Medicare A Growth Market L. Craig Taylor MA CLF CLTC DIA Assoc. - - PowerPoint PPT Presentation
Medicare A Growth Market L. Craig Taylor MA CLF CLTC DIA Assoc. Director Med Solutions Senior Market Sales - Omaha, Ne Agenda 1. The Role of NAHU in Medicare 2. How big is the Medicare market? 3. Whats happening in the market? 4.
period, giving seniors the flexibility they have had in the past to choose the right plan for them.
needs but may need to change again due to a change in health status, physician availability, or other reasons. The OEP gives them that chance to choose the appropriate coverage for their needs.
and enroll in traditional Medicare, when another MA plan may fit their needs better. H.R. 2581 would allow seniors a one-time
plan that may not be appropriate for their needs.
include:
changed until after accessing medical care for the first time in the new plan year.
for them or they would prefer a different MA plan.
and March, a beneficiary could benefit financially from a switch.
bad weather, sometimes beneficiaries need a little more time to make a thoughtful decision.
1. COBRA is a federal law that may let you keep your employer group plan coverage for a limited time after your employment ends or after you would otherwise lose coverage. This is called "continuation coverage." 2. In general, COBRA only applies to employers with 20 or more
employers with fewer than 20 employees to let you keep your coverage for a period of time.
3. In most situations that give you COBRA rights (other than a divorce), you should get a notice from your employer's benefits administrator or the group health plan telling you your coverage is ending and offering you the right to elect COBRA continuation coverage. 4. COBRA coverage generally is offered for 18 months, and 36 months in some cases. If you don't get a notice, but you find out your coverage has ended, or if you get divorced, call the employer's benefits administrator or the group health plan as soon as possible and ask about your COBRA rights.
5. If you qualify for COBRA because the covered employee either 1) died, 2) lost his/her job, or 3) became entitled to Medicare, the employer must tell the plan administrator. Once the plan administer is notified, the plan must let you know you have the right to choose COBRA coverage. 6. If you qualify for COBRA because you've become divorced or legally separated (court issued separation decree) from the covered employee, or if you were a dependent child or dependent adult child who is no longer a dependent, then you or the covered employee needs to let the plan administrator know about your change in situation within 60 days of the change.
5. Before you elect COBRA coverage, it's a good idea to talk with your State Health Insurance Assistance Program (SHIP) about Part B and Medigap.
Policyholders and…
from the Patient Protection and Affordable Care Act's (PPACA) and medical loss ratio (MLR) calculation is one of NAHU's top government affairs priorities, and it has made significant legislative progress during the past week. The legislation is scheduled to be voted upon by the full House Energy and Commerce Committee on Thursday, September 20 at approximately 11:45am.
health insurance company can spend on administrative costs. Unfortunately, the rules crafted to implement this requirement not only include independent agent and broker compensation in an insurer’s MLR calculation, but also classifies it as an administrative expense.
passed-through fees folded into insurance premiums as a consumer convenience and as a means of complying with state tax and consumer protection laws; they never have been any part of the insurer’s bottom line.
seeing a net reduction of their business incomes of 30 to 50
to afford to stay in business, and many have begun reducing services to their clients and cutting jobs.
Source: Medicare and You 2014. www.Medicare.gov.
hospital stay requirement for Medicare beneficiaries who need rehab from a skilled nursing facility.
“Beneficiaries in need of skilled nursing care are typically the most vulnerable
timely critical rehabilitation services due to Washington red tape,” said Renacci.
protecting the doctor-patient relationship and removing barriers to their health care.” Seniors many times are unaware of their inpatient or outpatient status while in the hospital and, as a result, are often left on the hook for thousands of dollars in medical bills after their SNF stay.
is also supported by medical professionals throughout the country.
Fudge of OH, Jon Carney (DE), Reid Ribble (WI), Larry Bucshon (IN), Mike Kelly (PA), Richard Nugent (FL), Keith Rothfus (PA), Derek Kilmer (WA) and John Delaney (MD). If one of your elected officials, you may want to give them a thanks!
an enrollment decision
changes
enrollment mechanism that permits organizations that offer both a Medicare Advantage (MA) plan and a non-MA health plan (e.g., Medicaid, employer) to seamlessly convert individuals in the non-MA plans into the MA plan when those individuals first become Medicare eligible.
approval from the Centers for Medicare & Medicaid Services. However, the Medicare-Medicaid Coordination Office (MMCO) has heard from some organizations that while they can easily identify those about to turn age 65, they are challenged to identify individuals in their Medicaid-only plans that will become eligible for Medicare based on reaching the end of their 24-month Medicare disability waiting period.
http://cms.hhs.gov/Medicare/Eligibility‐and‐Enrollment/MedicareMangCareEligEnrol/Downloads/FINAL_M A_Enrollment_and_Disenrollment_Guidance_Update_for_CY2012_‐_Revised_872012_for_GY2013_v3. pdf
minimal impact in terms of numbers compared to what it is today
Review the specific changes made to Medicare supplement insurance (Medigap), under HR 2, the Medicare Access and CHIP Reauthorization Act of 2015, which was signed into law April 16, 2015 (Public law 114- 10).—Essential Revise and conform Model #650, Model #651 and consumer guides and training material on Medigap to the specific enacted changes prohibiting coverage of the Medicare Part B deductible for beneficiaries that become eligible for Medicare beginning on or after Jan. 1, 2020.—Essential
A few other Plan “G” benefits are:
normally associated with Plans “A”, “C”, and “F”.
business associated with the block, rate increases on a Plan “G” are often times lower than that of a Plan “F”.
adjustments, your clients will be less likely to look for alternative coverage.
commissions, retaining your current customers provides more time for new client prospecting, cross marketing current customers and many other responsibilities that can help grow your business.
Plan “G” is coming out as the ideal choice for your clients who have a good health history and are looking for an immediate cost savings. By satisfying their Part B deductible at doctor visits they will be able to take advantage of historically fewer rate increases with an increase in persistency for you as their agent
http://www.markfarrah.com/healthcare-business-strategy/New-Medicare-Opportunities-with-Medigap.aspx
http://www.markfarrah.com/healthcare-business-strategy/New-Medicare-Opportunities-with-Medigap.aspx
Lower healthcare costs Maximize reimbursement rates… Coding Intensity & Nurse Home visits Reduce
expenses
http://www.forecast-chart.com/inflation-medical-care-cost.html
Medical prices are rising at their slowest pace in a half century, a shift in the health-care industry which provides relief to government and businesses' budgets also signals that consumers are being left with a larger share of the bill The recent slowdown in medical inflation is partly the result
attention to prices. Fifteen years ago, pricing was not as important…but when the co-pay is coming out of a patient's pocket, they more often want to know what they're paying.
http://www.wsj.com/articles/SB10001424127887323342404579081312680485476
Craig Taylor MA CLF CLTC DIA 402-343-3685 ctaylor@seniormarketsales.com