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Home 2023 June
Medicare Out of Pocket

Medicare Out of Pocket

By Ed Crowe | General Articles | 0 comment | 29 June, 2023 | 0

Medicare Out of Pocket

Original Medicare provides broad healthcare coverage for senior citizens and those with certain disabilities in the United States. It consists of Part A, which is hospital insurance, and Part B, which is medical insurance. It is a fee-for-service health plan managed by the federal government.  Learn what Medicare out of pocket expenses beneficiaries should expect.

 

For many people, it is a relief to qualify for Medicare. It is guaranteed healthcare coverage and the costs do not increase based on age like so many other insurance plans. The ability to get coverage also does not change based on any pre-existing conditions. However, there are costs associated with this service. Deductibles, premiums, co-insurance, and more can all cost a surprising amount. For people on a fixed income, it is particularly important to be aware of the following 5 out-of-pocket Medicare expenses.

Doctors who do not participate in Medicare

While it is rare, there are doctors who do not accept Medicare insurance plans for payment. This becomes a problem when beneficiaries need to see a specialist, as there are often fewer of those to choose from in their area. This issue is compounded if they need to see one sooner rather than later. These providers will nearly always cost more out-of-pocket than a participating provider in Medicare.

Providers that do not accept assignment

There are also providers and facilities that do accept Medicare for payment but they do not accept assignment. Assignment is the agreed-upon amount that Medicare will pay for a service, exam, or procedure. Doctors or other healthcare providers who do not accept assignment do not accept Medicare’s standard rates and may charge up to 15% more for their services.

 

Doctors who operate outside of a Medicare Advantage plan network

While Original Medicare has a nation-wide network of providers that are covered, Medicare Advantage plans are far more local. That means that if a provider does accept Medicare but is not within the beneficiary’s Medicare Advantage network, the beneficiary could still be paying more in cost-sharing for any services they receive. There are protections in place that do not allow those doctors who are out-of-network to charge more than they would under Original Medicare, however.

 

Inpatient versus observation stays in a hospital

Contrary to popular belief, staying overnight in a hospital does not mean that someone is admitted to a hospital, meaning they are not inpatient. Inpatient hospital stays are covered under Original Medicare through Part A (hospital insurance) and 20% Part B coinsurance for any physician services. If someone is placed under observation, however, they are responsible for 20% of any services they receive. That can add up very quickly.

 

Three day rule

Leaving the hospital does not mean someone is ready to go home. Often, people are transferred to a skilled nursing facility (SNF). If the beneficiary was in the hospital for three days as an inpatient, then Medicare will only cover a short-term stay in a SNF. If the person’s stay does not meet those requirements, they could be required to pay for a SNF stay on their own, out-of-pocket.

 

These are some of the possible unexpected major costs for Medicare beneficiaries. It makes financial sense to learn more about these and take steps to plan for the possibility that out-of-pocket costs could be higher than originally thought.

Licensed Medicare agents

In order to sell this plan, agents need to complete an additional certification and training.  Exclusive training will familiarize agents with all the components and properly represent the benefits of this ISNP.

Learn what working with one of the top FMOs gives you. 

Keep up with all of our current events by clicking here. 

Free leads!

Ready to contract?   GET  STARTED NOW.

Subscribe to our YouTube channel.   We provide weekly training and informational webinars.

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What is Balance Billing

What is Balance Billing

By Ed Crowe | General Articles | 0 comment | 29 June, 2023 | 0

 What is Balance Billing?

Codes of ethics and even regulations and laws govern medical billing. This is to ensure uniformity across the healthcare industry and to keep everyone, providers and patients alike, operating under the same moral guidelines. However, there are some exceptions to this uniformity.

Balance Billing occurs when a doctor or healthcare provider bills their client more than the amount that would be reimbursed by Medicare for the services that they provided to the client. Normally, Medicare beneficiaries would pay their deductible and coinsurance, and Medicare would pay the healthcare provider the agreed upon assigned cost of the procedure, test, exam, or service. With balance billing, the doctors or other providers try to recoup the portion of the bill that was written off by Medicare coverage.  They charge the beneficiary a bill for more than the normal deductible and coinsurance out-of-pocket costs.

Luckily, balance billing is often prohibited. If the healthcare provider is a participating member with Original Medicare, they cannot balance bill any of their patients for any reason. At last count, over 93% of non-pediatric primary care providers are participating providers with Medicare, so balance billing is likely very rare. If a doctor or provider is in-network with a Medicare Advantage insurance plan, balance billing is also not allowed.  Balance billing is excluded under their contract with the insurance carrier.

Non-participating Providers

Balance billing can occur when a physician or facility is not a participating provider but also hasn’t opted out of Medicare. These are called non-participating providers, and they can balance bill their clients. However, they cannot charge more than the original Medicare amount for the service plus 15%. Medicare will pay these non-participating doctors 95% of the Original Medicare assigned amount.  The doctor can then charge up to 15% more to their patient. For doctors who have opted out of Medicare altogether, there is no such limitation. This is rather rare among primary care physicians, but can be common among specialties. Only 1% of doctors have opted out of Medicare, but over 37% of psychiatrists have opted out of Medicare.

For members, it is vital to be aware of their doctor’s opt-in or opt-out status.  Knowing avoids surprise balance billing and limit their unexpected costs.

Licensed Medicare agents  – What is Balance Billing?

Get information about the new five star UHC ISNP.   This plan is offered only to Crowe and Associates agents.  In order to sell this plan, agents need to complete an additional certification and training.  Exclusive training will familiarize agents with all the components and properly represent the benefits of this ISNP.

Learn what working with one of the top FMOs gives you. 

Keep up with all of our current events by clicking here. 

Free leads!

Ready to contract?

Subscribe to our YouTube channel. 

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Medicare Advantage Commissions 2024

Medicare Advantage Commissions 2024

By Ed Crowe | General Articles | 0 comment | 29 June, 2023 | 0

Medicare Advantage Commissions 2024

Medicare Advantage commissions 2024 are now official.   CMS releases the max allowable commission for MA and PDP plans every year.   Carriers can pay agent level commissions up to the max listed amount.  While this is the amount they can pay it does not necessarily mean they will pay the max.  Traditionally most do pay at the max however.   A number of carriers have been increasing the renewals to the max for new renewals and in many cases for renewals on existing business.

There are 4 different commission groups:

The Medicare Advantage and PDP commission are broken up into different state categories.  They are staying the same for 2024.  Categories are (PA, CT and DC), (CA and NJ), (Puerto Rico and US Virgin Islands) and the (national rate).  The national rate is all the other states not in the previous categories.   PDP commissions are the same for all states.

Watch our tips on taking AHIP for 2024:

Take the 2024 AHIP for the discounted rate of $125 using our link

Learn about all the programs and benefits Crowe and Associates offers to Medicare agents and agencies

Medicare Advantage and Part D referral fee for 2024

The max allowable referral fee for MA and PDP plan sales is remaining the same. ($100 MAPD and $25 PDP) This represents how much agents can provide to other agents for a referral fee.  It should not be confused with the amount that can be given to to other Medicare beneficiaries which is $15 for a referral.

Here is the official CMS commission document

Medicare Advantage Commissions 2024

2024 max allowable compensation and historical amounts.

Plan Year Medicare Advantage PDP
National Rate PA,CT,DC CA, NJ National Rate
2009 $400 $200 $450 $225 N/A N/A $50 $25
2010 $403 $202 $454 $227 N/A N/A $53 $26
2011 $403 $202 $454 $227 $504 $252 $53 $26
2012 $402 $201 $453 $227 $503 $252 $55 $28
2013 $413 $207 $466 $233 $517 $226 $56 $28
2014 $425 $213 $480 $240 $532 $266 $56 $28
2015 $408 $204 $461 $230 $510 $256 $56 $28
2016 $429 $215 $483 $242 $536 $268 $63 $32
2017 $443 $222 $498 $249 $553 $277 $71 $36
2018 $455 $228 $511 $256 $567 $284 $72 $36
2019 $482 $241 $542 $271 $601 $301 $74 $37
2020 $510 $255 $574 $287 $636 $318 $78 $39
2021 $539 $270 $607 $304 $672 $336 $81 $41
2022 $573 $287 $646 $323 $715 $358 $87 $44
2023 $601 $301 $678 $339 $750 $375 $92 $46
2024 $611 $306 $689 $345 $762 $381 $100 $50
Puerto Rico & US Virgin Islands Referral Fees
MA Plans $100
2020 $350 $175 PDP Plans $25
2021 $370 $185
2022 $394 $197
2023 $411 $206
2024 $418 $209

How are commissions paid?

How much an agent receives for a MA or PDP sales depends on a number of factors.  What type of sale is a full commission on a 12 month advance?  When is commission a renewal only payment?  Will you receive a pro-rated commission?  We have a video explaining all the factors agents need to understand.

CLICK TO WATCH VIDEO

Crowe and Associates programs for Medicare agents

Crowe and Associates has a number of programs for insurance agents including a T-65 Medicare seminar program, Free Medicare lead program and a number of others.

ISNP United Healthcare

ISNP United Healthcare

By Ed Crowe | General Articles | 0 comment | 28 June, 2023 | 0

ISNP United Healthcare

If you are a Medicare agent, you have probably heard about the ISNP United Healthcare or (UHC IESNP) product.  Fortunately, this product is now available exclusively to Crowe and Pinnacle agents & agencies.

The UHC IESNP is now commissionable to our partners!

This is a great opportunity to our agents as it covers both dual and non-dual members either at home or institutionalized.  The UHC IESNP plan offers benefits that rival the best dual plans.  Clients are quickly and easily approved

Now is the time to get appointed to sell!

Why sell

  • 5-star plan (PPO plan)

  • Big benefits advantage over non-dual plans

  • Exclusively for PFS and Crowe partners

  • $1,500 or $1,600 OOP

  • $160 to $200 quarter OTC

  • $2,400 to $3,500 dental

  • Transportation benefit

  • Both Dual and non dual, drug help or no help at all

Get contracted with Crowe to sell these plans

Click here to begin a new contract with Crowe and Associates.

Add a carrier or state to your current Crowe and Associates contract.

For intent to move instructions, click here.   Please note; Not all carriers are listed.   Call the office for instructions for unlisted carriers.

This plan is available in the following states:  NY, NJ, PA, FL and CT and will be expanding into over 20 more states by the end of August. 

See link below for coverage areas:

IESNP coverage area map

Who can enroll in this plan?

  • Duals and people with drug help:  Can check status on Jarvis
  • Those that are institutionalized or cannot perform ADL’s or cannot perform iADL’s.  A quick phone call can qualify your client in minutes!

Please check the list of ADLs (basic things you need to do to survive and be well) below:

Standard for defining the areas of Activities of Daily Living is the Occupational Therapy Practice Framework,  The activities are broken down into nine areas.

  • Bathing/showering
  • Toileting and toilet hygiene
  • Dressing
  • Eating/swallowing
  • Feeding (the setting up, arranging and bringing food to the mouth)
  • Functional mobility (the ability to get from place to place while performing ADLs, either under one’s own power or with the assistance of a wheelchair or other assistive device)
  • Personal device care (utilizing essential personal care items such as hearing aids, contact lenses, glasses, orthotics, walker, etc.)
  • Personal hygiene and grooming
  • Sexual activity

Some administrators narrow the essential living needs into six broader categories referred to as basic Activities for Daily Living (bADL)

  • Ambulating (moving)
  • Dressing
  • Feeding
  • Bathing/showering
  • Personal hygiene
  • Toileting

Instrumental Activities of Daily Living (IADLS) are the things you can do to enhance your personal interactions and/or environment.

IADLs are typically more complex than ADLs and are important components of both home and community living and are easily delegated to another person.

  • Care of others
  • Care of pets
  • Child rearing
  • Communication management
  • Driving and community mobility
  • Financial management
  • Health management and maintenance
  • Home establishment and management
  • Meal preparation and clean up
  • Religious and spiritual activities and expressions
  • Safety procedure and emergency responses
  • Shopping

Find out about upcoming webinars, zoom and agent events

Click here for more plan & training information

 

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UHC IESNP Plan

UHC IESNP Plan

By Ed Crowe | General Articles | 0 comment | 28 June, 2023 | 0

UHC IESNP Plan

The UHC IESNP Plan is a 5 Star Medicare Advantage PPO plan.

It is important to note; the only agents/agencies who are eligible to offer these plans to clients are Pinnacle/Crowe agents and agency partners of PFS/Crowe.

See below for some examples of who can qualify for this plan:

◦Special Needs Plan available to institutionalized people and those that require assistance with activities of daily living

◦Assisted Living, Home Healthcare, Memory Care or Independent Living

◦Dual and non dual members

◦Can be sold to members at home who qualify based on needs

◦Difficulties performing ADL’s (eating, bathing, getting dressed, toileting, transferring and continence

◦Inability to perform IADL’s:  Basic self-care tasks:  Examples:  housekeeping, managing money, food preparation, managing transportation, managing medications, etc.

Before enrolling a client in this plan , you must verify eligibility:

  1.  The first place to check if your client is eligible is on the UHC Jarvis portal
  2.   If you cannot determine eligibility, you will go to Wellsky, a third party TPA vendor, and they will conduct a phone verification with the individual.

Some of the key benefits of this plan are:

  1.  This is a 5 star plan
  2.  Plans include access to in-person (at home or a facility) care from a UHC employed nurse, nurse practitioner or PA as well as a care coordinator
  3.  The maximum out of pocket cost is between $1,500 and $1,600 (this is based on the state).
  4.  There is a $2,400 to $3,500 dental benefit included
  5.  The over the counter benefit is between $140 and $200 per quarter
  6. Hearing benefit of $2,000

Click here to see everything you need to know about the IESNP plans

In order to sell these plans, you must complete a separate certification:

The first step is to use the link below to view the training video.  Once you have finished, make sure you scan the QR code using your phone’s camera.

Click here for UHC Assisted Living Plan Training – IESNP training page .  Please note; you must be logged into the PFS site to access the video.

Once you complete the first step, you will receive a notification and in a couple days, the certification will be loaded into your Jarvis portal.  You will find it in the invitation only section of the knowledge center.

 

Additionally; this plan pays standard UHC Ma plan commissions.

 

 

 

 

 

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UnitedHealthcare Assisted Living Plan

By Ed Crowe | General Articles | 0 comment | 28 June, 2023 | 0

UnitedHealthcare Assisted Living Plan

Sometimes, despite best intentions and desires to live independently, beneficiaries have to rely on assisted living institutions to best provide their loved ones with the healthcare and services that they need. These institutions can be prohibitively costly, which puts more stress on an already often-difficult decision for beneficiaries or their loved ones to make. This is why the ISNP exists – the ISNP is an institutional special needs plan. These plans provide insurance coverage for beneficiaries who will need, for a period of 90 days or longer, care that exceeds what a reasonably skilled nursing facility or an inpatient intermediate care facility.  Marketing of the UnitedHealthcare Assisted Living Plan is an exclusive offer with us! 

Major insurance carrier UnitedHealthcare has released an ISNP called the UHC Assisted Living Plan. It is a five-star Medicare Advantage PPO (preferred provider organization). Beneficiaries can be eligible for this plan if they are in assisted living facilities, independent living, congregate housing, and memory care units.  Even those receiving care at home qualify. It is also available to dually enrolled beneficiaries.

The ISNP is meant to assist those who need help with what are known as the “activities of daily living,” which include housekeeping, food preparation, money management, transportation, or medication management and administration. UnitedHealthcare’s ISNP has a clinical component that other ISNPs lack – there will be a physician’s assistant, nurse practitioner, or nurse on site to provide care to members of the plan at no additional cost to the beneficiary. This is beneficial for the facilities as well as the beneficiaries.  It increases the average stay of the beneficiary by six months while increasing the quality of care at the same time.

United HealthCare contracted (Wellsky) as a third party.    Wellsky conducts a phone assessment to determine eligibility.

 

Licensed Medicare agents

In order to sell this plan, agents need to complete an additional certification and training.  Exclusive training will familiarize agents with all the components and properly represent the benefits of this ISNP.

Learn what working with one of the top FMOs gives you. 

Keep up with all of our current events by clicking here. 

Free leads!

Ready to contract?   GET APPOINTED NOW WITH THIS EXCLUSIVE PLAN.

Subscribe to our YouTube channel.   We provide weekly training and informational webinars.

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Medicare Final Rule 2024

Medicare Final Rule 2024

By Ed Crowe | General Articles | 0 comment | 28 June, 2023 | 0

Medicare Final Rule 2024

Every year, the Center for Medicare and Medicaid Services (CMS) adjusts and makes amendments to the requirements and regulations that govern Medicare Advantage plans. For this coming year, 2024, there are important new requirements for third-party marketing organizations (TPMOs). Aetna, one of the primary carriers of Medicare Advantage insurance plans, sent a press release explaining the key points of the final ruling for the new marketing requirements.  What is the Medicare Final Rule 2024?

Beginning September 30, 2023

These are some of the most pertinent changes and new regulations that will govern how brokers can market Aetna Medicare Advantage plans in the coming year. The following changes will be effective on September 30 of 2023:

Third-party marketing organizations that are authorized to sell Medicare Advantage must submit their multi-plan marketing materials to the Health Plan Management System (HPMS). This happens after it has been pre-reviewed by Medicare Advantage organizations. Health Plan Management System is a website where health insurance and prescription insurance plans, plan consultants, third-party vendors (like agents), and pharmaceutical manufacturers can fulfill the compliance requirements of Medicare Advantage and Medicare Part D plans.

Superlatives (best, most, etc.) are no longer to be used in marketing communications unless certain pre-existing documentation needs are met.

Any marketing materials that use the Medicare ID card image must be approved and authorized by CMS before use.

When marketing any products, plans, costs, etc., the Medicare Advantage organization name must be visible as it is listed in the HPMS.

Plan benefits must be advertised in the area that is eligible for their services.

Marketing materials cannot compare the costs of the uninsured in order to advertise potential savings due to a Medicare Advantage plan.

In addition to these new requirements, CMS has updated the definition of marketing. This new, clarified definition broadens the content that is classified as marketing. Any type of materials that mention plan benefits is now considered marketing material.

Medicare Final Rule 2024 – Marketing Materials

In order to be in compliance with the updated regulations from CMS (the Center for Medicare and Medicaid Services), third-party marketing organizations (TPMOs) such as brokers must make sure their sales and marketing materials are in line with the following requirements:

It is always prohibited to visit a beneficiary without an appointment. This is the rule even if the beneficiary has expressed that they are interested in a Medicare Advantage insurance plan or product.

Medicare Advantage organizations need to provide customers with an annual opportunity to opt out of plan marketing calls. There will likely be further clarification on this topic from carriers such as Aetna to their third-party marketing organizations (TPMOs).

Events

If a Medicare Advantage organization is holding an educational event, they can no longer set up personal marketing appointments for the future at said educational event. The organization is also prohibited from asking beneficiaries to complete the Scope of Appointment forms at the educational event. There needs to be a sharp divide between educational and marketing events.

Marketing events and educational events must take place more than 12 hours apart in the same location. When the regulation uses the term “same location,” it means the same building or adjacent buildings.

There must be at least 48 hours between the beneficiary completing the Scope of Appointment forms and the beginning of the personal marketing appointment.

A beneficiary’s request for information is valid for 12 months from the signature. This applies to Scope of Appointment forms, business reply cards, and any other requests to receive additional information.

Before enrollment, the beneficiary must be provided with a pre-enrollment checklist (PECL). This applies to enrollments made over the telephone.

In their disclaimer, TPMOs must provide the number of plans and products they offer. Those who offer all plans and products must also provide a version of this information in their disclaimer.

Beneficiary health plan needs will be reviewed before enrollment.

TPMOs must record the entirety of all of their marketing, sales, and enrollment calls. This includes the audio of any web-based marketing calls. Other types of calls do not need to be recorded in their entirety.

As is evident by the new requirements for compliance from CMS, the industry takes the ethics of marketing and selling Medicare Advantage very seriously and will continue to adjust to a changing marketplace.

Medicare agents – Click here to see what Crowe and Associates has to offer 

Keep up with all of our current events by clicking here. 

Ready to contract?   Begin here.

Subscribe to our YouTube channel.   We provide weekly training and informational webinars.

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2024 CMS call recording requirements

2024 CMS call recording requirements

By Ed Crowe | General Articles | 0 comment | 27 June, 2023 | 0

2024 CMS call recording requirements

Because there are strict regulations for selling Medicare, the 2024 CMS call recording requirements is a very important subject.  Due to some confusion among sales agents, CMS has clarified that agents must record only marketing , sales and enrollment calls in the their entirety,

Additionally, CMS will require agents to record any virtual/video or other telepresence calls for enrollment, marketing, or sales.

If you are calling to schedule an appointment, invite someone to an event or see if they received materials or have questions, you do not need to record the call.

Effective October 1, 2023;  all third party Medicare marketing for calendar year 2024 must contain the following disclaimer:

“We do not offer every plan available in your area. Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Please contact Medicare.gov,1–800–MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.”

2024 CMS call recording requirements – A few more updated rules (not about calls) for anyone who offers Medicare plans:

Click here to view a more details of the Medicare final rule for 2024

There will now be restrictions on appointment planning at educational events

Agents cannot collect SOAs or schedule appointments during an educational event.  You may however, collect permission to contact forms as well as business reply cards (BRCs).  The distribution of business cards is also permitted.

You may not schedule a marketing event in either the same location, building or adjacent buildings within a 12 hour time period of an educational event.

See more rules for health plan marketers 

Time limits for SOAs & BRCs

Any SOA or BRC you collect is now valid for a limited time; 12 months from the date of the beneficiary’s signature.  Once the time limit has expired, you must collect a new scope or  PTC form.

SOAs must be collected 48 hours before a scheduled sales meeting

Yes, the 48-hour SOA (scope of appointment) rule is back in place.  However, there are a couple Exceptions to this rule.

  1.  If the beneficiary is 4 days or less from the end of a valid election period.
  2. Walk -in (un-scheduled) meetings initiated by the beneficiary

Need help with AHIP – view our test tips on YouTube

Learn about pro-rated Medicare commissions

How does Medicare work with employer coverage?

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Humana HMO Network Change

Humana HMO Network Change

By Ed Crowe | General Articles | 0 comment | 23 June, 2023 | 0

Humana HMO Network Change

There is a Humana HMO network change for the Medicare Advantage insurance plans . Humana is now partnering with two different companies that provide durable medical equipment (DME) for Medicare Advantage beneficiaries. These changes will streamline providers and offer them all one source of DME, making it easier to connect people with the products they need. It is also to save Humana, and therefore the beneficiaries of their Medicare Advantage plans, money. The designated durable medical equipment providers will need to transition their existing rentals to providers that are now in-network with Humana. They will have 90 days to do so.

The press release from Humana stated that the two DME companies that they are now partnered with are AdaptHealth Corp. and Rotech Healthcare Inc. Their goal will be to help their Humana Medicare Advantage HMO beneficiaries achieve their best health at home with durable medical equipment. This is a more unified approach to sourcing DME and will allegedly provide a higher level of service to the beneficiaries who need these vital pieces of equipment for their quality of life.

Humana HMO Network Change – Impacted Items

The following bulleted lists are from the Humana press release and give a succinct grouping of what DME rentals must be transferred and which can remain un-transferred.

These DME groupings should be submitted to the designated DME provider (e.g. AdaptHealth Corp. for the Southeast Region) under this network change.   Respiratory supplies are included.   Beds and support services transferred.   Mobility aids, including wheelchairs and standard power mobility also transfer.

 

What’s Not Changing

Additionally, DME suppliers who focus on the following areas are not imp acted by this change.  Prosthetics, custom orthotics, and diabetic shoes remain unchanged.  Mastectomy items and wigs, hearing aids, custom power wheelchairs also remain unchanged.   And finally, there is no change to ostomy, urology and diabetic supplies.

With these changes in mind, what does an agent need to do now? Agents are free to reach out to their clients on a Humana Medicare Advantage HMO plan who use DME and notify them on the coming changes. Providers must take note of these changes and submit referrals accordingly when sourcing DME. These changes are effective on July 1st of 2023. The carrier itself, Humana, will be notifying its members of the coming changes as well.

Licensed Medicare agents

Learn what working with one of the top FMOs gives you. 

Keep up with all of our current events by clicking here. 

Free leads!

Ready to contract?   Begin here.

Subscribe to our YouTube channel.   We provide weekly training and informational webinars.

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Medicare Advantage and VA Benefits 

Medicare Advantage and VA Benefits

By Ed Crowe | General Articles | 0 comment | 23 June, 2023 | 0

Medicare Advantage and VA Benefits

Veterans who receive benefits often feel like they have to choose between purchasing a Medicare Advantage plan and getting health insurance coverage from their VA benefits. However, Medicare Advantage plans issued by reputable carriers can be a complement to VA benefits. It does not have to be an either or question but rather a question of how to get the best possible and fullest coverage for those who have served our country.

 

A Medicare Advantage plan can offer more options for care than the VA does because there are more options for plans and more institutions and doctors to choose from. These options could be closer to home and even more cost effective. Some veterans may even be eligible for Medicare Advantage plans that have $0 premiums and offer what VA benefits do not, like dental care. By choosing a plan that includes prescription drug coverage, some veterans may even be able to use their local, in-network pharmacy.

Reducing Gaps

While all Medicare Advantage plans work to reduce gaps in healthcare coverage, there are certain plans that were designed for veterans specifically, including those using their VA benefits. The Humana Honor Medicare Advantage plans, for example, offer additional benefits such as a $0 premium and dental care, which compliments the VA benefits while working to get veterans the care they need.

Choosing a Plan

Choosing an MAPD in addition to VA coverage is particularly beneficial for prescription drug coverage. While the VA does cover prescriptions written by a VA doctor and would continue to do so after the veteran enrolls in their Medicare Advantage plan, there are some things they will not cover. These include some types of injectables and infusion medications. A Medicare Advantage plan with prescription drug coverage would cover those medications if prescribed by an in-network doctor.

Medicare Advantage and VA Benefits – TRICARE and CHAMPVA

Medicare Advantage plans can also work with TRICARE and CHAMPVA. If a veteran who is covered by either of those decides to enroll in a Medicare Advantage plan, that plan will then become their primary coverage. This would require that the beneficiary see in-network providers. If a veteran using TRICARE or CHAMPVA does not mind being limited to a network of providers and can coordinate billing, considering enrolling in a Medicare Advantage plan may help them reduce gaps in coverage and cover more of their healthcare needs closer to home.

Medicare agents – Click here to see what Crowe and Associates has to offer 

Keep up with all of our current events by clicking here. 

Ready to contract?   Begin here.

Subscribe to our YouTube channel.   We provide weekly training and informational webinars.

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Online Enrollment- Enroll prospects online without the need for a face to face appointment. Access to all major carriers with the ability to compare plan benefits and prescription drug costs. Link to recorded webinar https://attendee.gotowebinar.com/recording/2899290519088332033

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