. For instance, if you’re transitioning from a Plan G to a Plan N, which offers slightly reduced coverage, you’re likely to encounter more affordable premiums compared to your Plan G.

When can I apply for a Medicare Supplement plan in 2023? 

There are several factors to consider when evaluating a Supplement.

For those already on a Medicare Supplement plan in 2023 and looking to transition to a more budget-friendly provider, you have the flexibility to compare premium costs throughout the year. Many individuals tend to review their premium rates closer to their policy’s renewal date.

Switching from a Medicare Advantage plan to a supplemental plan involves a few more steps. To make this transition, you’ll first need to sign up for a Part D plan, which will facilitate your exit from the Advantage plan. However, enrollment in a Part D plan is contingent on having an open election period. As such, this change necessitates a bit more foresight.

Open Enrollment 

For those venturing into Medicare, the ideal moment to opt for a Medicare Supplement is during your open enrollment phase. Medicare participants are granted a unique six-month open enrollment duration, which is aligned with their Part B commencement date. Within this timeframe, you can secure a Medicare Supplement without undergoing any health evaluations.

For individuals making the shift to Medicare in 2023, it’s crucial to pinpoint the conclusion of your open enrollment phase to ensure you don’t overlook it.

Underwriting  

After the conclusion of your unique open enrollment phase, there’s a high probability you’ll be subjected to health evaluations when seeking a Supplement plan.

While certain states offer deviations from this norm, be aware that if you’re contemplating a change in plans or insurance providers, health assessments might be a prerequisite for approval. Depending on the outcome of this underwriting, you could be accepted, rejected, or face elevated premiums due to prior health conditions.

Compare your options 

Medicare Supplemental policies are available across all 50 states. However, the specific plans accessible to you hinge on the offerings of insurance providers in your region. It’s essential to weigh your options and make a choice that aligns with both your medical requirements and financial capacity.

Understanding the nuances of your Medicare coverage is crucial. At Boomer Benefits, we’re equipped to assist you in assessing aspects like a provider’s fiscal stability and typical rate augmentations, enabling you to pinpoint the optimal choice for your situation.

Key Takeaways

• Participants choose Medicare Supplemental Policies to manage post-Medicare medical and hospital bills.
• The top choices for Medicare Supplemental policies in 2023 are Plan G and Plan N.
• It’s recommended to secure such a plan during the designated Medicare Supplement Open Enrollment period; otherwise, health evaluations might be required when applying.

The post Choosing a Medicare Supplement Plan in 2023 appeared first on Insurance Specialists Group.

Besides pinpointing the right time to sign up, it’s equally important to be aware of the anticipated Medicare costs and the kind of coverage essential for your needs. But before diving deeper, may I ask at what age you’re planning to retire in 2023?

“Set to Retire at 65 in 2023?”

If you’re eyeing retirement at 65, you’ll need to register for Medicare during your Initial Enrollment Period (IEP). This period spans seven months, starting three months before you turn 65 and concluding three months after your birthday. If you enroll prior to your 65th birthday month, your Medicare benefits will commence on the first day of that month. However, if you register in the three months following your 65th birthday, your coverage will kick off on the first day of the subsequent month.

Typically, employer-provided insurance remains active until the month’s end, when you retire. However, this can differ based on the employer, so it’s wise to touch base with your HR team to ascertain the exact termination date of your workplace insurance.

What to do If You Retire Before 65

If you’re looking to retire before hitting 65 and won’t retain insurance from your former employer, you might want to think about opting for an ACA plan. You can explore available plans in your vicinity on healthcare.gov and select one that aligns with your budget.

It’s essential to note that ACA plans don’t count as creditable coverage for Medicare. Hence, when you approach 65, it’s advisable to shift to Medicare. Ensure you register for Medicare within the 7-month IEP timeframe. Subsequently, delve into Medigap or Medicare Advantage plans to determine which aligns best with your requirements. After finalizing your Medicare coverage, reach out to your ACA provider to terminate the plan. Ideally, you can arrange for your ACA coverage to conclude at the month’s end, with Medicare taking over at the start of the next month.

If you retire before 65 and opt for Cobra from your past employer, you should still enroll in Medicare during your IEP.

Are You Past 65 and Retiring in 2023?

If you’ve missed your IEP window but either you or your spouse are still actively employed with a large company, you’ll qualify for a Special Enrollment Period (SEP) to register for Medicare once that employer’s health coverage ceases. You’ll be granted an 8-month period to sign up for Medicare after losing such coverage or ending employment to avoid any penalties for late enrollment.

Yet, many opt to have their Medicare benefits kick in right after their previous employer-based coverage concludes. It’s advisable to initiate the Medicare application roughly two months before you want it to take effect, given that Social Security processing can span several weeks. When applying due to the loss of creditable coverage, ensure you provide both CMS Form 40B and CMS Form L564 to the Social Security office.

For those considering employment with a smaller firm post-65, it’s crucial to understand that Medicare will be the primary coverage, with the group plan acting as secondary. Hence, it’s wise to enroll in Medicare during your IEP to sidestep any penalties for delayed enrollment.

Retiree Coverage

Should you be presented with Cobra or retiree insurance upon retirement, it’s typically beneficial to activate Medicare immediately when transitioning to Cobra or the retiree scheme. These alternatives often act as supplements to Medicare Parts A and B. To get clarity on how your retiree insurance integrates with Medicare, it’s best to liaise with your HR team or directly reach out to Medicare.

Post-Employer Coverage to Consider with Medicare

If your previous employer provides you with a retiree plan option, it’s worthwhile to juxtapose that with plans from private insurers, like Medicare Advantage or Medicare Supplement plans. Often, these private plans might offer more financial advantages compared to the retiree plan.

Medicare doesn’t shoulder the entirety of your hospital and medical service costs. Anticipate some shared expenses, including copays, deductibles, and a 20% coinsurance for services, without a ceiling on these charges. This shared cost aspect underscores the rationale behind many opting for supplemental insurance.

Medicare Supplement Option

A Medicare Supplement Plan, often referred to as Medigap acts as a secondary plan to assist in covering those additional expenses. Its primary function is to address costs after Medicare has made its payment, aiding in managing deductibles, copays, and coinsurance. Upon the activation of your Part B, a 6-month Medigap Open Enrollment period commences, during which you can join a Medigap plan without undergoing any health-related inquiries. However, after this period, in several states, you might be required to respond to health-related questions.

Prescription Drug Plan

Furthermore, it’s advisable to sign up for a Part D prescription plan to secure outpatient drug coverage. If you register for Medicare during your IEP, you should also join a Part D plan within that same seven-month timeframe. Some individuals might opt to enroll at a later stage, post their IEP, especially if they continue working beyond 65 and their workplace insurance caters to their medication needs. In such cases, a 2-month Special Election Period is granted from the day the employer-provided coverage ceases, allowing enrollment into a Part D plan.

Medicare Advantage Option

Another avenue to consider is the Advantage plan, which serves as an alternate method to avail your Medicare benefits. This plan comes into play for hospital visits or any medical service requirements. Advantage plans might extend coverage for services not encompassed by Medicare, like regular dental, vision, and hearing care, and can also incorporate drug coverage.

The registration periods align with those of Part D. If you’re initiating Medicare at 65 upon retirement, you can enroll during the same seven-month span. But, if retirement comes post-65, a two-month timeframe is available for Medicare Advantage plan sign-up. Should you overlook this period, you’d need to await the subsequent enrollment opportunity, like the Annual Election Period that rolls around each autumn.

Medicare Costs You Need to Know Before Retiring in 2023

The majority of individuals don’t pay a monthly fee for Medicare Part A, given they’ve worked a minimum of 40 quarters within the U.S. If you haven’t met this 40-quarter criterion, the premium could be either $278 or $506, contingent on the number of quarters worked. Eligibility for complimentary Part A can also be achieved through a spouse aged 62 or older, provided you’ve been wed for at least a year. Even an ex-spouse’s or deceased spouse’s work record can grant you this benefit, so most don’t bear the cost for Part A.

Conversely, every Medicare recipient is obligated to cover the Part B premium. For 2023, the standard foundational premium stands at $164.90. Certain individuals might incur a higher Part B fee, influenced by their earnings.

Social Security assesses your tax documentation from two years prior. If, in 2021, your MAGI exceeded $97K as an individual or $194K jointly, your 2023 fee will be higher. The surplus you remit beyond the foundational premium is termed the Income Related Monthly Adjustment Amount (IRMAA). Should there be alterations in your income, you have the option to contest the IRMAA. Annually, Social Security revisits your Part B premium, notifying you of any changes for the forthcoming year via a Benefit Determination Letter, typically dispatched in December or January.

Beyond the premiums for Original Medicare, it’s prudent to gauge the potential costs of a Medicare Advantage plan, Medicare Supplement plan, and Part D plan as you approach retirement in 2023, ensuring a smoother transition.

Final Point

Preparing for retirement requires meticulous attention, given the various enrollment periods to monitor and understand. Moreover, it’s essential to be clear on your financial limits and evaluate all available choices, ensuring you select the most economical solution tailored to your needs.

Many eagerly anticipate retirement, and our primary goal is to facilitate a seamless shift for our clients into Medicare. Our proficiency in Medicare registrations and plan options sets us apart. If 2023 marks your retirement year and you seek guidance exploring your alternatives, don’t hesitate to reach out. Our assistance comes at no cost to you.

Key Takeaways

• In 2023, consider registering for Medicare if retiring before age 65.
• Use the designated Initial Enrollment Period for Medicare registration.
• For those retiring after age 65, two specific forms need to be completed.
• Submit the completed forms to Social Security.
• If provided with retiree benefits, evaluate them.
• Compare retiree benefits to Medicare Supplement or Medicare Advantage plans.

The post Planning to Retire in 2023? Essential Medicare Enrollment Information for You. appeared first on Insurance Specialists Group.

Medicare Advantage plans come with their own set of advantages and disadvantages. If you’ve ever watched television, you’ve likely seen numerous ads touting the extra benefits these plans offer.

The abundance of information and sometimes misleading claims can make the process of selecting a plan quite challenging and perplexing. In our exclusive Medicare Q&A community on Facebook, we often encounter questions about why someone would opt for a Medicare Advantage plan when so many seem to endorse Medicare Supplement plans. To address this, let’s delve into some crucial factors you should weigh when deciding on a plan.

First, how do Advantage plans even work?

Before delving into the reasons for considering an Advantage plan, it’s crucial to grasp how they operate.

Medicare Advantage plans serve as an alternative to traditional Medicare and are provided by private insurance firms. Opting for an Advantage plan means you decide to access all your Medicare benefits (Part A, Part B, and Part D) via the chosen insurance provider. While these plans are mandated to offer benefits equivalent to Medicare Parts A and B, the expenses can differ across plans.

It’s also worth noting that Medicare Advantage plans come with specific network limitations. The insurance provider establishes a network of healthcare professionals and pharmacies, to determine your cost-sharing amounts. It’s vital to compare costs between plans, as once you commit, you’re bound to that plan for the entire year.

Why might someone choose a Medicare Advantage plan? 

Upon understanding the intricacies of Medicare Advantage plans, you might conclude, “That seems manageable,” or “It feels a tad overwhelming.”

We’re addressing your health coverage here. Merely skimming the surface and overlooking the specifics isn’t the best approach. It’s imperative to delve deeply into the subtleties, grasp the plan’s framework, and be aware of your privileges. Here are 10 considerations that might influence someone to select a Medicare Advantage plan:

1. You Can’t Be Turned Down

Contrary to Medigap plans in many regions, Medicare Advantage plans won’t reject your application because of prior health issues. That’s correct! Providers of Advantage plans don’t pose health-related queries in their forms, ensuring you won’t be refused coverage based on your health status.

2. Low monthly premiums 

Given that Medicare Advantage plans might lead to higher out-of-pocket costs compared to Medigap, several providers offer reduced or even no-cost plan premiums. The potential savings in monthly premiums, when compared to Medigap plans, can be quite appealing for healthier seniors who may not frequent the doctor or for those adhering to a tighter budget.

3. Out-of-Pocket Maximum 

With just Original Medicare, Part B covers 80% of your outpatient services, leaving you responsible for the remaining 20%. Regrettably, this 20% has no upper limit. However, with a Medicare Advantage plan, there’s a set yearly maximum for out-of-pocket expenses. Regardless of the total cost of your medical services, you’re assured it won’t surpass a specified limit.

4. No rate increases due to age 

Medigap plans come with varied rate classifications, implying that some individuals might experience a premium hike based on their age. In contrast, with Medicare Advantage plans, your premium remains unaffected by age-related factors. While all insurance plans might see increases due to elements like inflation or escalating healthcare costs, there’s no concern of facing a significant premium jump between the ages of 65 and 80 solely based on age.

5. You can switch every year

Occasionally, after enrolling in an Advantage plan, you might find it’s not the right fit. Fortunately, there are two periods each year when you can switch plans. Each year, you’ll receive a letter notifying you of any alterations to your existing plan for the upcoming year. The good news is, you’re not bound to accept these changes if they don’t align with your preferences. Making a switch can help guarantee that your chosen plan consistently meets both your health requirements and financial constraints.

6. Only one ID card 

A notable advantage of the Medicare Advantage plan is the convenience of managing just one ID card. It consolidates both your medical and prescription benefits. In contrast, with a Medigap plan, you’d have to juggle cards for Original Medicare, Medigap, and Part D. With the Advantage plan, you can securely store your Medicare card and only need to carry the card associated with your Advantage plan.

7. Extra Benefits, anyone? 

In exchange for higher out-of-pocket costs, several providers include added perks in their plans, like dental care, reimbursement for Part B premiums, or even gym memberships. Although these benefits aren’t mandatory and can vary each year, numerous providers nationwide have been enhancing these additional offerings to stay ahead in the market.

8. Networks are not a dealbreaker

A significant point of debate regarding Medicare Advantage plans, in contrast to Original Medicare, is the network limitations inherent to Advantage plans. For many, this poses a challenge, especially if they desire the liberty to choose any healthcare provider or wish to continue with their long-time doctor.

However, this isn’t a concern for everyone. Some individuals don’t mind transitioning to different doctors or pharmacies. It’s also worth noting that the size and scope of Advantage plan networks vary. A good number of individuals discover they’re part of a broad network, offering a diverse range of healthcare providers compatible with their plan, should they need to consult a specialist or switch doctors.

9. Get to pay as you go 

For some, paying a higher monthly insurance premium is acceptable. The assurance of being protected during unforeseen events outweighs potential savings. On the other hand, some view elevated premiums as unnecessary expenditure and lean towards the pay-as-you-go approach of an Advantage plan. This choice becomes particularly attractive for seniors in robust health, as they stand to save considerably on annual premiums if their doctor visits are infrequent.

10. Affordable copays/coinsurance 

While the payment structure might not be as straightforward as Medigap plans, the copays and coinsurance under a Medicare Advantage plan can often be much more affordable than with Medicare alone. For instance, you might face a daily copay for an inpatient hospital visit, but you won’t be immediately hit with the Part A deductible (valued at $1,600 in 2023) as you would with just Medicare Parts A and B.

Tracking these copays and coinsurance can sometimes be a bit challenging, but they serve as an alternative to potentially paying large sums all at once.

How do you get an Advantage plan?

Initially, you need to be registered with Medicare Parts A and B. Without this foundational step, plan enrollment isn’t possible. Then, ensure you’re within the appropriate enrollment period to explore these plans. Collaborating with a broker, like our team at Boomer Benefits, can guide you in pinpointing a plan that aligns with both your health requirements and financial constraints, as well as inform you about the right time to apply.

After joining a plan, any changes or switches can only be made during a legitimate enrollment period. For the majority, this period is the Annual Election Window, which spans from October 15 to December 7. Hence, when zeroing in on a plan, it’s crucial to ascertain whether it’s the best fit for your needs.

To fear or not to fear?

When considering Medicare Advantage plans, it’s essential to review the plan’s Summary of Benefits and its formulary before committing. You should have a clear understanding of your potential annual out-of-pocket expenses. Additionally, it’s crucial to examine the plan’s Part D drug list to ensure it’s cost-effective and includes your vital medications.

While the additional perks from an insurance provider might seem enticing, it’s vital not to overlook the core medical coverage offered. Regardless of your health status, understanding how a plan addresses your medical needs is paramount.

It’s worth noting that the plethora of plan options available varies by location, meaning the choices available to someone might differ from yours. Some individuals swear by their Advantage plans, praising the seamless care they receive, while others have faced challenges like claim rejections and network complications. Remember, the Advantage plan plays a pivotal role in overseeing your care.

Personal experiences can significantly influence one’s perception of these plans. Like many aspects of Medicare, there’s always scope for refining Advantage plans. However, they have been a boon for numerous seniors, offering them cost-effective care they might not have accessed otherwise, leading them to opt for a Medicare Advantage plan.

Key Takeaways

• Advantage plans often come with budget-friendly monthly rates.
• They limit your overall expenses.
• Offer extra benefits not found in standard plans.
• There are no rate increases based on age progression.
• Flexibility to alter plans each year.
• Operate on a pay-per-use model.

The post What Motivates an Individual to Opt for a Medicare Advantage Plan? appeared first on Insurance Specialists Group.

Rapid Healthcare Provision :

CMS is working towards refining the prerequisites for prior authorization for its beneficiaries. Starting in 2024, if an enrollee, already under a treatment regime, opts for a new Advantage plan, a transition span of a minimum of 90 days will be obligatory. With the introduction of fresh guidelines on prior authorization applications, the aim is to overhaul the system that existed before 2024, making it more streamlined for all parties involved: the patient, the medical professional, and the insurer.

Additionally, it’s now imperative for MA plans to constitute a Utilization Management Committee. This committee will be responsible for an annual evaluation of policies, ensuring they are in harmony with the foundational decisions and protocols of Original Medicare.

Updated Regulatory Guidelines :

CMS has unveiled a significant modification, emphasizing clearer clinical criteria directives. The objective behind this is to guarantee that those enrolled in Medicare Advantage receive medical care equivalent to that offered by Medicare.

With this updated directive, MA plans are mandated to adhere to the same protocols and benefit stipulations as set by Traditional Medicare. Consequently, MA plans will face limitations in introducing their unique service guidelines.

In situations where definitive coverage criteria remain elusive, MA entities have the discretion to formulate their own coverage standards, drawing from prevalent treatment protocols or recognized clinical research. It’s crucial to understand that this provision is permissible only under specific conditions, aiming to foster transparency and decisions rooted in evidence.

The Latest Medicare Marketing Directives:

CMS is rolling out fresh marketing standards to shield beneficiaries from misleading promotional tactics. Advertisements lacking a distinct plan name or those utilizing verbiage, visuals, or Medicare emblems that could potentially distort or mischaracterize a plan are no longer permissible.

Furthermore, CMS is intensifying its oversight of the actions of agents and brokers to curb any aggressive practices.

Moreover, one of CMS’s objectives is to enhance beneficiaries’ ability to access accurate information about Medicare coverage and other trustworthy sources.

Star Ratings Program :

CMS is keen on refining the Star rating system for enrollees. A fresh directive introducing a health equity index (HEI) incentive is set to take effect in 2027. The primary goal of this initiative is to motivate Medicare Advantage and Part D plans to elevate the quality of care, with a particular focus on beneficiaries impacted by societal risk elements.

Fair Medical Practices :

In a move to bridge health gaps and champion medical fairness, CMS has unveiled a comprehensive directive that broadens the categories of potentially underserved groups that Medicare Advantage entities must cater to, taking into account their unique cultural or group-specific needs. This directive seeks to foster greater diversity and representation within Medicare Advantage offerings.

For instance, the updated directive aims to encompass individuals with language barriers, diverse racial and ethnic backgrounds, those with disabilities, varied sexual orientations and gender expressions, as well as those grappling with economic challenges.

Furthermore, CMS is set on ensuring that Medicare Advantage entities integrate strategies in their quality enhancement programs that actively work towards diminishing these health disparities.

To address the challenge of digital health unfamiliarity, MA entities are mandated to provide digital health training to their members. This initiative is designed to bolster their utilization of telehealth services.

Expanded Reach for Mental and Behavioral Health Care :

To bolster the availability of behavioral health care, CMS is offering clearer guidelines on the sufficiency of provider networks and the duties of MA entities in delivering these services promptly.

Medicare Advantage providers are now obligated to inform members should their behavioral health or primary care professionals exit the network during the year.

advantage-plan-network-adequacy Among the detailed policy adjustments are the establishment of network criteria for Clinical Psychologists and Licensed Clinical Social Workers, and the stipulation that emergency services related to behavioral health bypass the need for prior approval.

Furthermore, CMS’s latest directive emphasizes that care integration programs should maintain parity between behavioral and physical health services.

The objective behind this revision is to foster a more holistic approach to patient care.

Broader Qualification Criteria for Additional Assistance :

CMS is broadening the criteria for beneficiaries to access the comprehensive low-income subsidy (LIS) benefit, commonly referred to as “Extra Help.” This initiative assists those with limited incomes and resources in managing their prescription costs, covering aspects like premiums, deductibles, and other expenses.

Starting from January 1, 2024, those with incomes amounting to 150% of the federal poverty benchmark and who fulfill certain conditions will be eligible for the complete Extra Help financial aid.

Essentially, individuals who were previously only eligible for a partial subsidy under Extra Help will now have access to full financial support. As per CMS’s statement, this modification aims to “facilitate more affordable prescription medication access for an estimated 300,000 economically challenged Medicare beneficiaries.

Dedication to Enhanced Health Insurance Provision :

Updates introduced by CMS have the potential to enhance both the Medicare Advantage and Part D initiatives significantly. These revisions are designed to promote medical fairness, ensure prompt healthcare services, shield beneficiaries from misleading promotional strategies, amplify the availability of behavioral healthcare, and incorporate directives from recent laws, including the 2022 Inflation Reduction Act and the 2021 Consolidated Appropriations Act. By addressing these pivotal issues and formulating new promotional standards for Medicare, the aspiration is to elevate the quality and overall beneficiary experience within Advantage and Part D schemes.

Essential Highlights :

• For the 2024 calendar year, Advantage and Part D schemes will undergo rigorous scrutiny as they roll out these updates.
• Adjustments in prior authorization and revamped promotional standards aim to curb misleading marketing strategies moving forward.
• Enhancements in coverage and the broadening of the ‘Extra Help’ initiative are anticipated to broaden healthcare access for numerous beneficiaries.

The post Government Intensifies Scrutiny of Medicare Advantage and Part D appeared first on Insurance Specialists Group.

As of 2023, the standard cost of Medicare Part B is $164.90 for individuals who are newly enrolled. This rate is applicable to the majority of beneficiaries. However, those in the uppermost income bracket might find themselves liable for notably higher amounts.

The determination of what you’ll pay is conducted by Social Security based on your modified adjusted gross income (MAGI), which is reported to the IRS. Should you face an increased premium, Social Security labels this additional amount your “income-related monthly adjustment amount” (IRMAA). This sum will be deducted from your Social Security income disbursement. If you’re not currently receiving income benefits, it will be invoiced to you.

The IRMAA appeal is essentially a petition that you can submit to Social Security with the aim of reducing your Part B premium. This entails filling out Form SSA-44 to inform Medicare that you’ve encountered a life-altering event that has impacted your income.

Before delving into the appeal process, let’s delve into the details that factor into the calculation of your premium.

Modified Adjusted Gross Income

Your modified adjusted gross income (MAGI) is comprised of your overall adjusted gross income and any tax-exempt interest earnings. (The Form SSA-44 provides instructions detailing the specific line numbers on your IRS Tax return to use for this calculation.)

Examples of income that you might have disclosed on your tax return encompass wages, dividends, received alimony, rental income, farm income, investment gains, capital gains, and Social Security benefits. Deductions that you may have claimed on your tax return could include items like student loan interest, alimony paid, tuition expenses, and contributions to retirement plans.

Social Security bases its calculations on the income details you provided in your most recently submitted federal tax return. Consequently, they often determine your premium using the MAGI reported from two years prior to the present time. In other words, your Medicare premiums for 2023 will typically hinge on the MAGI from your 2021 tax return, and this pattern continues for subsequent years.

If they determine you owe a higher premium based on your MAGI, they will send you a letter to notify you of your new amount. They will also give you the reason for their determination. If you disagree with this amount, you have the right to appeal it via a reconsideration request.

Qualifying Reasons for a Medicare Part B Premium Appeal

There are various grounds on which you may become eligible for a reduced premium. Social Security designates these instances as “Life-Changing Events.”

Among the most frequent scenarios is the transition from active employment to retirement or a decrease in working hours. During this shift, your monthly income typically experiences a notable decline compared to your working years. For instance, consider a scenario where you are an individual and your earnings were $96,000 at the time of your retirement in 2021. Subsequently, your post-retirement income consists of solely $40,000 from Social Security and IRA distributions. This situation lends weight to your argument against being subjected to a heightened Part B premium based on your former income.

Other reasons for an IRMAA appeal may include:

• Changes in marital status such as marriage, divorce, or becoming widowed
• Loss of income-generating assets
• Modifications or discontinuation of a pension plan
• Reception of a settlement from an employer due to company closure or bankruptcy

At times, individuals may also dispute the accuracy of the MAGI information reported by the IRS to Social Security. In such instances, it is necessary to communicate with the IRS and rectify the data prior to initiating an appeal. Filing an amended tax return could potentially rectify the issue.

Our team has received feedback from numerous clients concerning appeals, revealing a range of outcomes. For instance, in situations where a year included capital gains or the sale of property that raised annual income, the results of appeals have been mixed. Approvals may be influenced by the magnitude of the gain. On some occasions, your premium might be adjusted, while in others, it could be argued that your tax return indicates substantial earnings, justifying a higher Medicare Part B premium for the year.

If there’s one piece of advice I could offer, it would be this: There’s no harm in attempting an appeal, especially if you can provide evidence of an income change. The appeal process incurs no cost, and by presenting your case effectively, you may potentially save on expenses. For insights into how to initiate an appeal and what documents to submit, you can also refer to our YouTube video on IRMAA appeals.

How to file your Medicare Reconsideration Request

If you intend to challenge your IRMAA, you should obtain and print Form SSA-44 titled “Medicare Income-Related Monthly Adjustment Amount-Life-Changing Event.” This form provides step-by-step guidance for updating your income details and outlines the necessary documentation to validate your revised MAGI.

Similar to any appeal, the crux lies in your documentation. Draft a cover letter elucidating the reasons for your belief that you’re being charged excessively. Subsequently, present corroborative documentation. For instance, you could enclose a letter from your former employer confirming your retirement, coupled with a copy of your last pay stub illustrating your previous earnings that are no longer applicable.

Additional documents that could support a case of income loss encompass bank statements, termination or retirement letters from employers, and other financial records.

In essence, furnish as many authorized documents and factual details as possible to bolster your argument.

Upon a successful appeal, Social Security will automatically correct your Medicare Part B premium rates. In the event of an appeal denial, you’ll receive instructions on how to escalate the appeal to an Administrative Law Judge.

Keep in mind that while your appeal is being processed, you will continue paying the elevated Medicare Part B premium. Nonetheless, if your appeal is granted, it might apply retroactively to months for which you’ve already made payments. If this applies to your case, a refund won’t be issued, but the overpaid premiums will be credited toward your upcoming Part B premiums.

Part D Income Adjustments

IRMAA also affects your Part D premium. Unlike Medicare Part B, your Part D premium varies based on which Part D drug plan you have chosen to enroll in. Right now, in 2023, Part D premiums range from around $7 to over $180/month, depending on where you live. (For more on finding the right Part D plan, visit our pages about Part D.)

It is important to note, the extra amount you pay will not be part of your plan premium. Most people have the extra amount taken out of their Social Security check. Should you choose not to have it taken out of your check, you will receive a bill from Medicare directly. In order to keep your Part D coverage, you must pay the extra amount in full.

Let’s say you enroll in a plan that has a $30/monthly premium. If Social Security has advised you that you owe an income adjustment for higher income, you will pay an “adjustment” on top of your $30 monthly premium.

Plan the timing of your Medicare enrollment

Social Security handles the adjustment of your premium annually, coinciding with the commencement of each new year. Typically, in December or January, you will receive a letter detailing your upcoming premium for the impending year. Consequently, if your income has declined, Social Security will eventually catch up and automatically decrease or eliminate your IRMAA. This serves as a glimmer of hope on the horizon!

For those aware in advance that they will face higher premiums, strategic retirement planning becomes crucial. Collaborate with your financial advisor to determine the optimal timing for initiating distributions from retirement accounts, aiming to minimize the impact on your Medicare premiums.

Initiating an appeal to reconsider your Medicare Part B premium constitutes the primary step. Once you’ve addressed your Medicare costs and are prepared to explore Medicare supplement options, additional opportunities for savings arise. It’s truly astounding how numerous individuals with higher incomes remain unaware of these plans. Agents who neglect to discuss these money-saving alternatives with their clients are doing them a disservice.

The suitability of these plans for individuals with higher earnings becomes evident due to their financial reserves. This offers the flexibility to consider Medigap plans that involve a degree of cost-sharing in exchange for significantly reduced monthly expenses. While there might be instances where you incur costs like deductibles or coinsurance during years marked by medical expenditures due to health issues, the cumulative savings over the years can be substantial.

Plans that Save You Money

Plan G stands out as a particularly favored option among our clients with higher incomes. In exchange for covering a modest annual Part B deductible ($226 in 2023), it’s feasible to encounter premiums that are up to $250 lower compared to those of a Plan F. This translates to retaining more funds in your own pocket.

Beyond Plan G, Medigap Plans L, M, N, and High Deductible F also emerge as excellent solutions for individuals with higher incomes. Curiously, these plans aren’t frequently discussed by agents, yet they offer substantial savings while entailing slightly elevated cost-sharing. The noteworthy aspect is that Medicare continues to cover 80% of your outpatient expenses. By opting for a plan featuring a slightly higher deductible or increased coinsurance, you can seize the opportunity for considerable savings. Moreover, selecting a plan with lower premiums can help counterbalance any heightened Medicare Part B premiums you might be subject to.

Key Takeaways

• Social Security evaluates your income from 2 years prior to determine what you will pay for Medicare Parts B and D in the current year.
• The income brackets and premiums change every year.
• You can appeal IRMAA if you have a qualifying event.

The post How to Appeal a Higher Medicare Part B Premium appeared first on Insurance Specialists Group.

The post Understanding Medicare Trial Rights appeared first on Insurance Specialists Group.

Technology

• • • These will be your most expensive and valued components. Without them, you cannot do your job.  Your technology will consist of computer, printer/fax/scan, phone and appropriate software.
    • Remember that any investment you make in your business, can be a tax write-off so keep all receipts and expenses.
    • Computer – Either a desktop or a laptop.  
      • We recommend getting a laptop so that you can be portable and take everything with you.
      • We recommend getting a laptop that has touch capability.  This way clients can sign the electronic applications with their finger or a stylus.
      • Make sure it has a camera.  In today’s world, virtual meetings are more commonplace.  You want them to be able to see your smiling face without a mask.
      • Ensure it has at LEAST 8 GB of memory.  More is always better.
      • It is your preference on whether you get an Apple or a Window’s machine.  We are only familiar with Windows machines and would not be able to assist with Apple issues.
      • Get one with a descent size screen, but is lightweight enough for you to lug around.
      • Multiple USB ports are necessary.
      • Make sure it has good high speed wi-fi.
      • With a laptop, you can get a docking station so that when you are working in your office, you can hook it into dual monitors, a mouse and more.
      • You should be able to find a decent one for $500-$750.  When you see ones on sale, check how much memory they have, typically the really cheap ones don’t have enough.
      • We recommend at least having Windows 10 if you are buying a refurbished one.  Refurbished ones usually come with a good warranty and can save you money. 
      • If you opt for a desktop instead, then consider getting a tablet or IPAD for when you want to go and take applications electronically when you are not in your office.  Most of the carriers have apps for the IPAD vs a tablet.  You can get good refurbished IPAD’s from Apple’s website.  They might not be the latest one, but they do offer good deals on them and they come with a warranty and the Apple store guys will help you get it all set up.
      • If you go with a desktop, we find that dual monitors (2 of them) are the way to go.  You can have things on both monitors for easily seeing multiple windows.  We can’t live without them in our office.  Once you go dual, you’ll never go back.
      • Make sure you have all the necessary firewall and anti-virus software on your machine.  We use MalwareBytes for security on each and every computer in our office. It is inexpensive and easy to use and install.
      • We recommend you back up your files regularly on your machine. Look under the database section for our recommendation on Carbonite.
      • Security is totally necessary.  It is not important to put encryption on your hard drive, but your CRM software and logon should have a secure not easy to hack password. ALWAYS have a power on or logon password to even get into your machine.  Never leave it in your car where it is easily seen so it can be stolen.  Lock it in your trunk or take it with you.  A stolen machine could result in your PHI or client information stolen. If that happens, you will have to report the breach to all the carriers and if anyone’s information gets out, you will need to be purchasing Identity Theft protection for them.  All bad, a hassle and potentially devastating for you and your business.

Printer

• • • • Pretty much any printer will work.  You may want to consider a laser printer as the ink lasts longer than the ink jet printers.  Ink is always the most expensive part of a printer.
      • If you are wanting something more professional and business like, consider getting ahold of Duplicator Sales and Service (502-458-5555) and see if they have a refurbished Lexmark for sale.  You don’t need to buy or lease a new one. Refurbished will be fine. The cost will be more expensive ($1000 or more), but you will get a machine that can fax, scan, copy, etc.   They can come with maintenance contracts that will provide free toner and service calls.  We highly recommend getting a Lexmark. We have used other printers in the past and love our Lexmark printer. They are easy to use, set up and very reliable.
      • If you are interested in printing brochures in color, you may want to get a printer that prints color as well.  If you don’t do that much color printing, consider just getting your color brochures, etc. printed at Office Depot, Staples or another place when you need them done.  
      • Anthem will give you a discount at the Fed-Ex places if you use account number 0324616799.  This can offer you a large savings on your printing needs.
      • We recommend getting an all-in-one printer. These can print, scan and fax.  Why have multiple devices when one will do the job.  
      • You will need to scan documents in.  If you take a paper application (sometimes unavoidable), you will need to scan it in or fax it.  You may need to scan in scope of appointments to upload when you submit an application.  Taking pictures with your phone will not always cut it.
      • There is an app for the phone called Cam Scanner.  It can be used to scan things in, but can be bulky if you are scanning in many things.
      • Most all-in-ones will enable you to fax as well.  See our fax option below if you won’t be having a home office phone.
      • Some printers will allow for wireless printing from your laptop, IPAD or phone.

Phone

• • • • Will you only be using your cell phone as your business phone or will you have a separate land line?
      • If you are using your cell phone, keep in mind that clients could call you at any time.  Do you want to be accessible 24 hr/day?  How will you distinguish between personal and business calls?
      • If you are going to use your personal cell phone for business, make sure that you have personal limits on when you will answer business calls or return them.  Remember, you have a life.  Clients DON’T need to be able to reach you at all hours.  They can’t reach their doctor or dentist, why should they be able to reach you… unless you want them to.
      • Google Voice may be an option for you.  This choice allows you to receive calls and texts to your current cell phone from a DIFFERENT phone number than what you have with you carrier.  To do this, here are some things to know:
        • This is a FREE service via Google.  You only get charged if you use the service on international calls and, even when you do that, it is something like one cent per minute.
        • Its best to initially sign-up for this option on your computer and then install the app on your phone.
        • When you have WIFI, the app uses that.  When you don’t have WIFI, the app will use your cellular data so it’s best to have an unlimited data plan so you can answer work calls wherever you are
        • Your phone number will work…ANYWHERE IN THE WORLD.  
        • Once you sign-up, you will pick an available local number from the options Google gives you.  This will be your work phone number.  Clients will use that number to call/text you.
        • You can customize the settings of Google Voice to do many things, including the following:
          • Put it on do not disturb
          • Customize voice mail messages
          • Set it so you can see if it is a work or personal call in-bound
      • If you have a land line, is it separate from your home number?  If not, then again, when someone calls how will you know if it is personal or business?  Do you have family members that may pick up the phone not knowing it is a client?  
      • If you do a land line, we recommend having one that you use solely for business.  You can make calls from it or fax from it.  You can also write it off as a business expense.
      • Some carriers will give you a discount for a second phone line.  In my personal home, we use our cell phones for calls from friends and the land line for our internet and fax only. 

• Fax

• • • • There are multiple ways to handle your faxing. Most have added costs.
      • EFax – was MaxEmail. 
        • Pay a subscription fee and any faxes received to your designated number will be sent to you via e-mail. They typically come as a PDF File.
        • The cost can be very affordable. 
      • Google E-fax options and you will find more. It has been a while since we personally used this sort of service. If you want to send a fax, typically you have to scan it in and upload it.  The fax phone number you receive faxes on may not be a local number.  But the faxes come to you as a PDF in the email.
      • With an E-Fax option, you have to be able to scan the document in to upload and fax it. Resolution of the scans might not be the best when the e-fax sends it out.
      • Designated fax line with machine. If you get an all-in-one printer, they will come with fax capabilities.  You need to have a land line for them to send out.  You can use your business line or personal line to fax out on.  Note that you will not be able to use your phone line when you are faxing.
      • You can always go to Office Depot, Staples, Fed Ex, UPS stores to fax. This will cost you money per page and will not always be convenient.  Getting a printer that can fax as well as print will be much more cost effective.
    • Database Program – CRM
      • You need to keep track of your clients. The cleaner, the better and the earlier you start, the easier it is.
      • There are CRM (Customer Relationship Manager) programs out there that you can purchase and use.  AgencyBlock, Radiusbob, Salesfore Hubspot, ACT.
      • Before investing in a CRM, take a demo of it or do a trial.  See if it accomplishes what you want.  Is it customizable, flexible, can you import your commissions? What does it cost?  Some of them can be really good but fairly expensive on a monthly basis.
      • At a minimum, start an Excel spreadsheet of your clients.  Capture the basic information like name, address, phone, etc.  At least that way you can print mailing labels easily for your newsletters and mailings.
      • You need to have a way to keep track of your clients and their information.
      • We utilize Sage ACT! for our database.  We have highly customized it and it contains ALL our client information. We track policies through the opportunity feature and can attach all documents (applications) to a client with the Document tab.  We are happy to show you our system.  A license with support costs $300/year.  You get all the most recent versions and support to get it installed and working on your system
      • You could use an Access database with Microsoft office, but unless you are a tech-weenie, it might be too complicated.
      • No matter what you use, MAKE SURE YOU BACK IT UP REGULARLY. There is nothing like a hard drive crash to make you lose all your data.  If possible, back it up to the cloud or an external hard drive that you save in a good place.  That way if your machine gets stolen or damaged, you have all your data separate.
      • Purchase a copy of Carbonite, which runs $79/year to back up all important files on your machine to the cloud. That way you can always recover them if necessary, with minimal data loss.

Security

• • • • We have discussed this above a couple of times.  Security of your data is paramount.  Any breach of your data must be reported to all carriers and the Department of Insurance.
      • You could be liable if your client’s info is compromised.
      • Keep secure passwords for all of your agent sites, computer logons, database logons.
      • Make sure your computers all have virus protection and malware protection.  We use MalwareBytes as it covers all these sorts of things and monitors in real time. It is also not very expensive.
      • Make sure your router and internet have secure firewall protection.  Check with your internet provider. They may have some things built into it.
      • Ensure you regularly run scans of your hard drives
      • Have real time monitoring for issues
      • Back up your data regularly and either to a remote drive or to the cloud.  We find Carbonite to be inexpensive and will continually back up new files.

Internet

• • • You can’t have a connection that it too fast.  
    • If you have DSL, your internet and phone will come over the same line.
    • If you have cable, then your internet will come over your cable line. You can also get a phone that will come over your cable line.
    • Make sure you have security on your router.  Your internet provider can assist with this.
    • On your wireless, make sure you have a strong password so someone can’t sit outside your house and access your wireless and your network.  Make sure you have security on your wireless connection.

Car box or briefcase contents

• • Often times, if you are meeting a client in their home or outside of your office, there will be times when you will need to change your recommendation based upon new information learned or something the client forgot to tell you.  Be ready so you don’t have to set another appointment and take more of your and their time.
  • You need to be prepared for questions you may not know or have extra applications in case you have to change your pre-determined plan.  This way you can just go to your car and get what you need.
  • If you will be doing all your applications electronically at the point of sale, it is always good to have a car box as a backup.
  • You need a box in your car with the following:
    • Extra Scopes, drug plan forms, doctor list forms and authorization forms if you will be accessing their Medicare.gov account
    • Forms for signing up for Part B and the Form for Employers to fill out.
    • Copy of the IRMAA and LIS Charts
    • 1-2 application kits for every plan.  Make sure you replenish the box when you use one.
    • A copy of the carrier contact book or reference book in case you need the information.  You can also store this on your computer.
  • In your briefcase if you have one, make sure you have extra scopes, drug lists, doctor lists and authorization forms in case you have a walk-in or additional person attending the appointment.  If the client only marked one box on the scope and wants to talk about something else, you need a new scope of appointment signed before you can discuss the items.
  • You will also need your marked up copy of the Medicare and You book.  We use this in many appointments to either reinforce a point or show clients where they can find information.  See the section below on what to put in and how to mark up the Medicare and You book.
  • Have a copy of the IRMAA chart to give to clients.
  • You don’t want your briefcase to be too heavy but you also want to be prepared. That is why you can also put things in your car box.  Don’t be afraid of saying you have that but you need to get it from your car.  It shows you are prepared.
  • I use a yellow pad of paper.  It stands out when the client is looking for something.  If they are coming back you can easily see the paper you used.  My leave behind is also printed on yellow paper.  Yellow paper copies blind on a copier so it won’t be too dark if you make a copy.
  • You will want to have extra pens in your briefcase.  Make sure you have a few thicker ones as those are easier for an older client to write with.
  • Make sure you have a calculator or use the app on your phone.

Carrier Contact Book

• • It is very helpful to have all of your carrier’s contact information handy in a single book.
  • Make changes to it as things change at the carrier or as you find out additional information.
  • We have provided you with a starting page for each of the carriers you are contracted with.  Updates can be provided upon request.
  • Keep track of the date you make changes so you know how old the information is.  
  • We keep the information in a spreadsheet that we update as we get additional info.
  • You can add other information about a carrier that might be specific to them like how to set something up on a bank draft, etc.

Process Book

• • Because we know how frustrating it is to learn the hard way, we have written a step-by-step document for how to submit every application.
    • Please note that the process may change from year to year when the carriers change the apps and online tools.  We make every attempt to keep it updated.
    • You will need to keep your copy updated as the processes change for a company.  
  • You may keep it digitally or print it out so you can make notes as you enter applications.
  • If you see any errors or changes to the documents we have provided, please let us know so we can change our documents.
  • We are providing this so that you don’t have to suffer through learning things the hard way.  Accuracy in application submission will save you many hours of headaches.  It is easier to do it correctly the first time than it is to fix a problem.
  • The processes are written for our business so you may see some things that refer to what an agent does and what an administrator does.

Reference Book

• • We put this as a separate section in our Carrier Contact Book
  • You will keep references like Federal Poverty Limit chart, IRMAA chart, Carrier Rates and health questions, Drug plan PCN/Group/BIN info, local Medicaid office contact information, the annual PDP/MAPD comparison charts (these are not to be shared with clients), etc.
  • You may need to look to one of these on the fly and having them at your quick disposal keeps things rolling.  It is easier to open a notebook and quickly find the information than it is to browse all over your computer for it.  
  • You will be provided with an initial copy of these items. We update this information annually and distribute it via email when there are new files.

Medicare & You Book

• • • Each year, the Center for Medicare & Medicaid Services (CMS) issues an updated Medicare & You Handbook. Every Medicare beneficiary receives one every year and you can order one from www.medicare.gov.   It is typically available in late September or early October.
      • On the Medicare.gov site go to the top and type in “Medicare and You” in the search bar
      • You can download it to save on your computer if you want.
      • To order one to be mailed to you go to medicare.gov/publication-ordering/10050
      • Pick the language you want and click on Next
      • Enter your information and click on Place Order
      • It should arrive in 2 weeks.
    • Good book to read to understand Medicare’s coverage.  READ IT in its entirety every year.  Highlight things that you find important.  Put little post-it notes sticking out with labels of the sections you will need.
    • You will out the good information that is new each year by reading it. This book is as good or even better than AHIP in telling you about Medicare.
    • Put the IRMAA and LIS chart into the proper part of the book.
    • Important parts to bookmark and highlight. This is based upon the 2021 book.
      • Section 1
        • What are the Part A and B sign up periods?
        • Note the part about COBRA not being credible for Part B
        • Should I get Part B – this deals with employer coverage
        • Does my other insurance work with Medicare – shows you what is primary if they are working or retired.
        • How much does Part B coverage cost – this is where you will put the IRMAA chart
      • Section 2
        • Part B-covered services – note all the things with the apple are preventive care.
        • Highlight the timeframe or limitations for each one. IE.  Mammogram every year, Pap or Pelvic Exam every 24 months.
        • Where it says you may be charged 20%, the Medicare supplement will pick that up.
        • What is NOT covered by Part A and B?
      • Section 3
        • What’s assignment
      • Section 4
        • What are Medicare Advantage Plans?
        • What should I know about Medicare Advantage Plans?
        • Types of Medicare Advantage Plans
      • Section 5
        • When to buy Medigap plans
      • Section 6 
        • When can I join, switch or drop a plan?
        • What is the Late Enrollment Penalty?
        • Which drugs are covered?
        • How do other insurance and programs work with Medicare drug coverage?
      • Section 7 
        • Put the LIS chart here.
        • What if I need help paying my Medicare health care costs? – this is about Medicaid
      • Section 8 
        • What is an “Advance Beneficiary Note of Noncoverage”?
      • Section 9
        • My Medicare.gov account
        • Blue Button
        • Contact info
      • Section 11
        • This is basic and very limited info of the plans offered in KY. You will get the KY book if you have a KY address.
        • Clients will refer to this. Tell them this is very general info and not really helpful in picking a plan.
        • It will give you all the MAPD and PDP plans available.  Note that some are not in all counties

Browser Favorites

• • Aetna Producer World = https://www.aetna.com/producer_public/login.fcc?TYPE=33554433&REALMOID=06-aab84995-cc4b-11d5-8cb8-0008c7df6a81&GUID=&SMAUTHREASON=0&METHOD=GET&SMAGENTNAME=9NWmdAXtfwwGZqBv5rDqq1qMVYyM9FS3lCpWttzwfIo1Jnc9iDx7L9edteIktZdz&TARGET=-SM-https%3a%2f%2fwww%2eaetna%2ecom%2fproducer%2fLogin%2edo
  • Humana Broker Portal = https://www.humana.com/logon/
  • Anthem Broker Portal = https://brokerportal.anthem.com/apps/ptb/login
  • Lasso = https://lassohealthcare.com/2021/agents
  • UHC Jarvis = https://www.uhcjarvis.com/content/jarvis/en/sign_in.html?open=512&objID=282&mode=2&in_hi_userid=237008&cached=true#/sign_in
  • Wellcare Agent = https://wellcare.callidusinsurance.net/ICM/
  • Wellcare ID Now = https://wellcare.identitynow.com/login/login
  • Good RX = https://www.goodrx.com/
  • Social Security Extra Help = https://secure.ssa.gov/i1020/Ee001View.action
  • Silverscript PDP/Aetna = https://www.enrollmentportals.com/Auth/Login.aspx?insCo=ssi
  • Anthem Brochure ordering = https://custompoint.rrd.com/xs2/prelogin?&qwerty=21021402
  • Aetna Medicare Supplement = https://www.aetnaseniorproducts.com/ssi/index.html
  • Mutual of Omaha = https://accounts.mutualofomaha.com/?r=https%3A%2F%2Fproducer.mutualofomaha.com%2Fenterprise%2Fmyportal
  • My AARP Connection = https://www.myaarpconnection.com/
  • Medico = https://mic.gomedico.com/login.aspx?
  • UHC Renew Active = https://uhcrenewactive.com/home
  • Delta Dental = https://kentucky.deltadental.com/
  • Delta Dental Broker Portal = https://brokers.mwadmin.com/
  • Dental Care Plus = https://www.dentalcareplus.com/
  • UHC Dentegra Dental Info = https://www.dentegra.com/
  • Gordon Marketing = https://www.gordonmarketing.com/
  • Doctor Lookup
    • Anthem = https://shop.anthem.com/medicare/standalonetools/find-doctor?state=KY&brand=ABCBS&role=consumer&locale=en_US
    • Anthem Liberty Dental = https://client.libertydentalplan.com/anthem/FindADentist
    • Aetna = https://www.aetnamedicare.com/en/find-doctors-hospitals/find-provider.html
    • Humana = https://www.humana.com/medicare/find-a-doctor
    • UHC = https://www.uhc.com/find-a-physician
    • Wellcare = https://www.wellcare.com/en/Kentucky
    • Delta Vision = https://www.vsp.com/eye-doctor
    • Delta Dentists = https://kentucky.deltadental.com/
  • Medicare = www.medicare.gov
  • Social Security = www.ssa.gov

The post The tools you need to get the job done – Medicare appeared first on Insurance Specialists Group.

Medicare coverage options.

There are many different plan options within these combinations, but there are only a few ways to obtain your Medicare coverage.  The right combination depends on the client’s health, financial situation and what gives them “peace of mind”.  You might think you know what is best for someone, but until you review the options with them, you never know. This is why probing with questions before you start to fully understand their situation is critical.  Refer to the module probing for info

• Original Medicare + Part D Drug Plan
• Original Medicare + Supplement + Part D Drug Plan
• Medicare Advantage Drug Plan. 
• Original Medicare + Group health insurance.  

Someone can be Dual Eligible, which means they are on Medicare and Medicaid, but this eligibility depends on their income, assets and whether they apply for Medicaid with the state.  See our module on Medicaid for more information.

Medicare Supplement or Medigap Plans

Medicare supplements are also called Medigap plans because they supplement or fill in the gaps to original Medicare.  Medicare supplements were standardized in 1992.  The Medicare Improvements for Patients and Providers act of 2008 re-standardized Medicare supplement plans on June 1, 2010.  The standardization of the plans required all companies to offer the same coverage.  It ensured that plans could be easily compared and that the benefits would not change after someone had a policy.  The Medicare Access and CHIP Reauthorization Act of 2015 mandated that as of Jan 1, 2020, the Plan F and C are no longer available.  The Medicare supplement plans are no longer allowed to cover the Part B deductible.  If you were on Medicare as of Jan 1, 2020, you can still purchase a Plan F or Plan C.  If you are new to Medicare after Jan 1, 2020, you cannot purchase the Plan F or Plan C.

There are 10 different Medicare Supplement plans.  Plan A-D, F, G, K-N.  

* Plans F and G also offer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,370 in 2021 before your policy pays anything. (Plans C and F aren’t available to people who were newly eligible for Medicare on or after January 1, 2020.)

** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.

*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in inpatient admission.

If you live in Massachusetts, Minnesota or Wisconsin the plans are standardized differently.  You will need to refer to the Medicare.gov website for specifics.  (https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies)

You must have Part A AND Part B of Medicare to get a Medicare Supplement. That is because the supplement pays AFTER Medicare.  If Medicare doesn’t pay, then the supplement will not pay.  The only exception to this is foreign travel emergency.  As long as a provider accepts Medicare, they must accept the Medicare supplement no matter what company it is.

Part B Deductible

The Part B deductible is what the client pays before coverage starts on plans after Jan 1, 2020.  The Plan F and Plan C covered that deductible.  The Part B deductible is how much the clients has to pay for Part B services.  The cost the client pays during this phase is Medicare’s cost.  For example, if the doctor wants to charge $195 for an office visit, Medicare may only allow $50.  Your client will pay the $50 until they have paid out of their pocket the Part B deductible.  It may take more than one doctor visit to meet the deductible.  They may meet in in one doctor visit.  This deductible is in three different areas:  

1. Outpatient services like doctor visits, outpatient surgery and services, physical therapy, diagnostic tests, and more. See the Medicare and You book for a list of all the services provided.
2. Receiving the first 3 pints of blood.
3. Durable Medical Equipment (DME) like crutches, walkers, wheelchairs, diabetic testing supplies, oxygen, CPAP machines and more.

Even though the deductible is in three different areas, it is only ONE time per year.  A client might meet it by going to the doctor or by getting their diabetic testing supplies, but it is only met once per year.  The year starts over every January.

Guarantee Issue (GI) Situations – Medicare Supplements

You must have Part A AND Part B to get a Medicare supplement.  When a client first goes on Medicare at age 65 and picks up Part B, they have 6 months from their 65th birthday or Part B effective date, to pick up a Medicare Supplement with no underwriting (health questions).  If the client was on Medicare due to a disability, when they turn 65, they have another Initial Election Period to pick up a Medicare supplement with no underwriting.   Refer to our module on Disability for more information on the initial choices someone under 65 on Medicare has available to them.

If the client is coming off of employer coverage and already has Part B, they have 63 days to pick up a Medicare supplement with no underwriting.  If they are picking up Part B when they leave employer coverage, they have the 6-month guarantee issue window to get a Medicare Supplement.  When coming off employer coverage, they only have 63 days to get a prescription drug plan as Part D only requires Part A.  Part D doesn’t require Part A AND Part B.  Refer to the GI section for Part D below.  Likewise, they only have 63 days to pick up a Medicare Advantage plan.  Refer to the GI section for Medicare Advantage below.

The Medicare guidelines state that if you were eligible for Medicare prior to Jan 1, 2020, then you are GI for the Plan F.  Companies interpret this differently.  Some companies will base your Part B effective date as to whether or not you would be eligible for the Plan G guarantee issue.  Make sure you know the rules for each company.  If you are not sure, then call agent services for guidance.  For example, United Healthcare will not give you a Plan G GI if your 65th birthday or Part A effective date is before Jan 1, 2020.  This is true even if your Part B effective date is AFTER Jan 1, 2020.  Anthem, Aetna, Medico and Mutual of Omaha on the other hand will base your Part B effective date as to whether you are eligible for a GI Plan G.

Medicare Supplement Strategy

When meeting with a client, it is good to have an idea of what plan you might recommend. The right plan for a client is based upon their health, finances and what gives them peace of mind.  Never discount the fact that a client may spend more for coverage, just to have peace of mind. The other factor that comes into play is the cost for the plan and what provides the best value for a client.  

Not all insurance companies offer all plans.  They must offer a Plan A at a minimum.  If they offer any plan in addition to the Plan A, they must offer the Plan C or Plan F or Plan G. Look at the different plans and compare the premium difference.  Sometimes, that will drive what is the best plan.  For example, if the Plan G has a cost of $110 and the Plan N has a cost of $117, then it is no-brainer. The Plan G is the way to go because it is better coverage.  If on the other hand, the Plan G has a cost of $100 and the Plan N has a cost of $99, that is an $11/month difference.  Take that difference and multiply it by 12.  That is a difference of $132/year.  The main difference between the Plan G and the Plan N is that after the part B deductible you pay $0 on the Plan G and a $20 copay for the doctor on a Plan N.  Divide the annual difference by $20.  In this example, 132/20 = 6.6. That means if your client goes to the doctor more than 6 times per year, the Plan G is a better value than the Plan N.  Ask your client how many times the go to the doctor in a year.  Keep in mind that as we get older, we usually don’t get healthier.  If you show them what the difference in premiums mean, they can make an informed decision. 

The Plan K and High deductible F/G is a different sort of animal.  We call it the Medicare Advantage plan on steroids.  Refer to our module on Advanced topics for more information on selling those plans. 

Medicare Supplement Company Choices

Since premiums for every plan vary by company, what plan would be best for one company may not be for another.  Premiums are based on claims history.  You want to stick with a company that has lots of policy holders in your state.  Premiums and rate increases are approved by the Department of Insurance for a state. The annual percentage increase for Plan G will be different for Plan N.  It will also differ between Company A and Company B.  A company that is new to the market and doesn’t have lots of policy holders, may offer a very attractive rate as they are trying to build their business and attract clients.  The lowest price for a plan is not always the way to go.  That is because of the new company doesn’t get a lot of policy holders quickly, then a few large claims from some clients may skew the whole annual increase.  Clients can change their Medicare supplement at any time, but must go through underwriting to change.  Their health may have changed such that they will not pass underwriting with another company and will be stuck with the plan they have.

Every company will have an annual increase.  It is important that you let the client know that their premiums will go up each year.  If you know when the increases are for the company you are recommending then you can prepare them ahead of time for when to expect it.  The reason there is an annual increase is twofold.  

1. The deductibles within Medicare increase each year.  The insurance company is on the hook for more, so the client is on the hook for more.
2. Premiums are based on claims history, so if the insurance company is paying out more, they need to recoup some of those costs.  

Remember to make sure the client knows that their premium will not go up more just because they had a lot of claims. It is the same percentage for everyone in the state that has that plan for the insurance company.

Some of the companies offer some extra items like a gym membership, dental discounts, vision discount, hearing discounts and more. Refer to the brochure for the Medicare supplement on the specifics of those extras.  They are subject to change, vary by company and vary by state.  

Refer to our lesson on Analysis of Medicare companies for more specific information on each of the companies.  

• UHC typically has their annual rate increase in June.  The way they price their policies, is if you are within 10 years of your Part B effective date or your 65th birthday, they give you an early enrollment discount.  You will lose 3% of that on your anniversary.  That means that if your anniversary is in September, you will get an increase in June and a second one in September.  UHC is community rated which means everyone of the same gender pays the same price.  Because of the early enrollment discount, it looks and smells like and age rated plan but it is not.  UHC offers a $2 discount for couples using the same bank account.  As of July 2017, the pricing on this plan is very attractive compared to where it was.  They have a very reasonable history of rate increases. Typically, the annual increase comes in June of each year. This is a community rated plan. That means that the premium does not go up because of their age. Clients will see their rate go up a couple of times a year. The reason is for a number of reasons:

1. Usually in June is the annual rate increase
2. There is a 36% early enrollment discount when you turn 65.  That decreases the older you get.  On your anniversary, you lose 3% of that discount each year.  This means that most clients will see 2 increases per year depending on their anniversary.  
3. There is a 6-month rate guarantee. 

What this means is that if someone has an effective date of Feb 1 and their rate is $140/month, they will stay at $140/month until August. On Aug 1st, the rate will go to whatever the annual increase was in June (for example $144/month) because the 6-month rate guarantee will expire. From Aug to Feb, they will pay $144/month.  On their anniversary in Feb, the 3% discount will come off and their rate will go to $148.32/month.  Then in June they’ll get the annual increase. It is not necessary to get to this level of information with the client. 

They do need to be a member of AARP to get the UHC Medicare Supplement. They do NOT need to be a member to get the UHC-AARP Drug plan. They do not need to renew it to keep their Medicare Supplement, but they might like the benefits they get. If they are not a member when you enroll them, you can sign them up for a membership. You will need to get a credit card number to do that. DO NOT get a check that you will have to mail. That will totally slow down the application approval process. The membership fee is $16 for one year and will cover someone else living in the household with them for free. The AARP membership is done via your MyAARPConnection web portal. Additionally, you get a free 3-year AARP membership as an agent regardless of your age.  You do have to sign up for it on the MyAARPConnection portal. 

If you have 2 people in the household who have UHC Medicare Supplements, you only need one AARP membership because of the +1 membership. The only exception to that is if they want their Medicare Supplements to come out of 2 different checking accounts. In that case, you will have to do 2 separate AARP memberships. Each person will need their own membership.  UHC will not allow 2 members to use different bank account with only one AARP Membership. UHC offers a $2 discount for bank draft.  There is no additional discount for annual payment. If they have 2 people on the AARP membership, they will only get one $2 monthly EFT discount.  The UHC premiums for both people are lumped together into one payment.  Since there is only 1 payment, there is only one $2 discount. 

UHC Medicare Supplements do not come with the Silver Sneakers, but they do come with Renew Active.  It is similar to Silver Sneakers. The networks of gyms are not exactly the same but very similar.  

UHC Medicare Supplements are unique in that they will allow a client to switch their plan to any other plan as of the first of the next month with no underwriting. For example, if they want to do the Plan G when they first get the policy because they go to the doctor frequently, they can do that. Then once they don’t have the need to go to the doctor as much, they can move down to the Plan N and pay less in premium and have the $20 copay when they go to the doctor. Likewise, if they did the Plan K and then knew they were going into the hospital, they could move up to the Plan N and not have to pay the hospital deductible.  The exception to this is that if later they want to go back up to the Plan G, they will have to go through underwriting.  The plan change is made as of the first of the next month. 

There is a CMS rule that if within the first year of having an MAPD for the first time, if the client doesn’t like it and they dropped a Medicare Supplement to get it, they can get a Medicare Supplement again with no underwriting. UHC is the only company who extends this to 2 years.   

UHC’s underwriting is also the most lenient of all the companies. There are a few knock out questions. If they answer yes to anything in number 6, they are not denied a plan but are charged the Level 2 rates.  They will take people with Parkinson’s and Alzheimer’s where most companies will not.  UHC will do a med pull when they do the underwriting.  You will receive an email if your client is rated to a Level 2. There is an appeal process that you and your client can follow.  They will receive a letter stating why they were rated at Level 2.  They can call the underwriting number in the letter to get more clarification.  You cannot call underwriting without them on the phone. Underwriting will not talk to you about it because of HIPPA. 

UHC does not offer Medicare Supplements to people under 65 on disability. 

Commissions are paid as a 9-month advance and then monthly after that.  The Plan F/G are commissioned higher than the Plan N.  Plan K commissions are ½ of the Plan N commission. Commission amount is determined by the first plan written. If you write someone on a Plan N or K and then they upgrade to the Plan F, you are only paid at the Plan N or K rate. Roughly, commissions are less than what you might get paid from Anthem or Medico. Look at the difference in premium and have the client do a Plan G if they are going to the doctor frequently, then they can switch down to the Plan N if they want.  This way you are locked into the higher commission amount.  Having said that, you ALWAYS do what is in the best interest of the client. 

There are no Agent of Record (AOR) changes with UHC. The original agent is always the agent of record even if the client switches plans. The only exception to this is if there is a 30-day gap in UHC Medicare Supplement coverage. For example, if the client does an MAPD for January and then during OEP (1/1 to 3/31) and then goes back to and UHC Medicare Supplement.  You would then be the agent on the new plan.  You might want to use this strategy to move them to one of the new plans that came out July 2017 to get them a lower rate and to get paid on it. See Allison or Madeline for more information on this strategy. We call it the “Two Step”.   Remember, even with this, they are not GI for the Plan G.

• Anthem typically has their annual rate increases in January. They are an attained age rated plan. That means that each year they get older up to age 78, they will get an increase because they are a year older.  They also receive the annual increase, so your client will see one bigger increase once a year vs 2 smaller ones with UHC.  Anthem will offer a $2/month discount if the policy is on a bank draft and a $4/month discount for paying annually.  They also offer a 5% couples discount if 2 people living in the same household have a Medicare supplement policy with Anthem. This is a strong company in the major metropolitan areas.  In Louisville, the select plan has all of the hospitals in their network.  Typically, the premium will be a handful of dollars less than the UHC plan.  You have to check both company’s premiums based on their age. If they are eligible for a couple’s discount, then the difference in premium will be more attractive than the UHC. It is an attained age rated plan. That means their premium will go up for each year they get older. They will also get an annual increase typically each January.  This means that compared to UHC, they will see one bigger increase each year vs UHC which will typically have 2 increases. See our UHC section below for why that is.  The age-related increase caps out at age 78. That means that after that age, they will only see the annual increase. 

A Select plan means there is a network of hospitals for a non-emergency, in-patient hospital stay.  All of the hospitals in Jefferson county, Oldham county, Shelby county and over the river in Indiana are in the network.  If your client is outside the Louisville area, you MUST ask the person which hospital they would go to in a non-emergency to ensure it is in the network. I always caution people that the network is subject to change. A number of years ago, Norton and Anthem got into a spitting match.  All of the Norton hospitals went out of network for those 6 months.  It just means if you were planning surgery, you had to use a different hospital. In an emergency you can go to any hospital.  Just make sure they know they would need to go in through the emergency room.   

If someone has a select plan, they can go anywhere in the US to see a doctor, receive treatment, get a second opinion or have outpatient surgery.  If they move outside of the Select plan’s area (outside KY), they are guaranteed issue for a Medicare Supplement in the state they move to.  I always tell people, if you are outside this area and someone tells you that you need to be admitted to the hospital, go in through the emergency room.  If at any time it is an emergency, tell them to go to the closest place they need to get help. 

There are a lot of people in Louisville that have the Anthem Select plan. It has a good history of reasonable rate increases.  For the most part you can’t go wrong with this plan as clients will talk to their friends and their friends probably have this plan. The Anthem plans also come with Silver Sneakers, which is a free gym membership to participating gyms.  They can join as many gyms as they want. Any Anthem supplement effective after June 2010 now has the Silver Sneakers. The prefix of their ID number is VNG.  All clients got a new card in December 2016 if they were eligible for the Silver Sneakers. 

You will NOT propose the Standard Anthem plans.  These don’t have the hospital network. The premiums on those are really high.  Instead, you would do the UHC plan.  If you have a snow bird (someone who lives somewhere else part of the year) or if they would go to Mayo Clinic for something, then do NOT do the Anthem Select plan. In this case you would do the UHC plan. 

Anthem will offer a limited selection of Medicare supplements to clients under 65.  Only if they are coming off of employer coverage.  It does not have to be involuntary like Medico.  You will receive no commission for these plans.  They will take a third-party check for payment.  This is typically seen for people on dialysis where the American Kidney Foundation is paying their Medicare Supplement premium. 

For Medicare supplements commissions are a flat 21% for years 1-6.  They are paid now with a 9-month advance. After that they are paid monthly. In year 7 that drops to 4%.  If you AOR an older plan, the commission percent may be different depending on the level the agent that wrote it was at and how old the policy is.  If you write a new policy for a client who already has a Medicare Supplement and you are not the agent on that plan, you are not automatically made the agent by submitting the Medicare Supplement new application.  You will need to get an AOR signed by the client when you write the new Med Sup.  

With Anthem, you can “poach your way to prosperity”. Anthem will allow you to do an Agent of Record (AOR) change.  When you have your client sign a letter stating that they would like you to be their agent, you will begin to get commissions on their plan. Clients can choose to have their supplement taken from their bank account.  A couple can have 2 separate accounts for their bank drafts. The husband can use his account and the wife can use hers.  UHC is different. See their section below for that information.  Anthem gives a client a 5% discount for 2 people in the household both having Anthem Medicare supplements.  They do not need to be husband and wife, but can be partners or siblings. They just need to have the same address.  Anthem provides a $2/month discount for bank draft and a $48/year ($4/month) discount for annual pay.  The year is always prorated to 12/31.  Anthem’s annual year always starts on Jan 1.  So if the policy effective date is 7/1, then they would only pay for 6 months and would get a $24 discount (6 times $4).  

Enrollments are done online through your agent portal via MProducer.  You can take the application and then enter it electronically later. All products can be done this way.  The only exception to the online enrollment is for clients under 65 for whom you are submitting a Medicare Supplement. Those applications MUST be faxed to Anthem.  

• Humana – Humana’s Medicare supplements are not their bread and butter. Their plan can be attractive for price and with a 12% couple’s discount can look attractive.  The history of rate increases is not good.  We do not recommend their Medicare supplements.
• Medico typically has their annual rate increase in October.  Attained age???  Until July 2017, Medico was a company that we liked. They started a new company in KY and are now putting Medicare Supplements out under the new company. This has resulted in some rate increases that we have not been too pleased with, but they are not so bad that we will still sell them.  Medico will give you a 7% household discount if you live with someone over the age of 18.  So, if they have a spouse or child or grandchild that lives with them, they will get a discount.  That person does NOT need to have a Medico med sup for the household discount. 

Medico does not have MAPD or PDP plans. They have a very good Hospital Indemnity plan that you can add to an MAPD.  The household discount on the Hospital Indemnity plan only applies if BOTH members of the household have a Medico Hospital Indemnity plan. 

Medico’s rates for people in their 70’s are VERY competitive compared to Anthem or UHC.  With the 7% household discount, they can be significantly lower. 

Medico does offer a High Deductible Plan F which might be an option for your client and they are one of the 2 companies that we like that offers HDF.   

Medico is the only company that will pay you on under 65 Medicare supplements.  You only get 4% but it is better than 0%.  Under 65 people are only GI for the Medicare supplement if they are INVOLUNTARILY losing employer coverage. That means through no fault of their own.  For example, termination of employment or exhaustion of COBRA benefits.  They will require a letter with the application or shortly after before they will approve the application.  Under 65 Medicare supplements cannot be submitted through My Enroller.  You must fax them in.  Medico will NOT accept third party checks for payment of Medicare Supplements.  In the case where the American Kidney Foundation is paying, the AKF will send the money to the client and the client will send the money to Medico. 

Enrollments are done electronically via the My Enroller Application. It does not require a signature pad by the client. You can take the application and then enter it electronically later. The My Enroller also serves as a quoting tool for their products.  It can be put on your desktop or accessed via their agent portal.  We have process documents on this as well. 

Commissions are pretty good with Medico.  You get 19% (KY) for years 1-6 and then 2% until year 10. Anthem and UHC will pay you beyond year 10.

• Mutual of Omaha – Mutual of Omaha, United of Omaha, Omaha Insurance Company, are all the same.  Typically, Mutual of Omaha (the parent company) every 3-4 years will introduce a new company (usually with Omaha in the name). When this happens, they close the book of business on the old company. That means they are not adding new clients to the old company. This is called “Blocking the Business”.  What we have seen happen is that the premiums on the old book of business start to increase greatly over time. Clients will see 2 rate increases per year to the tune of about $20/month. Premiums are based on claims history, so if you aren’t adding those new, younger, healthier clients to the pool, then as the pool of clients age and have more claims, the premiums go up more.  This is the Omaha company strategy.  They also have rates for new people that are lower than what your attained age rate is.  For example, a client who is 68 will pay more than a 68 year old just getting a policy.  

Because of this strategy with the company and what we have seen with our own clients, we encourage you to steer clear of the Omaha companies. Outside of Louisville, there are a number of agents who push these plans. The premiums are based on zip code and out in the country can be very affordable. Make sure your clients know how the Omaha companies work and encourage them to look at a more stable company.  

Their underwriting can be a little more lenient as they have multiple underwriting categories. The categories are based on the height/weight ratio, so if you have someone who is too short for their height (nice way of saying overweight), you might be able to get them a policy with Mutual of Omaha or whatever Omaha they are now.  Enrollments can be done via your agent portal. Commission percentages are around 18%.

• Cigna – Cigna is another company like Mutual of Omaha who comes out with different companies every few years. They are the only company who will give a person under 65 who is first getting Medicare a Medicare supplement with no underwriting. In this case, the American Retirement Life company under Cigna has the best rates.  They will not accept third party checks so if the person is on dialysis and AKF is paying, then AFK will need to pay the client and the client will need to send in a check.  If they don’t have a checking account and pay with a money order, the client must include a note saying they purchased the money order themselves.  Under 65 Medicare supplements pay $0 commission.  

Do not get contracted with Cigna just to sell their under 65 Medicare supplements.  If that is the only business you write with them, they will terminate your contract and it is many years before they will allow you to recontract.  Instead, you will send the client to the customer service line to get the supplement. 

• Aetna – They offer Medicare Supplements
• Newest Companies – There is always a new player coming into the market.  Currently, there is Trivent, Combined, Central States, etc.  Our feeling about these companies is that while they might have a lower rate (usually not by much), they don’t have a proven track record of reasonable rate increases since they are new. They also don’t have a robust book of policyholders, which means their income isn’t as solid as a well-established carrier.  We like to stay with companies that we know are continually adding new, healthy clients to their book of business. A client can change their Medicare Supplement at any time, but they have to go through underwriting. This may mean they are stuck with the company they have now if they can’t pass.  Our recommendation is that you do not run out and start offering the newest kid on the block until you have seen their history of rate increases.  Our job it to provide the client with the best long-term solution as we want to be there for them now and in the future.  Use the Gordon Marketing Medicare supplement tool to get the market analytics on these companies.  

When you get a call from a marketer, and you will touting the newest lowest Medicare supplement in the state, ask them how long the company has been offering it in KY and what their last rate increase was.  Have them send you the summary of benefits and check the rates against Anthem, UHC or Medico.  You should not need to get contracted to get this info.  If they pressure you to get contracted, disengage from the call as quickly as you can.  You can always check with us to get our feedback.

Part D Prescription Drug Plans (PDP)

Part D drug plans (PDP) provide for prescription drug coverage for Medicare.  These are one-year contracts with insurance companies. Finding the right PDP for a client takes a little practice.  You start by putting their medications into the Medicare.gov website.  You can go enter them on a carrier’s website, but that does not compare them to all the different companies.  

The best way to compare plans is via Medicare.gov. The only way to save their medications on that site is to have the client create an account on Medicare.gov and share the logon information with you.  We suggest having the client sign an authorization form giving you permission to access their account. There are ways to logon to the account that don’t allow you to see all their other information.  Inform the client that is how you will access their info.  We have a process document detailing how to enter their medications into the Medicare.gov site and how to pick a plan.  

Most plans have preferred pharmacies.  Using a preferred pharmacy will save the client money. Copays are lower and generic drugs costs might be waived at a preferred pharmacy.  Run the client’s plan using the pharmacy they prefer and then take the best plan and run it with a preferred pharmacy for that plan so you can show the client how much they can save.  Many clients are willing to change pharmacies to save money. 

The only time a client can change their PDP (unless it is a SEP) is during the annual enrollment period from Oct 15th to Dec 7th.  If they utilize the OEP (Jan 1st to Mar 31st) to drop an MAPD, they can then pick up a PDP.

Guarantee Issue Situations – PDP

When a client is first going on Medicare, they have 3 months before and 3 months after their Part A effective date to get a PDP.  It only takes Part A in order to get a PDP.  This is important to note because if there is no other SEP reason, a client cannot pick up a PDP later. For example, if they did not pick up Part B when they turned 65 and are enrolling in Part B during the OEP, when their Part B starts on July 1st, they will not be able to add a Part D drug plan.  They would need to pick it up during AEP as a PDP only takes Part A. 

If a client is coming off of employer coverage, they only have 63 days to pick up a PDP without a penalty.  If they miss that window, they will only be able to add a PDP during AEP.  They will also have a Late Enrollment Penalty (LEP).

PDP Coverage Limits Explained – Put the document here.

Late Enrollment Penalty – Put the document here

PDP strategy

Do we have in the process document?

PDP Company Choices – Add from script

Medicare Advantage Plans

A Medicare Advantage plan is where the government pays money to a private insurance company to take on all the risk of Medicare.  They are paid a fee per person, per month to provide Medicare. The client will NOT use their Medicare card, but instead will use a card from the insurance company.  They still have to pay the Part B premium as this goes to help fund the fee paid to the insurance companies. Most of the plans include prescription drug coverage in them.  If they do not, you cannot purchase a separate drug plan.  Medicare Advantage plans must cover the same benefits as original Medicare and can offer additional benefits.  These plans are county specific so the plans available in one county may not be available in a neighboring county.

Medicare Advantage plans come in a couple of different ways.  

• MAPD – Medicare Advantage Prescription Drug. This is most common type of plan.  These include not only the healthcare coverage, but prescription drug coverage as well. There can be multiple types of these kinds of plans. There is an alphabet soup of plans. See below for the differences between them.
• MA (Medicare Advantage) plans only.  These do not include drug coverage in them.  A client cannot purchase a separate drug plan to go with it. These are primarily oriented toward Veterans who get their medications through the VA but want some extra benefits and the ability to go outside the VA system.  The client might have other credible coverage through an employer that they want to use instead of a Part D plan. These can be either a PPO or an HMO.
• MSA – Medicare Savings Account. These work similarly to an HSA.  It is a high deductible plan where the company puts money into an MSA account.  It acts like an HSA.  The client can use the money to pay for items during the deductible.  The client cannot add money to the account, but the money stays in the account and rolls over from year to year.  It is the client’s money.  They pay all of Medicare’s cost until they reach the deductible, which can be $5000+ per year.  They can use the MSA account for any qualified health expense.  

Types of MAPD Plans

As mentioned above, MAPD can come in various types.  Most of them have networks.  They can be HMO, HMO-POS, PPO (LPPO and RPPO), PFFS, SNP plans.  

HMO – Health Maintenance Organization

Generally, unless it is an emergency, urgent care or out-of-area dialysis, the client must receive their care from doctors, other care providers or hospitals in the plan’s network.  In most cases they will cover drug coverage and have that built in.  The client will need to choose a primary care provider (PCP).  With some companies, you must get a referral from our PCP in order to see a specialist.  Some companies, referrals are recommended but not required.  You need to check with the carrier to know their policy on this.  PCPs can become “gatekeepers”.  If the client receives care outside the network, other than for emergency care, they will pay the full cost.  Often times with companies, the client must get prior approval for certain services.  It is necessary to check with the carrier.  

The out-of-pocket maximums and extra benefits are usually more generous with an HMO.  This is because the insurance company has different contracts with the doctors and are able to better control costs.  Usually because you need a referral to see a specialist, so the PCP is more involved and potentially reducing the number of specialists a client sees.

HMO-POS – Health Maintenance Organization – Point of Service

Basically, all the same information above, applies to the HMO-POS.   The exception is that for certain services the client can go out of network.  A higher fee will apply if the provider is not in the network.  It is not for all services. The client needs to check with the insurance company for what is allowed.  

PPO – Preferred Provider Organization

There can be LPPO – Local PPO or RPPO – Regional PPO plans.  They have a network of doctors, specialists, hospitals and other care providers, but you can also use out-of-network providers.  You will pay more (sometimes a lot more) for using out-of-network providers.  You are always covered for emergency and urgent care as being in network. You don’t necessarily need to choose a PCP and referrals are usually not required to see a specialist. Most of the plans have drug coverage built into it.  You cannot purchase a PDP if your plan does not have it built in. The plan may include some extra benefits that you would not get with original Medicare.  

Local PPO plans typically have a network of doctors that is in the region the plan is offered in.  A Regional PPO plan is typically good in the entire state and the network includes doctors across the whole state.  In general, the RPPO plans do not offer as many extra benefits as the LPPO plans.  You need to check the summary of benefits for the plan to determine the exact benefits.

PFFS – Private Fee For Service

With a PFFS plan, you can see any provider that takes Medicare and agrees to accept the plan’s payment terms and agrees to treat you.  If the PFFS plan has a network, you can see any of the network’s providers who have agreed to always treat plan members.  If the provider is not in the network, they can choose to treat a person or not, except in an emergency. This choice to treat can be on a case-by-case basis. They may choose to see you one time and then not after that.  They may choose to see your neighbor and not you.  Not all PFFS plans include drug coverage.  With this type of plan, if it does NOT include drug coverage, then a client CAN purchase a stand-alone drug plan. You will not need to choose a PCP and do not need referrals to see a specialist.  The plan decides how much you will pay for a service.  Some PFFS plans will allow “balance billing”.  This means that providers can charge you up to 15% over what the plan pays for a covered service.  You would pay the difference between what the provider charges and the plan’s reimbursement.

SNP – Special Needs Plan

Agents pronounce these “SNIP” plans.  These sorts of plans provide benefits and services to people with specific diseases, health care needs or limited incomes. They may tailor their benefits, drug formularies and provider choices to meet the specific needs of the group.  Most SNP plans are HMOs so they will not cover out of network providers.  They must all provide drug coverage in them.  In most cases you will need to choose a PCP and need referrals to see specialist.  There are 3 types of SNP plans.

• D-SNP – Dual Eligible Special Needs Plans. You must be eligible for both Medicare AND full Medicaid.  See our module on Medicaid for more information on this.  The extra benefits provided by these plans are generally very generous compared to the other Medicare Advantage plans.  You must verify before submitting an application that they are eligible for a D-SNP plan. Some companies require a special code to be able to enter the application.  Verification of their eligibility can be done on various carrier websites or via the agent support number.
• C-SNP – Chronic Condition Special Needs Plan.  These plans cater to people with specific severe or disabling chronic conditions such as diabetes, heart failure, dementia or End-Stage Renal Disease (ESRD). A client will need to get certification from a doctor that they have the condition for which the C-SNP provides coverage.  You can enroll anytime during the year.  But can only make one selection.  MORE
• I-SNP – Institutional Special Needs Plan. For people who live in certain institutions (like a nursing home) these plans may be available.  They may be specific to that particular institution but can provide county wide services if they have at least one long-term care facility that can accept enrollment and is accessible to the county residents.

Guarantee Issue Situations – MAPD

You must have Part A AND Part B to get an MAPD.  That is because it takes the place of Part A and Part B.  When a client first goes on Medicare at age 65 and picks up Part B, they have 3 months before and 3 months after their birth month to enroll into an MAPD.  Once the plan is active, they can no longer change the plan until the annual enrollment period.  Until the plan is active, they can change their plan choice.  There are no health questions for enrolling into an MAPD.

If the client is coming off of employer coverage and already has Part B, they have 63 days to pick up an MAPD with no underwriting.  If they are picking up Part B when they leave employer coverage, they have the 3-month window to get an MAPD.  

The AEP – annual enrollment period (Oct 15th to Dec 7th) is a time when a client can change their Medicare Advantage plan. They can enroll in as many as they want. The last one processed is the one that will take effect on Jan 1st.  

The OEP – open enrollment period (Jan 1st to Mar 31st) is a time when a client can make ONE change to their Medicare Advantage plan.  If the plan has not gone active, they can make a change.  Once the plan is active, there are no other changes unless there is a SEP or until AEP. 

Trial Rights.  GI if MAPD leaves service area. 

MAPD Strategy

Selecting the right MAPD for a client take a little finesse.  Start by putting their medications into Medicare.gov.  Ensure you put the right zip code and pick the correct county as MAPD are county specific.  See which plans are the lowest for their medications and cover all their medications.  Note that there are some medications that no plan will cover. Ensure your client knows this when presenting the plan.  Find them a Good RX coupon for the medication. Then look up their doctors in the network for the plans you are considering.  You must look up the doctors on the carrier’s website.  DO NOT call the doctor’s office to ask if they are in network. The people in the office are not reliable.  Look up EVERY doctor the client lists on their paperwork. Always as, do you see any other doctors or are there doctors you would want to see.  You may find that not all the doctors are in the network for the plan you want.  If the client is not willing to change their doctor, then move on to the next best plan.  It is uncommon, but you might not be able to find a plan where all their medications are covered and all the doctors are in the network.  

If you find 2 or 3 plans where the medications are about the same and all the doctors are in the network, then start to look at the copays between the different plans.  You may find a plan where the copays for most procedures are lower than another plan.  You don’t want to be presenting 3 different plans to a client.  You do the shopping for them and make a recommendation as to what plan you think is best.  Be prepared to backup or defend your plan.  

MAPD Company Choices

Networks, formularies, copays and extra benefits can vary greatly by company.  Always refer to the summary of benefits for any specific information.  You are not permitted to create your own comparisons between plans and benefits.  Everything must come from approved sources.  You can print off the information from the Medicare.gov website or put the summary of benefits side-by-side to assist your client in comparing plans.  Imagine creates a side-by-side spreadsheet of the benefits of each company. This is for agent use only and CANNOT be shared with client.  Refer to the MAPD comparison in the reference material. Refer to the lesson on Company Analysis to get our thoughts about the different companies.  This part is not finished.

• Anthem – Anthem’s MAPD plans have been very consistent over the years. As of 2021, they offer an HMO, 2 PPOs, 1 RPPO, D-SNP and a no RX Medicare Advantage plan. See our MAPD comparison document for the details of all these plans. Anthem has a D-SNP (Dual Special Needs Plan) if someone has Medicare and Medicaid. You should call agent support or use the D-SNP tool in MProducer to verify that they have the right level of Medicaid.  Anthem will take some levels of Medicaid that other companies will not.  To enter the application, you must have the D-SNP code.  they do have a relationship with an agent, you do not want to sever that.  Perhaps over time if you help them with their drug coverage, they will value you more and sign the AOR. As of 3/1/21, MAPD and PDP can no longer be AOR-ed without a plan change. You would need to write the client on a new policy in order to be the agent of record.  Enrollments are done online through your agent portal via MProducer.  You can take the application and then enter it electronically later. All products can be done this way.  If you are doing an MAPD or PDP, you MUST upload the Scope of Sales Appointment Form.  
• United Healthcare – They offer HMO, PPO, D-SNP and a no RX Medicare Advantage plans. Their MAPD plans also offer the insulin savings.  As of 2021, they have only been in the MAPD arena in KY for a few years. They are still working on developing their network of doctors.  They are also not in every county in KY. Enrollments can be done electronically via the LEAN application. You must have a signature pad or email them for an electronic signature to do the enrollment. You must also be connected to the internet to do the enrollment. If you don’t do it via LEAN, you will need to fax the application to UHC.  HRA
• Humana – Historically their Medicare Advantage plans have been pretty good.  They tend to have a LOT of difference Medicare advantage plans which can make it really confusing.  Refer to our MAPD comparison document for the differences between them.  They have 2 different HMO plans. The networks are very different for each one.  The Community HMO only has Jencare and some Norton doctors in the network.  The only hospitals in the network are Norton.  The Gold Plus HMO has a much better network.  It is really pretty good.  Their Community and Gold Plus plans offer the insulin savings plan. Humana’s PPO plan is good and the network is good. You really need to understand the differences between all the PPO plans as the differences can be subtle.  Humana has multiple Special Needs Plans (SNP). They have a dual for people with Medicare and Medicaid, one for people with chronic diseases (Heart and Diabetes). Within the D-SNP, there are is the Community Network and the Gold Network like the HMO above.  The Chronic SNP (C-SNP) only uses the Community Network. The C-SNP requires that the doctor fill out a form confirming they have a Heart of Diabetes problem or the plan will be cancelled.  Make sure this is done in the right time frame. Enrollments are done via faxing the application or doing an electronic enrollment on the enrollment hub. With enrollment hub you can either take their signature with a signature pad or mouse/finger signature or email them a link where they can click on it and electronically sign it.  NOTE: If you are doing that and the client wants to logon to your computer to get to their email, you will get a violation. Humana tracks the IP addresses.  You cannot have the client’s signature come from your machine.  It has to be done on a separate computer. HRA
• Wellcare – The network is pretty good.  It has gotten better over the years as they also have Medicaid plans.  They have a number of different HMO plans and a PPO plan.  They also have a DSNP plan.  The copays on their MAPD plans are very reasonable especially when it comes to the diagnostic tests.  The complaint we have about Wellcare is that their customer service doesn’t always speak English very well.  The customer support is in the Philippines.  You can ask to be transferred to a US based agent.  Enrollments are done via the Ascend application.  We have a process document on that walking you through the process. If you are doing a D-SNP, you will need to do an additional Special Populations (SPOP) call to get a code.  If you don’t do the SPOP call, the SNP plan will not show up as an option when you enroll.    Immediately after the enrollment you can do a HRA (Health Risk Assessment).  Purchased by Centene
• Aetna – Yes, they have them. We need more info here.

The post Medicare Options appeared first on Insurance Specialists Group.

• Your appearance
  • Make sure your hair is clean and styled.  Keep it washed and not stringy looking.  Get a hair cut on a regular basis.  No one wants to meet with a Yeti.
  • Make sure your clothes are appropriate
    • Don’t have food stains on your clothes
    • Do your clothes look like they just came out of the hamper?  Make sure they are not wrinkled.
    • Make sure they don’t reveal too much.  You don’t want your cleavage to be the thing that your client keeps looking at.  Likewise, if you are female, don’t have a skirt or dress that is too short.  Make sure when you sit down that is long enough to not show your underwear or higher on your thigh.
    • Are your clothes too tight?  If so, invest in ones that fit properly
    • Make sure your clothes are not too old.  Are they fraying, pilled looking?  If so, get some new ones. 
    • It is ok to have just a few outfits you rotate around when you are meeting clients.  You don’t have upgrade your whole wardrobe, but make sure you have some nice outfits to wear when you are meeting with clients.
    • You don’t have to dress in a suit or dress or skirt, but make sure you look professional.  Business casual is good.  Khakis, polo shirt, dress pants, nice top.  Wear what you would if you were going to an interview. After all, you are interviewing to be their agent.  Never wear sweat pants or a T-shirt unless your client is expecting you to be casual like that.
    • If you have piercings or tattoos, make sure they are not visible.  Remember the demographic that is your client.  For the most part, they are more conservative than the younger people. Whereas grandma may now have tattoos, you should keep in mind that it may turn some people off.  
    • You want to be a chameleon.  Blend in and mirror your client.  Dress the way that they do.  
  • Make sure you don’t smell.
    • If you think you may have bad breath, then you do.  Pop a mint or piece of gum before you sit face to face with someone.
    • Make sure you don’t have body odor.  Some people are nose blind to their own smell.  Make sure you bathe and use deodorant if necessary.
    • Make sure your clothes are clean.  If you are a smoker, your clothes will retain a smokey smell. Be aware of that, but don’t drowned it in perfume.
    • Don’t use too much perfume or cologne.  I have had clients come into my office and stink the whole thing up.  If you use perfume or cologne, a little will go a long way.
  • People will see your hands a lot as you are talking and pointing things out.  Make sure under your nails is clean.  If you bite your nails, stop it.  No one wants to look at gnawed on fingers.  Invest in a manicure (yes even you men) every so often.  
  • Be approachable looking and acting.  Look like someone they would want to introduce to their friends.  

• Exhibit confidence.  
  • Remember that you know more than your client does.  
  • You know what you are talking about. Act like it.  
  • Clients come to you because they don’t know what to do. They are trusting you to take care of their insurance needs.  
  • Never make someone feel stupid for the questions the ask.  When they say, “I have a stupid question”, your response should be “Don’t be silly, there are no stupid questions.”  People will appreciate your patience and understanding.
  • If you don’t know something for sure, then don’t be afraid to tell the client, “That’s a really good question.  I’m not sure about my answer, so let me research it and get back to you.”  NEVER, NEVER tell them something if you are not sure.  
    • Research the question.
    • Call agent support
    • Google it.
    • Get with another agent who has been doing this longer.
    • Make sure you get back with the client in a timely manner.  Follow up to see if they have any more questions.
  • Practice your appointment script.  Know what is coming next.  If you have a standard script you use, practice it so that if you are thrown off course, you can comfortably come back to where you were.  Our suggested script is later in this guide.
  • Use a leave-behind so that you keep on track with what you want to cover.  It also provides the client a reference for after the meeting.  We have provided a sample for you to use.  
  • If you feel comfortable with the material, you will naturally have the confidence you need in an appointment.
  • Some of this will come with time.  Remember you always know more than your client.
  • After you get proficient with running an appointment, or when you have 5 in a day, you can get in a rut.  Always remember that this is your client’s first time hearing it.  If you are tired, take a break between appointments to get your head back on track.  

• Be Prepared for every appointment
  • Make sure look up things ahead of time.
    • We suggest you get a list of medications and doctor’s ahead of time when you are getting your scope of appointment. 
    • Scope of appointments are required for every sales appointment. You might think it only applies to those in person, but conference calls, Zoom meetings and virtual meetings all require a Scope of appointment in advance. If you are talking anything plan specific, you need a scope.  If you don’t get it in advance, then it should be your first order of business after you introduce yourself.
      • Some carriers offer electronic scope of appointments.  Make sure you feel comfortable in how to use them.  Be able to explain to a client how they electronically sign it. Not all clients are tech saavy.
    • Research your networks, rates and formularies before you sit down with your client. 
    • Have an idea of what you want to present, but listen to the client and be prepared to make changes to what you think they want based on questions you ask.
    • This keeps the appointment flowing and shows that you are efficient and prepared.
    • Clients will throw you curve balls. They will forget a doctor or a medication.  It’s ok. Relax and regroup as necessary.  
    • We have had appointments where you thought you understood what the client wanted and part way through you realize you misunderstood.  If it will take more time than you have to readjust and get the info ready you need, don’t feel pressured to continue the appointment.  It is ok to reschedule so you feel confident and prepared.  It may take you 20 minutes to get back on track.  If you think the client can wait then do, but if not, reschedule.  You won’t look bad in your client’s eyes. They will respect that you don’t want to waste their time.
  • Have your brochures marked up or highlighted ahead of time.
  • Have your PDP or MAPD printout ready and marked up appropriately. This will be covered more in later modules. 
  • Practice filling out each application so that you don’t bumble through it while with a client. Know all the places they need to sign. One missed signature out of ten will cause the application to pend longer.
  • Make sure you feel comfortable with the electronic applications.  Know which ones require and internet connection and which ones don’t.  Some carriers have “Sand Boxes” where you can enter the applications in a practice mode.  
  • Be able to explain what they are signing. Not all, but a few clients will want to read the applications disclosures.  As we have clients sign the papers, we explain as they are signing what it is they are signing. This will be covered more in the appointment script.
  • Keep a copy of a correctly filled out application for reference.  We are more than happy to grade your application and let you know what you need to change.
  • If you don’t know how to answer a particular question, call Agent Services.

• Sell compliantly.  This is a must. 
  • Even if you have honest intentions, there are points you must touch on for every product in order to be fully compliant. 
  • Create an appointment checklist and a fillable client-take-home sheet that details things specific to them. 
  • Create a take-home packet that expands on those compliance points like the deductibles, potential for plan changes, the donut hole, etc.
  • Make a copy of the fillable sheet that outlines the plans they are enrolling in.  This is for your own protection.  If you ever get a sales allegation, you have proof of what you talked about.  It can save you tons of time and agony if you can produce that document.
  • The repercussions of noncompliance can be severe and can result in losing your appointment with a carrier or your license all together.  Some disciplinary action may include:
    • Loss of appointment with a carrier
    • Loss of state license to sell, which means you will lose your appointments with ALL carriers. This license revocation can last your entire life.
    • Commissions can be withheld or terminated immediately. You are 100% commission based. This is a big deal.
    • Fines, financial penalties and lawsuits. Either way, you will pay.
    • If you get an allegation, respond quickly to it and shower them with the documentation you have on the appointment. Documentation will save your skin.
  • You want to avoid damage to a client’s coverage. Doing the wrong thing, intentional or by honest ignorance, can impact someone’s coverage for the rest of their life. With great power comes great responsibility. We can significantly help people by being a local insurance agent.  If you have any doubt as to what you are recommending is appropriate, please ask another agent or us. We are here to help you learn the business.  What we do it not rocket science, but it does have its nuances.  
  • Avoid damage to your reputation. In time, all of your business will come from word-of-mouth referrals. Consequently, if someone thinks you wronged them, they will tell people, as well.  The word is that if someone is unhappy, they will tell 7-10 people.  If they are happy, they will tell 3-4.  What we have found that is if people are happy with you, they will tell everyone you know.  
  • Your integrity is the most important quality you have. Always be honest with your client.  If what you have to offer is not the best for them, tell them so.  They will appreciate your honesty and will recommend you even more.
  • Try to avoid personal failure. Working closely with people has its ups and downs. You will have ups and downs within yourself, too. Suffering from an honest mistake can make you feel bad. Making sure you are covering all your bases helps prevent mistakes or missing things.  You can’t please all the people all the time. Some people are just hard to work with. Clients will be frustrated and take it out on you.  Don’t take things personally.  You need to be like a duck.  You just let bad things roll off your back.  Learn from your mistakes, but if it is not your fault, don’t let it ruin your day.
  • ALWAYS DO THE RIGHT THING. Integrity is doing the right thing even if no one is looking.
  • Your first order of business is to NEVER DO HARM.  

The post Getting Prepared appeared first on Insurance Specialists Group.