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Medicare Blog | Medicare News | Medicare Information

Will CMS Policy Changes Have an Impact on the Healthy Age-in Market?

Posted by www.psmbrokerage.com Admin on Thu, Oct 04, 2018 @ 04:40 PM

Will CMS Policy Changes Have an Impact on the Healthy Age-in Market?


For many years Deft Research studies have shown that persons who are aging into Medicare coverage are equally likely to gravitate toward Supplemental Medicare (aka, Med supp) products and Medicare Advantage (MA) products. The primary reasons for Medsupp remaining attractive despite its price disadvantage are its unrestricted access to doctors and hospitals, and the simplicity of coverage terms leading consumers to feel more certain about what they are buying. Suspicion and lack of trust in Medicare Advantage’s detailed list of provisions and restrictions drives many away. 

But in coming years, Medicare Advantage product designers will have opportunities to restore trust among consumers.  And if they do, they will steer more market share toward these plans.  For the MA 2019 contract year, the Centers for Medicare and Medicaid Services (CMS) has promulgated new policies allowing MA plans to offer more supplemental benefits and allow more flexibility in how benefits are offered. The new policies create opportunities for MA plans to meet a wider set of consumer needs.  However, getting consumers to react to the term “coordinated care” and communicating health care value to consumers is difficult. It remains to be seen whether those new to Medicare – the age-ins – will recognize the value and be more likely to select MA over Medsupp.   

From a high altitude, the new policies enable MA plans to include supplemental benefits in their health plan designs.  This conjures visions of greater care coordination, more differentiated products, stronger relationships with providers, and increased opportunities to promote wellness and reduce costs. 

CMS outlines two sets of criteria for supplemental benefits to be accepted as health-related and appropriate for inclusion in an MA package. A supplemental benefit must be “used to diagnose, prevent or treat an illness or injury, compensate for physical impairments, act to ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and health care utilization.”  Secondly, the benefit must be “medically appropriate, focus directly on the enrollee’s health care needs and be recommended by a physician or licensed medical professional as part of a care plan.” 

In advance of the June bids, there were several areas of supplemental benefits that CMS stressed (and no doubt these were subsequently emphasized in the health plan bids submitted).

  • Adult Day Care Services– these are services for adults who need a safe place to be during the day when other caregivers may not be available. The health status of the consumers using ADCS varies, but the service tends to be used by persons with some health problem that requires at least monitoring or assistance. 
  • In Home Support Services and Home-based palliative care– are services performed by personal care attendants to help persons with activities of daily living, and/or provided by health professionals to diminish pain and other symptoms in very ill persons, and/or enhance bathrooms and other areas of the home to reduce the risk of injury. 
  • Transportation– must be used to accommodate an enrollee’s heath care needs and, for this discussion, is not an emergency service. Missing appointments and failure to fill prescriptions are common signals that health problems are not managed, prevented, or addressed as well as could be.  By making travel more convenient, a transportation service can contribute to better health. 

MA companies are excited about the CMS allowance of greater flexibility on offering benefits. 

For health plans, this means benefits can be offered to targeted populations, and generate a greater return on investment. This prompts greater sustainability of programs. Health plans will be able to reduce cost sharing for certain covered benefits, offer tailored supplemental packages targeted for specific populations, and reduce deductibles for beneficiaries that meet specific medical criteria.  

Other supplemental benefits exist beyond what is outlined here. Many of the supplementals and new flexibility CMS address the needs of consumers who are quite ill. So how could these changes affect the broader Medicare market? There are three ways that new age-ins’ can be made more likely to consider a Medicare Advantage plan. 

  1. By being different. The changes are enough to signal to age-ins that MA is no longer the same old deal.  The new offerings change the old value proposition. 
  2. By presenting higher value. Studies show that presenting a “Cadillac” plan containing extended benefits generates more attractiveness even though consumers may not need the benefits at the time of purchase. 
  3. By generating more trustworthiness. Extended supplemental benefits can be positioned to support the promise that, “we will take care of you if the worst happens.”  They help reduce the worry that a managed care plan limits services and won’t deliver in a time of greatest need.  They show that the health plan is organized to provide a complete package to meet every need, thereby offering a proof of trustworthiness

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Tags: Medicare Advantage, Medicare, Medicare Supplement, med supp

Medicare Drug Premiums to Rise for Second Year

Posted by Jeremy Davis on Fri, Aug 08, 2014 @ 11:13 AM

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Medicare says premiums for prescription drug plans will rise in 2015 for the second year in a row. Officials said Thursday that Medicare's average monthly drug premium will rise next year to $32. The modest increase of $1 a month comes amid worries over the future impact of costly new medications.

Sovaldi, for example, cures hepatitis C but costs $1,000 a pill. Most Medicare beneficiaries have prescription drug coverage. But consumers should pay attention because the average premium says little about what any one person pays. Premiums change every year, so consumer advocates say beneficiaries should check their plan during open enrollment, from Oct. 15 to Dec. 7, and seek better deals if they're not satisfied.

This year, the average premium also went up by $1, after three stable years.


Source: miamiherald.com

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Tags: Medicare Supplement, med supp, medicare drug premiums, healthcare costs rise

Gingrich's Correct Prediction About Medicare's Future

Posted by Jeremy Davis on Fri, Jul 11, 2014 @ 09:04 AM

Medicare Supplements

On Oct. 24, 1995, Newt Gingrich made an assertion about what would happen to Medicare if its beneficiaries could choose between it and private plans. Medicare is “going to wither on the vine because we think people are voluntarily going to leave it — voluntarily.” Over the nearly two decades since, Mr. Gingrich’s claim has undergone something of a test — and it has largely passed it.

Today, 30 percent of Medicare beneficiaries are enrolled in a Medicare Advantage plan, more than at any time in history. What explains the growing popularity of private Medicare plans? One answer is that baby boomers, who are just entering Medicare-eligibility age, are more accustomed to the types of insurance Medicare Advantage offers, such as H.M.O.s, than their predecessors were.

Given a choice between traditional Medicare or more benefits from more highly subsidized private plans, Medicare beneficiaries may well be willing to let the former wither on the vine.


Source: nytimes.com

Additional Updates:
  • 2015 Medicare Advantage Plan Benefits and Certification Details Coming Soon

Tags: Gingrich Medicare Prediction, Medicare History, Medicare Supplement, med supp

Happy Independence Day from PSM

Posted by Jeremy Davis on Wed, Jul 02, 2014 @ 09:15 AM

Medicare Supplements

In honor of our country and forefathers, we've gathered a few classic patriotic quotes for you to take in during this 4th of July holiday.

As a reminder, PSM will be closing Thursday at noon and will be closed all day Friday in observance of the holiday.

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness."
                                                                       - Thomas Jefferson

"They that can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety."
                                                                       - Benjamin Franklin

"Idleness and pride tax with a heavier hand than kings and parliaments. If we can get rid of the former, we may easily bear the latter."
                                                                       - Benjamin Franklin

"I am well aware of the toil and blood and treasure it will cost us to maintain this declaration, and support and defend these states. Yet through all the gloom I see the rays of ravishing light and glory. I can see that the end is worth all the means. This is our day of deliverance."
                                                                       - John Adams

"We must all hang together, or assuredly we shall all hang separately."
                                                                       - Benjamin Franklin

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Tags: Medicare Supplement, med supp, 4th of July Quotes, Independence Day Quotes

12 Things to Know About Seniors and Retirement

Posted by Jeremy Davis on Thu, Jun 26, 2014 @ 02:15 PM

Medicare Supplements

They are seniors who haven’t retired yet because they like to work; they are still paying for the house of their dreams; they won’t downsize their homes; and they believe that the 2008 economic crisis has made them stay longer in the workforce. However, they are optimistic about pulling through and having enough on their retirement plan.

These results are part of Retirement Advisor’s 2014 Senior Survey, which interviewed more than 200 seniors. The survey revealed that 60 percent of seniors have financial advisors, and 64 percent of them look primarily for an advisor they can trust. In contrast, 78 percent said that they dislike or avoid advisors who are too pushy, while 10 percent said they avoid those who are too expensive.

According to the survey, a whooping 56 percent are confident or very confident that their current financial and health conditions will help them meet their retirement goals, while 30 percent are somewhat confident. Just nine percent are not confident they will meet their financial retirement goals.

And how did the economic downturn affect seniors' plans? While 42 percent didn't specify or selected "other," 31 percent noted it kept them working longer than they would like, 18 percent said that it made them lose faith in financial institutions, and nine percent said they had to turn their 401(k) into a 201(k).

12 things about seniors retirement


Source: lifehealthpro.com


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Tags: Medicare Supplement, med supp, retirement advisors survey

5 Ways to Sell to Seniors

Posted by Jeremy Davis on Fri, Jun 20, 2014 @ 08:14 AM

Medicare Supplements

As longevity increases and more Baby Boomers advance into their senior years, those 65 and older are the most prevalent demographic on many advisors’ prospecting lists. With such a large pool of potential clients looking for retirement and financial advice — and also likely to make referrals to their friends and family — you can’t afford to miss the mark. Try these strategies on for size:

  1. Differentiate yourself online: You might think digital marketing is most effective when targeted towards younger generations, but a 2014 Pew Research Center study shows that 59 percent of seniors today are increasingly Internet savvy.
  2. Be an educator: By providing education to the senior community, advisors establish themselves as experts and earn credibility and trust.
  3. Be available to communicate often: Meaningful conversation is a surefire way to earn a senior’s trust, whether you’re discussing their finances or their children and grandchildren.
  4. Be patient, not pushy: Many times, people get impatient when they’re working with seniors, and it’s the first thing that will kill a sale.
  5. Make your business senior-friendly: Your office and presentation style should be tailored to seniors; handicap access, for example, speaks volumes to your elderly clients when they meet with you for the first time.

Source: lifehealthpro.com


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Tags: Medicare Supplement, med supp, tips on selling insurance to seniors

7 Secrets of Success!

Posted by Jeremy Davis on Fri, Jun 13, 2014 @ 09:39 AM

Medicare Supplements

There are certain secret habits practiced every day by all the highest-paid salespeople. The regular pursuit of these habits virtually guarantees your movement to the top of your field. Here are 7 simple secrets for achieving your career goals:

  1. Get serious. Make a decision to go all the way to the top of your field. Make a decision right now to join the top 10 percent. There is no one and nothing that can hold you back from being the best and achieving your career goals—except you.
  2. Determine your weakness. Identify your weakest single skill and vow to become absolutely excellent in that area. Ask yourself “What one skill, if mastered, would have the greatest positive impact on my sales?” Write down the answer, set a deadline, make a plan and work on it every single day. This one decision can change your entire career.
  3. Get around the right people. Get around successful people who have a positive attitude. Associate with people who are pursuing their own goals. Remove yourself from those who are negative, critical or complaining. They will drag you down, tire you out, distract and discourage you. You don’t need that.
  4. Take care of your physical health. You need high energy levels to sell effectively and bounce back when rejection does occur. Be sure to eat the right foods, exercise and get plenty of rest. And find time for recreation. If you spend every last moment working, you’ll quickly burn out.
  5. Visualize yourself at the top. Imagine yourself performing at your best all day long. Imagine how it would feel to achieve your career goals. Feed your subconscious mind with vivid pictures of yourself as positive, confident and competent. Program your subconscious with these clear mental pictures.
  6. Practice positive self-talk. Take control of your inner dialogue. Notice if you have a tendency to berate yourself. Try to talk to yourself as you would to a good friend or someone you care deeply about. Be gentle with yourself.
  7. Take daily steps towards your career goals. Be proactive; grab the bull by the horns. If you’re not happy with your income, get out there and get face to face with more prospects. Whatever it is that dissatisfies you, accept responsibility for it and make a change.

Successful salespeople are intensely action-oriented. They have a sense of urgency about accomplishing their goals. They have a bias for action and a compulsion for closure. They are in control of their own destinies, and as a result, easily take their places at the top. And there is absolutely no reason you can’t join them there.


Source: lifehealthpro.com


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Tags: success secrets, Medicare Supplement, med supp

Industry coalition defends Medigap plans

Posted by Guadalupe Cantu on Fri, Nov 01, 2013 @ 02:18 PM

Medicare Supplements The Coalition to Promote Choice for Seniors has asked Republican leaders on the House Ways and Means and the House Energy and Commerce committees to protect the Medicare supplement program.

The coalition which is made up Industry insurers, producers and includes organizations as the National Association of Health Underwriters, the National Association of Insurance and Financial Advisors, America's Health Insurance Plans and the Blue Cross and Blue Shield Association groups.

Moreover, the CPCS has defended the Medigap program and has written to Republican leaders in response to allegations that some Medigap plans drive up Medicare program costs.

The Medicare Supplement program helps pay the out-of-pocket expenses not covered by traditional Medicare Part A and Part B, like medical care, co-payment, coinsurance and deductible requirements.

Medicare Supplement insurers are required to offer standardized packages of benefits by law. Supporters for the program say that seniors who purchase the higher quality plans are the ones that know they are more likely to require the need for more expensive care, minimizing their out-of-pocket costs. Critics argue seniors may be encouraged to get unnecessary care, adding little or no value, due to the ease of access to the richer Medigap products.

In October 21st in a letter to Congress, the coalition cautioned “that higher levels of cost sharing would result in delayed treatments that could increase future Medicare costs and result in adverse health outcomes for vulnerable beneficiaries.” They said that restricting the plan options could lead to millions of beneficiaries, who already spend 15% of their income on health related issues, to financial hardship.

Under the existing federal and state law, Medigap contracts are “guaranteed renewable.” Any changes to the law “could result in significant complaints and litigation by changing existing insurance contracts”.

Debates over restricting access to richer Medigap products and imposing surtax on some or all its policyholders are fiercely debated by leaders of the House.

Please give us your feedback!
Question: Will altering the Medigap plan hurt financially vulnerable seniors who are already beneficiaries, or will it discourage seniors from seeking unnecessary care and help the plan save money on the long run?


Source: LifeHealthPro

Additional Updates:
    • 2014 Medicare Advantage and Part D Certifications are now available! Learn More

Tags: Beneficiaries, Medicare, Law, Medicare Supplement, Medigap, med supp

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