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Medicare HMO vs. PPO plans

If you are considering a Medicare advantage plan, you will need to weigh Medicare HMO vs. PPO plans.  The first thing we need to do is explain that HMO stands for Health Maintenance Organization plans.   On the other hand, PPO stands for Preferred Provider Organization plans. Each of these plans provide its own set of benefits.  The plan you choose will impact your healthcare experience.

Understanding the Basics:

Medicare HMO and PPO plans operate within the broader framework of Medicare.  Both types of plans cater to the healthcare needs of Medicare beneficiaries.  Although the share the goal of providing essential healthcare coverage, they function differently in terms of network flexibility, cost structure, and coverage options.

Medicare HMO Plans:

HMO plans typically require beneficiaries to choose a primary care physician (PCP).  The PCP coordinates their care as well as provides referrals to specialists within the HMO network. This approach supports a structured healthcare management system.  This ensures a comprehensive and coordinated approach to treatment.

Additionally, Medicare HMO plans often come with low premiums and lower out-of-pocket costs when compared to some PPO plans. They also may provide some benefits such as a Part B giveback that PPO plans typically do not. However, the trade-off for these cost savings is the restricted network access.  This may limit the choice of healthcare providers and facilities.  In most cases HMOs do not cover medical care received outside the HMO network, except in emergencies or urgent care situations.

Medicare PPO Plans:

On the other hand, PPO plans offer more flexibility in choosing healthcare providers and facilities.  This allows beneficiaries to seek treatment both in and out of the PPO network. Although there is a network of preferred providers, beneficiaries can still access care from out-of-network providers.  It is important to note; out of network services will have a higher cost to beneficiaries than in-network.

In general PPO plans may have a higher premium and greater out-of-pocket costs when compared to HMO plans. Nonetheless, the flexibility to see specialists or visit healthcare facilities without referrals can be advantageous.  This is helpful for those who require specialized care or have established relationships with trusted providers.

Key Considerations for choosing a plan:

When deciding whether an HMO or PPO plan best suits your needs, there are several key factors to consider:

1. What are your healthcare needs – Think about your healthcare requirements, this includes how often you require the care of a specialist.  You may need to go out-ot-network for some providers.
2. Cost Considerations – Compare the premiums, deductibles, and co-pays associated with both plans. Do not discount potential out-of-network costs for either plan.
3. Provider Network – Research the size and quality of the provider network. It is important to consider the availability of preferred doctors and specialists within each plan.
4. Network area – If you frequently travel or reside in multiple locations throughout the year, it is important to consider the geographic area of coverage available.
5. Prescription Drug Coverage – It is very important to research the prescription drug coverage provided by each plan.  This is imperative if you require regular medications.

Making the Right Choice:

Ultimately, the decision between a Medicare HMO and PPO plan hinges on your individual healthcare needs, financial circumstances, and preferences.

While HMO plans offer cost-effective, structured care within a limited network, PPO plans provide greater flexibility at a higher cost. Carefully evaluate your healthcare priorities and compare the specifics of each plan to make a well-informed decision.

It is a good idea to consult with a trusted healthcare advisor.  A licensed Medicare agent can help you review plan documents thoroughly and find the best option for you. A well informed agent can also answer your health coverage questions and is available to you when you need them.

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Medicare AEP Marketing

It’s no secret that the Annual Enrollment Period (AEP) can be the most stressful time of the year for insurance agents. It’s imperative that you try to communicate with and service nearly your entire book of business in a less than eight-week-long time period. Other than the mandatory steps like making sure all your business practices are in compliance with the new CMS regulations and guidelines, what can you do now to prepare for a less stressful AEP? We have five Medicare AEP Marketing tips sure to improve your work-life balance during the next few months

Get personal

How large is your book of business? Is it 250 clients or less? If so, you might be an ideal candidate for a more intimate approach – your clients will like that you’re speaking to them like individuals in your marketing material and fewer than several hundred clients is still pretty manageable. Some agents use postcards, some use emails, some mail greeting cards! There are many ways to reach out, but the goal is the same: make your clients feel like you’re invested in their best healthcare outcome before the start of AEP.

Start communicating in September

In the second half of September, it can be helpful to ask your clients to create Medicare.gov accounts if they do not already have them. This makes collecting and comparing data all the more essay, including more accurate drug comparisons. Getting this done in September will make October and November, Medicare AEP Marketing run more smoothly.

Hire seasonal help or interns

If it’s a reasonable expense for your business, consider hiring some seasonal help. How much easier would your AEP be if there was somewhere there to answer the phone, or return emails, or keep track of which clients need a call back? Anything they can take off your plate during the busiest eight weeks of the year would probably make a world of difference.

Try an online scheduling system

There are lots of options out there, but two that are easily integrated into websites are Calendly and TimeTap. Depending on how busy you are and how technologically savvy your clients are, it might make sense to have a way for them to book an appointment with you on their own via the website.  Automate appointments as part of your Medicare AEP Marketing.

Find an outlet!

No matter how well you manage your time and resources, AEP is going to be busy. Finding an outlet to better manage your stress can make a world of difference, no matter what it is.

With these five tips, you can set yourself up for a better work-life balance during this Annual Enrollment Period.

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What Are Medicare Excess Charges

Excess Medicare charges can come as a surprise to many beneficiaries. Excess charges are seen in the following situation: A  beneficiary goes to a doctor or provider who does not accept Medicare assignment, although they are included in the network. That doctor or provider may charge up to 15% of the bill in addition to what is provided by Medicare Part B as compensation. That 15% is known as an excess charge. As you can imagine, depending on how much the bill costs in the first place, that 15% charge can very quickly add up.

Does Connecticut Allow Excess Charges?

The short answer is yes. Most states allow excess charges. The exceptions are thought to be Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. However, for Connecticut, this is misleading information. Connecticut providers and doctors can, and do, use Medicare excess charges to  Part B beneficiaries. However, they cannot use these charges if that beneficiary is enrolled in a QMB, or Qualified Medicare Beneficiary program. This is a level of Medicare Savings Program (MSP) that ensures that additional charges cannot accrue for those enrolled.

How to Avoid Excess Charges

There are two types of    Supplement Insurance policies, or Medigap policies, that cover excess charges for Medicare Part B. They are Medigap Plan F and Medigap Plan G. Plan F is not available to people who became eligible for Medicare after January 1, 2020. Plan G is nearly identical to Plan F and accessible to later-qualifying beneficiaries. It does not, however, cover the Medicare Part B deductible. The other option for avoiding excess charges, if the beneficiary does not want to purchase Medigap insurance, is to make sure that the doctor or provider they have chosen to work with accepts Medicare assignment. If the doctor accepts Medicare assignment, there will not be any additional payment due.

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Pros And Cons Medicare Advantage

With the Annual Enrollment Period just around the corner, agents need to brush up on all kinds of knowledge and regulations to better serve their clients in the coming months. Let’s look at the pros and cons of Medicare Advantage plans.  Here’s a quick breakdown of the benefits and drawbacks of choosing a Medicare Advantage plan:

Pros And Cons Medicare Advantage – Pros

• Medicare Advantage plans (also known as Medicare Part C) typically have cheaper premiums than Original Medicare. This can be a good choice for beneficiaries who need lower monthly premiums or out-of-pocket costs.

• Medicare Advantage plans typically include drug coverage. This is not the case with Original Medicare.

• There is an in-network out-of-pocket maximum for plan holders, which means that a beneficiary will not pay more than $8,300 a year for healthcare.

• Medicare Advantage plans often come with perks, such as some vision, hearing, and dental services that do not come with Original Medicare plans. In some cases, they even include gym membership stipends or preventative chiropractic care.

Pros And Cons Medicare Advantage – Cons

• Because there is a network of healthcare providers for each Medicare Advantage plan, beneficiaries are limited to the providers that are in-network. This means that they can use only certain hospitals, providers, and services in their area.

• There is an approval process for some services and prescriptions, like preauthorization on seeing in-network specialists. Many services do require referrals in order to be covered by the plan. Original Medicare does not include this restriction.

• The network of providers may change throughout the beneficiary’s plan, which may lead to inconsistencies in their doctors and providers being covered.

• Costs are based on how often the beneficiary sees a doctor. The monthly premiums in Medicare Advantage plans are low or even free.  Co-pays, coinsurance, and deductibles contain most of the cost. This means that a health emergency or expensive medical care could cost the beneficiary more with a Medicare Advantage plan than with an Original Medicare plan.

With this information, agents will be able to better help their clients.    Better evaluate if a Medicare Advantage plan is right for them.

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Medicare Advantage Pros and Cons

If you watch T.V., you have probably heard about Medicare Part C also known as Medicare Advantage plans. Private insurance companies contract with Medicare to offer Medicare Advantage plans. These plans must provide the same level of coverage as original Medicare. If you are considering a MA/MAPD plan, you should think about the Medicare Advantage pros and cons before signing up.

Because your healthcare is a very important decision, there is a lot to consider when choosing between Original Medicare and a Medicare Advantage plan.

 We will go over some of the features Medicare Advantage plans offer that may or may not provide the type of coverage you are looking for.

Medicare Advantage Pros:

Low premiums and cost shares

Many Medicare Advantage plans offer $0 plan premiums. There are plans with a premium, but they are usually quite reasonable.  It is important to note; you must continue to pay your Medicare Part B premiums when you enroll in a Medicare Advantage plan.  If you opt for Original Medicare and a supplement, the premium will cost you substantially more and you will also need to purchase a separate PDP (prescription drug plan).  Paying for two plans can add up especially compared to a $0 MAPD plan that also provides prescription drug coverage.

Some in-network doctor’s visits have a low or no cost share with a MAPD plan.  While the same visit with Original Medicare may leave you with a 20% co-insurance payment.

Medicare Advantage plans provide an annual maximum out-of-pocket expense limit. This means, when you reach the maximum, your plan pays 100% of your covered medical expenses for the rest of the year. You pay nothing.  There is no maximum out-of-pocket cap with Original Medicare.  In other words, there is no limit to what you could spend for medical treatment in any given year.

Comprehensive coverage

Medicare Advantage plans provide the same benefits Original Medicare, both Part A & Part B, offers. MA plans also provide additional benefits not offered by Original Medicare. Some MA plans offer vision, hearing, dental, OTC and more.  MAPD plans offer comprehensive prescription drug coverage.

Beneficiaries of MAPD plans only need 1 plan and 1 card for medical, hospital and prescription coverage. This is a convenient way for beneficiaries to cover all their needs.

Several Value-added benefits:

Medicare Advantage plans provide many additional benefits above and beyond what was already mentioned.  Some plans include fitness benefits like gym memberships or incentives for active lifestyles. Many plans offer rides to and from medical appointments to ensure you get the care you need. MA plans may also offer incentives for wellness visits or preventative services they may also cover chiropractic services or acupuncture.  These services are not usually covered by Original Medicare.

Please note:  additional benefits vary by plan and provider.  Beneficiaries should check their plan’s summary of benefits to view the full range of benefits available.

Some Medicare Advantage plans operate as managed care networks or HMOs.  This means beneficiaries must use in-network providers who often work together to coordinate care and can in turn save beneficiaries money. Plans also offer telehealth consultations with healthcare providers.

Medicare Advantage Cons:

Must use only in-network providers

Beneficiaries enrolled in Original Medicare or Original Medicare and a Medicare supplement plan can use any provider who accepts Medicare assignment.  On the other hand, enrollees in Medicare Advantage plans are limited to seeking care with in-network providers. Any services received out-of-network can be either denied coverage or may result in a higher co-pay amount. Additionally, the cost of your care may not apply to your out-of-pocket maximum.

Additional costs

Medicare Advantage plans may include additional costs.  These costs include co-pays, deductibles and co-insurance. These out-of-pocket costs can add up if you visit the doctor often.  The costs depend on the plan, provider, and the services received.

See below for some situations that can raise the out-of-pocket cost for a MA plan:

1. Beneficiaries may have a copayment for doctor’s visits.  Co-pays also apply to some prescription drugs.
2. In some instances, there may be coinsurance cost for some services.  This may apply to specialist visits or DME (durable medical equipment).
3. Out-of-network charges.  Anytime a beneficiary visits an out-of-network provider there may be higher out-of-pocket costs (co-pays, coinsurance or the entire cost) for services received.
4. Many plans have an annual deductible.  Beneficiaries must meet the deductible before some medical expenses are covered. This may also include cost of specific the prescription drugs.  This will depend on the tier of each medication.

Please remember; beneficiaries should be aware of the MA/MAPD plan’s summary of benefits to understand the potential costs associated with any plan.

Prior authorization

Because Medicare Advantage plans try to assure their plans are not misused, beneficiaries may need to have prior authorization for hospital stays, home health care, and some medical procedures as well as medical equipment. This may include a primary care doctor’s referral before a specialist visit is approved.

Additionally:

Because there is so much to consider, it is a good idea to seek the advice of a licensed Medicare agent when considering all your plan choices and comparing all the benefits that are important to you.

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Humana OTC catalog 2024

If you are a member of participating Humana Medicare Advantage plans you will have the added benefit of the Humana OTC catalog 2024.  In 2024, CenterWell Pharmacy will provide members of participating plans OTC products.

If you want to verify that your plan provides an over-the-counter benefit, you should check your plans summary of benefits or call the customer service number on the back of your card.  You can also call this number to check your Health and Wellness allowance.

Download a copy of the OTC catalog

There are a few different ways to place your order:

1.  Order via mobile app.  Just go to either the APP store for Apple devices or from Google play for Android devices.  Once you are there, search for the CenterWell Pharmacy app and download it to your mobile phone.  With the app, you an order products whenever you like as long as you have an available balance.
2. Place an order online.  You will need to go to CenterWellPharmacy.com Once you are in, you can either create an account by following the prompts or log in to an existing account.  You will then choose Over-The -Counter (OTC) items from the “Shop OTC & Supplies” drop down.
3. Mail your order in.  If you choose this option, please allow for extra time.  Be sure to submit your order by the 2oth of the month to avoid orders going toward the following months benefit.  If you have a quarterly benefit amount, submit your order no later than the 20th of the last month of each quarter (March, June, September and December).  Fill out the order form you find in the OTC catalog and mail it to:  CenterWell Pharmacy, P.O. Box 1197, Cincinnati, OH 45201-1197.
4. Send your order via fax. Send your order form to: 800-379-7617.

Things to know before you order:

Be sure you know your plan’s allowance.  Check the summary of benefits for your plan to find this information.  If you have a plan with a rollover allowance, any unused balance carries over to the following month or quarter.  Please note; all balances expire on December 31, 2024.  If you do not have a plan that offers a rollover, you must use your benefits by the end of each month or quarter depending on your plan.
Orders that exceed the plan’s allowance will require payment by check , money order or credit card.  Orders include sales applicable sales tax.
Orders that contain multiple items may arrive in more than one shipment.
If you have an OTC allowance or Healthy Options allowance, you must activate your prepaid card before making purchases from the catalog.  Activate your card either by phone at 855-396-0691, 24 hours a day, Seven days a week or go to HealthyBenefitsPlus.com/Humana.

If you have questions about your OTC benefit; call 855-211-8370 (TTY:711).  Customer care specialists at CenterWell pharmacy are available M-F from 8 AM until 11PM, and Saturday from 8 AM until 6:30PM EST.

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Connecticare OTC catalog 2024

The Connecticare OTC catalog 2024 is just one of the many benefits MA plan members receive.  The ConnectiCare OTC benefit is provided through NationsBenefits.

Please note:  this catalog is for all participating ConnectiCare MAPD plans, this includes the Choice Dual Vista.  It is not for use by Choice Dual plan members.  Those members will receive a card for their OTC benefits.

There are 4 ways to use your benefit, find the one that is right for you:

1. Benefits Pro Portal – This is one of the fastest ways to order.  Just visit ConnectCare.com/mailotc and log into your account. If this is your first time visiting the portal, you need to register by following the directions on the webpage.  You will find all the items available in the portal.  Search for what you want by price, category and more.  View product information.  Check your available benefit amount.  Place your order and track it.

If you require help with your order or the Benefits Pro Portal, call 877-239-2942 (TTY:711).  There are Member Experience Advisors to help you from 8:00 AM until 8:00 PM, Monday through Friday.  Please note: language support and other formats are available if you need them.

Click here to download the NationsBenefits OTC catalog 2024

2.  Benefits Pro App – It is very easy to order using the app.  First you need to download the app onto your smart phone.  Just visit either      the App store for apple devices or Google Play for Android devices and search “Benefits Pro” and download the app from there.  Once the app is downloaded, you can easily order OTC items by scanning the QR code.

3.  Order by Mail – To place an order by mail, just fill out the order form and send it in with the postage-paid envelope you receive with your OTC catalog when you get your annual ANOC and benefit information packet.  Send your order to:  NationsBenefits, 1700 N. University Drive, Plantation, FL 33322.  Please be aware:  It will take more time to receive your order by mail, please allow extra time when ordering with this method. In the event your order is not received by the 20th of the month, it may be processed in the following benefit period.  If you are concerned about timing it is best to order by phone or online.

Download the Nations Benefits order form – Click here

4.  Order by Phone – Call 877-239-2942 (TTY:711).  Member Experience Advisors are ready to help you starting at 8 AM until 8 PM local time, Monday through Friday.  Please have your order ready before you call.  This includes the item number and quantity.

More OTC benefit information:

This benefit is for use by plan members only.

Certain items, amounts sizes and values are subject to change depending on availability.

Out of stock items may be substituted for a similar product of higher value.

Please allow two business days for product delivery.

Due to the personal nature of these items; returns are not permitted.  Damaged items will be replaced without returning the original item.

If you disenroll from your plan, your OTC benefit will terminate immediately.

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Medicare Part B costs 2024

For many people the updated Medicare Part B costs 2024 is important information to have.  Although, most people do not think about the cost of Medicare Part A because most Medicare beneficiaries receive their Part A benefit for free.  As long as they have worked for at least 40 quarters in a Medicare covered job as decided by the department of Social Security. The premium payment for Medicare Part B is quite different than Part A due to the fact that most people do have to pay for Part B coverage.

What’s is Medicare Part A & Part B:

Part A

Part B

2024 Part B costs:

In 2024, the premium for Part B will increase from $164.90 monthly to $174.70.  This is an increase in cost of $9.80 per month.  The annual  medical deductible for Part B will also increase in 2024.  It will go from $226 in 2023 up to $240 in 2024.  This is a price increase of $14.

Click here to learn more about Medicare premiums and deductibles

It is important for beneficiaries to stay up to date with all the changes in their Medicare coverage as well as costs.  Having all the facts gives beneficiaries the opportunity to plan their healthcare expenses more effectively.

Here are the costs associated with Part B

1. The premium is the first cost you need to be aware of.  As we stated above; the monthly premium for Medicare Part B will increase to $174.70.  This is an additional cost of $9.80 per month from 2023.
2. More costs associated with Part B include; deductibles and co-insurance.  For 2024 the deductible will increase to $240 in 2024.  This is up from $226 in 2023. Once your deductible is met, you are left to pay about 20% of any Medicare  Part B approved expenses.
3. If you do not sign up for Part B on time, you may be stuck with a LEP (late enrollment penalty).  Make sure you know when to sign up for Medicare Part B and be aware of any special enrollment periods in order to keep from paying a penalty. Learn more about late enrollment penalties.
4. Individuals with high incomes may be subject to an IRMAA.  If this is the case for you, you may pay a higher Part B monthly premium than other individuals.

Click here to watch our YouTube video on Medicare Part B IRMA and IEP, SEP rules

How to save on Medicare Part B costs:

There are many programs available to provide help to beneficiaries pay their Medicare costs. Programs such as; Medicare Savings Programs, Extra Help for Medicare Prescription Drug Plans as well as state programs that provide payment assistance for Medicare premiums, deductibles, and coinsurance.

It is a good idea to contact a licensed Medicare agent for advice with enrollment in a Medicare plan. This can provide you with all the information you need to make the right coverage choices that fit your personal needs.

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What Medicare Part B covers

Because many people are confused as to what each part of Medicare covers, in this post we will go over what Medicare Part B covers.  Understanding what Medicare Part B covers and doesn’t cover is crucial for individuals who rely on this program for their healthcare needs.  Although Part B provides extensive coverage for various essential medical services, it is important to consider additional coverage options.  These options help provide comprehensive healthcare coverage access to members for services not 100% covered by original Medicare plan.

Medicare Part B Covers:

1. Part B provides coverage for a wide array of services provided by your doctor.  The appointments can include office visits, consultations & preventative services as well as screenings for various conditions.
2. If you require any outpatient care, Part B will cover it.  Outpatient care may include some services you receive at the hospital as well as various other healthcare facilities.
3. Preventive services are a very important part of Part B coverage.  Preventive care, includes screenings for cancer, cardiovascular diseases, and diabetes, among others. These screenings are important to have in order to detect health issues early and promote overall wellness.
4. It pays for Medical Supplies when they are medically necessary.  Supplies include things such as; blood sugar monitors, lancets, and test strips for diabetics as well as durable medical equipment such as wheel chairs, walkers or hospital beds when it is specified as medically necessary.
5. Some Home Health Services are covered by Part B.  As previously stated, Part B covers specific medically necessary services.  If you require the care of a home health agency under certain circumstances, it is covered.

Click here for a list of covered DME 

Medicare Part B Doesn’t Cover:

1. Long-Term Care is not covered by Medicare Part B.  This includes any custodial care you receive in a nursing home or assisted living facility.
2. If you require routine dental care, such as check-ups, cleanings, fillings, and dentures, they are not covered by Medicare Part B.
3. Routine care for vision is also not covered.  Routine vision care includes, eye exams for prescribing glasses. Although in specific cases where you require treatment for eye disease or an injury, you will be covered.
4. The cost of hearing aids or exams is also not covered by Medicare Part B.
5. Although some Medicare Advantage plans may offer members coverage for acupuncture services, original Medicare including Part B does not cover this treatment option.
6. This one is not going to be a surprise; procedures considered solely cosmetic, such as facelifts or other elective surgeries, aren’t covered by Medicare Part B.

Some things to remember:

Part B does not cover 100% of your approved medical costs.  In most cases, it covers about 80% of your cost after your meet your annual deductible.

This leaves about 20% of the cost for you to pay.  That is why many beneficiaries opt for supplemental insurance to help cover the gaps in their healthcare coverage needs. Both Medigap and Medicare Advantage plans are popular options that can provide additional coverage to beneficiaries.

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Things you can’t say when selling Medicare

There are very strict guidelines put in place by CMS that state the things you can’t say when selling Medicare plans.  We will cover some (not all) of them in this post.

Click here to view the CMS Medicare Marketing guidelines.

It may be difficult to understand but the CMS’ Final Rule 2024 states that agents must not use the word Medicare in any way that could be misleading or confusing either on your website or in the name of your business.  In some areas, you may need to remove the word Medicare from your business name.  Using the word Medicare in your business’ name may lead people to believe that you work for the government,

It is important that prospects understand you are an independent advisor and represent a limited number of Medicare plans in any given area.  This language should be clearly stated on your website, business cards or any other marketing materials you hand out.

Watch our YouTube video on Medicare Marketing rules

We offer every Medicare plan available:

Statements like this are not accurate considering that there are plans that do not even work with independent agents.  You may be appointed to sell several great plans, but misleading potential clients is not acceptable.  You must be very careful with the wording of anything you say or printed materials you use to represent your business.

To read more about CMS’ 2024 Final Rule, click here.

CMS also requires all TPMOs to put a disclaimer on all marketing materials or communications.  The disclaimer is also required when making phone calls to prospective clients.

You cannot state that any Medicare plan is free:

The marketing guidelines of CMS clearly state that neither Plan D plan sponsors nor agents can use the word free when describing a plan premium.  They are also not allowed to use the term free to describe a deductible or premium reduction a low-income subsidy or any cost sharing pertaining to dual eligible individuals.

Although there are currently many Medicare Advantage plans that offer enrollees a $0 premium, using the word free to describe any plan can be confusing to some people.  Even if some plans do not charge a premium or co-pays for some services, that still does not mean the plans are free.  Enrollees will still need to pay co-pays, deductibles and co-insurance.   Clients must also use specific in-network providers for many services to be covered.

Do not claim any plan will cover all of someone’s needs:

There is no such thing as a plan that can cover every need of its members.  As an agent you should always look for the plan that best fits the needs of each individual client.  That is all anyone can do.  You must explain the pros and cons of each plan and provide a comparison of potential plans.  This way the client can choose which is the best fit.

Never claim any one plan is the best plan available:

As a sales agent, it may be easy to say one plan stands out as the best.  You should also know that the best plan for one person is not the best for another.  In this business there is no one fits all plan.  Each person has their own needs and wants when making a decision on which plan to choose.  Do not use misleading superlatives or unsubstantiated claims for advertising or when describing a plan to potential members.

The only time it is ok to use superlatives in a plan description is when you have actual data to support your claim.  All claims either written or spoken must meet CMS requirements.

A few more things not to say to clients:

Do not tell a client that their current coverage might change.

If you are looking at plan options for a potential client, you must explain the differences between a potential new plan and their current coverage.  This ensures they are satisfied with any plan changes they make.

Never claim that Medicare approves of the benefits offered by a plan.

Do not use this terminology when communicating with clients/potential clients either in person or on any marketing materials you use.

Don’t mention products in a sales appointment that are not on your scope of appointment.

If a client requests information about non-Medicare products during a Medicare sales appointment, you must tell them you can discuss these products at another time.  You should not try and bring up products that they did not agree to talk about when they signed the scope of appointment.  If they want to discuss life, annuities or other products, simply suggest an alternate time to discuss those products.

Do not ask for contact information for your client’s friends or family.

It is ok to let your clients know you appreciate a good review or referral. It is not ok to ask for anyone’s phone number or address if they did not consent for you contacted them.  You can provide clients with extra business cards to give to anyone who is interested in your services.  This way they can contact you if they choose.

Never offer a gift or money to anyone for enrolling in a plan.

It is important to know, it is illegal to offer gifts or financial incentives in exchange for enrollments.

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Medicare Government Shutdown

What Happens to Medicare During Government Shutdown?  As you’ve surely seen on the news, heard on the radio, or read in the paper, the United States government is facing a spending crisis. At the time of this article being written, lawmakers in Washington have until October 30th to pass a spending bill or the federal government will shut down, and many of the essential programs our citizens rely on will shut down with it.

People are, reasonably, worried. Many of those people are older retirees who rely on Social Security and Medicare for their income and healthcare services. Since the federal government is in charge of these programs, people wonder, what happens to them during a government shutdown?

The Good News

Here’s the good news: “Checks will continue to go out,” according to Bill Sweeney, who is the senior vice president of government affairs at the AARP.  Mandatory spending include Social Security benefits.  These continue to go out to their beneficiaries. As far as Medicare goes, everything should continue mostly as normal. People with Medicare can continue to seek healthcare services.   Providers continue to get paid. Where this comes into question is based on how long a government shutdown, should there be one, continues. Medicare beneficiaries, Medicaid beneficiaries, and those enrolled in the Affordable Care Act could still use their coverage, and their doctors and providers could continue to submit bills and get paid.

If a shutdown lasts a long time, it is more and more likely to affect those benefits. Medicare beneficiaries are most likely to feel an effect from a shutdown if the shutdown lasts a month or more. For the government shutdown looming at the time this article was written, Medicare has funding available for the next full three months, regardless of whether or not a spending agreement is reached before the October 1st deadline.

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