Medicare – A Growth Market L. Craig Taylor MA CLF CLTC DIA Assoc. Director Med Solutions Senior Market Sales - Omaha, Ne
Agenda 1. The Role of NAHU in Medicare 2. How big is the Medicare market? 3. What’s happening in the market? 4. Medicare Supplement 2020 and Beyond
Medicare Working Group Activities • Identify and monitor legislative priorities • Identify and monitor regulatory priorities • Draft a Medicare Position Paper • Publish a Bi-Monthly Newsletter • Provide input on Medicare & You publication • Developed NAHU Medicare Certification Course
Notable NAHU Accomplishments • Complete Regular calls with CMS • Success in avoiding Part D compensation decreases • Education of NAHU members • Promoting bipartisan legislation • Linkedin group for working group issues • Met during Cap Conference with staffer from House Ways & Means Committee
Medicare issues currently under consideration on Capitol Hill Currently in the mix for 2018: Medicare Open Enrollment Period (OEP) HR2581 COBRA as creditable coverage The OEP issue is in the Ways and Means Committee (W&M) and the COBRA issue is in W&M and Energy and Commerce Committee (E&C) Broker Bill – allowing Agents to contact Carriers and clients to service MA Policyholders
Medicare Open Enrollment Period (OEP) HR2581 • H.R. 2581 would restore the Medicare OEP to its original time period, giving seniors the flexibility they have had in the past to choose the right plan for them. • Medicare beneficiaries choose a plan during AEP that fits their needs but may need to change again due to a change in health status, physician availability, or other reasons. The OEP gives them that chance to choose the appropriate coverage for their needs. • Currently, beneficiaries must dis-enroll from their MA coverage and enroll in traditional Medicare, when another MA plan may fit their needs better. H.R. 2581 would allow seniors a one-time option to choose another plan instead of being forced into a plan that may not be appropriate for their needs.
• Some reasons why a senior would take advantage of OEP include: • The beneficiary didn’t realize that plan benefits or providers have changed until after accessing medical care for the first time in the new plan year. • The beneficiary decided that after trying a MA plan that it wasn’t right for them or they would prefer a different MA plan. • Due to change in health status or financial status between November and March, a beneficiary could benefit financially from a switch. • Since the AEP for Medicare is during a busy time filled with holidays and bad weather, sometimes beneficiaries need a little more time to make a thoughtful decision.
COBRA as Creditable Coverage 1. COBRA is a federal law that may let you keep your employer group plan coverage for a limited time after your employment ends or after you would otherwise lose coverage. This is called "continuation coverage." 2. In general, COBRA only applies to employers with 20 or more employees. However, some state laws require insurers covering employers with fewer than 20 employees to let you keep your coverage for a period of time.
COBRA as Creditable Coverage 3. In most situations that give you COBRA rights (other than a divorce), you should get a notice from your employer's benefits administrator or the group health plan telling you your coverage is ending and offering you the right to elect COBRA continuation coverage. 4. COBRA coverage generally is offered for 18 months, and 36 months in some cases. If you don't get a notice, but you find out your coverage has ended, or if you get divorced, call the employer's benefits administrator or the group health plan as soon as possible and ask about your COBRA rights.
COBRA as Creditable Coverage 5. If you qualify for COBRA because the covered employee either 1) died, 2) lost his/her job, or 3) became entitled to Medicare, the employer must tell the plan administrator. Once the plan administer is notified, the plan must let you know you have the right to choose COBRA coverage. 6. If you qualify for COBRA because you've become divorced or legally separated (court issued separation decree) from the covered employee, or if you were a dependent child or dependent adult child who is no longer a dependent, then you or the covered employee needs to let the plan administrator know about your change in situation within 60 days of the change.
COBRA as Creditable Coverage 5. Before you elect COBRA coverage, it's a good idea to talk with your State Health Insurance Assistance Program (SHIP) about Part B and Medigap.
Broker Bill –HR 1206 • Allows Agents to contact Carriers and clients to service MA Policyholders and… • This bill to remove independent agent and broker commissions from the Patient Protection and Affordable Care Act's (PPACA) and medical loss ratio (MLR) calculation is one of NAHU's top government affairs priorities, and it has made significant legislative progress during the past week. The legislation is scheduled to be voted upon by the full House Energy and Commerce Committee on Thursday, September 20 at approximately 11:45am.
Broker Bill –HR 1206 • The MLR requirements were designed to limit the amount that a health insurance company can spend on administrative costs. Unfortunately, the rules crafted to implement this requirement not only include independent agent and broker compensation in an insurer’s MLR calculation, but also classifies it as an administrative expense. • In reality, health insurance agent and broker commissions are passed-through fees folded into insurance premiums as a consumer convenience and as a means of complying with state tax and consumer protection laws; they never have been any part of the insurer’s bottom line.
Broker Bill –HR 1206 • As a direct result of the MLR requirements, many agents are seeing a net reduction of their business incomes of 30 to 50 percent. This means that fewer agents and brokers will be able to afford to stay in business, and many have begun reducing services to their clients and cutting jobs.
Observation Status • Skilled Nursing Facility Care • After 3-day minimum inpatient hospital stay for related illness or injury. It must be skilled care and condition must continue to improve. • NAHU and recent legislative efforts to change this (next slide) Source: Medicare and You 2014. www.Medicare.gov.
Skilled Nursing Facility Care • Rep. Jim Renacci (OH) introduced a bill to eliminate the three-day inpatient hospital stay requirement for Medicare beneficiaries who need rehab from a skilled nursing facility. • H.R. 290 the Creating Access to Rehabilitation for Every Senior (CARES) Act . “Beneficiaries in need of skilled nursing care are typically the most vulnerable of the Medicare population, and they should not be prevented from receiving timely critical rehabilitation services due to Washington red tape,” said Renacci. • “ The CARES Act will enhance access to quality care for our nation’s seniors by protecting the doctor-patient relationship and removing barriers to their health care.” Seniors many times are unaware of their inpatient or outpatient status while in the hospital and, as a result, are often left on the hook for thousands of dollars in medical bills after their SNF stay . • Eliminating the three-day stay requirement is not only supported by seniors, it is also supported by medical professionals throughout the country. • Other co-sponsors include Dave Joyce, Bob Gibbs, Mike Turner and Marcia Fudge of OH, Jon Carney (DE), Reid Ribble (WI), Larry Bucshon (IN), Mike Kelly (PA), Richard Nugent (FL), Keith Rothfus (PA), Derek Kilmer (WA) and John Delaney (MD). If one of your elected officials, you may want to give them a thanks!
US Population Projections – who could be impacted
Proposed CMS Regulations for 2019 • Allowing plans to send more materials electronically • Reducing material requiring CMS approval to those leading to an enrollment decision • Artificial Limits/Meaning Difference requirements removed • Flexibility in MA plan designs • Opioid drug management program • Dual-eligible SEP one time per year • Seamless Enrollments for duals only • OEP Switch Period reintroduced • Expedited substitutions of generics and mid-year formulary changes
Opioid Crisis and Management
Seamless conversion • Seamless conversion is an existing statutory and regulatory enrollment mechanism that permits organizations that offer both a Medicare Advantage (MA) plan and a non-MA health plan (e.g., Medicaid, employer) to seamlessly convert individuals in the non-MA plans into the MA plan when those individuals first become Medicare eligible. •
Seamless conversion • In order to offer this optional enrollment mechanism, organizations must submit a proposal and obtain prior approval from the Centers for Medicare & Medicaid Services. However, the Medicare-Medicaid Coordination Office (MMCO) has heard from some organizations that while they can easily identify those about to turn age 65, they are challenged to identify individuals in their Medicaid-only plans that will become eligible for Medicare based on reaching the end of their 24-month Medicare disability waiting period. http://cms.hhs.gov/Medicare/Eligibility ‐ and ‐ Enrollment/MedicareMangCareEligEnrol/Downloads/FINAL_M A_Enrollment_and_Disenrollment_Guidance_Update_for_CY2012_ ‐ _Revised_872012_for_GY2013_v3. pdf
Recommend
More recommend
