Medicare Advantage Plans Plagued With Wrong Info in Provider Directories

by Leslie Small | FierceHealthcare

Jan 26, 2018 2:09pm

Medicare Advantage organizations (MAOs) continue to do a poor job of maintaining accurate provider directories—and it’s landing some in hot water with the federal government.

In its second round of online provider directory reviews, the Centers for Medicare & Medicaid Services found that 52% of the provider directory locations listed had at least one inaccuracy.

Those errors included providers who weren’t at the location listed, providers who didn’t accept the plan at that location, providers who weren’t accepting new patients despite the directory saying that they were, and incorrect or disconnected phone numbers.

When CMS conducted its first review of MAOs’ provider directories, it found that 45% of locations listed were inaccurate. While the report does say that the first and second reviews aren’t directly comparable “due to minor updates to the review methodology,” at the very least, the latest review’s results indicate the problem isn’t getting any better.

CMS also noted that its findings were not skewed by a few organizations but instead were widespread in the sample reviewed, which was about one-third of all MAOs. “Very few organizations performed well in our review,” the agency said.

At a minimum, provider directory errors can make members frustrated with an MAO, the report noted. But they can also cast doubt on the adequacy and validity of the MAO’s network as a whole, and even more seriously, prevent members from accessing services that are critical to their health and well-being.

Based on the results of its reviews, CMS has sent 23 notices of noncompliance, 19 warning letters and 12 warning letters “with a request for a business plan” to Medicare Advantage insurers.

However, the agency emphasized that MAOs themselves “are in the best position to ensure the accuracy of their plan provider directories.” It also said it was encouraged by pilot programs aimed at developing a centralized repository for provider data that would be accessible to multiple stakeholders.

In the near term, CMS added, MAOs should perform their own audits of their directory data and develop better internal processes for members to report errors.

See the original article here:
https://www.fiercehealthcare.com/cms-chip/medicare-advantage-provider-directory-errors-network-adequacy

 

Say Hello to the New Medicare Card

There is a giant Medicare card changeover that the Centers for Medicare and Medicaid Services (CMS) program is preparing. It all comes about starting in April 2018 when new Medicare cards begin to be mailed out.

Medicare will begin sending new identification cards to more than 55 million Medicare beneficiaries. The new cards are being sent out in response to new legislation that requires Social Security Numbers no longer be used as part of the Medicare ID.

new medicare card

The proposed new Medicare card

The legislation is called the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA. Section 501 of that legislation requires CMS to replace Social Security numbers with a randomly-generated number. This will be the Medicare Beneficiary Identifier, or MBI.

Implementing Change

CMS plans to have all Medicare cards that use SSI numbers replaced within 12 months. You should receive your new Medicare card with the MBI on it by April 2019, if all goes as planned.

Here is a short video CMS released that talks about the change and how it prevents fraud:

CMS has also set up a website with more information about the coming changes to your Medicare card. There is already a lot of confusion about Medicare. This change – although necessary because of identity theft protection – can make an already confusing topic even more confusing. We are here to try to help explain the new system and help you navigate it.

 

Potential Problems With New Medicare Cards

The new Medicare cards should not have a negative effect on enrollees in Medicare “Advantage” plans. MA enrollees no longer need to use their Medicare ID card since they have chosen to go with a Medicare replacement plan. MA enrollees are not required to show their Medicare card to health providers as all of their care is controlled by their plan provider and not Medicare itself.

One issue we can see right away is for people who wish to enroll in a Medigap plan but have not received their new Medicare card yet. There is no way to notify the insurance company of what that randomly-generated ID number is going to be until the card arrives. We have not heard from the insurance companies how they are going to deal with this issue going forward as of the publication of this article.

There is also the issue of cards that never arrive. This could cause a big problem for those who are waiting for healthcare services. It could possibly delay their ability to enroll in a plan to cover the gaps in Medicare until the new card arrives.

 

Keith Murray is an independent agent and the founder of Integrity SeniorSolutions Inc. Keith has over 21 years of experience working with Seniors on their Medicare insurance needs. He can be reached at 1-888-228-6119 or through the website at https://medigap.us.

 

Why Your Medigap Company’s Financial Rating Matters

Many insurance agents and insurance companies know that price sells. Unfortunately, in the race to the bottom on price, many will sell a policy on price alone. It makes for an easy sale for them. But this can be very costly to you in the long run. The Medigap company rating with companies like A.M. Best plays a vital role in determining long-term rate stability. A low rate today does not guarantee rate stability tomorrow!

Medigap plans are the absolute easiest insurance product to comparison shop. That is because the coverage for any particular plan is identical from company to company. You never have to worry whether you are comparing apples to apples on Medigap plans. The Medigap plan you choose – whether Plan G or Plan F, or another plan – offers the same coverage no matter what company name is on your insurance card.

When you are trying to choose from the 25-plus carriers that offer plans in your area, price should not be the lone determining factor. If you are in your Open Enrollment or a Guaranteed Issue period, you have one chance to go with whichever company you want to. There are no medical questions to be answered during this period. You don’t want that fantastic opportunity to be wasted. There are the factors you need to consider when making that choice.

 

Company Financial Ratings Matter

The leading independent rating company for insurance carriers is A.M. Best. It is the oldest and most widely recognized provider of ratings, financial data and news with an exclusive insurance industry focus.

The ratings can help you determine a company’s size and stability. At Integrity Senior Solutions, we recommend carriers with a rating of B+ or higher for Medigap coverage. These companies will typically be more established and have more money in reserves than companies with a lower rating.

 

Longevity Matters

With over 22 years in the Medigap business, we have seen companies come and go. Even some very strong companies, like AFLAC, have entered the Medigap market only to leave it shortly thereafter.

Over the years there have been many small companies that enter new Medigap markets. As of the writing of this article, we have seen three new small companies come in with some really low rates in the last few months. Two of those three are companies we had never heard of before.

Consider Both Ratings and Longevity Together

It is important to consider the financial rating along with the history of the carrier. Just as we don’t recommend low-rated companies, we also do not recommend companies that are new to the Medicare market.

We have seen many times where even an established company in one state will expand to a new state with unrealistically low rates. Each company has a team of actuaries who determine what the anticipated loss ratio will be for their company. Loss ratio is how much claim money and expenses are being paid out versus how much premium money is coming in. The percentage of expenses to income is the loss ratio. We have software that shows us the current financial ratings and loss ratio of every company in the market. We can share that information with you, saving you hours of research on your own!

The actuarial process of determining what the anticipated loss ratio will be is very advanced and complicated. Some companies nail it. Others miss it by a mile. When they do miss it, it means that the loss ratio is going to be very high. It also means that a large rate increase is very likely coming soon.

Don’t Get Trapped With a Bad Company

medigap company financial rating

Here is a scenario where a high loss ratio and rate increases would be problematic: Mary is turning 65 and in her Open Enrollment period. She has developed a chronic health condition that will always be there. Right now in Open Enrollment, Mary can choose coverage with any Medigap company she desires without having to be underwritten.

Mary chooses to go with the lowest available price on the plan she chooses. She does no research and gets no help from an independent agent. For the first 12 months, Mary’s rate is locked in. But because of the company not pricing themselves appropriately for the market, she gets a rate increase of 20% when her rate lock is over. This increase hits her budget hard because she is on a fixed income.

The problem is – with her chronic health condition – she will likely not qualify to go with a cheaper company to save money. She is outside of her Open Enrollment – which lasts 6 months from Medicare Part B eligibility.

Annual Election Period (AEP) Won’t Help!

Because of the tremendous amount of marketing in the fall about the Annual Election Period, many people assume they can switch plans during that time. Some well-known companies even use misleading advertising and refer to AEP as “Open Enrollment.” It is not. AEP only applies to changes in your Part D drug plan or Medicare Advantage plan. Outside of Open Enrollment or Guarantee Issue periods, the only way to change Medigap plans is to go through an underwriting process. Since Mary has a chronic condition, she is very unlikely to qualify for changing companies or plans.

Mary does have the option during AEP of dropping her original Medicare and going with Medicare Advantage. As long as she lives in the service area of the plan and does not have End Stage Renal Disease, she can make that switch. But Medicare Advantage is a Medicare replacement plan. What if her doctors who provide her care are not in her network under that Medicare Advantage plan?

We get a lot of calls from people looking to leave their Medicare Advantage plan to go back to original Medicare once a bad report comes from the doctor. I cannot remember the last time we got a single call from someone with a chronic health problem who wanted to leave their Medigap for a Medicare Advantage plan. For more on how Medigap plans and Medicare Advantage compare, check out our article at this link.

 

Don’t Pay More For a Name Brand

At the same time that it is important to look for an established, highly-rated company, there is also no need to pay a higher premium to go with a well-known brand. The number one selling company in America for Medigap plans is UnitedHealthcare. Yet, in many markets and on many plans, we see them $30-60 more for the exact same coverage. It costs a lot of money for all that advertising they do. There is no need for you to pay more for your Medigap coverage just to support their outrageous advertising costs.

There is no difference in Medigap coverage because of the name of the company! We often get asked about Silver Sneakers, and UHC offers a Silver Sneakers program with their Medigap plans. The Medigap coverage is the same, but they add this enticement. Here is a snippet from another of our articles that addresses this:

A side note about Silver Sneakers – there are a couple of companies that do offer those memberships for “free” when you take their Medigap coverage. The problem is that those companies are usually $50-60 more per month than other companies for identical coverage. So it is not free. They are just rolling the cost of it into the premium in hopes that you will be enticed and drawn by their well-known brand name company.

It’s not worth it. Save on the premium and buy your own membership. Most gyms offer discount plans for adults age 60 and over. It will cost you way less than the difference in premium. We did our own research. Most gyms we have checked with offer memberships for anywhere from $8 – $22 per month for Seniors, and even less per person for a couple. Don’t pay $60 more for your Medigap plan to get a brand name and membership that is worth less than $22.

All the Medigap plans are standardized by law. A company cannot change any of the benefits of those plans A-N. So whether you have a Cigna Plan G or a Mutual of Omaha Plan G or Aetna Plan G, the benefits are identical.

Are Smaller Companies Safe to Work With?

As we mentioned, it is important to check the Medigap company financial rating of the company you are considering. We can help with this information. You don’t have to automatically disqualify a company that you’ve never heard of. Any company with a B+ or better rating is capable of handling a large influx of claims all at once. If they also have a good rate history, we have no issues with recommending them. My own mother has been with a B+ rated company for 4 years that you’ve likely never heard of. They have paid their claims like clockwork.

A smaller company may not be as well-known to you. One reason is that many of them depend on the agents to get the word out about their plans. They have chosen not to spend millions and millions on advertising. That savings is passed on to you in the form of lower premiums.

Big and Small Companies ALL Pay the Same Way

You may know someone that has a big brand company and loves to brag on how well it pays. That’s no big deal! ALL the companies have to pay well.

When Medicare covers their 80% of your doctor charges, your Medigap company HAS TO pay their 20%. They cannot decline their portion. They cannot dispute their portion.

Medicare passes the claim to your Medigap company seamlessly through a process called crossover filing. It is done electronically. It is one of the main reasons we rarely have to follow up on claims with Medigap plans. Your doctor files, Medicare pays, your Medigap plan pays, period.

 

Finding the Best Companies for Medigap

That last scenario with Mary sounded pretty awful. But it is not uncommon. By working with an independent agency like ours, we can provide you with the A.M. Best rating of any company. We can also tell you how long they have been in the Medicare business and what their rate history looks like.

We get asked often if we represent all of the available companies in a particular area. While we do offer most companies, we have found that some companies do not meet our high standards on their rate increase history or customer service. We only want the best for our customers.

There are many very strong, very well-known companies that have a long history, including reasonable rate increases from year to year. If you have been diagnosed with a chronic health condition or have a history of it, you will want to find a company that fits that criteria. Even if they are a few dollars more in the beginning, in the long run, it could save you substantially.

As I mentioned, we have special software that allows us to see every company’s rate, financial rating, rate increase history, and history in the market. We can share this with you by utilizing our screen sharing option in real time. We can also provide a PDF comparison for you to look at.

Give us a call and let us go to work for you. Our service is free. No matter what company you choose, you pay the same whether you call the company directly or utilize the many services of an independent agent.

Call us today at 888-228-6119 or use the form to send us a quick message!

 

 

 

Medigap Plan Review – Which is the BEST Medigap Company?

Which Medigap Company You Should Choose

There are many companies that offer Medigap coverage. When considering which Medigap company to enroll with for your Medicare Supplement coverage, there are some things you need to take into consideration. We have provided this Medigap plan review page to help you know what to look for in the company behind your Medicare supplement coverage.

 

Medigap Coverage is Identical From Company to Company

medigap-plan-review

Every Medigap Plan (Plans A through N) is standardized by federal legislation which governs how the plans cover you. This means that one company cannot change how they cover the gaps in Medicare. Choosing one company over another will not change how your gaps in Medicare are covered. As we have covered extensively in other articles on our website and videos, a Plan G has identical coverage from one company to another. Regardless of the company you choose, the coverage is the same.

Some companies may try to entice you with costly added benefits – like SilverSneakers or discounts on additional services. These additional “benefits” cost you more in the long run. As we mentioned in our article where we talk about buying your gym membership out of pocket, it is cheaper for you to buy a lower cost Medigap plan with identical coverage and pay for the membership out of pocket.

Most gyms give a discount to Seniors. You can almost always find a gym membership for less than $25 a month, sometimes even less. Yet, the companies that offer an included gym membership are usually $25 to $45 more per month for otherwise identical coverage.

 

Customer Service Considerations

Claims Handling

First of all, if you enroll with Integrity Senior Solutions, dealing with the insurance company is not something you will have to worry about. We take the stress out of dealing with problems related to your Medigap coverage. If there is ever an issue, you can call us directly.

If Medicare approves a claim, it cannot be denied by your Medicare supplement company. When your provider submits the bill for claim payment to Medicare, Medicare will pay its portion and then forward the claim directly to your insurance company. This process is referred to as “crossover” claims. It is all done electronically and seamlessly.

It is important to also note that there are a lot of complaints and bad Medigap plan reviews on the internet. In almost every single case, those complaints are referring to Medicare Advantage plans. “Advantage” plans are well known for their billing issues and claim denials. Many companies offer both Medigap and Medicare Advantage plans. Some of these companies include Aetna, Cigna, Humana, Blue Cross Blue Shield, and UnitedHealthcare.

Complaints about these companies will be referring to their Medicare Advantage division. The companies do not have their Medigap and Advantage divisions working together. In most cases, those divisions are in totally different cities. The billing and claims processes are completely different, so they keep them separated.

I can tell you with 100% certainty after working in the Medigap arena for over 21 years that the claims handling by Medigap plans is almost flawless from our experience. In contrast, when we first tried the Medicare Advantage plans a few years ago, we had more claims in the first few months after those policies went into effect than we had in several years of working with Medigap only. It is one of the reasons we went back to concentrating on Medigap, despite the fact that Medicare Advantage pays the agent more than twice the commission. Giving our clients the best recommendations is paramount to our success. And it’s one of the reasons we chose the name Integrity Senior Solutions.

Replacement Cards and Billing Changes

The biggest reason you may feel the need to call a company directly is to get a replacement card or change your billing information. You don’t even have to call them in that situation, either. You can call us and we will handle your customer service needs so you don’t have to call the company. People sometimes tell us when we find that they have called directly that they didn’t want to bother us with a petty service issue. But that is what we are here for. We take care of even the small issues for you!

Your Agent is Paid By the Company to Help You

You have the option to go directly to the insurance company to enroll for coverage. Most companies offer direct enrollment. They are happy when you do that. You see, the agent is paid a commission for providing all of these valuable services to you. That commission is already figured into the premium you pay for coverage. So if the company can cut out the agent, they are happy. That is more profit for them.

Then when you need a replacement card or a claim somehow gets messed up, you only have one option – you call the company yourself. If it is a time of high call volume, you get to sit on hold and listen to music you don’t like so that you can talk to someone who doesn’t have a vested interest in looking out for you. When you enroll through us, you pay the exact same premium. But when an issue arises, you call us and we handle it from there. That is the value of using Integrity Senior Solutions as your independent agency.

 

Choice of Doctors, Specialists, and Hospitals

Unlike the Medicare Advantage plans, there are no network restrictions. You can go to any doctor, specialist, hospital, or any other facility without worrying about whether they are in network. And you also need NO REFERRAL to go see a specialist! As long as your doctor accepts Medicare, your Medigap plan will pay the gaps according to the plan coverage you have.

Your doctor does not care who your Medigap provider is. They file the claim with Medicare and then it is out of their hands. They actually prefer the Medigap plans because it is less hassle for their office staff. As I mentioned, dealing with all the issues related to the Medicare Advantage plan claims is a major headache.

 

The BIG Factor – Financial Stability

The one area that needs the most attention when it comes to the Medigap plan review process is financial strength and rate stability. This is where you really need to be on your toes when it comes to choosing the best Medigap plan.

As we have covered extensively here and in other articles on our website, the plans are identical from company to company. What is not identical is the company offering the coverage. The premium varies from company to company mostly related to how much they are sending out each month in claims versus premium that is coming in. This is referred to as loss ratio. Loss ratio is one of the factors we consider and share with you when considering which company will work best for you. If a company is not making a profit with a high loss ratio, that is a telltale sign that a rate increase is imminent.

It is also important to check what the rate history of the company you are considering is. Sometimes that information is not easily available. Being active in the business for 21 years, we have seen companies play little tricks like opening a new company under a new name so they can bring lower rates. Then those who have had some health diagnosis and are not able to pass underwriting to move to the new company are stuck in an old plan where the rates are going to start going up exponentially. These are facts you will not get by calling the company directly to enroll. We have seen how some of these companies have badly treated their customers. We know who to avoid.

Lowest Rate is Not Always Best

Another issue is with new companies coming in with low rates. It happens almost every year. We get notified by the big insurance marketers that some new company is coming to certain states and their rates are going to blow everyone out of the water. And they do. They come in with low-ball rates. Then the less experienced agents who don’t know what is about to happen will enroll people into these cheap plans. They sell by price alone, and it is a pretty easy sell.

We are all about saving you as much as possible on your premiums. The problem arises 18-24 months down the road when that new company has written a good bit of business and then raises the rates up really high. We see it every year without fail. Cheaper is not always better. You have to find a balance.

As a general rule, we also like to stick with companies that are A-rated or better with A. M. Best rating company. We do have a few B+ carriers that we represent, but only those with whom we have seen keep rates steady and give good customer support. Sometimes our clients prefer going with the cheapest company regardless of their rating. That’s your choice and we can still help you with those. We prefer the more stable and higher rated companies when possible. We are always trying to look out for our clients first and foremost.

 

So What is the Best Medigap Company?

There is no definitive answer. I know. I know. You wanted a straight answer on it. Believe me, I’d love to give you one. There are a lot of factors that go into choosing which company will be best for you. But I will tell you what we recommend at Integrity Senior Solutions.

We do have a handful of companies we prefer to use when it is feasible. Our agency has worked with them long enough to know who has the best support and the best rate history. We want to recommend companies that take care of you, our client.

When we run your comparison, we like to look for one of the companies with a very long track record of taking care of their (and our) customers. Almost always, we can find a Cigna, Aetna, or Mutual of Omaha plan within the lowest two or three premium rates for your area. Many times one of our preferred companies is the cheapest option, which makes it a no-brainer in those cases. If one of the top companies is not one of the lowest rates, we will make a recommendation based on what is available. We are not beholden to one company or group of companies. That is one of the beautiful things about working with an independent agency. We work for our clients. We are not employees of any insurance company.

You can find out which plans are offered in your area at what price by sending us a message through the contact form on this page or calling us at 1-888-228-6119. One of our licensed agents will provide you with a comparison of all the plans. We give you the information you need to make an informed, educated decision. I know that is what you want to do. Otherwise, you would not be reading this article and researching your options so thoroughly. We can help. Let us know how we can best serve you.

 

1-888-228-6119

Best Medigap Plans – How To Save Money On Your Plan

Finding the Best Medigap Plans

As I was driving in to the office this morning, I was thinking about how computers and the internet have changed the way we buy and sell insurance. When I first started the insurance business in 1996, we would go sit down with folks face to face. That was how people shopped for the best Medigap plans and coverage. I would have to flip through the rates of every carrier to see who had the best price for where they lived.

But with the advent of technology and computers, that has all changed. The days of you having to get dressed up and make sure the house is spiffy for a stranger to come in are behind us. You can work directly with an independent agent over an internet connection and/or phone wearing your bathrobe while sipping coffee if you want to! You don’t have to leave the house and you don’t have to let a stranger in.

Technology Has Made Things Better

I was thinking about what I miss about those days, Best Medigap Plans by phonethough. I do love that we can help so many more people now. And we work all across the United States now. We are not limited by how far we are willing to drive to see someone face to face. But I do miss those times of seeing the look on a widow’s face when she realizes how much she just saved by changing Medigap companies without any change in coverage. I especially miss the times of getting a hug on the way out the door for having helped someone save so much! I love my “job” and that I get to make a living by genuinely helping people.

As an independent agency, Integrity Senior Solutions uses a software system that allows us to compare every available Medigap plan in your ZIP code side by side. Be sure to check the YouTube video at the bottom of this post for more information.

We can give you rate comparison information quickly and easily over the phone. We can also allow you to watch our computer screen as we share it to your computer or tablet screen in real time. You can see our screen, but we can’t see yours.

 

The Most Important Factor When Comparing Medicare Supplement Prices

Here is the biggest factor in comparing Medigap plans among the companies – each lettered plan offers the same exact coverage from company to company. A company cannot alter the coverage in any way. Here is the official Medicare comparison chart for Medigap plans:

Medigap Comparison Chart for best medigap plans

The chart shows what each plan covers. Each company must adhere strictly to that coverage. A company can offer extras like a Silver Sneakers membership or discounts on eyewear. But the coverage for medical care and covering the gaps in Medicare Part A and B cannot vary one bit. Massachusetts, Minnesota, and Wisconsin have different standardized plans. Click here to see how those states differ.

A side note about Silver Sneakers – there are a couple of companies that do offer those memberships for “free” when you take their Medigap coverage. The problem is that those companies are usually $50-60 more per month than other companies for identical coverage. So it is not free. They are just rolling the cost of it into the premium in hopes that you will be enticed and drawn by their well-known brand name company.

It’s not worth it. Save on the premium and buy your own membership. Most gyms offer discount plans for adults age 60 and over. It will cost you way less than the difference in premium. Most gyms we have checked with offer memberships for anywhere from $8 – $22 per month for Seniors, and even less per person for a couple. Don’t pay $60 more for your Medigap plan to get a brand name and membership that is worth less than $22.

Pricing Difference on Medigap Plans Between the Companies

Weiss Ratings is a company that rates the financial strength of various financial entities including banks and insurance companies. In 2011, they did an exhaustive study of Medigap insurers and their product offerings. They analyzed 165 insurers nationwide and compared over 5.6 million premium rates on various Medigap plans.

The difference in rates was stunning. This is information you need to be aware of to make the best financial decision regarding your healthcare choices on Medicare. Here is a breakdown of their findings:

2011 Medicare Supplement Rate Range

2011 Medicare rate disparity findings

 

Some examples of dramatic pricing differences include:

  • In Florida, Plan C costs $4,647 with Humana Health Insurance Company of FL, but only $2,880 with State Farm Mutual Automobile Insurance Company, representing a 61% difference in cost.
  • Plan C in California would cost $5,133 with United Teacher Associates Insurance Company, which is three times more than the $1,693 with Globe Life & Accident.
  • In Maine, premiums for Plan F vary from a low of $1,916 with Globe Life & Accident to a high of $3,590 with Humana Insurance Company, representing an 87% difference in cost.
  • Plan F rates in Missouri run from $955 with Old Surety Life Insurance Company to $3,002 with Standard Life and Accident Insurance Company, a 314% difference.

Medicare Says You Should Compare Plans

Every year, the Center for Medicare and Medicaid Services puts out a publication about Medicare. It is called Medicare and You. Here is page 100 from the 2016 Medicare and You book. Notice in the middle it says in bold lettering, “Different insurance companies may charge different premiums for the same exact policy.”

Best medigap plan comparison

 

We Have Done the Research For You

Weiss Ratings senior financial analyst Gavin Magor commented:

“For 20 years Medigap rates have varied due to regional differences in pricing methodologies, state regulations, and the cost of health care. While we expect these differences in pricing among plans and across regions, we find that there is no justification for such wide price differences for exactly the same product in the same area. Consumers who research their options are likely to find opportunities for significant cost savings when purchasing Medigap insurance.

You can spend hours or days doing that research on your own. Or we can do a quick comparison of all of the companies side by side for you in minutes. Call us at 1-888-228-6119 for a free consultation and comparison. We work with people like you to compare all the plans every day.

 

Finding the Best Medigap Company

Many people go immediately to the big brand names for buying products. People – myself included – look for quality when shopping around. Cheap is not always better. But that is not as necessary in Medigap insurance. Let me explain why.

As we have covered here and in other articles, the Medigap plans are standardized. A Plan F from UnitedHealthcare is identical to a Plan F from Cigna or Mutual of Omaha, or any other company for that matter. There is no need to pay more to get a popular brand. One of those companies I just named spends millions and millions every year on TV ads, spokespersons, mass mailings, blimps – all kinds of advertising. And their high premium reflects their high advertising costs.

It is important to note that all Medigap plans are going to have potential increases in premiums from year to year. Any agent that tells you otherwise is lying to you. Run away from them. That’s why it is also important to know a company’s rate history. Some companies will close a book of business and start a new company to try to get fresh enrollees in their plans. The problem is that those old plans will still have people stuck in them and those rates will go up, up, up over time. We have seen which companies have pulled this questionable practice and can help you avoid getting caught in their trap the next time they do it.

Some companies will close a book of business and start a new company to try to get fresh enrollees in their plans. The problem is that those old plans will still have people stuck in them and those rates will go up, up, up over time. We have seen which companies have pulled this questionable practice and can help you avoid getting caught in their trap the next time they do it.

Cheaper is Not Always Better

As important as it is to stay away from the overpriced big brands, it is just as important to be wary of small companies or companies with low ratings. With the software that we use, we can see the rate increase history of every company. We also can see how long they have been in the market. And most importantly, we can see what their financial strength is.

Most of the time, we can find companies rated “A” by the rating companies that are in the top 3-4 in premium. In many cases, they will be the lowest on premium.

Having been in the Medigap business for over 21 years, I have seen small companies – especially “B” rated companies – come in with low-ball rates. Once those companies get some business on the books, they usually start raising the rates. Once you are outside of Open Enrollment or Guarantee Issue Periods for Medigap coverage, you will have to qualify medically to change Medigap plans.

Many times we have seen where someone took a cheap rate with a new, low-rated company to try to save a little, only to have that rate go up significantly once that smaller company sees they cannot maintain low rates and be profitable. If that person has developed any health issues, they might not qualify to move to a cheaper plan. So now they are stuck at whatever rate that company decides to go to. Their health could prevent them from taking advantage of a better price on their Medigap plan.

 

The Secret About Medigap Pricing the Companies Don’t Want You To Know

Check out this YouTube video below. We give a couple of real examples of how we have saved people over a thousand dollars a year for identical coverage. I also show you how our software works. You can see how we can compare all of the companies for you at one time. It is well worth a few minutes of your time to watch it.

Once you watch it, be sure to click the SUBSCRIBE button on the bottom right of the screen to find more of our teaching videos about Medicare and Medigap.

 

Call us at 1-888-228-6119 for your no-obligation quote and to have all your questions answered. You can also leave a question for us in the form to the right.

We Have Moved To Our New Domain!

Welcome to the New Home of Integrity Senior Solutions

If you typed in ExpertMedicare.com to your browser, you may be wondering what you are doing at this website, medigap.us. We moved! Medigap.us is our new domain name and our new home.

best medicare plans

All of our old web addresses and links will bring you to this site from now on. We are looking at new ways of expanding our services and making it easier to connect with our clients as we continue to grow. In the last 15 months, we have grown from working in two states to now working all across the United States!

We are very excited about the growth. We are hiring new employees and expanding our services as fast as we can. Most of our growth has been fueled by technology as we have started marketing and teaching through YouTube videos and through our website.

As always, we can be reached by phone toll-free at 1-888-228-6119. I just wanted to drop a quick note to explain how you ended up at this new domain. We are so excited about the future and invite you to grow with us!

Medicare Excess Charges – Should I Be Concerned?

Plan N and Plan D are great plans that we get asked about a lot. Those plans have premiums that are much lower than more popular plans. Some clients are concerned about not getting the Medicare Excess Charges covered. That is because unlike Plan F or G, Plan N and D do not cover Excess Charges.

I am often asked how those charges work and if they should be concerned about Medicare Excess Charges under Part B. This can be a very complex issue. I will try to make it as simple as possible without boring you with too much math and statistics.

**There are some states that do not allow any excess charges to be billed to the Medicare beneficiary. As of 2017, these states include Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont. If you live in one of these states, you can enroll in a Plan N or Plan D without any concern about having to pay excess charges.

Basically, there are three contract options for physicians when it comes to Medicare:

  1. Participating agreement (PAR)
  2. Non-participating agreement (non-PAR)
  3. Private contracting

 

Medicare Participation

Medicare has approved amounts for medical procedures and practices, also known as “assignment.” Participating (PAR) physicians sign an agreement with Medicare in which they agree to accept assigned costs as payment in full for all covered services for that calendar year. This means they medicare excess chargesaccept the 80% from Medicare and the 20% payment from the patient or patient’s insurance as that full payment. The physician cannot charge the patient any more than the 20%. This participation contract is for the duration of the calendar year. But the physician can go from PAR to non-PAR on an annual basis if they want to.

There are incentives for physicians to be a part of PAR:

  • Medicare pays a 5% higher rate to PAR physicians than it does to non-PAR physicians for all services
  • Medicare administrative contractors (MAC) provide toll-free claims processing lines to PAR physicians and process their claims more quickly.
  • Directories of PAR physicians are provided to senior citizen groups and individuals who request them.

Non-Participation

A non-participating physician has the option of whether to accept the Medicare assigned rate for services on a case by case basis. But if that physician does not accept it, the payment is lower.

The Medicare-approved amounts for services provided by non-participating (non-PAR) physicians (the 80% paid by Medicare and the 20% patient responsibility) are set at 95% of the Medicare-approved amounts that are paid to PAR physicians. However, non-PAR physicians are allowed to charge more than PAR physicians. This extra charge is known as the Part B Excess Charge.

Non-PAR physicians are limited to how much they can charge you for services. This amount is set at 15% above the Medicare-approved amount for any given service. Because the Medicare-approved amounts for non-PAR physicians are 95% of the rates for PAR physicians, the 15 percent limiting charge is effectively only 9.25% above the PAR-approved amounts for any given service.

Taking into account the cost of running a business, and particularly the fact that physicians already make so little money when taking Medicare patients, it really is not worth it to try and make a few extra dollars by being non-PAR. Just a few bad debts, collections, or unpaid claims and they are losing money by doing so when the profit margin is so low at 9.25% above PAR rates.

 

Private Contracting Physicians

The Balanced Budget Act of 1997 gave physicians and Medicare patients the right to contract privately outside of the Medicare system for health care services. These private contracting decisions cannot be made on a case by case basis, though. Once a physician has opted out of Medicare, he cannot submit any claims to Medicare for any patients for a two-year period.

Very few physicians are opting out of Medicare. In fact, on a national level, the number of physicians billing Medicare has continued to rise at the same rate of growth as Medicare enrollment.

Over the past decade, more than 96% of all physicians and clinical professionals have signed participation agreements with Medicare. This means they are accepting Medicare’s payment schedule as payment in full for the services they provide to their Medicare patients.

According to the Center for Medicare and Medicaid Services, as of September 2013, among all US physicians in clinical practice, only 4,863 – less than 1% – have signed affidavits with Medicare informing them that they have “opted out” of the Medicare program completely. These physicians must tell their patients. They must have their patients sign a release stating that they understand that the physician has opted out of Medicare. It also must state that Medicare will not pay for any services provided by that physician.

 

Statistics From Aetna About Medicare Excess Charges

In August 2016, Aetna reported that 99.34% of the claims they process have no excess charges. Of the 0.66% of claims that do have Medicare excess charges, the average amount of the charge is less than $20.

 

Conclusion

  • There are 8 states that have a ban on Medicare Excess Charges. Those states are Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont (as of 2016).
  • Fewer than 1% of all US physicians have opted out of Medicare
  • More than 96% of US physicians accept Medicare Assignment as payment in full
  • Of the less than 4% of physicians that are non-PAR, many of them do accept assignment on many claims. Accepting assignment helps to avoid the reimbursement penalty. This also helps to avoid the costs and hassle of collecting from the Medicare beneficiary. By being non-PAR, they have the flexibility to decide on a case-by-case basis

So although there is a possibility that you could receive Excess Charges, that possibility is very small.

Plan N does not cover excess charges and is a great option for keeping premiums very low. Here are the details on Plan N:

The advice on this website is informational. Please consult us before making a purchasing decision to determine what is best for your individual situation. You can contact Keith Murray’s office at 888-228-6119.

Keith Murray is an independent agent and the founder of Integrity Senior Solutions Inc. He has over 21 years of experience working with Seniors to meet their insurance and financial needs.

Prescription Drug Plans For Medigap

Medicare Supplement (Medigap) insurance policies do not provide prescription drug coverage. If you have a Medicare Supplement plan, you can still get drug coverage through a separate prescription drug plan through companies that offer drug plans such as Silverscript or Humana. Prescription drug plans are also known as Part D of Medicare.

 

Prescription Drug Coverage Under Legacy Medigap Plans H, I, and J

Up until 2010, Medicare supplement plans H, I, and J offered drug coverage as a part of their coverage. Those plans were eliminated in 2010 and replaced with plans K through N – none of which offer prescription drug coverage.

You can continue to receive your drug benefits from one of the discontinued plans if you still have it in force. But you cannot have a Plan H, I, or J and also have a Part D drug plan unless you have your insurance company to remove the prescription drug coverage from your Medigap plan. This could also change your monthly premiums.

Those legacy plans are not getting new, healthy enrollees coming into the plans, and that is a problem. You can expect the premiums on those three plans to continue to rise in the future. Insurance companies need new, healthy policyholders to help keep premiums low. That is not an option since those legacy plans are no longer available for sale.

There are better options available today if you are on an older plan. You can call our office at 1-888-228-6119 to speak with a licensed independent agent about your situation.

 

How To Get Prescription Drug Coverage

If you are enrolled in Medicare and have a Medigap plan other than H, I, or J, you have two options. First, you can enroll in a stand-alone Part D prescription drug plan. Your second option is to move to a Medicare Advantage plan. Although over 80% of Medicare Advantage plans have drug coverage included, most Seniors are not willing to give up the freedom and autonomy they have with a Medigap plan to go onto a Medicare Advantage plan with all of its restrictions. You cannot be enrolled in a Medicare supplement and a Medicare Advantage plan at the same time.

There are only certain situations under which you can enroll in a Part D plan, such as turning 65 or going onto Part B of Medicare for the first time. In both of those cases, you can enroll three months before or three months after the month that your Part B coverage begins. You can also enroll or change plans each year during the Annual Election Period (AEP). That period runs from October 15 through December 7. AEP restrictions apply to Part D or Medicare Advantage plans only. With your Medigap plan, you can make changes to your plan any time of year.

 

Enrolling in Standalone Prescription Drug Plans

There are a lot of prescription drug plans to choose from, and you don’t want to shop on premium alone. If you need a standalone Part D prescription drug plan, we recommend you call Medicare directly at 1-800-MEDICARE (633-4227). You can also visit them at http://medicare.gov.

If you give them a list of your medications, they will give you the lowest priced plan based on what you are currently taking and where you live. They are totally unbiased and willing to help. One recommendation is to call them late at night or very early in the morning. They are available 24 hours a day.

We are also available to help you choose a drug plan. Call us today at 1-888-228-6119. We can compare your drugs and show you the options available.

I recommend going with a company with a high star rating from Medicare. These rating come from the customers themselves. A company with a 3.5-star rating or higher, such as Silverscript or Humana, generally do a better job with customer service and claims.

 

In this YouTube video, we show you how to navigate the Medicare.gov website to do your own Part D comparison and enrollment if you would like to do it yourself:

 

The advice on this website is informational. Please contact us before making a purchasing decision to help determine what is best for your individual situation. You can contact us at 888-228-6119.

Keith Murray is an independent agent and the founder of Integrity Senior Solutions Inc. He has over 21 years of experience working with Seniors to meet their insurance and financial needs.

2017 Medicare Deductibles, Premiums, and Co-Pays

2017 Medicare Deductibles, Premiums, and Co-Pays

The Center for Medicare and Medicaid Services (CMS) just released the new 2017 Medicare deductibles, co-pays, and Part B premium amounts. Most important for our clients include: Part B Deductible – from $166 to $183 for 2017

This means that if you are on a Plan G (our most popular plan in our office), Plan N, or Plan D, you will pay the first $183 annually for Part B (outpatient and physician) services. If you have a Plan F, this means that the higher deductible will be added into the other calculations that determine the Plan F rates. This means that again this year, we expect to see Plan F premiums increase at a higher percentage rate than Plan G or N.

 

The information below was copied from the release from CMS. It covers all the changes in detail.

 

 

2017 Medicare Parts A & B Premiums and Deductibles Announced

Date
2016-11-10
Title
2017 Medicare Parts A & B Premiums and Deductibles Announced
Contact
[email protected]

2017 Medicare Parts A & B Premiums and Deductibles Announced

Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2017 premiums for the Medicare inpatient hospital (Part A) and physician and outpatient hospital services (Part B) programs.

Medicare Part B Premiums/Deductibles

Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and other items.

On October 18, 2016, the Social Security Administration announced that the cost-of-living adjustment (COLA) for Social Security benefits will be 0.3 percent for 2017. Because of the low Social Security COLA, a statutory “hold harmless” provision designed to protect seniors, will largely prevent Part B premiums from increasing for about 70 percent of beneficiaries. Among this group, the average 2017 premium will be about $109.00, compared to $104.90 for the past four years.

For the remaining roughly 30 percent of beneficiaries, the standard monthly premium for Medicare Part B will be $134.00 for 2017, a 10 percent increase from the 2016 premium of $121.80. Because of the “hold harmless” provision covering the other 70 percent of beneficiaries, premiums for the remaining 30 percent must cover most of the increase in Medicare costs for 2017 for all beneficiaries. This year, as in the past, the Secretary has exercised her statutory authority to mitigate projected premium increases for these beneficiaries, while continuing to maintain a prudent level of reserves to protect against unexpected costs. The Department of Health and Human Services (HHS) will work with Congress as it explores budget-neutral solutions to challenges created by the “hold harmless” provision.

“Medicare’s top priority is to ensure that beneficiaries have affordable access to the care they need,” said CMS Acting Administrator Andy Slavitt. “We will continue our efforts to improve affordability, access, and quality in Medicare.”

Medicare Part B beneficiaries not subject to the “hold harmless” provision include beneficiaries who do not receive Social Security benefits, those who enroll in Part B for the first time in 2017, those who are directly billed for their Part B premium, those who are dually eligible for Medicaid and have their premium paid by state Medicaid agencies, and those who pay an income-related premium. These groups represent approximately 30 percent of total Part B beneficiaries.

CMS also announced that the annual deductible for all Medicare Part B beneficiaries will be $183 in 2017 (compared to $166 in 2016). Premiums and deductibles for Medicare Advantage and prescription drug plans are already finalized and are unaffected by this announcement.

Since 2007, beneficiaries with higher incomes have paid higher Medicare Part B monthly premiums. These income-related monthly premium rates affect roughly five percent of people with Medicare. The total Medicare Part B premiums for high-income beneficiaries for 2017 are shown in the following table:

Beneficiaries who file an individual tax return with income: Beneficiaries who file a joint tax return with income: Income-related monthly adjustment amount Total monthly premium amount
Less than or equal to $85,000 Less than or equal to $170,000 $0.00 $134.00
Greater than $85,000 and less than or equal to $107,000 Greater than $170,000 and less than or equal to $214,000 53.50 187.50
Greater than $107,000 and less than or equal to $160,000 Greater than $214,000 and less than or equal to $320,000 133.90 267.90
Greater than   $160,000 and less than or equal to $214,000 Greater than $320,000 and less than or equal to $428,000 214.30 348.30
Greater than $214,000 Greater than $428,000 294.60 428.60

 

Premiums for beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Beneficiaries who are married and lived with their spouse at any time during the year, but file a separate tax return from their spouse: Income-related monthly adjustment amount Total monthly premium amount
Less than or equal to $85,000 $0.00 $134.00
Greater than $85,000 and less than or equal to $129,000 214.30 348.30
Greater than $129,000 294.60 428.60

If you are paying a higher premium for your Medicare Part B, see our article on How To Appeal a Part B Premium Penalty.

Medicare Part A Premiums/Deductibles

Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services. About 99 percent of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment.

The Medicare Part A inpatient hospital deductible that beneficiaries pay when admitted to the hospital will be $1,316 per benefit period in 2017, an increase of $28 from $1,288 in 2016. The Part A deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2017, beneficiaries must pay a coinsurance amount of $329 per day for the 61st through 90th day of hospitalization in a benefit period and $658 per day for lifetime reserve days. For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $164.50 in 2017.

Enrollees age 65 and over who have fewer than 40 quarters of coverage and certain persons with disabilities pay a monthly premium in order to receive coverage under Medicare Part A. Individuals who had at least 30 quarters of coverage or were married to someone with at least 30 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $227 in 2017, a $1 increase from 2016. Uninsured aged and certain individuals with disabilities who have exhausted other entitlement and who have less than 30 quarters of coverage will pay the full premium, which will be $413 a month, a $2 increase from 2016.

Part A Deductible and Coinsurance Amounts for Calendar Years 2016 and 2017 by Type of Cost Sharing
2016 2017
Inpatient hospital deductible $1,288 $1,316
Daily coinsurance for 61st-90th Day 322 329
Daily coinsurance for lifetime reserve days 644 658
Skilled Nursing Facility coinsurance 161 164.50

For more information on the 2017 Medicare Parts A and B premiums and deductibles (CMS-8062-N, CMS-8063-N, CMS-8064-N), please visit https://www.federalregister.gov/public-inspection.

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Medigap Plans for Diabetes with Neuropathy

This week we had a case with a gentleman who had diabetes and a history of mild neuropathy. On the applications for most Medicare supplement companies, they are not questioning the severity of diabetes with neuropathy or retinopathy.  They simply want to know if you have been diagnosed with it or treated for it within a certain timeframe. The good news is that there are companies that will accept you with this condition, so there could be coverage available for you under Medicare supplement for diabetes with neuropathy.

 

Diabetes With Neuropathy When New To Medicare

If you are turning 65 or leaving an employer plan and enrolling in Medicare Part B for the first time, most of what we will discuss here to does not apply to you right now. When you first enroll in Part B, you have an Open Enrollment period that entitles you to choose any Medicare supplement plan that you want – no questions asked – for 6 months following your enrollment into Part B. So finding a Medicare supplement for diabetes with neuropathy is not an issue. While in Open Enrollment, you can enroll with any company you choose for any plan available. There is no waiting period. You are covered from day one under the Medigap plan of your choosing if enrolling during Open Enrollment.

 

If New To a Medicare Advantage Plan

Medicare has a provision for those that enroll in a Medicare Advantage plan and want to leave it during the first 12 months. This is referred to as your Trial Right. Information available on the federal government’s Medicare.gov website says that if you joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining and then decide you want to switch to Original Medicare, you can purchase any Medigap plan available in your state from any company you choose.

They are required to sell you a Medicare supplement. They must cover all pre-existing conditions. Also, they cannot charge you more because of your health. You simply can call Medicare to disenroll from your Medicare Advantage plan and move back to original Medicare. They can also help you choose a Part D Prescription drug plan at the same time.

Call us and use our free comparison shopping service to find the best plan in your zip code if you are wanting to take advantage of this provision. Our number is 888-228-6119 and a licensed independent agent will be glad to assist you.

 

Guaranteed Issue For Losing Group Coverage

If you are losing employer coverage and are already covered by Medicare Part B, you have certain guaranteed-issue rights that allow you move onto a Medigap plan. Here is the information from the Medicare.gov website concerning that:

You have the right to buy Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state.

If you have COBRA coverage, you can either buy a Medigap policy right away or wait until the COBRA coverage ends.

You can/must apply for a Medigap policy no later than 63 calendar days after the latest of these 3 dates:

  • Date the coverage ends
  • Date on the notice you get telling you that coverage is ending (if you get one)
  • Date on a claim denial, if this is the only way you know that your coverage ended

For Everyone Else

If you are outside of an Open Enrollment or Guaranteed Issue period, you will have to go through underwriting to enroll in a new Medicare supplement plan. There are some companies that will take you depending on the severity of your diabetes diagnosis.

With the gentleman I mentioned at the beginning of the article, he was taking Metformin to control blood sugar and Gabapentin for the pain in his feet from neuropathy. We had two companies in the state of Georgia that would accept that situation according to their application for coverage. Everest Reinsurance Company has one question on their application concerning diabetes. They want to know if within the past five years you have been prescribed or taken more than 100 units of insulin a day. Considering his other health history was good, other than taking a medication to control blood pressure, cholesterol, and a pain medication for an injury, he was eligible for coverage with them. However, every underwriting situation is different. So let us compare your health history against all the companies to see where you may qualify.

This gentleman would also qualify for Blue Cross Blue Shield of Georgia. We were looking at a Plan G Medicare supplement for him. The issue we had with BCBS was that their Plan G was just released last month. And considering that there is a $70 premium difference between their Plan F and Plan G, I am not comfortable putting people with them just yet. That is a very big premium difference considering the only thing Plan F covers that Plan G does not is the Part B deductible, which is $183 in 2017. Also, considering the rate increase history of Blue Cross Blue Shield, I am not confident that their premium will stay that low for long. If his health were to decline any at all, this client may be stuck in that plan and forced to pay whatever premium they increase to for those covered under Plan G.

The third option he had was to go with UnitedHealthcare. In most states, UHC will not ask any underwriting questions if you are within three years of enrolling in Part B for the first time – which was the case here. One issue that he saw with them was that they do not offer Plan G as of the time of this article, which is what he wanted. The only other options for having diabetes with neuropathy he would consider were Plan F and Plan N, both of which UHC offers. Also, they require you to be a member of AARP to get their coverage, and he did not want to join AARP. But if he had been declined by the other companies, he had them as a last resort for getting a Medicare supplement for diabetes with neuropathy.

Conclusion

As I mentioned in the article, every underwriting situation is different. Let us check to see where we can get you placed. Our service is free. It costs you the same exact price whether you go directly to the company or use an independent agent, like Integrity Senior Solutions. If you go directly to the company, they will never tell you their competitor’s prices. They will not tell you of their upcoming rate increases. And if they decline you, they will also not tell you what other companies are an option for you. We can do all of those things and it costs nothing more for us to do it for you. We are licensed all across the country, so we can help you.

If you go directly to the company, they will never tell you their competitor’s prices. They will not tell you of their upcoming rate increases. And if they decline you, they will also not tell you what other companies are an option for you. We can do all of those things and it costs nothing more for us to do it for you. We are licensed all across the country, so we can help you.

 

The advice on this website is informational. Please consult us before making a purchasing decision to determine what is best for your individual situation. You can contact a licensed agent at 888-228-6119 or by using the form on the right side of the page.

Keith Murray is an independent agent and the founder of Integrity Senior Solutions Inc. He has over 21 years of experience working with Seniors to meet their insurance and financial needs.