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the resource BLOG

Medicare Supplement Open Enrollment & Guaranteed Issue Rights

10/23/2023

 
When it comes to Medicare Supplement policies there are times and situations when your client has the right to enroll in a Medigap plan without answering any health questions. The most important of those times being during their six month Medigap Open Enrollment period. This occurs when your client turns 65 or when they first enroll in Medicare Part B. 

​​However, there may be times when you have a client who wants to enroll in a Medicare Supplement and they fall outside of their Open Enrollment period. Perhaps you have a client who's moving and they want to switch plans. ​Or you might have a client who was enrolled in a Medicare Advantage plan and they want to make the switch to a Medicare Supplement. Regardless of the situation, there may be Guaranteed Issue or Trial right available, allowing them to enroll in a Medigap plan without answering health questions. 
Insurance agent explaining Open Enrollment to clients
Examples of Guaranteed Issue & Trial Rights:
  • Your client is in a Medicare Advantage Plan, and the plan is leaving Medicare or stops giving care in their area, or your client moves out of the plan’s service area.
  • Your client has Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending. Note: In this situation, your client may have additional rights under state law.
  • Your client has Original Medicare and a Medicare SELECT policy. If your client moves out of the Medicare SELECT policy’s service area. Call the Medicare SELECT insurer for more information about their options.
  • Your client joined a Medicare Advantage plan or Programs of All-inclusive
    Care for the Elderly (PACE) when they were first eligible for Medicare Part A at 65, and within the first year of joining they decided they wanted to switch to Original
    Medicare. This is called a trial right.
  • Your client dropped a Med Supp policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, and they've been in the plan less than a year, and want to switch back. Again, this is a trial right.
  • Your client's Medicare Supplement carrier goes bankrupt and they lose coverage, or their Medigap policy coverage otherwise ends through no fault of their own.
  • Your client leaves a Medicare Advantage Plan or drops a Medigap policy because the company hasn’t followed the rules, or misled your client.

Example: Same Client - Different Situations

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Year-round Enrollment & Other Rules

​​​If your client doesn't fall under any of the Guaranteed Issue/Trial Right situations listed above, there are certain states that have year-round open enrollment periods. There are also states that have birthday and anniversary rules which allow your client to switch plans without going through underwriting. Each state has its own regulations and guidelines so it's important to familiarize yourself with them before enrolling your client in a Medicare Supplement plan. ​
Open Enrollment Birthday Rule Map
State
Rule
California
Your client can change their Medicare Supplement policy during the month of their birthday without underwriting. They must have an existing policy in place to qualify though.
Connecticut
​Connecticut has a Medicare Supplement Open Enrollment period year-round and has specific rules regarding enrollment.
Idah
​In Idaho your client may switch to a different Medicare Supplement plan of equal or lesser coverage and this window begins on their birthday and ends 63 days after.
Illinois
​Clients aged 65 to 75 years old have 45 days after their birthday to change their Medicare Supplement policy without underwriting. They can only purchase a policy with equal or lesser coverage from their current policy.
Louisiana
Any client who is at least 65 years of age can switch to another Medicare Supplement policy without answering health questions and may do so up to 45 days after their birthday.
Maine
Year-round open enrollment period occurs in Maine and your client can switch to another Medicare Supplement plan with equal or lesser benefits.
Maryland
Your client can change their Medicare Supplement policy during the month of their birthday without underwriting. They must have an existing policy in place to qualify though.
Massachusetts
​Massachusetts offers year-round open enrollment and an additional guaranteed issue window between February 1st - March 31st that enrollees can use to change their Medicare Supplement policies without underwriting.
Missouri
Your client can switch insurance carriers, while keeping the same level of coverage, during the months surrounding their Medigap anniversary. The window to make this change begins 30 days before the issue date of your client's existing Medicare Supplement policy and lasts until 30 days after the issue date. As for the level of coverage, they can switch from a Plan G to a Plan G without underwriting, but not from a Plan G to a Plan N, for example.
Nevada
​In Nevada your client may change their plan to a different plan that has equal or lesser coverage without underwriting. This window occurs on the 1st day of their birthday month and lasts for 60 days.
New York
New York state has a year-round Medicare Supplement Open Enrollment period with specific rules regarding enrollment.
Oklahoma
Your client may switch to another Medicare Supplement plan of equal or lesser value and has a 60 day window that starts on their birthday.
Oregon
Your client can change their Medicare Supplement policy during the month of their birthday without underwriting. They must have an existing policy in place to qualify though.
Vermont
Vermont has a Medigap Open Enrollment period year-round with specific rules regarding enrollment for applicants.
​Washington
If your client has a Plan A, they can only switch to another Plan A without underwriting. However, if they have ANY other Medicare Supplement plan, they may switch to any other Medicare Supplement plan without underwriting.
If your client falls outside of their open enrollment period, doesn't live in a state with year-round open enrollment and doesn't qualify for guaranteed issue rights, they will likely have to go through underwriting; and that requires answering medical and pharmaceutical questions on the application as well as during a phone interview.
Insurance agent shaking hands with client
If you have any questions regarding Guaranteed Issue rights, birthday rules or getting your client through underwriting, please reach out to us and we'll be happy to assist you. Additionally, feel free to download our Medicare Enrollment Periods guide.
By Carolyn Portanova
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Marketing Strategies for Insurance Agents

3/17/2023

 
Being an independent insurance agent is a rewarding career, but the challenges that can come with marketing yourself and rising above the competition can be daunting. There are some clear and actionable strategies you can put into place to attract more clients and market yourself effectively.

Your Audience
When you think about the insurance products you offer, think about the target audience you want to focus on. If you only sell senior healthcare products, you want to make sure your message is targeting the senior demographic. If you sell Life insurance and Annuities, you have a much broader demographic that you can target. The goal is to reach your target audience with content that is meaningful to them.

Your Website
People research everything online and that most definitely includes insurance products. If they stumble upon your website and you have little to no valuable information to share with them, they will quickly move on. Make sure your website is up to date, has a clear call to action, has your contact information easily accessible, offers the ability to run quotes, has informative information that educates the visitor about the products you offer and be sure your website is mobile-friendly. These are hard, fast rules that you need to have implemented. If your website isn't current and leaves the visitor feeling that you're not an expert in your field, they will not do business with you. You have one time to make a first impression, and your website is it.

SEO (Search Engine Optimization) is a complicated and ever-changing process that search engines continuously tweak. If your website isn't getting much traffic, then it may be time to consider working with a professional. Ranking high in search results takes a lot of work and it's not something that happens overnight.
Insurance Agent with Laptop
Meet Them Where They Are
Think about the age of your clients. Baby Boomers who are enrolling in Medicare do more online than you may give them credit for. They bank online, have social media accounts, shop online, research online. Millennials, X-Geners and Gen Z do everything online. I personally, don't remember the last time I picked up a newspaper, listened to the radio, wrote a check, used cash or walked into a bank and I'm Gen X. The point is, people do things very differently today vs. 10 or 20 years ago. It's crucial to pivot and meet people where they are.

​Advertising
Free advertising exists and it's available on your social media accounts. Sharing relevant, educational, informative content vs. the standard, run-of-the-mill content churned out by every other agent is what will set you apart. Paid advertising on social media will get you even further and it won't break your budget.

Running ads on Google is a whole other game that is best left to the professionals. It's a complicated bidding process that no amateur should enter into. If you want to run ads on Google, be sure to research a marketing firm that can assist you with that and be prepared to pay for that service. There are many facets to running Google ads and where they will be displayed, as well as many types: search ads, display ads and video ads to name a few.

​Conclusion
Don't let the agent down the street take your clients away from you because you don't have a marketing strategy in place. Be vigilant with your efforts and reach out to us if you need assistance. In this day and age, it's imperative to take the reins and make marketing an integral part of running your business. ​
By Carolyn Portanova
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Create a Wellness Strategy for Your Clients

12/14/2022

 
After the Medicare Annual Enrollment Period ends on December 7th it's natural to slow down during the last couple weeks of the year after the frenetic pace you've endured since October. And it's important to regroup and plan for the coming year ahead. As part of your New Year's business strategy think about creating a Wellness Strategy for your clients. Sit down, be it virtually or face-to-face, and talk to them about ALL of their insurance needs. After all, they were pummeled with Medicare ads and mailings for months, and that was their (and your) primary focus. Come the New Year though, it's a great time to think about the bigger picture. As you know there are an array of insurance products available on the market that can be hugely beneficial to your clients, but until you talk to them, they may never know about them or even worse...be headed for a catastrophe if they're under-insured.

Let's face it, the last thing anyone wants is to be up-selled, and that's not what this blog post is about. It's about getting to know your clients and learning about their individual needs. We're going to take a dive into some of the insurance products you can discuss with your clients to create a well-rounded solution for 2023.

No one wants to be up-selled, but having sufficient coverage is crucial.

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To start off, consider discussing Critical Illness insurance which can be so important if a client suffers a heart attack, stroke or a cancer diagnosis. Some plans even cover other illnesses such as Parkinson's Disease, End Stage Renal failure and Multiple Sclerosis, among others. Explain to your clients how Critical Illness insurance works and that a lump sum is paid out to the beneficiary once a diagnosis has been made that can help cover the costs that add up quickly. It's very affordable and creates a safety net in the event they need to access a large sum of money in the future. Relay to them that it can be used for any number of things, including mortgage payments, rent, groceries, child care, etc. It does not have to be used strictly for medical bills.

More than 25% of Americans become disabled before retirement, and on average the disability lasts more than three months, making Disability insurance an important topic to discuss. Go over the fact that there are Short-term and Long-term policies available and they typically cover 60 - 80% of a beneficiary's monthly income. The policy will include details about what constitutes a disability and how the payout will be made. The funds can then be used for bills or day-to-day living expenses. Remind them that premiums can vary depending upon the insurance carrier and their job occupation can also affect rates.

Dental, Vision and Hearing insurance is hugely important. Original Medicare Parts A and B do not cover dental, vision or hearing, as they're probably aware. And unfortunately Medicare Supplement policies do not cover these items either. Some Medicare Advantage plans may cover portions of the costs, but it depends upon the plan. Having an affordable DVH plan to help cover the costs of cleanings, fillings, tooth extractions, dentures, eye exams, eyeglasses, contact lenses, hearing exams and hearing aids just makes so much sense. Talk to your clients about getting them on a plan if they don't currently have one in place.

Now let's get into long-term care. This is a must-have conversation with your clients as 70% of people over the age of 65 will need some type of long-term care in their lifetime. Explain to them that Medicare does not cover the costs of long-term care and the costs of private nursing home rooms or even semi-private rooms are absolutely staggering. You can share the 2022 costs for long-term care services provided by Mutual of Omaha's '2022 Cost of Care' study below.
  • $113,529.60 - private nursing home room
  • $99,410.40​ - semi-private nursing home room
  • $61,936.16​ - home health aide
  • $57,916.08 - assisted living facility
Having a Long-term care policy or even a rider on a Life insurance policy can protect them for the future. A long-term care rider might be the best fit, which would allow them to access a portion of their policy's death benefit to pay for long-term care expenses. But again, until you have that conversation with them, you won't know.

Life insurance is for the living. We've all heard that phrase, and if your clients haven't heard it, be sure to use it. Explaining how Life insurance works - that it's not for those who've passed away - it's there to protect and help loved ones during an incredibly difficult time - will help them understand the need for it. You can review the different types of Life insurance available below and review any existing policies they may already have in place.
  • Whole Life insurance is a type of policy that stays in effect as long as your client pays the premium. Whole Life policies can be a bit more complex as they build cash value over time, and the longer your client has the policy, the more cash it builds. Additionally, they can lock in affordable premium rates that will never increase for as long as they own the policy. 
  • Final Expense products offer your clients peace of mind. Covering funeral expenses or providing emergency cash eases the financial burdens during a very difficult time. 
  • Term Life insurance expires after a set number of years, making it a good choice for clients who expect to build wealth over time and won’t need the financial benefits Life insurance provides later in life. 
  • Simplified Issue Term is Life insurance that requires very few medical questions on the application. It's a policy that is in effect for a specified amount of time, unlike Whole Life.
Talking with your clients about their specific situation will give you insight as to what product(s) would work best for them, and this can (and likely will) change over time, making it imperative to review their needs.
Insurance agent with clients
The New Year is a great time to have conversations with your clients to learn about their health, wealth and lifestyle so you can create the best solution for them. Setting aside time with them after the holiday rush is over and resolutions kick in is ideal. Take the time to reach out to your clients and create a Wellness strategy  to set them up for an amazing year ahead. If you need assistance with product selection, have questions about rates or underwriting, simply reach out to us. We're always here to help.
By Carolyn Portanova
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CMS Closely Monitoring Agents Marketing Medicare Advantage & Prescription Drug Plans During AEP

10/24/2022

 
CMS released a memo last week regarding the marketing practices of TPMOs (Third Party Marketing Organizations - which includes independent insurance agents.) during the Annual Enrollment Period. They are quite concerned because they have reviewed thousands of complaints and numerous recorded phone calls and have identified issues with regard to the information that is being provided to consumers. 

CMS has been conducting a "Secret Shopping" program by calling numbers associated with Medicare Advantage and PDP marketing efforts (tv and newspaper ads, internet searches and mailers) and these secret shoppers have been receiving inaccurate or misleading information regarding plans they inquired about. Additionally, some TPMOs are not complying with the new regulations put into place, and some are even pressuring consumers into purchasing plans that may not be the best fit for them or have been misrepresented.
Insurance agent on the phone
CMS is closely monitoring all activities during the open enrollment period, and will take compliance action for activities and materials that do not meet their requirements. ​​

​
To learn more...

CMS recommends that TPMOs immediately implement the following:

  • Ensure beneficiaries know how to file a marketing complaint with 1-800-MEDICARE or the plan, as well as highlight for beneficiaries that it is important to provide an agent or broker name, if possible. Plans must clearly display this information on plan websites and include this information in all mailings.
  • Immediately review all allegations raised by any source against an agent or broker.
  • Take all necessary and appropriate action to address inappropriate agent behavior.
  • Track complaints against each agent or broker, looking for any outliers with respect to rapid dis-enrollments.
  • Ensure agents and brokers obtain Scope of Appointment (SOA) forms. Plans should remind agents and brokers that they may only discuss products with potential enrollees that have been agreed to in advance on the SOA. CMS retains the right to request copies of SOAs.
  • Review “upstream” entities associated with agents who are outliers with respect to complaint numbers and determine potential patterns or connections to potentially inappropriate Field Marketing Organization activities.
  • Ensure all agents and plan marketing materials clearly state when certain benefits may not be available to all enrollees. CMS may determine that the agent’s activity or marketing is misleading if the benefits being marketed are only available to a subset of plan members.
  • Ensure all agents and brokers review the required Pre-Enrollment Checklist with a beneficiary prior to enrollment. The items in this checklist must be covered in full and the agent must confirm that the beneficiary understands all items addressed.
  • Provide translation services for beneficiaries with limited English proficiency. For those beneficiaries who have requested documents in a language other than English, the plan must continue to provide required documents in that language until the beneficiary has changed his or her request.
  • Provide agents a list of required questions or topic that they must cover in their sales presentations particularly basic topics or questions, such as use of provider specialists, whether the beneficiary is looking for a lower premiums and copays, may need DME, or whether the beneficiary has questions about the costs associated with the plan.​​
By Carolyn Portanova
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MedicareCENTER Enhancements Including Call Recording, Mobile App, Personal URL and LeadCENTER Integration & More

9/29/2022

 
Big things are happening with MedicareCENTER and these new enhancements are making it even easier for our agents to sell more, earn more and grow more.
Let's dive right in! The call recording feature built into MedicareCENTER allows agents to compliantly record their phone calls when they're selling Medicare Advantage and Prescription Drug plans. It also allows them to access those calls any time they need them - as they'll be stored for 10 years. And there is no charge for this service. As with all the tools built into MedicareCENTER, the platform is complimentary for agents working with us.
The MedicareCENTER mobile app is now available in the App Store and the Google Play store and has all of the same capabilities as the web version. This makes managing your business even easier! Download the app and login to take your business where ever you go on your phone or tablet.
The next feature we're going to discuss is the personal URL which allows your clients to shop and enroll on our consumer-facing website, MedicareEnroll.com. When clients use your personalized link, they will see your contact information. They’ll be able to shop, compare and enroll in the Medicare plans you’re appointed to sell — and you’ll get the commission! ​
The newest feature to be integrated with MedicareCENTER is our LeadCENTER which allows our agents to receive leads directly into MedicareCENTER with the flip of a switch. This new tool allows agents to receive verified leads as soon as they're online and ready to receive phone calls. 
Save time and produce more with MedicareCENTER this AEP and year-round. Quoting and enrollment tools built in to MedicareCENTER allow you to enroll clients in Medicare Supplement plans as well as Medicare Advantage and Prescription Drug plans. MedicareCENTER combined with LeadCENTER is the most powerful tool a Medicare agent can have at their disposal. To learn more about all the capabilities of MedicareCENTER visit our MedicareCENTER page. And to begin working with us so you can have access to all these free tools, please visit our Contracting page.
By Carolyn Portanova
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