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Changes in the Idaho Medicare Supplement Market – Are You Ready?

Medicare supplement plans

January 28, 2022 by Lance Hoeltke

If you’re selling Medicare Supplement in Idaho, be prepared for some significant changes to the market in 2022. Beginning March 1, Idaho will be implementing the “Birthday Rule” for all Medigap policyholders and will also require Community Rating of Med Supp carriers to determine plan pricing.

Below we explore how these changes affect brokers interacting with their Medigap clients. But first, let’s take a look at exactly what these new rules mean.

Idaho’s New Birthday Rule for Medicare Supplement

Idaho residents who are Med Supp policy holders will have a 63-day window every year starting on their birthday to enroll in a different Medigap policy without having to go through medical underwriting. This is a great opportunity for all Med Supp policy holders and will ensure even more parity in the Idaho market. Here are a couple of important details:

  • The change must be to the same type of policy or one with lesser coverage. For instance, someone with a Plan A could not switch to a Plan G by using the Birthday Rule (see chart below). 
  • The Birthday Rule only applies to beneficiaries that already have a Med Supp policy. Someone without a policy, whose Open Enrollment Period has passed and doesn’t possess any other guarantee-issue rights, will have to go through medical underwriting.

Birthday Rule Options Chart

Policy Holders of Medigap Plan…Can replace it with Medigap Plan…
AA
BA or B
CA, B, C, D, K, L, M, or N
DA, B, D, K, L, M, or N
EAny Plan
FAny Plan
High Deductible FHigh Deductible F or High Deductible G
GPlan A, B, D, G, K, L, M, N, “HD” F, or “HD” G
High Deductible GHigh Deductible G
HA, B, D, K, L, M, or N
IA, B, D, G, K, L, M, or N
JAny Plan
High Deductible JHigh Deductible F or High Deductible G
KK
LK or L
MM or N
NN

Community Rating Going Into Effect

Premium rates for new Medicare Supplement policies will be based on “Community Rating” rather than the attained age of the applicant. This means that premiums are based on a single rate for all ages and classes within the group.

For instance:

If on March 1, 2022, 65-year-old Ms. Jones and 72-year-old Mr. Anderson both enroll in ABC Insurance Company’s Plan G Medigap policy, they will be paying the same premium.

Current holders of Issue-Age Rated Medigap policies will keep this rating unless they switch plans after February 28, 2022.

As has been the case in other states that have gone to Community Rating, policies for those that are younger (70 and under) will probably be higher than Issue-Age Rated policies. But Community Rated policies for older (over 70) beneficiaries may be less than Issue-Age Rated policies. This makes sense when you consider the average Issue-Age Rated Medigap policy will increase 2 to 3% annually.

What This Means For Brokers

If you want to maintain your Medicare Supplement book of business, it would be wise to start reaching out to your clients a month or two before their birthdays to let them know what options they have available. Because if you don’t, someone else will.

We all know how easy it is to obtain prospect birthday data. Rest assured that call centers and hungry agents will be contacting your clients to offer them a more affordable policy.

While it can be easy to become lazy with annual reviews, the Birthday Rule implementation will make them much more of a necessity.

Be the trusted source to inform your client if there is a better option available. For your older clients that still have an Issue-Age Rated policy, there may be a more affordable Community Rated option available. For your younger clients, you can give them the confidence that they are still on the most affordable option or you can provide them with something better.

In a nutshell, if you want to maintain your Idaho Med Supp book of business, reach out to every client at least a month prior to their birthday. Don’t leave any low hanging fruit for your competition.

Filed Under: Med Supp, Medicare supplement, Medicare supplement plans, Medigap plan

July 26, 2021 by Lance Hoeltke

One of our brokers recently had a situation with a client that wanted to leave his Medicare Savings Account (MSA) Plan in the middle of the year for a Medicare Supplement Plan. He was within his first year of coverage and had never purchased a Medigap policy before (see SEP code 12J).

Sounds straightforward enough, right? Unfortunately, there is more to making this kind of change than meets the eye.

If you have a client wishing to leave an MSA, then there are a few takeaways you can utilize from this broker’s experience. Keep reading to get the full insight and guidance for clients leaving an MSA.

The Nuances of a Medicare Savings Account Plan

As it turns out, while MSA plans are considered Medicare Advantage plans, there are a few nuances that separate them from your more traditional MA HMO, PPO, and PFFS plans.

Qualifying Special Election Periods

One such nuance is the inability to dis-enroll during the year to take advantage of the above-mentioned Special Election Period.

That leaves the following SEPs that can be utilized outside of the Annual Election Period:

  • Member moves into a nursing home (OEPI).
  • Member moves out of the service area (MOV).

Grounds for MSA Plan Cancelling Member’s Enrollment

Also, the MSA plan can cancel a member’s enrollment for any of the following reasons:

  • Member gets Medicaid.
  • Member enrolls in a Federal Employee Health Benefits Program.
  • Member has Tricare or VA benefits.
  • Member gets benefits that cover all or part of the annual MSA deductible.
  • Member is outside of the service area for over 6 months.

What Happens when a Member Leaves an MSA Plan?

If a member does leave an MSA plan prior to the end of the year, they will be required to pay a portion of the annual deposit back to Medicare. The amount paid back will be based on the number of months left in the calendar year.

Alternatively, if the member decides to leave the MSA plan at the end of the year, they will need to make that decision during the Annual Election Period.

Members electing to join a different Medicare Advantage plan will be automatically disenrolled from the MSA at the end of the year. Members that choose to return to Original Medicare will need to notify their MSA plan of their desire to disenroll, or they can call 1-800-MEDICARE. 

So, if you have a client turning 65 that wants to enroll in an MSA plan, make sure they are aware that they will need to keep that plan for the remainder of the year. They can still take advantage of the “first 12 months” rule as it pertains to purchasing a Medigap policy. They will just have to wait until the Annual Election Period to make that decision.

Have more questions regarding MSA plans or simply need support serving a client? Think “Plan Advisors first!” We’re here to help you help your clients.

If you’re an existing Plan Advisors brokers, request support on our Broker Portal. New to Plan Advisors? Let’s talk to learn how Plan Advisors can support you.

Filed Under: Med Supp, Medicare election periods, Medicare supplement, Medicare supplement plans, Medigap plan Tagged With: Medicare Savings Account, MSA, SEP

October 8, 2014 by Lance Hoeltke

[Read more…] about Bishop Marketing and Practice Health Partnerships team up in NYC

Filed Under: Get to know Bishop Marketing Agency, Humana MAPD plan, Humana Medicare Agents, Humana Medicare Plans, Humana’s Medicare health plans, Lance Hoeltke, MAPD Distribution, MAPD enrollment, Marketing Humana Medicare Plans, Medicare Advantage growth, Medicare Annual Enrollment Period, Medicare Beneficiaries, Medicare lead generation, Medicare supplement plans, selling Medicare Advantage Plans, Service

May 8, 2014 by Lance Hoeltke

Check out the press release below detailing the latest offering for our team of agents!

[Read more…] about Bishop Marketing offers Total HIPAA Compliance ‘s Online HIPAA 2.0

Filed Under: Bishop Marketing Agency, CMS guidelines, HIPAA compliance and training, Humana Medicare Plans, MAPD Distribution, MAPD enrollment, marketing Medicare Advantage, Medicare Health Plans, Medicare legislation, Medicare supplement plans, PDP enrollment, selling Medicare Advantage Plans, Service, Total HIPAA

June 26, 2013 by Lance Hoeltke

Marketing Humana Medicare PlansSo you want to grow your Medicare client base through MAPD and PDP education and enrollments. Well, you can’t call anyone, even if they’re referred to you. Can’t email anyone, unless they give you permission to. Direct response can be effective, but requires an investment to yield response rates of approximately 1%. 

Prospecting in the Medicare space requires creativity, professionalism, and optimizations of the remaining pathways to Medicare beneficiaries allowed by CMS and your state DOI. One opportunity that has proven to be a powerful way to engage new clients is through the Walmart workstations made available to authorized agents during AEP. 

It is said that 80% of Medicare beneficiaries live within 15 minutes of a Walmart! Through Humana’s strategic alliance with the world’s largest retailer (3,700 stores), an agent may cover a shift in the store of their choice, provided they are equipped and certified to represent the portfolio of Humana products available in their market, and can commit to a predetermined shift of at least six hours per week (e.g. Monday/Wednesday 1pm-4pm). This pathway is deemed an unadvertised seminar by CMS, meaning hours committed to must be reported to CMS for secret shopping opportunities. Nevertheless, it is a wonderful resource for engaging new Medicare beneficiaries (or their friends and loved ones) in their quest to determine the best product available for their specific needs. 

In our experience, over 70% of the best performing agents last year played a role at a Walmart workstation last season, so there’s a high correlation between productivity and this resource. Of course this is also predicated on the degree of effort and focus the agent demonstrates while present. Interfacing with the local store and pharmacy managers and staff also helps drive interested parties to your workspace accordingly. 

Like anything else, you get what you put into it. We believe this to be a wonderful opportunity for ambitious agents out there in the Medicare space, and provide over 500 store coverage opportunities nationally on behalf of Humana. Want to learn more? Fill out this form to get started.

Filed Under: Humana Insurance, Humana’s Medicare health plans, Marketing Humana Medicare Plans, Medicare Health Plans, Medicare supplement plans, Selling, Walmart Workstations

June 18, 2013 by Larry Bishop

Thirty three years ago when I started selling Medicare Supplement plans, in the back of my mind I knew someday I would be on Medicare myself.  What I did not know was the range of choices that would be available to me beyond traditional Medicare Supplement plans.
 
As I have indicated in the past my wife and I went onto Part A and enrolled in Part B of Medicare this year.  I started on May 1st and my wife February 1st.   Just some background, the past eight years I have had a high deductible plan with Life Wise of Washington state.  We had a $6000 family deductible plan and was paying about $700 per month the last year we had the plan.  I had also enrolled in an HSA eight years ago as well so today the balance of my HSA account is over $50,000.  As most of you know this fund can be used for co-pays for doctors visits as well as prescription drugs.  
 
My wife and I both chose the $0 premium MA only PFFS plan available in Washington state. (My wife does take some prescription drugs so I enrolled her in Humana’s WalMart standalone PDP, as I do not take any drugs, I chose not to enroll in a PDP.)  This is a Medicare look alike plan meaning I am responsible for the Part A hospital deductible and 20% of the Part B outpatient expenses, however, there is no Part B deductible, I pay 20% from the first dollar of charges.
 
I have used this plan three times so far, twice at the ophthalmologists and once at the dermatologists.  I could not be happier with how the plan works.  First of all, I am not paying for my healthcare in advance in the form of a premium.  Not for a high deductible plan like I did before going onto Medicare or for a traditional Medicare supplement.  I am only paying for 20% of the Medicare approved charge and that is a lot less the than the $8400 in premium I paid for Pat and I last year.  If I had chosen a traditional Plan F my premium would have been around $200 per month for me and $200 for Pat or about $4800 per year.  
 
I have my annual physical scheduled for the fist week of August with the doctor I have had the past several years.  In past her office accepted Life Wise.  Before going onto Medicare I called my doctors office to explain I was planning on enrolling in Humana’s MA only PFFS plan.  The office manager explained they did not officially accept Humana but as I was currently a patient, the office would accept Humana’s terms and conditions and bill them directly so I could continue to keep my current doctor.
 
So far I could not be happier with the choices I have made.  I now go to the downtown YMCA using Silver Sneakers and no longer pay $55 per month to OZ fitness.  The best part is on October 15th I can look at all the options available for 2014 and make a new choice if I find a better option with no pre-existing conditions or waiting periods.  The new choices today really are a win win situation for Medicare beneficiaries like me. 

[Read more…] about Larry affirms his Medicare Health plan selection two months later

Filed Under: Agent Testimonial, Bishop Marketing Agency, Humana, Humana Medicare Plans, ICEP, Medicare Advantage growth, Medicare Annual Enrollment Period, Medicare choices, Medicare Health Plans, Medicare options, Medicare supplement plans, MGA Testimonial, PDP enrollment, selling Medicare Advantage Plans, seniors choose Medicare Advantage, Service

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