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  • 2018 Medicare Part A and B Premiums and Deductibles Announced

    Last week CMS released the Medicare Part A and B premium, deductible, and co-insurance amounts for 2018.

    The Part B premium will not increase and will remain at $134 for 2018. This premium will apply to new enrollees, individuals who are not currently receiving Social Security benefits, and those who currently pay more than the standard premium due to an IRMAA. Those who are already enrolled in Medicare Part B and who are currently receiving Social Security benefits and are not subject to an IRMAA will likely not be charged the full premium, but may still see a premium increase due to the Social Security Cost of Living Adjustment for 2018. Beneficiaries who are impacted by this “hold harmless” provision who want to find out exactly what their premium will be for 2018 should contact Social Security directly.

    The Part B deductible will remain at $183 for 2018, the same as in 2017.

    The Part A deductible and coinsurance amounts can be found in the table below.

    Inpatient hospital deductible $1340
    Daily coinsurance for days 61-90 $335
    Daily coinsurance for lifetime reserve days $670
    Skilled nursing facility daily coinsurance for days 21-100 $167.50

    You can view the complete CMS fact sheet by clicking here.

  • Get to Know Your Carriers

    We want you to take a moment and answer a couple questions. (We promise these are easy.)
    1. How many carriers are you appointed with?
    2. How many of their websites have you been to?

    The reason we ask is there is a whole network of information on those carrier websites.
    • Detailed information about their products
    • Live chat
    • Direct phone numbers for Agents Only
    • Material ordering (that sometimes goes straight to your house)
    • Promo ordering
    • Insurance Resources
    • Contact forms
    • Specials/prizes/events

    With AEP right around the corner we think it would be a great time for you to familiarize yourself with the companies that you are appointed with. By doing so, you have all the knowledge you need to give potential clients.

    Need some help finding your carrier website? Type the carrier name in the search bar of your preferred internet search engine and the carrier you are looking for should pop up on the top of your search.

    With that being said, we have another great reference for you to use:

    That’s right. Agent Pit Stop. Did you know that on our webpage you can:
    Click on the CLIENTS tab to see all your clients, plus you can see all upcoming birthdays. Making it easy for you to give them a phone call, send a card, or let them know of plans that may be more suitable to their health needs.

    Under the CONTRACTS tab you can see which documents we have on file and when they are expiring, plus you can request contracting information for carriers you may not be appointed with.

    The RATES tab has a search engine for you to use to better prepare you for your appointments. It helps your clients know the most updated rates that are available.

    The BILLING tab will show any balances you have with Van Berg.

    The COMMISSION STATEMENTS tab will show you exactly that. What date you were paid, the company/companies, and a file to download of the statement for that date.

    The SECURE EMAIL tab is for those who would like to sign up or log in to their secure email page.

    Last, but not least, the BLOG tab. Keep up to date with information about carriers, helpful tips, changes in insurance, and other information that may be pertain to the business.

    As always, if you cannot find what you are looking for here and still need additional help, we have several people in the office to help point you in the right direction. Please do not hesitate to call us at (800) 723-5228.

  • Guide to Medicare Part C and D Enrollment Periods

    One of the most common questions an agent has to answer is “when can I enroll?” Because there are a wide variety of situations, CMS has created a handy chart to help you determine the options available to a client.

    enrollment periods

    You can click here to view and download the full document from Medicare.gov

  • Why Do Clients Want a Brand Name?

    Often agents can be frustrated by a client’s insistence on going with a particular brand name carrier, despite price and benefits that suggest they should go with a different company. So what is it that makes clients willing to spend more money for a brand name?

    They think higher cost is worth lower risk – Clients can perceive the more familiar company as being a lower risk than another, lesser known company. Higher cost is a tradeoff that they’re willing to make, because health care isn’t the type of thing on which most people want to take a risk.

    They think higher price means it’s better – It’s not uncommon for clients to expect that the higher priced product with the company name they know is somehow better. As an agent you know this may or may not be true, but clients are generally looking at their insurance purchase the same way they would any other purchase. The more expensive brand name is likely better than the less expensive generic version. Remind them that it’s more like generic prescriptions, where they’re essentially the same thing at a much lower cost than brand name.

    So how do you combat this?

    Show clients the CMS materials – By showing clients the “Medicare and You” or “Choosing a Medigap Plan” booklets, you can help them see that plans are regulated and that they’re protected by the federal government. For Medicare Supplement clients, show them the chart in the “Choosing a Medigap Plan” booklet that shows the different plan benefits and the part where it says that all letter plans are standardized and provide the same benefits.

    Show them ratings and explain company track records – Star ratings and financial ratings for insurance companies can go a long way to soothe a nervous client who is reluctant to choose a plan that would be a better fit because of company brand recognition. If you can show a client that both plans they’re considering are four star plans, or that both companies have an A rating, it can help them see past their bias towards a familiar company.

    Give them what they want – Ultimately, if a client is set on a particular “brand name,” give them what they want. Explain the benefits and the downsides and let them make the choice, even if it isn’t the one you would make. They’re the ones who have to be comfortable with the coverage provided and the cost.

    As is usually true, your job is simply to educate your clients and let them make the choice with which they’re comfortable.

  • What to Know About Specialty Drugs

    Recent advances in the pharmaceutical industry have brought major innovations to the treatment of diseases like cancer, rheumatoid arthritis, and hepatitis B. New medications can offer hope and better quality of life to patients struggling with life threatening or chronic conditions, but these drugs come at a high cost and can be a burden even for people with coverage through a Medicare Advantage or stand-alone Prescription Drug Plan.

    Here are some important considerations for clients who may need these new and advanced drugs.

    CMS allows plans to include a specialty tier in their formulary – Plans are allowed to place any drugs with a monthly cost over $600 on a specialty tier. This tier is not restricted to the usual 25% maximum cost sharing, so a member may be expected to pay up to 33% of the cost for drugs in this tier.

    Only a small number of drugs are in most plan’s specialty tires – On average, less than 10% of the drugs in the CMS reference formulary are included in a plan’s specialty tier. Just because a drug is new does not necessarily mean it won’t be covered at a lower tier. The specialty designation is generally reserved for the most expensive drugs used by the smallest group of people.

    Part B vs Part D covered drugs – Some drugs can be covered under either Part B or Part D, depending on how and where they’re administered and how they’re prescribed. As a general rule, drugs administered in a doctor’s office or other outpatient facility are covered under Part B, while drugs administered by the patient at home are covered by Part D. However, there are exceptions that can have a significant impact on what a patient pays for the same treatment. For example, oral chemotherapy drugs used in place of traditional infusion chemotherapy are covered by Part B, even if the patient takes them on their own at home. Other oral cancer drugs that could not alternatively be given via IV or injection in a doctor’s office are covered only under Part D. For a client with most Medicare Supplements, this can mean the difference between having no out of pocket cost once Original Medicare pays their 80% and their Medicare Supplement covers the remaining 20%, and paying up to 33% of the thousands of dollars that the drug could cost under Part D. In contrast, a patient with only Original Medicare and a Part D plan may save money with the Part D covered drug over the full course of their treatment, because Original Medicare does not have the out-of-pocket maximum that their Part D plan does.

    The coverage gap – For clients taking Part D specialty drugs, they will likely quickly become familiar with the coverage gap. Once they have exhausted their initial coverage, it’s important that they continue to show their Part D membership card when filling prescriptions, even if they’re paying out-of-pocket. This will allow them to access the manufacturer discount offered while in the gap and will help make sure that their out-of-pocket cost is tracked correctly to get them into catastrophic coverage as quickly as possible.

    There are programs to help cover the cost – Clients who even might be eligible for the Low Income Subsidy (LIS), also called Extra Help, should apply. Especially for those taking specialty drugs, the subsidy can save someonethousands of dollars a year. For people whose income is too high to qualify for LIS, there are manufacturer patient assistance programs from many drug companies. These programs can offer significant discounts, even completely covering the cost of a drug. Typically clients can apply on the manufacturer’s website and will be sent a card to use at the pharmacy to access the discount. If clients are not able to get LIS or help from their drug’s manufacturer, there are various charity programs designed to help people with high medical costs.

    Clinical trials have their own rules for Medicare Advantage plans – Members wishing to enter a clinical trial for a new treatment for their disease can do so while remaining in their Medicare Advantage plan and paying fee-for-service costs for clinical trial care. Their Medicare Advantage plan is required to continue to cover necessary treatment for their condition even while in the trial. Any cost sharing paid by a member for a clinical trial also must be counted towards their in-network out-of-pocket maximum by their Medicare Advantage plan.

    Dealing with a life threatening or chronic illness is difficult enough. Be prepared to arm your clients with this information to help make their treatment a little bit easier.

  • Does Your Client’s Doctor “Take Medicare?” What Does That Really Mean?

    Often people say that a certain doctor or other medical provider “takes Medicare,” but it’s not an accurate description of a doctor’s contract status with Medicare. There are actually three distinct categories of provider when it comes to Medicare, each with their own potential costs and limitations for clients.

    Participating
    – A participating provider is one that agrees to accept assignment of Medicare benefits and can charge no more than the Medicare fee schedule amount for any services.
    – Clients will not be liable for excess charges, even without a Medicare Supplement plan that would cover them.
    96% of providers who offer services that Medicare would cover are participating providers.

    Non-particpating
    – Non-participating providers can choose to accept Medicare assignment on a per-service basis. If they accept assignment for a particular service, they can bill Medicare directly and the member will pay no more than their usual cost-sharing.
    – If they choose not to accept assignment for a service, the client is liable for excess charges and may need to pay up front and wait for reimbursement from Medicare for the covered amount. Excess charges are limited to 9.25% of the Medicare approved amount for a service, in addition to whatever the member’s usual cost-sharing would be. You can check our post on excess charges for more details.

    Opted out
    – Providers who have opted out cannot accept reimbursement from Medicare and must enter into a private agreement with their patients.
    – Patients will sign a contract with the provider agreeing to that provider’s fees and policies.
    – Patients who see a psychiatrist should be especially aware of the limitations for providers who have opted out. While only 4% of providers nationwide have opted out, 42% of those are psychiatrists.
    – Medicare Supplement plans will not pay anything towards services from a provider who has opted out.

    Knowing the difference between participating, non-participating, and opted out providers can save your clients money and headaches!

  • Happy Anniversary to Medicare!

    In July of 1965, President Lyndon Johnson signed the legislation that formed the Medicare and Medicaid programs. In the fifty years since, millions of Americans have gotten the important care they need thanks to the Medicare and Medicaid programs, and it’s difficult to imagine health care in the United States without it.

    By caring for some of our most vulnerable populations, Medicare and Medicaid provide a vital service in protecting the health of those who need help the most.

    As part of their celebration of Medicare’s golden anniversary, CMS is collecting stories of the lives changed by this program. If you’d like to share your story, you can do so on Medicare.gov by clicking here.

  • Being Kept “Under Observation” Can Matter More Than You Think

    It’s a common practice for doctors to keep a patient in the hospital “under observation” when their condition needs monitoring, but may not require an extended hospital stay to stabilize. Even a patient who stays overnight in the hospital may still technically be considered an outpatient under observation. But what does this mean for your clients?

    A few important things to know about the difference between being an outpatient under observation and an admitted inpatient.

    Costs for the same services over the same timeframe can vary significantly depending on patient status – Because patients under observation are still considered outpatients, their treatment is covered by Part B. Once admitted as an inpatient, Part A takes over coverage for any required services. Because the deductibles and coinsurance are separate, the cost can vary for clients who have certain Medicare Supplement plans. For example, a client with Plan G would pay nothing for an inpatient stay, since their plan covers both the Part A deductible and Part A coinsurance, but would pay Part B charges out-of-pocket until the Part B deductible is met. While Medicare Advantage plans may not mirror the same inpatient and outpatient deductibles in their coverage, their copays and deductibles likely still differ between inpatient and outpatient services.

    Outpatient observation days do not count towards a qualifying hospital stay for skilled nursing facility care – To be eligible to have skilled nursing facility care covered under Original Medicare and a Medicare Supplement plan, a member has to first have a qualifying hospital stay of at least three days. Time spent under observation, even preceding an inpatient stay, does not count towards the required hospital days. However, Medicare Advantage plans will vary and many do not require a previous inpatient stay.

    Only a specific doctor’s order can change a patient’s status from outpatient under observation to inpatient – Inpatient status is not a factor of the length of time spent in the hospital. A patient could theoretically go to the ER, spend hours in the ER being evaluated, then be moved to a regular hospital bed for another day or more for observation, and never officially be admitted to the hospital. Only once a doctor determines that a patient requires a full inpatient stay and writes an admitting order is someone considered an inpatient.

    Some Medicare Advantage plans will not charge an Emergency Room copay and a hospital copay for the same day – Under some MA plans, the ER copay is waived if you’re admitted to the hospital during the same visit, but this does not apply if you stay in the hospital under observation and are then released.

    It’s easy to assume that being in the hospital is enough to qualify as an inpatient, but it’s important to remember that there can be more to it than simply being in a hospital bed.

  • Concierge Medical Practices and Medicare

    Some doctors are beginning to switch to a concierge practice model, where they offer comprehensive services for a flat annual or monthly fee instead of charging patients for each individual service they receive. Some practices may also provide additional personalized services like a wider range of available appointment times or after-hours phone or email access to doctors.

    This practice model can work with Medicare, but there are specific things to be aware of if a client is considering coordinating their Medicare benefits with a concierge practice.

    Many concierge practices simply don’t take insurance at all – Many providers are switching to the concierge model to avoid the limitations on reimbursement from Medicare or private insurance and to save them the work of submitting claims. If a client’s existing doctor is considering switching to a concierge model, it’s important for them to find out if the practice will remain willing to work with the Medicare program at all, or will be opting out entirely.

    Concierge practices cannot charge access fees or administrative fees without providing additional benefits to members – If a concierge practice that does still accept Medicare assignment charges any kind of administrative or membership fees to Medicare beneficiaries, they must be providing some kind of services to the member beyond what would be covered by Medicare. If not, the fee is considered double billing and is against federal regulations. See page 15 of this document.

    If a provider in a concierge practice has opted out of Medicare entirely, the member cannot file claims themselves – Providers who have opted out of Medicare are required to enter into a private agreement with patients, entirely removed from Medicare. This includes members paying out of pocket for services and then filing a claim with Medicare themselves. If a provider has opted out, any services offered are no longer considered Medicare eligible.

    If you’re unsure, clients can always check Physician Compare on Medicare.gov for information on whether a provider participates in the Medicare program.

  • Can Home Technology Help Seniors Stay Independent Longer?

    Maintaining the independence to stay in their homes is a high priority to most seniors, and emerging technology may make that easier. Things like home monitoring systems, telehealth programs, and new types of mobility aids can help future generations of seniors avoid lengthy nursing home stays. As a result, this can help them preserve their savings, peace of mind, and independence.

    What needs to happen to help keep seniors in their homes?

    Seniors need better access to reliable, affordable cell phone and internet service – Things like home monitoring systems require high speed internet service, and telehealth services often make use of video calling features on newer smart phones. Access can be limited in rural areas and the costs can be prohibitive for seniors with limited income.

    Providers and members have to think beyond brick and mortar – Some seniors may be reluctant at first to use telehealth services or other technology, and will need support to get accustomed to it. Providers may also shy away, fearing their senior clients won’t use new technology and the effort to implement it will go to waste.

    Get Medicare and carriers on board – Seniors will only use most of these new technologies if at least some portion of the cost is covered by Medicare or secondary insurance. Medicare and carrier guidelines need to be updated to handle claims for these new services.

    We’ve embraced technology in so many areas of our lives, it’s only a matter of time before we do the same thing when it comes to caring for our seniors.

    You can read more about this at LifeHealthPro.com