The Resource Blog
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Dual Eligible Special Needs Plans, also known as D-SNPSs, are special Medicare Advantage plans for those who are receiving both Medicare AND Medicaid assistance. These plans extend their Medicare coverage and help coordinate care and benefits between Medicare and Medicaid. They can ultimately provide the most comprehensive, affordable coverage for these individuals.
These plans cover the same health care services that traditional Medicare Advantage plans cover, including Medicare Parts A and B and they also include prescription drug coverage. Many D-SNPs also offer Dental, Vision and Hearing coverage, Personal Emergency Response Systems (PERS), tele-health options, fitness and gym memberships, OTC (Over the Counter) cards (with prepaid credit to buy health products and groceries) and even transportation assistance. Many of these plans offer $0 premiums making them highly attractive to those with limited incomes.
Individuals who are eligible for D-SNPs are a diverse group of people that can include those with multiple chronic conditions, physical disabilities, mental illnesses, cognitive impairments and developmental disabilities. It can also include individuals who are relatively healthy. These individuals typically require assistance managing their care, which is where the care coordination of these plans is hugely beneficial for them.
Who pays for what and how does it all work? With most Medicare Advantage plans, your client pays a portion of the plan cost out of pocket. With a D-SNP, Medicare and Medicaid pay most or all of the costs. Medicare is the primary payer for care services. State-run Medicaid then steps in by providing assistance with Medicare premiums and cost sharing and also covers some services that Medicare does not cover, such as Long-term care services. In 2020 there were 12.3 million people enrolled in both Medicare and Medicaid.
This is a very under-served market and there is no shortage of potential clients who could benefit from a Dual Special Needs Plan.
If you have clients that are currently enrolled in both Medicare and Medicaid programs, discuss the benefits of enrolling them in a D-SNP. There are a variety of D-SNPs available. Some are Health Maintenance Organizations programs and some are Preferred Provider Organizations programs. These plans vary by state and by insurance carrier, so it's important to research plans in your client's area thoroughly before enrolling them. Premiums, copayments, coinsurances, and deductibles also vary depending on the plan. You can enroll clients during their Initial Enrollment Period, during the Medicare Annual Enrollment Period (October 15th - December 7th), during the Medicare Advantage Enrollment Period (January 1 - March 31) or during a Special Enrollment period: January–March, April - June or July - September, if they have a qualifying event which allows them to do so. To learn more about the different enrollment periods, visit CMS.gov or Medicare.gov. If you're looking to find potential D-SNP prospects, you're likely to find them in low income housing communities, senior centers, churches, and certain retirement communities. Volunteering at food banks, charity events and community centers is a good way to reach out and help those who may be eligible. If you have questions about Dual Special Needs Plans or need help offering them, please reach out to us.
Over 4 million Medicare beneficiaries pay income-related adjustment amounts (IRMAA) for their monthly Part B and Part D premiums due to their higher income levels. Most beneficiaries don't pay Part A premiums because they (or their spouse) worked for at least 10 years and paid Medicare taxes. However, people who do buy Part A will pay a premium of either $274 or $499 each month in 2022 depending on how long they or their spouse worked and paid Medicare taxes.
The standard monthly Part B premium for 2022 will be $170.10, which is what most Medicare beneficiaries will pay. For higher earners, that amount will range from $238.10 - $578.30, depending on their income level. Part D surcharges next year will range from $12.40 to $77.90 (that’s in addition to any Prescription Drug Plan premium they may pay as well).
These surcharges are based on your clients' tax returns from two years prior - which may not accurately reflect their current financial situation.
If your clients' income has changed significantly, they can appeal those income-related adjustment amounts by completing the Social Security Administration's Life Changing Event form AND by providing proof that their income has changed, which can include:
Talk to your clients if they've recently retired or had a change in income. They may qualify for lower Part B and Part D premiums. Learn more about Medicare costs by visiting Medicare.gov/your-medicare-costs
You may have heard the terms: Part B giveback, reduction or rebate. Do you know what that means or how it works for your clients?
The give-back benefit is another term for Part B premium reduction. This is when a Medicare Advantage plan reduces the amount your client pays towards their Part B monthly premium. These givebacks are offered by some Medicare Advantage plans and are designed to make plans even MORE affordable. The amount of the givebacks can range depending upon the plan and location. They can be as low as $20 and some plans offer more than $100 in giveback rebates.
How it Works:
If a beneficiary is on Social Security, the Part B premium comes out of their monthly benefit before it hits their bank account OR it's reflected in their monthly check. The giveback reduces their Part B premium, which means more money ends up in the individual’s bank account. If your client pays their Part B premium directly (not by automatic Social Security check deduction), their Part B premium statement will be updated with the giveback amount credited to what they owe. The standard Part B premium for 2021 is $148.50. This amount changes yearly and is based on income. Learn more.
Example:
If a beneficiary's monthly Social Security check is normally $1600 and their giveback is $100, their Social Security benefit will now be $1700. If they pay the standard Part B premium ($148.50) the amount they will owe after receiving the giveback will be $48.50.
Part B givebacks can offer Medicare beneficiaries yet another way to save money by choosing a Medicare Advantage plan.
To be eligible for this program your client must be responsible for paying their own Part B premium, which means they are NOT eligible to receive Medicaid or participate in a Medicare Savings Plan.
As always, it's important to make sure the Medicare Advantage plan fits your client's needs and budget. It's also crucial to make sure it includes access to the doctors and hospitals they need, as well as making sure their prescription drugs are on the plan’s formulary.
The Annual Enrollment Period which occurs every fall is right around the corner. October 15th kicks off the beginning of that window when your clients can make changes to their Medicare Advantage plans. So now is the time to go through our AEP checklist to ensure you're ready for the busiest time of year. Whether you're selling Medicare Advantage products, Prescription Drug Plans, Medicare Supplement products or any combination of the three, being prepared is your best asset. Below we'll go over our AEP checklist as well as review what your clients can do during the Annual Enrollment Period which ends on December 7th.
What can your clients do during AEP?
1. Change from Original Medicare to a Medicare Advantage plan (or vice versa)
2. Switch from one Medicare Advantage plan to another Medicare Advantage plan 3. Switch from a Medicare Advantage plan that doesn't have drug coverage to one that does offer drug coverage (or vice versa) 4. Join a Medicare Prescription Drug Plan (PDP) 5. Switch from one Prescription Drug Plan (PDP) to another PDP 6. Drop Medicare Prescription Drug coverage completely There are many scenarios that can play out during AEP and it's in your best interest to review your clients' policies with them to ensure they have appropriate coverage for the coming year. Many of your clients may want to review their Medicare Supplement plans during this time as well, and it's the perfect time to do so. AEP Checklist
1. Contracting
If you need to finish any contracting you may have started, complete it and review any carriers you wish to add. Carriers have blackout dates where you can no longer move your contract. You can review our carrier black out dates on our AEP page. 2. AHIP Training Be sure to complete your AHIP training. Many carriers offer discounts, but you must access the training through the carriers' agent websites to receive that discount. 3. Product Training Login to agent sites and complete all product training. You'll get notified by the carrier when you’re eligible to being selling. Watch your Inbox carefully. 4. MedicareCENTER Login to MedicareCENTER and get familiar with all the new tools available. Upload and update your clients in the CRM and review the training and best practices guides. 5. Electronic Applications Familiarize yourself with electronic applications now (before the rush). This will make them much easier to complete. You can download carrier e-App training guides from our Electronics App page. 6. Order Supplies & Materials Order any supplies you may need from your carriers directly, and be sure to request our complimentary*, branded marketing materials to help you promote yourself.
Make sure you're ready to go and have everything you need to make this your most successful AEP yet. We're here to help you succeed and are always available to assist you with your AEP strategy.
*Must be a contracted producer to qualify for our complimentary marketing materials.
Baby Boomers love Facebook and thanks to the pandemic more seniors are hanging out on there than ever before. If you're selling Medicare solutions to seniors and you're not using Facebook as a marketing tool, you're missing out. Sharing relevant content consistently and running targeted ads is an easy and economical way to get more leads. Ready to learn more?
Facebook's advertising process is straight forward and easy to work with. You must have a Facebook business page set up first. If you don't have a business page, it's easy to get that set up too. Once you have that up and running you can start advertising your insurance services. To run an ad, you're stepped through a series of questions which will determine what type of ad you want to run. You then upload your ad content, determine the audience, the price you want to pay and the duration of your ad. Once you finish that quick process, you then submit your ad for approval and within 24 hours (sometimes even sooner) you get an email alerting you to the status of your ad. Once approved your ad runs for the length you determined and will even cross post on Instagram if you have a professional Instagram account set up.
Running targeted ads on Facebook is easy and economical.
Still unsure? Feel free to download our Facebook Ads Quick Start Guide to walk you through the process. Screen shots and step-by step instructions will show you exactly what you need to do to target a specific audience in your preferred geographic area, and it will even show you how to drill down to target leads with certain life events or interests. This type of targeting will ensure your ad is being shown to the people you want to see it.
So now that you have an ad running, when will you start seeing leads? After your ad begins running, you can track and manage leads through the Facebook Ads Manager which shows you when someone has responded to your ad. It will give you a plethora of other statistics too, but for the sake of keeping this blog post simple, we'll focus on the main goal: leads! You download them via an Excel file and the important thing to remember is that you need to login daily to check for leads. Facebook will not email you when you receive new leads. So make it a habit to login to the Ads Manager to track them and download them.
What if you don't get any leads from your first ad? Don't despair. Much of marketing is based on A/B testing. And what that means is you have to test out your ad, just as marketers do to see what type of ad content resonates with their targeted audience. The fact that Facebook makes advertising economical and you don't have to pour thousands of dollars into an ad campaign, allows you to test your ads and tweak them when necessary. Marketing has many nuances to it, and lead nurturing can take time. But if you're willing to put in a bit of effort and take the plunge, you will see proven results.
A/B testing allows you to test out your ad content to see what resonates with your audience.
Hands down, Facebook advertising is the fastest and easiest way to get leads quickly. It's not a complicated process and it won't break the bank. Buying expensive leads from lead vendors can quickly add up, so if you haven't spent the time to learn how to advertise on Facebook, dedicate a couple hours to setting up your business page, creating ad content (or if you're one of our contracted agents, we'll create ad content for you) and go through the process of submitting your first ad. You'll be happy you did once those leads start filtering in.
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