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NABIP

NAHU (National Association of Health Underwriters) changed their name to NABIP (National Association of Benefits and Insurance Professionals.  The brand name change started in January of 2023. NABIP represents more than 100,000 Licensed health producers including agents, consultants, brokes and upline entities. As an organization, they host a number of state and national events.  Use the link at the bottom of this post to see upcoming events near you.  Agents can register for each event through the link.

About Members

NABIP Members work with and help millions of consumers get the best policy at the most affordable price. Members also help clients with service, compliance and claims issues. NABIP advances the interests of health insurance profesionals through advocacy at state and federal levels of the government.  Their members help millions of health insurance consumers with both individual and group benefit decisions on an annual basis.

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Members clients

The clients of NABIP members range from individuals and small businesses under 5 employees to Fortune 500 companies.  Members help their clients find the best healthcare at the most affordable price. In addition, members advise clients on a full line of other products such as dental, Medicare Advantage, Medicare Supplements, disability and a full range of indemnity products.  NABIP holds members to a Code of Ethics which requires them to make recommendations with their clients best interest in mind.

NABIP member benefits

Members have access to a number of educational opportunities such as advanced professional designations, CE classes and online learning courses. NABIP promotes its members with professional conferences, networking functions, business tools and mulitple publications. They also advocate for members at the state and federal level of government in the interest of their members.

NABIP Medicare Portal

The Medicare Portal gives members access to a variety of helpful information and tools from certification information to legislative updates. NABIP is the only organization currently representing agents and brokers working with Medicare products.

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CLICK FOR MEDICARE PORTAL

Calendar of events

The NABIP event calendar lists upcoming events such as the Annual Convention, NABIP Capitol Conference, Regional Conferences, State Conferences, Medicare Summits and Industry Meetings.

CLICK FOR CALENDAR OF EVENTS

FIND AND AGENT

Find an agent with the link below.  A zip code range will yield the best results.  A single zip code will yeild the best.

CLICK HERE TO FIND AN AGENT

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How to avoid Medicare mistakes

If you are getting close to your 65th birthday, you need to know how to avoid Medicare mistakes.  Some mistakes can be difficult to repair and may end up costing you money.

Let’s start by explaining what original Medicare is;  Original Medicare is a health insurance program offered by the federal government.  There are 2  parts to original Medicare.  The first part is Part A.  In general, Part A covers hospital costs.  The second part is Part B.  Part B covers things such as doctor’s visits as well as other outpatient services.  Most providers participate in original Medicare.

Here are some mistakes people make with Medicare:

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 Common Definitions in Medicare and Supplemental Insurance

The jargon around Medicare and insurance in general can feel very inaccessible to potential clients. One of the ways that agents can earn the trust of those clients as well as inform them and help them find coverage that works for them is to know the common definitions in Medicare and Supplemental insurance.

The following are some of the common Medicare-related terms that clients will need to know:

Annual Election Period (AEP):

This is the period of time during which people can enroll in, disenroll from, or change their Medicare Advantage, Supplemental plans or prescription drug plans. This is also the period of time in which beneficiaries can return to original Medicare. Choices made during this time period are effective January 1st of the following year.  The time period is October 15th to December 7th.

Coverage Gap or Donut Hole:

Not every beneficiary will reach this gap. However, the coverage gap for 2023 begins after the beneficiary and their drug plan have spent $4660 dollars on covered and approved medications. While in this coverage gap, members with higher prescription drug costs will  pay a higher percentage of the cost of their medicine.

Deductible:

This is the amount that beneficiaries will pay for benefits before the plan begins to pay for their benefits.  These include medical coverage, including services, prescriptions, and products.

Initial Coverage Election Period:

This is often referred to by its acronym, the ICEP. This is the period of time when a person who is eligible for Medicare can sign up to receive those benefits for the first time. It begins three months before the person’s birthday month, includes the birthday month, and ends three months after the birthday month. It is a seven month period.

Medicaid: It is easy to get confused between Medicare and Medicaid. Medicaid is a program that provides health-coverage for certain low-income people. Most often included are pregnant women, the elderly, and those with disabilities. It is funded jointly by federal and state money.

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Five Strategies for Getting and Keeping Clients

Agents need to learn how to effectively approach their potential clients in order to provide them with appropriate supplemental health insurance that will cover what is needed. Here are five strategies for getting and keeping clients.

1. Establish Rapport

This can truly be as simple as treating clients like the people and individuals that they are rather than as revenue. Empathy and confidence can go a long way here, as well as asking open-ended questions to get clients to open up to you in ways that may help you determine how to best help them.

2. Understand Motivations

There are nearly unlimited options for Medicare Supplemental Plans. With this in mind, it is crucial that an agent find out what is important to the client. Once the agent understands what procedures, services, and goods are likely to be needed, it will be much easier to recommend a supplemental plan that fits with the client’s lifestyle.

3. Educate Clients

It is vital that clients are informed about all of their options. Before they will buy a supplemental plan, they need to believe that they need what the agent is offering them, which requires the knowledge to evaluate their options. Part of educating clients is illustrating how the right levels of coverage will affect their lives moving forward. Many clients who come to purchase supplemental insurance will have little idea of how the system works, so it is very important that agents are knowledgeable enough to give them the information they need to make educated decisions.

4. Tell Relatable Stories – (key to getting and keeping clients)

Often, agents can be tempted to quote facts and figures as a way to convince clients to purchase supplemental coverage. However, it is often much more effective to tell personal stories. Anecdotes about how the right level of coverage has positively affected former customers or acquaintances can do much more for convincing than abstract numbers can.

5. Discuss Costs in a Positive Light

Although clients will have to pay to purchase the supplemental plans, agents can make this far more palatable. One of the ways to do this is to give examples of how the level of coverage they are paying for will positively affect their lives.

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What Do Healthcare Customers Want?

Healthcare is an unusual industry because the patient, or beneficiary, is also the customer.  What Do Healthcare Customers Want?  Customers, by and large, have an ever-evolving list of things they look for in choosing which products they want to purchase. In order to help best determine which supplemental insurance plans are best for your clients, you need to know what is important to them. Here are the top five things that healthcare consumers are looking for now:

Convenience

Life is busy, and it’s only getting busier.  People rely on convenience.   Automated tasks and obligations are necessary.    Healthcare is no exception.  Additionally, some are available online. If a task is not convenient, it is often put off. And when healthcare decisions or services are put off, there are often disastrous consequences. Luckily, increasing technology is making healthcare more convenient to access even as our lives get busier. Some of the ways healthcare companies are making their services more accessible are the following:

• Online scheduling

• Telehealth appointments and remote appointments are less time consuming.

• Automated prescription refills

• X ray and other scan access from a cloud rather than in person

• Online pharmacies that can deliver medications to the patient’s home address

What Do Healthcare Customers Want? – Transparency

Health insurance is hard to navigate for most.  No one likes to feel like the wool is being pulled over their eyes. Today’s consumers want transparency from their healthcare. There is increasing demand for more clarity in billing.  Many beneficiaries do not know what they will be charged up front in a doctor’s office or facility. It is also not only about costs – beneficiaries want their medical advice to be transparent, too. This can include the pros and cons of a particular procedure, prescription alternatives, and second opinions. Transparency on all levels is about building trust.

Good Bedside Manner

Overly authoritative, dismissive, or just plain rude doctors and facilities can no longer sneak under the radar in the age of the internet. Negative reviews can have real adverse effects on a business or practice. Patients have special insights into their own bodies.  As a result, their own concerns and symptoms need to be listened to carefully and seriously and considered in the diagnosis and treatment process.

Access To Information

Beneficiaries want to know the answers to their questions and concerns – point blank. They expect information about their healthcare and supplemental plans to be readily available. Some ways insurance companies are beginning to provide online portals that allow beneficiaries access to their information from anywhere at any time. Consumers also want more accessible information regarding coverage. They need to understand any potential coverage gap in their supplemental plans.  The Medicare world is over flooded.  Provide access to solid information.   Teach clients to discern accurate information from marketing schemes.

What Do Healthcare Customers Want? – Options For Care

Beneficiaries want to be included in their insurance company’s deliberation processes.  Customer feedback is imperative.  They prefer to make collaborative decisions about their care, not simply be told what is covered and what is not. Healthcare providers and companies who take these desires seriously are more likely to have happier, more loyal consumers for a longer period of time.

Turning Back the Clock

Learn a brief history of Medicare and Medicaid.

Here is a history of Medicare RX plans.

How did Medicare Advantage come about?

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What is a Medicare Appeal?

Sometimes, beneficiaries’ insurance plans can deny them coverage. A Medicare appeal is the action they can take if they disagree with a decision or payment by their Medicare plan. Beneficiaries can appeal if their Medicare plan denies them the following:

• A request for a health care item, supply, service, or drug that the beneficiary thinks that Medicare should cover.

• A request for a payment for a service, supply, drug, or health care item that the beneficiary already received.

• A request for a change of the amount the beneficiary must pay for the service, supply, drug, or health care item.

How to File an Appeal:

A beneficiary can start their appeal process through their plan if they have a Medicare Health Plan. The following are generic directions to follow to begin an appeal:

• The beneficiary, their representative, or their doctor will ask for an appeal within 60 days of the date of the coverage decision. If the deadline is missed, a reason for the delay must be provided.

• Include the following required information in the written appeal:

  • The beneficiary’s name, address, and the Medicare Number on their Medicare card [JPG]

  • The items or services for which they’re requesting a reconsideration, the dates of service, and the reason(s) why they are appealing.

  • The name of the beneficiary’s representative and proof of representation, if applicable.

  • Any other information that may help the beneficiary’s case.

• Beneficiaries can request a fast or expedited decision from their appeal if they think their health could be seriously harmed by waiting the standard 14 days for a decision. This means that the plan must provide a decision within 72 hours of their receipt of the appeal if they agree that the beneficiary’s health would be seriously harmed by waiting the time period for the standard decision.

• Submit  online.   Click here to begin.

How long an insurance plan has to respond to a beneficiary’s Medicare appeal depends on the type of request:

• Expedited (fast) request—72 hours

• Standard service request—30 calendar days

• Payment request—60 calendar days

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What Doesn’t Medicare Part D Cover?

Medicare Part D is prescription drug coverage, provided by private insurance companies licensed by the federal government. There are certain kinds of drugs that are excluded from coverage, however. Medicare coverage does not include the following:

• Drugs used to treat anorexia, weight loss, or weight gain

  • Note: Part D may cover drugs used to treat physical wasting caused by AIDS, cancer, or other diseases

• Fertility drugs

• Drugs used for cosmetic purposes or hair growth

  • Note: Drugs used for the treatment of psoriasis, acne, rosacea, or vitiligo are not considered cosmetic drugs and may be covered under Part D

• Drugs that are only for the relief of cold or cough symptoms

• Drugs used to treat erectile dysfunction

• Prescription vitamins and minerals (except prenatal vitamins and fluoride preparations)

• Non-prescription drugs (over-the-counter drugs)

How to Access Medicare Part D Coverage:

In order to avoid additional medical expenses, it is a good idea to work with your doctor and pharmacy to ensure that what they are prescribing you is covered under your private prescription drug coverage. The following are some ways to ensure this coverage:

• Before you go to the pharmacy, find out if your drug is on your plan’s formulary. If possible, ask your doctor to check that your prescription is covered. Otherwise, call your plan directly or check your plan’s website.

• Find out whether your plan places any restrictions on coverage, such as:

  • Prior authorization: you must get prior approval from the plan before it will cover a specific drug

  • Step therapy: your plan requires you try a different or less expensive drug first

  • Quantity limits: your plan only covers a certain amount of a drug over a certain period of time, such as 30 pills per month

• Use a preferred, in-network pharmacy to fill your prescriptions. Many pharmacy networks include both preferred and non-preferred pharmacies. You typically pay less for your prescriptions at preferred pharmacies.

These steps will help you avoid gaps in coverage and unexpected fees and costs from prescriptions that are not covered by Medicare Part D.

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Why Purchase Medicare Part D

Medicare has four parts. The original Medicare consists of Parts A and B, the original federal program. Part C is Medicare Advantage. Medicare Part D is prescription drug coverage, which helps cover the costs of medicine. Prescription drug coverage is optional.  Additionally, it is only available through private insurance companies approved by the federal government. While it is optional, Part D is offered to everyone who qualifies for Medicare. Costs, of course, can vary from plan to plan depending on the provider.

How to Get Medicare Part D?

There are two different ways to acquire Medicare Part D:

1. Purchase a standalone prescription drug plan. If you have Medicare Parts A and B, you can choose to add Part D to cover the costs of prescription drugs. The cost is separate cost from any existing coverage.

2. Purchase a MAPD.   Medicare Advantage Plans include Parts A and B.  And, many include prescription drug coverage.

What Does Medicare Part D Cover?

Each Medicare Part D plan has a list of approved drugs.   This list is the formulary.   Formularies identify what is covered and what is not covered. Plans sort their list of prescriptions into categories called tiers. Usually, drugs in a lower tier will cost less than drugs in a higher tier. The tiers often go from one to five or six.  Tier one is  low-cost.  These are typically common generic RX.  Tier five or six are specialty drugs.  These are the highest cost drugs and specialty medications. Not all medications are covered by Medicare Part D, however. Coverage may be limited due to medical necessity, availability, cost, or safety.

How To Enroll in Medicare Part D

Usually, if you qualify for Medicare, you qualify for Medicare Part D.  However, beneficiaries must have a qualify for a valid enrollment period.

• Your Medicare Initial Enrollment Period (IEP): You can enroll in a Part D plan in the 3 months you turn 65, the month of your 65th birthday or 3 months after.

• The Medicare Annual Enrollment Period (AEP): This runs from Oct. 15 to Dec. 7 every year. During the AEP, you may make changes to your Medicare Part C and Part D coverage. They will take effect on Jan. 1 of the following year.

• The Medicare Advantage Open Enrollment Period (OEP): This lasts from Jan. 1 to March 31 each year. You may add, drop or change your Part D coverage during this time.

• Special Enrollment Period (SEP): You may be able to enroll in a new Part D plan if you’re eligible for an SEP. You may qualify for an SEP under certain circumstances, such as if you make changes to a job-based drug coverage plan, or if you have or lose Extra Help.

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Medicare Supplement Plan G

Also known as Medigap Plan G, Medicare Supplement Plan G has been available for several years now. Another plan, Medigap Plan F, was very popular and was phased out in 2022. In its absence, Medigap Plan G has taken its place.

Medigap Plan G is one of the ten standardized Medicare Supplement Policies.  Plans are named in chronological order of the alphabet (A, B, C, etc.). Original Medicare does not cover all the treatments and services that many people need.  These policies are available to fill in the gaps. Any hospital, facility, or doctor that accepts Medicare will accept the Medigap Plan G. The vast majority of hospitals and doctors in the United States do accept Original Medicare.   Additionally,  Plan G is one of the plans that cover foreign travel.

What Does Plan G Cover?

Plan F, which is now unavailable, was considered the gold standard of Medigap Plans because it covered 100% of the gaps in Medicare. However, when it was phased out last year, Plan G soon became one of the most popular plans because it is almost as much coverage as Plan F. Medigap Plan G is nearly as much coverage, with one distinct difference. Plan G does not cover the Original Medicare Part B deductible, which was $233 in 2022. Even with the difference in coverage, beneficiaries of Medigap Plan G find it more cost-effective than Plan F when considering their respective premiums. Plan G covers everything that Original Medicare (Parts A and B) cover at 100% except for the Part B premium. This means that beneficiaries will pay nothing out of pocket for covered services and treatments after the deductible is met.

Medigap Plan G, much like Plan F, also covers “excess charges.” An excess charge is what happens when a doctor does not accept the full Medicare-approved amount for the payment, which can mean that they charge beneficiaries up to 15% more than the Medicare-approved amount for services or procedures. Since the year 2016, the following states have made excess charges illegal: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont.

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How Do Medicare Supplement Plans Work?

Original Medicare consists of Part A and Part B, which are Hospital Insurance and Medical Insurance, respectively. Together, Medicare Parts A and B cover and pay for many, but not all, of the healthcare services and supplies that seniors will need. A Medicare Supplement plan will help pay for the beneficiary’s share of some things that Medicare does not cover.

Here are some important things to know:

• Medicare supplement plans are not the same as Medicare Advantage plans.

• Beneficiaries must pay a monthly premium for their Medicare Supplement plan in addition to the Part B premium from original Medicare.

• Private insurance companies that provide Medicare supplement policies cannot cancel the beneficiary’s coverage even if they have persistent health problems.

What Do Medicare Supplement Plans Cover?

Medicare Supplements help to cover costs not covered by Original Medicare. Each plan provides a range of benefits. Basic benefits can include the following:

• Part A coinsurance and hospital costs up to an additional 365 extra days after Medicare benefits are used

• Part B coinsurance or copayment

• Blood (first 3 pints)

• Part A hospice care coinsurance or copayment

Certain Medicare Supplement plans may include additional benefits such as:

• Skilled nursing facility care coinsurance

• Part A deductible

• Part B deductible

• Part B excess charge

• Foreign travel exchange (up to plan limits)

• Out-of-pocket limit

What Do Medicare Supplement Plans Not Cover?

While Medicare Supplement plans cover many things, there is a general list of procedures and services that they do not cover. This list includes the following:

• Long-term care (like non-skilled care you get in a nursing home)

• Vision or dental services

• Hearing aids

• Eyeglasses

• Private‑duty nursing

• Prescription drug coverage

Beneficiaries who need prescription drug coverage can find it under Medicare Part D. To get coverage for the previously mentioned products, and other goods and services, a Medicare Part C, a Medicare Advantage Plan, can be a good option.

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