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A field marketing organization (FMO) specializing in the senior insurance market

Home Health Care FAQ

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Original Content From Senior Benefit Services, Inc.

SBS blog is a compilations of all Senior Benefit Services Blogs posted over the years. These blog vary in topic from tech help, productivity, to selling opportunities and other related insurance needs. Scroll through to check out our blogs and discover something new!

If you have any question, contact our Marketing Department here.

Home Health CareYou may have noticed we’ve been doing a lot of talking about Home Health Care lately! A lot of agents have reached out to us with some questions and we thought it might be helpful to put together a list of some of the most frequently asked questions about home health care.

 

Q: How many days does my client need to spend in the hospital before they can get the benefits from the Home Health Care Plan?

A: NONE!  There is no prior hospitalization stay required in order to access the plan benefits.  Benefits are available if your client suffers a cognitive disability or can’t perform 2 of the 6 Activates of Daily Living (ADLs)

 

Q: How difficult will it be for my client to qualify medically for this plan?

A: Not difficult at all.  There are only 2-3 underwriting questions, and there are no medical exams required!  And by 2-3 questions we don’t mean questions 1A, 1B, 1C like you’ll see on some other apps.  The app only has 2 or 3 simple yes or no health questions.

 

Q: Does the client need to be receiving Home Health Care in order to take advantage of the built in Rx benefit?

A: No.  As long as the prescriptions are filled after the policy is in effect, your client can start taking advantage of this awesome benefit as they continue to buy and pick up their prescriptions just like they always have.  Even better, the Rx benefit is not subject to the policy’s Pre-Existing Condition Limitations.

 

Q: Who are agents selling this to?

A: Everyone!  It’s a perfect add on for any of your clients.  The benefits are all paid directly to your client so even if their current plan covers a home health care service, they’ll still receive the Home Health Care benefits.  If you know your clients are taking medications or if they’ve expressed concern over how they can afford to recover at home, this plan is perfect for them.

 

Q: What’s the best way to bring this up to my clients?

A: A lot of our agents are having great success handing over a copy of the 1 page infographic (email us to request a copy for your state) during what would normally be a down time in their appointment (like when you’re double checking or signing an application).  Then discuss with your client the immediate Rx benefit and the additional coverage they’ll receive to have the ability to recover at home.

 

Q: I see there are 3 plan options.  What’s the most popular?

A: The most popular plan option is Option B.  It’s a great mix of competitive premiums and great plan benefits.  Plus it has the same $600 maximum Rx Benefit that Option C has, but at a lower premium.

 

Q: What are the real selling points for this plan?

A: Above all the Rx Benefit – for many clients the maximum Rx benefit is higher than their annual premiums!  If you know the medications your clients are taking you can easily calculate their benefits.  Even if they don’t totally exhaust the Rx Benefit, they’ll only be paying a few dollars a month to have access to Home Health Care benefits.  If your client is on the fence about ever needing the plan, show them the Return of Premium Rider.  This will returned 100% of their premiums paid (minus claims) if they pass away before they turn 86.

 

Have a question we didn’t answer? Feel free to ask us in the comment section below or contact the Marketing Department either by email at Marketing@Srbenefit.com or by calling our office at 1-800-924-4727 and asking for Marketing.  Plan benefits and availability vary by state.  Contact the Marketing Department for state specific information.

 

The Open Enrollment Period (OEP) is from January 1st to March 31st

Now is the time your clients are able to switch Medicare Advantage policies. Since this opportunity hasn’t been available for Medicare Advantage clients in a while (since 2011!) here’s some clarification of the OEP Rules:

If your client is enrolled in a Medicare Advantage plan, they’ll have a one-time opportunity to:

  • Switch to a different Medicare Advantage plan (Please remember: clients can only switch one time and the effective date would be the 1st of the month after which they apply)
  • Drop their Medicare Advantage plan and return to Original Medicare, Part A and Part B
  • Sign up for a stand-alone Medicare Part D Prescription Drug Plan (if they return to Original Medicare). Most Medicare Advantage plans include prescription drug coverage already. Usually the client can’t enroll in a stand-alone Medicare Prescription Drug plan if they already have a Medicare Advantage plan, but there are some situations where they can.
  • Drop their stand-alone Medicare Part D Prescription Drug Plan

Please remember that the OEP is not the Annual Enrollment Period (AEP) and the agent cannot solicit or advertise the OEP to switch their client to another Medicare Advantage policy or back to regular Medicare.

Want more details? Check out this article found on CMS.gov.

Over the years there have been many different terms used to describe the time of the year Medicare Beneficiaries can add, change, or drop their Medicare Advantage or Medicare Prescription Drug Plan. The two main acronyms that agents refer to are the AEP and the OEP, which have been used interchangeably over the years, but it’s important to note they both have very separate definitions.

The AEP stands for Annual Election (or Enrollment) Period. The Annual Election Period is October 15th – December 7th and is the one time of the year that Medicare Beneficiaries can switch their Medicare Advantage, or Part D plans, or return to Original Medicare.  Please note that during this time the Medicare Beneficiary can switch Medicare Advantage or Part D plans as much as they want until they decide on their new coverage effective January 1st. To find out more information on the AEP click here to review the Medicare Advantage – The Basics.

The OEP stands for Open Enrollment Period. Typically agents hear “OEP” and think of the guaranteed issue period in which someone is new to Medicare can purchase a Medicare Supplement without underwriting. But in this context the OEP is actually Medicare Advantage Open Enrollment Period. Beginning in 2019 the Medicare Advantage Open Enrollment Period will start January 1st – March 31st. During this time the Medicare beneficiary has an opportunity to:

  • Switch to a different Medicare Advantage plan
  • Drop their Medicare Advantage plan and return to Original Medicare Part A and Part B
  • Sign up for a stand-alone Medicare Part D Prescription Drug Plan (only if the beneficiary returned to Original Medicare)
  • Drop the stand-alone Medicare Prescription Drug Plan

 

The Medicare Advantage Open Enrollment Period replaced what was previously known as the Medicare Advantage Disenrollment Period that ran from January 1st to February 14th. The Disenrollment Period is where clients had an opportunity to switch from a Medicare Advantage Plan to Original Medicare and enroll in a Part D Prescription Drug plan.

Outside of the Annual Election Period (AEP), the OEP is also available for those new to Medicare that enroll when they are 65 or obtain their Part B. The OEP will run for the 1st month with an additional 2 months. So for example if a Medicare Beneficiary enrolls in a Medicare Advantage plan effective July 1st then their OEP will be from July 1st – September 30th.

Hopefully this gives you some clarification on the AEP vs the OEP. For more detailed information about Election Periods check out this link to the Medicare Plan Enrollment/Election Periods Job Aid for Agents.

Any questions or comments? Feel free to reach out to us!

 

This concludes the 5-Part Series on Medicare Advantage and I hope you found this helpful! If you didn’t get a chance to check out the full series then click on the links below to our previous articles.

Part 1 – The Basics
Part 2 – Marketing Medicare Advantage Plans
Part 3 – Educational Events vs Marketing/Sales Events
Part 4 – During The AEP

– updated October 2019 –


  • https://q1medicare.com/q1group/MedicareAdvantagePartDQA/FAQ.php?faq=What-is-the-difference-between-Annual-Election-Period–AEP–and-Open-Enrollment-season–&faq_id=557&category_id=124
  • https://medicare.com/medicare-advantage/new-open-enrollment-period-for-medicare-advantage/
  • http://medicareadvocacy.org/reminder-medicare-advantage-disenrollment-period-madp-ends-february-14th


The Annual Election Period (AEP) has arrived! Now is the time you can enroll your client in a Medicare Advantage (MA) or Prescription Drug Plan (PDP) from October 15th to December 7th.  If you already checked out our previous articles in our Medicare Advantage series we reviewed the basics and the marketing guidelines for MAPD plans and PDPs (see below for article links!). So now let’s review what you can expect during the AEP.  

What The Agent Can Do For The Client During the AEP

  • Switch from Original Medicare to a Medicare Advantage plan
  • Switch from their Medicare Advantage plan to Original Medicare
  • Switch from one Medicare Advantage plan to another Medicare Advantage plan
  • Switch from a Medicare Advantage plan that doesn’t include prescription drug coverage to one that does (and vice versa)
  • Enroll, switch, or drop a Prescription Drug Plan

 

While the above seems pretty basic on what you can do for your client during the AEP there are some details that the agent should keep in mind. During your clients’ appointments make sure that you also touch base on the following details to avoid confusion in the future.

  1. The Scope of Appointment form will need to be signed – Make sure the client knows that this is like a permission slip to review what plans and products they want to discuss and they are not required to enroll in any plan during the appointment. While the previous 48 hour rule has been lifted by CMS, the agent will still need to have the client complete the Scope of Appointment form before discussing any plans or plan details. Download the generic SOA form here.
  2. The client will still be paying their Part B Premium – Even though the client decides to enroll in a MA plan, make it clear to the client they will be paying the Part B Premium for the following year in addition to any costs of the MA plan. 
  3. Review the service area and network for each MA Plan – The availability of MA plans can vary by state and county so double check the client’s location to make sure they can use their new plan. In addition, make sure to double check the client’s network. Some MA plans are available in the client’s county but the client’s doctor or preferred hospital might not be in the network. This is important especially if the client has a HMO plan and will absolutely need to receive care within the plan’s network.
  4. There is no penalty to switch plans and the client is guaranteed approval – Many clients do not think they can switch plans once they decide on something. Make it clear to the client that they can switch anytime from October 15th – December 7th and they are guaranteed a policy effective January 1st. The only exception is if the client has End-Stage Renal Disease (ESRD) – They will not be approved for coverage and will need to look for a specific Special Needs Plan (SNP).
  5. Clients cannot have a Medicare Supplement plan and a MA plan – If the client switches from Original Medicare to a MA plan they will have to cancel their Medicare Supplement plan (if they even have one) effective January 1st, when their new MA policy takes effect. Make sure the client doesn’t cancel their Medicare Supplement insurance right away or else they will be without coverage until the New Year. 
  6. This is the one time of year clients can switch plans – Make sure the client knows that this is the time to join, switch or drop a plan. Whether it’s a MA plan or a PDP, reach out to your clients to make sure they know they have the option to change their current MA or PDP coverage. 
  7. Clients can enroll on their own – The client is free to enroll in a MA plan or PDP on their own. They can do so by calling the carrier direct, contacting 1-800-Medicare (1-800-633-4227), or by utilizing the Plan Finder Tool on www.Medicare.gov to enroll online (read more about the new Plan Finder Tool here). However, let the client know that if they have any issues with their new plan you, as the agent, might have a more difficult time resolving any problems (if you can help out at all!) since you did not complete the original application.   

 

Conclusion

There’s a lot going on during the AEP so if you any questions or feel as if we missed something please feel free to comment below! Hopefully this guide will help you during your Medicare Advantage appointments or give you some more insight into selling Medicare Advantage plans during the AEP.

Check out our previous articles about Medicare Advantage below:
Medicare Advantage Part 1 – The Basics
Medicare Advantage Part 2 – Marketing Medicare Advantage Plans
Medicare Advantage Part 3 – Educational Events Vs Marketing/Sales Events

It’s officially October.  While most people are thinking about the leaves changing colors, play-off Baseball, and pumpkin everything, those of us in the Senior Insurance Market are bracing ourselves for the craziness that is AEP.  A lot of my Tech Tuesday articles have been about looking at something new to improve or help your business.  This post will be a little different.  Let’s talk about all the “old stuff” instead.  Think back to the days where you’d pop the hood on the car before a long family road trip and check the belts and the oil before hitting the road.  You’d make sure everything was in good working order so you weren’t stranded on the side of the road.  Well, it’s a great time to pop the hood on all your tech stuff to make sure you’re not stuck on the side of the road this AEP.  Taking the few extra minutes to check on things now so you can avoid some issues can keep all of your tech stuff running smoothly and at least eliminate that stress from the mix as things get crazy.  Here’s a list of a few things I wander through the office checking each fall.

 

Can I print that from here?

If you’ll be working from different areas, like a conference room, or shared meeting space instead of your desk, make sure you can print from there.  If you need to unplug all the cords from your laptop, can you still print?  Incredibly frustrating to have something all typed up or you just found the document you need online, only to click that print button and have nothing happen.  Do a quick test now and know when and where you can print.  This is a good idea if you use multiple devices too.  iPads and tablets can be finicky when it comes to printing.  While you may be able to access the same webpage or document on a different device, how or if it will print aren’t always the same.  While we’re talking about printers, if you don’t have a spare ink cartridge, buy one now.  It doesn’t matter if you can print or not if the printer is just spitting out blank paper.  It’s not a bad idea to grab an extra ream of paper too while you’re at it.

 

Are you powered up?

AEP can sometimes mean longer working hours than normal.  While you might be able to keep yourself going with an extra cup of coffee or two (or three or four if you’re like me), your electronic devices won’t benefit if you dip them into your cup.  There’s nothing worse than sitting on hold for 30 minutes and then having your phone battery die two minutes into your conversation with an actual person.  Grab some extra charging cables for your devices and stash them in strategic locations like your briefcase, your desk drawer, or in your car.  That way when the battery starts to get too low you are not stuck without a life line.  Keep in mind too that you won’t always need a wall outlet to charge things up.  With smart phones especially, a device with a USB port (like your laptop, your car, or even a TV) is sometimes all you need to keep your device from going dead.

You can also be proactive and start your morning off in Low Battery Mode.  Many laptops and devices have settings that will automatically reduce the amount of energy your device consumes as you use it.  If not, look for settings you can turn off or turn down when you’re not using them, like screen brightness, Bluetooth connections, etc. Making the switch even when your batteries are fully charged will help you avoid having to play catch up with a dead batter later in the day.  It’s also a good idea to have “low tech” alternatives in case your batteries go dead, like a wired mouse in case your wireless one goes dead.

 

Will you be connected?

For agents working out in the field, connectivity can be very unpredictable, so be sure you have a backup plan for that as well.  You may find yourself in a client’s home with no Wi-Fi or limited cell phone service.  Make sure you can still access the information you’ll need even without an internet connection.  Often times you can download forms ahead of time on your devices which will allow you to access them even when a connection isn’t possible.  You can use “airplane” mode to test what you can and cannot do when you lose your connection.  Having a cheat sheet or a couple hard copies of supplies isn’t a bad idea either.  Or, you can always pick up the phone and give our office a call (just make sure you have our number with you!).

If you’ll be working solely from the office, will your current connection be fast enough?  Especially if you’re in a shared office, increase in workload will also mean increased demand on your internet service.  Contact your internet service provider to see about a boost to your speed.  Faster internet might well be worth the investment over the next three months to improve your efficiency.  It’s also not a bad idea to run a test of your internet speed to make sure you’re getting the speeds you’re paying for or that you’re promised.

 

Make a note of it!

Take a few minutes and visit each of the important website you’ll be accessing through the AEP.  Be sure to save them to your favorites or bookmark these pages to make accessing them quicker and smoother for when you’re meeting with your clients.  It’s also important to make a note of them elsewhere.  This way if you’re using a device that they are not book marked on, or need to share a link, you can quickly access the information.  I also suggest notating your logins for important sites as well.  Though be sure if you’re notating links, usernames, and passwords all on the same document you’re storing or sharing that document securely.

 

Checking In?

There might be apps, or devices that have been collecting dust over the summer.  Take a moment to blow the dust off of anything you may use in the coming weeks.  It’s a good idea to power up any unused devices, then do a complete shut down of them and then power them back up.  This will force that device to check for any updates and reset all of its connections.  If you’re running windows, chances are there are some updates that will pop up after you do this shut down.  Go through and update your systems now while you’re not in desperate need of them.  It’s awful to be in the middle of something, when your computer automatically restarts to install and update.  Be proactive and force the machine to update when it’s convenient for you.  The same goes for apps on your mobile devices or any other programs you frequently use.  The exception to this update advice would be for any “major” updates on programs or devices that are functioning properly.  iPhones and iPads for example just came out with a major update to their operating system.  It may be in your best interest to avoid the update so you’re not re-learning where they’ve moved things or how to do things while you’re in the midst of the AEP chaos.

 

I hope this article gives you some idea of things you can take care of now, to avoid headaches, minor inconveniences, or even major tech disasters when you least want them.  So take a few minutes now to pop the hood on your tech and make sure everything is in good working order so you’re not technologically stranded this AEP.

“Pop the Hood” AEP Tech Checklist

  • Make sure you can print from different sections of the office from your laptop or tablet
  • Purchase extra ink for printer
  • Purchase extra ream of printer paper
  • Get extra charging cables for your phone or tablet – have spares in your car, work bag, and office
  • Download forms ahead of time on your laptop or tablet. Hint: Test access to these forms by putting your phone in airplane mode.
  • Consider boosting your current internet connection for the rest of the year and run a test of your internet speed
  • Bookmark the important websites for easy access on your laptop or tablet.
  • Make a note of your bookmarked websites, username and passwords all on the same document on a secure file.
  • Power up any devices that haven’t been used in a while and complete any needed updates: Windows updates or app updates for tablets or mobile devices.

 Is it Safe to Send? – Protecting Your Emails

It feels like I’ve been harping on security here lately.  So why stop now?

The staff in our office deals with all kinds of information coming in and out from all different types of sources. However, the source I want to focus on today is email.  Email is great!  It allows us to quickly send text, links, images, and files almost instantly.  We send and receive email on our computers, laptops, tablets, cell phones, and even our watches!  Email has become such a “normal” thing we just adopt it into how we do business taking the whole process for granted.  And taking it all for granted isn’t a big deal if we are talking about getting a new promo code from an online retailer or a notification that your friend posted something new on social media.  But when we start talking about personal information and those dreaded 5 letters: H-I-P-A-A it is a big deal.

Just yesterday I received an email like this:

Hi Eran,

My client, (CLIENT’S NAME) needs a Med Supp and a Part D Plan.  She was born on (DATE OF BIRTH) and she has (MEDICAL CONDITION).  (INSERT LIST OF ALL HER MEDICATIONS)

She got Medicare Part A on ##/##/#### and Medicare Part B on ##/##/####, and was covered under a group plan until ##/##/#### She was told she would still be able to get a policy without having to go through underwriting.  Is that correct? Also can you get me a list of some competitive Med Supps and Part D plans for her? 

Please call me if you have any questions or if you need more information.

Thanks,

Here’s the issue, while this email itself gave me all the information I needed in order to research some plan info it also contained HIPAA protected information. This includes the client’s name, date of birth, and a long detailed list of her medical conditions and prescriptions.  Additionally, on the same day I received another email that included a PDF copy of a completed application with “someone else” copied on it.  There are two problems with this, one: who’s that other person?  Maybe it’s the client? Maybe it was supposed to be the client but the sender accidently auto filled the wrong email address.  Two: the application is more than likely filled with a ton of HIPAA protected information, not to mention other sensitive information like bank account numbers, or social security numbers.

There’s no need to panic, there are solutions!

I’m not saying we need to shut everything down, we just need to be a little more careful of how we’re going about our business.  There are little extra steps, that at first will feel like a giant pain, but is really what’s in your client’s, and your business’s, best interest.

Here’s some quick, effective, and easy to implement solutions

Here’s the easiest thing you can do:

Do not click send.  First and foremost, double check the address you’re going to be sending your email to and make sure it’s correct.  This is one of those things that I think we all get out of the habit of doing pretty quickly.  It’s also a good idea to make sure there aren’t any extra people copied on an email if you are replying to an ongoing conversation.

Pick one or the other

After you’ve double checked where your email is going, reread the message itself.  If your email contains a client’s name AND medical info then start deleting!  Take a look at the example email I provided for you. The agent included BOTH personal identification information and medical information, causing a HIPPA violation.  So when you reread your email ask yourself which is more important – My client’s name being included? Or my client’s medical information being included?  In this example the client’s date of birth, Part A and B effective dates, and Prescription Drugs were pretty important information for me to use in comparing plans.  But it didn’t matter at all what the client’s name was.  Even without including the client’s name, your internal (and secure notes) will help you match things up without sending everything in the same email.

Lock it up

That completed application you’re about to email, why not put a password on it?  Each program is different, but do a quick Google Search for “adding a password to files in ”.  Then send that password protected file over.  The file itself is useless to anyone who doesn’t have the password.  Just make sure you send a separate email (not the same as the one with the file) that includes the file password, or give the recipient a call with the password.  We work with an agency that does this regularly and it’s a lot easier for all of us than it sounds.  Plus it protects their client’s personal information, keeps them HIPAA compliant, and it’s all done at no additional cost to them.

Or just go all in:

Start sending your sensitive email “secure.”  There are a ton of online solutions out there that you can sign up for to send secure emails.  The difference between secure email and “regular” email is encryption.  Basically once you click send your email message is scrambled.  Only the proper recipient is able to decode the original message.  Think of it as putting your letter in a “digital” security envelope versus sending a postcard through the mail.  If you’ve been working with our office chance are you’ve received a secure email from us through a company called SendInc.  They offer plans that are free and are pretty easy to use.  And even their “free level” product delivers emails that stay HIPAA compliant.

If nothing else, I hope this blog post causes you to stop and think about the emails you are sending out and how they are being received.  I’ve said this before, any steps in the right direction are better than no steps at all.  If you have any questions about what you should and shouldn’t email, or how you should email feel free to give our office a call.  We’d be more than happy to talk it out with you.

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