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  • How Periodic Reviews Can Help Build Your Business

    Here are a few reasons why periodic reviews with your clients can keep money in your gas tank and your clients happy.

    Situations change, and clients may not think to call you every time – As an agent, you know that sometimes even relatively minor changes — a small decrease in income, a change in treatment regimen, seeing a new specialist — can mean big changes in what coverage makes the most sense for a client. By scheduling an annual or semi-annual meeting or phone call to review your client’s situation, you can determine if there are changes that should be made, and make sure that they continue to trust you as their agent.

    Just because they have a Medicare Supplement plan doesn’t mean they can’t make changes after their initial enrollment, even as they age – In California and Oregon, clients have the opportunity to change their Medicare Supplement plan to an equal or lesser plan with any carrier for thirty days before and after their birthday every year, without having to go through medical underwriting. As carriers open and close blocks of business and rate changes take effect, this is a great way for you to make sure that clients continue to get the coverage they need at a price they’re comfortable with and that you keep them on the books. Even in states without the birthday rule, clients may be able to pass underwriting and change their Medicare Supplement plan as needed. Remember that every carrier has different underwriting guidelines and that a condition or medication that’s an automatic knock out on one carrier may be perfectly fine on another. If changing plans seems to make sense, keep looking until you find a carrier and a premium that works for the client.

    Plans change every year, and your clients might not be aware of it – For MAPD clients in particular, every year can potentially bring with it plan exits, arrivals, and network and benefit changes. Just because a particular carrier made sense when they were initially eligible or during last year’s Annual Enrollment Period doesn’t mean that a year or more later, the same plan will make sense. Check in early in AEP with your MAPD clients, make sure that their plan isn’t leaving the county, that there isn’t a new plan being introduced to their area that might be a better option, and that their providers and medications are still appropriately covered by the plan they have. If not, find them an option with which they’re comfortable.

    Keeping in contact with clients keeps you in their mind, and gives you the chance to uncover additional needs – Clients won’t need or want to change their Medicare Supplement or Medicare Advantage plan every year, but meeting with them gives you a chance to find out if there are new, unaddressed needs that you should be discussing. Pay attention to the cross-selling regulations, especially if you’re dealing with an MAPD client, but don’t leave opportunities for things like final expense or long term care coverage on the table.

    Building relationships builds your business – The more you talk with your clients, the more trust you can build with them. If they trust you and feel like they have a relationship with you, they’re less likely to be pulled away by another agent and they’re more likely to refer their friends and family.

    First and foremost, insurance is a service business. Even if it doesn’t directly lead to money in your pocket, checking in with your clients is just smart business.

  • Is Your AARP/UHC Appointment In Jeopardy?

    Most agents maintain appointments for a variety of carriers with whom they rarely write business, either because the carrier serves a specific niche market, the carrier was previously a large player in their region and may become so once again, or simply because they want to maintain as large a variety of options for clients as possible. In most cases this is a smart choice, even if you almost never write any business with certain companies, as long as you’re sure to keep up with your certifications and licensing. The UHC AARP branded products, however, are an important exception.

    AARP/UHC uses what they call the Authorized to Offer (A2O) program. Agents are split into levels based on the amount of business written, both in a given year and a lifetime, and agents who reach the higher level are given certain perks. More importantly for some agents, however, is that AARP/UHC enforces a minimum quota to maintain the ability to write Medicare Supplement business. There are some key things to remember.

    You must write a minimum number of active and paid Medicare Supplement plans to maintain authorization. – If you meet the annual minimum of five active enrollments, you maintain your A2O level one status for that year. If you don’t meet the minimum, you’ll be placed on a temporary deauthorization from selling AARP branded Medicare Supplement plans. You can also maintain your level one authorization, regardless of the amount of new business written in a particular year, if you have minimum of 100 active enrollments on the books. This is good news for anyone who may be transitioning away from AARP but would like to keep it as an option just in case.

    You aren’t completely banned from AARP products during initial deauthorization. – If you don’t write enough business to maintain your level one status, you’ll be temporarily deauthorized. During that period, while you can’t write AARP branded Medicare Supplement business, you can write their MAPDs and PDPs, assuming you’re certified for them. Of course, this business does not count towards meeting your minimum production requirement.

    If you fail to meet the minimum production requirement two years in a row, the deauthorization becomes permanent.  The permanent deauthorization only applies to Medicare Supplement plans, the same as the initial deauthorization.

    If you do get deauthorized, it doesn’t impact commissions on business already on the books. – Any renewal commissions, or commissions on new business under the minimum production requirement, will still be paid even if you’re later deauthorized. It will obviously prevent you from writing new Medicare Supplement business with them, but you’re existing business will continue to earn you ongoing income regardless.

    While there are other carriers who will terminate non-producing agents, it’s rare to see such a specific system of quotas. AARP has a powerful brand draw for many seniors, and is a good choice in some demographics, so it’s important to bear in mind what you need to do to continue to offer their Medicare Supplement plans.

  • Medicare Coming to Disabled or Injured Beneficiaries for Reimbursement?

    Many Medicare beneficiaries expect, and usually rightly so, that once a Medicare claim has been paid, there’s no reason for them to think about it again. For beneficiaries with other coverage, however, or who may receive a settlement due to an accident or injury for which their employer or another person is liable, it’s important to understand when and how Medicare may pay, and when they may seek reimbursement from the beneficiary.

    The Strengthening Medicare and Repaying Taxpayers (SMART) Act of 2012 establishes Medicare as secondary payer in cases where a beneficiary is covered by a designated primary payer — either a group health plan, liability insurance, no-fault insurance, or a worker’s compensation plan. If claims are paid with Medicare as the primary payer and it’s later determined that some other party should have been primary, Medicare will seek reimbursement either from the other responsible party or from the beneficiary directly. Medicare ultimately has the final say in whether the person or company liable for the claim or the beneficiary themselves is responsible for the reimbursement. While this can theoretically impact any of your clients who may find themselves with additional coverage or with an accident or injury settlement, it’s disproportionately likely to affect those who are Medicare eligible due to disability, as they’re more likely to have an insurance settlement or ongoing responsibility for medicals agreement. It’s easy for clients to see the potential to have Medicare come to them for reimbursement of claims that have already been paid as a source of great anxiety, but there is some basic information that you as their agent can offer to help them understand whether they may be asked to reimburse Medicare, and how the process may play out for them.

    Correct billing can save a lot of headaches – Most doctor’s offices are familiar with how to coordinate benefits for patients who have coverage through multiple sources, but it’s good to get your clients into the habit of reviewing and saving their Explanations of Benefits and any bills they receive from their doctor’s office. It’s also important that clients know to specify to their doctor’s office if particular coverage should be charged or the bill submitted to a particular company if it changes from visit to visit. For example, if a client has both a work related back injury and an unrelated ankle issue and seeks treatment through the same orthopedist, he or she will likely need to specify on each visit who to bill for treatment to avoid the potential to have to reimburse Medicare.

    Medicare will provide conditional payment for services – Medicare will pay claims presented for treatment on behalf of current beneficiaries without concern for whether the cost may later be found to be the responsibility of another party. Once Medicare determines that another payer has primary responsibility for the claim, they’ll seek reimbursement from whover is deemed the responsible party. What this means is that if a Medicare beneficiary needs to seek treatment as a result of an injury or illness that they believe will be determined to be the fault of another party, they should still seek treatment promptly and have the claim processed by Medicare if they have not yet received a judgement or do not yet know who the primary payer will be. Claims can be settled up later, the first concern should be to get the care they need.

    Medicare can provide information on reimbursement amounts to parties settling claims in advance – If a member is in the process of negotiating a settlement or having a judgement determined as a result of an injury or illness that is the fault of another party, they can request information on the amounts for which Medicare will seek reimbursement in advance, so that that can be taken into consideration.

    There is an appeals process – If an individual beneficiary is identified as the debtor for the purposes of reimbursement, they have a right of administrative appeal and judicial review. It can, understandably, be a lengthy process, but it’s important for people to know that the appeals process is there before they feel forced to pay a bill for which they believe they are not responsible.

    Medicare does not need proof that the claim was as a result of a particular injury or incident to seek reimbursement – The wording of the statute does not require Medicare to have proof that a claim is for treatment of a particular injury or illness that is the fault of another party. Medicare is only required to demonstrate proof that another party has primary payment responsibility. Especially in the case of insurance settlements where ongoing responsibility for medicals is included, there may be some room for interpretation of whether a particular claim should be covered by Medicare as the primary payer or not.

    Medicare paying second doesn’t mean they won’t pay at all – Medicare being the secondary payer doesn’t mean they won’t pay any claims. It simply means that they’ll pay after the primary payer has covered whatever they’re responsible for, essentially the same way that a Medicare Supplement plan pays after Original Medicare has picked up their share. If there are things that Medicare would cover that for whatever reason the primary payer won’t, those services would still be covered by Medicare.

    While this isn’t a situation that you can probably expect to see very often amongst your clients, if at all, it is something to be aware of. Having Medicare asking for reimbursement of claims that have already been paid can cause a lot of stress and worry for your clients, and knowing enough to help them understand the process can go a long way towards keeping them happy and, for that matter, keeping them as clients.

  • Using Social Media In Your Insurance Business

    Health care and insurance have a reputation for being industries that are slow to adopt new technology, and for many agents it can seem unnecessary to develop a strong online presence. For most agents, however, this represents a huge missed opportunity to connect with current and potential clients, build a reputation within your community and industry, and be ahead of the curve as an influx of tech savvy Baby Boomers and older Generation X’ers age in to Medicare and younger Americans look for individual coverage as a result of the Affordable Care Act.

    Some key points to think about as you consider your use of social media:

    Don’t think it’s unnecessary just because your business is primarily in the senior market. – Older Americans are increasingly tech savvy, with a 2013 Pew Research Center survey showing that 59% of Americans 65 and older go online, and 82% of those who go online said they do so at least 3-5 times per week. In addition, 27% of Americans 65 and older use some kind of social media. Not only that, but the rate of internet use among seniors increased six points between 2012 and 2013 alone. As the relatively tech savvy Baby Boomers continue to age in to Medicare, this percentage is only going to increase. It’s also important to remember that many seniors seek help from their children or other younger relatives and caregivers to make decisions about things like their medical insurance, and these younger people are ever more likely to turn to the internet, especially social media, for information.

    If you’re on social media, you have to be easily accessible. – We know how busy independent agents are, so no one is going to expect you to be monitoring your Facebook or Twitter feed all day, every day, but it does need some monitoring. Social media moves qucikly, and if someone has a question, they expect a rapid response and will potentially move on to another source of information if they don’t get it. If you can’t do the monitoring yourself, you may want to consider hiring someone else to do it for you, which can be done for a reasonable cost in the case of most small businesses. If your social media accounts aren’t being actively monitored by anyone (and in this case, actively means roughly hourly at least during business hours), make sure alternate contact info that will reach you quickly, whether it’s an office or cell phone number or an email address, is prominently displayed on your page.

    Don’t be afraid to show your personality. – People connect with people, not with brands. Professionalism is wonderful and absolutely necessary, but that doesn’t have to mean generic or robotic. Even something as simple as a comment about community events or sports teams, or a reminder about something seasonal like flu shots or allergy medication, can go a long way to humanize your social media presence.

    It’s social media, so be social. – Obviously you want to share your own content and thoughts, that’s why it’s your page, but remember that the first word in social media is social, and you have to interact to really get the full value of being there. Get involved in a discussion with other people in the industry or share relevant news items, whatever makes sense to you to avoid sending nothing but a steady stream of your own marketing.

    Don’t forget about compliance. – General health tips, general Medicare information, being reachable for clients with simple information — all great. But remember that in the Medicare Advantage arena, anything plan or benefit specific is likely subject to review and approval and should probably just be skipped. If you want to share information that is plan specific, your best bet is to link to an approved marketing piece or website, whether it’s yours or the carrier’s. Also remember that client personal information should never be sent via social media. If they have a specific question and reach out to you online, give them a call or set up a time to meet with them face to face and go from there.

    Go where your audience is.  There are an ever growing number of social media networks out there, and especially for an independent agent or small agency, being on all of them is likely not practical or even necessary. Figure out where your audience is and focus on wherever that is. In general, older Americans tend to be more active Facebook, while younger Americans are more active on Twitter. You also want to figure out what your strengths are. If you really have the gift of gab and love being in front of the camera, maybe a YouTube channel where you discuss health news is a good option. If you do better one-on-one or don’t enjoy public speaking as much, it’s likely something you should just skip.

    Even referrals or existing clients are looking for you online.  Clients who lost your phone number, referrals who want to check you out before getting in touch, potential clients who saw an advertisement with your name on it — all of these people are looking at your online and social media presence to get in touch with you or decide whether to do business with you. It doesn’t have to be elaborate and it doesn’t have to take up all of your time, but if you don’t have anything, or if all you have is outdated, there’s a potential for your business to come off as shady or unprepared.

    Social media is an unavoidable part of marketing now, and this is only going to be more true as it becomes an ever more integral part of our daily lives, so get on it now if you haven’t already! Your business will thank you.

  • Clarifying The “Improvement Standard” for Skilled Nursing Care

    It’s common to hear Medicare’s standard for covering skilled nursing care described in part as the patient needing to show a reasonable expectation of improvement. However, it’s important to note that that is not always accurate per the specifics of the Medicare guidelines. The 2012 settlement of the Jimmo v. Sibelius suit, in which Glenda Jimmo challenged her denial for skilled nursing care due to a “lack of improvement”, requires CMS to undertake education campaigns aimed at clarifying how long term care and skilled nursing care claims are to be adjudicated, and to allow for review and redetermination of cases where coverage has been denied due to lack of potential for improvement. However, it’s important to note that CMS is very clear to point out that this is not an expansion or modification of benefits, but a clarification of the standard that has always been in place.

    What you need to know:

    • If the treatment goal is maintenance to prevent or slow further deterioration, as in the case of a chronic and progressive illness, NO improvement standard should be applied. If care is reasonable and necessary and requires skilled nursing or skilled therapy services, it should be approved. However, if the care can be effectively provided by non-skilled personnel, coverage would not be available.
    • If the treatment goal is restorative, as in after an illness or injury, the improvement standard can be applied to evaluate whether the care being requested is reasonable and necessary.
    • In all cases, coverage determinations should be based on whether the care is medically indicated, and whether the specific services requested are reasonable and necessary.
    • The CMS education program is ongoing, so some providers may initially not believe a service will be covered because they’ve previously had it denied in similar circumstances.
    • Original Medicare’s limits on days of skilled nursing care covered are not changed, however this ruling can potentially help clients with Medicare Supplement plans or Medicare Advantage plans access the additional coverage they’re entitled to through those plans.

    It’s important to remember that the specific CMS guidelines are sometimes differently worded than the coverage guidelines of specific carriers, and that the Medicare appeals process is there in the instance of what a client believes is an incorrect denial of coverage, whether by a carrier or by Medicare itself.

  • Social Security Numbers to Be Removed From Medicare IDs

    More than a decade after the initial recommendation from the Government Accountability Office, a non-partisan agency designed to monitor the processes and spending of Congress and provide recommendations for improvements, the federal government has made the first moves towards removing Social Security numbers from Medicare numbers and identification cards. The existing numbers, which typically consist of a member’s SSN followed by a letter indicating why the individual is eligible for benefits, will be replaced over the next several years with a random member number similar to what private insurance carriers have been required to use for some time. New Medicare enrollees over the next four years will receive the new numbers, while Medicare administrators have an additional four years to issue new numbers to existing beneficiaries.

    While the recommendation to disassociate Social Security numbers from Medicare numbers has been made numerous times over the past decade, it hasn’t been acted on until now both due to the resources required to switch over the millions of current and upcoming Medicare beneficiaries, and because of the demands put on HHS by the implementation of the Affordable Care Act and the health insurance exchanges for which the legislation called.

    However, in the wake of the recent rash of high profile security breaches, including insurance giant Anthem, there’s an increasing focus on limiting the exposure of beneficiaries’ personal information, particularly Social Security numbers (and Medicare numbers by extension), to security lapses, theft, and fraud. By removing Social Security numbers from Medicare numbers, beneficiaries would no longer need to carry that information in their wallet, hand it over to reception and billing at every doctor’s office they visit, or have it on file with their local pharmacy. Depending on how individual carriers implement the change, they may not even need to have their SSN on file with their Medicare Advantage or Medicare Supplement plan at all. As a society we’re coming to understand that there’s no way to entirely prevent the kind of breaches suffered at Anthem and other companies, but we can develop strategies to limit what information is given out and when, and thereby limit the long term negative effects of any potential breaches. Unauthorized access to a member’s name, address, and randomly generated Medicare number and carrier ID number would still certainly have ramifications, but nothing close to what it would under the current Medicare number system. Social Security numbers are still the key to unlock identity theft, and for the already vulnerable population of Medicare beneficiaries, this is an important step towards helping them keep their identities, and by extension their financial and emotional well being, safe and secure.