Published by Carolyn Portanova and Cassandra Bennett

Becoming an independent insurance agent is a great career path and if you’re contemplating entering the senior healthcare market, you get the fulfillment of assisting seniors with their healthcare coverage. And when it comes to the senior healthcare market, Medicare is at the top of the list. Even if you’re a veteran and have been offering Medicare solutions for years to your clients, it can still be complicated. So, let’s discuss the top five mistakes new agents make and how to avoid them.

1. Confusing Open Enrollment vs. Guaranteed Issue
2. Not asking enough probing questions on underwritten cases
3. Using the wrong application
4. Using an invalid enrollment period or anniversary/birthday rule
5. Leaving a client uninsured when switching plans

​Confusing Open Enrollment vs. Guaranteed Issue
Many times, the terms Open Enrollment and Guaranteed Issue are used interchangeably. Much of this is because in both situations a client can acquire a new Medicare Supplement plan without undergoing Medical Underwriting. CMS and the carriers’ definitions of Open Enrollment and Guaranteed Issue are two different things.
 
An Example of a Client in their Open Enrollment Period:
Mr. Stewart is turning 65 and signs up for Part B and wants to purchase a Medicare Supplement plan. He is within his six-month Open Enrollment period (within 6 months from his Part B effective date) and can purchase a Medicare Supplement plan without any medical underwriting.
 
An Example of a Client Who is a Guaranteed Issue:
Mr. Smith signed up for Medicare Part B at age 65, but his wife is still working (more than 20 employees) and has great health benefits. Mr. Smith decides to enroll in Medicare Part B and remain on his wife’s health plan. Three years later when he is age 68 his wife retires, and they lose their group health coverage. Now Mr. Smith (and his wife) needs to sign up for a Medicare Supplement policy. He is no longer in that six month
period when he signed up for Part B and no longer qualifies for Open Enrollment. Instead, he is a Guaranteed Issue situation, and can only sign up for plans A, B, C*, D*, F*, G,*, K or L that are sold in his state by any insurance company (per MACRA rules).
 
Guaranteed Issue in Medicare Supplement Terms:
is defined as the rights a client has in certain, special situations when insurance companies are required to sell or offer the client a Medicare Supplement policy (these rights are listed in the 'Choosing a Medigap Policy’ booklet.
 
*Plans C and F are no longer available to people new to Medicare on or after January 1, 2020.
However, if your client was eligible for Medicare prior to January 1, 2020 (but not yet enrolled), they may be able to purchase Plan C or Plan F. People new to Medicare on or after January 1, 2020, have the right to purchase Plans D and G instead of Plans C and F.

​Not asking enough probing questions on underwritten cases
When a client must answer health questions to be considered for a Medicare Supplement policy it’s imperative that you ask questions and get detailed answers about the status of their health. Insurance companies have certain lookback periods that they use to determine whether a client will pass Underwriting. If you don’t have a thorough understanding of their current (and past) health situation, it causes delays with the application process. Keep in mind, you can always call the Underwriter to ask if the application should be submitted and you can also use the Underwriting feature in our quoting tool to see if your client will qualify.
If you’re selling Medicare Advantage plans, you don’t have to worry about asking probing health questions. Medicare Advantage plans are required to accept any Medicare eligible applicant regardless of health status.

​Using the Wrong Application
The easiest way to submit applications is electronically to avoid any issue with using an outdated or incorrect application. However, there are times when a paper application may be necessary. To avoid any complications, it’s important to make sure you’re using the correct application for your client. Always double check the carrier’s forms and materials to ensure you’re using the most up-to-date paper application to avoid any delays and headaches.

​Using an Invalid Period and/or Anniversary/Birthday Rule
Below we’ll go over the different enrollment periods and Anniversary and Birthday rules that are state-specific. It’s important to understand the differences and to know when your client can enroll or dis-enroll.
Medicare Annual Enrollment Period (AEP)
AEP runs from October 15th through December 7th each year. During this time, Medicare-eligible individuals can:

• Change from Original Medicare to a Medicare Advantage plan (or vice versa)
• Switch from one Medicare Advantage plan to another Medicare Advantage plan
• Switch from a Medicare Advantage plan that doesn't have drug coverage to one that does (or vice versa)
• Join a Medicare Prescription Drug Plan (PDP)
• Switch from one Prescription Drug Plan (PDP) to another

 
Initial Enrollment Period (IEP)
The Initial Enrollment period is a seven-month period when someone is first eligible for Medicare (Parts A and B). For those eligible due to age, this period begins three months before they turn 65, includes the month they turn 65, and ends three months after they turn 65. During this time, they are also eligible to enroll in Part D (Prescription Drug Plan) or Part C (Medicare Advantage Plan). If a consumer misses their Initial Enrollment Period, they may have to wait to sign up and will be
liable for late enrollment penalties. For those eligible due to disability or certain qualifying circumstances dates are calculated differently.
 
Medicare Advantage Open Enrollment Period (MAOEP)
Between January 1st and March 31st each year, individuals enrolled in a Medicare Advantage Plan (MA or MAPD) can:

• Switch to another Medicare Advantage Plan (with or without drug coverage).
• 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.
• Switch to another Medicare Advantage Plan (with or without drug coverage) or go back to
• Original Medicare (with or without drug coverage) within the first 3 months they have Medicare.

 
Special Enrollment Period (SEP)
Special enrollment periods are enrollment periods outside of the usual IEP, AEP or OEP when an individual may enroll in a plan or change their current plan. There are various types of SEPs, including SEPs for dual-eligibles (those enrolled in both Medicaid and Medicare), and for individuals whose current plan terminates, who change residency and who meet exceptional conditions. Depending on the nature of the special enrollment period, an individual can:

• Discontinue an enrollment in a Medicare Advantage (MA) plan and enroll in Original Medicare
• Switch from Original Medicare to a Medicare Advantage plan
• Switch from one Medicare Advantage plan to another MA plan

 
Medigap Open Enrollment Period (MOEP)
Medicare eligibles have a six-month open enrollment period that begins the month they turn 65 or older and are enrolled in Part B. During this one-time open enrollment period, they can enroll in a Medigap (Medicare Supplement plan) regardless of their health status, and they cannot be denied coverage. If they do not enroll during their six-month enrollment period, they will have t to answer health questions, may pay higher premiums and may be denied coverage all together.
 
Anniversary/Birthday Rule
Medicare Supplement enrollees can change their Medicare Supplement plan in certain states to another plan of equal or lesser benefits around the date of their anniversary/birthday each year without answering health questions. If your state does not have an underwriting exception such as the Medigap Birthday Rule, your client will likely have to go through underwriting. You must refer to the state’s and carrier’s rules regarding enrolling your clients under a Birthday or Anniversary rule.

​Leaving a Client Uninsured When Switching Plans
When moving a client from one plan to another it’s crucial to ensure that your client has coverage during the transition period. Not using the proper time frame set forth by the carrier or criteria to move a client can be disastrous. Each carrier has very specific rules about transitioning your client from one policy to another and they’re also state specific. Be sure to thoroughly go over all the parameters when it comes to re-writing your client into a new policy.
 
The world of Medicare can seem daunting to seniors and to new insurance agents as well, but with the proper training and education - and an FMO who will be there for you to answer any questions you may have - you’ll be destined for great success. Reach out to us today if we can assist you on your Medicare journey.

Published by Carolyn Portanova

When you have a client who needs to go through underwriting for a Medicare Supplement policy it's important to interview them beforehand. Typical health questions on a Medicare Supplement application will ask if your client has ever had certain health conditions during a specific period, and generally that look back period is two years. Every carrier is different and has their own specific underwriting guidelines, so it's important to know them before applying. Oftentimes answering "yes" to certain health questions can result in an automatic decline. To prevent that from happening, be sure to get a complete picture regarding your client's health. Below is an example of a typical underwriting question on a Medicare Supplement application:

​In the past two years have you been diagnosed with or treated for any of the following conditions?

• Atrial Fibrillation
• Cancer
• Chronic Obstructive Pulmonary Disease (COPD)
• Diabetes - Type 1 or 2
• Heart Conditions
• Hypertension
• Rheumatoid Arthritis
• Stroke

Certain conditions such as minor high blood pressure and even high cholesterol are typically not an issue for a Medicare Supplement application. Being overweight is also not usually an issue, if your client is not morbidly obese. 

Some insurance carriers require that a certain window of time has passed after a major surgery, before accepting an application. If your client has had recent surgery or is still being treated, you should wait before submitting the application. If your client has been hospitalized in the last few years, is receiving home health care, or if they live in a nursing home, they may also be declined for coverage. Again, every carrier is different, and you need to check their Underwriting guidelines.

​When it comes to cancer, Medicare Supplement carriers usually want your client to be cancer-free for at least two years before they will accept them. However, there are certain carriers who will approve clients with cancer or other serious conditions, but they will charge higher rates for coverage. Therefore, it's wise to run quotes for multiple carriers and review their underwriting guidelines to determine the best course of action.

Diabetes is a condition that could result in a decline, but it depends upon the situation. Underwriters look at the entire picture. For example, if your client has diabetes and high blood pressure and high cholesterol, it's much harder to get approved than if they just have diabetes without any other health conditions.

​It's important to advise your client that insurance carriers have access to national records with regards to prescription history. Encourage your client to remember any and all medications they've been prescribed. Reviewing their medical history is incredibly important. If their doctor has previously prescribed a medication for a certain condition, and you don't mention it on the application, that’s a red flag in the underwriting system. Even if your client never filled the prescription or never took the medication, it needs to be explained.

​When you're ready to submit the application be sure to make the policy effective date a few weeks in advance. This gives the Underwriter plenty of time to review the application and the answers to the medical questions. After the application has been reviewed, an Underwriter will call your client to conduct a phone interview which is a very important part of the decision process. It's important to remind your client to simply answer the questions that the Underwriter asks. Volunteering additional information or over-sharing could cause problems with the application process.

Be sure to let your client know that it's important NOT to cancel any current coverage until after you've been notified that their application was approved. Once it's approved, they will need to call and cancel their existing coverage. 
 
If your client gets denied, it's worth exploring other carriers. Always keep in mind that your client may be better off keeping their current coverage. In addition, remind them that there are no repercussions for applying for a new Medicare Supplement policy in the future.

If you have questions regarding underwriting, please reach out to us and we'll be happy to assist you.

Published by Carolyn Portanova

If you're not discussing Plan N with your clients, it's time to start. Why? It has very similar coverage to Plan G, which is clearly one of the most popular Med Supp plans out there, next to the Plan F. If your clients are unable to purchase a Plan F due to MACRA, then you may tend to encourage them to purchase a Plan G. And that's always been a smart move. However, the differences between Plan G and Plan N are as follows:

• Plan N requires policy holders to pay the Part B deductible ($240 in 2024)
• Plan N requires policy holders to cover the cost of any copays (up to $20 for some office visits and up to $50 for ER visits)
• Plan N requires policy holders to pay any Part B excess charges (15% more than what Medicare covers).

Here's where it gets really interesting though. The vast majority of Plan N policy holders never end up paying the Part B excess charges because nearly every doctor in the U.S. (96%) who accepts Medicare, only charges the amount Medicare has approved for their services. So what does that mean? It means that your Plan N clients will likely only pay the cost-share copays and the Part B deductible.

Let's dig a little more into the Plan G vs. Plan N discussion. 
If your clients purchase a Plan N:

• they will have nearly identical coverage to Plan G
• their premiums will definitely be lower
• they will likely not experience rate increases as quickly as those with Plan G
• their out-of-pocket costs will be the Part B deductible and any copays they may incur​

*Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in admission.

Consider offering Plan N to your clients and carefully explain to them the cost differences, and how in the end, Plan N might be their better option, especially if they don't visit the doctor frequently. In the end, they could wind up saving more money over a Plan G and have the best coverage for their needs.​

Published by Carolyn Portanova

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:

• 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.

​​​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.