Medicare Announces It Has Finished Mailing New Medicare Cards!

In an email blast on 2/13/2019, Medicare.gov announced that it had finished mailing the last of the Medicare-number replacement cards to people who have been using Medicare cards using their social-security numbers. Here is the text making the announcement. This will affect what you say to your clients.

Good news: We’ve finished mailing new Medicare cards across the country! You should’ve received your new card by now. 

Here’s what to do next:

  • Carry and use your new Medicare card when you need care.
  • Protect your Medicare Number and card, just like you would protect your credit card.
  • Destroy your old Medicare card to help protect your identity.

Haven’t gotten your new Medicare card yet? Sign in to your secure MyMedicare.gov account to see your Medicare Number and print your official card. If you don’t have a MyMedicare account yet, sign up for free at MyMedicare.gov today!

Posted in Medicare Tagged with:

Coordination of Health Insurance Benefits With Traditional Medicare

National Academy of Elder Law Attorneys (No publication date given except 2018)

What Is Coordination of Benefits?

When a person is covered by more than one health insurance carrier it is important to know which insurance is responsible to pay for what service(s) and in what order of priority. Failing to understand how health insurance benefits coordinate or failure to make sure that all possible sources of payment have been properly billed, may result in the beneficiary becoming responsible for greater out-of-pocket financial liability. Since 1965, Medicare has been the primary payer for the medical services of individuals age 65 or older and disabled individuals (unless covered by worker’s compensation). However, during the 1980s, Congress enacted several provisions that required Medicare to be the secondary payer (commonly referred to as Medicare Secondary Payer or MSP) of medical services to that of other primary plans.

The term primary payer refers to any entity required or responsible to make a payment for an item or service before another entity makes a payment. With respect to services provided to a Medicare beneficiary, the phrase secondary payer indicates that Medicare will pay after another entity (or payer) has made payment. There are various instances in which Medicare will serve as primary or secondary payer for medical services provided to its beneficiaries.

Instances in Which Medicare Will Serve as Primary Payer

Medicare will serve as primary payer for retirees and dependents of retirees who are eligible for Medicare based on age or disability. Medicare also will be primary for such beneficiaries and their dependents who are covered by an employer-sponsored group health plan (EGHP) but who are not considered “currently employed.” Medicare pays first for these individuals ­regardless of the size of their former employer. Medicare will also serve as primary payer for Medicare beneficiaries covered under the Consolidated Omnibus Budget Reconciliation Act (COBRA) and for beneficiaries covered under TRICARE (military health service plan). (The rules are different for people eligible for Medicare based on End Stage Renal Disease, as explained further in the section entitled “Medicare Secondary Payer (MSP) and End Stage Renal Disease (ESRD))

Medicare Secondary Payer (MSP) and Employer Group Health Plans (EGHP)

Medicare will act as a secondary payer for medical services of persons aged 65 and older who are covered under an EGHP sponsored by an employer with at least 20 employees and who are insured by virtue of their current employment status or the current employment status of a spouse of any age. Employers with 20 or more employees must provide the same benefits, under the same conditions, to any employee or spouse age 65 or older as it would to any employee or spouse under the age of 65.

As primary payer, the employer plan is responsible for and required to make a primary payment on the claim pursuant to the terms of its contract. If the primary payment does not fully cover the medical costs associated with the claim, a Medicare secondary payment may be applied to cover the medical costs.

Medicare Secondary Payer (MSP) and Large Group Health Plans (LGHP)

Medicare benefits are to be paid secondary to Large Group Health Plans (LGHP) when an individual is under age 65 but is entitled to Medicare due to disability (has received 24 months of Social Security disability benefits). LGHP coverage must be based upon the individual’s current employment status or the current employment status of a family member. LGHPs are sponsored by employers with 100 or more employees. In contrast, if the disabled Medicare beneficiary is covered by an employer plan with under 100 employees, then Medicare will act as primary payer.

What Medicare Will Pay as Secondary Payer

In determining how much Medicare will pay when it is secondary to an EGHP and the provider’s charge is not fully paid by the primary plan, the following rules are to be applied. The amount that Medicare will pay is the lowest of the following amounts, calculated without reduction by the usual coinsurance or deductibles:

1. The Medicare payment amount if there were no EGHP;

2. For payments calculated by Medicare on a cost-related basis (mostly Part A), the Medicare payment amount minus the EGHP payment;

3. For payments calculated by Medicare on a basis other than cost (most reasonable charge basis payments under Part B), the higher of the EGHP allowed amount or the Medicare allowed amount, minus the payment actually paid by the EGHP.

If Medicare is secondary to an EGHP that requires enrollees to use network providers, Medicare generally will not pay for the non-covered, out-of network care. Medicare may pay if the person can demonstrate that she/he did not know that Medicare would not pay for such care.

Medicare Secondary Payer (MSP) and End Stage Renal Disease (ESRD)

Individuals who are diagnosed with ESRD and who have enough quarters of coverage to be eligible for Social Security disability or retirement benefits may apply for Medicare.

If an individual is insured under an EGHP and has been diagnosed with ESRD, Medicare will generally be the secondary payer during the 30 month coordination period. Medicare will only pay primary if an individual was already receiving Medicare benefits due to age or disability. Once the 30 month period has elapsed, Medicare will be the primary payer of services provided.

Unlike the coordination of benefit rules for beneficiaries who are eligible for Medicare based on age or disability, the coordination of benefit rules for beneficiaries with ESRD do not depend on the size of an employer and the employment status of the beneficiary. Group health plans, regardless of their size, may not take into account the ESRD status of an individual eligible or entitled to receive Medicare coverage. Health plans are also strictly prohibited from differentiating between the benefits they provide to individuals covered by the plan who have ESRD and other individuals covered under the health plan.

COBRA is the secondary payer to Medicare for people who are eligible for Medicare based on age or disability. However, COBRA is primary to Medicare when an individual is eligible for Medicare based on ESRD. Employee-related health insurance is generally primary to Medicare for people with ESRD, regardless of their employment status, for the 30-month coordination period.

Responsibilities of Beneficiaries Under MSP

CMS advises beneficiaries who have other health insurance plans to take certain steps to ensure that the Medicare Secondary Payer rules are applied accurately.

Beneficiaries should:

• Respond to Initial Enrollment Questionnaire (IEQ) and MSP claims development letters in a timely manner to ensure correct payment of their Medicare claims,

• Be aware that changes in employment, including retirement and changes in health insurance companies may affect their claims payment,

• Tell their doctor, other providers, and the Coordination of Benefits (COB) Contractor about any changes in their health insurance due to current employment or coverage changes once they have received health care services.

This information is provided as a public service and is not intended as legal advice. Such advice should be obtained from a qualified Elder and Special Needs Law attorney.

Posted in Boomer Products, Government, Insurance, Medicare Tagged with: , , , , ,

Exciting Changes to the 48-Hour Scope of Appointment Rule

The 2018 Medicare Marketing Guidelines turned heads by removing the 48-hour Scope of Appointment requirement. Many agents are asking what this means in terms of compliance.

Let’s review what changed and what you’re still responsible for regarding Scopes of Appointment (SOAs) for 2018.

What’s Different This Year?

In the 2018 Medicare Marketing Guidelines (MMG), the Centers for Medicare & Medicaid Services say the following about SOAs:

“When conducting marketing activities, in-person or telephonically, a Plan/Part D Sponsor may not market any health care related product during a marketing appointment beyond the scope that the beneficiary agreed to before the meeting. The Plan/Part D Sponsor must document the scope of the appointment prior to the appointment.”

What’s noticeably absent from previous guidelines is language regarding how far prior to the appointment an SOA needs to be obtained. While the 2018 guidelines still state that SOAs must be documented “prior to the appointment,” we interpret that to mean “same-day scopes” are compliant for any reason.

We interpret the 2018 MMG to mean same-day scopes are compliant in all cases.

Note: Some carriers may understand the SOA rule differently or have their own policies, so it’s imperative that you operate within the guidelines of the carriers you represent.

What Does It Mean for You?

The new guidelines have the potential to streamline your entire sales process from lead to appointment, to presentation, to enrollment.

In the past, you had to delay meeting with a client interested in hearing about their health plan options until at least 48 hours after he or she signed the SOA. Now, that same client can request an appointment with you through a Scope, meet with you, and enroll in a health plan on the same day.

Additionally, if the client you’re meeting with indicates they’d like to talk about a health product they did not agree to discuss in advance, you can simply collect a second SOA for the additional product type and continue the appointment. It goes without saying, but that’s an easier way to do business.

If a client expresses interest in non-health products such as life, annuities, or final expense options with you, reserve that discussion for another appointment at a later time.

Did the Scope of Appointment Itself Change?

What’s required as part of an SOA remains the same for 2018, and you’re still responsible for following those rules. If you need a refresher, we’ve got you covered.

According to the MMG, SOA documentation is subject to the following requirements:

  • The documentation may be in writing, in the form of a signed agreement by the beneficiary
  • Date of appointment
  • Beneficiary contact information (e.g., name, address, telephone number)
  • Written or verbal documentation of beneficiary or appointed/authorized representative agreement
  • The product type(s) (e.g., MA, PDP, MMP) the beneficiary has agreed to discuss during the scheduled appointment
  • Agent information (e.g., name and contact information)
  • A statement clarifying that:
    • Beneficiaries are not obligated to enroll in a plan
    • Current or future Medicare enrollment status will not be impacted
    • The beneficiary is not automatically enrolled in the plan(s) discussed

Additionally, an SOA isn’t required for an application taken at a compliant marketing/sales event. However, a beneficiary should sign an SOA at a compliant marketing/sales event in order to schedule a future appointment.

One Reason We’re Excited About These Changes

Ritter introduced a revolutionary electronic Scope of Appointment (eSOA) on their Medicareful platform last year, and now it’s more powerful for agents than ever.

Now, a lead visiting your personal Medicareful site can select the “Contact Us” button and open the compliant eSOA. By providing a few simple contact details and the product types they’re interested in, they create an eSOA that’s delivered straight to you. From there, you’re free to contact the lead and begin the presentation and enrollment process in person or over the phone that same day.

You can also activate direct enrollment buttons on your personal Medicareful site for qualifying carriers that you’re contracted with. Enrollments can happen in just a few clicks! Learn more about Medicareful 

● ● ●

Your Medicare sales process includes the same steps it always has, but these changes and the new technology available helps you get things done faster than ever. The opportunity to complete enrollments faster should be extremely satisfying for both you and your clients, and we’re really excited to hear how it makes your job easier this AEP.

Posted in Agent Only, Business Development, Government, Medicare, Sales & Marketing Tagged with: , , , , , ,

Do’s and Don’ts of Medicare Compliance

Life as an agent before Medicare’s Annual Enrollment Period is a flurry of contracting and certifying. But there’s another C that’s even more important: Compliance.

It’s not just something to consider during the busy season. Compliance should be a year-long goal for every agent.

We’ll teach you how to stay compliant through all of your client interactions – from the point of first contact all the way through the enrollment process.

Permission to Contact

Every interaction with a potential client has a starting point. The Centers for Medicare and Medicaid Services (CMS), which oversees healthcare compliance, state that agents cannot make unsolicited direct contact with potential beneficiaries or approach potential enrollees in common areas. To begin the conversation with potential enrollees, you’ll need Permission to Contact, or PTC. You can use lead providers to send out business reply cards (BRCs) or flyers including an optional form to collect this permission. PTCs are event specific and not open-ended permission for future contact.

We’ve talked before about the importance of an online presence, but be forewarned, likes or shares on social media do not constitute PTC for sales purposes. Additionally, PTCs are not the same as a Scope of Appointment, or SOA. The PTC comes first, hopefully followed by an appointment. At that time, you’ll need to fill out the appropriate SOA form.

Permission to Contact is not the same as Scope of Appointment. Mostly, PTC comes first, then SOA next.

Scope of Appointment

Scope of Appointment means just what it says. It’s a form outlining exactly what you’ll be presenting to a client during a meeting. The SOA ensures that potential enrollees will not be pitched plans other than those they originally requested. The latest MMG removed the requirement for SOAs to be recorded 48 hours in advance. We interpret that to mean “same-day scopes” are compliant in any and all cases.

Every face-to-face meeting requires a Scope of Appointment. Additionally, SOAs must be filled out for one-on-one phone conversations. Per CMS, agents must keep SOA forms on file for at least 10 years, even if the appointment didn’t end in a sale.

What happens if your client requests Medicare information outside of the Scope during your meeting? You must fill out a second Scope covering the new information before continuing the meeting. If they’re interested in non-health related products, you must schedule a future appointment to discuss them.

Marketing Rules

CMS also regulates marketing and plan presentations including when you’re allowed to market, and how you market.

Agents must wait until October 1 to begin marketing next year’s plans to potential beneficiaries, and cannot enroll members until October 15.

When presenting plans, you’re not allowed to use statistics without documentation and prior CMS approval. Do not attempt to make your own marketing materials, but instead use carrier materials that have gone through the stringent CMS approval process.

During presentations, you should never attempt to mislead your clients, willingly or unwillingly. Stay away from using absolutes and superlatives to describe plans and benefits. Your job is to present information, not show favoritism between carriers or plans. Similarly, if a potential enrollee expresses interest in just one plan, you must inform them that other plans are also available to them.

Avoid using absolutes and superlatives to describe Medicare plans and benefits.

CMS puts a large focus on agent transparency. Similar to their rules on absolutes and superlatives, agents should not use the word “free” to describe $0 premiums. CMS also states that the term free should not be used “in conjunction with any reduction in premiums, deductibles or cost share, including Part B premium buy-down, low-income subsidy or dual eligibility.”

While one component of your client’s health care may come at low or no cost, costs could be incurred in other areas. For example, $0-premium plans typically have higher copays, while plans with higher premiums offer lower out-of-pocket cost. By calling a plan “free” you’re generalizing just one part of the plan’s full package.

When mentioning star ratings, you must include that the rating is out of five stars. Agents must also let potential enrollees know when a plan has been assigned an LPI or Low Performing Icon by CMS. You may not showcase the overall star rating and fail to disclose that the plan has previously suffered from performance issues.

New for 2018, star ratings may not be published until CMS releases them on the Medicare Plan Finder. Agents must also now clearly identify which contract year they reference. You may not “reference the star rating that was achieved based on prior contract year data, when the marketing materials are for the upcoming year.”

Events & Appointments

The types of presentations you host throughout the year typically fall under one of three categories; educational events, sales events, and individual appointments.

Educational events are meant to inform Medicare beneficiaries about the parts of Medicare in general. When holding an educational event:

DO:

  • Distribute educational materials free of plan-specific information
  • Distribute educational health-care materials
  • Provide business cards only if requested by the consumer
  • Hold the event in a public venue

DON’T:

  • Distribute plan-specific materials or enrollment packets
  • Attach business cards or plan information to educational materials
  • Conduct sales presentations, even after the main educational presentation
  • Distribute and collect PTCs or SOAs
  • Require attendees to sign in (sign-in sheets MUST be optional)

Sales events, on the other hand, are designed to steer, or attempt to steer potential enrollees towards a limited set of plans. During a sales event:

DO:

  • Follow the specific carriers filing and reporting procedures prior to the event
  • Follow the specific carrier’s cancellation procedures
  • Make sure to use only carrier-approved materials
  • Collect applications

DON’T:

  • Offer meals
  • Make absolute statements
  • Use pressure to sign someone up
  • Cross-sell or promote non-health-related products
  • Require attendees to sign in (sign-in sheets MUST be optional)

Individual appointments fall under the same category as sales events and the same CMS regulations apply. Don’t forget, whether you’re meeting face-to-face, or discussing plans one-on-one over the phone, you must have a Scope of Appointment.

Meeting face-to-face or discussing plans one-on-one over the phone requires a Scope of Appointment.

Secret Shoppers

Staying compliant should be a year-long objective for every agent. Annual Enrollment is the culmination of revised CMS marketing guidelines, new 2018 plans, and all kinds of potential enrollees, some of which could be secret shoppers.

CMS secret shoppers measure quality of service and compliance with Medicare regulations as a way to gather specific information about products and services. These secret shoppers will be looking to make sure you’re compliant, from what you say to how you present it.

Websites

CMS requires any agent marketing MAPD or PDP plans to consumers to submit all website content to HPMS for approval. This is typically accomplished through the carriers. You may refer to the specific carrier’s policy regarding website review. CMS has increasingly cracked down on websites in recent years, so it’s important to be sure your website is properly evaluated.

If you’re looking for a simple way to market a website with your own contact information, Medicareful.com is a good place to start. It’s a free CMS-accepted website, exclusively developed by Ritter, with a quote engine, direct-enroll buttons, and electronic Scope of Appointment. And the best part of it all is Medicareful is filed and accepted for use by CMS. We did the hard work so you don’t have to!

As a certified agent, you’re responsible for following CMS guidelines. Compliance doesn’t have to be difficult, but it does require research and due diligence on your part. When in doubt, refer to Ritter for guidance!

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Editor’s Note: This was originally published in September 2016. It has been updated to include information more relevant to the 2018 Annual Enrollment Period.

Posted in Insurance, Medicare Tagged with: , , , , , , , , , , , , , , , ,

The Do’s and Don’ts of a Life-Insurance Exam

Applicant Preparation

Stone Hill is dedicated to helping your client prepare for their life insurance exam. It’s important to ensure the exam is accurate and that it produces the best possible results.  Follow these Do’s and Don’ts from ExamOne and you and your client will be on the way to an easy and fast exam experience.

 The Do’s

  • Get a good night’s sleep
    • Ensures the best resting pulse
  • Stay hydrated
    • Drink a glass of water 1 hour before the exam
    • Makes for an easier blood draw
  • Document medications
    • Prescription and over-the-counter medications including vitamins, herbs and supplements
  • Notify of any past blood draw issues
    • So the examiner can be prepared and bring a smaller needle if necessary

 The Don’ts

  • Consume salt/high-cholesterol
    • (24 hours prior)
    • May affect exam results
  • Do strenuous exercise  
    • (12 hours prior)
    • Working out excessively may release protein into the urine and elevate liver function tests
  • Drink alcoholic beverages  
    • (12 hours prior)
    • Alcohol may cause dehydration and liver function test elevation
  • Use nicotine or caffeine 
    • (1 hour prior)
    • Stimulants may elevate heart rate
    • Black coffee is okay up to 1 hour prior





Posted in Insurance, Life Tagged with:

Diagnosing The Development Stage of Your General Agency

As a general agent, your job is to motivate, educate, and support a group of agents so that they can support their families and so you can support yours. Often times, it is better to use more than just your head to identify problems and solve them, and your best resources are your agents. You have probably tried this at times, and been frustrated. But there is hope. You can use the table below to diagnose where you stand as a team. If you diagnose correctly, you can persuade your agents to have patience with each other while you slowly elevate the performance of all of them.

(Stone Hill is still looking for the authors/sources of this information so that it can be properly attributed.)

Table of 5 Phases of Group Development

Common Operating Characteristics During Stages of Group Development
 
  STAGES
ISSUES I MEMBERSHIP II SUBGROUPING III CONFRONTATION IV INDIVIDUAL DIFFERENTIATION V COLLABORATION
Atmosphere and relationships Cautiousness Greater closeness within subgroups Close within subgroups, hostility between subgroups Confidence and satisfaction Supportive and open
Goal understanding and acceptance Unclear Some greater clarity, but misperceptions likely Fought over Agreed upon Commitment
Listening and information sharing Intense but high distortion and low sharing Within subgroups, similarities over perceived Poor Fairly good Good
Disagreement and conflict Not likely to emerge; if it does, will be angry and chaotic False unanimity Frequent Based on honest differences Resolved as it occurs
Decision making Dominated by more active members Fragmented, deadlocks Based on power Based on individual expertise Collective when all resources needed, individual when one expert
Evaluation of performance Done by all, but not shared Across subgroups Highly judgmental Done as basis for differentiation but with respect Open, shared, developmental
Expression of feelings Avoided, suppressed Positive only within subgroups, mild ‘digs’ across groupings Coming out, anger Increasingly open Expressed openly
Division of labor Little, if any Struggles over jobs Differentiation resisted High differentiation based on expertise Differentiation and integration, as appropriate
Leadership Disjointed Resisted Power struggles common Structured or shared Shared
Attention to process Ignored Noticed but avoided Used as weapon Attended to compulsively or too uncritically Attended to as appropriate
Posted in Business Development Tagged with: , ,

John Hancock’s Accumulation IUL with Vitality & Retirement Planning – A Powerful Solution!

JOHN HANCOCK’S ACCUMULATION IUL WITH VITALITY CAN BE A VERY USEFUL BACKSTOP TO HELP PROTECT AGAINST VARIOUS RETIREMENT RISKS.

IT ALSO OFFERS INDUSTRY LEADING INCOME EARNING POTENTIAL PLUS VALUABLE REWARDS AND DISCOUNTS FOR HEALTHY LIVING.

AND, FOR EVEN GREATER PROTECTION, CONSIDER ADDING JOHN HANCOCK’S POPULAR LONG-TERM CARE RIDER TO THE POLICY!

Posted in Insurance

How to clear your cache and cookies in most Internet Browsers

If you ever run into a “Session Expired” error when using our Term Quote engine, all you have to do is clear the cache and cookies from your browser.  Follow this link on how to Clear Cache and Cookie and we walk you through how to do that in the most common browsers.  As always, if you need any additional assistance, please feel free to contact us.  We are here to help!

Posted in Life, Technology Tagged with: ,

Medicare and Veterans Affairs (VA) Benefits

You can have both Medicare and Veterans Affairs (VA) benefits. However, Medicare and VA benefits do not work together. Medicare does not pay for any care that you receive at a VA facility.

  • In order for Medicare to cover your care, you must receive care at a Medicare-certified facility that works with your Medicare coverage.
  • In order for your VA coverage to cover your care, you must generally receive health care services at a VA facility.

Medicare Part B and VA Coverage:

Many veterans use their VA health benefits to get coverage for health care services and items not covered by Medicare, such as over-the-counter medications, annual physical exams, and hearing aids. However, you may want to consider enrolling into Medicare Part B (medical insurance), even if you have VA coverage. Part B may cover services you receive from Medicare-certified providers and provide you with medical coverage outside the VA health system. In addition, if you do not enroll into Part B when you are first eligible to do so, you will most likely incur a Part B premium penalty for each 12-month period you were without Medicare Part B coverage. In addition, you may also experience gaps in coverage.

Medicare Part D and VA Coverage:

Some veterans only use their VA drug coverage to get their medications, since VA drug coverage may offer more generous prescription drug coverage than Medicare Part D, the Medicare prescription drug benefit. Since VA drug coverage is considered creditable, meaning it is as good as or better than the Medicare prescription drug benefit, you can delay enrolling into Medicare Part D without penalty. If you do lose VA drug coverage, make sure you enroll into a Part D plan within 63 days of losing your VA benefits.

Note that although you can have both Medicare Part D and VA drug coverage, the two do not work together. VA benefits only cover the drugs you get from VA pharmacies and Part D plans usually only cover drugs you get from pharmacies that are within the plan’s network.

You may want to join a Part D plan in certain situations. You may want to enroll in a plan if you move into a nursing home outside of the VA health system and need coverage for medications from the nursing home pharmacy. You may also want to enroll in a Part D plan if you qualify for Extra Help, the federal assistance program that helps people with Medicare afford their Part D drug costs.

If you have questions about VA benefits and coverage, contact the VA Health Administration Center at 1-800-733-8387 or 1-877-222-VETS (877-222-8387).

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Posted in Government, Insurance, Medicare Tagged with: , , , , ,