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 Medicare Advantage Year in Review

In nearly every line of work, circumstances can evolve and change at a rapid rate. In the Medicare field, there are so many moving parts because of the involvement with the federal government, assorted agencies, state governments, and private insurance carriers, it is vital to review the data from previous years to see what the rundown is. This can help inform savvy agents as to what to expect from the coming year as well as offer valuable perspective. These are some of the key trends and takeaways from Medicare Advantage in 2023.  Here is the Medicare Advantage year in review.

MAPD

• More than half of the people eligible enrolled in Medicare Advantage (MAPD) for 2023. That’s approximately 51% of beneficiaries, or 30.8 million people. As a piece of the eligible Medicare population, that means that that figure has jumped up by 19% in 2007 to 51% in 2023. Since 2022, the population enrolled in Medicare Advantage has increased by 8%. In the next decade, the percentage is expected to rise to over 62% enrolled in Medicare Advantage.

• One in five beneficiaries of MAPD are enrolled in a plan offered by a union or an employer. That is about 5.4 million people, or about 20% of the population. In the following five states, the group enrollees counted for a third or more of all enrollments: Alaska, Michigan, New Jersey, Maryland, and West Virginia.

• In the past five years, enrollment in Special Needs Plans (SNPs) has doubled. This means than 5.7 million Medicare beneficiaries are enrolled in special needs plans.

• Two private insurance carriers, Humana and UnitedHealthcare, account for nearly half of all Medicare Advantage (MAPD) enrollment nationwide. Together, the two companies account for about 47% of Medicare Advantage enrollment

This brief overview of some of the more variable statistics from this year may help agents to plan ahead for the future. For instance, the market for Medicare Advantage plans is expected to continue to grow. What can you do now to optimize your business?

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Tips for AEP 2024

Fall is on its way, and that means that the Annual Enrollment Period, or the AEP, is fast approaching. It’s often the busiest time of the year for agents and brokers. The vast majority of Medicare sales happen in that short 54 day period, and it can be stressful. Here are four questions to ask yourself and your agency before the AEP begins so you can optimize your success:

Am I following the new compliance rules?

As you surely know by now, the new rules from the Center for Medicare and Medicaid Services (CMS) are out and they have made some changes to their categorization of agents. All insurance agents and brokers are now considered Third Party Marketing Organizations (TPMOs). This comes with some new rules, including these disclaimers, which are required by law to be on all communications (website, emails, print, etc.).

If you are marketing fewer than all of the plans available in your area, use this one: “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.”

If you are marketing all of the plans in the service area, use this one: “Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. You can always contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) for help with plan choices.”

Am I recording phone conversations with clients eligible for Medicare?

This is another new regulation from CMS for this coming AEP season.  All calls with people who are Medicare eligible must be recorded (not just sales calls). This is to protect both the agents and the clients. There are many programs available to help make this process as streamlined as possible, like CallVault.

Who have I had the most success helping lately?

It is a good time to reflect on the last few successful client interactions you’ve had. Is there something they have in common? Did you use a certain approach with all of them, or did they share a common thread? Are they all from a certain background, of a certain age, or did the lead come from a particular source? And, are the clients you’re having the most success with also the clients that you’re spending the most time and money to access?

What does my Medicare portfolio look like?

Do the Medicare Advantage plans, prescription drug plans, and Medicare Supplement Insurance plans (or Medigap) fulfill the needs of your clients? Are they finding these plans appealing, or are they looking for something you currently don’t carry? If the products you have are what the clients are looking for in your area, that makes sales all the more simple.

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At Home Care and Medicare: What’s Covered?

If and when seniors have health issues later in life, the best case scenario is often recovering at home. People are most comfortable in their house and it allows for freedoms that hospitals or other institutions often do not allow for, like flexibility of schedule and movement. At home health care can be prohibitively expensive, however, and inaccessible for many people in retirement or on a fixed income. Thankfully, Original Medicare beneficiaries often have at home healthcare benefits.  How does at home care and Medicare work?

Both Original Medicare Parts A and B will cover eligible home health and care services. Part A of Original Medicare is hospital insurance and Part B is medical insurance, both of which cover certain services. Both of these parts will cover services for as long as the beneficiary is “homebound.” Homebound is defined as the following criteria:

• The beneficiary has trouble leaving their house without help (of a cane, walker, chair, etc.), specialized transportation, or another person assisting them. This can be due to an illness or an injury.

• Their condition(s) means that it is not recommended for them to leave their house.

• Or they are normally unable to leave their house because of how much effort it takes to do so.

Coordination of Benefits

Typically, a home healthcare service will coordinate the at home care that a doctor or other prescriber determines will be a good fit and orders for the beneficiary. The home healthcare agency must be Medicare certified, and most are.  Covered services include the following.

• Part time or intermittent skilled nursing care, as needed medically

• Physical therapy

• Occupational therapy

• Speech language pathology services

• Home health aide care (only if skilled nursing care is also ordered)

• Injectable osteoporosis drugs

• Medical supplies for at home use

• Durable medical equipment

What Original Medicare does not pay for is a much shorter list, which includes 24-hour care at home, meal deliveries, homemaker services not related to a care plan, or personal care for daily living activities (bathing, dressing, etc.) that are not related to other medical care.

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10 Medicare Freebies You Need to Know About

Most people are aware of the primary benefits of Medicare: increased access to quality healthcare for vulnerable populations. However, there are many other benefits that fewer people know about, and they’re even free (included at no extra cost with normal premiums). Here are the top 10 Original Medicare freebies beneficiaries should know about:

A “Welcome to Medicare” Visit

A new enrollee, you’re entitled to a welcome visit with your doctor. This is a preventative visit.  And, there are no out-of-pocket costs. Some doctors use this visit to give referrals to specialists for people who need them.  Also, these tell patients about important preventative care covered by Medicare. The welcome visit has to be completed during the first year of enrollment.

Annual Wellness Visits

These are free annual wellness visits that are also preventative. Annual wellness visits with a primary care provider  create a care plan to prevent illness and injury. Beneficiaries are responsible for follow up treatment.

Bone Density Tests

These tests are free to Medicare beneficiaries once every two years.  They are a way to determine the risk of broken bones. To qualify for these tests, beneficiaries need to meet the following criteria: be a woman at risk of osteoporosis, take prednisone, and/or have x-rays that indicate increased risk of osteoporosis.

Cardiovascular Behavior Therapy

These visits are with primary care providers and they often determine blood pressure and risk factors for ailments like heart disease.

Counseling

There are free tobacco and alcohol use counseling sessions for those who qualify.

Diabetes Management Training

Free self-management training for diabetes is available through Medicare. The initial training is up to ten hours and covers topics like nutrition, blood sugar monitoring, and medication administration.

Immunizations and Vaccines

Flu shots and COVID boosters are free every year.  And, some people may also qualify for two pneumococcal vaccines and a Hepatitis B vaccine.

Nutrition Therapy

Beneficiaries with a kidney transplant, diabetes, and/or kidney disease are eligible for up to 36 months of free nutrition therapy. There are group programs, lifestyle assessments, and follow up appointments as necessary.

Screening Tests

Medicare covers several different free cancer screenings .  Coverage includes mental health screenings. Additional free screenings include obesity, HIV, STIs, and Hepatitis C.

The Medicare “What’s Covered” App

The Medicare “What’s Covered” app launched in 2019.  This app helps beneficiaries find out which services, goods, and treatments Medicare will cover. This is available for free on tablets or smartphones.

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Get Started With Medicare

Medicare is its own universe  with its own jargon, terms, rules, and regulations. This can be intimidating, especially for those of us just starting out. However, signing up for Medicare is a vital step in making sure that you and your family have access to the essential healthcare you need in your golden years. Beware of Medicare scams!   Protect your Medicare ID and enrollment information.    Read on to learn how to get stared with Medicare.

 Learn the Basics

Original Medicare has two parts: Part A and Part B. Part A is hospital insurance, and Part B is medical insurance. Within these two parts, many of the basic health care you will need is covered. There is also Part D, which are prescription drug plans that are purchased separately. Medigap, or Medicare Supplemental Insurance, refers to additional coverage purchased from private insurance carriers that helps pay for the out-of-pocket costs of Medicare. Another name for Medicare Part C is  Medicare Advantage.   Part C is an alternative to Original Medicare.  Private insurance companies offer MAPDs.   The federal government does not offer these plans. These are bundled plans that usually include hospital, medical, and prescription coverage.  You must enroll in Medicare to qualify for one of these plans.

Prepare to Sign Up – Enroll

Get started with Medicare.   Most become eligible at age 65. And, promptly sign up.  Individuals receiving benefits from Social Security are automatically enrolled in Part A of Original Medicare.   Part A is hospital insurance. When they sign up for Social Security benefits, they have a choice about whether or not to enroll in Part B (medical insurance). Therefore, individuals not receiving Social Security benefits, must enroll in Part A.  Enrollment is not automatic for these persons. Here are the easiest ways to sign up:

• Online, at Social Security. The website is the easiest, fastest way to sign up and access any financial help you may qualify for.

• Call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.

• You can contact your local Social Security office.

• If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.

Regardless of method used to get stared with Medicare,  beneficiaries receive a welcome packet.     The welcome packet includes a Medicare card.   After enrollment, it takes about   2-3 weeks for the card to arrive.

Using Medicare

New enrollees will receive their Medicare card and start their coverage. It is a good idea to keep the Medicare card private, and only share it with medical professionals if necessary, as there are many scams around filing false claims to Medicare. The majority of doctors and service providers in the nation accept Medicare – about 93%. The most commonly excluded health care professionals, those who opt out of Medicare assignment, are psychiatrists and mental health practitioners, as well as pediatricians. It may also be helpful to give Medicare permission to share your information with someone you trust.  They can help if there is ever a medical emergency and you are unable to discuss treatment.

With these three simple steps, you will be well on your way to using Medicare successfully.

After Enrollment

The rise of automated and exclusively-online enrollment means that it can be easier to use technology to scam the unsuspecting.  Beware of Medicare scams!   Protect your Medicare ID and enrollment information. Medicare beneficiaries should always remember that Medicare will not reach out to beneficiaries via call or email unless they are answering their inquiry. Medicare will also never offer free gifts, medical equipment, or any other service for free.

Additionally, beneficiaries on an advantage plan do not need to show their Medicare card to providers.   Therefore, best if this card remains in a secure location not on them.

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Sales Dialer Discount

If you are like many Medicare agents, you are doing a lot of work from home.  That is why Crowe and Associates and ProspectBoss are offering agents a special sales dialer discount.

Any agent contracted through Crowe and Associates for at least 1 carrier, is eligible to take advantage of this offer.  Our agents have access to the Prospectboss.com Power Dialer CRM system at a reduced monthly cost on both programs listed below.  The Power Dialer CRM integrates a 3 line power dialer and a CRM (Customer Relationship Management) system.  Take a look at our pricing below. Please note, agents need to be contracted with at least one Medicare plan through Crowe and Associates in order to access the discounts.

Discounted Sales Power Dialers programs and rates:

• 3-line dialer with unlimited calling for $89.00 a month Triple your productivity! This is an exclusive 3-line dialer link for Crowe and Associate agents.

• 3-line dialer with unlimited calling and unlimited data for $199 a month.  Unlimited data allows you to run and download unlimited phone lists and contact info both scrubbed and non DNC scrubbed.

If you choose the data option, the monthly rate provide access to the dialer, CRM, and data as well as other features.

ProspectBoss offers many tools that can help you grow your book of business from the comfort of your own home.

Learn about the ProspectBoss Time management CRM dialer productivity tool

Read how to triple productivity with ProspectBoss

If you are not sure how a power dialer works;  take a look at a short video below to learn more or CLICK HERE for more information about Power Dialers vs. Predictive Dialers

CLICK FOR PRODUCT DEMO WEBINAR

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Find out what we can do for you.

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What is Medicare Part C

Many people see television ads telling them they need Medicare Part C.  In this post we answer the question; What is Medicare Part C and do you actually need it.

Medicare Advantage (Part C), gives Medicare beneficiaries an alternative coverage option to Original Medicare.  Medicare A & B provide coverage for essential health care benefits such as; doctor visits and hospitalization.  Part C (MA plans) take the place of your Medicare Part A & Part B benefits and are available through private insurance companies.  They also provide many value added benefits such as prescription coverage (Part D), dental, hearing, vision, OTC benefits and more.

More details about Part C:

All Medicare Advantage (Part C) plans are offered by private insurance companies.  MA/MAPD (Part C) carriers are regulated by CMS and must provide beneficiaries the same level of medical coverage that Original Medicare (A&B) provides.

Most Part C (MA/MAPD) plans offer a very competitive premium, many plans have a $0 premium as well as low out-of-pocket costs.  This gives people a very cost effective way to get the healthcare coverage they need.

If you opt for a MA/MAPD (Part C) plan, you should be aware of the plan’s provider network and confirm that your doctors are in-network with your selected plan.  Even if you choose a PPO plan, using an out-of-network provider can be a costly mistake.

Each year, during the AEP, you have an opportunity to either enroll in or out of your current Medicare plan.  The AEP starts on Oct. 15th and ends on Dec 7th.  If you are enrolled in a MA/MAPD, you have an extra opportunity to change your coverage options starting Jan 1 and ending March 31 each year; this is called the OEP.

Summary – Why Choose a Medicare Advantage Plan (Part C):

Part C (MA/MAPD) plans provide comprehensive coverage including additional benefits such as; dental, vision, hearing, prescriptions, OTC, rides to appointments and more. They also cover Medicare A & B charges for doctors and hospitals. Many plans include Part D, prescription drug coverage.  All you need is one card to cover your medical costs.

Because MA/MAPD plans have annual out-of-pocket maximums, beneficiaries can feel safe knowing the cost of their annual healthcare has a limit.  Plans also offer clear costs for services.  Some carriers offer coordination of care benefits which is a great way for all our providers to stay in the loop on your care needs.

There are several different plan options to suit your personal needs including; HMO, PPO, PFFS, DSNP, ISNP, etc.

A Medicare Advantage plan (Part C) is not for everyone:

It is important to consider many factors before choosing Medicare Part C coverage.  Some things to think about are; your personal healthcare needs as well as your budget. With careful research and an understanding of the plan’s features, you can make an informed decision that supports your health and well-being.

One of the most important points is to make sure our providers are in-network with the plan you choose.

Consider any medical conditions you may have an dhow often you will require medical attention.  It may be a better bet to join a Medicare Supplement and prescription drug plan depending on your personal health needs.  There are co-pays, deductibles and out-of-pocket maximums to think about with a Part C plan.

Make sure you are aware of the plans Star Ratings to be sure yo consider a good quality plan.

Remember; plans change every year.  Benefits are added and taken away.  That is why it is important to work with a knowledgeable, licensed Medicare agent to help you sort out all your plan options during the AEP or OEP enrollment periods.

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Choosing Medicare Drug Coverage

There are many things to consider when choosing Medicare drug coverage (Medicare Part D).  This is a very important decision that can cost you quite a bit if you are not careful.

Steps to help you choose the best Medicare drug coverage to fit your needs:

Decide what your medication needs are.

Make a list of all your current medications.  It is important to include the dose and how often you take them.  It is also important to consider which pharmacy you will use. Each plan has a list of preferred pharmacies that offer you a lower cost share when you use them.  You may also need to consider medications your doctor may add to your list in the near future.

Review your current coverage.

If you are new to Medicare and decide to go with Original Medicare (Part A and Part B), you need to purchase a stand-alone prescription drug plan (Part D).   Alternatively, you might opt for a Medicare Advantage plan (Part C) that includes prescription drug coverage.  These plans are referred to as MAPD plans.

If you already have either a Part D plan or an MAPD plan, you should review your plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC) document each year.  These resources will provide valuable notice of any changes in coverage, costs, or formulary for the upcoming year.

Know the Medicare enrollment periods.

It is important that you understand when you can enroll in a PDP plan.  For most people there are 2 main enrollment periods.  The initial Enrollment Period (IEP) occurs when you first become eligible for Medicare. It typically starts three months before your 65th birthday, includes your birth month, and extends for three months afterward.  Each year, The Annual Enrollment Period (AEP) Starts Oct 15 and runs until Dec 7 .  During this time, you can make changes to your Medicare coverage.

There are also some SEPs (Special Election Periods) where you can make changes to your plan.  Click here to learn more about SEPs.  

Please note; certain individuals who have a qualifying disability also have the option to enroll in a Medicare Part D (PDP) plan.

Compare the plan’s total cost.

Because there are many factors that make up the total cost for a Medicare plan, it is important to consider the plan premium, the cost of your medications, deductibles, copayments and co-insurance.  You also need to be aware of the coverage gap and catastrophic coverage thresholds, as these may affect your total out-of-pocket costs.

There are a couple ways to compare plan costs.  One of the best ways is to locate a licensed Medicare agent who is certified to offer plans from a variety of local carriers.  Agents should have access to online quoting tools that can show you plan comparisons. Comparisons include a cost breakdown of each prescription as well as plan premiums and other coverage information.  Agents are a great free resource.  They can help advise you on how coverage works and which plan will suit your personal needs.

Click here to view our YouTube video of Sunfire vs. Connecture Medicare quoting sites

You can also do a plan quote on your own by visiting medicare.gov and using the plan finder.  This is a free resource although, it does not offer a consultation like an agent can.

Consider each plan’s star rating.

Each year, Medicare provides star ratings for both PDP plans and MA/MAPD plans.  These ratings are based on many factors  and have a scale from 1 to 5 stars.  A rating of 1 is the lowest and 5 is the highest ranking.  Each plan is rated on the quality of the plan which is decided by customer satisfaction of care and customer service provided.

Remember:

Over time, both medication needs and health status changes; it is important to review your Medicare drug coverage each year during AEP.  This will help you prepare for the year ahead and keep costly surprises to a minimum, although none of us has a crystal ball.

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Medicare rules for physical therapy

If you are like many people, you may need physical therapy at one time or another.  Physical therapy (P.T.) can be a lengthy and expensive process.  If you are a Medicare beneficiary, you might ask about the Medicare rules for physical therapy coverage.

Why do you need physical Therapy:

Physical Therapy is provided to evaluate and treat injuries or diseases that impede your ability to function.  The goal of P.T. is to either improve or maintain current function as well as to slow the decline.

When it comes to physical therapy and Medicare coverage, in most cases, it is covered by Medicare Part B.  Medicare Part B covers outpatient services, including medically necessary physical therapy, occupational therapy, and speech-language pathology services.

In some cases, Medicare Part A covers Physical therapy if it is received as inpatient rehabilitation.  This is usually connected to an inpatient hospital stay.

Please note: members of Medicare Advantage plans need to check their evidence of coverage for benefit and coverage information.  If you do not have a copy, call the member services number located on the back of your ID card to get coverage details.

Physical therapy eligibility and medical necessity:

Although Medicare Part B covers physical therapy, it is important to understand that not all therapy sessions are eligible for reimbursement. Medicare requires that the therapy services are medically necessary to address a specific condition or injury.  Additionally, your doctor or healthcare provider must prescribe and oversee the therapy sessions.

Caps and Exceptions:

In the past, Medicare put annual therapy caps in place to limit the benefit amount members could use. However, as of 2018, Medicare has removed these caps.  This is because of MACRA (Medicare Access and CHIP Reauthorization Act). This change gives beneficiaries access to necessary therapy services without the stress of being cut off due to an arbitrary cap.

Although these days there is an annual “soft cap” in place, all this means is, providers must track their patients’ progress and state that the Pt is medically necessary, and coverage will be provided.  Once a patient gets close to the threshold, providers must use a KX modifier when submitting claims to prove services are medically necessary.

In 2023, the threshold is $2,230 for PT and SLP services combined.  For OT services it is $2,230.  This is a total annual coverage amount even if a patient seeks therapy for several different conditions during the course of the benefit period.  All services count toward that patient’s threshold. This threshold (soft cap) is not intended to prevent Medicare patients from obtaining medically necessary care.  It is just in place to avoid abuse of the system and track a patient’s progress to ensure the medical necessity.

Please note; as long as your physical therapy is medically necessary there is not limit on outpatient therapy services in one year.

What is the cost for physical therapy:

Under Medicare Part B, most beneficiaries pay an annual deductible. Once you meet your deductible, you must pay the 20% of the Medicare-approved amount for covered therapy services. If you have a Medicare Supplement plan, that plan pays the 20% left after your deductible is met and Medicare pays its part.  It’s important to verify that your therapy provider accepts Medicare assignment, which means they agree to accept the amount that Medicare deems reasonable for their services as payment in full.

Requirements for therapy providers:

To make sure Medicare covers the services you receive, your physical therapy must be provided by a qualified healthcare professional who meets Medicare’s standards. This rule applies to licensed physical therapists (PTs), licensed occupational therapists (OTs), as well as licensed speech-language pathologists (SLPs).

Documentation and Progress Reporting:

In order to receive continued coverage of physical therapy sessions, your provider must document your progress regularly.  Documenting helps justify the medical necessity of ongoing therapy as well as provides insight into your functional improvements. It is also important to attend all recommended therapy sessions and actively participate in your treatment plan.

Once you know the rules and requirements for Medicare coverage for physical therapy, you can move forward with your recovery without having to worry about any possible financial strain your treatment may cause. It is imperative that you communicate with your healthcare provider and therapy team to maximize the benefits of Medicare’s coverage and work towards achieving your health and wellness goals.

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How to Choose an Annuity

Annuities can be an integral part of financial wellness plans for the golden years of your life, as well as a plan for the future of your family’s financial security. But, like many financial decisions, choosing an annuity can be intimidating. Here are four simple steps to choosing an annuity and starting to safeguard you and your family’s future during your retirement:

 Choose when payouts begin

There are two options for the date that payouts begin on an annuity. The first is called deferred, meaning that payouts will begin in the future at a previously determined date. The second is called immediate, which means payouts begin shortly after the first premium is paid. In this case, the premium is a lump sum.

 Select the rate of return deciding how to choose an annuity

This selection depends very much on the level of financial risk that you are comfortable taking. There are three usual options:

• Guaranteed/Fixed

These payouts are based on the amount that is guaranteed in the contract. The company bears the investment risk so the client doesn’t have to, and the payments are typically the same regardless of timing.

• Variable

Although some variable annuity contracts may offer minimum payout guarantees, both the account payout and the earnings are variable and not guaranteed with this type of annuity.

• Indexed

This is a combination of the two previous, essentially. Indexed rate of returns provide a minimum guaranteed interest rate and an interest rate tied to the market index.

  Select payout term when  – how to choose and annuity

These are very similar to life insurance terms. There are five types:

• Lifetime of policyholder

• Lifetime with remainder of funds to beneficiary

• Guaranteed for five, ten, fifteen, twenty years, etc.

• Joint and survivor

Of these, all of them except for the “lifetime of policyholder” allow remaining funds to be transferred to a survivor or beneficiary at the end of the policyholder’s life.

 Select payout type

There are two standard types of payouts on an annuity. Lump sum withdrawal is when the policyholder receives all the funds at once, and some fees can apply to this. The other type, annuitize contract, is when monthly payments are sent to the specified recipient in the previously chosen payout term.

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