To the senior health agents struggling to expand their business with ACA: Pivot!

Have you been expanding your Medicare business into ACA? Do you feel overwhelmed by changes in the ACA market? This article will help you learn to pivot your Medicare business to continue selling!

An exercise in frustration – changes to ACA

Our Phoenix Health Plans agents in Arizona had to swallow a bitter pill last month when the carrier announced its 2016 Affordable Care Act plans are non-commissionable. (Don’t worry — PHP Medicare Advantage and Dual-Eligible plans will be paying agents for their business.) The rest of our contracted Medicare agents who have been working hard to expand their business with ACA probably threw their hands up last week when they heard United Healthcare, the nation’s largest carrier, lowered its projected ACA earnings and suggested it might exit the Marketplace in 2017. 

United Healthcare’s office in downtown Phoenix. The carrier lowered its projected earnings outlook for its ACA business this year and suggested it may leave the Marketplace in 2017. Image courtesy of CityScape Phoenix official website

Pivot Your Medicare Business

It’s obvious to say that ACA has been volatile for agents and brokers since the Marketplace opened two years ago. Carriers have been self-protective in light of the health care law’s sweeping industry changes and the simple fact it hasn’t been around that long. Agents have been overwhelmed with confusing onboarding processes, lack of specialized support and competition from the new health insurance navigators. It also doesn’t help that ACA is highly politicized and faces an uncertain future as we near the end of an administration. On the other hand, Medicare is seen as tried and true by carriers and agents alike.

Take stock and then get ahead of the changes

I’m fond of saying that being able to adjust your strategy in light of changes beyond your control is the key to surviving in this business. The situation we’re seeing as market forces and regulatory challenges put ACA agents in difficult sales environments is a perfect example of why the best agents are resilient.

On that note, I have two recommendations for agents who feel like they’re in over their heads: Leverage the better parts of ACA and pivot your Medicare business.

Don’t think that ignoring ACA is the way to deal with everything that’s been happening. As I’ve previously written, agents working with Medicare and ACA have an excellent opportunity to market their portfolio to entire families and not just to grandma and grandpa. The open enrollment period is longer than the Medicare Annual Enrollment Period, which closes on Monday. It might blow your mind to know there are no stringent guidelines for marketing your ACA business, unlike the regulations you need to follow for Medicare Advantage.

Stay up to date with carrier activity and make sure you’re contracted with the right plans.

While Medicare is our primary focus here at RB Insurance, a few of the ACA plans we have available for contracting are the highest commissionable products in Michigan and Texas. Barring the serious disincentive of PHP’s non-commissionable status for Arizona agents, we have contracting opportunities with the best alternatives to the Meritus co-op plans, which are being discontinued by order of the state Department of Insurance. Thousands of Meritus clients will need help finding new coverage. If you do business in Arizona, can you see yourself offering that support as you generate Leads for your senior business?

My second recommendation is central to what makes RB Insurance stand out among the many marketing organizations out there: Turn your attention to the underserved seniors out there who are eligible for both Medicaid and Medicare.

Why Dual-Eligible and Low Income Subsidy members?

When you work with Dual-Eligible and Low Income Subsidy (LIS) seniors, you can earn year round because of their unique statuses. A lot of agents worry that Dual-Eligibility and LIS mean more technical work or case management, but they’re overthinking it. RB Insurance has helped agents connect to these seniors for 20 years, and we’re ready to share our expertise with you. Most people who are eligible to receive assistance that could save them hundreds each month aren’t even aware there’s help out there, so the rewards for working with this market can be more than just financial.

Dual Eligible seniors and LIS recipients represent a low-competition market because many agents out there hesitate to work it. This group of seniors tend to live in rural areas or less than desirable parts of town. The fact of the matter is if you’re one of a few non-judgmental agents servicing these areas, you’re going to have a bigger share of the market and a larger ROI. Dual Eligible seniors are the ideal target market for final expense, and LIS seniors are prime for hospital indemnity cross selling. As Baby Boomers like myself age in to Medicare, a lot of them are discovering that Social Security Income is not enough to live on. Many seniors have chronic illness and need to take several prescriptions. These are the people we’re talking about — these are your potential Dual Eligible and LIS clients.

Results are in — and they are excellent indeed!

Two of our agents who pivoted their business to this market have seen phenomenal results in the past year. An agent in New Mexico earned $40,000 while working full time in the field for two months straight with direct mail marketing and community marketing. We had another agent working with Dual Eligible clients in California earn $16,000 in one week. They clearly tapped the market.

The Dual Eligible/LIS market is our favorite topic at RB Insurance. We’re happy to discuss contracting and sales opportunities one on one with agents by phone at 1(800) 997-3107, via email or in-person at our Chandler office. Stop by and learn how to pivot YOUR Medicare business today!

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

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 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.

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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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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Hospital indemnity coverage is not minimum essential coverage

Hospital indemnity plans, often referred to as HI, have become a valuable add-on for many Medicare beneficiaries. With Medicare Advantage plans’ increasing copays and coshares, these HI options can be a relatively inexpensive solution for your senior clients. Yet seniors are not the only ones who can benefit from HI — you have the opportunity to sell these plans to younger prospects who are not eligible for Medicare.

Your non-Medicare clients may also benefit from a hospital indemnity plan. Just make sure clients have a health plan that fits minimum essential coverage requirements before you write. (Image courtesy of iStock)

Make sure your non-Medicare client is enrolled in a health plan that meets the minimum essential coverage guidelines as defined in the Affordable Care Act (ACA) before you write. All Medicare clients enrolled in Medicare Part A or who have a Medicare Advantage (Part C) plan are deemed to have minimum essential coverage. The on-exchange and off-exchange ACA plans also meet the guidelines, as do most of today’s employee group plans and a limited number of other health plan types.

If your non-Medicare client does not have a plan that complies with the minimum essential coverage guidelines, you should not write him or her a hospital indemnity plan. The carrier will most likely not issue the policy, which would result in a declined application and a disappointed client. An explanation of CMS’ regulation and guidance on the matter is available — start at page 54 after clicking on the link.

RB Insurance works with numerous carriers offering Hospital Indemnity coverage, including GTL, Equitable, Medico and others. Visit our Carriers page to find immediate contracting opportunities.

RB Insurance-affiliated agents can explore the excellent commissions HI can generate with our available online training and one-on-one training. Call (800) 997 3107 or email me for more information.

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Look to the star ratings for more Medicare sales

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.

How do federal poverty guidelines affect your Book of Business?

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

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

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

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

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

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

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

• Payment of Medicare co-insurance and deductibles

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

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

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

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

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

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

GOP looks to privatize Medicare in 2016 budget unveiling

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

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

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

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

In King v. Burwell, ACA heads to SCOTUS once more

The Supreme Court proceeded to hear arguments from both sides on March 4 in King v. Burwell, the third legal challenge to the Affordable Care Act (ACA) to reach the nation’s foremost judicial authority. The case will be examining an unclear portion of the health care law that may determine whether subsidies it established to lower eligible individuals’ monthly insurance premiums may only be distributed through state-run exchanges and not through the federal Health Insurance Marketplace.

The Obama administration’s highly politicized, signature legislation intended to make health care more accessible faces being dismantled if the Supreme Court decides against it, not unlike the situation in 2012, when the court examined and later upheld the constitutionality of the tax penalty for not possessing health insurance in National Federation of Independent Business v. Sebelius.

According to the Associated Press (AP), one phrase in the 906-page law will be scrutinized by lawyers representing four individuals who reside in Virginia and the Department of Health and Human Services. The plaintiff argues subsidies are only available to eligible individuals through exchanges “established by the states” per the law’s wording. Therefore, they say, the federal exchange is not a valid means of distribution. Virginia does not have its own exchange, which means the individuals would have to use the federal Marketplace to apply for subsidies.

Only 13 states created their own exchanges for individuals to apply for subsidies and purchase a plan; currently, individuals living in the 37 states that declined to set up their own exchange may apply for subsidies and purchase a plan through the federal Marketplace.

The main question of King v. Burwell is whether subsidies established by the Affordable Care Act can only be distributed through state-run exchanges and not the federal Health Insurance Marketplace per disputed wording in the law.

According to the New York Times, America’s Health Insurance Plans, the insurance industry’s main lobby, has stated putting an end to the federal Marketplace “would leave consumers in those [37] states with a more unstable market and far higher costs than if ACA had not been enacted.” Individuals who used the federal Marketplace would lose their subsidized coverage if the court rules against the defendant.

USA Today reports the defendant argues ACA must be interpreted in its entirety. It was “designed to provide health insurance protection to ‘all Americans’ [, and this] must be considered paramount to any literal interpretation of those four words.”

The court may affirm ACA’s mission to make health care more accessible and more affordable by deciding in its favor and giving the federal Marketplace an official OK for distributing subsidies to eligible individuals. AP also reports that “federal agencies get the benefit of the doubt” when a law is determined to be too nebulous to enforce; however, if the court rules the law’s wording is too unclear, a future administration may be able to change parts of it.

The simplest observation would be that the letter of the health care law conflicts with its spirit. However, the political ramifications of the court’s possible ruling against ACA would be serious for Republicans and Democrats alike, who have already begun preparing for the 2016 election. The pending ruling’s impact on consumers also has yet to be seen.

RB Insurance will keep agents who have contracted to sell individual plans available on state or federal exchanges up to date on the case’s developments, and it will continue to focus on Medicare products and the dual-eligible market.