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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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Understanding Medicare Supplements: The Basics of Medigap

Medicare covers many health essentials for citizens sixty-five and older but it does not cover everything. Particularly for those with more complex medical histories (or futures), Original Medicare (Parts A and B) is often not enough as they move into their golden years of retirement. This is where understanding Medicare Supplements, or Medigap insurance policies come into play.

What is it?

Medigap is essentially extra insurance. Beneficiaries can buy extra insurance policies from private carriers to help pay their share of the out-of-pocket expenses that come with Original Medicare. Original Medicare is funded by the federal government.   The federal government also contracts with private carriers to ensure that their Medigap policies are safe, uniform, and sufficient. Beneficiaries must have Original Medicare in order to buy a Medigap policy. This means they must sign up for Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) to be eligible to purchase Medigap.

As previously mentioned, the insurance carriers that provide Medigap policies are contracted with the United States government. This means that the carriers must meet certain guidelines in order to keep their contract each year and continue to sell these policies. All Medigap policies are standardized, meaning that they all cover the same basic health benefits regardless of which company they were purchased from or which state the beneficiary lives in. There are ten different types of Medigap policy, and they are distinguished by letters (A, B, C, etc.). Price is the only difference between carriers’ plans of the same letter. This means that plans with the same letter offer the same coverage regardless of carrier. It is important to note, however, that in Massachusetts, Minnesota, and Wisconsin, the plans are standardized in a different way. Despite this, every Medigap policy must follow state and federal laws to protect their beneficiaries.

What does it cover?

The benefits of each Medigap plan differ (again, usually by letter, or tier), but they are all designed to do one thing: help cover the beneficiary’s share of costs from Medicare Parts A and B. This means Medigap policies can help cover co-payments, coinsurance, and deductibles. Some Medigap policies can cover services that Original Medicare doesn’t cover, like emergency medical care outside of the United States.

What’s not covered?

Medigap can’t cover everything that Medicare Parts A and B doesn’t. Some of the services that are not covered under Medigap policies are long-term care, vision or dental care, hearing aids, eyeglasses, and private nursing. Medigap plans that were sold after 2005 do not include prescription drug coverage, and beneficiaries can opt in to Medicare Part D for that kind of coverage.

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Prescription Drug Help in Connecticut

Prescription drugs are often life-saving, essential aspects of comprehensive health care. However, they can be cost prohibitive, particularly if the patient is expected to use them long-term, and not every health insurance plan provides coverage for them. Here are six ways that Connecticut residents can get help with their prescription drug costs:

Medicaid (Husky Health)

The state of Connecticut has a Medicaid program called Husky Health Insurance that provides prescription expense assistance for those who qualify. Typically, those people are low-income adults and children, as well as pregnant women. There is a portal to visit to qualify for prescription drug assistance, known as Husky Pharmacy Assistance, and most enrollment for Husky Health can be done through AccessHealthCT.

Medicare Part D

Also known as Medicare Rx, Medicare Part D is the part of Medicare that provides prescription drug and pharmacy coverage to its beneficiaries. It is offered through private companies, but those carriers must partner with the federal government and meet their requirements for plans every year to be allowed to provide Medicare Part D plans. The program is not required, but encouraged for those aged sixty-five and above. There is a penalty for people who do not have sufficient or comparable prescription drug coverage, as well, but decline Medicare Part D. More information can be found at Medicare’s government website.

Low Income Subsidy (LIS) for Medicare Part D

Because Medicare Part D is provided by private carriers, the premiums deductibles, and copays can vary with the type of plan selected. Beneficiaries with limited income may be eligible for further assistance called the Low Income Subsidy. This is a subsidy that pays part of or all of the expenses associated with Medicare Part D premiums. Only those with limited assets or low fixed income will qualify for this subsidy.

Free or Low Cost Prescription Programs

These programs are also known as patient assistance programs. To qualify for these programs, beneficiaries must have no insurance, have low income, and not be eligible for a government assistance program like Medicaid, which would otherwise pay for part or all of the prescription drug costs. One of these programs is called the Partnership for Prescription Assistance. More programs can be found here.

Discount Prescription Programs

Some bigger box stores, such as grocery stores, that have pharmacies offer lower cost prescription drugs because they can procure them at discount prices, particularly the generic versions of popular prescriptions. Not all generics are covered, but some stores that do this include Big Y, CVS, and Walmart. Some hospitals also offer these generics discounts, such as Saint Raphael in New Haven or Saint Vincent Medical Center.

Online or Mail Order Prescription Programs

The popular medical advice website WebMD offers information on how to obtain prescription drugs through the internet or mail services.

In Connecticut, there are many ways that residents can access assistance with their prescription drug costs. Help is available for premiums, copays, deductibles, or simply the cost of the medication itself.

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Short-Term Medical Insurance

Short-term medical insurance is not available nationwide. It is, however, available in Connecticut, but on very limited terms. Health insurance coverage that lasts less than twelve consecutive months is Short-term medical  insurance. Individuals can extend and renew for up to thirty-six months. Connecticut is also one of the few states in which it is illegal to deny a person coverage due to a preexisting condition.  Unfortunately, no insurance carriers offer such terms for short-term coverage. Therefore, individuals obtain short-term medical insurance three main ways in this state.

Affordable Care Act Plans (ACA)

Through what is known as Obamacare, people can sign up for a health insurance plan using Connecticut’s Health Insurance Marketplace (AccessHealthCT). The carriers that offer plans through this marketplace are Anthem Blue Cross Blue Shield and Connecticare Benefits, Inc. There are five levels of coverage.  Four are named after metals: bronze, silver, gold, platinum, and then catastrophic coverage. Each level covers a different percentage of essential health services.

Generally speaking, bronze will cover 60%, silver will cover 70%, gold will cover 80%, and platinum 90%. Catastrophic coverage has a low monthly premium but offers the lowest amount of coverage. Tax credits based on income are applied to the health insurance plan premium to help cover the cost, and there is special enrollment, which means that major life events qualify residents for enrolling outside of the normal enrollment period. Some qualifying events are a marriage or divorce, birthing or adopting a child, and job change.

COBRA

COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. This act  offers coverage to those who leave a job with employer-offered coverage.  Individuals no longer employed buy that plan. That being said, the premiums are likely to go up considerably because the employer is no longer subsidizing them. Former employees are only disqualified from COBRA if they are fired for something egregious, or gross misconduct. The former employer must be notified if the former employee wants to use COBRA to continue in their health insurance plan and that plan can be extended for up to thirty-six months from the job change or termination.

Medicaid – Short-Term Medical Insurance

Medicaid is a state program that is available to pay for health insurance for residents who cannot pay for it themselves. There are a variety of reasons that someone would qualify for Medicaid.

• Adults ages 19-64 who are low-income and not eligible for Medicare

• Pregnant women and infants

• Children up to age 18

• Parents and caretaker relatives

Applicants can apply through their Department of Social Services or through AccessHealthCT.

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Sell Medicare All Year

What Happens After AEP? Learn to sell Medicare all year.

The AEP, or Annual Enrollment Period, is one of the busiest times of the year for Medicare insurance agents and agencies. It can be draining and exciting all at once. Annual Enrollment Period is the period of time when beneficiaries are eligible to sign up for Medicare insurance, and it runs from October 15 to December 7 each year. The new coverage choices that people make during the AEP go into effect on January 1 of the following year. Choices made in the AEP of this year, 2023, will be effective on January 1 2024.   Learn to sell Medicare all year.

As a single agent or broker or as part of an agency, it is important to do three things after making it through another annual enrollment period.

Celebrate Accomplishments

Look at what worked out in favor of the agency/agent this year. Enrollments, for example: How many were successful? Of those, which strategies worked well in getting beneficiaries to enroll in an insurance plan that fit their needs? Being as specific as possible about what worked well and what did not can help make the process more seamless and bring in more revenue in the following year.

Other things to consider are leads: where did the bulk of the leads that resulted in enrollments come from this year? Was it a new channel or was it with previously-known contacts?

Look at Opportunities for Improvement

No matter how well an agent or team did over AEP, there is always room for improvement. Two very common areas that agents report wanting to improve in are time management and carrier options.

Time management can be difficult over such a busy time like the annual enrollment period. If an agent takes meetings all day, things like marketing, returning emails and calls, and paperwork can be neglected and vice versa. One way to streamline the process of enrollment for busy periods is to identify which activities are taking up the majority of the time in the office. Then, agents can redistribute resources to ensure that time is more equitably spent across several activities rather than one.

Having access to multiple carrier options can be vital for closing deals during the annual enrollment period. After all, the purpose of selling Medicare insurance is to connect beneficiaries with the best plan for their individual needs. After AEP is over is an excellent time to determine whether or not the agency or agent wants access to further insurance carrier options next time around.

Regroup for Next Enrollment Period

The lull between enrollment periods can be a great time to regroup for the next round. Many agencies like to consider this as an opportunity to work on weaknesses, begin following up with clients, create new or improved marketing strategies, and re-educate themselves on Medicare Advantage compliance rules.

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Medicare AHIP Training

The AHIP Exam, or America’s Health Insurance Plan Exam, is the most widely-recognized Medicare training certification in the health insurance industry. Over 100,000 brokers and agents take this exam every year. The exam covers Medicare, details of how the industry works, and the Fraud, Waste, and Abuse training. Together, all of this information is referred to as MFWA Training.

The Medicare side of this exam will cover the following:

• Basics of Medicare

• Eligibility and coverage

• Anti-discrimination training

• Marketing and enrollment strategies

The Fraud, Waste, and Abuse side, on the other hand, will include:

• Identifying fraud, waste, and abuse

• Some of the industry efforts to detect fraud

• How legal tools can combat fraud, waste, and abuse

• The human and financial costs of fraud, waste, and abuse

• Compliance requirements for brokers and agents

• How to report fraud, waste, and abuse

• Loopholes and obligations

The AHIP exam itself consists of 50 questions, all of which are taken randomly from the five different portions of the training in order to cover all the topics. Each participant has three chances to score a 90% or higher. While agents have reported that they can get through the exam in an hour or less, the time limit for taking the final exam is two hours per attempt.

Here are some tips for taking the AHIP exam successfully:

1. Use Google Chrome as the browser.

Since this is an online exam, some agents have reported errors with submission when they used different browsers. To be on the safe side, Google Chrome is typically a good bet.

2. Study the review questions.

It is not unusual for the final exam to include between 30 and 40 questions taken directly from the exam study guides. Module quizzes are helpful for practicing and readily available online.

3. Be able to apply the knowledge from the training.

It is not enough to memorize facts for this exam. The test will ask participants to apply that knowledge to real-life situations, like examples of which plan would be best suited for a fictional beneficiary.

4. Set a sustainable pace.

With 50 questions and two hours to complete the test, the participants should allot about two minutes per question on the exam in order to finish in a reasonable timeframe.

Taking time to study, practice, and apply the knowledge learned in the training modules will set agents up for success when they become some of the 100,000 who take the AHIP Exam each year.

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Tips For Selling Medicare Over The Phone

The vast majority of Medicare beneficiaries will have their first conversations with an agent either over email or over the phone. Particularly since the pandemic, many people are more prepared to discuss, choose, and even purchase their plans over the phone rather than in person, in an office. With this in mind, here are some basic tips for successfully marketing and selling Medicare insurance plans over the phone.

How to Get Prospects to Call

In general, the nature of Medicare insurance plans means that outgoing calls or cold calls are not the most successful way to sell Medicare. Agents can call pre existing contacts, of course, and beneficiaries ready for re-enrollment, but in general, it is best to let potential clients come to you.

One marketing tip is to get involved in the local and wider community. An agent having a presence in their community means that, when people are ready for Medicare insurance enrollment, that agent will be the one they think of and are most likely to call. Some of the ways agents can do this is by writing newsletters in local papers, giving free seminars at local libraries, and getting involved with local business groups to network with local business owners. Community is where sales come from and opportunities as well. If the agent develops a reputation as an expert in their community, that will drive members of the community to them as needed.

How to Make Outbound Calls

There are many rules about making outbound calls as a Medicare insurance agent. They are rather strict, and the following is a list of what an agent can do:

• Call current enrollees, including those in non-Medicare plans, to discuss plans

• Return phone calls and messages to those who contact them

• Call with permission.  Examples include an online phone call or contact request or a business requesting a return call from the agency

These rules exist to protect beneficiaries, and are related to the ethics of selling Medicare insurance plans. The following are some of the things that agents cannot do:

• Make unsolicited phone calls to prospective beneficiaries and clients

• Call about other business and then switch topics to Medicare

• Agents cannot call about referrals – the referred person must call the agent

• Call someone who attended a sales event – the only exception to this rule is if the agent has express permission for this phone call from that sales event.  Proof of permission must be documented.

• Agents cannot call about whether or not prospective clients received something in the mail

With those rules in place, the most ethical and easiest way to generate business for a Medicare insurance agent is by getting people to call them; not the other way around.

Licensed agents – Selling Medicare Over the Phone

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