A Day in the Life of a Medicare Advantage Application

AEP is Almost Here, and I’m Confused

For the last seven years one thing we have all been through is “CHANGE” in the Medicare Advantage market. This is not only frustrating, but requires our time and attention in order to participate in what is the peak annual Medicare sales season. Let’s review some past changes:

• ·       New CMS regulations regarding what we can and can’t do.
• ·       New company certification requirements.
• ·       Company mergers and outright withdrawals of plans and areas.
• ·       Companies suspended from sales activity.
• ·       New networks.
• ·       Networks being abandoned.
• ·       Plans changing premium, out-of-pocket costs, deductibles, co-pay and benefits both positively and negatively.

And the list goes on… So, why do we do this year after year?

Since inception over 15,000,000 Medicare recipients have enrolled in a Medicare Advantage Plan. Currently only 11,000,000 recipients own a Medicare Supplement policy (industry numbers show that 60% of Medicare Supplements sold are sold in the fourth quarter of the year). Medicare Advantage has grown the market share, of companies that supplement Medicare, exponentially in only SEVEN YEARS!!! Medicare Advantage has allowed more agents to sell more plans and receive more commission dollars than any other change in Medicare since 1965.

Is it worth the trouble??? At Senior Marketing Specialists we believe it is. Last year our agents enrolled over 10,000 Medicare recipients in MA plans and we anticipate that number increasing this year.

Let us help you adapt to the constant changes and challenges of a program moving from adolescence to maturity. Call us… WE ARE YOUR MEDICARE EXPERTS!!!

Did You Know: CMS defined Standard Benefit Plan changes

Here are the highlights for the CMS defined Standard Benefit Plan changes from this year to next. This “Standard Benefit Plan” is the minimum allowable plan to be offered.

• Initial Deductible: will be decreased by $15 to $310 in 2014
• Initial Coverage Limit: will decrease from $2,970 in 2013 to $2,850 in 2014
• Out-of-Pocket Threshold: will decrease from $4,750 to $4,550 in 2014
• Coverage Gap: begins once you reach your Medicare Part D plan’s initial coverage limit ($2,850 in 2014) and ends when you spend a total of $4,550 in 2014.
In 2014, Part D enrollees will continue to receive a 52.5% discount on the total cost of their brand-name drugs while in the coverage gap.  The 50% discount paid by the brand-name drug manufacturer will still apply to getting out of the donut hole; however the additional 2.5% paid by your Medicare Part D plan will not count toward your TrOOP. Enrollees will pay a maximum of 72% co-pay on generic drugs while in the coverage gap.
• Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit**: will increase to greater of 5% or $2.55 for generic or preferred drug that is a multi-source drug and the greater of 5% or $6.35 for all other drugs in 2014
• Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees:  will increase to $2.55 for generic or preferred drug that is a    multi-source drug and $6.35 for all other drugs in 2014

Plan G vs. Plan F

As your clients continue to look for cost effective choices to cover the expenses that Medicare does not pay you may want to take a second look at how Plan G compares to Plan F.

Here are a few things to look at when comparing G to F:

• Plan G now covers 100% of excess charges just like Plan F

• Most carriers do not pay commissions on the Part B coverage of Plan F and many deduct amounts well in excess of the $147 prior to calculating your commissions.

• When you compare monthly premiums remember that saving enough to cover the Part B deductible calculates to $12.25 per month. So if you can save your client more than that to move to a Plan G it might be a wise choice.

• Another consideration is using the premium that they are now spending on a Plan F and building a stronger plan for your client. Using a Plan G, setting aside money for the Part B deductible and adding a plan like the Kemper home health care plan that refunds money for prescription drugs can add substantial benefits to your client without adding more out of pocket expense for them. It also dramatically changes the commissions you would earn on that case.

Plan G can create some fantastic cross selling opportunities and help your clients obtain the coverage that they will need as Medicare continues to change.

How does an individual qualify for Medicare to pay Home Health Care?

To qualify for the Medicare home health benefit, a Medicare beneficiary must be under the care of a physician, have an intermittent need for skilled nursing care, or need physical therapy, speech -language pathology, or continue to need occupational therapy. The beneficiary must be homebound and receive home health services from a Medicare approved home health agency (HHA).