Dual Eligibles – Who are they?

What are Dual Eligibles, and why is everyone talking about them?

Simply put, dual eligibles are individuals who are eligible for both Medicare and Medicaid. These individuals are typically part of an under-served market and are eligible for a year-round SEP based upon their low income status.

Finding Dual Eligibles

As most of you know, Medicare is a federal program with deductibles and cost sharing associated with Parts A, B, and D. Medicaid is a federally funded but state run program. Because the funds come from the federal government, the feds get to tell the states what they MUST cover. The states determine on their own if they WANT to cover additional benefits. An individual who has both Medicare and Medicaid is entitled to have all of their cost sharing for Parts A and B paid for by Medicaid. For beneficiaries of a Part D Benefit, Medicare will automatically enroll them into a Part D plan that has a premium below the regional benchmark.

If a beneficiary has Medicare and has all of their cost sharing paid for by Medicaid, why would a Medicare Advantage plan be a good fit? It is really simple…Dual Eligibles receive EXTRA BENEFITS!!! A D-SNP (Dual Special Needs Plan) typically covers additional benefits such as dental, routine eye exams and eyeglasses. Some D-SNPs include transportation, hearing aids and over-the-counter benefits as well! The downfall to an MA plan is most D-SNP’s are HMO’s with specific doctor networks. The good news is that Medicaid beneficiaries are already accustomed to using Medicaid networks and getting referrals, so the fact that most D-SNP’s are HMO plans is not a detrimental factor in most cases.

Dual Eligibles are Members of Medicare Savings Plans or MSP’s

All states have Medicare Saving Programs (MSP’s) as well. Medicare Savings Plans pay for Part B premiums if you make below a certain income limit. For instance, SLMB’s can make up to 120% of the Federal Poverty Level (FPL) and are guaranteed to get their Part B premium paid for by the state. QI-1’s can make up to 135% of the FPL, but the funds to pay the Part B premiums are first come first served and are NOT guaranteed by the state to be available to pay the Part B premiums. Each state Medicaid sets their own rules and regulations for benefits in that state depending upon income and other factors.

Every year I meet two or three people who do not know about these Medicare Savings Plans, or that they may be eligible to receive Low Income Subsidy (LIS) benefits to reduce their prescription drug costs. Once I sit down with these folks at the kitchen table and help them see real savings, I know I’ve made a meaningful impact in their life!  By spending just a few minutes on this, I can add a lifetime client to my book of business who is more than happy to send friends and family my way.

You can save your client up to $300 a month or more by helping them apply for LIS and other Medicare Savings programs. Most programs do not require them to be full Dual Eligibles. Individuals who make between 100-135% of the Federal Poverty Level (FPL) can apply to have their Medicare Part D premium covered and their prescription cost sharing significantly reduced as well as their Medicare Part B premium covered. Click here for a link to your state’s programs.

Join us on March 14th for the “Finding Dual Eligibles” webinar to learn more!

RB Insurance Group is here to make it happen for you!

Upcoming Training Events:

Senior Insurance Acronyms for New Medicare Brokers

Senior Insurance Acronyms

RBI’s Senior Sales Coordinator: James Gramp

About the Author: With his signature common sense, quiet good humor, and brilliant customer service, Jim is an integral part of the RBI team — we’d go so far as to say we’d be lost without him! An Arizona native, Jim manages agent relationships for the East Coast and specializes in the RBI agent tools, especially the Agent Market Edge. Jim has been a licensed health insurance agent for 2 years, and has worked at RBI for almost 3 years. An accomplished bassoonist, he is known around the office for his amazing musical skills. In addition to keeping busy around the office, Jim frequently contributes to our blog, bringing a new agent’s perspective to the RBI online presence.

Senior Insurance Acronyms

for New Medicare Brokers

Compiled by RBI’s Senior Sales Coordinator: James Gramp

Are you a newly licensed Health producer?  Can’t wrap your head around the seemingly endless list of Senior Insurance Acronyms? Look no further!  This post is just for you, a new agent who’s looking to get started in the Senior Health Insurance (Medicare) market.

Consider your options: Best Contracting Partners

A few things before we jump in that you should be thinking about when choosing to work with an agency or contract directly with the insurance company:

  1. Do new agents receive training opportunities?
  2. Does marketing support come with the contract?
  3. Are the most competitive products in my area available with this partner?
  4. Does this partnership include CRM systems or other tools to keep track of your clients and potential clients?

The bottom line is, your FMO should work for you.  In the post I just linked to, Justin Bever, our Director of Marketing, highlights exactly how your FMO should work for you and ultimately help you reach and exceed your business goals!

Without further ado, I present you with the ultimate abbreviation cheat sheet!

Senior Insurance Acronyms for New Medicare Brokers:

MA – Medicare Advantage

MAPD – Medicare Advantage Prescription Drug plan

HI – Hospital Indemnity

FE – Final Expense

SOA – Scope of Appointment form: Permission slip to talk to beneficiaries who aren’t already your clients about specific benefits of MA plans.  The SOA should be signed by the beneficiary 48 hours prior to appointment.

HMO – Health Maintenance Organization: Type of Health plan, must use plan doctors for covered services.  Members are assigned a Primary Care Physicians and require referrals to see Specialists (dermatologists, cardiologists, etc.)

PPO – Preferred Provider Organization:  Type of Health plan where members can go out of network for care.  Going to in-network providers offers better co-pays/co-insurance

PFFS – Private Fee For Service: type of MA plan that may or may not cover prescriptions.  Only MA plan that you can buy a stand-alone PDP as long as the PFFS doesn’t already cover prescriptions.

SNP – Special Needs Plan: Medicare Health plans for people with special needs.  There are 3 different kinds of SNP’s; I-SNP, D-SNP, and C-SNP.

I-SNP – Institutional Special Needs Plan: plan for beneficiaries needing treatment from a LTC facility for more than 90 consecutive days.

D-SNP – Dual Special Needs Plan: Designed for people with Medicare and Medicaid

C-SNP – Chronic Special Needs Plan: Designed for people with chronic health conditions

Med-supp/Medigap – Medicare Supplement: offers plans A through N.  These plans are standardized and offer the same benefits regardless of carrier.

PDP – Prescription Drug Plan: Rx coverage, typically sold with Medicare Supplements.

LIS – Low Income Subsidy: Federal program to help with Rx costs.  Need to make under 150% of the Federal Poverty Level to qualify.

MSP – Medicare Savings Program: Federal program designed to help with premiums, co-pays, and co-insurance. Different levels of help are: QMB, SLMB, QI-1. Make under 135% of the FPL to qualify.

AHIP – America’s Health Insurance Plans: company that provides the core medicare certification required to sell Medicare Advantage plans.

AEP – Annual Enrollment Period: 10/7 through 12/7, period when Medicare beneficiaries can enroll in a MA/MAPD or a PDP.

SEP – Special Enrollment Period: period that you can enroll in an MA/PDP plan outside of AEP

IEP – Intial Enrollment Period: 3 months before, the month of, and 3 months after your 65th birthday.  Can enroll in any Medicare Health Plan during this time.

OEP – Open Enrollment Period for Medicare Supplement: 6 months after a Medicare beneficiary is enrolled in Medicare Part B and is 65 or older.

If you’re looking for a partner to grow your new business, look no further! We love helping agents get started — whether you’re a brand new agent, or you’re getting back into the market after being away: welcome! Call us today to learn about opportunities to work together: 1-800-997-3107

2022 AHIP
2020 ahip discount certification
Medicare cost-sharing
Aetna certification

Dual Eligible New Plan Member Outreach

James Gramp

 RBI Sales Coordinator/Independent Agent: James Gramp

Pro Tip: If you can solve your client’s problems that have nothing to do with Insurance, you will be their hero.  It can even be as simple as remembering something that they have going on in their life and asking them about it.  I know an agent really went the extra mile from a conversation with one of their clients. The Dual Eligible member had mentioned that she wanted to get a bike for her son’s birthday that was coming up but couldn’t afford it.  The agent was able to find a local organization that gives bikes to under-privileged kids and the mother was able to get her son a bike, thanks to this agent’s work.  Treat Dual Eligible beneficiaries like human beings and not just a client and I promise you that you’ll see more business stay on the books.

Dual Eligible New Plan Member Outreach

RBI Sales Coordinator/Independent Agent: James Gramp

Are you tired of hearing about why you should be taking advantage of the great opportunity you have to sell Dual SNP’s year-round? No? Good, because I’m not done talking about it!  The biggest complaint I hear from agents that don’t want to bother with Dual Eligible beneficiaries is that DSNP members can change plans throughout the year, are harder to keep as clients, and agents eventually lose them much sooner than a regular MA client.  So what’s the secret to retaining your DSNP business?  Member outreach.

What does member outreach look like?

When dealing with your Dual Eligible clients, you need to be reaching out to them regularly. Make sure they know that you’re there for them when they have problems.  By following my new member outreach strategy, your clients will not only see you being proactive with their insurance, but you’ll solve problems before they even arise!

5 steps to great member outreach (with a timeline!)

Step 1: Thank you letters (Next day or end of the week)

The first thing I do after enrolling someone in a Dual Eligible plan (I do this for every client of mine, not just Dual beneficiaries) is to send them a thank-you card, showing your appreciation for being their healthcare agent.  To give it a more personal touch, I also like to include a picture of myself and hand sign the letter. Bonus points if you hand write the whole letter! (If you want to get some help on thank you letters, RBI works with print and fulfillment companies for huge agent discounts!)

Step 2: Call to follow-up (2 weeks after the appointment)

Two weeks after submitting the member’s application, give them a call and confirm that they got their member ID card.  It’s the perfect time to order a new member ID card from member services if they haven’t gotten it yet.  Just call member services with your client on the line.

Step 3: Ask how their coverage is going (30 days after receiving the member ID card)

After 30 days of their new coverage, remind your DSNP beneficiary of any outreach that carriers do for new members, like welcome calls or any Health Risk Assessments.  Ask if they’ve seen their Primary Care Physician yet. (Especially if they’re seeing a new doctor!)  Also confirm that they received any other materials related to plan benefits like OTC cards and catalogs.

Step 4: Help them contact doctors (2 months after enrollment)

Two months after enrolling them, if they still haven’t seen their doctor yet (when you asked them the previous month) then make sure and find any phone numbers they need to schedule a doctor visit.  Make sure your members understand how all of their extra benefits work and how to utilize them.

Step 5: Make yourself available like clockwork (every other month after first doctor visit)

After I’ve made sure my DSNP clients know exactly how their plan works and how to use it, I follow-up every other month just to make sure they’re not having any problems.

Your members will appreciate that you’re being proactive rather than waiting for a problem to come up with their insurance.  Keeping your DSNP clients (and all clients) on the books boils down to giving the best customer service possible. When you step up your member outreach and make sure your clients are utilizing the plans benefits to its fullest, you’re ensuring that your clients never need to seek out help from another agent.

Want more great Dual Eligible advice? Click here to see our webinar “Finding Dual Eligibles” and get started! Click here for a list of carriers in your area, or call RBI at 1-800-997-3107 to speak to our team! Let’s get YOUR Dual Eligible book of business activated today! 

Senior Insurance Acronyms
Dual Eligible New Plan Member Outreach
Reboot: Finding Dual Eligibles Roll-up

Video: Reboot: Finding Dual Eligibles Roll-up

Did you miss Webinar Wednesday this week? Catch up by watching our Reboot: Finding Dual Eligibles Roll-up, below!

Our Dual Eligibles webinar was so popular we brought it back with this reboot! Dual Eligibles are a very under-served market, due in part to a lack of training for agents. RBI is here to fix this problem. If you are not sure where to start, watch our Reboot: Finding Dual Eligibles Roll-up below.

Here’s a few things you may not know about Dual Eligibles:

  • A Dual Eligible client is someone who qualifies for both Medicare (a federal program) and Medicaid (a state program).
  • Dual Eligibles have a year-round SEP, or Special Enrollment Period, which means they can be enrolled into a plan year-round.
  • Dual Eligibles are a very underserved community, with many members not fully understanding what help is available
  • Join Charlie Ferrell, RBI’s National Sales Manager, in our 60 Second Roll-up below for more details!

Reboot: Finding Dual Eligibles Roll-up

Look for this symbol on all our new “60 Second Roll-up” videos!

As you heard, there is a lot of opportunity to grow your business by serving this community. If you would like to get more details, you can watch the recording of the Webinar Wednesday, by clicking here.

Click here to attend our event “Contracting for Success” to learn how to build a portfolio that works for you! You can follow this link to see a list of our carrier partners and get contracted with a Dual Eligible product in your area.

Still not quite sure what’s next?  RBI has resources for you! Click here to sign up for our Medicare Marketing Crash Course on March 28.  Attend in person at RBI’s Chandler, AZ office, or join us via live stream!  Call RBI at 1-800-997-3107 to speak to our expert team! 

2022 AHIP
2020 ahip discount certification

ICYMI Duals for Newbies Wrap-up

Charlie Ferrell

National Sales Manager

Charlie started his senior insurance career after a brief 30-year stint in the restaurant industry. In the 12 years since then, he has been blazing trails and setting standards for excellence all over! A native son of Utah, he has been a state manager for RBI as well as a managing general agent for UHC, Coventry, Molina and other carriers! Charlie came to RBI as the National Sales Manager in 2015, and is an invaluable resource for our agents and staff for marketing, compliance, and sales topics! If all of that wasn’t enough, Charlie specializes in the Dual-Eligible market and is leading the charge behind RBI’s new “Dual Eligibles for Newbies” seminars!”

ICYMI Duals for Newbies Wrap-up

National Sales Manager, Charlie Ferrell

As many of you know, it’s our commitment to help our agents achieve more! As you can read about here, we take our agent’s needs very seriously. So out of all of our training options, we were excited to see that the Dual Eligibles for Newbies class went so well! We had a great group of agents, both in person and joining us on the simulcast also. If you weren’t able to attend, or if you aren’t contracted with us for a DSNP carrier, here’s the ICYMI Duals for Newbies Wrap-up!

ICYMI Duals for Newbies

Week 1: “What is a Dual Eligible?” –  We spent some time the first week discussing, “what is a dual eligible?” We learned who qualifies and what the different income levels for the different Medicare Savings programs (or MSP’s) are. We also distributed some great handouts with the different qualifications for MSP’s, now updated with the 2017 Federal Poverty level that became effective January 31st, 2017. We covered how Medicaid plans coordinate care and billing (or don’t coordinate and leave it up to the provider). The homework was to drive your neighborhood to find these resources close by.

ICYMI Duals for Newbies

In Case You Missed It (ICYMI): Duals for Newbies

Week 2: “Where to find Dual Eligible members” – The second week, we covered where to find Dual Eligible members. We learned how to use the Census.gov website as well as the HUD housing search tool. We also did several live searches for other community services to see where they are concentrated. Homework was to schedule at least one Medicare Educational event.

Week 3: “Planning your week for max results” – This 3rd session was all about how to plan your week, especially how to vet your potential resources to see if it would be a good match. Our takeaways? Make sure you treat this as a full time job and you will be rewarded with a full-time unlimited income. Plan out your week, month and quarter and set your goals appropriately.

Week 4: “Create a marketing plan” – The 4th and final session was structured around building a marketing plan. As our marketing department always says, you have 2 resources to generate income: time and money. Just a couple changes can increase your sales dramatically. Direct mail is a great way to generate leads quickly and is very affordable. RBI has resources, such as the “Every 5 Sales Drive” which makes more marketing money available based upon your sales. We used the MAPS method to plan a budget and then schedule out a complete week including study time.

What’s the bottom line?

Here’s just a few of the impacts we are seeing already: the production of agents who attended all 4 sessions is 100% higher for the month of January than their production for the month of January in 2016. 75% of all attendees created marketing plans. Best of all, 100% of attendees developed at least 1 new referral source to increase their business. All of our agents had some sales success during the event and were excited to get out and out their newfound knowledge to use. Almost all of them purchased some kind of direct mail piece and community marketing together to jump start the new year.

RBI – we make it happen for you!

If you weren’t able to attend the Dual Eligibles for Newbies class this time around, consider joining us for Webinar Wednesday on February 15 at 10 AM: “Reboot: Finding Dual Eligibles.” This is a great way to kickstart your Dual Eligible game!

Want to get started? Take a look at our carrier-partners to pick up additional contracts! Call RBI at 1-800-997-3107 to speak to one of our sales team! 

2022 AHIP
2020 ahip discount certification

Video: Finding Dual Eligibles Roll-Up

Did you miss this a Webinar Wednesday? Check out our Finding Dual Eligibles Roll-up!

Now that AEP is over, are you struggling to know what’s next? If so, check out our Finding Dual Eligibles Roll-up!

Dual Eligibles are a largely under-served community of Medicare recipients who also qualify for Medicaid.  Dual Eligible clients are a valuable market for agents because they have a year-round special enrollment period or SEP.  If you don’t know much about Dual Eligibles, or would like to get started, we have resources to help you out! Join Charlie Ferrell, National Sales Manager at RB Insurance Group, to learn more. Watch the 60 Second Roll-up below!

Dual Eligibles Roll-up

Look for this symbol on all our new “60 Second Roll-Up” videos!

Dual-Eligible clients offer a great financial opportunity for agents who want to keep their AEP momentum going!  In addition, many agents say that their experiences serving the Dual-Eligible community has been a rich lesson in compassion. If you would like to get involved, click here to access a related blog post.  Finally, to watch the recorded version of the “Finding Dual Eligibles” webinar, click here.

Interested in getting started, but still not quite sure what’s next?  RBI has resources for you! Click here to sign up for our 4-part class “Dual Eligibles for Newbies” or call 1-800-997-3107 to speak to our team!   

USA Senior Care Network
2019 AHIP
New Agent

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.