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  • Bonus Programs and Structure

    Let's Talk Money

    Most companies have bonus programs to help you earn extra cash. Before you start planning your next trip to the Caribbean with all of this newly acquired money, make sure you check out the details of each program.

    THE FINE PRINT <—That’s what I am talking about. You need to pay attention to get paid. Make sure you are reading the fine print for each of these programs because you will notice that they differ from carrier to carrier. Policies will only count towards bonus qualification if they meet the requirements, such as the effective date of the policy, whether the policy is underwritten, or which plan it was. You must make sure you are reading the details.

    KEEP TRACK OF YOUR APPS!
    I cannot say this enough. You may have to submit a form to collect your extra bonus, and you will be out of luck if you were not keeping track. Even if you racked up thousands of dollars, it is your job to keep track of the apps you are submitting, so make sure you are doing so.

  • 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.

  • Should Medicare Add a Long Term Care Benefit?

    One of the biggest misconceptions many have about Medicare is that it will cover their potential long term care needs. While Medicare may provide some coverage for this type of care, there are significant limitations. As a result, most people who need long term care will still be forced to pay for it out of pocket, or through Medicaid or a private long term care insurance policy.

    If Medicare were to add a true long term care benefit, what would it look like and how would it work? A proposal recently published by Health Affairs presents several interesting ideas on how to integrate a long term care benefit into the existing Medicare framework.

    In-home care – The core of the proposal is built around an in-home health care benefit that would be available to anyone with dementia or who cannot perform two of the Activities of Daily Living on their own. There would be a daily benefit limit, similar to private long term care insurance. The focus on in-home health care keeps with the growing trend towards “aging in place”, which allows seniors to continue to live at home as independently as possible even as they need additional supportive services.

    Integration and coordination of care – Beneficiaries would be encouraged to enroll in what the proposal calls an Integrated Care Organization. These ICOs would coordinate care between doctors, long term care providers, and unpaid care givers like loved ones to ensure that patients receive all the medical and support services they need.

    One of the obvious challenges to adding long term care benefits to Medicare is the associated cost to an already strapped system. Aside from a relatively modest monthly premium and a moderate increase in the existing payroll tax that goes to fund Medicare, a significant portion of the cost would be covered by sliding scale co-insurance. The co-insurance would range from 5% for the lowest income beneficiaries to 50% for those with the highest incomes. This would be especially significant for middle income seniors who currently have too much in assets and income to qualify for Medicaid, but cannot comfortably afford the full cost of long term care.

    While it may not be a perfect proposal, it does start a necessary conversation on the real struggles of many seniors to receive the long term supports they need to live their later years with comfort and dignity.

  • The Impact of the Election Year on Medicare Marketing

    The results of the upcoming Presidential election could bring about a host of changes, but even before that, the election year itself can mean new marketing challenges for agents during AEP. So what should you be prepared for?

    Fear of changes – Because Medicare is a major campaign issue, seniors are likely to be more concerned about potential changes and less certain about their options for 2017. With the promise of a new administration reforming Medicare, clients may be worried about making a decision, only to have things change.

    Congested advertising space – Remember that the election is smack in the middle of AEP! In the final lead up to the election, people will be inundated with campaign related direct mail pieces, television commercials, and print ads, making it harder for yours to be seen.

    Limited advertising available – Due to the volume of political ads being scheduled in the lead up to the election, television networks will almost certainly run out of available advertising space, and print publications may as well. Both will likely charge a premium, particularly on the specific networks and publications that best reach seniors.

    So, how do you combat this?

    Be prepared to reassure clients – Clients may be more cautious with their choices or less sure about their options because of potential changes to the Medicare program. Have some talking points in mind to remind them that any changes as a result of a new Presidential administration will take time and they should make the best choice they can based on where things stand now.

    Plan for advertising early – Get in touch with your contacts at television providers, newspapers, and direct mail houses earlier than you think is necessary to make sure you can get your advertising out when you need to. There’s likely to be longer turn around time in addition to less availability, so getting in early will be key.

    Be as creative as possible – There will be so much advertising, it will be more important than ever to find ways to stand out from the crowd. People are going to have red, white, and blue postcards by the dozens in their mailboxes and wall to wall ads in their newspapers and magazines, so start thinking now about how to make yours stand out.

    While planning marketing for AEP is always a significant undertaking, remember that this year will bring with it unique challenges. Plan ahead and save yourself some headaches!

  • 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.

  • Proactive vs Reactive: The Importance of Contracting Before it’s too Late

    During the weeks before Annual Election Period there is a spike in the number of agents contracting with new carriers. But why wait until the busiest time of the year to contract? Why not have the tools you need to insure you’re prepared for each client all year round? Here are just a few reasons to contract now:

    Be Proficient – First off, ask yourself if you are currently confident with all of the products you have to offer a client. Are you prepared if you receive a call from a referral that is in a neighboring town outside your usual area? Don’t be caught without the most competitive plans in not only your direct area, but surrounding areas as well. The most competitive plan in one zip code can be drastically different in the next. When you’re missing something from your “tool bag,” clients can become uneasy about your ability to write the policy that best fits their needs. You might also miss out on referrals that could otherwise help grow your book of business.

    Be Prepared – Having the right materials and information for a company can be crucial to making the right sale. Applications and promotional materials can take a while to arrive. The same goes for properly registering sales events and advertising materials. Contracting early allows you to have these supplies sooner and on hand when needed.

    Stop Losing Sales – Clients often hear of health insurance plans from commercials or through their friends and they’re suddenly set on having that specific product. No other product will do in their minds. This happens more and more often. Advertising is effective and friend’s opinions matter. Just because you personally think that another plan might be better doesn’t mean your client will be set on that product. Offering more options opens up more opportunities.

    Don’t Scramble – Clients need to feel like you have a handle on their insurance needs. Waiting until a client requests a company and then starting the contracting process is an easy way to lose a client. Especially if they’re a new client and don’t have long until their enrollment period ends. You don’t want to have to refer your client to another agent and lose a potential sale.

    Know Your Contract – While keeping everything else listed above in mind, it’s also important to know your limitations or if it’s time to rework your contracts. Know the difference between being a captive agent, career agent and a broker and contract in the way that makes the most sense to you. Captive agents can only sell the products from the company they are employed by, while a career agent can offer other products but only after first offering the products from the company they work with. Brokers, on the other hand, are not chained down. They are able to sell any product that they are successfully appointed and certified with, ensuring they have a wide range of products to cover their client’s needs including unexpected referrals.

    For more information on what companies are available and contracting in general, please visit www.agentpitstop.com or contact contracting at contracting@agentpitstop.com.

  • 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.

  • What Your Medicare Advantage Clients Need to Understand About Provider Networks

    The first thing many clients ask when presented with a new plan is “can I keep my doctor?” It’s an easy enough question to answer with a quick search in a provider directory or a quick call to member services, but there can be more to it than a simple yes or no.

    Here are some things about provider networks your clients need to be aware of before they choose a plan.

    Networks can change at any time – Providers can drop their contract with a plan essentially whenever they want. A provider who is in network when the plan year starts or when a client becomes Medicare eligible won’t necessarily still be in network even just months or weeks in the future.

    Different plans from the same carrier can have different networks – Some carriers have certain plans with lower costs or more robust benefits than their other plans. In exchange, these plans have smaller networks. It’s not enough to know that a provider works with a certain carrier, you also have to be sure that they’re in network for the specific plan in question.

    Every doctor in a practice may not be in network for a certain plan and carrier – In most cases, an entire practice or medical group will be contracted together with a particular carrier. However, there are times when this may not be true, depending on how the business side of the practice is run. It’s a good idea to double check on each provider individually, even if it’s providers who share an office.

    They may have a Special Election Period if their doctor leaves the network – If a carrier makes significant changes to their network, CMS may determine that affected members are eligible for a one time SEP to move to a different MAPD. In California, they’re also likely eligible for guaranteed issue into a Medicare Supplement plan in accordance with the Knox-Keene Act, with certain restrictions.

    They may have continuity of care allowances – Some carriers will allow a grace period during which they’ll allow their members to see providers who have left the network while they transition to a new provider. This is typically limited to members who are considered in active treatment, and the timeframe can vary.

    Making sure clients understand the ins and outs of their plan’s network will help them get the care they need and help you keep a happy client.