The Medicare GEP (general enrollment period) is a chance for eligible individuals to enroll in Medicare Part A and Medicare Part B. The GEP runs each year starting January 1st and ending March 31st. In years when the GEP ends on Saturday or Sunday, Social Security allows individuals to enroll the following Monday in one of their local offices. If they receive a written request for enrollment with a stamp dated by the last day of the GEP, Social Security will honor it.
If individual is eligible for Medicare benefits and has to pay a Medicare Part A premium, they can use the GEP to enroll in Medicare. If they are like most people and do not have to pay a Part A premium, they can enroll in Medicare Part A anytime. Eligible individuals who did not enroll in Part B during either their IEP or an SEP can use the GEP to enroll in Medicare Part B.
Eligible beneficiaries who went a year or more without Part B or Part A, if they have to pay a premium for it, may pay a late enrollment penalty when they use the Medicare GEP to enroll. Penalties for Part A and Part B differ. See below for details:
The penalty for Part A only applies to individuals who are not eligible for premium free Part A benefits. If a penalty applies, 10% is added to the premium cost. The penalty lasts for twice the number of years the enrollee delays Part A enrollment. For example, (If enrollment was delayed for 2 years, a penalty applies for 4 years).
Part B penalties add an additional 10% to the Part B premium each year the beneficiary delays Part B enrollment. An example is (a delay of 2 years will equal a 20% penalty). The Part B penalty lasts for as long as they have part B coverage.
Those who did not enroll in Medicare Part B because they had insurance coverage through theirs or a spouse’s employment, do not pay an LEP. There is also no penalty for beneficiaries who qualify for an MSP (Medicare Savings Program).
Before 2023, no matter what date beneficiaries enrolled in Medicare during the GEP, their coverage would start July 1. Since the CMS rule change that began is 2023, there are no longer delays in Medicare effective dates for beneficiaries who enroll during the GEP. In other words, coverage begins the first day of the month following the enrollment.
Most people have heard about the additional benefits offered on some Medicare plans. One of the most asked about benefits are Medicare dental benefits. Although dental care is an integral part of overall health, in the vast landscape of healthcare, dental benefits are often overlooked.
Medicare plays a crucial role in ensuring individuals over the age of 65 and qualifying individuals with disabilities. Unfortunately, the comprehensive healthcare coverage Medicare provides is definitely lacking when it comes to dental coverage.
As we have already mentioned, Medicare provides a great deal of coverage for various health services, yet dental care has traditionally held a separate status. Neither Part A nor Part B (Original Medicare) cover routine dental care. This includes things like check-ups, cleanings, fillings, and extractions. These services can be quite expensive and many people on fixed incomes simply do not have the resources to afford the costly dental care they require. This lack of coverage frequently leaves beneficiaries looking for supplemental options that will cover their oral health needs.
These days, many people look to Medicare Advantage plans (Part C) to provide some relief from the high cost of dental work. Medicare Advantage plans are offered by private insurers and often provide additional benefits beyond Original Medicare. Many Medicare Advantage plans include dental coverage. This coverage usually includes preventive and a few additional services. In some rare instances, more extensive treatments like root canals or dentures are also covered to some extent.
Many Medicare beneficiaries ask about dental coverage because they understand the importance of dental health. This is where you need to explain that supplementary (stand-alone) plans cater specifically to dental care needs. There are many different options available and many dental insurance carriers. Each carrier provides a few different coverage options that include things like checkups, cleanings, fillings and various other dental procedures. It is imperative that beneficiaries understand dental plans only work well if they use an in-network provider for dental care. As an agent, you need to check that their dentist is in network with any plan they are considering.
While navigating Medicare and dental benefits, it’s imperative to understand how important routine dental care is. Oral health can significantly impact overall well-being. There are several studies that link poor oral health to various systemic conditions. Maintaining regular dental visits preserves a healthy smile and also contributes to overall health and quality of life.
Because of the critical role oral health plays in overall well-being, there’s an ongoing call for expanding Medicare to include comprehensive dental coverage. Both advocates and policymakers continue to push for changes within the program to include preventive and restorative dental services. The goal is to provide better access to essential oral healthcare for Medicare beneficiaries.
As the healthcare landscape continues to evolve, understanding the importance of Medicare dental benefits remains pivotal for individuals seeking comprehensive healthcare coverage. Although the current scope of dental coverage in Medicare has many gaps, exploring supplemental options like Medicare Advantage plans or standalone dental coverage offer some help addressing oral health needs.
If you are an insurance agent or you have seen some of the Medicare commercials on tv, you have probably heard about dual eligible special needs plans or DSNPs. This might make you wonder, what is a DSNP.
DSNPs are Medicare Advantage plans that provide specialized healthcare benefits to qualified individuals who have both Medicare and Medicaid benefits.
For many beneficiaries who qualify for dual-eligible healthcare benefits, it may be difficult to coordinate their health care benefits between Medicare and Medicaid. That is why the DSNP (special needs plans) area a good choice. These plans provide members with an easy way to manage their healthcare coverage with the use of 1 plan as opposed to multiple plans and ID cards.
DSNP plans all include prescription drug coverage as well as some of the benefits in listed below.
Please note: each plan provides its own list of benefits. To view a full list of benefits for a particular plan, check the Summary of benefits or evidence of coverage.
DSNPs are offered to qualified beneficiaries through private insurance companies. The insurance companies that offer the plans are required to include all benefits that Original Medicare covers (Part A & Part B). Each individual state controls the extra benefits that providers can offer. These plans are not available in all states.
You can quickly find out which plans are available in each state by running a quote on Connecture or Sunfire.
Each type of DSNP is based on your level of eligibility for Medicaid. Insurnace carriers offer a limited choice of DSNP plans based on the service area. The level are as follows:
In order to receive Medicaid benefits, you must:
As a licensed insurance agent, you can help sort out all the plan choices as well as the additional benefits each plan offers so your clients feel confident in their plan choice.
Each time a Medicare agent meets a new client a Medicare fact finder is a great way to address what they want and what they need. This is a great tool to help you make personalized suggestions for coverage.
If you are in the senior market, your fact finder should focus on Medicare coverage. It may also include additional options like hospital indemnity, life products or other relevant products you offer. You should design your fact finder to fit your client’s needs and the services that you have to offer. The only way to know what the client is looking for is to ask questions.
This question is very important to ask. Clients need to understand the parts of Medicare and how they work to know what type of coverage they want and need. Your job is to make sure they know about all the coverage options available and make an informed decision. This includes what is covered by Part A, Part B, Part C and Part D.
When you ask this question as part of your fact finder, you gain valuable insight into what type of coverage the client is looking for. This will help sort out which benefits are important to them, and which are not. This can be very useful in sorting out MA/MAPD plan benefits as there are so many to choose from and they offer different benefit packages.
The answer to this question can help decide if a Medicare Supplement or a Medicare Advantage plan is a better option for your client. That is a reason to include it in your Medicare fact finder. Many of your clients’ plan choices will come down to simple mathematics. Medicare Advantage plans require a copayment for visits to either PCPs or specialists. The amount of each copay can make a difference in your client’s budget.
If a client uses medical care from several providers on a regular basis, they may have a difficult time finding a Medicare Advantage Plan that all their chosen providers participate with. It is your job to be sure they can continue to use the providers they want and are aware of the cost for each visit. In some cases, an MAPD plan may not be the best option for the client.
Please be aware, it is up to the client if they want to disclose this information. However, it is important to help them find the best coverage options for their needs and can be very costly if they make an ill-informed decision. Each MAPD and PDP plan has a specific formulary. This means they cover each medication differently. There can be very large differences in the cost for prescriptions that may place a burden on your clients when they are trying to maintain their health.
The cost of each prescription also depends on the pharmacy your client chooses to use. This must be explained to them as well. Carriers for Part D coverage often have preferred network pharmacies that can save the client money when they fill prescriptions there.
There are specific Medicare Advantage plans that provide coverage of certain chronic health conditions, such as ESRD. Although they cannot enroll in most Medicare Advantage plans, these SNP plans cover their specific needs, and they cannot be denied coverage for pre-existing conditions.
This may be an important question to include in you Medicare fact finder. Medicare supplement plans are good in any doctor’s office or facility that accepts Medicare assignment. On the other hand, Medicare Advantage plans have a local provider network and clients may not find an in-network provider when they spend months living out of their home state. This can end up costing quite a bit out of pocket for care. It is important to check the benefits of each plan for travel and residency coverage.
In some cases, client have retiree plans that work with Medicare to provide coverage for health care needs. If this is the case, the client should check with their company’s benefits coordinator to see how a Medicare plan affects their retiree coverage and how they work together.
These are just a few possible questions to use. It is important to decide which questions to add or subtract based on your personal preferences.
Let your client know what you are doing and why. This will help them understand that you see each client as an individual and will do your best to fill their personal health coverage needs. It is best to finish the questions and go over the answers before you try and make any sales presentation to the client. Making the suggestions at the end will let the client know you are listening to every answer and using all the information to make the most informed suggestions.
There are a lot of moving parts to selling Medicare plans including several choices for Enrollment opportunities. We will explain a little about the Medicare SEPs for emergencies or disasters. This SEP may be available to some of your clients.
It can be very helpful to know that in some instances, CMS allows a SEP (special enrollment period) for beneficiaries to enroll in or change either a Medicare Advantage or prescription drug plan. This SEP is available to individuals affected by either a disaster or a federal, state or local government declared emergency. The SEP can only be used if you missed a valid election period during the time of the disaster or emergency. It is important to check with each carrier to see if they are accepting the SEP for enrollments or plan changes.
If you have a beneficiary who may qualify for this SEP, be sure you check to see if the carrier of the desired pan is accepting this SEP. The beneficiary may need to verify they live in the area that was declared an emergency or disaster. You also need to be able to verify that they have missed a valid election period during the emergency/disaster. After you verify that they qualify, you can move forward with the application.
When you are filling out the application, you will look for the SEP choice that pertains to an Emergency or disaster declared by FEMA or other government agency. The application may ask for the dates of the valid enrollment period that was missed.
CMS will need to decide if the SEP election period is valid. If there are any questions, the carrier will contact the agent or the client or both with any questions.
If CMS approves the enrollment, the plan will start the first day of the month after you submit the application.
If you are considering a Wellcare Medicare Advantage plan, you should take a look at the Wellcare OTC catalog 2024. In 2024, Wellcare is providing beneficiaries of participating plans have access to Wellcare Spendables dollars. Members of Wellcare plans can use this benefit purchase OTC items such as pain medication, vitamins or toothpaste. Use the healthy foods benefit to purchase fruits and vegetables or bottled water just to name a few choices.
Use one of the catalogs below to search for some of the options available. You will find more choices either online or in participating stores.
When your Wellcare Spendables card arrives, you need to activate your benefit. Do this either online at member.wellcare.com or by calling 1-855-256-4620 (TTY 711) there is someone there to answer your call 24 hours a day 7 days a week. You can also access your benefit by downloading the Healthy Benefits+ mobile app for apple devices at the app store or for Google devices at googleplay.
Once you download the app, you can easily scan your card from your phone when you go to the checkout to purchase eligible items. Use the app to scan items and verify eligibility. You can also use your app to shop online and place your order as well as check your available balance.
Find a participating store such as; Walmart, CVS or Kroger with the app or by checking your online account.
The Wellcare OTC catalog 2024 includes several sections dedicated to specific conditions including a section for diabetes supplies.
Daily living aids, such as blood pressure monitors, scales and thermometers are also included. There are also feminine health items as well as eye and ear care products.
The store finder app can help members find more than 55 thousand retailers who participate with the Healthy benefits nearby.
There are many choices of different food categories to choose from such as meals & sides, protein drinks and even condiments.
Online and in-store prices may vary from the prices listed in the catalog. If this happens, the store price will be applied at the checkout.
Sales tax is applied to all orders.
If the cost of your order is more than the balance on your card, you can use another payment method to make up the difference.
To replace a lost card; just visit member.wellcare.com or call 1-855-744-8550 (TTY 711) between the hours of 8am and 8pm local time 7 days a week from October through March, the hours to reach customer service are 8am until 8pm Monday – Friday from April through September.
Sometimes it feels like a sprint; sometimes it feels like a marathon; sometimes it feels like you’re sprinting a marathon. Annual Enrollment Period (AEP) is the busiest time of the year for most insurance agents, and you made it through. But don’t relax just yet – here are four things to do to make sure to cement all your success from the previous eight weeks to selling Medicare plans.
If you have a team or even if you’re on your own, it’s important to acknowledge all of your hard work and success and even the learning experiences that just happened. Whether you met your goals or not, celebrating what you did achieve is good for morale and mental health.
A spreadsheet with new client names, plans, their contact information, and anything else pertinent can be a great way to keep all of the new clients in order. Many agents find that their new client information gets out of order during AEP because of how busy they are, so right afterward is a good time to put everything in its place. There are also many different platforms that have ways of keeping your data organized, like MedicareCENTER.
It might seem old-fashioned, but sending a thank-you card or email is the kind of personal touch that people like in their business dealings. Insurance agents deal with such personal and intimate information for people that it’s imperative that trust is involved, and thanking your clients for trusting you can go a long way towards retaining them. It can also be good marketing if they mention it to friends or family.
Open Enrollment Period (OEP) is only a few weeks away! With a start date of January 1st, OEP is another busy season for the insurance industry. Even though you can’t reference OEP directly in your marketing just yet, you can plan ahead by calling your clients about their insurance cards and wellness appointments and checking on which other areas of their life need coverage, like life insurance or annuities. They’ll appreciate the personal attention and you might even get a commission out of it.
Even though AEP is over until next year, there are things you can do to make the next one even more successful. Congratulating yourself and your team, organizing new client information, sending thank-you cards, and preparing for OEP could have tangible benefits for your business.
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CMS developed the Star Ratings system. The system is used to rate both Medicare Advantage and Medicare Prescription Drug plans. The star ratings are based on a scale from 1 (the lowest score to 5 (the highest score). These ratings are based on the quality of each plan as well as the level of customer satisfaction. The CMS looks at each plan’s performance on an annual basis.
Star ratings were put in place by CMS to improve the quality of the plans available to Medicare beneficiaries. They are also a good way for CMS to track customer satisfaction with the care they receive from providers, hospitals and other healthcare facilities that work with Medicare beneficiaries.
This is measured by member access and use of preventative services. This includes physicals, vaccinations and screenings. This category shows how well a plan encourages members to use their preventative services through incentives and communication.
This step monitors if members receive recommended treatments or testing for long-term health problems. This shows if the plan provides encouragement and for members to get needed treatments and testing done. Each plan offers its own programs and resources for members to manage health conditions such as, diabetes, osteoporosis, arthritis or high blood pressure.
The member feedback is extremely important. This category is based on how the members of a plan feel they were treated. Their experiences include the care they receive from doctors who participate with the plan as well as how they rate their ease of filling their prescriptions.
The number of complaints and problems beneficiaries report is tracked as well as if the plan has made improvements to address such issues.
This also includes how appeals and new enrollments are handled. Are they taken care of in a reasonable amount of time? Does the plan provide TTY services or interpreters for foreign language speaking clients.
This includes (Part D) Prescription Drug as well as Medicare Advantage (MAPD) plans that include drug coverage. These plans receive an overall rating which is decided by the same categories as above as well as drug safety and accuracy of drug pricing. The prescribing of medications is monitored to ensure safety and accuracy for each beneficiaries’ health conditions.
When a plan gets a rating of 5 stars, it is thought of as excellent. If a plan has 4 starts, it is considered above average by CMS. Either of these ratings let a potential enrollee know they are considering a plan that offers good customer service and a solid benefits package.
However, if CMS gives a Medicare plan less than 3 stars for 3 years continually, it is marked as low performing. CMS will contact enrollees of low preforming plans so they can find better options if you want.
If you are unhappy with your current Medicare plan, you can use a special enrollment to join a Medicare plan with a 5-star rating. This SEP is specifically for enrollment into a qualifying 5-star plan if there is one available in your area. This SEP is available from December 8 through November 30.
If you enroll in December, your plan will be effective as of January 1. Enrollments that are processed from January through November are effective the first day of the month following the enrollment request.
Please note: beneficiaries may only use this SEP one time from December 8 through November 30.
Plan ratings may change every year and are available in October.
Each year during AEP, when you are looking at your plan options, consider the star ratings of each plan for a glimpse into what to expect from each plan.
To get a full explanation of star ratings, go to Medicare .gov. A licensed Medicare agent will be able to help you choose the best coverage options for you as well as provide the up-to-date star ratings.
Everyone has probably heard about the Medicare annual enrollment period, but there is another opportunity to change your MA plan. This is opportunity is available during the Medicare Advantage open enrollment period or the MAOEP.
The MAOEP or Medicare Advantage open enrollment period is an additional enrollment period available to only MA/MAPD enrollees. It begins January 1 through March 31 each year. Members of Medicare Advantage plans can either change to a different Medicare Advantage plan or to Original Medicare. Beneficiaries are only permitted to make one plan change during this time.
This is a great opportunity for those people who missed the Annual Enrollment period for some reason. If their MA/MAPD plan had auto renewed and it had changed in ways that no longer met their needs, this is an opportunity to fix that.
It is also a chance for those who are not happy with a new plan they chose during AEP (Oct 15 through Dec 7) to make a change that better fits their needs.
Beneficiaries who switch from a Medicare Advantage plan to Original Medicare are eligible to purchase Prescription Drug Plan (Part D) coverage.
It is important to note; beneficiaries who have Original Medicare and Part D coverage cannot use this enrollment period to change their coverage. This Enrollment period is exclusively for Medicare Advantage enrollees.
Another important thing to understand is; if you want to change from a Medicare Advantage plan to Original Medicare during this time, you may not have guaranteed issue rights for Medicare Supplement coverage. This depends on the state you reside in (there are only 4 guaranteed issue states) or how long you have had a Medicare Advantage plan.
Most beneficiaries make plan changes during the AEP that runs from Oct 14 through Dec 7 each year. It is the best time to change plans. If you change during this time and you are not happy the MAOEP gives you a chance to change back or to another plan. If you wait until the MAOEP, you cannot change plans again until the following AEP.
It is important to consider all your options carefully. A licensed insurance agent can help you see all your options side by side and make an informed decision.
Keep in mind; making a plan change during AEP and having your new plan start in January is really the best way to keep your annual out-of-pocket cost down. If you start the year with one plan and then change plans a few months later, you will have to start over with a new deductible and out-of-pocket maximum.
Social Security retirement age The age that an individual can receive their
Online Enrollment- Enroll prospects online without the need for a face to face appointment. Access to all major carriers with the ability to compare plan benefits and prescription drug costs. Link to recorded webinar https://attendee.gotowebinar.com/recording/2899290519088332033
All agents receive a personalized enrollment website. Prospects can use the site to compare plans, check doctors, run drug comparisons and enroll in plans. Agents are credited for all enrollments. Click Here