Medicare could cover end of life counseling as early as Jan. 2016

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Advance care planning could become a standard part of Medicare as early as January 2016, CMS announced last month as it seeks public comment on a proposal to reimburse providers who start a conversation with beneficiaries about their final wishes.

According to a statement released by CMS on July 8, “The proposal includes a number of provisions focused on person-centered care and continues the Administration’s commitment to transforming the Medicare program to a system based on quality and healthy outcomes.” Also known as end of life planning, the service being considered consists of providers ensuring an individual’s care preferences are respected in the event of a critical health situation like terminal illness. 

Find tips on how to help your clients make sure their health care preferences are respected and adapt your senior business to policy change at the end of this article. Image courtesy of iStock

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Gently opening a conversation about advance care is “an important step in the right direction” for health care, Dr. Joseph Agostini writes for Aetna’s Health Section. “By making the end-of-life conversation a regular part of delivering high quality care, doctors may be more inclined to broach the subject with patients, their family members and loved ones … The policy change would also encourage physicians and their patients to talk about care preferences and plans before potentially tough and emotional decisions have to be made under the stress of a serious medical condition.”

This is the second time end of life planning has been proposed by the Obama administration. It was dismissed by conservative fixture and 2008 Republican vice presidential candidate Sarah Palin as part of political opposition to the Affordable Care Act (ACA), who likened it to a government-sponsored “death panel” in a post to her Facebook page six years ago.

Nonpartisan Kaiser Family Foundation has prepared a Frequently Asked Questions article about Medicare’s role in end of life care that goes over how end of life care responds to the sensitive nature of dying as well as the increased costs end of life care presents for the health care program. According to the FAQ, just over a third of people age 65 and older surveyed in 2013 incorrectly believed ACA established a “death panel” to make decisions on their behalf due to earlier political uproar.

The proposal has been reintroduced with language that makes it clear end of life planning affirms Medicare beneficiaries’ command over their health care (Click here to view it). It states “For Medicare beneficiaries who choose to pursue it, advance care planning is a service that includes early conversations between patients and their practitioners, both before an illness progresses and during the course of treatment, to decide on the type of care that is right for them.”

The FAQ also states beneficiaries accrue high costs in the last year of life because many of them experience multiple serious health issues at the end of their lives. According to Kaiser, “Roughly one-quarter of traditional Medicare spending for health care is for services provided to Medicare beneficiaries in their last year of life — a proportion that has remained steady for decades.” End of life planning seeks to decrease these costs for the program by making sure undesired care is not provided.

“Getting someone the right care at the right time is more likely to be of value in the long-term for everyone involved, including patients and their families,” Agostini writes about the cost-saving aspect of end of life planning.

Agents can be proactive as end of life planning receives greater recognition. Being sensitive to clients’ needs and wishes by advising them on Medicare’s changing policies is the first step — clients need to be aware of what is added to Original Medicare and what additional benefits Medicare Advantage may provide in the future. Reviewing Physician Directives, which are encouraged by all hospitals and skilled nursing facilities, is another course of action. Building a mutual relationship with a financial planner to establish a back-and-forth referral channel for clients interested in setting up or adjusting wills is a way to adapt and find new clients. Adding final expense with legacy safeguard planning to your sales portfolio is another option for helping clients make sure they are not caught unprepared.

Call RB Insurance at (800) 997 3107 or email Sales Manager Charlie Ferrell to learn more about end of life planning and Physician Directives.

Subscribe to The Agent’s Advantage to receive updates about advance care planning and other Medicare policy news from the agent’s perspective. RB Insurance will never sell or share your information.

Dual eligibility is your sales opportunity

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Seniors who are eligible for both Medicare and Medicaid, otherwise known as dual eligibles, are truly an untapped market. It’s estimated that approximately 8.3 million people in the United States are covered by both Medicare and Medicaid, including low-income seniors and low-income individuals with a disability who are 18 or older. CMS recently reported that 11 percent of these dual eligibles nationwide are enrolled in a Dual Special Needs Plan, which agents can sell year-round as part of their portfolio of products.

Dual Special Needs Plans are a type of Medicare Advantage plan administered by private carriers like United Healthcare and often include extra benefits not covered by Medicare or Medicaid such as Dental, Vision, Hearing Aids, OTC and non-emergency medical transportation. In addition to these needed extra benefits, having a Medicare Advantage Special Needs plan simplifies things for the enrollee — he or she will have to worry about just one card instead of three to access health benefits and prescription coverage, and he or she will have just one customer service line to call should there be an issue. Another selling point is that Special Needs plans offer care coordination so clients have help managing multiple or chronic conditions.

One of the best ways to reach out to dual-eligible prospects is with community marketing. Community marketing simply refers to getting yourself in front of as many individuals who could use some advice about their insurance options as you can. Whether it’s volunteering at a food bank or a Special Olympics event (something I enjoyed doing when I lived in SLC), people see that you really care and are much more likely to send potential clients to you when you give back to your community and let people know you are there to help. So many families are looking for a helpful guide because they often don’t know where to start when it comes to benefits.

You can focus your marketing efforts at key places I’ll list below if you are interested in selling dual-eligible plans. Remember I’m just giving you a starting point — I’ve known agents who have expanded their community marketing beyond what I have here. Also, some carriers expect you to let them know you are marketing to potential beneficiaries in HUD or Section 8 housing.

Here are the Top 10 places for dual-eligible marketing and Lead generation:
1. Section 8 housing
2. County housing authorities apartment buildings or HUD housing
3. Senior centers
4. Area agency on aging or counseling groups
5. Faith-based organizations or churches
6. Food banks or pantries
7. Support groups for foster grandparents
8. Thrift stores like Goodwill
9. Senior expos and health fairs (Check out Senior Broker Trainer Tom O’Neil’s post on marketing yourself at these events)
10. Non-profit organizations supporting those with disabilities (Click here to read my community marketing story with Special Olympics Utah)

For more specific information about marketing to dual-eligible seniors as part of your senior insurance business, give me a call at (800) 997 3107 or email me with your questions. I’m happy to give you more specific advice for your market.

GOP takes on health care programs as it passes 2016 budget, announces candidates

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We’re already seeing the first real thrusts of Republicans’ strategy to take back the White House as majorities in the House and Senate pass the first Congressional budget in over five years and half a dozen of the party’s presidential hopefuls announce their campaigns for the 2016 election. The GOP has the spotlight to further its case for balancing the federal budget in part by changing Medicare and Medicaid and possibly moving closer to delivering on its promise to repeal the Affordable Care Act (ACA).

The Republican budget aims to cut federal spending by $5.3 trillion in the next decade, reducing $4.2 trillion from benefit programs that include Medicare and Medicaid. However, the Hill reports that two dozen vulnerable Republican incumbents seem to be keeping a low profile when it comes to what specific changes they would make to the programs to match the nonbinding budget blueprint. They’re not only thinking how they will counter Democrats’ opposition to their bills, but also how they will retain their voter base in the next election.

Republicans in the House and Senate are using budget proceedings and the upcoming 2016 presidential campaign to push for changes to the country’s health care program as it aims to reduce federal spending. White House image courtesy of Flickr via Creative Commons.

The Hill also notes that Texas Sen. Ted Cruz and Kentucky Sen. Rand Paul, both running for president, voted against their party’s budget plan, while Florida Sen. Marco Rubio voted in line with his party weeks after announcing his campaign. Democrats predictably voted in total opposition to the budget in the House and Senate.

The Washington Post reports that under fast-track budget rules, Senate Democrats would not be able to filibuster Republicans’ attempt to vote on legislation calling for an end to ACA. However, President Obama would be sure to veto any budgetary action that would do away with his administration’s signature health care law. It’s assumed Republicans will do something to replace ACA to respond to voter concern over losing their subsidized health insurance as a result of their action.

Bloomberg News reports that Senate Republican leaders are considering legislation that would extend the ACA tax credits through 2016 in the event the Supreme Court invalidates the federal exchange later this summer.

Some Members of Congress are quietly discussing other entitlement changes related to Social Security. According to the New York Times, Paul Ryan (R–Wisc.) and Gov. Chris Christie (R –N.J.), who has said he’s thinking about running for president, have suggested “means testing” and an increase in the retirement age to solidify Social Security. An outlier in the conservative discussions regarding entitlements has been presidential candidate and former Arkansas Gov. Mike Huckabee, who promised he would “never rob seniors of what our government promised them and even forced them to pay for” in a video announcing his second run for the white House.

As we move closer and closer to the 2016 election, talk about the major health care programs and the possible political implications of action those words may inspire, however unlikely, should only get more interesting. Agents may want to pay attention to any upcoming bills dealing with Medicare, Medicaid, ACA and Social Security in case clients voice concern based on their own perusal of the daily news.

Subscribe to The Agent’s Advantage or join our professional network on LinkedIn to stay connected and informed.

Medicare Part B deductible will no longer be covered by Med Supps

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The bipartisan Medicare reform that repealed the “Doc Fix” also calls for changes to Medicare Supplement plans, which can be sold year-round and under less regulation compared to Medicare Advantage plans. Per the reform, Medicare Supplements can no longer cover the Part B deductible.

Language in the Medicare Access and CHIP Reauthorization Act gives a January 1, 2020, effective date for the plans to drop Part B deductible coverage, including the popular standardized Plan C and Plan F. Any Medicare member who already has a Supplement that covers the Part B deductible or enrolls before this date will be grandfathered in, meaning they will not see the change as long as they continue to pay the premium.

What’s happening now is similar to what happened when Medicare Part D was signed into law in 2003 — some Agents recall Plans I and J covered prescription costs before it made prescription coverage a major part of the senior health program.

States that currently do not approve standardized Medicare Supplement policies, which range from Plan A-N, will be prohibited from selling riders that cover the Part B deductible under the new reform.

The goal of the changes is to make seniors more conscious of the care they receive, which some have argued would lower costs by making patients think twice about their care because they now have to pay something. Research presented by the Congressional Budget Office confirms that higher out-of-pocket expense will reduce utilization, but that doesn’t necessarily mean the reform will actually save Medicare any money. The reasoning is short-term savings can be accomplished for Medicare if seniors utilize fewer medical services because of the deductible. But if some put off medical care they truly need because the Part B deductible is no longer covered, the change could potentially drive the costs up for Medicare in the long term due to lack of preventative care and an increase in more complex or serious medical conditions.

Congress has also decided to do away with first-dollar coverage starting in 2020, so it may take some time to find out if overall Medicare costs are overall reduced by using this strategy.

Editor’s note: The post has been updated to correctly report the reform’s changes to Medicare Supplements’ Part B deductible coverage. Eligibility criteria were not restructured; first-dollar coverage will be eliminated for all new Medicare Supplements members starting in 2020.

Subscribe to The Agent’s Advantage and join our professional network on LinkedIn to receive the latest updates on this and other health program changes.

What you need to know now about the “Doc Fix” repeal

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President Obama recently signed the Medicare Access and CHIP Reauthorization Act, one of the most significant pieces of  Medicare legislation in years, into law. Here’s the short list of how the permanent fix to the “Doc Fix” will affect Medicare providers and members:

Doc pay: The reform package will give doctors a 0.5 percent payment increase in each of the next five years as Medicare transitions to a system that rewards physicians on qualify of care rather than quantity of procedures performed.

Cost to seniors: Currently, beneficiaries with incomes starting at $85,000 (or $170,000 for joint filers) pay a higher monthly premium for Medicare Part B as well as an additional premium for Medicare Part D plans. Beginning in 2018, the new plan will move a higher percentage of program costs to wealthier seniors. Those with an income of $133,000-$160,000 (twice that for couples) will pay 65 percent of total premium costs of the program rather than the 50 percent paid today. Those with incomes of $160,000 -$214,000 will pay 80 percent rather than the 65% under current law. About 2 percent  of beneficiaries are expected to be impacted by these changes.

Medicare Supplement changes: Starting in 2020, “first dollar” Medigap policies will not be able to cover the Part B deductible, currently at $147 per year, for new beneficiaries. First-dollar Medigap coverage afforded by standardized Plans C and F is disputed to cause overuse of Medicare services.

The legislation will also impact the Federal CHIP program, the Qualifying Individual (“Q-I”) program that pays Part B premiums for lower-income beneficiaries as well as payments to post-acute providers such as long-term care facilities, rehab hospitals, skilled nursing facilities and home health and hospice facilities.

For a more detailed examination of the new legislation, check out Associate Editor Jennifer Gunther’s coverage here on The Agent’s Advantage. Sales Manager Charlie Ferrel goes more in depth about Medicare Supplement changes tomorrow.

“Doc Fix” is no more: Senate approves Medicare reform

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The bipartisan Medicare reform passed by the House on March 31 was approved by the Senate Tuesday in a 92-8 vote. The reform puts and end to the unpopular Sustainable Growth Rate (SGR) and nearly two decades of Medicare provider pay cut procrastination that came to be known as the “Doc Fix.” Congress put off a 21 percent cut to Medicare providers’ pay one more time as the reform awaited Senate approval with little or no change — cuts originally scheduled for April 1 will not go into effect on April 15, the Senate’s deadline for acting. President Obama has said he is eager to sign the bill into law.

The Medicare Access and CHIP Reauthorization Act, the reform’s official name, replaces the SGR with a new payment system and new financial incentives for physicians to see Medicare patients in a more quality-based arrangement, the Associated Press reports. It also funds the Children’s Health Insurance Program (CHIP) for the next two years and makes changes to Medicare Member payments and Medicare Supplement plans.

The Agent’s advantage recommends USA Today, The New York Times and The Hill for further reading about the Senate’s discussion of its vote.

 

Look to the star ratings for more Medicare sales

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If you’re not looking to the stars — that is, the Star Ratings available for each Medicare Advantage and Prescription Drug plan offered by a carrier  — to increase your sales, now’s a great time to start. A recent article from Avalere Health confirms what some Agents may have already been observing: Medicare Advantage Members gravitate to plans with higher star ratings, which typically means four or five stars.
The Medicare Program Star Ratings range from 5 stars to 1 star, from Excellent to Poor.

For the 2016 list of CMS’ plan rating criteria visit CMS’ website. The star ratings for all Medicare Advantage and Part D drug plans can accessed on the Medicare plan finder, which I wrote about last week.

Aries is a five-star constellation, but not a five-star Medicare plan. Use the Star Ratings available for each plan to educate your clients and increase their confidence in finding the highest-quality plan to seal the deal.

According to Avalere, 60 percent of Medicare Advantage plan Members now belong to plans with four or more stars. There are some logical reasons for these results: Under the Affordable Care Act, plans rated with four or more stars receive Quality Bonus Payments (QBPs) from CMS. QBPs may vary from $65 to $105 per member per month (usually noted as PM/PM) in a county with an average plan bid of $900 PM/PM. Plans awarded QBPs may use these CMS incentives to enhance Part D benefits, fund extra benefits, reduce copays or, in some cases, reduce Part B or Part D premiums.

For 2012 – 2014, 3 and 3.5 star-rated plans received adjusted QBP payments under a CMS demonstration authority. Those plans now rated with 3.5 stars or lower will no longer reap the benefit of the QBP payments. Star Ratings reflect many categories of plan performance so it is expected that CMS’s star rating program will improve the overall excellence of Medcare Advantage plans.

Agents can enhance their sales presentations and bring critical information about a plan’s quality to their clients by reviewing Star Ratings and explaining in detail how the ratings reflect plan performance. Plans rated with 4 or more stars offer the agent an attractive sales advantage over lower rated plans.

Affiliated Agents who would like additional information on how to educate their clients and enhance sales with Star Rating information can call (800) 997 3017 or email me to schedule a short and informative briefing regarding Star rating use in the sales presentation.

Think of Medicare.gov as your sales asset

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Most independent agents offering Medicare Advantage and Part D prescription drug plans are at least generally aware of Medicare’s official website, though relatively few of them think of it as a sales asset.

Medicare.gov is a handy tool for determining MA plan availability by ZIP code, and it also offers filtering options to determine a client or prospect’s Medicaid and/or Prescription Help eligibility level for a Special Needs Plan. Additional filters can display Chronic Illness Plans available for qualified beneficiaries. It’s the perfect resource for helping your clients or prospects find the best plan for their budget and health needs.

Prescription medications can be entered into the program to compare both MA and PDPs against the formularies on record with CMS. The drug list and plan comparison can be retrieved anytime with a simple, anonymous code and entry date auto-generated by the site. 

Medicare.gov’s Plan Finder is a great way to give your clients and prospects credible information about MA and PDP availability and eligibility for Medicaid and Prescription Help. Photo courtesy of iStock

Some agents are not aware they can print detailed comparison information from the site on behalf of their client or prospect. This very credible CMS-generated information comprises general copay details for both medical and prescription benefits, star ratings and reduced premium quotes for beneficiaries awarded LIS Prescription Help. More detailed information can display monthly medication costs, drug restrictions and even an estimate of when a plan member might enter the prescription “donut hole” and exit into catastrophic medication coverage.

Medicare.gov is a tool that can be especially beneficial to agents who represent a broad offering of MA plans and PDPs in his or her marketing area. An agent printing a side-by-side comparison of up to three plans from Medicare.gov can let your client or prospect know they can be confident you are giving them valid and useful information. This personalized comparison can be saved and retrieved from the website at any future time.

Independent agents affiliated with RB Insurance who’d appreciate a more detailed tour of Medicare.gov can give me a call at (800) 997 3107 or email me to schedule a personalized, 15-minute training tour of this site with an emphasis on closing sales with this fully compliant client-facing information.

Here’s a helpful video I’ve found from The Oregonian that gives a good rundown of Medicare.gov’s Plan Finder.

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

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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.

 

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

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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!