• Changes Coming to Medicare Supplements

    The National Association of Insurance Commissioners (NAIC) has released their proposed breakdown of Medicare Supplement plans to take effect in 2020, to comply with new regulations on first dollar coverage passed by congress last year. H.R. 2 eliminates first dollar coverage (discussed further below) as part of Medicare Supplement plans beginning in 2020, along with changing the reimbursement rates for Medicare providers.

    What is first dollar coverage?

    Simply put, first dollar coverage is coverage without any deductibles or coinsurance. The coverage is considered “first dollar” because from the first dollar spent, the coverage pays its share. Medicare Supplement Plan F is an example of first dollar coverage, because the plan pays the Part A and Part B deductibles.

    How does this change Medicare Supplement plans?

    Starting in 2020, plans C and F will only be available to existing Medicare beneficiaries. New Medicare beneficiaries will have their choice of the remaining plans, with Plan G offering the richest benefits. NAIC has also proposed the introduction of a high deductible Plan G to take the place of high deductible Plan F.

    Why are they making this change?

    Many believe that first dollar coverage encourages overuse of services, because beneficiaries have no financial incentive to limit their care to only what’s truly necessary. By passing along a share of cost even to those people who have Medicare Supplement plans, the hope is to lessen the strain on the Medicare program.

    While the new plans won’t take effect for several years, this is sure to significantly change the Medicare Supplement landscape for agents and beneficiaries alike.

  • What to Know About the Knox-Keene Act

    For agents in California, the Knox-Keene Act can be a magic bullet in some tricky situations where a client needs to change to a Medicare Supplement but couldn’t pass underwriting. So how does it work?

    The Knox-Keene Act provides guaranteed issue rights to existing Medicare Advantage plan members if the plan does any of the following:

    1) increases premium by 15% or more
    2) reduces benefits
    3) increases physician, hospital, or drug copayments by 15% or more
    4) discontinues its relationship with a provider who is currently furnishing services to an individual

    Of course there are some restrictions to be aware of.

    GI rights apply to the same carrier’s Medicare Supplement plans first. If the company that offers the Medicare Advantage plan the client is coming off of also offers Medicare Supplement plans, the GI rights only apply to that carrier. If that carrier doesn’t offer Medicare Supplement plans but an affiliated company like a parent or a subsidiary does, then the GI rights only apply to the parent or subsidiary. If none of those companies offer Medicare Supplement plans, then the GI rights extend to any issuer.

    Except in the case of a provider leaving a plan’s network, enrollments using these GI rights must happen during AEP. This isn’t especially restrictive, because the other changes would only be happening effective January 1 and any plan changes would be happening during AEP anyway, but it does mean you can’t just wait and disenroll during the Medicare Advantage Disenrollment Period in January and February and set up the Medicare Supplement then.

    Remember you’ll likely need to submit your client’s Annual Notice of Change or a notice from the plan or their doctor about a network change along with the Medicare Supplement application. It’s a little bit of work to potentially make a client very happy!

  • Quick tips for Submitting a Clean app and Avoiding Kickbacks

    Applications being rejected or kicked back can be frustrating and time consuming. You are not only setting aside time to figure out what plan works best for the client but to also meet with them and help fill out the application as needed. Don’t let your time or your client’s time be wasted because of little mistakes that could have been prevented by taking an extra minute to check over your work.

    Be Thorough – One of the biggest hold ups with processing can be that you’re missing the most basic information on an app. As an agent you are responsible for obtaining information such as a client’s name, phone number, address and Medicare ID and these are very important bits of info. However when you get into the groove of writing apps, especially in group settings or during the annual election period where the process comes at a faster pace, you may move right past a question without answering it. Always scrub your own app before submitting to check for these easy to fill questions.

    Make sure the plan selected actually works for your client – Sometimes a simple mistake of choosing the wrong plan can create a kickback. For instance Blue Shield of California only partially covers Contra Costa County and Care1st has a partial county in Alameda County. Knowing a plans coverage area and double checking zip codes is key to making sure you’re selecting the right plan for your client in situations such as those

    Other possible snags to watch out for are making sure you’ve selected the correct special election period (SEP), whether or not your client is dual eligible, or choosing a plan that helps with a specific health issue such as diabetes or a heart condition.

    Provide the Right Paper Work – At various times extra paper work is needed along with the client’s application. Think ahead and predict what documentation could be needed. For instance, in California, Medicare supplements being written on the birthday rule almost always require proof of prior plan. Having a copy of the client’s previous policy ID card and submitting it with the application could save you time from needing to do so later, while the application sits on hold. When writing an application that has an SEP it’s also very important to include the correct information on why it’s an SEP. If the client has recently moved to a new zip code or state where their plan no longer exists then include a letter from their policy’s provider showing they have moved out of the network.

    Paper work showing Power of Attorney (POA) is particularly important to point out because many agents often forget about including documentation for POA since it doesn’t frequently come up. Although there are a few companies that don’t require documentation, the majority of companies do, which is why it’s a good policy just to always include POA documentation.

    Don’t Dawdle with Corrections – If you do have an issue with an application (like you wrote down the Medicare ID incorrectly or have missing paper work, etc.) make sure to get it to the company ASAP. Providers offer a time frame to get corrections in before they reject applications. Once you miss a deadline it is rare that the company will open that application back up again. This leaves you either having to write an entirely new app if the election period is still open or, worst case scenario, it can leave your client without coverage.

  • 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 or contact contracting at

  • Medicare Supplement Commissions Cheat Sheet

    Note: Updated with commissions as of 4/1/18

    Agent Pitstop can help you find the best rate for your client through our online rate engine but while you’re writing, it’s nice to know what you’re getting out of it. Especially if there is more than one company in an area with similar rates.

    Here is a Medicare Supplement Commissions Cheat Sheet to help you know what commissions should be coming your way depending on what company you write:

    Click here for a downloadable PDF.

    commission cheat sheet 2018
  • 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.

  • Excess Charges – Should Your Medicare Supplement Clients Be Worried?

    Where Medicare Advantage plans have the question of balance billing, Medicare Supplements have excess charges. Medicare Supplement Plan Comparison ChartYou’ve likely noticed in the comparison charts for the different types of Medicare Supplement plans that plans F and G cover what they call “Part B excess charges.”
    For some clients, the idea of these unspecified excess charges can be intimidating, as they bring with them visions of crushing medical bills and the attendant financial ramifications. Even for some agents, it’s difficult to feel comfortable quantifying what excess charges are, how much they can be, and how concerned about them a client should be.

    The important things to remember are as follows:

    – Medicare participating providers are prohibited from billing Medicare beneficiaries for anything outside of their co-insurance or copayment, as determined by standard Medicare coverage rates and whatever Medicare Supplement plan the member may have.

    – Medicare Supplement plans F and G cover excess charges, so members with either plan should never run into excess charges directly, even when seeing non-participating providers.

    96% of providers who offer Medicare-covered services are participating providers. This means that Medicare beneficiaries are statistically unlikely to ever encounter a situation where excess charges are even potentially an issue. You can help members look up providers they may want to see by checking Physician Compare on

    – Medicare non-participating providers can choose on a per-service basis whether or not to accept assignment, so a member who uses a non-participating provider may not necessarily see excess charges every time.

    – If a non-participating provider is going to bill for excess charges, the member will typically be required to pay for the entire service up front. The provider will then submit a claim to Medicare and the member will receive a reimbursement check for the amount covered by Medicare. The end cost to the member will likely be small, but for some people having to pay up front for the service and wait for reimbursement may be a concern.

    – Excess charges themselves are limited by Medicare. Non-participating providers who are not accepting assignment for a given service can charge up to the Medicare limiting charge of 115% of the non-participating provider reimbursement rate, which is 95% of the Medicare fee schedule amount. This works out to 109.25% of the Medicare fee schedule amount, which means the member would be liable for 9.25% of the Medicare amount, in addition to whatever usual cost-sharing may apply. For example, if the Medicare fee schedule amount for a particular office visit is $175, a non-participating provider can only be reimbursed by Medicare up to $166.25. This makes the Medicare limiting charge 115% of $166.25, or $191.19. A member with a Medicare Supplement plan that covers the cost-sharing for Part B services but does not cover excess charges (Plan A, B, C, D, or M) would be liable to pay the difference between the Medicare limiting charge and the Medicare fee schedule amount, which would be $16.19. Beneficiaries with Medicare Supplement plans that have some share of cost for Part B services and do not cover excess charges (Plan K, L, or N) would pay whatever their usual coinsurance or copayment amount is, plus the excess charges of $16.19. Beneficiaries with Plan F or G would pay nothing.

    – Excess charges only apply to services rendered by non-participating providers, not to services from providers who have completely opted-out of Medicare. Providers who have opted-out enter into a private contract with the individuals they treat, regardless of their Medicare eligibility, and patients must be notified before services are provided that they will be liable for the total cost of any services provided and informed that they may be able to have the same services covered by seeing a different provider.

    In many cases, the potential excess charges will be less than the premium difference between a plan that would cover them and one that wouldn’t. For clients whose doctors are Medicare participating, there’s likely minimal if any benefit to a plan that protects them from potential excess charges. For clients who have a Medicare Supplement plan primarily because of the flexibility it affords them in seeing whatever doctor they want, excess charges may be a more significant consideration, particularly if there’s a provider they would like to see consistently who is non-participating. Understanding the economics of excess charges and how to estimate them can help you and your clients decide how to balance premium cost and the cost of getting care to find a solution that works.