Thank bipartisanship for long-awaited end to “Doc Fix”

House Speaker John Boehner (R–Ohio) and Minority Leader Nancy Pelosi (D–Calif.) are claiming passage of a bill that does away with the Medicare Sustainable Growth Rate (SGR) as victory for their respective parties. The Republican-controlled House passed HR2, The Medicare Access and CHIP Reauthorization Act, which will be voted on by the GOP-led Senate after spring recess.

Congress’ 18-year delay of Medicare provider payment cuts — otherwise known as the “Doc Fix” — is being replaced by a 0.5 percent provider payment increase over the next five years and changes to member premiums thanks to a bipartisan effort that is by no means the norm in today’s polarized political climate. The reform also calls for restructuring payment models to be based more on quality of care.

The Associated Press (AP) reports the reform will cost $210 billion over the next 10 years, with two-thirds of it being financed by other federal deficits. Medicare members and providers are expected to cover the other third, which comes out to about $70 billion.

According to AP, Medicare Beneficiaries whose incomes are $134,000 or higher will see increased premiums for medical services and prescription drugs starting in 2018. By 2020, the proposed law will require seniors who purchase Medicare Supplements to pay a minimum out-of-pocket cost of $147. Currently, the popular Plan C and Plan F Supplements usually have a $0 out-of-pocket cost.

Concern over increases in higher-income member’s monthly premiums and increased out-of-pocket costs has been expressed by Democrats as well as AARP and other senior interest groups.

The New York Times reports Judith A. Stein, executive of director of Center for Medicare Advocacy, said the reform package “Asks too much from beneficiaries and nothing from the pharmaceutical or insurance industry.”

A Kaiser Family Foundation FAQ says the bill permanently extends the Qualifying Individual or QI program, which provides premium payment assistance to low-income seniors.

Language related to the Hyde amendment, a 1979 provision annually renewed by Congress to restrict federal funding of most abortion services, cast doubt over the bill’s passage last week, just as it delayed passage of an anti-trafficking measure debated in the Senate earlier this month.

President Obama has endorsed the reform, which also includes provisions for the Children’s Health Insurance Program, Medicaid, funding for community health centers and funding for rural hospitals. The Senate is expected to pass the reform after it returns from a two-week-long-spring recess.

RB Insurance specializes in selling Special Needs Plans for individuals eligible for Medicare and Medicaid, including those eligible for the QI program. Learn more about QI and expanding your Book of Business by assisting low-income Medicare members by clicking here.


6 Secrets of 6-Figure Advisors: Part 2

I won’t keep you in suspense, so here are the next two secrets:

6-Figure Senior Insurance Advisor’s Secret #3: They believe in their ability to earn 6 figures.

No, Tony Robbins or T.D. Jakes is not about to jump out and begin sermonizing on the power of faith. But face it, if you don’t believe it is possible, then it won’t be. Henry Ford put it this way: “Whether you believe you can do a thing or not, you are right.”

The confidence in your ability to join the 6-figure club is based on three primary things:

  1. Your ability
  2. Your plan
  3. Your willingness to do what it takes

Thankfully, two of these three things can be developed. Whether you are new to the industry or a seasoned veteran, your ability can be increased, improved and developed to provide you 6-figure skill in this business. If you need a plan, there are great ones available (like my program, 6 Hours to 6 Figures — Sure, shameless plug!). The things that only you can control are your willingness, desire and persistence.

Before we go to secret #4, did you notice that the first three are about your thoughts, your perceptions and your belief in yourself? OK, maybe I am about to turn into Tony Robbins or T.D Jakes, but I have coached, mentored and trained thousands of agents in this business. This business can be tough.

If people are not mentally prepared for the journey, it is better they not attempt it at all.

6-Figure Senior Insurance Adviser’s Secret #4: They are focused on excellence in service

Mention the word “service” and for some it conjures images of a waiter filling your glass with water, hustling to bring your food and getting it right all in the hopes that you are generous with your tip. Yes, sometimes sales feels like this.

Yes, just taking an order is service, but it is not excellence in service.

The best senior insurance advisors know going the extra mile in every interaction — Yes, that means before and after the sale — separates them from those who are merely order takers. Excellence in service has three fundamental elements:

  1. Provide a “one-stop” portfolio approach to assisting your clients with the most comprehensive solutions — that means understanding your clients’ needs and knowing your products well.
  2. Meticulously follow up on all of your promises and your clients’ questions. Keeping your word is the hallmark of sincerity and integrity.
  3. Staying in touch beyond the initial sale. 6-figure professionals reach out even when there is nothing to sell! For example, call to learn if a client is feeling better after a hospitalization, check to see if he or she had any questions about their plan or any bills that have arrived. They will appreciate the concern and extra effort!

If you can do these three things you will easily (Yes, I said easily!) separate yourself from the thousands of agents who are doing “just enough for the city” (Any Stevie Wonder fans out there?). Doing more that expected also has a corresponding impact on your income. Yes, another occasion to remind you of my value equation mantra:

Next time, the final two secrets of 6-figure advisers.

Until then, I wish you Money, Power, Success!

Contract with Guarantee Trust Life (GTL) hospital indemnity to earn more commission

Find out how to sell Guarantee Trust Life hospital indemnity plans. Click here to contract with GTL today!

We all know our Medicare Advantage commission advance shrinks as the year progresses, so what can we do to maintain our income stream?

Guarantee Trust Life has your answer. Commissions for its Advantage Plus hospital indemnity plan are paid weekly, directly to you from the carrier, and simple yes-or-no underwriting makes for jet-speed submission. Advantage Plus helps fill the gaps in popular Medicare Advantage and ACA individual plans at a superbly reasonable premium, something your clients will undoubtedly appreciate.

What you and your clients can expect from this plan is impressive to say the least. For them, daily hospital confinement benefits range from $100 to $600 daily and are paid directly to the policyholder. Observation stays that last 24 hours or longer are also covered at 100 percent of the daily benefit, giving your clients peace of mind. Reach aging-in clients (guaranteed issue for 64 ½ to 65 ½ years old) with this plan and offer it to your younger, ACA-covered clients whose deductibles may still present a financial risk — Advantage Plus is issued starting at age 40.

Some of GTL’s Advantage Plus Hospital Indemnity’s other great features:

  • Great first year and renewal commissions (50-55% First Year in most states!)
  • Emergency room coverage is included in base plan and, there are four optional riders, including Lump Sum Cancer
  • Presenting a hospital indemnity plan is totally compliant with Medicare Marketing Guidelines! Hospital indemnity plans are right there on the Scope of Appointment form.

Agents interested in contracting now with GTL and RB Insurance can click here. Call me, Tom O’Neil, at (800) 997 3107 if you’ve got any questions.

*This is not a GTL-approved advertisement for prospects and clients.

Add dental to your portfolio to make you and your clients smile

Let me start with a question: Do you offer Medicare Advantage Plans or Part D Prescription drug plans? Those of us who do have learned to navigate prospect contact guidelines from CMS, which restrict what and how much we can market in the appointment. In getting used to these rules, we may be forgetting how our contact with current clients is under less scrutiny.

Dental insurance and dental discount plans are a great way to polish your marketing strategy for current clients, especially during the lock-in period, because they are not subject to CMS marketing rules. Dental plans are also the second most requested plans after primary health insurance, and due to the Affordable Care Act many large and small companies have eliminated sponsored or voluntary dental plans. Discount dental plans have become increasingly attractive because dental plans are getting more expense and subject to various limitations, waiting periods and exclusions.

If you need a few more reasons why dental should be a part of your portfolio, I’ve got seven of ’em:

Dental insurance and dental discount plans are not subject to CMS marketing rules, which makes them a great strategy for selling during lock-in and caring for your clients.

  • Immediate coverage — No waiting periods for full benefits.
  • 20 to 60 percent savings with contracted providers.
  • No claim forms and transparent fees.
  • 25 percent level commission rate, lifetime.
  • Dental discount plans can be sold across most state lines (Not available in MT, VT or WA).
  • Careington, one the most popular dental discount plans with more than 9 million members in the United States provides an agent retail site and URL for your clients with online enrollment.
  • Unlike Medicare Advantage or Part D, you can phone and email your clients! No scope of appointment necessary.

Read more about building your client base with dental and find an immediate contracting opportunity by clicking the link.

And remember: Just give me a call at (800) 997 3107 if you have any questions about dental and how to offer the most to your clients. You can also email me, or simply subscribe to our blog to catch more of my tips.






How to build a compliant Medicare marketing website that works (Part 1)

Whether you are building your own Agent site or running a massive network of Lead generation sites, everyone who mentions Medicare-regulated products or carriers on their site must adhere to the 2015 Medicare Marketing Guidelines as well as rules or requirements published by the carriers you choose to represent on your site. CMS recently distributed a memo to MA and Part D Plan Sponsors on Compliant websites, which you can view by clicking here.

Take Note: This memo only applies to websites marketing Medicare Advantage, Part D or other Medicare regulated plans. If you only advertise Medicare Supplement plans or other non-regulated products, you are not required to adhere to the MMGs. However, we recommend including the disclaimers mentioned below in the footer of your site if you discuss any Medicare-related products.

Agent websites are subject to the 2015 Medicare Marketing Guidelines. Contact us with your compliance questions as you increase your online presence as part of a solid marketing strategy.

Agent's Advantage Blog

Taken as more than a gentle reminder, the majority of our carrier partners offering Medicare-regulated products have released agent notices via email to Agents and Agencies requesting review of their websites exhibiting logos, their brand name or product names to ensure compliance with this recent CMS memo. If you’re worried that you missed one of these notices in your inbox, call RB Insurance at (800) 997 3107 or email Rob Bever, our Director of Sales, Training and Compliance, and we will forward any communication we’ve received from your contracted carriers on this subject to you.

Here are a just few tips to follow when designing your Medicare marketing website to ensure it is compliant. Check back later in the week for a list of Do’s and Don’ts for your compliant Medicare marketing website.

Section 50 of the Medicare Marketing Guidelines lists required disclaimers for plan sponsors, but what do you have to pay attention to as an Agent? The tough answer is: All of it.

Disclaimers in the Medicare Marketing Guidelines apply both to plan sponsors and their contracted third parties and/or entities.

The advice offered below is intended for generic Agent/Agency websites:

What is a generic site? A generic Medicare marketing website means you market yourself and your services on your site. If you wish to avoid potential compliance violations, don’t mention or list specific plan sponsors or plan details on your site. If you are just launching a new site, it’s always safer to host a generic Medicare marketing site.  The moment you mention a specific plan sponsor name, plan or benefit, your site is no longer considered generic and you must submit it to each carrier you mention/list of your site for approval.

Needless to say, the more detailed your site is — particularly if you include information on specific plans, benefits, plan premiums, providers networks or formularies — the more compliance challenges you will face.

 If you have specific questions about your existing website or building a new compliant site, give us a call at (800) 997 3107 or drop us a line on our Contact page. We can answer your compliance questions and help you build a productive, compliant agent website together.

Read Part Two of this series here.

How do federal poverty guidelines affect your Book of Business?

Each January, the Department of Health and Human Services adjusts the poverty guidelines most federal and state programs use to establish eligibility criteria for assistance programs to reflect changes in the Consumer Price Index. These guidelines are sometimes referred to as the federal poverty level or “FPL” by Agents. The FPL can be your opportunity to help an underserved population and grow your Book of Business.

Most state Medicaid programs that take the FPL into account are required to update their eligibility criteria by April 1 to reflect the annual adjustment. In the senior insurance business, states set the eligibility criteria for Medicare Savings Programs or MSPs, which help seniors with their Medicare premiums and cost sharing. The different MSP classifications correspond with a percentage of the FPL.

For example, Qualified Medicare Beneficiaries (QMBs) earn less than 100 percent of the FPL; Specified Low-Income Medicare Beneficiaries (SLMBs) earn less than 120 percent of the FPL and Qualified Individuals, otherwise known as QI-1s, earn less than 135 percent of the FPL.

The FPL is also used for the federally facilitated Health Insurance Marketplace and the 13 state-run health exchanges to determine eligibility for subsidies that lower the monthly premium cost of a health plan purchased from either of the two.

This table shows the 2015 federal poverty guidelines, known more colloquially as the federal poverty level or FPL. Hawaii and Alaska have their own tables, which are available from <a href=”″>HHS</a>.

For example, anyone with a QMB status has an annual income that is lower than 100 percent of the FPL is eligible for the following benefits:

• Payment of Medicare Part A (if not free) and Part B premiums

• Payment of Medicare co-insurance and deductibles

All states add what is called a $20 income disregard to the FPL to determine MSP eligibility.  For instance, if the FPL for an individual is $981 this year, the allowable income is increased to $1,001. This is the income amount you will be looking for to help your clients determine if they are eligible for assistance through one of the MSPs.

Another example for you: Individuals who make more than 100 percent of the FPL, but less than 120 percent would be considered SLMB and receive payment of their Part B premium, but no other benefits from the state.

Low Income Subsidy or the LIS also uses the FPL for calculation of its initial income levels for Medicare beneficiaries.

Under the Affordable Care Act, a family of four can make up to 400 percent of the FPL and still receive premium assistance from the government for the plan they purchase in the Health Insurance Marketplace or their state’s exchange (Remember, you must be certified to sell Marketplace plans). The assistance is only valid for plans purchased through either the federal or state exchange.

If you want to go the extra mile for your clients, the first thing you can do is find out more about different assistance programs available in your state. The second thing you can do is help your clients enroll in Low Income Subsidy and encourage them to fill out their Medicaid application to pay for their Part B premium. $1,200 back into a customer’s pocket is a huge deal when they are on a fixed income and make less than $1,000 per month. Never assume clients know about or are receiving all of the benefits they are entitled to.

Feel free to contact me at (800) 997 3107 or email me if you are interested in learning more about the FPL or Medicare Savings Programs. Subscribe to our blog to read more of my posts about outstanding sales opportunities with the dual-eligible market.

6 Secrets of 6-Figure Advisors: Part 1

I normally hate using the word “secret” when writing. It’s just a sexy hook to get people to keep reading. I have to admit, though, it’s effective.

Take my headline as an example. Now if you’re already making $100,000 or more in this industry, it may have elicited nothing more than a yawn from you. But if you are currently not making six figures, you’re likely to be pretty curious about these secrets by now, right?

Funny thing about most “secrets” is the fact they’re usually the obvious things that people know, but for various reasons don’t do. Three of these secrets involve your beliefs and attitudes, and the other three focus on how you go about your daily work.

As you read them, give yourself a check-up to see how many of them you already know, but more importantly, how many you actually do!

6-Figure Senior Insurance Advisor’s Secret #1: They desire breakout success

For most industries, sales people have the ability to generate incomes based on their efforts and corresponding results. It takes a focused and determined person to work successfully without the security of a salary. There is a daily equation of risk that comes from “straight commission” income.

The reward for that risk? The ability to generate high incomes and become part of the coveted 6-figure club. Those that are the most successful don’t just focus on the money, they have a call for higher service as well. They know that the income will be commensurate with the value they provide. My mantra for that equitable exchange:

6-Figure Senior Insurance Advisor’s Secret #2: They see the opportunity that is in front of them as one filled with 6-figure possibility

What do you see below?

Some people see

and others see

Perspective determines which one you see. The 6-figure advisor’s secret is that they see the glass half-full, their cup runneth over, that “it never rains in Southern California”… you get the picture. They are optimistic about the future of the industry and have decided to participate in it.

There are three questions I ask every adviser in this business, who doubts that the opportunity for 6-figure income remains in this business:

  1. Does this industry with first year commission and renewals, allow for this type of income? The answer is yes!
  2. Is anyone in this industry earning 6-figures?  The answer again is yes!
  3. If it can be done and is being done, then why are you not doing it, too?

Next time, the next two Secrets of 6-Figure Advisors.

Until then, I wish you Money, Power, Success!

I normally hate using the word “secret” when writing. It’s just a sexy hook to get people to keep reading. I have to admit, though, it’s effective.

Take my headline as an example. Now if you’re already making $100,000 or more in this industry, it may have elicited nothing more than a yawn from you. But if you are currently not making six figures, you’re likely to be pretty curious about these secrets by now, right?

Could this finally be the year “Doc Fix” is repealed?

2015 could be the year the Medicare Sustainable Growth Rate (SGR) problem, more commonly referred to as the “Doc Fix,” is permanently taken care of by Congress. A bipartisan endgame to the unpopular cost-saving formula both parties have been hesitant to deal with has Medicare providers anxious about payment changes, and Medicare members are concerned about possible increases to their premiums or deductibles in light of a repeal.

McClatchyDC, an online newspaper covering politics, reported Friday that a bipartisan bill that would replace the SGR and create a 0.5 percent pay increase for the next five years was unveiled. The bill would adopt a payment model based more on quality of care than volume of care, and it would also require physicians to receive a minimum amount of payment through the Alternative Payment Models by 2020, McClatchy reports.

News outlets have noted how unusual it is for House Speaker John Boehner (R–Ohio) and Minority Leader Nancy Pelosi (D–Calif.), oftentimes each others’ political adversary, to be working together to repeal the “Doc Fix.” The Associated Press reported earlier this week that the two leaders have been meeting to form a strategy to block a 21 percent cut in Medicare provider payments that would go into effect on April 1 if no action is taken. They are also interested in continuing funding for the Children’s Health Insurance Program, which works with state Medicaid programs to assist low-income children nationwide.

In addition to seeing a 21 percent pay cut, many Medicare Advantage providers who have their reimbursement level tied to rates under Original Medicare could also see cuts if an agreement is not reached.

Year after year, addressing the issues posed by the Medicare Sustainable Growth Rate (SGR) has proven to be a tough pill for Congress to swallow. There’s a possibility it could be repealed this year in a new bipartisan effort.

For the past 18 years, lawmakers have delayed the SGR from taking effect to incentivize doctors to continue providing services to Medicare members. SGR was formulated by Congress in 1997 to reduce the federal deficit by basing Medicare provider payments on economic growth, the Kaiser Family Foundation notes in a special FAQ about the “Doc Fix.”

“In 2002, doctors were furious when they came in for a 4.8 percent pay cut [under SGR],” Kaiser says in the FAQ. “Every year since, Congress has staved off the scheduled cuts. But each deferral just increased the size of the fix needed the next time.”

According to Kaiser, the Republican-controlled House and Senate would need to find a way to pay for up to $70 billion of a $200 billion reform package. One possibility is increasing Medicare Part B premiums for higher-income beneficiaries ($80,000 or more per year for an individual) and requiring all Medicare Supplement members to pay a $250 minimum deductible on an annual basis.

Repealing the “Doc” Fix is explicitly mentioned in President Obama’s budget proposal for the next fiscal year and may be alluded to in the Republican proposal.

This is not the first time hopes have been high to fix the “Doc Fix” once and for all. NPR reported in 2013 that multiple bills were passed by the Democrat-controlled Senate and Republican-run House to repeal it. Interest groups representing the medical industry and Medicare members voiced opposition to them, though, because they did not want to see doctors and seniors pay for the issue Congress brought on itself by continuously putting off the SGR from going into effect.

In a press release dated January 22, 2015, AARP, the nation’s largest senior interest group, expressed its position on current efforts to end the SGR:

“[A]ny SGR proposals should not include shifting costs onto Medicare beneficiaries through higher cost-sharing or reduced benefits,” the release said.

According to the press release, AARP president-elect Eric Schneidewind has testified before Congress on behalf of seniors, saying the group “firmly believes that any discussion of offsets to pay for Medicare reimbursement reform must include savings from prescription drugs.”

 Our Director of Sales, Training and Compliance, Rob Bever, contributed to this post. If you have further questions about the “Doc Fix” and how it may affect you and your clients, give us a call at (800) 997 3107. Subscribe to our blog for more updates!

RBI trophies at Southwest Double Gun Expo

One hundred sixty competitors armed with shotguns and a healthy sense of competition stepped up Saturday to shatter thousands of clay pigeons at the Southwest Double Gun Expo, held at the Ben Avery Clay Target Center in north Phoenix to benefit Phoenix Art Museum. Bob Bever, our CEO, took home second place in his gauge class, while Rob, our Sales, Training and Compliance Director, and Justin, our Marketing Director, shot the same score in their respective gauge class.

Shooting with a 20-gauge, Bob hit 32 pigeons and took home an authentic Native American kachina to commemorate his marksmanship. Rob and Justin fired 12-gauges, both hitting 34 out 50 targets. The bright day warmed up quickly to a high of 90 degrees by late afternoon as the Valley experiences a fleeting springtime — (mostly) perfect conditions for outdoor clay sporting.

SWDGE is one of four annual events put on by the Men’s Arts Council to benefit Phoenix Art Museum, the largest museum of its kind in the Southwest providing visual arts and educational programming. This year, over $70,000 was raised for museum programs geared toward low-income or at-risk children.

The museum is located in the heart of the midtown museum district and is an official Phoenix Point of Pride. Current exhibits include Andy Warhol: Portraits, featuring some of the artist’s most iconic silkscreens, and Leonardo da Vinci’s Codex Leicester and the Power of Observation, an exclusive presentation of the genius’ creative process and continuous influence on the arts featuring his only manuscript to belong to an American collection.

Visit its official website for address and transportation options, admission prices, membership and special event listings.



GOP looks to privatize Medicare in 2016 budget unveiling

Republicans in the House and Senate unveiled their respective budgets for fiscal year 2016 this week, proposing major changes to health care programs as part of their strategy to balance the federal budget within the next decade. House Republicans presented “Balanced Budget for a Stronger America” on Tuesday, which would privatize Medicare, restructure Medicaid to be based on block-grant distribution to states and repeal the Affordable Care Act. On Wednesday, the GOP-controlled Senate announced a less specific version of the budget with a similar cost-cutting goal.

The annual drafting of the federal budget tends to survey parties’ ideology and political goals more than it sets a legally binding limit on how much can be spent by a program. In other words, Congress hasn’t decided how it will spend taxpayer dollars on health care for 2016, so for now Medicare, Medicaid and the Affordable Care Act remain status quo. Any changes that do occur may also be implemented by Congress in stages and are contingent on lawmakers being able to agree across party lines. Disagreement within the Republican party will also influence debate.

The Republican budget is a response to the budget President Obama laid out last month. The Kaiser Family Foundation, a nonprofit, nonpartisan health care news and analysis organization, has pulled together parts of the president’s plan that deal with Medicare in an easy to follow article you can read here.

As Congress continues to set the budget for the next fiscal year, which begins on October 1, The Agent’s Advantage will keep you updated on possible structural changes to Medicare and other health care programs we work with. Agents working with Medicare Advantage plans, especially C-SNP and D-SNP plans, should pay close attention to developments in Congressional budget debates as they will likely impact them financially if the proposed budgets are passed in their current form.