AgentPitstop.com Blog

For agents in California, the Knox-Keene Act can be a magic bullet in some tricky situations where a client needs to change to a Medicare Supplement but couldn’t pass underwriting. So how does it work?

The Knox-Keene Act provides guaranteed issue rights to existing Medicare Advantage plan members if the plan does any of the following:

1) increases premium by 15% or more
2) reduces benefits
3) increases physician, hospital, or drug copayments by 15% or more
4) discontinues its relationship with a provider who is currently furnishing services to an individual

Of course there are some restrictions to be aware of.

GI rights apply to the same carrier’s Medicare Supplement plans first. If the company that offers the Medicare Advantage plan the client is coming off of also offers Medicare Supplement plans, the GI rights only apply to that carrier. If that carrier doesn’t offer Medicare Supplement plans but an affiliated company like a parent or a subsidiary does, then the GI rights only apply to the parent or subsidiary. If none of those companies offer Medicare Supplement plans, then the GI rights extend to any issuer.

Except in the case of a provider leaving a plan’s network, enrollments using these GI rights must happen during AEP. This isn’t especially restrictive, because the other changes would only be happening effective January 1 and any plan changes would be happening during AEP anyway, but it does mean you can’t just wait and disenroll during the Medicare Advantage Disenrollment Period in January and February and set up the Medicare Supplement then.

Remember you’ll likely need to submit your client’s Annual Notice of Change or a notice from the plan or their doctor about a network change along with the Medicare Supplement application. It’s a little bit of work to potentially make a client very happy!

Being a health insurance agent is hard work and can be very time intensive, especially during open enrollment. Although the staff at Agent Pitstop is here to help where we can, it?s also important to look at what you know and evaluate if you could be a self-reliant agent if the circumstance were to arise.Knowing how to be more independent could be the difference between making a sale and completely dropping the ball.

But what does it mean to be self-reliant?

It?s really all about knowing your industry and what you need to do in order to help your client?s to the best of your ability. Here are some tips for learning to be self-reliant.

Know How to Market Yourself ? Whether through leads or by becoming more involved in your community to help generate referrals, you need to be marketing yourself to make money. Marketing is absolutely key in growing your business and the only way marketing happens is through spending your time, money or both to make sure clients are coming your way. Being proactive with implementing a marketing plan is one of the most important steps you can take towards being a self-reliant agent.

Popular methods of marketing include buying leads, generic print advertisements, direct mail business reply cards or holding meetings.

Know Your Product & Where it Comes From ? Know the plans in your area and the benefits of the various plans. If you aren’t confident in your product knowledge, there are trainings you can seek out through company offered trainings or from your up line.

Self-reliant agents also know who to contact to order supplies and they have them on hand before needing them. If you don?t know how to order something, calling a company?s broker support line or your up line is usually the best bet when looking for a way to get supplies. If broker support can?t help you, they?ll at least know where to direct you.

Just keep in mind the company wants you to have product on hand so that you?re able to write business if the opportunity arises so don?t feel shy about reaching out to request what you need.

Know What a Clean App Looks Like and Know How to Submit it ? Submitting a clean app and knowing how to write the app, as well as knowing who to send the app too once it?s complete, is important. You can know your product information inside and out but unless you know how to properly complete the enrollment process, your knowledge doesn’t help you or your client.

Submitting a clean app can save hours of headache and upset.

Know How to Follow Up and Resolve Issues ? Making sure you are up-to-date with your applications is key to being a self-reliant agent. The first step is making sure your application has been submitted correctly. After a few days you need to follow up on the application and make sure your client was successfully enrolled. If there are any issues with the application you need to act quickly to take care of these issues. Don?t sit on something that could be taken care of easily because it could result in the application being terminated.

Track Your Commissions and Know How to Problem Solve ? A self-reliant agent has a method in place to help track their commissions. They know what they?re supposed to be getting and when they?re supposed to be getting it. This way, if something isn?t paid out, the issue can be caught sooner rather than later.

This is something where you?ll have to find the best method that works for you, however if you?re an agent with Agent Pitstop then you?ll be able to track most of your commissions using your agentpitstop.com account.

**If you?re an agent with Agent Pitstop and have a commissions discrepancy, please fill out a commissions discrepancy form and forward the form to commissions@agentpitstop.com via secure email.

Download the discrepancy form by clicking here.

Know Your Tools and Use Them Frequently ? Many companies offer a broker portal or resource site of some sort. Here at Van Berg & Associates we offer AgentPitstop.com to track application submissions, contracting, and commissions. These tools, when utilized, help you keep on top of everything else listed above. If you?re not utilizing tools such as broker portals and resource sites like agentpitstop.com than you?re making your job harder than it needs to be.

The only things certain in life are death and taxes, right? Maybe not the first one, according to some researchers. But how could this be possible?

Preventing the degeneration that comes with age – For years the focus of research around increasing lifespans, and eventually avoiding death altogether, has been on preventing the degenerative effects of aging. As we get older, our bodies naturally become damaged and this is what leads to the negative effects of aging that present themselves in illness and eventual death. If we could prevent that cumulative damage, then longer lifespans would be possible, eventually even resulting in cheating death entirely. So far, unfortunately, this has shown only limited success.

Repairing the degeneration that comes with age – Unlike trying to prevent what may be simply the inevitable result of aging, some researchers believe the key is to repair the damage. Cambridge gerentologist Aubrey de Grey, co-founder of the Strategies for Engineered Negligible Senescence Research Foundation, believes that the chances that the first person to escape the negative health effects of aging has already been born are “probably about 80 percent.” How would this be possible? De Grey and his colleagues believe they have found gene therapy treatments which could take, for example, “people aged 60, and rejuvenate them thoroughly enough so they won?t be biologically 60 again until they are chronologically 90.” Meanwhile, the technology would have had thirty years to advance even further, allowing even more advanced techniques to repair the damage when the time came.

Digital consciousness – You could argue whether or not it counts as living, but technology may be advancing to the point that someday someone’s consciousness could be uploaded to a computer prior to their physical death, allowing them to mentally live on. According to Stephen Hawking, ?the brain is like a program in the mind, which is like a computer, so it’s theoretically possible to copy the brain onto a computer and so provide a form of life after death.? This technology is further off than other options for extended longevity, but may prove the ultimate way to cheat death.

As technology, both medical and otherwise, advances further, we may soon be approaching a time when the perils of old age are a thing of the past.

Knowing our agents are busy meeting with clients and running their business, we at Van Berg & Associates strive to help out where we can and make our agents lives as easy as possible. ?As a Van Berg agent, using your password protected Agent Pitstop account can be a wonderful resource in helping to manage your applications, review client information, and track commissions. Our goal is to be as transparent as possible regarding your book of business and commissions. Therefore, we try and provide everything you need in one secure place.

Here are just some of the tabs you?ll find under your personal Agent Pitstop account:

Clients: Easily access your client information including address, phone number and even the policy ID for the client?s plan.

Commissions Statements: Commissions statements are uploaded under this section whenever a commission is paid out. The statement shows where your money is coming from, helping you track your commissions.

To access more tabs, hover over the ?Account? tab.

Invoices: This tab allows you to see any outstanding balances you might have for things such as leads, advertising, marketing, charge backs, etc. Clicking on the title of the invoice will bring up more information about the charge.

Recent Submissions: ?This feature helps you to keep up to date with a client?s application. Once the application is submitted and entered into the system, it will show on your Agent Pitstop account. From there you can track application status and also view your client?s policy ID.

My Contracts: This section allows agents to see which companies they are currently contracted with through Van Berg & Associates, as well as companies they have been termed or cancelled from. This is also where you can find your writing ID for the companies you?re contracted with.

Checking Agent Pitstop frequently and utilizing these tools is an easy way to help manage your clients, check application status and keep on top of your commissions.

Don’t have an Agent Pitstop account yet? Call us today at 877-776-8919 and we’ll help get you set up.

Applications being rejected or kicked back can be frustrating and time consuming. You are not only setting aside time to figure out what plan works best for the client but to also meet with them and help fill out the application as needed. Don?t let your time or your client?s time be wasted because of little mistakes that could have been prevented by taking an extra minute to check over your work.

Be Thorough ? One of the biggest hold ups with processing can be that you?re missing the most basic information on an app. As an agent you are responsible for obtaining information such as a client?s name, phone number, address and Medicare ID and these are very important bits of info. However when you get into the groove of writing apps, especially in group settings or during the annual election period where the process comes at a faster pace, you may move right past a question without answering it. Always scrub your own app before submitting to check for these easy to fill questions.

Make sure the plan selected actually works for your client ? Sometimes a simple mistake of choosing the wrong plan can create a kickback. For instance Blue Shield of California only partially covers Contra Costa County and Care1st has a partial county in Alameda County. Knowing a plans coverage area and double checking zip codes is key to making sure you?re selecting the right plan for your client in situations such as those

Other possible snags to watch out for are making sure you?ve selected the correct special election period (SEP), whether or not your client is dual eligible, or choosing a plan that helps with a specific health issue such as diabetes or a heart condition.

Provide the Right Paper Work ? At various times extra paper work is needed along with the client?s application. Think ahead and predict what documentation could be needed. For instance, in California, Medicare supplements being written on the birthday rule almost always require proof of prior plan. Having a copy of the client?s previous policy ID card and submitting it with the application could save you time from needing to do so later, while the application sits on hold. When writing an application that has an SEP it?s also very important to include the correct information on why it?s an SEP. If the client has recently moved to a new zip code or state where their plan no longer exists then include a letter from their policy?s provider showing they have moved out of the network.

Paper work showing Power of Attorney (POA) is particularly important to point out because many agents often forget about including documentation for POA since it doesn?t frequently come up. Although there are a few companies that don?t require documentation, the majority of companies do, which is why it?s a good policy just to always include POA documentation.

Don?t Dawdle with Corrections ? If you do have an issue with an application (like you wrote down the Medicare ID incorrectly or have missing paper work, etc.) make sure to get it to the company ASAP. Providers offer a time frame to get corrections in before they reject applications. Once you miss a deadline it is rare that the company will open that application back up again. This leaves you either having to write an entirely new app if the election period is still open or, worst case scenario, it can leave your client without coverage.

As you likely know from your work in the senior market,?longer lifespans mean?more and more people will need long term care. But what is it, and how can you prepare and educate your clients to pay for it?

What is LTC?
Long term care is the help you need when you are no longer able to complete the Activities of Daily Living on your own. These include eating, bathing, dressing, toileting, transferring from bed to chair, and continence. Generally, if you cannot complete two or more of these without help, you are considered to need long term care. Long term care can be nursing home care, home health care, hospice care, and even home maker services to help you cook and clean.

What is LTCI?
Long term care insurance is insurance designed to pay some or all of the costs of long term care. Some policies will reimburse you for covered expenses up to a daily limit, and some policies will pay you a cash amount per day that you’re certified as needing care. You can also pay for long term care through additional benefits added on to whole life policies, or through hybrid products.

Why have it?
Skilled nursing facility care can cost close to $100k a year and home health care can cost close to $50k a year,?and the cost is rising. Imagine if your clients suddenly had to pay that kind of cost out-of-pocket. Would many of them be able to, or would they be forced to sell off their assets in the hopes of Medi-Cal covering the necessary care?

Who needs it?
In short, everyone! Two out of three people will need long term care services at some point in their life, and one in three will need nursing home care. Even just a year or two of that kind of care can ruin a family’s finances. Because premiums are generally based on the age at time of issue, presenting long term care insurance to even your younger clients makes sense, as buying younger can save significant money in premiums over the life of the policy.

We all hope that we’ll live independent, carefree lives to the end, but the reality is that most of us will need some kind of long term care in our later years. Be prepared to present the options to your clients and help them protect themselves and their families.

During the annual election period (AEP) those on Medicare are actively searching for agents to help them enroll onto Medicare plans so it?s far easier to grow your book of business. But what about the other 10 months of the year? Here are some tips to help grow your business all year round.

Visit Local Doctor?s Office ? Going around to local doctor?s offices and introducing yourself could potentially get you referrals. Make sure to bring business cards or flyers to leave behind. Often clients talk to their physicians or doctors? offices for guidance on insurance. This is especially true for clients who have formed a relationship with their doctor over the years. Knowing the doctor?s offices in your area and making yourself known to them could potentially be an easy way to gain more clients.

Invest in Leads ? Ordering leads is a simple way to open yourself up to new markets, make new contacts and gain more business. There are various lead types to choose from based on your budget. Internet leads tend to be pricier but usually mean the client is actively searching for information. Mail drop leads are much cheaper but the return rate is only around 1-2%. Also, since leads are generated by people actively looking for information on health coverage, it is important to act fast on leads. Acting fast will ensure the client doesn?t go looking for information elsewhere and helps you to get the sale.

Pay attention to trainings year round ? Many companies offer training or informational classes throughout the year to discuss how they can help you grow your business during lock-in. Take advantage of these opportunities and hear what they have to say. Although their suggestions could be tips you already know about, they could also be offering support that could help you toward your goals that you wouldn?t get on your own.

Have (and know) the right products to sell ? Make sure you?re contracted with the right products to help bring you more business outside of AEP. Developing a relationship with a client by starting out with life products could potentially lead to them coming to you for health insurance in later years. Medicare supplement plans are also key to helping grow business during lock-in. This is especially true in states such as California where the birthday rule applies.

Run meetings within your area ? When a person first enters into Medicare it can be difficult for them to navigate the system. Hearing about the various plans can seem confusing and frustrating so having someone on their side who can competently explain their insurance options can drastically ease their worries. Holding meetings throughout your community or service area can help build relationships that lead to sales and referrals. It also helps you become a staple within the community so people know who to go to when they?re ready for help with their insurance needs.

Recent advances in the pharmaceutical industry have brought major innovations to the treatment of diseases like cancer, rheumatoid arthritis, and hepatitis B. New medications can offer hope and better quality of life to patients struggling with life threatening or chronic conditions, but these drugs come at a high cost and can be a burden even for people with coverage through a Medicare Advantage or stand-alone Prescription Drug Plan.

Here are some important considerations for clients who may need these new and advanced drugs.

CMS allows plans to include a specialty tier in their formulary – Plans are allowed to place any drugs with a monthly cost over $600 on a specialty tier. This tier is not restricted to the usual 25% maximum cost sharing, so a member may be expected to pay up to 33% of the cost for drugs in this tier.

Only a small number of drugs are in most plan?s specialty tires – On average, less than 10% of the drugs in the CMS reference formulary are included in a plan’s specialty tier. Just because a drug is new does not necessarily mean it won’t be covered at a lower tier. The specialty designation is generally reserved for the most expensive drugs used by the smallest group of people.

Part B vs Part D covered drugs – Some drugs can be covered under either Part B or Part D, depending on how and where they’re administered and how they’re prescribed. As a general rule, drugs administered in a doctor’s office or other outpatient facility are covered under Part B, while drugs administered by the patient at home are covered by Part D. However, there are exceptions that can have a significant impact on what a patient pays for the same treatment. For example, oral chemotherapy drugs used in place of traditional infusion chemotherapy are covered by Part B, even if the patient takes them on their own at home. Other oral cancer drugs that could not alternatively be given via IV or injection in a doctor’s office are covered only under Part D. For a client with most Medicare Supplements, this can mean the difference between having no out of pocket cost once Original Medicare pays their 80% and their Medicare Supplement covers the remaining 20%, and paying up to 33% of the thousands of dollars that the drug could cost under Part D. In contrast, a patient with only Original Medicare and a Part D plan may save money with the Part D covered drug over the full course of their treatment, because Original Medicare does not have the out-of-pocket maximum that their Part D plan does.

The coverage gap – For clients taking Part D specialty drugs, they will likely quickly become familiar with the coverage gap. Once they have exhausted their initial coverage, it’s important that they continue to show their Part D membership card when filling prescriptions, even if they’re paying out-of-pocket. This will allow them to access the manufacturer discount offered while in the gap and will help make sure that their out-of-pocket cost is tracked correctly to get them into catastrophic coverage as quickly as possible.

There are programs to help cover the cost – Clients who even might be eligible for the Low Income Subsidy (LIS), also called Extra Help, should apply. Especially for those taking specialty drugs, the subsidy can save someonethousands of dollars a year. For people whose income is too high to qualify for LIS, there are manufacturer patient assistance programs from many drug companies. These programs can offer significant discounts, even completely covering the cost of a drug. Typically clients can apply on the manufacturer’s website and will be sent a card to use at the pharmacy to access the discount. If clients are not able to get LIS or help from their drug’s manufacturer, there are various charity programs designed to help people with high medical costs.

Clinical trials have their own rules for Medicare Advantage plans – Members wishing to enter a clinical trial for a new treatment for their disease can do so while remaining in their Medicare Advantage plan and paying fee-for-service costs for clinical trial care. Their Medicare Advantage plan is required to continue to cover necessary treatment for their condition even while in the trial. Any cost sharing paid by a member for a clinical trial also must be counted towards their in-network out-of-pocket maximum by their Medicare Advantage plan.

Dealing with a life threatening or chronic illness is difficult enough. Be prepared to arm your clients with this information to help make their treatment a little bit easier.

During the weeks before Annual Election Period there is a spike in the number of agents contracting with new carriers. But why wait until the busiest time of the year to contract? Why not have the tools you need to insure you?re prepared for each client all year round? Here are just a few reasons to contract now:

Be Proficient ? First off, ask yourself if you are currently confident with all of the products you have to offer a client. Are you prepared if you receive a call from a referral that is in a neighboring town outside your usual area? Don?t be caught without the most competitive plans in not only your direct area, but surrounding areas as well. The most competitive plan in one zip code can be drastically different in the next. When you?re missing something from your ?tool bag,? clients can become uneasy about your ability to write the policy that best fits their needs. You might also miss out on referrals that could otherwise help grow your book of business.

Be Prepared ? Having the right materials and information for a company can be crucial to making the right sale. Applications and promotional materials can take a while to arrive. The same goes for properly registering sales events and advertising materials. Contracting early allows you to have these supplies sooner and on hand when needed.

Stop Losing Sales ? Clients often hear of health insurance plans from commercials or through their friends and they?re suddenly set on having that specific product. No other product will do in their minds. This happens more and more often. Advertising is effective and friend?s opinions matter. Just because you personally think that another plan might be better doesn?t mean your client will be set on that product. Offering more options opens up more opportunities.

Don?t Scramble ? Clients need to feel like you have a handle on their insurance needs. Waiting until a client requests a company and then starting the contracting process is an easy way to lose a client. Especially if they?re a new client and don?t have long until their enrollment period ends. You don?t want to have to refer your client to another agent and lose a potential sale.

Know Your Contract ? While keeping everything else listed above in mind, it?s also important to know your limitations or if it?s time to rework your contracts. Know the difference between being a captive agent, career agent and a broker and contract in the way that makes the most sense to you. Captive agents can only sell the products from the company they are employed by, while a career agent can offer other products but only after first offering the products from the company they work with. Brokers, on the other hand, are not chained down. They are able to sell any product that they are successfully appointed and certified with, ensuring they have a wide range of products to cover their client?s needs including unexpected referrals.

For more information on what companies are available and contracting in general, please visit www.agentpitstop.com or contact contracting at contracting@agentpitstop.com.

Often people say that a certain doctor or other medical provider “takes Medicare,” but it’s not an accurate description of a doctor’s contract status with Medicare. There are actually three distinct categories of provider when it comes to Medicare, each with their own potential costs and limitations for clients.

Participating
– A participating provider is one that agrees to accept assignment of Medicare benefits and can charge no more than the Medicare fee schedule amount for any services.
– Clients will not be liable for excess charges, even without a Medicare Supplement plan that would cover them.
– 96% of providers who offer services that Medicare would cover are participating providers.

Non-particpating
– Non-participating providers can choose to accept Medicare assignment on a per-service basis. If they accept assignment for a particular service, they can bill Medicare directly and the member will pay no more than their usual cost-sharing.
– If they choose not to accept assignment for a service, the client is liable for excess charges and may need to pay up front and wait for reimbursement from Medicare for the covered amount. Excess charges are limited to 9.25% of the Medicare approved amount for a service, in addition to whatever the member’s usual cost-sharing would be. You can check our post on excess charges for more details.

Opted out
– Providers who have opted out cannot accept reimbursement from Medicare and must enter into a private agreement with their patients.
– Patients will sign a contract with the provider agreeing to that provider’s fees and policies.
– Patients who see a psychiatrist should be especially aware of the limitations for providers who have opted out. While only 4% of providers nationwide have opted out, 42% of those are psychiatrists.
– Medicare Supplement plans will not pay anything towards services from a provider who has opted out.

Knowing the difference between participating, non-participating, and opted out providers can save your clients money and headaches!

Agent Pitstop can?help you find the best rate for your client through our online rate engine but while you’re writing, it’s nice to know what you’re getting out of it. Especially if there is more than one company in an area with similar rates.

Here is a Medicare Supplement Commissions Cheat Sheet to help you know what commissions?should be coming your way depending on what company you write:

Downloadable PDF – Click Here

Anyone who deals with the public will at some point encounter difficult clients, especially with something as emotionally charged as health care. Whatever has upset your client or made them challenging to work with may not be your fault and may not even have anything to do with you, but you still need to find a way to work through the problem and resolve it.

Take a look at our tips on working with difficult clients.

Empathize, but don’t escalate – It can be tempting to let your emotions come to the surface when dealing with someone who is angry or frustrated, but you have to remain calm and maintain control of the situation. If the client is upset because of someone else’s actions, responding with your own emotion, even in sympathy, can escalate the situation. Calmly acknowledge your client’s feelings to make them feel like you’re on their side without adding more fuel to the fire.

Get to the root of the issue – You can’t solve a problem you don’t understand. Ask open ended questions until you understand exactly what mistake or misunderstanding led to the problem. Especially if someone is upset, you may have to sort through a certain amount of venting to get to the heart of the issue, so be patient and keep asking questions until you’ve figured it out.

Don’t apologize for things that aren’t your fault – Eliminate “I’m sorry” from your vocabulary unless something truly is your fault. It can be instinctive to apologize to someone who is upset, but by doing so you indirectly take responsibility for the problem. You can be empathetic and acknowledge someone’s feelings of frustration or disappointment, just use language that focuses on their emotions and not on accepting blame. Phrases like “I can understand why you’re frustrated” or “I’d be upset in your situation, too” can work as alternatives.

Don’t over-promise to smooth things over in the moment – Promising you’ll fix something right away is well-meaning and may calm a client down in the moment, but if it turns out you can’t fix it or that it will take some time or involvement from other people, you’ve just created another problem. Now not only is the client upset about the original issue, they’re upset about being promised a resolution that hasn’t materialized. If you’ve offered solutions and your client has refused them, don’t offer them everything just to make them happy. Ask them something like “what resolution are you looking for today?” or “what would make this right for you?” If what they initially ask for isn’t possible or isn’t appropriate, offer an alternative.

Take ownership of the situation – Whether the situation is your fault or not, you’ll gain your client’s trust by taking ownership of the problem and committing to find a solution. This doesn’t mean you have to do everything single handed, but it does mean you stay involved until the problem is resolved. If a problem requires several steps or a period of days to fix, communicate that clearly to your client and follow up as things progress.

Know when to say no – There are going to be times when a client simply wants something from you that you can’t give them. If you’ve tried to offer solutions and been turned down, you’re better off simply telling the client that those are the options and if they’d like to try and find a solution elsewhere they’re welcome to. Don’t compromise your personal ethics or business practices for the sake of one angry person.

Dealing with difficult clients can be a challenge, but if you can turn one around, they’re often the most loyal and supportive clients you can find.

We know that Medicare Advantage plans can often be less expensive month to month, but is it possible that they can also lead to better health?

A few reasons why Medicare Advantage plans may actually lead to healthier clients.

Help catch problems early – MAPD plans with robust claims and records tracking systems can help make sure that a member is receiving the routine preventive care and follow-up visits that they need. Many also offer wellness programs for things like starting an exercise program or quitting smoking, that can help curb common health problems like high blood pressure and high cholesterol.

Coordinate care between different providers – A designated primary care physician handling specialist referrals can mean a member’s doctors has a better understanding of their overall health and to better coordinated treatment plans.? Medication Therapy Management (MTM) programs offered by plans can also help make sure that prescriptions written by different doctors are working together, and work with doctors when adjustments may be warranted.

Cut back on repeated or unnecessary tests and procedures – No one likes to go in for blood work, MRIs, or other diagnostic tests. Medicare Advantage plans can help keep track of tests ordered by various doctors and save clients time and money by preventing duplicate procedures, or procedures that may not be necessary in light of their overall health.

Get better outcomes at a lower cost – Appropriately coordinated care can save members money in copays and help keep premiums affordable for everyone. Most importantly, getting the right care at the right time can result in healthier members!

Medicare Advantage plans won’t be the right option for every client and it’s important to offer the appropriate plan, whether it’s a Medicare Advantage plan or a Medicare Supplement. However, it’s important to consider the potential benefits of coordinated care through a Medicare Advantage plan, and not just the lower cost.

With the recent hacks of high profile insurers and retailers, data security has become headline news. As an independent agent, you are responsible for ensuring the security of any data you have in your possession.
Below are some recommendations for how to ensure your clients’ data is protected.

Password protect any computers or mobile devices that can access client information – Any devices that can access client information should be secured. Every device will allow you to set a password or passcode, and some devices may also allow alternate methods like security patterns or fingerprint scans. Remember that this doesn’t just apply to computers. Smart phones and tablets that can access your email or address book should also be secured.

Keep your software updated – Software developers do their best to fix any security issues or add protection against new threats as quickly as possible, but it’s still your responsibility to make sure that those updates are installed as soon as they become available. It’s also important to pay attention to when developers end support for older software. For example, Microsoft stopped releasing security updates for Windows XP in April of 2014.

Use only secure wi-fi networks – Any time you access an open or public wireless network, other people may potentially be able to access your data. Fake networks in cafes or other public places are also a popular way for identity thieves to gather information. If you must use a network that is not secured, do not access any client data while you’re connected.

Limit access to client data – If you have employees or family members who have access to your computer, mobile devices, or your office in general, do your best to limit the information they can access. Set up separate accounts on computers so that you can limit access to only necessary data, and keep close track of mobile devices.

Only transmit client data by secure email or fax – Any time client personal information needs to be sent to another party, it must be sent either via secure email or by fax. Even if you’re sending the information to the client themselves, it must be sent securely in case the email is intercepted or accessed inappropriately.

Lock hard copy files in file cabinets or a separate file room – Many hard copies of applications or client policy information may still need to be kept to comply with records retention requirements. Invest in a locking file cabinet, or keep files in a separate room that can be locked. Also, don’t leave client files sitting out unattended while you’re working if your desk or other workspace can be accessed by other people.

Keeping client data secure does require some extra steps, but those extra steps can save you and your clients expensive and time consuming problems.

In July of 1965, President Lyndon Johnson signed the legislation that formed the Medicare and Medicaid programs. In the fifty years since, millions of Americans have gotten the important care they need thanks to the Medicare and Medicaid programs, and it’s difficult to imagine health care in the United States without it.

By caring for some of our most vulnerable populations, Medicare and Medicaid provide a vital service in protecting the health of those who need help the most.

As part of their celebration of Medicare’s golden anniversary, CMS is collecting stories of the lives changed by this program. If you’d like to share your story, you can do so on Medicare.gov by clicking here.

It’s a common practice for doctors to keep a patient in the hospital “under observation” when their condition needs monitoring, but may not require an extended hospital stay to stabilize. Even a patient who stays overnight in the hospital may still technically be considered an outpatient under observation. But what does this mean for your clients?

A few important things to know about the difference between being an outpatient under observation and an admitted inpatient.

Costs for the same services over the same timeframe can vary significantly depending on patient status – Because patients under observation are still considered outpatients, their treatment is covered by Part B. Once admitted as an inpatient, Part A takes over coverage for any required services. Because the deductibles and coinsurance are separate, the cost can vary for clients who have certain Medicare Supplement plans. For example, a client with Plan G would pay nothing for an inpatient stay, since their plan covers both the Part A deductible and Part A coinsurance, but would pay Part B charges out-of-pocket until the Part B deductible is met. While Medicare Advantage plans may not mirror the same inpatient and outpatient deductibles in their coverage, their copays and deductibles likely still differ between inpatient and outpatient services.

Outpatient observation days do not count towards a qualifying hospital stay for skilled nursing facility care – To be eligible to have skilled nursing facility care covered under Original Medicare and a Medicare Supplement plan, a member has to first have a qualifying hospital stay of at least three days. Time spent under observation, even preceding an inpatient stay, does not count towards the required hospital days. However, Medicare Advantage plans will vary and many do not require a previous inpatient stay.

Only a specific doctor’s order can change a patient’s status from outpatient under observation to inpatient – Inpatient status is not a factor of the length of time spent in the hospital. A patient could theoretically go to the ER, spend hours in the ER being evaluated, then be moved to a regular hospital bed for another day or more for observation, and never officially be admitted to the hospital. Only once a doctor determines that a patient requires a full inpatient stay and writes an admitting order is someone considered an inpatient.

Some Medicare Advantage plans will not charge an Emergency Room copay and a hospital copay for the same day – Under some MA plans, the ER copay is waived if you’re admitted to the hospital during the same visit, but this does not apply if you stay in the hospital under observation and are then released.

It’s easy to assume that being in the hospital is enough to qualify as an inpatient, but it’s important to remember that there can be more to it than simply being in a hospital bed.

The first thing many clients ask when presented with a new plan is “can I keep my doctor?” It’s an easy enough question to answer with a quick search in a provider directory or a quick call to member services, but there can be more to it than a simple yes or no.

Here are some things about provider networks your clients need to be aware of before they choose a plan.

Networks can change at any time – Providers can drop their contract with a plan essentially whenever they want. A provider who is in network when the plan year starts or when a client becomes Medicare eligible won’t necessarily still be in network even just months or weeks in the future.

Different plans from the same carrier can have different networks – Some carriers have certain plans with lower costs or more robust benefits than their other plans. In exchange, these plans have smaller networks. It’s not enough to know that a provider works with a certain carrier, you also have to be sure that they’re in network for the specific plan in question.

Every doctor in a practice may not be in network for a certain plan and carrier – In most cases, an entire practice or medical group will be contracted together with a particular carrier. However, there are times when this may not be true, depending on how the business side of the practice is run. It’s a good idea to double check on each provider individually, even if it’s providers who share an office.

They may have a Special Election Period if their doctor leaves the network – If a carrier makes significant changes to their network, CMS may determine that affected members are eligible for a one time SEP to move to a different MAPD. In California, they’re also likely eligible for guaranteed issue into a Medicare Supplement plan in accordance with the Knox-Keene Act, with certain restrictions.

They may have continuity of care allowances – Some carriers will allow a grace period during which they’ll allow their members to see providers who have left the network while they transition to a new provider. This is typically limited to members who are considered in active treatment, and the timeframe can vary.

Making sure clients understand the ins and outs of their plan’s network will help them get the care they need and help you keep a happy client.