Mergers and Acquisitions

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2019 United Healthcare

(Updated on February 9, 2017. ) I’m sure you have all heard the news that the Federal government is suing to stop 2 healthcare mergers and acquisitions from happening. The latest news has both Aetna/Humana and Anthem/Cigna at odds with the Justice department. Both cases should be wrapped up soon.

Aetna would potentially owe Humana a “break-up” fee of $1 billion if their deal is not closed by February 15th, 2017 while Anthem would owe Cigna a $1.8 billion fee if that deal is not done by April 30, 2017. Aetna and Humana are vigorously defending their position to allow the sale to proceed. The Anthem/Cigna merger has had several setbacks and is in question.

On the Aetna/Humana merger: (Blocked January 23, 2017)

  • Aetna/Humana released a statement announcing a sale of some of their Medicare Assets to Molina Healthcare. You can see the press release here. The asset sale is contingent upon the sale of Humana to Aetna being completed.
  • The DOJ called Molina a junk-bond-rated company and Molina responded they could easily shoulder the additional 290,000 members in addition to their current membership of roughly 4.3 million lives, and restated their position as the 10th largest health insurer in the country hardly qualifies it as “junk status.”
  • In its final argument, Aetna said, “The government has rested its case upon theory and speculation from beginning to end.”

On the Cigna/Anthem merger: (Blocked February 8, 2017 )

  • Attorneys for the federal government have said that the deal would harm competition in the national insurance market. Anthem countered they are only a regional player licensed in 14 states.
  • The merger would make the combined carrier number 2 nationally in overall lives insured second only to United Healthcare.
  • In some markets, the combined carrier would reduce the number of insures down to 3. The federal government says the competition between Cigna and Anthem in these markets is leading to innovation, while keeping prices down. Anthem and Cigna contend that the merger will decrease prices due to better bargaining power with large provider groups, lowering costs to the consumers even more.

Both of these were bench trials and final arguments have been made.  The Anthem/Cigna merger is expected to be blocked but there is no time frame for the ruling. The outcome of the Aetna/Humana merger was blocked today on Antitrust grounds. Aetna has said it plans to appeal the DOJ ruling.

We are continuing to follow these carrier mergers and acquisitions, and will bring you up-to-date information on our blog.  Click here to subscribe!   

USA Senior Care Network

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2019 Medicare Broker Compensation

Medicare Broker Compensation Announced 2019

2019 AHIP

2019 AHIP Update Plus $50 Discount!

New Medicare Cards, Changes to Medigap, and Scammers; Oh my!

Medicare cost-sharing

2018 Medicare Cost-Sharing

Medigap 102: Revisited for 2017

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Part 1 of our series went over what the different Medicare Supplements (Medigap plans) cover and how they work with Original Medicare.

In Part 2 of our series we are going to discuss the different enrollment periods for Medicare supplements as well as some of the underwriting criteria major carriers use in pricing their plans. Remember, in order to enroll into a Medicare Supplement policy, beneficiaries must have Medicare Parts A and B.medigapxplanxcoveragexpicturexa-n

Open enrollment for Medicare Supplements is the 6 months following a beneficiaries Part B effective date and they are 65 or older. No health questions asked. Full commission paid according to contracted rates.

Underwritten policies can be issued at any time after the open enrollment period and beneficiaries are able to pass underwriting questions. Some policies have relaxed underwriting for a higher premium. Full commissions paid according to contracted rates.

Underwriting guidelines vary from carrier to carrier. Some carriers allow diabetics with no issues and other carriers will not issue policies at all for diabetics. Almost all Medicare Supplement carriers have a “prohibited prescriptions” list that tells you the application will be declined if a member takes the medication on the list for a specific condition. Some carriers include this list in every kit they send out.

Guaranteed issue. According to federal guidelines, carriers must issue a Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in the state under the following conditions;

  • A beneficiaries’ current Medicare Advantage plan is leaving the area either due to financial reasons or is no longer going to offer that plan.
  • During a Medicare Advantage members 12-month trial period
  • Beneficiaries’ employer group plan that pays after Medicare is ending. This includes retiree and COBRA coverage
  • Beneficiaries leave a Medigap or Medicare Advantage plan because the company hasn’t followed the rules
  • Most states allow new move-ins a guarantee issue period for the first 63 days they are in a new service area.

Remember that some carriers will pay reduced or no commission on Guarantee issue business. Always do the right thing for your client but do it knowingly. Sometimes a client can still pass underwriting which allows you to get paid your full commission. Also, remember the plan letters listed above have Guarantee issue according to Federal guidelines (A, B, C, F, K and L). United Health Care also has guaranteed issue into the Plan N in many states. (At a reduced commission of course)

Medicare Supplements for Beneficiaries under age 65. Not all states require Medigap plans to cover beneficiaries under age 65. In some cases states may only require carriers to offer certain plans for those under age 65 or cover certain conditions such as ESRD. In all cases, under 65 policies are more expensive than a regular Medigap policy since carriers know the beneficiaries will be using more benefits than those over 65 on original Medicare.

Contact us today to get contracted with the highest rated carriers in your area. Many plans are only competitive in certain zip codes so don’t be fooled by all their hype. Let us help you with all of your Medicare Supplement contracting needs.

Increase Your Cash Flow with Hospital Indemnity plans

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As the National Sales Manager, I have spent countless hours on the road, teaching agents, conducting training sessions, and hosting recruiting events. I have realized that, no matter how diverse my audiences may be, certain things are universal- such as the unmistakable way my audience’s eyes glaze over as soon as I mention Hospital Indemnity plans. Most agents understand Indemnity plans in theory. They also agree that it is important to include a variety of ancillary products in their portfolio. But when it comes down to it, the majority of agents do notHospital Building bother to pitch Indemnity plans to their clients. Whether they don’t fully recognize the value, or the flat out don’t know how to sell it- RBI is here to help!

“Never leave money sitting on the table.” The old sales adage rings true. If you are not selling your clients an indemnity policy to complement their low-premium Medicare Advantage plan, that is EXACTLY what you are doing! Indemnity plans are extremely affordable, and you will quickly become your client’s hero once he or she experiences the benefits after that first hospital visit.

The primary concern of my Medicare Advantage clients is often, “How on earth will I pay for a hospital stay?!” I have also had several clients who grew frustrated with the high cost of Medicare Supplements, yet were afraid to switch to Medicare Advantage with their higher Hospital co-pays.. In either case, my solution was to enroll them into a low-premium (or no-premium) Medicare Advantage plan, along with a hospital indemnity plan for added coverage.

I never sign up a client for the “bare minimum.” It is better to have more coverage and not need it – than to not have it when you need it! Hospital costs continue to rise, and insurance plans evolve, but the health of my clients is generally not improving. I make sure to cover them for a hospital stay a little above and beyond the current hospital copay amounts. I do this because if a higher amount of coverage is needed at a later time, chances are they probably will not be healthy enough to pass the underwriting necessary to increase coverage. So far, not one of my clients has turned down the extra money they received from filing a claim.
RBI offers agents a variety of ancillary product carriers- GTL, Equitable, American Continental and Medico. GTL’s Advantage Plus plan is the only plan with a guaranteed issue period for ages 64 ½ to 65 ½. Bill Ellsworth, Vice President of Equitable, recorded an excellent presentation last year on how to sell hospital indemnity during a Medicare Advantage appointment. Frankly, it is probably the best training example I have ever seen, and I strongly recommend all Equitable agents seek it out on the Equiline broker site. Following Bill’s outline, I am confident you will be able to increase your commissions throughout the year.

Health products are the only products you can discuss during a Medicare appointment. You must make sure your client understands the need as you make your presentation. Show them the holes in their current plan, then fill it with an indemnity policy. All of the indemnity products can be cross-sold during an MA appointment. There is even a “Hospital Indemnity Plan” checkbox on the generic CMS-approved Scope of Appointment form most of us already use.

An Indemnity Webinar Invitation

Join us on Thursday, April 7th at 10:00 am (MST) for a webinar about how to cross sell indemnity products year round to protect your clients and increase your commissions. This is particularly important since carriers are now prorating all MA commissions other than a person that is new to Medicare.

To Register, Click Here

 

 

 

Don’t leave money on the table this AEP: Sell Hospital Indemnity with Medicare Advantage

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My first insurance sales trainer loved to tell me, “Don’t leave money on the table.” When it comes to coupling hospital indemnity plans with Medicare Advantage, his advice resonates a little louder. Hospital indemnity plans are very affordable for your clients and pay excellent first-year commissions, often in the 50 percent range (Of course, commission varies by states).

Most hospital indemnity plans offer inpatient confinement benefits ranging from $100 to $600 as well as an ER benefit. Depending on the carrier, optional features include benefits for skilled nursing facility days, follow-up appointments, outpatient surgery and even payment for the dreaded observation status. A cancer rider is an important option you can review with clients when discussing hospital indemnity.

Guarantee Trust Life, Equitable and Medico are carriers we are proud to affiliate with and offer to our agents. Just click on our Carriers page for more information or contact us at the number below. For those of you who concentrate on the T-65 market, note that GTL’s Advantage Plus plan is guaranteed issue for ages 64 ½ to 65 ½.

Bill Ellsworth, VP of Equitable, recorded an excellent presentation last year on how to give a good explanation of hospital indemnity during a Medicare Advantage appointment. Frankly, it’s the best training example I’ve seen, and I refer all of our Equitable agents to Bill’s training located on the password-protected Equiline.com broker site. My contact information is below if you’re an Equitable agent and are interested in learning more about Bill’s winning presentation.

In fact, Bill came out to our Arizona office last year to give us additional pointers on presenting Equitable’s EquiCash product. He definitely made me a believer. If you follow Bill’s outline, you should be able to double your MA commission for a surprisingly large number of your AEP and Lock-In appointments.

Cross selling you say! Presenting a hospital indemnity plan with a Medicare Advantage plan is totally compliant with the Medicare Marketing Guidelines.
Hospital indemnity plans are right there on the Scope of Appointment form. If the CMS-approved Scope form you are using does not list hospital indemnity, Medicare Supplements and DVH products, I’ll be glad to email you a copy.

Finally, don’t forget the younger members of the household. Many of these hospital plans are offered from 40-80 years of age. They’re particularly reasonable for the younger folks and can really help fill in those hefty ACA deductibles. Just remember that hospital indemnity coverage is not minimum essential coverage.

For contracting opportunities with GTL, Medico and Equitable, and to receive more useful training content, call RB Insurance at (800) 997 3107 or email me.

Show clients what’s really going on with doctor compensation

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Our recent Harbor Health Plan 2016 Medicare Advantage product roll-out meeting in Detroit was one of the few meetings I’ve been a part of where a single agent didn’t leave early (That’s directed toward those of you who have stepped out, say, a few hours before an industry affair was totally over — you know who you are). In case you missed it or are curious about what packed the house, let me give you a quick rundown here.

I set the stage with a piece of information that applies to any open-access network plan you can sell during AEP. RB Insurance currently has Harbor Health Plan in Michigan, Allegian Health Plans in Texas and Phoenix Health Plans in Arizona available for agent contracting.

Help your prospects and existing clients looking to make a change see the difference between doctor compensation models that affect their freedom of choice. The differences between open-access networks and what are called capitated networks can be the deal breaker in your appointments this AEP. Your prospect or client is looking for freedom of choice as their bottom line, so why not show them where it is?

Open-access plans have similarities to PPO networks because a member does not need to get a referral from a primary care physician (PCP) in order to make an appointment with a specialist. Open-access plans that use a Fee For Service (FFS) model only pay doctors when you see them for care. On the other hand, many HMO networks today use capitated provider payments to control costs and access to health resources. That means members must receive a referral from a PCP to visit a specialist unless they have an existing treatment plan. Doctors in capitated networks are paid monthly regardless if patients see them or not.

The limitations don’t stop there with capitated networks. A patient often has a limited window of time to see the specialist they’ve been referred to. With open-access plans, patients can go to any doctor in the network as many times as they like without worrying about referrals or being surprised by a crowded PCP office.

There you go: Use freedom of choice as your sales pitch and educate your prospects and clients about how their care is received. Providing them with this information will increase your close ratio during AEP.

Following me, 6 Hours to 6 Figures author, speaker and 30-year industry veteran Brandon Clay got into his element as he let the audience in on his new online training series. He went over the nuts and bolts of the sales process, showing agents how to maximize each step’s potential for sales.

Brandon showed a lot of agents how to let new and already existing clients you’re still there for them after the sale and promoted life insurance. The goal, of course, is to lock in renewals and generate referrals. You can catch up with Brandon’s posts on our blog here to get in on his expertise.

Everyone loved what he had to say, and I think they’re all motivated to follow through on his word this AEP. I hope the same goes for you.

Call RB Insurance at (800) 997 3107 or email us to request your Harbor Health Plan, Allegian Health Plans or Phoenix Health Plans contracting today. Subscribe to our blog here to receive one weekly newsletter of sales tips from our experienced agents.

ICYMI: Our 2016 Aetna Medicare Advantage benefits preview was a day at the beach

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For all of you who missed our 2016 Aetna Medicare Advantage benefits preview meeting last week, you sure passed up a great opportunity to learn about how competitive Aetna will be for this year’s Annual Enrollment Period (We also gave away a free Android touch tablet loaded with carrier enrollment tools to one of the lucky agents who registered for our event!). Don’t sweat it too much — here’s a quick rundown of what we covered.

Also, if you live in the Phoenix metro area and are interested in joining us as a presenter, read on to learn more about upcoming opportunities at our next Aetna events!

At the top of everyone’s mind was Aetna’s recent takeover of competitor Humana in a $37 billion acquisition yet to be cleared by the Justice Department. The short answer to what’s going to happen next is simply “nothing for now” — the carriers won’t be completely reorganized until next year, so all of the 2016 plans that have been filed will remain the same. The earliest anything could happen to Aetna Medicare Advantage benefits is January 2017, and even that is pushing it considering benefits are filed every year by June 1.

We all know Aetna is a well recognized brand and, for agents who work in our home state of Arizona, it has partnered with Banner Health Network to come up with a great plan with great co-pays. We have a special link for licensed agents to preview the benefits, though you do have to attest that you are a licensed agent and will not share them with beneficiaries.

Click here to preview the 2016 Aetna Medicare Advantage benefits

Marketing Director Justin Bever talked about RB Insurance’s discounted AHIP program and how agents can get a 100 percent reimbursement for their 2016 AHIP certification if they use our link.

Justin also shared how our own Senior Broker Trainer Tom O’Neil got a perfect score on his AHIP test (not the first time that’s happened) and how we can help agents struggling to get through the test. Many agents don’t realize the AHIP is an open book exam and don’t know how to best go through their study material to help them ace the AHIP on their first try.

It was like a day at the beach for senior insurance agents who got a first look at a great set of plan benefits!

Click here to get your $50 AHIP discount and learn more about RB Insurance’s exclusive AHIP reimbursement opportunity

RB Insurance and Medicare Compare will be hosting sales events for Aetna agents across the Valley this year, and we need qualified presenters to run these meetings. We have 30 scheduled so far in the east Valley, but are still looking for locations in the west Valley side as well as agents to run them. These events are being advertised by Aetna via print and other media, so we expect a huge turnout!

Call us at (800) 997 3107 or email me to learn more and sign up.

Aetna is not requiring a face-to-face certification this year for their Medicare Advantage products as they have in years past, but if you’re interested in being a part of the RB Insurance/Medicare Compare team as a presenter, you will need to attend a two-hour class on running a public sales meeting. CMS Secret Shoppers will be out in force this year, so the fairly brief training is required —no one wants to deal with allegations that the benefits were not completely explained.

Acquisitions and reforms: Learn to adapt to changes in Medicare Advantage

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Over the past few weeks I’ve received hundreds of emails from senior insurance advisors all over the country with questions about recent sea changes in Medicare. A quick review: Yes, in a few years first-dollar payment Medicare Supplements (like the popular Plan F) will no longer be available to consumers. Continuing a long-term trend, some of the biggest carriers in the industry have been acquired by other carriers. Some agents have also gotten much smaller renewal checks due to unexpected charge-backs dating all the way back to 2008.

Have you been wondering about any of these changes?

People might have hardly noticed if just one of these things happened, but in the dynamic environment we’re working in today this rapid succession of events can makes some agents uneasy, even make them question whether this is still the right industry for them.  I understand that change brings uncertainty, but I also remember an old saying my father used all the time:

“The more things change, the more they stay the same.”

I’ve been in this industry since 1996, and I can tell you that quote holds true.  I’ve seen great waves of change, but I’ve also noticed that opportunity has continued to grow. That’s why, as with all change that’s beyond our control, we must do two fundamental things:

1. Understand the changes

As agents in an industry that blends the private and governmental sectors, we have to stay abreast of ongoing developments.  Most of these changes are a result of people (of vastly differing opinions, mind you!) working to keep the system operational and fiscally sound for the next decade. Based on the U.S. Census Bureau’s 2008 National Population Projection, 75 million people in this country will be over the age of  65 by 2030.  The actions being taken by private- and public-sector leaders are an attempt to to stay ahead of that growth.

I’m often asked, “Is Medicare going away?” My answer is “Hardly!” Companies buying other companies for billions of dollars reflects a bullish view of Medicare’s future. Who would pay such large amounts for something that will go away?

Yes, products will change.  As history has demonstrated, new products will take the place of ones that are being eliminated.  Consumer demand and corporate profit opportunity will necessitate innovation.  Just look at the growth of Hospital Indemnity products when Medicare Advantage companies increased inpatient copays.  That change made an opportunity for beneficiaries to purchase more comprehensive coverage and allowed agents serving them to earn additional commission.

The future will be no different with Medicare Supplements. After all, “The more things change …”

2. Adapt to these changes

After the initial shock wears off, we all have to evolve our business to maximize the new opportunity that has been created.  There are webinars, seminars and programs you can tap into that will help you make money in the changing environment.  This is not a time to engage in negative water cooler discussions with agents who have already made up their minds.  Partner with organizations that can help you make the most of these changes and be willing to roll with the punches!

That’s why every email I wrote this past week boiled down to these two simple words: Understand and adapt.