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Home Posts tagged "Medicare Enrollment" (Page 25)
Medicare sales permission to contact

Medicare sales permission to contact

By Ed Crowe | General Articles | 0 comment | 26 October, 2023 | 0

Medicare sales permission to contact

When you have a potential clients you need to keep all the CMS guidelines in mind before you begin.  You need to be compliant and use a Medicare sales permission to contact.

What is Permission to Contact:

This process helps stop agents from contacting beneficiaries through the use of dishonest sales tactics. Unfortunately, in the past, some agents have pressured Medicare beneficiaries to get a Medicare sale.  Permission to contact is one way to help deter uninvited agents to approach beneficiaries when they are not prepared.

To avoid non compliance, it is important the beneficiary gives permission for the agent to contact them before you try and meet, call or email them for Medicare Advantage or PDP sales.

Here are some ways you can contact a potential client:

  1. You can return their call if they request you do so.
  2. Through email as long as there is an opt-out option clearly provided.
  3. If they respond to a business replay card.
  4. When they fill out an online contact form.

Here are some ways you cannot contact a potential client:

  1. Do not knock on a potential client’s door without an invitation.
  2. You are not permitted to send texts to anyone without their permission.
  3. Directly contact through social media

When is permission to contact required:

Anytime you want to contact a potential client, you should obtain permission to contact.  This is very important if they may be considering a Medicare Advantage or Prescription Drug Plan enrollment. Please note; even if you contact a potential client for a Medicare Supplement plan which does not require permission to contact, they will most likely need a Prescription Drug Plan to go with it, therefore it is always a good idea to have permission to contact.  Be sure to include the following disclaimer “This is a solicitation of insurance” on the Permission to contact form.

Please note: If you are contacting your own clients; you do not need permission to contact.

It is acceptable to email potential clients as long as you include an opt-out option.  You cannot send anything that could be considered marketing material.  Marketing material includes specific plan information such as premiums, co-pay amounts or other benefit information. All communications must meet CMS guidelines as well as  CAN SPAM Act requirements.

How long is the permission to contact good for:

Once you have collected the permission to contact, you have 12 months to contact that beneficiary.  If you do not contact them within that time, you must collect another PTC before contacting them.

A couple more things to note:

If you employ a third party marketing organization for lead generation, it is important that they are compliant with all the CMS rules.  Do not forget, it is your name on the materials they are sending so you are the one who is ultimately responsible for what goes out to the public.  Beneficiaries need to be told either verbally, in writing or electronically depending how they are contacted, that their information will be given to a licensed Medicare agent who will contact them.

Do not confuse permission to contact with a Scope of appointment.

You still need to collect a scope of appointment from the beneficiary once you are able to set up a meeting or call to go over plan options.  It is important to follow all guidelines for Medicare sales in order to maintain compliance and maintain your ability to offer Medicare plans.

Download a generic scope of appointment form

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Medicare HMO vs PPO Plans

Medicare HMO vs. PPO plans

By Ed Crowe | General Articles | 0 comment | 25 October, 2023 | 0

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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Humana OTC catalog 2024

Humana OTC catalog 2024

By Ed Crowe | General Articles | 9 comments | 19 October, 2023 | 0

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

Connecticare OTC catalog 2024

By Ed Crowe | General Articles | 0 comment | 18 October, 2023 | 0

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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prepare for aep

Prepare for AEP

By Ed Crowe | General Articles | 0 comment | 13 October, 2023 | 0

Prepare for AEP

Prepare for AEP early.    As an independent insurance agent, Fall can be one of the most stressful times of the year due to the Annual Enrollment Period. But it doesn’t have to be! Although it will still be busy, there are four easy steps you can take now to ensure you’ll feel more prepared by October 15th. With these steps, you’ll be ready to capitalize on the biggest Medicare Advantage sales period of the year.

Prepare for AEP – Take time to review and choose carrier plans

This is the moment to take stock of your portfolio. Which carriers are you representing? Which of their plans have sold the best for you in the past? What do you have to offer new and returning clients? An agent should be familiar with the ins and outs of the plans they offer, including the benefits, costs, and applications so that you can meet the needs of your clients.

 

Prepare for AEP -Get ready to sell

Make sure that the basic requirements that you need to have met in order to legally and ethically sell Medicare Advantage have all been met. AEP is no time for surprises! Are your carrier certifications all completed? Is your AHIP exam completed and passed? Have you familiarized yourself with the new regulations from the Center for Medicare and Medicaid Services (CMS)? It is vital that you be in compliance with all certifications, exams, and regulations in order to sell Medicare products.

 

Prepare for AEP -Gather resources and marketing tools

AEP can go much more smoothly if you partner with an FMO, or a Field Marketing Organization. They often offer their agents and partners access to many free marketing tools and resources, like event planning, reimbursement for certain purchases that go towards marketing, compliance support, online portals for data analysis and platforms for call recording, and even teams of people whose job it is to support your sales.

 

Look at the data

This is a good time to look at the numbers from previous AEPs. Are there certain demographics you do particularly well with? Do you have some plans in your portfolio that haven’t sold well in a few years? Look for trends and patterns and use them to identify strengths and areas of improvement to focus your energy on during this AEP.

 

With these steps, AEP may seem much less stressful than previous years, and maybe even much more exciting.

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How to disenroll from Medicare Part B

How to disenroll from Medicare Part B

By Ed Crowe | General Articles | 0 comment | 9 August, 2023 | 0

How to disenroll from Medicare Part B

In this post, we will go over how to disenroll from Medicare Part B.  Although it is a rare occurrence, you can terminate your Medicare Part B (Medical Insurance). Although you may need to have a However, you may need to have a personal interview with Social Security to go over the risks of dropping coverage.  They will also be able to help make sure you have everything you need to process your request.

If you  want help terminating your Medicare Part B or to schedule a personal interview, you can contact Social Security either at 1-800-772-1213 (TTY: 1-800-325-0778) or in person.  Click the following link to  find your local  Social Security office.

To cancel Medicare Part B, you will need to download and print Form CMS 1763.  Once you have the form, do not fill it out until you have your interview with Social Security.  They provide instructions on how to fill it out.  If you already have your Medicare card, you’ll need to return it.  You can do this either during the in-person interview or by mail once you complete the phone interview.

Reasons to disenroll from Part B:

You were automatically enrolled

If you are receiving either Social Security or Railroad Retirement Board benefits when you age into Medicare, enrollment in Medicare Parts A & B may happen automatically.   If that is the case, you will probably receive a Medicare card even if you have not applied for benefits.

You may not want to pay a Part B premium.  If you do not opt out in time, your Part B premium might be automatically deducted from your Social Security or Railroad Retirement Board check.

You have insurance coverage through your employer

If you have rejoined the workforce and now have access to employer-sponsored health insurance, you may decide to disenroll from Part B and stop paying the premiums.  If this is the case, you need to determine if your employer coverage is either primary or secondary to Medicare.

When your employer coverage is primary, they pay for your care before Medicare kicks in; if there are any left over charges.  If your employer coverage is secondary, Medicare pays your medical bills and then the employer coverage pays if there are any left-over charges.

In the event your employer coverage is the primary payer,  It may be a good idea to disenroll from Part B if you like.  The added coverage you receive may not be worth paying the Part B premium.  When your employer coverage is secondary, it is probably better to stay on Part B so you do not get charged Medicare’s portion of your medical expenses.

It is always a good idea to speak with your human resources department at work as well as a licensed Medicare agent to determine what your best coverage options are. They can also help determine which plan would be primary and which would be secondary.

You can’t afford the premiums

When you are not sure you have the money to pay your Part B premium, please be aware of the risks of not having medical coverage. If you become ill, you could end up paying a lot more than a Part B premium.  If you do not have health coverage that is at least as good as Medicare, you might have to pay a late-enrollment penalty once you do sign up.  The penalties can make your premium even higher and they last for as log as you are enrolled in Part B.

You may be eligible for Extra Help or Medicaid coverage if you have a limited income and few assets. If you qualify for one of your states Medicare savings programs, you may receive help paying for your Part B premium.

Some risks to disenrolling from Medicare Part B:

If you do not have health coverage, you could become injured or ill and be stuck paying for all your medical services out-of-pocket.

Any time you go without creditable coverage, you have a coverage gap and will pay a late enrollment penalty unless you have a SEP (special election period) once you do sign up.  You also need to wait until the next General Enrollment Period to get coverage.  This period runs from January 1 through March 31st annually.

Click here to learn more about the risks of late enrollment in Part B

Any month that you are enrolled in Medicare Part B, you will pay a premium.  Once you disenroll from Part B, it will end the first of the following month after you file the request. If you decide to keep Part A, you will receive a new Medicare card showing Part A only.

Can I re-enroll in Medicare Part B if I disenroll now

Disenrollment from Part B does not prevent you from re-enrolling at a later date.

Click here for Medicare Part B enrollment form

There is a good chance that you will not be able to enroll online if you have Part A and disenrolled from Part B.  See instructions below to re-enroll in Part B.

Download and fill out the Part B Enrollment form –Click here for Medicare Part B enrollment form

If you currently have coverage through an employer, make sure you have them complete Section B of the form.  You may need supporting documents from your employer to prove you had creditable coverage.  Click here for help with your application

Send your completed forms either by mail to your local Social Security office or by fax to 1-833-914-2016.

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Medicare Connecture Comparison

Medicare Connecture Comparison

By Ed Crowe | General Articles | 0 comment | 26 July, 2023 | 0

Medicare Connecture Comparison

Medicare Connecture Comparison:  Sunfire vs Connecture vs MyMedicarebot

There are many different quote and enrollment programs that agents and agencies can use to assist their perspectives and beneficiaries find plans, compare plans, enroll in coverage, and even find doctors and hospitals in-network. Three of the most commonly used are SunFire Matrix, Connecture, and MyMedicarebot.

 

What they have in common

All three of these online programs are free to use for agents with Crowe and Associates and can be accessed through connect4medicare.com. Additionally, all three platforms work in a similar manner. They allow agents to quote and compare plans and enroll clients without the need for a face-to-face meeting. Here are some of the features they have in common:

  • Basic CRM functions that can save client information, applications, scope of appointment documents, drug lists, and plan history

  • Ability to text or email plan comparisons to prospective clients

  • To run doctor and drug lists against plans to see which has the most comprehensive coverage

  • Record all phone calls in compliance with the CMS regulations (updated for 2024)

  • Enroll prospects over the phone with text or email

  • Ability to see and compare all plans even if the agent is not contracted with that carrier

Much of what these programs do is interchangeable, but they are different programs and thus have some individual features.

Medicare Connecture Comparison – Sunfire, Connecture, MyMedicareBot

SunFire Matrix

SunFire Matrix’s press says that they provide transformative and proven technology solutions to support the Medicare landscape. Their software has been used to secure coverage for over 50 million senior citizens. Due to their size, they can collect and distill data from more than 80 insurance carriers, offering a total of more than 1300 Medicare Advantage and Prescription Drug insurance plans. Like the other programs on this list, SunFire can save the prospective’s personal information in order to identify the ideal plan with the lowest annual cost for an agent to enroll them in.

 

Connecture (Medicare Connecture Comparison)

Connecture is advertised as the most personalized software for quotes and enrollment for agents and agencies. It is also referred to as Connect4Medicare. The idea behind this level of personalization is that it helps not only drive enrollment, but helps protect against dissatisfaction and plan disenrollment as well. Connecture is a commonly-used platform for small to mid-sized agencies. They are also the largest Health plan-FMO-Agent distribution network in Medicare and thus can provide access to more information than some of the smaller software companies.

 

MyMedicareBot

MyMedicarebot is yet another software program that can quote and enroll prospective clients. However, they are unique on this list in that they have the ability to record both sales and enrollment calls in compliance with the CMS regulations for AEP 2024 and have integrated call analytics for agent and agency usage. MyMedicarebot also offers a Portfolio Analytics and Consulting feature that can distill data from CMS, competitive marketing intelligence, and the unique user membership and identify the best markets and prospects. This level of personalization is meant to optimize sales and retention.

 

While all three of these commonly used software programs have the ability to do the basics of quotes and enrollment for agents and agencies, they all have certain individual features that may make one a better choice than another, depending on the agency’s needs.

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Medicare open enrollment period

Medicare Open Enrollment Period

By Ed Crowe | General Articles | 0 comment | 21 July, 2023 | 0

Medicare Open Enrollment Period

Because there is some confusion as to what the Medicare Open Enrollment Period actually is, we will take a few minutes to explain it.

Many people confuse the term Medicare open enrollment period or OEP and the term Medicare Annual Enrollment or AEP.  It important to understand the differences between these two enrollment periods.

The Medicare OEP, Open Enrollment Period:

This enrollment period takes place each year from January 1 to March 31.  Anyone who is enrolled in a Medicare Advantage plan (Part C) can use this enrollment period to go over their current MA plan and make changes if they are necessary.

What can enrollees do during this time:

  • Change from one MA or MAPD (Part C) plan to a different MA or MAPD plan.
  • Drop your MA/MAPD plan and go back to Original Medicare (Parts A & B).
  • If you go back to original Medicare, you can Enroll in a Medicare PDP prescription drug plan (Part D).

The new plan starts on the first day of the month following the submission of the member’s application.

Please note; the Medicare Advantage Open Enrollment Period is for Medicare Advantage plan members only.

Beneficiaries on Original Medicare cannot switch to a Medicare Advantage plan at this time. If that is what they want to do,  they must wait for the Medicare Annual Enrollment Period. 

The Medicare AEP,  Annual Enrollment Period:

During this enrollment period, it is wise to review your client’s Medicare coverage and make any changes they decide on.  The AEP runs from October 15th through December 7th each year.

What can beneficiaries do during AEP:

Switch from Original Medicare to Medicare Advantage (or vice versa).

If you’re enrolled in Original Medicare (Part A and Part B) and want to add benefits such as; prescription drug coverage, dental, vision, OTC and more, you may wan to try a Medicare Advantage plan.  On the other hand, if  you’re on a Medicare Advantage plan and want the flexibility of Original Medicare, you can return to it.

  1. Change Medicare Advantage Plans: If you’re already enrolled in a Medicare Advantage plan that doesn’t fully meet your needs, you can explore different plan options in your area.
  2. Enroll in a prescription drug plan (Part D): If you don’t have credible prescription drug coverage through your current plan or are in Original Medicare, you can join a standalone Medicare Prescription Drug Plan to help manage medication costs.
  3. Enrollees can either switch or drop prescription drug plans: Beneficiaries already enrolled in a Part D plan should compare prescription drug plans each year to ensure they have the most suitable coverage for their needs.
  4. Review Medicare Supplement Insurance (Medigap) Policies: Although Medicare Supplement plans are not part of the Annual Enrollment Period, it is a good idea to review these plans annually to assess whether they offer the best coverage for your needs.

Why are the Medicare Open Enrollment Period & Annual Enrollment periods important:

The significance of these enrollment periods is that they allow beneficiaries an opportunity to reassess their healthcare needs as their circumstances change.  This gives them a chance to potentially save money on premiums, deductibles, and copayments or purchase additional coverage.

Anyone who fails to take advantage of this window may be stuck in an ineffective or expensive plan for another year.  This can result in less coverage than they need and higher medical costs.

Tips to Help Clients Make Informed Choices:

  1. Assess Current Coverage: Review your client’s current plan to identify any gaps in coverage or services they require. Consider their healthcare expenses over the past year and anticipate any potential changes in healthcare needs for the upcoming year.
  2. Compare Plans: Use your resources through connecture or sunfire to compare the various plans available in the area. Look for plans that cover your specific medical needs, including prescription drugs, doctors, and hospitals.
  3. Check for Plan Changes: Insurance providers can make changes to their plans each year.  This includes adjustments to premiums, drug formularies, and networks. Be sure you understand how these changes impact coverage and costs.
  4. Consider Future Needs: While it’s essential to address current healthcare needs, try to anticipate possible medical events or changes that may require different coverage choices in the future.

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Medicare Special Enrollment Periods

Medicare Special Enrollment Periods

By Ed Crowe | General Articles | 0 comment | 6 June, 2023 | 0

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 Enrollment Trends

Medicare Advantage Enrollment Trends

By Ed Crowe | General Articles | 0 comment | 18 May, 2023 | 0

Medicare Advantage  Enrollment Trends

 

There are continually increasing populations of people who become eligible for Original Medicare and Medicare Advantage plans each year in the United States. Since 2006, the amount of enrollees for Medicare Advantage plans has grown steadily.  In 2022, more than 28 million people are enrolled in a Medicare Advantage plan, accounting for nearly half or 48 percent of the eligible Medicare population. This number also accounts for nearly half of the federal Medicare spending.  Let’s explore the Medicare Advantage enrollment trends.

 

In 2022, the average Medicare beneficiary has access to nearly 40 Medicare Advantage plans, which is the largest number of plans available in over a decade. This looks like 2.2 million new beneficiaries between 2021 and 2022, which is an eight percent increase in enrollees.

 

Employer Group Versus Individual Plans

 

In 2022, of the 28.4 million beneficiaries enrolled in Medicare Advantage.   The smallest percentage were enrolled in special needs plans, at a mere 16%. The next smallest group of beneficiaries was those enrolled in union-sponsored or employer-offered Medicare Advantage plans.   These account for 18% of the total. The largest group of beneficiaries by far is those in individual plans –  open for general enrollment.   This group makes up 66% of the 28.4 million beneficiaries. That is about two thirds of this group, or approximately 18.7 million people. Since 2021, that is an increase of about 1.3 million enrollees. However, the share of those in individual plans open for general enrollment has not increased.  It remains steady at about two thirds of the enrollment since 2018.

 

Medicare Advantage Plans By State

 

The share of Medicare beneficiaries who are enrolled in Medicare Advantage Plans varies greatly by state and has a very wide range of percentages across the country. However, in 25 of the states, at least half of those eligible for Medicare Advantage plans are enrolled in them. The more rural a state is, the more likely it is to have lower funding for Medicare and lower enrollment in Medicare Advantage plans. South Dakota, North Dakota, Wyoming, and Arkansas are the states with the lowest Medicare Advantage enrollment, which is less than twenty percent, or fewer than one fifth of eligible beneficiaries. Puerto Rico, on the other hand, has the highest percentage of enrolled beneficiaries, with 93% of Medicare beneficiaries also enrolled in a Medicare Advantage plan. This is largely thought to be due to policy choice, as many people in Puerto Rico are dually enrolled automatically in Medicare and Medicaid.

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