2017 MA compensation announced

On May 27th, 2016, CMS announced new rates for 2017 Medicare Advantage and PDP commissions. In the majority of states, the commission rate will be $443 for beneficiaries who are new to MA, and $222 thereafter for renewals. In California and New Jersey, initial sales compensation will be $553 per application.  Connecticut, Pennsylvania and the District of Columbia will be $498 for an initial enrollment. Puerto Rico and Virgin Islands will be $304. PDP compensation is $71 for the initial enrollment, with a $36 renewal rate.

This is roughly a 3.26% increase over 2016 rates. Although most carriers follow this structure, they are not required to pay the full rate. CMS’s only stipulation is that “the compensation amount paid to an independent agent or broker for an enrollment must be at or below the fair market value (FMV) cut-off amounts published yearly by CMS.”

Most carriers will announce their compensation around the same time their product certification comes out. So far United has announced their certification date, June 27th, 2016, just one week after the 2017 AHIP certification goes live. Humana is scheduled to release it’s 2017 certification modules sometime in August. Keep an eye on our calendar and blog for carrier certifications as they are released.

In the meantime, let RBI help you save $50 on the 2017 AHIP certification!

Be sure to sign up for our blog to enjoy the discounted AHIP Certification rate of $125 ($50 off the retail price of $175). As soon as AHIP goes live on June 20th,  we will send you a personalized link with the $50 discount. You don’t have to wait for any carriers to get the reduced rate, and because our offer is independent of other programs, you will still remain eligible for other possible carrier reimbursement incentives.

Check out our 5-2-1 program and get the remaining $125 reimbursed!

  • 5 -Make five Medicare Advantage sales with our carriers by January 1, 2017
  • 2 -Contract with at least 2 of our Medicare Advantage carriers 
  • 1 -Receive your reimbursement check for $125

It’s as simple as that! Once you’ve met the reimbursement criteria, every five additional sales submitted thereafter will earn you a 1,000-piece mailer for only $300. That’s a $125 discount off of our regular price and a great way to jump start your 2017 sales with fresh direct mail leads.

Learn how to ACE the AHIP by attending our Webinar!

If you find yourself struggling with the AHIP exam, let us help! We are holding weekly webinars on “How to Ace the AHIP exam”

How to Read The Agent’s Advantage blog

With over a year in the making, our new website is easy to use and is easier on the eyes … Consider The Agent’s Advantage to be your new home for contracting, lead management and product promotion news from RB Insurance.

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The straight facts on observation status and Medicare

According to, there was more than a 400 percent increase in Medicare-recognized observation status hospital stays lasting up to 72 hours between 2006 and 2011. Observation status means a beneficiary receives hospital care without being considered inpatient, making them ineligible for the Medicare Part A benefit as they transition to skilled nursing facility (SNF) care. Hospitals are currently not required to disclose observation status to patients. Patients may learn about their status if they ask first, but the unfortunate reality is most of them discover they were not inpatient and did not have their SNF care covered by Medicare when the bill comes.

Medicare requires beneficiaries to stay in the hospital for a minimum of 72 hours before it covers SNF care. Calculating the three hospital days can be complicated, however, due to how the rule is written. Health care policy experts say care improvements have made the rule outdated and an obstacle to accessing SNFs for seniors — three days is now a long time to treat many common senior health issues. What makes this rule especially challenging for beneficiaries is “observation status,” which does not count toward the three days necessary to unlock the SNF benefit.

This will change in August 2016. Congress passed the NOTICE Act this summer, which requires hospitals to give written notice of observation status hospitalization that lasts more than 24 hours to Medicare beneficiaries within 36 hours of their stay. This reform will protect seniors from unexpected bills, but it will not be implemented until next summer.

So, what can you do now to help your clients avoid high costs related to hospitalization and SNF care? First and foremost, remind them to be proactive about their health care and to ask questions. Talk to them about their Medicare rights and specifically go over how Original Medicare counts hospital days for the SNF benefit. If you’re selling Medicare Advantage during AEP, your client will appreciate knowing that most of these private Medicare plans cover SNF care from the first day.

Agents also have a year-round opportunity to sell hospital indemnity products to their senior clientele as well as non-Medicare-eligible individuals to help them out. Just remember these products may cover your client under observation as well as admittance depending on the company — it does not equate to the minimum essential coverage.

Cross-sell ACA, Medicare during overlapping enrollment periods

Most of the time RB Insurance Group is a marketing organization for the Medicare side of health insurance. We’ve been busy these past few months getting independent agents Ready To Sell a portfolio of Medicare Advantage and other senior products for the Annual Enrollment Period, which started October 15 and ends December 7 this year.

Did you know we also have a few opportunities for agents interested in selling individual plans connected to the Affordable Care Act (ACA)? Open enrollment for federal and state ACA markets started November 1 and will continue until January 31, 2016. It overlaps a fair amount with AEP. Cross-selling ACA and Medicare to families will help you take advantage of the overlapping enrollment periods.

If the idea of a double sales rush makes you feel exhausted, remember that a vast majority if not all Medicare beneficiaries have kids, who may also have kids of their own. You can generate ACA Leads from your Medicare book of business relatively quickly, especially if your senior client has been happy with your service.

Marketing your ACA products and Health Insurance Marketplace expertise should be less complicated than marketing your Medicare business because CMS currently does not have guidelines set for ACA. Cold calling and leaving door hangers may be illegal for marketing Medicare, but you can do them for ACA. Just be careful — if you’re at the kitchen table with a married adult couple who’s taking care of grandma at home, you’ll need to be able to switch gears when discussing ACA plans with the couple and Medicare with grandma. You’ll need to fill out a Scope of Appointment for any interaction you have with a Medicare beneficiary. Getting a referral from a family member is an excellent way to get permission to contact a Medicare beneficiary.

If you’re focused on running as many Medicare appointments as possible, consider hiring someone to make cold calls for ACA plans based on leads you pick up or receive from a marketing organization like RBI. It’s legal, and it will save you time and energy.

Call RB Insurance at 1 (800) 997 3107 or email Sales Manager Charlie Ferrell to learn more about our ACA contracting opportunities. Receive important Medicare policy and compliance updates in your Inbox. Click here to subscribe to The Agent’s Advantage newsletter.

What’s going on with the Medicare Part B premium?

The “Doc Fix” bill that passed this spring includes a provision to level the portion of Medicare Part B costs paid for by beneficiaries. This means the premium has to go up to cover the unfunded portion. According to an analysis by the Center for Retirement Research, quoted in this Fiscal Times article, up to 15 million beneficiaries could see their Part B premium increase from $104.90 to $159.30 a month. Couples could be paying more.

Click here to view the 2015 Annual Report from the boards that manage Medicare’s trust funds, and jump to pages 201-203 to view rate tables.

70 percent of the Medicare population gets their Part B premium taken out of their Social Security check. There is a “hold harmless” provision of the Social Security Act that does not allow Medicare beneficiaries to have any costs passed on to them if there is no Cost of Living Adjustment (COLA) to cover that increased premium. So, most beneficiaries’ premiums will remain stable at $104.90 this year.

Unfortunately for the 30 percent of Medicare beneficiaries who do not have their premium taken out of their Social Security check, it just so happens that if there is no COLA increase they are responsible for covering the entire amount of their premiums, which will be raised more than 50 percent to $159.30.

This also includes all of those on Medicaid that have their premium paid by the state as well as all individuals who have either chosen to delay taking Social Security or are not full retirement age yet (age 65-67).

Agents need to be proactive this AEP let their prospects and clients know what could happen to their medical costs so they’re prepared. My 82-year-old mother heard on the news that her premium was going to $159 and she was very worried about what was going to happen.

Most seniors do not know the details of the situation. As their agent, you can be the first one to educate them and earn their trust.

Don’t miss a thing this AEP. Subscribe to The Agent’s Advantage for more Medicare policy news that can affect your book of business. Call RB Insurance at (800) 997 3107 or email me to learn more about how Medicare Part B premiums may be changing for your prospects and clients this AEP.

Editor’s note: This post has been updated to include more sources and to clarify the premium increase.

Educate your clients on hospital observation stays and the NOTICE Act

Congress finally updated the rules hospitals must follow when they keep Medicare beneficiaries for observation.

The NOTICE Act, which is short for “Notice of Observation Treatment and Implication for Care Eligibility,” requires hospitals to provide written notification to patients within 36 hours of beginning observation care that lasts more than 24 hours. Hospitals must explain that patients under observation status have not been admitted and why, and they must also notify patients of the potential financial implications. Hospitals have 12 months to comply with the NOTICE Act, so it may be a while before it’s fully implemented. 

Help your Medicare Advantage clients understand how their plan covers hospital observation stays. A new law requires hospitals to disclose whether a Medicare beneficiary has been admitted or is under observation status. Image courtesy of iStock.

Hospital, Medical, Insurance, Indemnity, Agent, Commission

According to a press release from the American Health Care Association, the House unanimously passed the bipartisan legislation on March 16, and the Senate unanimously passed it on June 24 without amendment. Policy wonks can read the full text of the reform here. President Obama signed the bill into law on August 6.

Prior to the reform, Medicare regulations allowed hospitals to observe patients for up to 72 hours without actually admitting them. Beneficiaries who thought they were admitted to the hospital subject to Medicare Part A billing would be shocked to find their entire stay under observation was actually billed subject to Medicare Part B deductibles and cost sharing.

As agents we have a responsibility to make sure our clients know how to use their benefits, especially as the incidence of claims that hospitals submit for observation care continues to skyrocket. According to a Kaiser Health News analysis using the most recently available data from CMS, total claims increased 91 percent between 2006 and 2013 to 1.9 million. Long observation stays, which last 48 hours or more, rose by 450 percent to 170,219 during the same period.

Most Medicare Advantage plans cover hospital observation stays as an outpatient surgery co-pay at an in-patient facility (also known as a hospital). Make sure you check with each individual plan you represent so you can inform your clients before unexpected observation status happens. If they call you in panic after being hopsitalized, you can reassure them of their coverage and how it works. It’s that kind of consideration that can get you friend and family member referrals.

Read more about advising clients on hospital observation status here.

Beneficiaries’ potential liability doesn’t end with hospital costs either. Medicare regulations require an individual be hospitalized for three midnights in order to qualify for Medicare Covered Skilled Nursing  facility (SNF) care. With the high rate of observation stays, more beneficiaries face astronomical costs in a SNF without help from Medicare. Most simply cannot afford the $200+ per day cost of a SNF out of their own pocket.

Fortunately for some, most Medicare Advantage plans waive Medicare’s outdated three-midnight rule. Certain members can go directly to a SNF after 1 day in the hospital. I had a Medicare Advantage client who fell, broke her hip and went from the ER to surgery to recovery to SNF without ever spending the night in the hospital.

As always, you can call RB Insurance at (800) 997 3107 or email me to learn more about the NOTICE Act and other changes in Medicare policy.

Click here to subscribe to The Agent’s Advantange to get the latest news on Medicare reforms and changes to Medicare Part B. RB Insurance will never share, sell or rent your information.

King v. Burwell Update — Lawmakers await King v. Burwell ruling

King v. Burwell Update — The Affordable Care Act (ACA) was subjected to a third round of scrutiny when the Supreme Court decided to hear King v. Burwell, whose focus is the validity of the federal Health Insurance Marketplace. Lawmakers are anxious whether the court will side with the plaintiffs and invalidate the federal exchange or uphold one of ACA’s primary means of increasing health care access and affordability by siding with the federal government when it delivers its final word by the end of the month.

HHS Secretary Sylvia Burwell says it will be up to governors and Congress to respond if SCOTUS strikes down the federal health care exchange. Image of Congressional assembly during President Obama’s 2015 State of the Union address courtesy of Creative Commons and Flickr user NASA HQ Photo

Speaking at the Catholic Health Association Assembly on Tuesday, President Obama said his signature health care law “is now a part of the fabric of how we care for one another,” according to the New York Times. “It seems so cynical to want to take health care away from millions of people.”

Obama’s remarks were interpreted by many to be directed to the court’s nine justices as they near a ruling that would impact millions of people in the 37 states that use the federal exchange. They were dismissed by Republican leaders, who retorted that the president was “divorced from reality” as they argue ACA has produced more negative effects than positive. The New York Times also notes ACA and health care will be a major issue during the 2016 presidential election.

Governors and Congress will need to be the first responders if the court invalidates the federal exchange, Health and Human Services secretary Sylvia Burwell said Wednesday according to Kaiser Health News. She told the House Ways and Means Committee as the government would not be able to keep the federal exchange online or even available in a different form.

Republicans grilled Burwell over what legislation the GOP-controlled House and Senate could put together that would survive the president’s veto power. According to Kaiser, Burwell said the president will not accept any measure that calls for a repeal to ACA as part of a strategy to mitigate consumer losses if the court rules in favor of the plaintiff. Sen. Ron Johnson, R–Wis., has drafted a bill that would make federal subsidies available until August 2017, but do away with the individual mandate and other parts of ACA that have been contested by its opponents.

Kaiser has reported that Pennsylvania and Delaware are the only states that have already begun to develop alternative means of delivering federal subsidies to eligible individuals in the event the Supreme Court strikes down the federal exchange.

Subscribe to The Agent’s Advantage blog to receive the latest in King v. Burwell Update, HHS and CMS news as well as senior market sales tips.

Fed, states push and pull over Medicaid expansion

How the Affordable Care Act (ACA) connects Medicaid expansion to federal funding for state Medicaid programs has been subject to just a portion of the legal and political challenge as other parts of the health care law, like the individual coverage mandate or the requirement that contraceptive coverage be at no-cost to the consumer.

As Montana recently became the 29th state to expand its Medicaid program, other states like Florida, Texas and Kansas have voiced opposition to the government’s push for states to expand their Medicaid programs in order to receive funding for hospitals and doctors who treat low-income individuals.

Florida Gov. Rick Scott filed suit against the Obama administration on April 28, arguing the federal government is coercing his state to expand its Medicaid program by making hospital funding contingent on it.

The Associated Press (AP) reports that Scott believes the Supreme Court’s 2012 ruling in National Federation of Independent Business v. Sebelius that Congress does not have the constitutional power to link state Medicaid expansion with provision of full Medicaid funding applies to the Low-Income Pool (LIP) program, which gives special funding to Florida and several other states to provide care for low-income individuals. According to AP, legal analysts have said Scott’s new case against Obama administration may not be congruent with the 2012 ruling because Congress retains broad discretion over the optional LIP, which may not be an integral part of Medicaid.

The Agent’s Advantage recommends The New York Times and Kaiser Family Foundation for further reading about state-by-state Medicaid expansion.


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

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.

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

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.

SCOTUS nears ruling on federal Obamacare subsidies

King v. Burwell, the latest Supreme Court case to examine the Affordable Care Act (ACA), is drawing to a close.

Speculation has arisen over the future of the federal Health Insurance Marketplace that serves most of the nation in the two months since the plaintiff broached whether language regarding the federal exchange’s role in delivering subsidies conflicts with its mission to make health care more accessible to more Americans. How lawmakers will respond to the court’s ruling, which could invalidate the federal exchange if it sides with the plaintiff, has been ruminated by Republicans and Democrats alike as momentum starts to build for the 2016 general election.



The Supreme Court is deciding whether the federally facilitated exchange that’s part of the Affordable Care Act is valid in light of unclear wording. East facade of SCOTUS building courtesy of Creative Commons

The ACA was constructed with the creation of state-run exchanges in mind, in which eligible individuals could purchase a health insurance plan with federally issued subsidies to lower their monthly premium. When only 13 states set up their own exchanges, mostly due to staunch opposition from conservative states, the federal exchange delivered subsidies to people living in the 37 states that did not set up their own exchanges. 11.4 million people enrolled in a health plan for 2015 coverage during‘s second open enrollment period, which was extended with a special enrollment period due to confusion over tax penalties for not having prior coverage.

The New York Times’ Frequently Asked Questions page for the case notes the plaintiff has been persuading the court to uphold the literal interpretation of the law’s “established by the states” language to invalidate subsidies delivered through the federal exchange. As the defendant, the federal government argues “the phrase is a term of art, which Congress intended to mean both state and federally run marketplaces.” It adds that the law as whole references both state and federal exchanges as means of delivering subsidies to eligible individuals.

Though the FAQ notes a ruling in favor of the defendant could be based on the Supreme Court’s precedent in ruling that Congress ultimately decides how to interpret its own confusing language, a ruling in favor of the plaintiff would be a victory for the health care law’s opponents because it would substantially limit how the government may continue implementing ACA. A ruling in favor of the plaintiff would not equal an outright repeal of the health care law, which Republicans have repeatedly called for.

Bloomberg News commentator Noah Feldman writes the court’s recent ruling in U.S. v. Kwai Fun Wong, which upheld the concept of equitable tolling in light of unclear procedural language in the Federal Tort Claims Act, might guide the court as it decides whether the federal exchange remains a valid means of delivering subsidies in light of its own legal murkiness.

Though no official response has been prepared by Republicans, The Hill reports Rep. John Barrasso (R – Wyo.) has been leading meetings among party members to discuss what to do if the court rules in favor of the plaintiff. Conservatives have been sensitive to a change in leadership tone that supports revision rather than a total repeal of ACA; this may be the GOP’s way of  mollifying voters who are anxious about losing their coverage as multiple party members announce their run for the presidency.

The Hill also reports that Democrats in Congress, who are no longer the majority, would most likely work to pass a revision to the original language to bring direct clarity to the issue should the court decide against the Obama administration.

The court is expected to reach a decision by the end of June.

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