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As a Medicare sales agent, it is important to stay informed about all of the benefits Medicare provides to ensure that you are delivering the best possible service to your clients. While many beneficiaries may be aware of the basic benefits provided by Medicare, some of the lesser-known benefits are often overlooked.

These lesser-known benefits can provide valuable coverage and support for your client's healthcare needs. Additionally, discussing these lesser known benefits can help you build trust and rapport - leading to stronger, longer-lasting relationships. 

Although there are certainly more, here are a few examples of the lesser known benefits that we'll cover today: 

•    Durable Medical Equipment (DME) 
•    Mental Health Services 
•    Diabetes Management 
•    Home Health Services 

Durable Medical Equipment (DME) 
To qualify for Durable Medical Equipment (DME) under Original Medicare. a beneficiary must have a medical need for the equipment and a doctor's prescription. The DME must also be considered medically necessary and reasonable for the treatment of a specific medical condition. Some examples of DME covered by Medicare include wheelchairs, oxygen equipment, walkers. and hospital beds. This benefit helps reduce out-of-pocket expenses for beneficiaries who would otherwise have to pay for DME on their own. 

Mental Health Services 
To qualify for Mental Health Care under Original Medicare, a beneficiary must have a mental health condition that requires treatment and a doctor's referral for the services. Medicare covers a range of mental health services, including individual and group therapy, psychiatric evaluations and medication management. Beneficiaries can receive these services in a variety of settings, including outpatient clinics, hospitals and community mental health centers. 

Diabetes Management 
The Diabetes Prevention Program (DPP) and Diabetes Self-Management Training (DSMT) are two distinct programs under Original Medicare that address different aspects of diabetes care. 

• The DPP is a lifestyle change program designed for individuals who are at high risk for developing type 2 diabetes. It focuses on healthy eating, physical activity. and other lifestyle changes to prevent or delay the onset of diabetes. To qualify for the Diabetes Prevention Program (DPP) under Original Medicare. a beneficiary must be at high risk for developing diabetes. have a body mass index (BMI) of 25 or higher. and receive a referral from their doctor for the program.
  
  
• On the other hand, DSMT is a program designed for individuals who have already been diagnosed with diabetes. It focuses on educating patients on how to manage their diabetes. including monitoring blood sugar levels. taking medications. and making lifestyle changes. DSMT also provides patients with individualized support and guidance on how to manage their condition effectively. To qualify for DSMT under Original Medicare. a beneficiary must have diabetes and a referral from their doctor for the training.

Home Health Services 
To qualify for home health services under Original Medicare. a beneficiary must meet the homebound status requirements set by Medicare. They must also have a plan of care established and their doctor will need to re-evaluate and recertify their plan of care every 60 days. 

To be considered homebound, your client must:

• Require the assistance of medical equipment or another person to leave their home. This could include using crutches. a walker. or a wheelchair. Additionally, their doctor may determine that their health could worsen if they leave their home.
  
  
• Secondly. it must be difficult for your client to leave their home, and they must typically not be able to do so without assistance.

By staying informed about these and other lesser known benefits. you can ensure you are providing the best possible service for your clients' healthcare needs all while building trust and rapport leading to stronger. longer-lasting relationships.

The Book of Business Download is Here!

You're busy each day meeting with clients and submitting business. The last thing you want to spend a lot of time on is figuring out what types of policies each of your clients have.

Fret no more. Mutual of Omaha's new Book of Business download is available now, and provides what've you've been wanting - a complete list of the in-force Mutual of Omaha policies* you've sold in one easy-to-sort file.

Why Use the Book of Business Download?

It makes finding information about your clients' in-force policies super easy, so you'll be more informed about your clients' coverages and be positioned to answer any questions about their policies.

Refer to the flyer for details on how to use the Book of Business download.

View the Book of Business Flyer

Note: If you currently have pop-ups blocked on your internet browser, you will need to change the setting to "Allow" to see Book of Business on SPA. Policies sold under a Special Agent contract are not accessible to the writing Special Agent.

As the 2023 Medicare Open Enrollment season winds to a close, and beneficiaries and enrollees finalize their decisions, nearly half, 48.7%, of people eligible for Medicare have decided on Medicare Advantage plans, up from 46.1% in March of 2022. Based on the Centers for Medicare & Medicaid Services (CMS) enrollment data for March 1, 2023, total Medicare Advantage (MA), including Medicare Advantage with Prescription Drug Plan (MA-PD) membership, stood at 31,753,301 with a net gain of 2,276,490 members from March 1, 2022. Medicare stand-alone prescription drug plans (PDPs) covered 22,533,411 members as of March 1, 2023, a net decrease of 910,978 from the previous year. Surprisingly, nearly 80 percent of MA enrollees selected one of 10 insurers, out of the 294 offering plans in 2023. This brief assesses Medicare Advantage and PDP performance, market share and market penetration by state as of March 1, 2023.

Medicare Advantage (MA) Membership

Medicare Advantage (MA) market penetration remains strong; however, there is still abundant opportunity for growth with 48.7% of the nearly 65.2 million people eligible for Medicare enrolled in a MA plan. According to CMS Medicare Advantage enrollment reports aggregated by Mark Farrah Associates (MFA) in Medicare Business Online™, total Medicare Advantage plan enrollment, as of March 1, 2023, increased 9.8% from March 2022. The top ten companies, each with more than 300,000 members in this segment, collectively provided coverage for nearly 80% of the market. Most leading MA companies realized year-over-year growth with an overall net gain of 8.2%.

MA Leading Plan Performance

There are 294 insurers covering the MA marketplace in the United States, however nearly 80 percent of MA enrollees selected one of only 10 insurers.  As of March 2023, UnitedHealth continues to dominate in this highly competitive segment. With over 9 million enrolled, UnitedHealth commands 28.5% of the MA market. Humana ranks second with nearly 18% market share and over 5.6 million lives. CVS maintains the third position, enrolling approximately 3.37 million, and Elevance Health (formerly Anthem) follows, with over 2 million lives. Together the top three insurers cover 56.9% of the MA market.

Source: https://www.markfarrah.com/mfa-briefs/nearly-80-percent-of-medicare-advantage-enrollees-covered-by-10-insurers/ 

Today, we'll be discussing the expectation of agents during telephonic enrollments. Although what we'll discuss mainly pertains to agents working in call centers, this information is certainly beneficial for all agents if you have a few minutes to spare. Recently, a carrier conducted an audit and found that most agents missed five key elements during telephonic enrollments. It's crucial for agents to be aware of CMS and Carrier expectations when conducting these enrollments, not only to protect the client, but also to safeguard themselves from corrective action.

Summary of Benefits 

First, it's critical that agents review the Summary of Benefits before completing the enrollment process. This document contains important information about the plan and must be completed by agents in accordance with the approved script requirement. Agents must also ensure they accurately answer any additional questions asked by the applicant or their legal representative, and provide accurate information on plan details described in the SOB. This includes details such as benefits, costs, and coverage limitations. By doing so, agents can provide the applicant with a clear and comprehensive understanding of the plan, which ultimately leads to a successful enrollment process.

Required Disclosures

During telephonic enrollments, agents must read all required and relevant disclosures. as outlined in CMS approved scripts, for the specific plan that the applicant is interested in. Agents should collect agreement and understanding from the applicant regarding these disclosures to confirm that everyone is on the same page and that the applicant fully comprehends what they are signing up for. These disclosures may be presented in various formats such as pop-up boxes or required statements and must be presented to the applicant clearly and concisely to ensure transparency and compliance with CMS and Carrier expectations. 

Complete the Application

When completing the caller's application, the agent must ensure they accurately enter the applicant's contact information, payment options, language preference, and alternate format election.

Additionally, the agent must:

•    Provide the name of the plan that the applicant is enrolling in. 
•    Advise the applicant of the plan's effective date. 
•    Confirm with the applicant that they are ready to complete the enrollment process. 

Call Closing

It's important to provide a compliant call closing to wrap up the call. To do so, you must provide the caller with the carrier name and customer service phone number so they know who to contact for support in the future. Additionally, it's important to provide the TTY number for the benefit of those with hearing impairments. Finally, make sure to provide an application confirmation number for the caller's records, so they have a way to reference their enrollment in the future. 

Accessing MARx 

Before accessing MARX, the agent must obtain and document the beneficiary's permission. The agent should explain that they may collect information related to the beneficiary's current enrollment status, dates of Medicare Part A and B entitlement, eligibility information, and incarceration, if applicable. The beneficiary must be informed about the purpose of accessing this system and be given an opportunity to decline or approve the request. Lastly, the agent must document the beneficiary's response for future reference.

Updated Medicare Advantage and Part D policies ensure the overall Medicare program remains strong and stable for the 65 million beneficiaries today and future generations to come, payments to private insurance companies are accurate, and taxpayer dollars are well spent.

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), released the Calendar Year (CY) 2024 Medicare Advantage (MA) and Part D Rate Announcement that finalized payment policies for these programs. The final policies in the Rate Announcement improve payment accuracy and ensure taxpayer dollars are well spent. CMS will phase-in certain updates, and on average, CMS anticipates a payment increase for MA plans of 3.32% from 2023 to 2024, which is approximately a $13.8 billion increase in MA payments for next year.

Additional proposed policies to strengthen the MA managed care program that will hold health insurance companies to higher standards by:

• cracking down on abusive and confusing marketing schemes;
• addressing problematic prior authorization practices that prevent timely access to needed care;
• making it easier to access vital behavioral health care; and
• raising the bar on quality and driving toward more equitable care.

Taken together, these actions will make the overall Medicare program stronger.

Read the full article here.

PSM was a proud sponsor at this years NABIP Austin - Professional Development Day. We appreciate the local Austin agent community and time spent to engage with us.

AAHU The Austin Association of Health Underwriters is a local chapter of the National Association of Health Underwriters,(NAHU) and the Texas Association of Health Underwriters (TAHU) a volunteer member organization that represents nearly 20,000 licensed health insurance agents, brokers, consultants, and benefit professionals through more than 200 chapters across America. 

AAHU members help Central Texas consumers by guiding them through the complexities of Health, Dental, Disability, Medicare Supplements and Life insurance benefit decisions for  businesses and individuals.

Our organization is dedicated to providing professional development opportunities to our members so they can better serve their clients insurance needs. 

The Medicare market presents a significant phone sales opportunity for insurance agents. Here are some reasons why:

Large and growing market:
According to the Centers for Medicare & Medicaid Services, more than 61 million people were enrolled in Medicare in 2020, and this number is expected to grow in the coming years as the baby boomer generation reaches retirement age.

High demand for supplemental coverage:
Medicare covers many medical expenses, but there are still gaps in coverage that can leave beneficiaries with significant out-of-pocket costs. As a result, there is a high demand for supplemental insurance coverage, such as Medicare Advantage plans, Medigap policies, and prescription drug plans.

Convenience for beneficiaries:
Many beneficiaries prefer the convenience of purchasing insurance over the phone, as it allows them to compare plans and enroll from the comfort of their own homes.

Opportunity for cross-selling:
Selling Medicare insurance over the phone can also provide an opportunity to cross-sell other insurance products, such as life insurance, long-term care insurance, and annuities.

Compliance:
The Centers for Medicare & Medicaid Services has strict rules and regulations governing the marketing and sale of Medicare insurance products, including specific requirements for phone sales. However, with proper training and compliance procedures in place, agents can successfully navigate these regulations and grow their business.

PSM has teamed up with YourMedicare ℠ to bring you a revolutionary new Medicare enrollment platform to write more Medicare business. With our all-inclusive platform, you can sell Medicare Advantage and Part D plans on your terms.

Quote and enroll your clients online with our free platforms - View details

In summary, the Medicare market presents a significant phone sales opportunity for insurance agents, with a large and growing market, high demand for supplemental coverage, convenience for beneficiaries, opportunity for cross-selling, and compliance regulations in place to ensure ethical and responsible sales practices.

Source: https://chat.openai.com/ 

Here are ten traits of a successful insurance agent:

1. Strong communication skills: Successful insurance agents must be able to communicate effectively with clients. They must be able to explain complex insurance products and services in a way that is easy for clients to understand.

2. Persistence: Insurance sales can be challenging, and successful agents must have the persistence to overcome rejection and keep pushing forward.

3. Customer-focused: Successful agents are customer-focused and understand the importance of building strong relationships with clients. They listen to their clients' needs and provide solutions that meet those needs.

4. Strong work ethic: Insurance agents must be self-motivated and have a strong work ethic. They must be willing to put in the time and effort required to build a successful business.

5. Adaptability: The insurance industry is constantly evolving, and successful agents must be able to adapt to changes in the market and the industry. They must be willing to learn new skills and embrace new technologies.

6. Attention to detail: Insurance products and services can be complex, and successful agents must pay attention to detail to ensure that clients receive the right coverage for their needs.

7. Ability to build relationships: Successful insurance agents must be able to build relationships with clients. They must be able to establish trust and credibility with clients and work collaboratively with others.

8. Analytical skills: Insurance agents must have strong analytical skills to understand complex policies and coverage options. They must be able to evaluate clients' needs and recommend the right products and services.

9. Professionalism: Successful agents must maintain a professional demeanor at all times. They must be reliable, ethical, and trustworthy.

10. Resilience: The insurance industry can be challenging, and successful agents must have the resilience to overcome setbacks and keep pushing forward. They must be able to handle rejection and stay motivated to achieve their goals.

In summary, successful insurance agents possess a range of skills and qualities that enable them to build strong relationships with clients, adapt to changes in the industry, and provide valuable solutions to meet clients' needs.

Source: https://chat.openai.com/