The Resource Blog
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.
Examples of Guaranteed Issue & Trial Rights:
Example: Same Client - Different Situations
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.
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.
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.
On May 9, 2022 CMS put into place the following rules for marketing and communications with regard to offering Medicare Advantage and Prescription Drug Plans for 2023.
When marketing Medicare Advantage and Prescription Drug Plans the following language must include:
“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”
The message above must be:
If you're using marketing materials this AEP be sure to update them or request marketing materials from us with the disclaimer above. It's crucial to be compliant and be sure to follow the rules put forth by CMS.
You are NOT required to use the disclaimer when meeting with a Medicare beneficiary in person, if you only sell plans on behalf of one carrier, OR if you sell plans on behalf of more than one carrier and you sell ALL commercially available MA or PDP plans in a given service area. Additionally, it's always best to include “Not connected with or endorsed by the United States government or the federal Medicare program.” on any marketing materials you use.
Learn more about the CMS Communications & Marketing Guidelines.
Download the Agent Dos & Dont's from CMS.
Additionally, recording of all phone interactions between agents and consumers discussing MA and PDP must take place and recordings must be stored for 10 years. You should record ALL calls in their entirety beginning on October 1, 2022.
You must record all your calls with every beneficiary in their entirety. This includes all inbound and outbound calls including lead generation, marketing and the enrollment process. If you call an existing client or receive a call from an existing client and you believe that the call may lead to enrollment, then you should record the call from the outset. This can include: lead generation, marketing, discussing different plans, mid-year reviews, Medicare educational discussions on options, annual check-ins, or any other topic that involves the selling/enrollment of a Medicare Advantage or Prescription Drug plan.
Many states require that consumers be notified that their call is being recorded. As a best practice you should tell the consumer at the start of each call that the call is being recorded and explain to them why the Centers for Medicare & Medicaid Services has put this rule into effect. Make sure the notification is documented on the recording. If a consumer stays on the line, they have consented to the recorded call. If they don't wish to be recorded, then it's best to politely end the conversation.
“I understand that you may not wish to be recorded; however, new government regulations require certain calls with Medicare beneficiaries be recorded. In order for me to my due diligence and be compliant I must get your permission to record our conversation. The purpose of this rule is to ensure that the information that I give you is accurate.”
Read more about the CMS rule here...
How am I going to record my calls?
New call recording capabilities will be available in MedicareCENTER and will include the following:
What else can you do in MedicareCENTER ?
By utilizing our MedicareCENTER, you will be compliant and will have access to all of your clients' information. To learn more and get registered for MedicareCENTER, please visit our MedicareCENTER page.
Should you choose to use a different vendor for your call recording, please keep in mind that you are responsible for entering into an agreement with that vendor and paying for their service.
If you have questions about this CMS rule, please reach out to us for further information.
Helping your clients avoid Medicare penalties is an important aspect of guiding and educating them. Below are some tips to help your clients enroll on time to avoid paying more.
Part A Penalties
Most Medicare eligibles receive Part A for free however, if you have a client who has to buy Part A, and they don't buy it when they're first eligible for Medicare (age 65), their monthly premium may go up by 10%.
Your clients won't have to pay for Part A at age 65 if:
If your client has limited income and resources, their state may help pay for Part A.
Part B Penalties
If your client doesn't sign up for Part B when they're first eligible, their monthly premium may go up 10% for each 12-month period that they could've had Part B. In most cases, they'll have to pay this penalty each time they pay their premiums, for as long as they have Part B.
There is typically no late enrollment penalty if your client meets certain conditions that allows them to sign up for Part B during a Special Enrollment Period. As with Part A, if your client has limited income and resources, their state may help pay for Part B.
If your client has other creditable coverage, they can delay Part B and postpone paying the premium. They can sign up later without a penalty, as long as they do it within eight months after their other coverage ends. There are directions on the back of their Medicare card if they want to refuse Part B.
Part D Penalties
In order to avoid any Part D penalties make sure your client enrolls in drug coverage when they're first eligible. Even if they don’t take drugs they should consider joining a Part D Plan or a Medicare Advantage Plan that includes drug coverage. If they don't they may pay a late enrollment penalty if (at any time after their Initial Enrollment Period is over) there's a period of 63 days or more when they don't have Medicare drug coverage - or other creditable prescription drug coverage.
Additionally, make sure they enroll in drug coverage if they lose other creditable coverage (from an employer, union, TriCare, Dept. of Affairs, etc.) that's expected to pay at least as much as Medicare's standard prescription drug coverage. You'll want to advise your clients to keep records showing when they have other creditable drug coverage in order to avoid possible penalties in the future. If your client disagrees with a penalty, they can request a review by completing a 'reconsideration request form'.
Avoiding Medicare penalties doesn't have to be tricky as long as you advise your clients accordingly. Review their specific situation to determine when they should enroll in the different parts of Medicare to avoid any issues.
If you'd like to review the different enrollment periods, request our Medicare Enrollment Periods guide which goes over the following:
The Medicare Advantage Enrollment Period runs from January 1st - March 31st.
If your client is unhappy with their current Medicare Advantage plan, they can make a switch to another Medicare Advantage Plan (with or without drug coverage). They can also dis-enroll from their Medicare Advantage Plan and return to original Medicare. If they choose to do so, they'll be able to join a Medicare Prescription Drug Plan as well (Part D).
If they enrolled in a Medicare Advantage Plan during their Initial Enrollment Period, they can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without drug coverage) within the first three months they have Medicare.
If your client switches to a different Medicare Advantage Plan or goes back to original Medicare with or without a drug plan, their new coverage will start the first day of the month after their new plan gets the request for coverage. An important detail to remember though, if your client decides to go back to original Medicare, they may not be able to buy a Medicare Supplement policy.
The best time for your client to get a Medicare Supplement policy is during their six month Medigap Open Enrollment Period. During that time they can purchase any Medicare Supplement policy sold in their state, even if they have health problems. This period starts the first month they have enrolled in Medicare Part B and they're age 65 or older.
There are many details to consider, before jumping off their current coverage. However, there are options if their current plan is not a good fit.
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.
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