Quick Tip: Don’t forget the 48-Hour Rule

November 8, 2012

No, I’m not talking about the 48 hour “cooling off period” or the new 48 hour requirement regarding when Scope of Appointment Forms must be obtained for a Medicare Advantage or Part D appointment. While CMS applies this time frame to just about everything these days, this is specific to enrollment submissions.

To put it simply, the “48 hour rule” means that all enrollment applications should be submitted to the carrier within 48 hours of receipt by the agent.  It should be noted that the 48 hours are calendar hours, not business hours so weekends and holidays count as well.

Furthermore, if you are working with a carrier that requires you to submit your enrollments to your upline for processing, you need to make every effort to have those submitted within 24 hours so they can submit them to the carrier within the 48 hour window.

The reason behind the “48 hour rule” is to allow the carriers ample time to process the enrollment on their end before they have to send it to CMS. Carriers have seven calendar days to do this. Since Star Ratings are tied to latency for the first time this year, you should expect that carriers will be making a push to get as many enrollments submitted as possible within that 7 day window. This could result in disciplinary action for agents who consistently fail to submit their enrollments within 48 hours.

So, as you are submitting enrollments this AEP, make sure you keep the “48 hour rule” in mind. And again, if your enrollments go to your upline first, submitting them within 24 hours is ideal.

How to Order Your 2012 Medicare Advantage Enrollment Kits

October 12, 2011

We recently sent out several email blasts letting agents know how to pre-order enrollment kits. Below are links to those emails for companies that have provided their order procedure details. Carriers continue to provide us with information.  Be sure to check back for updates.

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Future Growth of Medicare Supplements

April 26, 2011

CSG Actuarial recently published a research paper entitled “Medicare Supplement: 2010-2020 Market Projection”.  In this research paper, CGS analyzes Medicare Supplement policy numbers from the past five years and gives projections on the growth of policies through 2020.

First off, if you sell Medicare Supplements, you should read this report.  CGS does a great job of explaining the market.  It’s packed with easy to understand information, graphs and data tables.  It only takes about 15 minutes to read and it gives you a better understanding of who is buying Medicare Supplements and why.

If you don’t have 15 minutes, below are my “CliffsNotes”:

The total number of Medicare Supplement polices has declined over the last five years.  CGS suggests three reasons for the decline:

  • Medicare Advantage enrollment increased from 4.8 million (2004) to 11.9 million (2010).
  • The cost of Medicare Supplement plans has increased since 2004.
  • The number of Medicare Part B beneficiaries has decreased.

Despite the declines of Medicare Supplement polices of the last five years, CGS concludes there will be a year over year increase in policies through 2020.  They list four primary opportunities for growth:

  1. Baby Boomers
  2. Medicare Advantage Reductions
  3. Decrease in Retiree Health Benefits
  4. New Medicare Supplement Plans

I’ve only posted a high level summary.  CGS’s research paper goes into more detail and provides data for each of the reasons and opportunities listed above.  Trust me; it’s worth the time to read it.

AP Article: Obama administration eases pain of Medicare cuts

April 20, 2011

Here is some good news to brighten our day.

The AP published an article last night (4/19/11) outlining the Obama administration’s plan to “ease the pain of Medicare cuts”.   The Health and Human Services (HHS) department is going to award quality bonuses to hundreds of plans that only have “average” star ratings.  The author compares HHS’s new methodology to grading on a curve.

What does this mean for you and your customers? 

For 2012, your customers will likely see benefits stay the same or improve.  The Medicare Advantage market is so competitive that companies will have to squeeze in more benefits to make sure they are hitting their enrollment goals.  It may also lead to less turmoil in the market place.  Sure, some plans are going to exit no matter what HHS does, but there are other plans that need just a little bit more margin to stay in a given market place.  It would be a welcome change of pace to not have to move your customers to a new Medicare Advantage plan during the 2012 SEP/AEP.

Below are a couple quotes from the article:

    • “The insurance industry says the bonuses will turn what would have averaged out as a net loss for the plans in 2012 into a slight increase.”
    • “The net result is that the boat didn’t get rocked.”

Here is a link to the AP article:

Obama administration eases pain of Medicare cuts

Medicare Supplement Sales Grew in 2010

April 15, 2011

Deborah Donahue, of Mark Farrah Associates, recently published an article analyzing the growth of Medicare Supplement sales in 2010.  Ultimately, the reduction in Medicare Advantage Private Fee for Service plans, the introduction of Medicare Supplements Plan N and Plan M, and the release of Modernized Medicare Supplements all contributed to the overall growth in 2010.

Click Graphic to Enlarge Source: MFA's Medicare Supplement Market Data; Health Coverage Portal™

Donahue also breaks down the Medicare Supplement market by company.  UnitedHealthcare owns a surprisingly high 32% of the market share.  When you add in Mutual of Omaha, these two companies own 43% of all Medicare Supplement polices.   What is the saying?… “So go these companies, so goes the market”.  As these two companies make changes to rates, underwriting and commission other companies are surely to follow.

Click Graphic to Enlarge Source: MFA's Medicare Supplement Market Data; Health Coverage Portal™

Lastly, Donahue also breaks down the Medicare Supplement market by plan type.  It’s not surprising that Plan F makes up 44% of all plans.  What is interesting are the numbers of Plan N and Plan M that have been sold since June 1, 2010.  Donahue writes, “Newly offered Plan N gained 147,912 members since June 2010 when it was introduced. Plan M did not fare so well, with only 265 covered lives.”

If you are selling in the Medicare Supplement market, you should read this article.  Deborah Donahue at Mark Farrah Associates does a fabulous job of breaking down the Medicare Market in a quick and easy to understand manner.

Here is a link to the Article: Growth in Newer Medicare Supplement Policies Continues

Health Care Reform and Agent Commission

March 17, 2011

As you probably know, commissions for the underage health market have seen significant cuts due to Health Care Reform. Now the question is; Will Medicare Supplement, Medicare Advantage and Medicare Part D commissions see the same cuts? There are pretty good arguments on both sides, but I’ve read two articles this week that show encouraging movement in regards to agent commissions. If this kind of movement for the underage market can continue, commissions for Medicare products are less likely to be affected.

Here are links to the articles:

National Underwriter: NAIC Panel Seeks Producer Commission Comments

NAHU Washington Update: NAIC Working Towards Legislation to Remove Agent and Broker Commissions from the MLR

Mutual of Omaha Announces Changes to Medicare Supplement Plan N Underwriting

February 2, 2011

Mutual of Omaha has announced underwriting changes to their Plan N Medicare Supplements.  This will affect all Mutual of Omaha companies including United World and United of Omaha.  Exceptions will include New York, where health questions may not be asked (per state regulations) and in open enrollment or other guarantee issue situations where health questions normally do not apply.

New Applications

The underwriting changes will also bring about new applications.  Where the new applications are already approved, the new underwriting guidelines will be effective with applications signed on or after February 16th 2011. The states are where the new applications have already been approved are:

United World:  AL, MD, MN, MT, ND, NJ, NM, PA, UT & WY

United of Omaha:  AR, AZ, GA, IA, ID, IL, IN, KY, LA, MI, MO, MS, NC, NH, OH, OK, OR, SC, TN, TX, VA, WV & WI

Commission Changes

This change will also affect commissions on Plans M and N.  Mutual of Omaha will have new commission schedules available shortly, but you can expect commissions on all plans to be uniform.

Here is a link to the announcement from Mutual of Omaha and more detailed information.

Even with these changes, Mutual of Omaha will continue be a leader in the Medicare Supplement marketplace.  That being said, this will open up many new doors to other Medicare Supplement companies that want to offer guarantee issue or limited underwriting plans.

Now the question is where do you put your clients who have health issues?  Do you wait until the Medicare Advantage AEP and put them in a plan then?  Or perhaps look for other Medicare Supplement companies with more lenient underwriting? 

One thing is for sure, it is important for agents to keep up with as many carriers as possible with the ever-changing Medicare market.  The slightest difference in underwriting can mean a declined or approved application for your client.

If you have any questions regarding Mutual’s changes, please feel free to contact us or reply below.

CMS Extends the Special Election Period Through February 28

February 1, 2011

CMS has extended the Special Election Period for members who lost their coverage December 31, 2010 due to plan exits. For any person that has not yet selected a Medicare Advantage plan (MAPD) or Medicare Part D plan (PDP) will now have until February 28th to enroll into a plan. Currently, these Medicare beneficiaries are on Original Medicare only. CMS will be sending out letters to anyone who falls into this category starting this week.

Keep in mind, this SEP extension is only for people who:

  • Were enrolled in a non-renewing plan that ended December 31, 2010
  • Are not currently enrolled in an MAPD or PDP plan (are on Original Medicare as of January 1, 2011) and have NOT yet used their SEP

In addition, anyone who has already enrolled in an MAPD or PDP will not be allowed to change plans. Also, anyone who has an SEP but does not select a plan prior to February 28 will stay on Original Medicare for the remainder of the year.

Click Here to see the form letter that CMS will be sending out to anyone who has not yet used their SEP. Almost 52,000 of these letters will be sent out so there is still a lot of opportunity to help beneficiaries choose MAPD or PDP plans.

Contact us if you have any questions.

Press Release: Integrated Benefits, Inc. Names Ryan Kimble President

January 14, 2011

I just wanted take a minute to say thanks for all your support and well wishes.   I’m humbled and excited to have this opportunity.   Integrated Benefits’ tremendous success is because of the great people who work here and the agents we serve.  I’m honored to lead this company as we continue to deliver the most competitive products and outstanding agent support.

- Ryan

Here is a link to the press release.  I’ve also copied it in below:

Integrated Benefits, Inc. Names Ryan Kimble President

Executive Vice President of one of the largest insurance marketing organizations in the country promoted to the role of President; carries on legacy of success and leadership.

(PRWEB) January 14, 2011

Ryan Kimble has been named President of Integrated Benefits, Inc. (AgentPipeline), an award-winning industry leader in the marketing and distribution of senior market insurance products. Kimble brings more than 12 years experience with insurance agent marketing and sales into his new role.

Ryan Kimble previously served as Executive Vice President. In his former role, Kimble led initiatives to expand Integrated Benefits’ footprint nationally to become a leading marketing organization in the senior market. He created an unmatched agent recruiting team and robust agent support unit. Furthermore, he developed new product offerings for independent agents throughout the country.

“Ryan brings a wealth of experience to his new role and understands the many demands and challenges of the insurance industry,” says Larry Kimble, founder and previous President of Integrated Benefits. “He has been an integral part of this company’s success. His broad base of experience will continue to produce outstanding results. Ryan’s proven leadership qualities will set us apart in today’s competitive marketplace.”

Kimble says of his new role “I’m very excited for this opportunity and it is an honor to lead this amazing group of individuals. I’m eager to build upon Integrated Benefits’ position in the marketplace.”

About Ryan Kimble

Kimble graduated cum laude from Liberty University with a Bachelor of Science degree in Business Finance and Economics. He has been a licensed insurance agent since 1994. Kimble is married to Deborah Kimble and has two children; Chloe (5) and Jacob (4).

About Integrated Benefits (AgentPipeline)

Integrated Benefits, founded in 1988, is a privately owned and operated national insurance marketing company dedicated to serving independent insurance agencies and agents. As a leading marketing company in the insurance industry, Integrated Benefits specializes in products designed for the senior market (Medicare Supplements, Medicare Advantage, Medicare Part D and Life Insurance). In 2010, Integrated Benefits produced $27.5 Million in Medicare Supplement sales. During the 2011 AEP, Integrated Benefits produced over 37,000 Medicare Advantage Plans and 22,000 Medicare Part D plans.

General information about Integrated Benefits is available through the Company’s Website at http://www.agentpipeline.com/ or the Company Blog at http://blog.agentpipeline.com/.

Source: Integrated Benefits, Inc.

2011 Changes to the Medicare Part D Coverage Gap (Donut Hole)

January 4, 2011

In 2011, the Affordable Care Act will help seniors with their drug costs once the reach they coverage gap or donut hole.  We’ve received several calls from agents with questions on how this will impact their clients.  This post is to help clear up any confusion on how the coverage gap will be handled in 2011.  If you have any additional questions, please feel free to post a reply or contact us.

First, here is a link to an About.com article on “Understanding the Medicare Part D Donut Hole”.  It goes into detail on the changes and gives a couple good examples.  Second, below is an agent Q&A put out by a leading Medicare Advantage company this week.  It gives a good explanation of the impact as well.

What is the coverage gap, and how will a member know when they have reached it?

Some Medicare drug plans have a coverage gap. This means that after a member and Universal have spent $2,840 for covered drugs, the beneficiary will pay the full cost of prescription drugs (up to a limit of $4,550 in out-of-pocket costs for 2011).

Every month a prescription is filled, Universal mails an Explanation of Benefits (EOB) notice stating how much a member has spent on covered drugs and if/when the member has reached the coverage gap.

 Who can receive the savings while in the coverage gap?

  • An Individual enrolled in a Medicare Prescription Drug Plan (including employer group health and waiver plans) or a Medicare Advantage Plan that includes prescription drug coverage
  • If an individual does not receive Extra Help (Low Income Subsidy)
  • The beneficiary has reached the coverage gap

How does the 50% coverage gap discount work for brand-name drugs?

Companies that make brand-name prescription drugs must sign agreements with Medicare to participate in the Medicare Coverage Gap Discount Program. This program requires the companies to offer discounts on brand-name drugs to people who have reached the coverage gap. Once a beneficiary has reached the coverage gap, they will automatically receive a 50% discount on brand-name prescription drugs at the time of purchase.

With this discount, they will only pay 50% of the price for the brand-name drug, but the entire price (including the 50% discount the drug company pays) will count toward the amount needed  to qualify for catastrophic coverage. The EOB notice will show any discounts paid by the drug companies. The beneficiary will still need to pay any dispensing fee (cost to fill a prescription). The dispensing fee isn’t discounted; it is added to the discounted amount of your prescription.

Example: Mrs. Anderson reaches the coverage gap. She goes to her pharmacy to fill a prescription for a covered brand-name drug. The price for the drug is $60 and the dispensing fee is $2. Once the 50% discount is applied, the cost of the drug is $30. The $2 dispensing fee is added to the $30 discounted amount. Mrs. Anderson will pay $32 for the prescription, but the entire $62 will be counted as out-of-pocket spending and will help Mrs. Anderson get out of the coverage gap.

Once the coverage gap is entered, will all Medicare-covered brand-name prescription drugs be discounted?

In 2011, manufacturers that produce over 99% of the brand-name drugs used by people with Medicare are participating in this program.

How is coverage for generic drugs changing in the coverage gap?

In 2011, Medicare will begin by paying 7% of the price for generic drugs during the coverage gap and the beneficiary will pay the remaining 93% of that price. The coverage for generic drugs works differently than the 50% discount for brand-name drugs. For generic drugs, only the amount you pay will count toward getting you out of the coverage gap. Also, the dispensing fee is included as part of the cost of the drug.

Example: Mrs. Anderson reaches the coverage gap in her Medicare drug plan. She goes to her pharmacy to fill a prescription for a covered generic drug. The price for the drug is $20 and there is a $2 dispensing fee that gets added to the cost. Once the 7% coverage is applied to the $22, she will pay $20.46 for the covered generic drug. The $20.46 amount she pays will be counted as out-of-pocket spending to help her get out of the coverage gap.

What if an individual has coverage from a State Pharmacy Assistance Program (SPAP)?

If someone is enrolled in a State Pharmacy Assistance Program (SPAP), or any other program that provides coverage for Part D drugs (other than Extra Help), they will still get the 50% discount on covered brand-name drugs. The 50% discount is applied to the price of the drug before any SPAP or other coverage.

What if I a member is in a Pharmaceutical Patient Assistance Program?

Patient assistance programs offered by drug companies are different than the Medicare Coverage Gap Discount Program. The beneficiary can check with the drug company to find out if its assistance program will change.

Will a beneficiary receive additional savings once they have reached the coverage gap if the Medicare drug plan already includes coverage in the gap?

Yes – the individual may receive a discount after the plan’s coverage has been applied to the price of the drug.

What if the member already receives Extra Help from Medicare?   Will they receive the discounts?

No. If someone receives Extra Help (LIS), they already have coverage for prescription drug costs during the coverage gap.


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