Do’s and Don’ts Of Medicare Compliance

Before you can begin selling Medicare, you must first get your license to sell Medicare products, followed by certifications from carriers to sell Medicare Supplement Plans. But after all that, there is still one more thing to be aware of before you’re ready to sell. You need to know how to remain compliant with all the rules surrounding Medicare sales. In order to show your commitment to honesty and integrity, as well as to fulfill your legal duty and contractual obligations to sell Medicare, you have to be compliant with the following rules in all of your interactions with customers. Here are some simple do’s and don’ts to help you stay in compliance.

Medicare Compliance For Selling

When Selling Medicare:

DO:

caucasian man with a white button up sitting down filling out a form
Before contacting a lead, make sure to fill out a Scope of Appointment.
  • Make sure that you have Permission To Contact the prospect. Agents are not allowed to make unsolicited phone calls or send emails to prospects without having an opt-out option. In order to obtain permission to contact, you must use a lead provider like Benepath, who will have prospects/leads sign a form that says they agree to be contacted by an agent.
  • Complete a Scope Of Appointment form before each face-to-face appointment and/or one-on-one phone conversation. These forms outline exactly what you’ll be talking about with your client during a meeting. Per CMS, you must keep these forms on file for at least 10 years, even if your conversation did not end in a sale.
  • Report any suspected violations to the Medicare Compliance Hotline toll-free at 1-877-211-2290.

DON’T:

  • Engage in door-to-door marketing or sales
  • Use high pressure sales tactics
  • Engage in outbound telemarketing or email campaigns
  • Discuss with prospects any products that are not specified in their Scope of Appointment form
  • Engage in any discriminatory activities, such as conditional enrollment based on a prospect’s mental illness, physical illness, or disability

Medicare Compliance For Marketing

CMS also has regulations in place for marketing, educational events and sales event presentations.

DO:

illustration of a man in a suit talking to a group of people sitting down.
When marketing, you can distribute educational materials at an event that are not plan-specific as well as your business cards.
  • Wait until October 1 to begin marketing next year’s plans to potential customers
  • Distribute educational materials that are free of plan-specific information
  • Give out your business card and contact info
  • Collect Scope of Appointment forms
  • Hold your event in a public venue

DON’T:

  • Attempt to mislead your clients, willingly or unwillingly
  • Use the word free to describe $0 premiums
  • Serve meals at sales events
  • Pressure attendees at events to complete a sign in, it must be optional
  • Distribute plan-specific materials at an educational event (only do this at sales events)
  • Discuss any carrier-specific plans or benefits at educational events (only do this at sales events)
  • Cross-sell or promote health-related products at events

It is important that you follow these rules for Medicare compliance set by CMS, or you risk violations, and you may lose your ability to sell Medicare if you are reported. If you are looking for leads that have given permission to contact, Benepath will provide these leads exclusively to you. We give you exclusive real-time leads when you want them. To find out more information, call 866-368-0377.

6 Things You Need To Know About Selling Medicare Supplement Plans

Did you know that more than 10,000 people in the United States turn 65 every day? For insurance agents, that can mean a lot of sales if you get into selling Medicare Supplement Plans. In order to create long-term sustainability for your business, you will need a residual income, and there is no better way to ensure this than by selling Medicare Supplement Plans. If you work hard enough, you could even see a six-figure residual income in as little as three to four years. In order to sell Medicare Supplement Plans, there are 6 things that you absolutely have to know.

illustration of an ambulance
Medicare covers ambulance services, doctor visits, and more.

1. How Medicare Works

In order to completely advocate for a customer, you have to be knowledgeable about the product you are selling. Medicare is divided into 2 parts: Part A (hospital insurance) and Part B (medical insurance). Part B covers essential medical expenses including:

  • Ambulance services
  • Doctor visits
  • Lab tests
  • Cancer screening
  • Diabetes screening
  • Rehabilitation
  • Durable medical equipment

Parts A and B cover 80% of costs after deductibles and coinsurance, and the other 20% is paid by the beneficiary out-of-pocket. However, if they purchase a Medicare Supplement Plan, it will cover that 20%.

Beneficiaries are automatically enrolled in Part A, but they need to sign up for Part B during their Initial Enrollment Period, which includes the 3 months before the month they turn 65, the month they turn 65, and the three months after they turn 65. If they do not sign up for Medicare Part B during this period, they will have to pay a late enrollment penalty of 10% for every year they delayed enrollment. The only way they can avoid this penalty is if they are still insured through an employer’s health insurance plan.

2. Medicare Supplement Open Enrollment

The Initial Enrollment Period mentioned above is also the best time for someone to purchase a Medicare Supplement Plan. Technically, a customer can sign up for a Medicare Supplement Plan whenever they want, but if they do not sign up during their Initial Enrollment, then they will face medical underwriting. They can then end up being denied or charged more due to pre-existing conditions.

3. What Medicare Supplement Plans Cover

bag full of dark red blood laying on a table with tubes
Medicare Supplement Plans help cover some things Medicare does not cover, such as blood transfusions.

Medicare Supplement Plans cover the 20% gap that Original Medicare does not pay for. What’s unique about these plans is that they cover health and wellness benefits that Medicare doesn’t cover at all. This includes:

  • Medicare Part A deductible
  • Part B excess charges
  • Coinsurance and hospital costs for up to one year after Medicare benefits are used up
  • Blood transfusions for up to three pints of blood
  • Hospice care coinsurance or copayment
  • Skilled nursing facility care coinsurance
  • Medical costs incurred while traveling outside of the U.S.

In addition, Medicare Supplement Plans K and L have annual out-of-pocket limits. Once you reach the plan’s limit, Plans K and L cover 100% of covered out-of-pocket expenses for the rest of the year.

4. What Medicare Supplement Plans Do NOT Cover

older asian man looking at a pill bottle in his hand with other bottles sitting on the table in front of him
Unfortunately, there are some things Medicare does not cover, such as prescription drugs.

Although Medicare Supplement Plans cover some services that Medicare does not, that does not mean that these plans cover everything. Medicare Supplement Plans do not cover:

  • Dental care
  • Eye exams
  • Eyeglasses
  • Hearing aids
  • Prescription drugs
  • Long-term care

5. When Medicare Supplement Plans Are Accepted

If a doctor accepts Medicare and Medicare assignment, then they will accept Medicare Supplement Plans as well. They can be used for treatment by any doctor, whether in-network or out-of-network. This makes these plans a great option for people who travel.

6. The Difference Between Plans & How to Switch Plans

There are 10 different Medicare Supplement Plans; the difference between all of them is the coverage that they offer and their price points. A letter identifies each Medicare Supplement Plan: A, B, C, D, F, G, K, L, M, N. Not all states offer all Medicare Supplement Plans, so you’ll have to know what plans are available for customers in your state.

chart of the different medicare supplement plans coverage

***Plans C, Medigap Plan F, and high-deductible Plan F are no longer available to seniors who became eligible for Medicare benefits on or after Jan. 1, 2020.

If your customer already has a Medicare Supplement Plan and wants to switch to a different plan, the only way that they can get the best price is if they pass the set of health questions the insurance company provides. If the customer is within their 6-month Medicare Open Enrollment, or if they have had their current Medicare Supplement Plan for less than 6 months, then they can bypass the underwriting process. If they are not switching within this time frame, then the company can charge them more or deny coverage due to pre-existing conditions.

5 Mistakes Medicare Agents Make

A good agent knows that they can only succeed with the help of their customers. Customers look to agents for help finding a plan that meets their needs without breaking the bank, and that is what you aim to do. But your work doesn’t stop there: you need to be constantly learning and educating, as well as connecting with your clients. Here are 5 costly mistakes to avoid, along with tips to keep you at the top of your game.

picture of caucasian hands on a laptop keyboard with "never stop learning" on the screen
It is important to never stop learning because Medicare is always evolving, and you need to be able to provide accurate information to your customers.

1. You Stop Learning/Training

When you’re an agent, there is no such thing as knowing too much about a product, and that includes Medicare. Medicare is always evolving, and you need to be able to provide accurate information to your customers. Plans can change, or even disappear, while new ones emerge. For example, Plan F, High-Deductible Plan F, and Plan C all disappeared this year, while High-Deductible Plan G was introduced to replace them. If you do not keep on top of information like this, then you won’t be able to properly sell your product. Work towards becoming an expert in your field by constantly learning with online courses and training webinars.

Even when you do become an expert in this field, you still need to keep up with company notices. If there are any changes such as rate increases, then you need to notify your customers on how they will be impacted.

2. Failing To Educate Your Customers

Your job is to help customers completely understand their insurance plan. The whole process of choosing and signing up for a plan can be confusing, so explain everything as simply as you can. Go over what is covered, what is not, and how Medicare Supplement Plans work with Original Medicare. Don’t assume they know as much about everything as you do! The more you educate them on how the system works, the more likely they will be to spot an issue on a bill or handle a problem on their own. Educated customers are happy customers – ones who will continue to use your services as well as refer you to others.

3. Not Following The Rules

caucasian man writing "know the rules" on a piece of paper pinned against the wall.

If you do not follow the rules that the CMS has set for agents, then you could lose your license to sell Medicare Supplement Plans. The CMS is very serious about monitoring agents and will monitor agents to make sure that they are being helpful to Medicare customers and not taking advantage of anyone. Breaking their rules could even mean facing jail time.

4. Not Knowing Guidelines

CMS is strict about agents complying with rules and regulations, and so are the carriers you work with. Carriers have additional guidelines that you have to follow, and if you fail to comply, then you can lose your business with them. Make sure you stay on top of the guidelines of all the carriers you work with.

green price tag with money symbol on it.
If you focus too much on price, and not your customers’ needs, you could end up losing sales.

5. You Focus Too Much On Price

If you focus too much on price, and not your customers’ needs, you could end up losing sales. Sell based on value, not price. Teach your customers the value of a Medicare Supplement Plan, and ask questions about what they are looking for. Ask questions and answer any of theirs that may come up. And always check on your customers to make sure they are happy with their plan, or if they might be interested in finding a different Supplement Plan.

2020 Medicare Changes You Need To Know About

New Medicare changes that will impact both current and future beneficiaries have now gone into effect. Keep your clients informed and help them make the best choices by staying up-to-date on these changes.

Increased Medicare Deductibles & Premiums

caucasian hand with a marker drawing an upwards arrow
Medicare premiums and deductible rates have gone up.

The first change to note is an increase in Medicare Part B premiums and deductibles. The new rates are:

  • Medicare Part A Hospital Deductible for the first 60 days of inpatient hospital care in a benefit period has gone up $44 from 2019 to $1,408.
  • Medicare Part A Deductible for a Skilled Nursing Facilityfor days 21-100 has gone up $5.50 per day since last year. The cost is now $176 per day.
  • Medicare Part B Deductible has gone up $13 from 2019 to $198.
  • Medicare Part B Premiums have gone up $9.10 from 2019. Premiums are now $144.60 a month.
  • Coinsurance for the 61st-90th day of hospitalization in a benefit period has gone up $9 per day from 2019, now costing $352 per day. For lifetime reserve days, coinsurance has gone up $22 per day from 2019, now costing $704 per day.

New IRMAA Bracket

In 2019, the income threshold for Medicare’s IRMAA (income-related monthly adjustment amount) was $85,000 for an individual and $170,000 for a couple filing taxes jointly. The threshold in 2020 has risen to $87,000 for individuals and $174,000 for couples.

No More First-Dollar Coverage Plans

One big change for Medicare this year is the disappearance of first-dollar coverage plans. Medicare Supplement Plans C, F and High-Deductible Plan F, which are considered first-dollar and all have zero out-of-pocket costs, will no longer be offered to new Medicare beneficiaries. Seniors who were on Plans C and F prior to 2020 will be allowed to stay on their plans.

Congress is hoping to save money by getting rid of these plans. They feel that Medicare beneficiaries may overuse healthcare services if they aren’t paying any out-of-pocket costs, so now all plans will be required to have a deductible. The hope is that beneficiaries will think twice about unnecessary doctor visits, which will help cut down on Medicare spending.

One alternative to these plans is Plan N, which is a cost-sharing plan. Beneficiaries will have a copay of up to $20 for doctor visits and $50 for emergency room care. Urgent care visits have no copays. Plan G is also a good option because it is most similar to Plan F. It offers most of the benefits of Plan F but with lower premiums.

New High Deductible Plan G Is Herenew pwroduct sign in red with yellow outline of the sun behind it

High-deductible Plan G is the 2020 replacement for the disappearing High-Deductible Plan F. High-Deductible Plan G’s deductible is $2,340 for the year (the same deductible as High Deductible Plan F), and any beneficiary can sign up for it whether or not they were “Medicare -eligible” before 2020.

The main difference between High Deductible Plan F and High Deductible Plan G will be the coverage options. Currently, HD Plan F covers the Part B deductible, whereas HD Plan G doesn’t. The benefits a beneficiary will receive with this new plan are:

  • Part B excess charges
  • Foreign travel emergency (up to plan limits)
  • Skilled nursing facility care coinsurance
  • Part A hospice care coinsurance or copayment
  • The first 3 pints of blood received
  • Part B coinsurance or copayment
  • Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
  • Durable Medical Equipment (DME)

Selling to seniors via video conferencing

The unaddressed truth behind Covid-19 is that until we get a vaccine, those of us who have an increased risk of serious health problems are going to need to remain socially distant even after the spike subsides. While a therapy for the virus could be found as early as June, a vaccine is much further away, with most experts looking at the end of 2020.

Adjusting to the times

For a variety of reasons, many of you prefer to sell face to face, and right now you can’t, for the safety of yourself and your clients.

You are left with one of three choices:

  • Stop selling
  • Sell over the phone
  • Sell over video

Why Video Conferencing

Seniors are not as tech-illiterate as many people think. In a study done by Amwell Health Solutions, data showed that 45% of American seniors have participated in video calls using FaceTime, Skype, and/or Google Hangout. Some seniors are even catching up to the new Zoom movement, using it to talk to their family and friends.

73% of seniors claim that faster health related services, such as insurance consultation, are the driving reason for their willingness to use video conferencing. Seniors have the will to participate, you just have to add this to your toolkit.

While calling could get the job done, you are missing an important layer – the visual cues. With phone calls we miss 50% of the conversation because you can’t see how the person you are talking to is responding. Video conferencing eliminates that limitation.

How do you do it?

So, how do you get seniors on the screen, not just on the phone? The first secret is that you have to make it easy. Best practice is to just have them click on a link you emailed them. You’ll probably need to include instructions on how to find the link, but the more simple you make the process, the more success you will have.

Ask the senior if they have used to using Hangouts, FaceTime or Skype. These popular systems are the most common, and you should adapt to their preferences. By adapting to their preference, the success rate of your calls will be significantly higher. While this may involve more flexibility on your end, it will undoubtedly benefit you in the long run.

The question “why you are taking meetings this way?” will come up, and be honest with them. Tell them it is to keep them safe in today’s environment. This expresses that you care about them as a person, not just a client, helping your overall rapport.

In conclusion

By incorporating live video into your sales process you’ll be able to:

  • See your customer’s visual cues
  • Share and go over your quality presentation materials
  • Build a deeper relationship with your customer
  • Make more sales!

And if you need help matching with Medicare insurance prospects, don’t hesitate to give us a call at 866-368-0377.

Medicare: The Gift That Keeps On Giving

Selling Medicare Supplement plans is a very rewarding job. Not only do you get to help seniors save money, but you get a residual income. In other words, Medicare is the gift that keeps on giving. But how?

Medicare Sales At All-Time High

man's hand with a blue marker going up in a line. the words "revenue"
Selling Medicare Supplement plans can give you a continuous revenue.

The AARP has found that each day 10,000 Baby Boomers turn 65 in America, a figure expected to continue well into the 2030’s. This is great news for Medicare agents. Many seniors cannot afford their Medicare Part B bills because they are on a fixed income, so they search for ways to help pay for it. This is where you come in to save the day with a Medicare Supplement plan. With the growth of the aging population, and increase in Medicare sales, there is no better time to sell Medicare!

Seven Years Of Commission

You read that right, when you make a Medicare Supplement sale, you will have a built-in commission for 7 years. This is where the residual income comes into play. Once you sell a Supplement plan, clients are commonly re-written year after year.

Let’s take a look at an example to simplify things. When you first make a sale, you spend $400 on leads to make that sale, and make a commission of $400. But because the consumer will likely sign (on average) for 8 years, there are 7 years worth of profits that can be made on that one sale. That equates to a $2800 profit for the life of that sale. So even though you have spent money on marketing and buying the lead, you still make that money back and more. You’re constantly winning.

The example below represents the residual income you could make over the years, assuming that you’re making $30,000 in new commissions each year:

Maintain Your Relationships!

Although you can keep earning a commission for 7 years, you can’t just forget about your customers. People are more willing to buy from someone they know and trust. Be sure to follow up with your clients to make sure they are happy with your product, and keep the relationship going. Some may want to make changes to their plans or enroll in a new plan. You want to make sure you are the one they turn to when this happens, so that you get the commission.

Do not snooze on Medicare Supplement sales or on your current clients. Medicare sales are through the roof because of the aging population. If done right, you will earn a 7 year commission on just one sale. Medicare leads are the gifts that keep on giving even after you spend your marketing dollars to acquire them.

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