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What is a pro-rated Medicare commission

Medicare commissions are an integral part of the healthcare insurance industry.  That is why, understanding what is a pro-rated Medicare commission is something that is important for Medicare agents.  Pro-rated Medicare commissions help ensure that both agents and brokers receive fair compensation.  We will explain a little about what pro-rated commissions are, how they work, and why they are important.

What is a Prorated Medicare Commission:

A prorated Medicare commission refers to the proportional payment that an agent or broker receives for enrolling individuals in either a Medicare Advantage or Medicare Part D prescription drug plan.  Once an agent submits an application for a beneficiary, the agent receives commission.  The amount of commission is based on the number of months the enrollee remains active in that specific plan.

How Does Pro-rated Commission Work:

Pro-rated commissions are based on the principle of fairness.  Agents/brokers receive a portion of the total commission for each month an enrollee remains on their plan. This is done instead of receiving the full commission upfront. This payment structure helps agents avoid chargebacks for unearned commissions.  This structure also motivates agents to provide on going support to clients and ensures they retain their book of business.  Once the initial enrollment is completed, if an agent provides continuous assistance, education and support to a client they are more likely to remain with that agent/broker.

To view more details on commission payments, click here

How do you Calculate a Pro-rated Commission:

To calculate a prorated Medicare commission, simply divide the total commission amount for a specific enrollment by the number of months the enrollee stays active in the plan. For example, if the total commission is $600 and the enrollee remains active for 10 months, the agent or broker would receive $60 each month.

Benefits for Beneficiaries:

Pro-rated Medicare commissions indirectly benefit beneficiaries by encouraging agents and brokers to maintain an ongoing relationship. In other words, beneficiaries have access to a reliable resource to guide them through plan changes, answer their questions, and assist with any issues that may arise during the coverage period.

Agent-Beneficiary Relationship:

Pro-rated commissions foster stronger relationships between agents and beneficiaries. Agents have a vested interest in delivering high-quality customer service, ensuring that beneficiaries have a positive experience throughout their Medicare coverage. Beneficiaries can rely on agents for personalized advice, plan comparisons, and assistance in navigating the complex Medicare system.

To sum it up, pro-rated Medicare commissions are a fair and transparent compensation structure for agents/brokers who enroll individuals in Medicare plans. By aligning incentives between agents and beneficiaries, prorated commissions contribute to better long-term relationships, ongoing support, and improved customer experiences. For individuals seeking Medicare coverage, partnering with an agent who receives prorated commissions can be a valuable resource for obtaining guidance and assistance throughout their healthcare journey.

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The Importance of Travel Health Insurance and Medical Insurance

As life expectancies increase and medical science improves, what was once the twilight of life is as lively and exciting as any other time. Those beneficiaries who are eligible for Medicare are still traveling, whether to see family, to adventure, or for business. For those who wish to travel internationally, however, their Original Medicare may not cover health emergencies that occur outside of the United States. There are several extremely specific emergency situations that Medicare may cover, but they are difficult to prove and the majority of medical situations do not qualify for coverage. Medicare Part D will not cover any prescription drug purchases at international pharmacies, nor will Medicare Advantage plans cover anything that Original Medicare does not cover outside of the United States. For these reasons, it is often imperative that beneficiaries purchase travel health insurance before an international trip.

Supplemental Travel Health Insurance and Medical Insurance

Travel medical insurance and medical evacuation insurance are both short-term insurance policies. They are supplemental and cover health care costs on a trip abroad. Best of all, they are relatively inexpensive, but could protect the beneficiary from a very large bill if they were to have a medical emergency while on vacation outside of the United States. For frequent travelers who make multiple trips outside of the United States every year, there are yearly policies available for purchase.

Medical evacuation insurance is particularly important when beneficiaries are traveling outside of major cities or areas where the health care is inadequate for their needs. Many rural areas the world over have no local hospital, and evacuation in an emergency can be the difference between life and death. The cost of evacuation can exceed $100,000.

To find a travel medical and medical evacuation insurance policy, beneficiaries should begin online. The following are resources for finding coverage that works for travelers:

• The Department of State

• International Association for Medical Assistance to Travelers 

• AARP 

When beneficiaries can rest assured that any medical assistance they need while abroad will be covered and available to them, they can relax and enjoy their travel.

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What is Indemnity Insurance

There is a lot of jargon, or context-specific, language surrounding insurance. As a result, those who are in the field often use language without thinking that can require definitions for their clients. One of the terms that keeps popping up in the health and medical insurance industry lately is indemnity insurance. What is Indemnity Insurance?

How it Works

As a general rule, indemnity insurance is the most traditional form of insurance. Although it used to be a very common form of insurance, it is no longer common. Indemnity health insurance is fee-for-service insurance. This means that beneficiaries have a greater range of choice in their doctors, hospitals, and medical centers. They can choose to change doctors at any point, without referrals. The insurance policy pays their share of the cost of service after they receive a bill for that service.

Like other modern insurance plans, once the beneficiary meets their deductible, the insurance policy pays for their share of the cost of service. Typically, this is 80% of the service, as long as the service is “usual and customary.” If the service costs more than the “usual and customary” amount, then the beneficiary is responsible for the copay and the difference in costs. Indemnity insurance policies sometimes do not pay for preventative care, but will cover medical tests and prescriptions.

Because this is a fee-for-service plan, beneficiaries often have to file claims in order to receive their insurance policy’s share of the service as well as save receipts for prescription costs and other purchases.

How to Get an Indemnity Policy in Connecticut

Although they are not as common as they used to be, indemnity insurance policies are still available in Connecticut under some larger insurance carriers. Some of the most recognizable names that provide indemnity insurance health and medical policies are Aetna U.S. Healthcare, Guardian Life Insurance Company of America, New England Life Insurance Company, and United Healthcare Insurance Company.

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Medicare Part B Excess Charges

Medicare Part B excess charges are, thankfully, not very common. However, they can be stressful for their beneficiaries when they occur. They are often a surprise cost and come at an already difficult time because of health trouble in the beneficiary’s life.

The majority of doctors and hospitals will “accept assignment” from Medicare Part B. This means that they accept the Medicare-approved amount as full payment or a service. When a doctor or hospital “accepts assignment,” they will send their bill directly to Medicare which will then pay 80% of the fee. The beneficiary is responsible for the remaining 20% (coinsurance).

How to Avoid Them

When a doctor or hospital does not accept Medicare assignment, that means they will charge more than the Medicare-approved total for the service. They may require the beneficiary to pay the bill upfront and then submit it to Medicare later for reimbursement. The beneficiary, in this case, is responsible for their coinsurance and the difference between the Medicare-approved amount and what the service actually cost.

Only 1% of non-pediatric physicians have opted out of the Medicare-approved costs for services. And, in the following states, it is illegal to charge more than the Medicare-approved amount: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont.

For beneficiaries who do not live in those states, Medicare Part B excess charges must be paid once they are charged. However, there are two steps that they can take next time to ensure they do not get charged again.

1. Discuss Medicare reimbursement in advance with health care providers. Finding out beforehand if they accept assignment will save beneficiaries from excess Medicare Part B costs. If the healthcare provider does not accept assignment, the beneficiary can choose to go elsewhere for their services.

2. Purchase a Medigap supplement policy. These insurance policies cover Part B excess charges if they are Plan F or Plan G.

While Medicare Part B excess charges are uncommon, when they do occur they can bring surprise costs and financial difficulty to beneficiaries. It is worth planning ahead to avoid them by discussing costs upfront with healthcare providers as well as purchasing a Medigap supplement policy that covers those fees if they occur.

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Connecticut AEP kickoff 2024

Be sure you save the date for the Connecticut AEP kickoff 2024!  This will be an important event to attend and a great opportunity to meet the representatives from the area’s top carriers.

This a a chance to gain valuable insights to help you have a successful 2024.  Come and enjoy the beautiful Mohegan Sun with Pinnacle and Crowe and start this AEP off right!

This year we will hold the kickoff on September 8th, 2023

This event begins at 10:00 am and runs until 5:00 pm.

Location:

Mohegan Sun Convention Center

1 Mohegan Sun Blvd, Uncasville, CT 06382

Don’t gamble with your success; click here to register now!

Attendees will learn things such as:

How to get your business noticed online with our SEO guidance.

Find out about NABIP.

Learn about the updates to Medicare legislation.

What the carriers are planning for 2024

Attendees can reserve a hotel room at a discounted rate and make a staycation out of it!

Please keep in mind, rooms  are available on a first come first served basis.  So be sure to reserve yours.

CLICK HERE FOR YOUR DISCOUNTED ROOM RATE

Meet the team members from Pinnacle and Crowe and see what we can offer you that will help grow your book of business!

Talk with some industry experts and find out how they grew their business.

See what Medicare products are proposed for the 2024 AEP.

It is always a good idea to know your Medicare carrier reps.  This comes in very handy when yo have questions or need help.

We will go over much more, to see everything we have to offer, be sure to attend.

If you are still on the fence, remember:

Seats are limited so be sure you register soon and reserve your spot.

Connecticut AEP kickoff is a great way to find out what’s in store for 2024 and also get some insights from local Medicare experts

Learn what you can do for our clients during Medicare AEP

Find out more about Medicare commissions

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Humana Medicare supplements CT

Connecticut has several Medicare supplement plan options available including the Humana Medicare supplements CT which offer great rates and plan discounts.

Starting  6-1-2023, Humana is offering Medicare beneficiaries the lowest cost Medicare Supplement plans G and N in CT.  They also offer a 12% household discount and a sales bonus program. 

See below for rates, highlights, bonus program and household discount details:

Click the following links to view the Connecticut Outline of Coverage and the App packets.

Click here to learn how to generate your own Medicare leads

Find out how much Medicare Advantage commissions are paying

Medicare Assignment of Benefits

Much like beneficiaries, healthcare providers can choose to participate in Medicare each year during an open enrollment period. For providers, this period is from mid-November to the end of December. Over 98% of doctors, hospitals, and healthcare providers choose to participate in Medicare. This Medicare assignment of benefits data is from as recently as 2022.

When a provider chooses to participate in Medicare, they are choosing to accept claims assignments for all Medicare-covered services to their patients. This means that they accept the amount that Medicare pays for these services as full payment. Healthcare providers may not collect more from the patient than the Medicare-approved assignment, or amount, in the deductible fee or Medicare copay. For participating providers, Medicare pays them directly and forwards their claims to Medigap insurance providers. For non-participating providers, Medicare pays them 5% less than the approved-amount. Those non-participating providers cannot charge their patients who are covered by Medicare more than 115% of the approved amount for the service according to the Medicare Physician Fee Schedule.

What’s the Impact to Beneficiaries?

For beneficiaries, there are different procedures for using a provider that does participate in Medicare, or accepts assignment, versus one who does not accept assignment. For providers who do accept assignment, the Medicare beneficiary may have lower out-of-pocket costs. They will only be charged their Medicare deductible and copay amounts, and then Medicare will pay their healthcare provider directly. The participating healthcare provider also submits the claim to Medicare on their own and does not charge the beneficiary a fee for doing so.

If a healthcare provider does not accept assignment, or opts out of Medicare participation, the beneficiary may be asked to pay the full fee for the service at the time of service. The healthcare provider can also charge up to 15% more for the service than if they were participating in Medicare.

For most beneficiaries, choosing doctors and hospitals who accept assignment can save them out-of-pocket costs.  Additionally, for most providers, it makes good business sense to increase their clientele by participating in Medicare and accepting assignment.

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Medicare HMO vs PPO

Choosing an insurance plan can be a minefield. There are many decisions to make in order to find a plan with the best coverage that fits an individual’s needs. One of these decisions is which type of plan makes the most sense: Medicare HMO vs PPO?

HMO

An HMO is a Health Maintenance Organization. The organization has a network of doctors, hospitals, and other healthcare providers. They provide services for a specific payment, which allows the organization to maintain lower costs for its members. Costs and choices are two factors that beneficiaries tend to appreciate HMOs versus other healthcare plans. HMOs are often less expensive with lower monthly premiums. However, they require referrals to use doctors other than the beneficiary’s primary care physician. HMOs do not offer coverage for out-of-network providers except for in the case of a true medical emergency.

PPO

PPOs are Preferred Provider Organizations. These offer a network of healthcare providers to use for the beneficiary at a certain cost. With a PPO, a beneficiary can choose to receive care from any healthcare provider regardless of if they are in the network. While PPOs do have higher monthly premiums, they offer flexibility that an HMO does not. They do not require that a beneficiary has a primary care physician or that they get referrals to see any healthcare provider. If a beneficiary wants to see a healthcare provider outside of the PPO network, they may have to pay the doctor upfront and then file a claim to get reimbursed from their insurance plan.

Insurance decisions must take a lot of factors into consideration. In general, however, an HMO may be a better choice for beneficiaries that need lower out-of-pocket costs. They tend to have lower deductibles and make sense if the beneficiary does not mind using a primary care physician as their primary healthcare provider for all of their needs. A PPO may be a better choice for beneficiaries who already have a healthcare team that they would like to keep, as well as the flexibility to see specialists at will. They can expect to pay higher costs for this flexibility.

Medicare HMO vs PPO: What’s the Difference?

Choosing an insurance plan can be a minefield. There are many decisions to make in order to find a plan with the best coverage that fits an individual’s needs. One of these decisions is which type of plan makes the most sense: an HMO or a PPO?

An HMO is a Health Maintenance Organization. The organization has a network of doctors, hospitals, and other healthcare providers. They provide services for a specific payment, which allows the organization to maintain lower costs for its members. Costs and choices are two factors that beneficiaries tend to appreciate HMOs versus other healthcare plans. HMOs are often less expensive with lower monthly premiums. However, they require referrals to use doctors other than the beneficiary’s primary care physician. HMOs do not offer coverage for out-of-network providers except for in the case of a true medical emergency.

PPOs are Preferred Provider Organizations. These offer a network of healthcare providers to use for the beneficiary at a certain cost. With a PPO, a beneficiary can choose to receive care from any healthcare provider regardless of if they are in the network. While PPOs do have higher monthly premiums, they offer flexibility that an HMO does not. They do not require that a beneficiary has a primary care physician or that they get referrals to see any healthcare provider. If a beneficiary wants to see a healthcare provider outside of the PPO network, they may have to pay the doctor upfront and then file a claim to get reimbursed from their insurance plan.

Deciding Between the Two

Insurance decisions must take a lot of factors into consideration. In general, however, an HMO may be a better choice for beneficiaries that need lower out-of-pocket costs. They tend to have lower deductibles and make sense if the beneficiary does not mind using a primary care physician as their primary healthcare provider for all of their needs. A PPO may be a better choice for beneficiaries who already have a healthcare team that they would like to keep, as well as the flexibility to see specialists at will. They can expect to pay higher costs for this flexibility.

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Medicare Special Enrollment Periods

While Medicare Annual Enrollment Period is only for several weeks out of the year (October 15 to December 7), there are certain events that qualify beneficiaries for enrolling in Medicare coverage outside of that time period. Chances to make a change to coverage are called Medicare Special Enrollment Periods (SEP). There are different rules that govern what beneficiaries can do depending on the type of qualifying event.

The most common qualifying life events that result in a special enrollment period are the following:

Change of residency

Sometimes, moving living locations results in a special enrollment period because the new residence is no longer in range for the coverage that the previous plan provided. When this happens, the beneficiary must notify the plan’s carrier. If the beneficiary notifies, then they will have about a two month window to make adjustments to their coverage, like choosing a new plan. If they do not choose another Medicare Advantage plan, they will be enrolled in Original Medicare when they are disenrolled from their previous plan.

Loss of current coverage – Medicare Special Enrollment Periods

This most often occurs when a beneficiary is enrolled in Medicaid and then is no longer eligible due to changing life circumstances like increased income or loss of disability status. The beneficiary can then switch to Medicare Advantage, drop the Medicare Advantage plan and return to Original Medicare, or drop the coverage that they previously had without making other changes. This will result in a lapse in coverage.

Opportunity for other coverage

A beneficiary can drop their Medicare Advantage plan and/or Part D plan if  an opportunity for other coverage arises.  Offers include as an insurance plan offered by or subsidized by a union or employer.  This special enrollment period can occur whenever the beneficiary is offered alternative coverage.

Plan changes its contract with Medicare

Sometimes, Medicare takes an official action called a sanction to protect beneficiaries. If sanctions occur, the contract the insurance carrier has with Medicare will be different and those differences will affect the plans that beneficiaries are enrolled in. If this happens, the beneficiary can enroll in a different Medicare Advantage plan offered by the same or a different carrier.

Other special circumstances – Medicare Special Enrollment Periods

There are multitudinous other circumstances that may result in a special enrollment period for beneficiaries. Some of them could be being eligible for both Medicare and Medicaid, qualifying for the Extra Help Pharmaceutical prescription drug coverage, qualifying for a Special Needs Plan and choosing that coverage instead, and the list goes on.

Regardless of the specifics of the beneficiary’s circumstances, a qualifying life event that results in a special enrollment period is an opportunity to get better, more comprehensive and appropriate care.

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Medicare Advantage Disenrollment

Medicare insurance agents have their beneficiaries best intentions at heart. For most, their desire to help is the reason they entered the field in the first place. Being able to help clients choose which level of coverage and plan is best for them and their families is an honor. However, sometimes, for a variety of reasons, beneficiaries do not renew their insurance plans or even disenroll from them. These are types of Medicare Advantage Disenrollment.   Beneficiaries that are enrolled in Medicare Advantage health insurance plans have the opportunity to disenroll from their plan and return to Original Medicare or switch to a different Medicare Advantage plan.

Most of the time, disenrollment is the beneficiary’s choice.  However, there are instances when a person is forced to disenroll. Some of the reasons that a beneficiary would no longer be eligible for a Medicare Advantage plan and be forced to disenroll would be if they changed living locations and are no longer covered under their previous plan, if they lose Medicare eligibility, or if they do not pay their premiums. Some of the reasons that a beneficiary may choose to disenroll are if they are dissatisfied with their coverage, if their medical needs change, or if the out-of-pocket costs are too high for them to pay.

Why This Matters To Agents

This is important to know for a variety of reasons. Voluntary disenrollment statistics may shed light on things like beneficiary satisfaction, quality of plans and providers, and likelihood of renewal. A conscientious Medicare agent or broker should be aware of all of these factors when recommending plans to their clients. High, voluntary rates of disenrollment may be cause for hesitancy recommending that particular plan or carrier, especially if the agent is looking to maintain a good relationship with the beneficiary. In 2021, 17% of enrollees voluntarily disenrolled from their Medicare Advantage plans. This is a significant increase from 2010, in which only 10% of enrollees voluntarily disenrolled.

The two most cited reasons for disenrolling were plan coverage issues and financial concerns. In fact, on average, across Medicare Advantage contracts, nearly a quarter of those who disenrolled reported that it was coverage problems with physicians and hospitals that made their decision. The ratio was nearly the same for financial concerns, with nearly 24% reporting that as the main cause of their disenrollment.

These kinds of statistics are vital for agents to be aware of, particularly before enrollment periods. It would be foolish to recommend Medicare Advantage coverage for beneficiaries that have a high rate of disenrollment.   This is beneficial for the agent’s sake and the beneficiary’s sake. Knowledge can help both agents and beneficiaries make informed decisions about their care and coverage moving forward.

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