Podcasts about special election period

  Learn more about the Medicare Advantage Trial Right Period. If you have a client who enrolled in Medicare Advantage but wants to go back to Original Medicare, they may qualify. Listen to find out more about how it works!   Read the text version.   Mentioned in this episode:   Definitive Guidelines for the New Open Enrollment Period Guaranteed issue rights Join, switch, or drop a Medicare Advantage Plan Medigap & Medicare Advantage Plans Stay Busy Outside of AEP With Special Enrollment Periods What to Know When Replacing Existing Med Supp Plans for Clients   More episodes you’ll like:   Definitive Guidelines for the New Open Enrollment Period Stay compliant during the new Medicare Advantage Open Enrollment Period. We outline everything you need to know ― including what you can and can’t do ― during this time frame! How to Be an Adaptable Insurance Agent Do you go with the flow, or do you like a little more control? Find out why adaptability is a great skill for insurance agents to master. How to Check Medicare Extra Help Eligibility for Your Client Is your client eligible for Medicare Extra Help (Low Income Subsidy/LIS)? Learn how insurance agents can look up that information, what the income limits are, and more in this can’t miss episode! How to Get Started in Medicare Sales New to the Medicare insurance industry? Welcome, and congratulations! We packed this episode with all the agent essentials - training, tools, enrollment periods and more! Basically, everything you want to know when starting out! Stay Busy Outside of AEP With Special Enrollment Periods Drive insurance sales year-round with Special Enrollment Periods. Learn how to find clients and what special kinds of plans should be in your portfolio. The Part D SEP Triggers That Can Help You Post-AEP A prospect wants to switch their Medicare Part D coverage, but AEP is over. Can you still help? YES! Listen to learn the different scenarios that can help qualify your client for coverage through a Special Election Period. Understanding Medicare Advantage Enrollment Periods Medicare Advantage has different enrollment periods than Medicare Supplements. What are the Med Advantage enrollment periods? How and when do your Medicare clients qualify for them? Get the answers to your MA enrollment period questions right now! What to Do If Your Clients Can No Longer Afford Their Permanent Life Insurance Premiums Have a client who's struggling to pay their permanent life insurance premium? Before they let their policy lapse, they DO have options! Help them salvage their benefits with our tips. What to Know About SOAs in Senior Market Sales >Have questions about SOAs? Find the answers to your frequently asked questions in this episode all about Scopes of Appointment. We help you stay compliant, whether it’s inside or outside of AEP! What to Know When Replacing Existing Med Supp Plans for Clients Learn how to switch your client's Medigap plans. We unpack it all, from why your clients might want to switch Med Supps, to the free look period and everything in between.   Articles to Share with Your Clients:   Internet Safety Tips for Seniors The internet can be an entertaining and informative place, but there's also a darker side to it. It's easy to fall prey to scams, identity theft, or bad information. Here are a few internet safety tips so you can protect yourself online. Mood Foods: Foods That Boost Your Mood If you're feeling a bit down, the solution might be in your kitchen! We found some foods that boost your mood when you need a pick-me-up. When Can I Get a COVID-19 Vaccination? There are many questions surrounding the rollout of the COVID-19 vaccination. When can you get one? Where? Is it safe? We're giving you some answers and resources where you can find additional information!   The latest from Ritter’s Blog:   Best Practices for Writing an Email to Your Insurance Clients A professional and effective business email takes some thought and care to construct. This is true across all industries — and even for insurance agents writing marketing or follow-up emails to their clients. How to Be an Adaptable Insurance Agent In today’s ever-changing world, being adaptable is not only good for business, it’s a necessity. As an insurance agent, you need this skill to keep up with the times and your clients’ unique needs. How to Take on an Upset Client in the Insurance Industry At least once in your sales career, you may meet an insurance client who had a negative experience with another agent, plan, or insurance in general. While these bad experiences were out of your control, you have the ability to make their next experience a positive one!   Subscribe & Follow:   Apple Podcasts Google Podcasts Overcast Podbean Spotify Stitcher   Connect on social:   Facebook Twitter YouTube LinkedIn  

  A prospect wants to switch their Medicare Part D coverage, but AEP is over. Can you still help? YES! Listen to learn the different scenarios that can help qualify your client for coverage through a Special Election Period.   Read the text version.     Mentioned in this episode:   4 Steps to Finding the Perfect PDP for Your Client 7 Powerful Practices for Selling Prescription Drugs Definitive Guidelines for the New Open Enrollment Period Find your level of Extra Help (Part D) How SPAPs and their SEPs Can Bring You New Business Programs of All-Inclusive Care for the Elderly (PACE) Special circumstances (Special Enrollment Periods) Special Enrollment Periods for Medicare Advantage Plans and Medicare Part D Drug Plans Stay Busy Outside of AEP With Special Enrollment Periods   More episodes you’ll like:   How to Follow up with Medicare Clients Compliantly Think your job as an agent is complete after the sale? Not so fast. We whole-heartedly believe that the fortune is found in the follow-up! If you’re not sure how to follow up with your clients, listening to this episode is a great place to start. Stay Busy Outside of AEP with Special Enrollment Periods Drive insurance sales year-round with Special Enrollment Periods. Learn how to find clients and what special kinds of plans should be in your portfolio. Understanding Medicare Advantage Enrollment Periods Medicare Advantage has different enrollment periods than Medicare Supplements. What are the Med Advantage enrollment periods? How and when do your Medicare clients qualify for them? Get the answers to your MA enrollment period questions right now!   Articles to Share with Your Clients:   Cooking for Beginners: Cutting Board Safety Cutting boards are extremely useful tools in the kitchen, especially for protecting your countertops. For that reason, cutting board safety is equally important so you don't accidentally hurt yourself or get sick! Does Medicare Cover COVID Testing? Does Medicare cover COVID testing? It's an important question to be answered, since testing can give you peace of mind and help slow the spread of the pandemic. The Coverage Rules for Medicare Part D Plans You've come to rely on your Medicare Part D plan to give you coverage for your prescription drugs, but there are rules that govern this coverage and its limits. What are they?   The latest from Ritter’s Blog:   What to Do If Your Clients Can No Longer Afford Their Permanent Life Insurance Premiums Are your clients struggling to pay their permanent life insurance premiums? They have options other than letting their policies lapse! Here’s how you can help them salvage their benefits. How to Take on an Upset Client in the Insurance Industry At least once in your sales career, you may meet an insurance client who had a negative experience with another agent, plan, or insurance in general. While these bad experiences were out of your control, you have the ability to make their next experience a positive one! Medicareful 2020 Year-in Review: Here’s What We Accomplished Selling Medicare plans? You’ve probably heard of Medicareful. We’re reviewing what this free Medicare quoting software helped agents accomplish in 2020 and how it set itself apart from other online Medicare sales tools!     Subscribe & Follow:   Apple Podcasts Google Podcasts Overcast Podbean Spotify Stitcher   Connect on social:   Facebook Twitter YouTube LinkedIn  

If you find the different enrollment periods within Medicare confusing, don't go anywhere. In today's video, we'll go over every part of Medicare and the enrollment periods that come with each.My name is Lindsay Engle, and I'm the Medicare expert for Elite Insurance Partners and MedicareFAQ.com.Medicare comes with many different parts and plans. Each one has a specific enrollment period, and some have multiple. In this video, I discuss which enrollment periods fall under each part.First, we'll discuss Part A and Part B. Part A is your inpatient coverage, and Part B is your outpatient coverage. These parts come with two different enrollment periods:• Initial Enrollment Period: When you can first enroll in Parts A and B. Begins 3 months before your 65th birthday, lasts the month of, and continues 3 months after your 65th birthday• General Enrollment Period: If you miss your Initial Enrollment Period, this is the next time you can enroll in Parts A and B.  It occurs annually between January 1 and March 31. Your coverage will start on July 1– If you have a change of circumstance, you can qualify for a Special Election Period (example: having creditable group coverage through your employer)Next, we'll discuss the different enrollment periods that come along with Medicare Advantage plans.• Initial Coverage Election Period (ICEP): Begins three months before your 65th birthday and when it ends is dependent on when your Part B becomes effective• Annual Enrollment Period: If you miss your ICEP, the next time you can enroll is during the Annual Enrollment Period (AEP), which occurs each year between October 15 and December 7• Medicare Advantage Open Enrollment Period: If you're enrolled in an Advantage plan, and you want to make changes, you can do so annually between January 1 and March 31– You could also qualify for a Special Election Period due to a change in circumstancePart D prescription drug coverage also comes with similar enrollment periods.• Initial Enrollment Period: During this time, you can also sign up for Part D• Annual Enrollment Period: If you miss your Initial Enrollment Period, the next time you can enroll is during the Annual Enrollment Period– You can also qualify for a Special Election Period, just like Parts A, B, and C (Advantage)Now, let's go over when you can enroll in a Medigap plan.• Medigap Enrollment Period: This is your only enrollment period for Medigap. It lasts six months and begins once you enroll in Part B – it isn't annual like the others– Outside of the Open Enrollment Period, you can enroll in a Medigap plan at any time of the year as long as you have Part B – the only difference is you will have to answer health questionsA common misconception is that you can enroll in a Medigap plan during the Annual Enrollment Period without having to answer any health questions. This is not true unless it overlaps with your Medigap Open Enrollment Period.The last enrollment period we'll go over today is for those eligible for Medicare due to a disability.Initial Enrollment Period: You become eligible for Medicare once you collect Social Security Disability Income for 24 months. After 24 months, your Initial Enrollment Period will begin. This is the same 7-month window we discussed at the beginning of the videoSecond Initial Enrollment Period: In addition to your Initial Enrollment Period, you get a second one when you age in at 65Thank you so much for watching! If you'd like more information on the different enrollment periods mentioned, make sure to check out our enrollment period playlist.Make sure to subscribe to our YouTube channel if you found this video helpful and turn notifications on, so you know as soon as we upload a new video.Facebook Community: https://www.facebook.com/groups/MedicareFAQ

Are you new to Medicare and considering delaying enrollment in Part D? Don't go anywhere – in this video, we explain how the Part D penalty works.My name is Lindsay Engle, and I'm the Medicare Expert for Elite Insurance Partners and MedicareFAQ.com.Part D works as prescription drug coverage alongside Parts A and B. The best time to enroll is when you're first eligible, during your Initial Enrollment Period.Your Initial Enrollment Period begins three months before your 65th birthday. Will be the month of, and continues for three months after your 65th birthday. This gives you a seven-month window to enroll.Like Parts A and B,  Part D comes with a late penalty if you delay enrolling without creditable coverage. If you don't have creditable coverage, you may qualify for a Special Election Period to eliminate this penalty.This penalty works differently from the Original Medicare penalties. With Part D, you'll be charged a penalty equal to 1% of the national average premium for every month you delayed enrolling without creditable coverage.You'll pay this penalty every month as long as you have Part D coverage. If you're penalized, you can appeal the penalty by submitting a reconsideration request. This is available on CMS's website.For example, say you waited 33 months after your Initial Enrollment Period to enroll in a Part D plan. Unless you had creditable coverage or qualify for a Special Election Period, you'd be charged 1% of the national average Part D premium for each of those 33 months.Currently, the average premium for Part D is $33.06. The penalty is calculated by multiplying $33.06 by 0.33 (33 months), which equals $10.90. The Part D penalty is rounded to the nearest 10 cents. Therefore, your Part D premium would be somewhere around $43.97. Your premium would continue to increase, as the average premium does each year.Each Part D carrier sets its premium and drug formulary. Even if you think you don't need Part D prescription drug coverage right now, many different carriers offer these plans nationally. The monthly premiums start at around $15.When choosing between paying the premium now and paying the penalty for the rest of your life, it makes more sense to enroll sooner. This way, you'll avoid the penalty.Part D plans change annually. Each September, you'll receive an Annual Notice of Change letter that will go over your drug formulary and notify you of any premium increases.During the fall Annual Enrollment Period from October 15 through December 7, you'll have the opportunity to compare other plans in your area and make sure you have the lowest premium available.As has been noted, the best time to enroll in a Part D plan, and avoid penalties, is during your Initial Enrollment Period.Part D: https://www.medicarefaq.com/original-medicare/medicare-parts/medicare-part-d/Part D Late Enrollment Penalty: https://www.medicarefaq.com/faqs/medicare-part-d-late-enrollment-penalty/Initial Enrollment Period: https://www.medicarefaq.com/faqs/medicare-initial-enrollment-period/Special Election Period: https://www.medicarefaq.com/faqs/medicare-special-enrollment-periods/Annual Enrollment Period/Open Enrollment Period: https://www.medicarefaq.com/faqs/fall-medicare-open-enrollment-period/We hope you enjoyed this video! Don't forget to subscribe to our YouTube channel. Turn on notifications, so you know when we upload a new video.If you use Facebook, please join our Community: https://www.facebook.com/groups/medicarefaq#MedicarePartD #LateEnrollmentPenalty #PrescriptionDrugPlan

Are you aging into Medicare and still working? Don't go anywhere! In this video, we explain how your employer coverage works with Medicare. My name is Lindsay Engle, and I'm the Medicare Expert for Elite Insurance Partners and MedicareFAQ.com. The size of your employer will be a factor in your Medicare decision when you're 65 years old and still working.If Your Employer Has 20+ Employees:If your employer has more than 20 employees, your employer coverage becomes primary, and Medicare becomes secondary. In this scenario, most beneficiaries choose to enroll in Part A because Part A is usually premium-free as long as you have paid into Medicare for sufficient quarters. If you end up at the hospital, your Part A benefits will help keep your out-of-pocket cost lower.Part B is your outpatient coverage, and Part D is your prescription drug coverage. As long as your employer has more than 20 employees, the coverage is considered creditable under Medicare. This allows you to delay enrolling in Part B and Part D without being penalized.Because employer group coverage usually includes outpatient services and prescription drug coverage, most beneficiaries choose to delay enrolling since each comes with a monthly premium. Down the road, when you retire, you'll qualify for a Special Election Period. You'll be able to enroll in both Part B and Part D without incurring any penalties. If Your Employer Has Fewer Than 20 Employees:If your employer has fewer than 20 employees, your Medicare becomes primary, and employer coverage is secondary. In this scenario, you'll want to enroll in both Part A and Part B. If you don't, you could be responsible for paying 80% of your outpatient services as well as incur a late penalty.An Exception:If you have a high-deductible plan and health savings account, and you plan to continue contributing or accepting your employer's contributions, you shouldn't enroll in any parts of Medicare. This is because the IRS states that if you have any additional coverage, including Part A, you cannot continue contributing to your HSA.Important Tips:• It's important to make sure your employer notifies Medicare that you  have retired to avoid rejection of any of your medical bills• If you're currently collecting Social Security Income, you will automatically be enrolled in Part A. You cannot collect SSI without also enrolling in Part A.If you plan to continue working past 65 and delay retirement, I hope you found this video helpful. If you did, make sure to subscribe to our YouTube Channel! Turn notifications on, so you know as soon as we upload a new video.Medicare and Employer Coverage FAQ: https://www.medicarefaq.com/faqs/medicare-and-employer-coverage/Medicare & HSA: https://www.medicarefaq.com/faqs/hsa-and-medicare/Our Medicare Facebook Community: https://www.facebook.com/groups/MedicareFAQ/#Medicare #Turning65 #EmployerGroupCoverage

There are many different enrollment periods for Medicare. Today, we will discuss one of the most important ones: the Medicare Annual Enrollment Period, which comes around every fall.My name is Lindsay Engle, and I'm the Medicare Expert for Elite Insurance Partners and MedicareFAQ.com.The Medicare Annual Enrollment Period is commonly referred to as the Annual Election Period or the Medicare Open Enrollment Period. It occurs annually, in the fall, between October 15th and December 7th.This enrollment period is for beneficiaries who are already enrolled in Medicare to make changes to their coverage. This means that you must either be enrolled in Part A and Part B of Original Medicare, a Medicare Advantage Plan, or a stand-alone prescription drug plan under Part D.If you're enrolled in Medicare Advantage, you can change from one carrier to another carrier or switch back to Original Medicare. When you switch back to Original Medicare, you can then choose to enroll in Medigap and Part D plans if you wish to do so.If you're currently enrolled in Part D, you can choose to switch from one plan to another or drop your coverage altogether. You can also enroll in a Part D plan at this time if you only have Original Medicare without any prescription drug coverage.A first key point to remember is if you're not already enrolled in Medicare, this is not the enrollment period for you. If you're looking to enroll in Part A and Part B for the first time and you're outside your Initial Enrollment Period, you'll have to wait until the General Enrollment Period, which runs annually between January 1st and March 31st.Another key point to remember is that if you're choosing to enroll in a Medicare Supplement Plan at this time, you'll still have to answer health questions and go through medical underwriting. The only way around this is if your Medicare Open Enrollment Period is also happening during the Annual Enrollment Period or, due to a specific circumstance, you qualify for a Special Election Period.The Annual Enrollment Period does not give you guaranteed issue rights. You can enroll in a Medigap plan at any time of the year. The only thing to remember is if you are outside of your Open Enrollment Period, which is the first six months after your Part B effective date, you will have to answer health questions. Any coverage changes you make during the Annual Enrollment Period will become effective January 1st of the following year.Each September, your Medicare Advantage carrier or Part D carrier will send you a plan annual notice of change that will give you a brief summary of all your benefits.Your notice of change will explain any plan coverage changes that will become effective the following year. You will want to pay attention to your premium. If you feel that the premium is increasing more than expected, it may be time to shop around for new plans.If you have Medicare Advantage, you should also pay attention to the doctor network. Make sure your doctor is still within your plan's network.Another important thing to check is your Part D drug formulary to ensure your current prescriptions will still be covered.Thank you so much for watching! If you have any questions about the Medicare Annual Enrollment Period, make sure to leave them in the comments section below.Like what you see? Join our Facebook group! It's a group dedicated to helping people become educated on Medicare. Whether you're a current Medicare beneficiary, taking care of a loved one on Medicare, or will be aging into Medicare shortly, this is your Medicare resource center. https://www.facebook.com/groups/MedicareFAQ/

There are many different enrollment periods for Medicare. Today, we will discuss one of the most important ones: the Medicare Annual Enrollment Period, which comes around every fall.My name is Lindsay Engle, and I'm the Medicare Expert for Elite Insurance Partners and MedicareFAQ.com.The Medicare Annual Enrollment Period is commonly referred to as the Annual Election Period or the Medicare Open Enrollment Period. It occurs annually, in the fall, between October 15th and December 7th.This enrollment period is for beneficiaries who are already enrolled in Medicare to make changes to their coverage. This means that you must either be enrolled in Part A and Part B of Original Medicare, a Medicare Advantage Plan, or a stand-alone prescription drug plan under Part D.If you're enrolled in Medicare Advantage, you can change from one carrier to another carrier or switch back to Original Medicare. When you switch back to Original Medicare, you can then choose to enroll in Medigap and Part D plans if you wish to do so.If you're currently enrolled in Part D, you can choose to switch from one plan to another or drop your coverage altogether. You can also enroll in a Part D plan at this time if you only have Original Medicare without any prescription drug coverage.A first key point to remember is if you're not already enrolled in Medicare, this is not the enrollment period for you. If you're looking to enroll in Part A and Part B for the first time and you're outside your Initial Enrollment Period, you'll have to wait until the General Enrollment Period, which runs annually between January 1st and March 31st.Another key point to remember is that if you're choosing to enroll in a Medicare Supplement Plan at this time, you'll still have to answer health questions and go through medical underwriting. The only way around this is if your Medicare Open Enrollment Period is also happening during the Annual Enrollment Period or, due to a specific circumstance, you qualify for a Special Election Period.The Annual Enrollment Period does not give you guaranteed issue rights. You can enroll in a Medigap plan at any time of the year. The only thing to remember is if you are outside of your Open Enrollment Period, which is the first six months after your Part B effective date, you will have to answer health questions. Any coverage changes you make during the Annual Enrollment Period will become effective January 1st of the following year.Each September, your Medicare Advantage carrier or Part D carrier will send you a plan annual notice of change that will give you a brief summary of all your benefits.Your notice of change will explain any plan coverage changes that will become effective the following year. You will want to pay attention to your premium. If you feel that the premium is increasing more than expected, it may be time to shop around for new plans.If you have Medicare Advantage, you should also pay attention to the doctor's network. Make sure your doctor is still within your plan's network.Another important thing to check is your Part D drug formulary to ensure your current prescriptions will still be covered.Annual Enrollment Period: https://www.medicarefaq.com/faqs/medicare-annual-enrollment-period/Medicare Supplement Open Enrollment Period: https://www.medicarefaq.com/faqs/medicare-supplement-open-enrollment/General Enrollment Period: https://www.medicarefaq.com/faqs/medicare-general-enrollment-period/Medicare Advantage Open Enrollment Period: https://www.medicarefaq.com/faqs/medicare-advantage-open-enrollment-period/Initial Enrollment Period: https://www.medicarefaq.com/faqs/medicare-initial-enrollment-period/Special Enrollment Period: https://www.medicarefaq.com/faqs/medicare-special-enrollment-periods/Annual Notice of Change: https://www.medicarefaq.com/faqs/medicare-annual-no

Hey Medicare Nation! www.TheMedicareNation.com Today, I'm finishing up my series on the Medicare Plan Sponsors that CMS has issued Sanctions and/or Civil Money Penalties for in 2020! THREE more plan sponsors to discuss! CMS sent notice to Ms. Aparna Abburi, President of Health Care Service Corporation (HCSC), on February 28, 2020, that CMS was imposing a Civil Money Penalty in the amount of $381,272.00! HUGE Penalty people! According to CMS Summary of Non-Compliance, HCSC disclosed to CMS that it "discovered" a backlog of unprocessed Part C (Medical) Appeals. The Majority of these appeals were from claims from providers (doctors and/or facilities) or ..... reimbursement requests from enrollees. HCSC has the right to Appeal CMS Decision.   NEXT Up..... is Triple-S Management Corporation! CMS sent a Notice to Ms. Madeline Hernandez-Urquiza, President of Triple-S Management Corporation, on February 28, 2020. CMS notified Triple-S that they had made a determination to impose a civil money penalty in the amount of $329,872.00! CMS reported that Triple-S failed to comply with Medicare requirements related to Part D Formulary and benefit administration. Triple-S has the right to Appeal CMS decision. Last up..... is Tufts Health Plan, Inc.  CMS sent notice to Mr. Thomas Crosswell, President and CEO of Tufts Health Plan, Inc., to advise them of CMS' determination to impose a Civil Money Penalty in the amount of $28,302.00. CMS Auditors reported that Tufts failed to comply with Medicare requirements related to Part D Formulary and benefit administration and coverage determinations, appeals, and grievances in violations of Medicare regulations. Tufts has the right to Appeal CMS' decision. If YOU are unhappy with any of the three Medicare Advantage Plan Sponsors, give Medicare a call. You can request a "Special Election Period," based on your experience with any of these companies. Call Medicare at  800 - 633 - 4227  24hrs a day, 7 days a week. www.TheMedicareNation.com   Thank you for listening to Medicare Nation! If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation! If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use  your help in putting the word out! If you have any questions, send them to Support@TheMedicareNation.com If I can answer it in one email - I will personally answer you! If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner. Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show! Thanks again for listening!  

  How do you keep your Medicare business thriving after Annual Enrollment ends? What can you sell outside of AEP? We talk products for your portfolio, selling strategies, and compliant follow-up, and more!    Read the text version.   Register with Ritter   Mentioned in this Episode:   2012 Facts from LIMRA 3 Ways to Calculate Your Clients’ Life Insurance Needs 4 Reasons Why Ritter Should Be Your FMO Insurance Agency Building Client Loyalty: More Than Just a Plan Genesys Releases Customer Satisfaction Surveys Getting Started Selling Medicare Supplements Ritter Leads Program Rules for Hosting a Compliant Medicare Educational Event SNPs: The Secret to Surviving Lock-in Secure a Bigger, Better Business with Ancillary Products Stay Busy Outside of AEP With Special Enrollment Periods The Part D SEP Triggers That Can Help You Post-AEP Try Cross-Selling Annuities to Fuel Sales   More episodes you’ll like:   January 17, 2020 | The Friday Five Oscar & Cigna teaming up, screening kids for toxic stress in CA, smart contact lenses, sweethearts are BACK, and our newest FREE eBook is now available for download! Starting Your Own Insurance Agency featuring Craig Ritter and Dave Dietz What does it really take to create your own insurance agency? We sat down with Craig Ritter, President and Owner of Ritter Insurance Marketing, and Dave Dietz, Senior Vice President of Marketing at Ritter, to pick their brains on the subject. These are just some of the questions they answer: When do I create an LLC? What qualities do I look for in downline agents? Should I follow the 80/20 rule? Listen now for the answers to these questions and more! The Beginner’s Guide to D-SNPs What is a Dual Eligible Special Needs Plan? How do you sell it? Where do you find dual-eligible prospects? Our D-SNP primer answers these questions and more! The Part D SEP Triggers That Can Help You Post-AEP A prospect wants to switch their Medicare Part D coverage, but AEP is over. Can you still help? YES! Listen to learn the different scenarios that can help qualify your client for coverage through a Special Election Period. Things to Think About Post-AEP AEP is over.

  Maximize your book of business with Special Needs Plans. We unpack the basics to help you get started.   Read the text version.   Mentioned in this episode:   Medicare Managed Care Manual The Beginner’s Guide to D-SNPs   More episodes you’ll like:   3 Easy Ways to Build Your Insurance Sales Territory Maximize your reach and grow your selling territory. We outline the best practices to follow. 5 Myths About Selling Medicare… Debunked! If you’re on the fence about selling Medicare, this episode is for you! Don’t let these myths hold you back from selling Medicare! The senior health insurance market is booming — and there’s plenty of room for more agents… like you! The Beginner’s Guide to D-SNPs What is a Dual Eligible Special Needs Plan? How do you sell it? Where do you find dual-eligible prospects? Our D-SNP primer answers these questions and more! January 3, 2020 | The Friday Five (SMART Goals) No resolutions here, but we are talking goals. Specifically, SMART goals and how to get your insurance business set for success in 2020. January 10, 2020 | The Friday Five The Friday Five for January 10, 2020: Governor Cuomo’s State of the State, Medicaid concerns in NY, study finds Medicaid expansion leads to better health, end-of-year spending bill revisited, and CES 2020. The Part D SEP Triggers That Can Help You Post-AEP A prospect wants to switch their Medicare Part D coverage, but AEP is over. Can you still help? YES! Listen to learn the different scenarios that can help qualify your client for coverage through a Special Election Period.   The latest from Agent Survival Guide:   What is E&O Insurance and Do You Need It? Mistakes happen, even to the best of us. Fortunately, errors and omissions (E&O) insurance can help you mitigate the risks and costs that come with your profession. The insurance for those who...(read more) Should You Sell D-SNPs? Dual Eligible Special Needs Plans are a great product to add to your portfolio, especially since 12 million Americans (20 percent of the Medicare population) have dual-eligible status. While we think selling...(read more) The Beginner’s Guide to C-SNPs Have you ever considered selling Chronic Condition Special Needs Plans (C-SNPs)? Yes or no, we’ve got the quick guide that you need to read! C-SNPs can allow health insurance agents to keep...(read more)   Subscribe & Follow:   Apple Podcasts Google Podcasts Overcast Podbean Spotify Stitcher   Connect on social:   Facebook Twitter YouTube LinkedIn  

A huge Medicare Part D Update for 2020. This is very important for anyone that used Medicare’s Part D Plan Finder when shopping for their Medicare Part D plan for 2020. In October, Medicare decided to roll out a new and “improved” Part D Plan Finder on their website on October 1st, 2019 only two weeks before the Annual Enrollment period. Unfortunately, the information in the Plan Finder was found to be conflicting with the information from the Part D carriers. Zip codes were incorrect, pharmacies, the premiums but most importantly the costs of the medications. There were numerous errors with their system. Unfortunately, anyone that was shopping for their Part D plan without the assistance of an agent or broker wouldn’t know if there were errors in the system and took their information as gospel. This has resulted in many seniors with the wrong Part D plan. Luckily, Medicare has admitted the mistake and has allowed a Special Election Period under this specific circumstance. On Medicare’s website it reads: “If you believe you believe you made the wrong plan choice because of inaccurate or misleading information, including using Plan Finder, call 1-800-MEDICARE and explain your situation. Call center representatives can help you throughout the year with options for making changes.” You can find this information under this link to Medicare’s website: https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances-special-enrollment-periods Senior Healthcare Direct’s customer service agents have tested this SEP and it works! So please, if you feel that you have purchased the wrong Medicare Part D plan because of incorrect information on their Plan Finder, give Medicare a call and explain the situation to them and they will correct the mistake and put you on the Part D plan that’s best for you. If you have any questions regarding Medicare, please give our office a call at 1-855-368-4717 or visit one of our pages: Website - https://www.seniorhealthcaredirect.com/ Facebook - https://www.facebook.com/MedicareBob/ Podcast - https://anchor.fm/MedicareBob Twitter - https://twitter.com/MedicareBob YouTube - https://www.youtube.com/c/RobertBache?_confirmation=1

  A prospect wants to switch their Medicare Part D coverage, but AEP is over. Can you still help? YES! Listen to learn the different scenarios that can help qualify your client for coverage through a Special Election Period.   Read the text version.   Mentioned in this Episode:   4 Steps to Finding the Perfect PDP for Your Client 7 Powerful Practices for Selling Prescription Drugs Definitive Guidelines for the New Open Enrollment Period Find your level of Extra Help (Part D) How SPAPs and their SEPs Can Bring You New Business Programs of All-Inclusive Care for the Elderly (PACE) Special circumstances (Special Enrollment Periods) Special Enrollment Periods for Medicare Advantage Plans and Medicare Part D Drug Plans Stay Busy Outside of AEP With Special Enrollment Periods   More episodes you’ll like:   4 Steps to Finding the Perfect PDP for Your Client Prescription Drug Plans are not one size fits all. Discover how you can help your clients find the PDP that fits their needs best. 5 Myths About Selling Medicare… Debunked! If you’re on the fence about selling Medicare, this episode is for you! Don’t let these myths hold you back from selling Medicare! The senior health insurance market is booming – and there’s plenty of room for more agents… like you! 7 Powerful Practices for Selling Prescription Drugs Improve your PDP selling strategy. Our best practices help you save time and are easy to implement. How to Follow up with Medicare Clients Compliantly Think your job as an agent is complete after the sale? Not so fast. We whole-heartedly believe that the fortune is found in the follow-up! If you’re not sure how to follow up with your clients, listening to this episode is a great place to start. January 3, 2020 | The Friday Five (SMART Goals) No resolutions here, but we are talking goals. Specifically, SMART goals and how to get your insurance business set for success in 2020. Understanding Medicare Advantage Enrollment Periods What are the different Medicare Advantage enrollment periods? How and when do your clients qualify for them? Get the answers to your MA enrollment period questions in this episode of the ASG Podcast!   The latest from Agent Survival Guide:   Should You Sell D-SNPs? Dual Eligible Special Needs Plans are a great product to add to your portfolio, especially since 12 million Americans (20 percent of the Medicare population) have dual-eligible status. While we think selling...(read more) The Beginner’s Guide to C-SNPs Have you ever considered selling Chronic Condition Special Needs Plans (C-SNPs)? Yes or no, we’ve got the quick guide that you need to read! C-SNPs can allow health insurance agents to keep...(read more) How to Transition from AEP to D-SNPs The lock-in period is approaching, but just because it’s not the “busy season,” doesn’t mean you can’t stay busy! You can keep sales and commission coming in by shifting your focus from...(read more)   Subscribe & Follow:   Apple Podcasts Google Podcasts Overcast Podbean Spotify Stitcher   Connect on social:   Facebook Twitter YouTube LinkedIn  

Hey Medicare Nation! www.TheMedicareNation.com How Do I get treatment & prescriptions during a weather emergency? Hurricane Dorian is moving up the East Coast of the U.S., and MILLIONS of people have evacuated the coastlines, to seek safety. What happens if you get sick or you need to fill prescriptions while you’re away from home during a weather emergency? Or…. What happens if you need to move into a Skilled Nursing Facility, but you haven’t fulfilled the “3 Day Prior Hospitalizaton” Rule….due to the weather emergency? Let’s take a look at these questions for you. After President Trump Declared Emergencies in Puerto Rico, Florida, Georgia & South Carolina….. Health & Human Services Secretary ….. Alex Azar….Declared Public Health Emergencies in those States.  Secretary Azar also declared a “Blanket Waiver” for Hurricane Dorian. What that means…… is some restrictions under Medicare are more “Flexible” during the Declaration. For example……. You evacuated your home in Savannah Georgia, to go stay with your relatives in Michigan. Prior to evacuating your home, you were receiving home health care for physical therapy…due to a sprained ankle. If you are on Original Medicare, you can contact “Any” home health agency that accepts Medicare to re-start your physical therapy at your relative’s home. They should be able to contact Medicare to get copies of the orders you had for the Physical Therapy. If you’re on a Medicare Advantage Plan, you will need to contact your Plan carrier…… advise them you evacuated from a Public Health Emergency area and that you need to “Resume” physical therapy at home ASAP. The plan should contact a home health care vendor in the area you’re temporarily staying in, to resume your physical therapy. If you have a Medicare Specialist, call them! You WILL need their help in expediting the process. Remember…… MILLIONS of people have evacuated coastal areas! Don’t Delay!!! If you need to use your Medicare benefits…. CALL as soon as possible. For Prescription Medications……let’s say in the stress of having to “evacuate,” you forgot all your prescriptions at home. under a Medicare Advantage Plan, call your carrier & tell them what happened. You should be able to get a “Refill” under the “Emergency Waiver,”  for most prescriptions. If you need an Extension for 60 – 90 days for your prescription, due to being out of the area, call your plan and ask them if they “offer” extended day prescriptions. If you’re on an “opioid” prescription……… call your plan & advise them of your situation. Hopefully, you can get a refill…. for at least a day…. or two…… under the waiver, until you can be seen by a doctor in the area you’re temporarily staying at. Your carrier will tell you which Pharmacy is “IN” network…. Where you’re staying.  If there is NO pharmacy “In” Network where you’re staying, ask the carrier if they will “reimburse” you for the cost of the prescriptions. You will need a receipt with the Pharmacy name,  prescription name, and the price you paid for the prescription on the receipt to submit to your Medicare Advantage Carrier for reimbursement. If you had Durable Medical Equipment …… Orthotics, Prosthetics,  or Oxygen Supplies for example….. that was lost, destroyed, “irreparably damaged” ….. or otherwise rendered unusable…… you should be able to replace it from a vendor in the area you’re staying….. with the “flexibility” to WAIVE the replacement requirements that are normally in place. If you are on a Medicare Advantage Plan, contact your carrier for assistance in getting a replacement…. And advise them the “Blanket Waiver” is in place. They will assist you in finding a local vendor to “Replace” your equipment.    For those of you needing to stay at a “Skilled Nursing Facility,”Under “Normal” Circumstances…… if you or a loved one needed to enter a “Skilled Nursing Facility,” you would be required to have a “ 3 Day Prior Hospitalization” … prior to entering the Skilled Nursing Facility. Under the “Blanket Waiver,” the 3 Day prior hospitalization is “waived,” so that you can enter the Skilled Nursing Facility without further delay. This rule would be in effect “temporarily,” for those who are …… “ evacuated, transferred, or otherwise…. “dislocated” as a result of the emergency. So….. if you “evacuated” your home in Puerto Rico, Florida, Georgia or South Carolina, due to Hurricane Dorian….. and let’s say you’re temporarily staying with relatives in Pennsylvania………and you need to enter a Skilled Nursing Facility……you would be able to enter the facility without the 3 day prior hospitalization. If you are on a Medicare Advantage Plan, you must contact your carrier to assist you in determining which “Skilled Nursing Facilities” has room for you to be admitted into.   These are examples of how Medicare “requirements” are more flexible during a Public Health Emergency WITH a “Blanket Waiver.”   How long does the Blanket Waiver Last? Until Secretary AZAR signs an order stating the Public Health Emergency is over. NOW….. let’s take a look at how FEMA affects enrollment into Medicare.   FEMA… which stands for the Federal Emergency Management Agency, also declared emergencies in Puerto Rico, Florida, Georgia, South Carolina AND the Virgin Islands (which are St. Croix, St. John, St. Thomas AND Water Island) ….., which creates a “Special Election Period” for Medicare Beneficiaries, who needed to enroll in a Medicare Plan during that time, but were unable to ….. due to the effects of Hurricane Dorian. This means if you needed to enroll in Medicare, or into a Medicare Advantage Plan for September 1st…….. you will be given a Special Election Period to do so…. Under the Emergency “Weather Event.” So….if you need to enroll into a Medicare Advantage Plan…..OR…. a Stand-Alone Prescription Drug Plan…. you can do so, most likely through the end of October…… or even November in South Carolina & Georgia, under the FEMA Emergency. You can call Medicare at  800 – 633 – 4227 or your Medicare Specialist for more information.   If you feel you are overly “stressed” with all the information on TV & social media, about Hurricane Dorian…… #1 ….. STOP watching the news continuously!  Listen to some music…. Read a book….. play a board game. Go out for a walk. Continuously Watching the news about the weather is the worst thing you could do! If you need to speak with someone, you can call the “Disaster Distress Helpline.” Call  800 – 985  - 5990 to connect with a trained counselor, who can assist you with your distress. You can even “TEXT” ….. TALKWITHUS   type the letters all together and send it to…. 66746. You can also go online to get more Public Health & Safety info by going to https://www.phe.gov/Dorian Finally….. if you would like to help those affected by Hurricane Dorian in the Bahamas….OR ….any of the other impacted States….. Call your local TV Station or go onto their websites to find information on how to volunteer or donate supplies. If you’d like to “donate” money to a cause….. For Animals. Go to the Humane Society of the United States website… HumaneSociety.org/Disaster-Relief The Humane Society is evacuating animals form Animal Shelters across Florida and the other States. They have already helped transport almost 100 animals here in Florida, that they will place in “safe shelters,” with the hope of being put up for adoption. If you’d like to contribute to a Humanitarian Charity….. or one that is specifically helping those in the Bahamas…… go to the Charity Navigator website & they have a list of highly ranked charities that are providing relief. Go to   http://charities.foundation/dorian To donate to one of these funds. That’s all for this special show and I wish everyone out there, in the path of Dorian…… that you & your loved ones are safe. Till next time.... Have a Safe & Peaceful week! Diane 

You Can Enroll Through March 31, 2019From January 1 through March 31, you can enroll in Part A and Part B if you have not done so, but should have. The effective date for Part A and Part B will be July 1, 2019. In addition, the Late Enrollment Penalty will continue to accrue until July 1, 2019. For those on COBRA, the pod explains that COBRA is very complicated, and doubly so for married couples. If you are enrolling in Part B late, then there is a Special Election Period which begins on April 1, and enrolling in a Medicare plan may be important for multiple reasons. Please rate the podcast on Apple Podcast and subscribe to the MYM Newsletter at www.maximizeyourmedicare.com! [/fusion_text][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]

When you’re first starting Medicare, this is called your Initial Enrollment Period, or IEP. You have 3 months before, the month of and 3 months after your 65th birthday to shop for you Part D drug plan. Anytime after that is called the Annual Enrollment Period, or AEP. This time frame allows you to shop your Part D drug plan once every year. The dates for this period start on October 15th and end on December 7th. If you are losing retirement/group insurance or you have moved out of the service area of your plan, this is called a Special Election Period, or SEP. Once you find out you are losing your coverage, you have 60 days before the last day of your coverage and 63 days after you lose your coverage to enroll in a Part D drug plan.

Hey Medicare Nation! It's Medicare Annual Enrollment Time! The Medicare Annual Enrollment Period runs from October 15th through December 7th, each year. Many of you are looking at different Medicare Advantage Plans and Prescription Drug Plans for 2018. Some of you are staying with the Medicare Advantage Plan you're already on. What many of you don't know.......is that the Center for Medicare & Medicaid Services (CMS) has added a Special Election Period for individuals affected by weather related disaster's since September. Anyone that resides in Alabama, Florida, Georgia, Puerto Rico, South Carolina or the U.S. Virgin Islands, may qualify for this special election period, due to hurricane Irma. Anyone residing in Louisiana and Mississippi may qualify for the Special Election Period, due to Tropical Storm Nate. Residents of Texas may qualify due to Hurricane Harvey. To determine if you qualify for this special election period, CMS has deferred the locations affected by Weather Disaster's to FEMA. Go to the FEMA website - www.fema.gov/disasters and click on the weather related emergency, to see if your location was declared an emergency by FEMA. If your county or State has been declared an emergency due to the unique weather event, you will be granted an SEP by CMS, to change your Medicare Advantage Plan or stand alone Prescription Drug Plan.  In addition, the weather related special election period is available to..... those individuals who don't live in the affected areas but rely on help making healthcare decisions from friends or family members who live in the affected areas. Go to www.fema.gov and click on the link for the weather related disaster in your State, to see if you qualify for this special election period. You can call Medicare if you have questions regarding the "weather event" special election period. Call 800-633-4227. The "weather event" special election period runs till December 31, 2017.  

Hey Medicare Nation! Over 17.5 Million of you are on a Medicare Advantage plan. And many of you have been, or know of a situation where your doctor has left the “network” and you are told by your Medicare Advantage Plan Carrier that you must find a new doctor. You tell your Medicare Advantage Plan carrier that you would like to change plans to keep your doctor, and they will tell you something that goes like this….”I’m sorry, you are unable to change plans mid-year. You will have to wait until the Annual Enrollment Period occurs to change plans, unless you have a special election. So….you’ll need to change doctors at this time.” Sound familiar? Well…..on today’s show, I’m going to discuss a “special election (SEP),” called – “Significant Network Change,” that many, many Insurance Agents don’t even know about. Revisions were made to the Medicare Managed Care Manual, which went into effect on April 22, 2016. The Significant Network Change Special Election Period, as written in the Medicare Managed Care Manual is listed as: “Pursuant to 42 CFR § 422.62(b)(4), enrollees who meet the exceptional conditions of being substantially affected by a significant no-cause provider network termination may be afforded a special election period (SEP). If CMS determines that an MAO’s network change is significant with substantial enrollee impact, then a “significant network change SEP” may be warranted. CMS will use a variety of criteria for making this determination, such as: (1) the number of enrollees affected; (2) the size of the service area affected; (3) the timing of the termination; (4) whether adequate and timely notice is provided to enrollees, (5) and any other information that may be relevant to the particular circumstance(s). The Medicare Advantage Organization will be required to notify eligible enrollees of the significant network change SEP if the SEP is granted by CMS. SEPs will not be granted when MAOs make changes to their network that are effective on January 1 of the following contract year, as long as affected enrollees are notified of the changes prior to the AEP.   According to the rules, if a Medicare Insurance Carrier makes a  “significant change” to one of their Medicare Advantage plan’s networks, that plan’s beneficiaries could possibly be granted a Special Election Period. This provider network change SEP allows beneficiaries “three months” to switch to traditional Medicare, with or without a stand-alone Prescription Drug Plan, or switch to a different Medicare Advantage plan, with or without Part D coverage. Whether or not beneficiaries qualify for this SEP is entirely up to CMS. CMS states in the Medicare Managed Care Manual that they may grant a provider network change SEP to beneficiaries based on some of the following factors: The amount of beneficiaries affected Whether or not beneficiaries received adequate and timely advance notice of the provider terminations The size of the plan’s service area The time of the year that the plan made changes to its provider network So…..if you have lost your primary care doctor, due to a non-cause termination in your Medicare Advantage Network, and it has caused you a “significant change” to your healthcare due to your doctor’s termination from the network, call Medicare and fight for this SEP! If Medicare denies your request for a SEP and you honestly feel you qualify under one or more of the criteria stated……. Call me and hire me to contact Medicare on your behalf! I have listed other Special Enrollment instances when you can make changes to your Medicare Advantage Plan outside of the Annual Enrollment Period. For a complete list, go to www.Medicare.gov   TRADITIONAL MEDICARE SPECIAL ENROLLMENT PERIOD Here’s quick guide to when you can make changes to your Medicare Advantage Plan: You can make your initial selection of a Medicare Advantage Plan when you enroll in Medicare at age 65. During the Annual Enrollment Period which is between October 15th through Dec 7th every year. You can dis-enroll from a Medicare Advantage Plan between January 1- Feb 14th, but you would have to go back on to Original Medicare because you cannot switch to another Medicare Advantage Plan at this time. You may have a “Special Election” that qualifies you to change your plan.   The Special Election Period that qualifies you to change your Medicare Advantage Plan, is what we want to focus on today.  There are certain circumstances which allow you to qualify for this option. If You Move If you move and your new residence is not in your plan service area. You would need to notify Medicare as soon as possible, because you have the rest of the current month you are moving and the following 2 full months as the Special Election Period. If you move to a new address and your plan is still in your service area, but by moving you now have new options available to you that you didn’t previously have, then you would have a Special Election Period to change to one of the new option plans. Snowbirds that live in 2 locations, have to determine which of those residences is your primary residence. Where you vote and where you pay taxes are going to determine which is your primary residence. If you move out of the country for a period of time and now you are coming back to live in the US,  that will trigger a Special Election Period. If you are moving into a long term care facility or a Skilled Nursing Facility with round the clock skilled nursing care, you would have a Special Election Period when you move into the facility, while you are residing in the facility and when you move out of the facility.  Losing Coverage: If you leave your Employer's Insurance Plan, or union through retirement, turning 65, etc. If you had an involuntary loss of drug coverage that was as good or better than Medicare drug coverage(credible coverage), that triggers a SEP. Or if you have had drug coverage through a Medicare Cost Plan and you leave the Cost Plan. If you leave a PACE (Program All-Inclusive Care for the Elderly) Program. If you had Medicaid and lost eligibility because of income requirements.   When there are plan changes with Medicare Contracts: If your Medicare Advantage Plan was sanctioned by CMS, then you would be able to contact Medicare directly to request a Special Election Period  to choose another Medicare Advantage Plan. If Medicare terminated a contract with your Medicare Advantage Plan, that will trigger a Special Election Period and CMS will notify you.   Special Circumstances You qualify as a Medicare & Medicaid recipient, you may change Medicare Advantage Plans as often as you'd like! If you qualify for LIS (Limited Income Sources) you may get extra help with prescription drug coverage and a Special Election Period to enroll in a different Medicare Advantage Plan. During your Initial Enrollment Period for Medicare, you may have enrolled in a Medigap plan, and decided to change to a Medicare Advantage Plan during your first enrollment year. If you decide you want to change back to a Medicare Supplement Plan during your first year of coverage, you qualify. SNP Plan - for chronic conditions (Diabetes, Heart Disease, COP) - may change your current Medicare Advantage Plan to enroll in a SNP plan, or you may no longer qualify for a SNP, so you can choose another Medicare Advantage Plan. f an error was made by a federal employee when you signed up for Medicare, and you can prove it, you may be granted an SEP. If you have a Medicare Supplement - a Medigap plan, you can change plans whenever you want because there is no SEP for Medicare Supplement Plans. Precautions: If you have a chronic illness, cancer, cardiovascular disease or other medical conditions, a Medicare Supplement (MediGap) plan does not have to enroll you after your first year of enrollment. You need to be careful and make sure you are going to be able to get coverage when you change plans. The Medicare Supplement carrier may not take you due to pre-existing conditions and once you drop your Medicare Advantage Plan, you may be "locked out" and not able to re-enroll until the next open enrollment period..Medicare Supplement Carriers can discriminate due to pre-existing conditions! The price of Medicare Supplement plans do change as you age, and where you live. Keep that in mind.   Need more information on "Special Enrollment Periods?" See the entire list at www.Medicare.gov    Do you have questions or feedback? I’d love to hear it! I may answer one of your questions on the air! email me: support@themedicarenation.com Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)     Find out more information about Medicare on Diane Daniel’s website! www.CallSamm.com  

Hey Medicare Nation! How many of you have just found out your Doctor is leaving the Medicare Advantage Network you're in? I'm certain there are "Thousands of you." That is the #1 complaint I receive from clients, is that their "Doctor" is leaving or has left their Medicare Advantage Plan (MAPD) Network. Medicare has regulations about how a Medicare Advantage Organization (MAO) can "terminate" a Doctor contracted in their network and in reverse, there are regulations on how a Doctor can leave a MAO. There are also regulations on how a MAO publishes it's "Provider Directory" for their network. Chapter 4, Section 110.1.1 of the Medicare Managed Care Manual, titled, Provider Network Standards, lists in part....  "MAO's are required to establish and maintain provider networks that: ...... Are accurately reflected in up-to-date directories. Plans are responsible for verifying and regularly updating their network directories to ensure that providers included in the directories are available to their enrollees (ie, listed providers accept new patients who are enrolled in the plan).   In section 110.2.2 labeled Provider Directory Updates, it states in part: ....MAO's must include information regarding all contracted network providers in directories at the time of enrollment. Directories must include information about the number, mix, and distribution of all network providers. MAO's may have separate directories for each geographic area they serve (e.g. metropolitan areas, surrounding county areas), provided that all directories together cover the entire service area. Provider Directories must be updated anytime the MAO becomes aware of changes. They have 30 days to update the changes or be non-compliant. When there is a change to the provider network (a provider is terminated or the provider is leaving the network), The MAO "must make a good faith effort to provide a written notice of a termination of a contracted provider at least 30 calendar days before the termination effective date to all enrollees who are patients seen on a regular basis by the provider whose contract is terminating." In regards to termination of "Primary Care Physicians," all enrollees who are patients of that primary care professional must be notified."   So.....what's being done about all the inaccuracies to provider directories?   CMS conducted it's first review of 54 Medicare Advantage Organizations (MAO's) online provider directories, between February and August of 2016. The finding......45% of provider directory locations listed in these online directories were inaccurate! About one-third of all MAO's with 5,832 providers were reviewed in total. Twenty-One MAO's received warning letters from CMS around January 6th, and they have 30 days to fix the errors or face possible fines or sanctions, which could include suspending marketing and enrollment of medicare beneficiaries. Here are the Medicare Advantage Plans that received warning letters from CMS to immediately fix the errors in their provider directories. Blue Cross & Blue Shield of Rhode Island - RI Rhode IslandBlue Cross Blue Shield of Michigan - FL MI, MO WI Catholic Health Partners - IA,KY, MI, OH CIGNA  - IL, IA Community Health Plan of Washington - WA Emblem Health Inc. - CT, NY, RI Fallon Community Health - MA Gateway Health Plan, LP - OH, PA, WV Health Partners Plans, Inc. - PA Highmark Health - PA Humana Inc. - WI Indiana University Health - IA Magellan Health Inc. - NY Moda, Inc. AK, ID, MT, NM, OR, WA Molina Healthcare, Inc. - UT Piedmont Community Health Plan - VA Premera - WA Samaritan Health Services - OR SCAN Health Plan - CA UnitedHealth Group, Inc. - CO Wellcare Health Plans - IL   Now.... if you are a member of one of these MAO plans that received a "warning letter," you may qualify for a "Special Enrollment Period," from Medicare. What should you do?........ 1. Call Medicare - 800-633-4227 2. Tell the Medicare employee that you are a member of the ________ Medicare Advantage Plan, that received a "Warning Letter" from CMS for non-compliance of their provider directory. 3. State (if it's true!) that you were not notified by your physician or the MAO of the termination of your doctor, and your directory wasn't updated. 4. VERY IMPORTANT  TO STATE.....     Tell the Medicare employee you RELY on the directory to locate an in-network provider, and by the Medicare Advantage Plan & the Doctor NOT informing you that he/she was LEAVING the network, it caused a SIGNIFICANT access to care barrier for you!  Because now...... You can't see your doctor who has taken such good care of you..... due to the error. 5. Ask for a Special Election Period, so that you can choose a Medicare Advantage Plan where your Doctor is in-network. 6. If they grant you the Special Election Period, tell the Medicare employee which Medicare Advantage Plan you want to be on. 7. If they say "NO,"  Thank the Medicare Representative for their help and say goodbye.   What do you do now???? See if you qualify for a different Special Election Period. Listen to my earlier episode on SEP's. Listen to Last Friday's episode on 5 STAR Plans. Listen to the episode on the Medicare Advantage Disenrollment Period. It also includes information on Special Need Plans. If NONE of these ideas offer you the opportunity to change your Medicare Advantage Plan to a better option, than you will have to remain on the Medicare Advantage Plan you are on until the Annual Enrollment Period to change plans. Do your Due Dilligence Nation! Don't enroll in another Medicare Advantage Plan.... just because the doctor who is leaving the network is on that one! Make sure the plan will fit your Medical, financial and prescription needs for 2017! Share Medicare Nation with someone! Teach your parents, your grandparents how to access this podcast! Buy them a smartphone. The more they know, the less they will ask you for help. It's not easy being the "Sandwich Generation." So...... do yourself and your parents a favor and help them listen to Medicare Nation!   

Hey Medicare Nation! Medicare has announced the 2017 "5 Star Plans." What are 5 Star Plans? Medicare rates all health and prescription drug plans each year, based on a plan's quality and performance. Medicare Star ratings will help you understand the job a plan is doing. There are 2 main types of Star Ratings: 1. Overall Star Rating that combines all of the plan's scores. 2. A Summary Star Rating that focuses on a plan's medical or prescription drug services. A few areas Medicare reviews for these Star Ratings include: 1. How plan members rate their plan's services and care. 2. How well a plan's network of doctors detect illnesses and keep members healthy. 3. How well a plan helps it's members use recommended and safe prescription medications. A plan can receive a 1 to 5 Star Rating. 5 Stars is Excellent 4 Stars is above average 3 Stars is average 2. Stars is below average and 1 Star is poor. You can only switch to a 5 Star Rating Medicare Advantage Plan or a 5 Star Stand-alone Prescription Drug Plan, that is available in your area. You can only switch to a 5 Star Medicare Advantage Plan, Medicare Cost Plan or Medicare Prescription Drug Plan once from December 8th to November 30th of the next year. Once you use your election to enroll in a 5 Star Plan, you cannot use it again. If a Medicare Advantage Plan or a Stand-Alone Prescription Drug Plan has received a 5 Star Rating from Medicare, it doesnot mean you automatically go out and enroll in the 5 Star Plan. That 5 Star Plan may not fit your unique needs! The option is available..... if you need it! Some people enroll in a Medicare Advantage Plan during the Annual Enrollment Period, and only switched plans because they received an incentive from the new plan. Ex: Your neighbor "Phil" tells you he is on the greatest Medicare Advantage Plan. He receives $30 in "Bandaids" from his plan every month. He tells you to "switch" plans so you can get $30 worth of over-the-counter supplies every month. Phil hands you his "Agent's" card. You call Phil's "Agent," who gladly comes out and enrolls you into the same exact plan that Phil has. The plan goes into effect January 1st. You call your Primary Doctor on February 6th for an appointment because you think you have the flu.  The secretary advises you that Dr. Jones does not accept the new plan your on. What? You didn't check to see if your Primary Doctor accepts the new plan? Phil's "Agent" didn't check to see if your Primary Doctor was in the new plan's network? Sorry......you should have done your due diligence. Now you will have to "remain" on this plan until the next Annual Enrollment Period. You are "locked-in," until October 15th.  Maybe you were better off on the plan you originally were on. In this example, you may have another option! You find out in January, that XYZ Medicare Advantage Plan has a 5 Star Rating in your area. You can look up the XYZ Plans and determine if one of their plans accepts your Primary Doctor in their network. Check the co-pays, co-insurance and deductibles on the new plan. Check that all your prescription drugs are in the new 5 Star Plan's formulary. If you like what you found out about the 5 Star Rating Plan that is available in your area, you are allowed to "switch" one time from the Medicare Advantage Plan you are stuck on, to the 5 Star Rating Plan available in your area.  Once you make the election to switch to the 5 Star Plan, you cannot enroll into another plan - whether it has 5 Stars or not.  Only a criteria that fits a Special Election Period will be allowed. Look on the www.Medicare.gov website for the list of Special Election Period examples. The 14 Medicare advantage Plans that received "5 Star Ratings" for 2017 are:      Company Name                           Service Area 1. KS Plan Administrators, LLC -     4 Counties TX 2. Kaiser Found. HP, INC                 31 Counties CA 3. Kaiser Found. HP of CO               17 Counties CO 4. Kaiser Found. of the Mid-            D.C. &         Atlantic States                              11 Counties MD                                                             9 Counties VA 5. Tufts Assoc. HMO                       10 Counties MA 6. BCBS of MA HMO Blue                11 Counties MA 7. Group Health Plan (MN)            87 Counties MN                                                           8 Counties WI 8. Aultcare Health Ins. Corp          12 Counties OH 9. Physicians Health Choice TX     19 Counties TX 10. Gundersen Health Plan            1 County IA,                                                                 8 Counties WI 11. Optimum Healthcare Inc.        25 Counties FL 12. Kaiser Found. HP of NW          9 Counties OR                                                            4 Counties WA 13. Sierra Health & Life Ins.         1 County CO,                   1 County KS, 2 Counties MA, 3 Counties MD.             1 County MI, 2 Counties NJ, 2 Counties PA,               2 Counties TX, 1 County in VA   If you live in the service area of the above 5 Star Rated Plans, you should go onto the Medicare.gov website and compare the 5 Star Plan to the Plan you are currently on. Make sure your doctors are in the network. Make sure ALL your prescription drugs are covered in the formulary. Look at the co-pays, co-insurance and any deductibles. Make sure the "5 Star Plan," is worth "switching" too! Just because it was given a 5 Star Rating from Medicare, doesn't mean the plan will automatically be the best choice for your unique needs. Do your Due Diligence!  You can check the Medicare.gov site for any 5 Star Prescription Drug Plans in your service area and Medicare Advantage Plans that are health plans only and do not offer prescription drug coverage on that particular plan. You can also listen to episode MN061. I give you information on the Medicare Advantage Disenrollment period and information on Special Need Plans. You don't have to be "stuck" on a Medicare Advantage Plan that doesnot suit your needs. This is the time of year to make changes. Make sure you switch to a better plan this time! Questions?? Send them to Support@TheMedicareNation.com Thanks for listening to Medicare Nation. If you like the information that is provided, give us a 5 Star Review on iTunes! The more reviews we get, the more exposure iTunes will give Medicare Nation, and that means more people will be able to find the show. https://itunes.apple.com/us/podcast/medicare-nation/id1031060767?mt=2 Have a happy, peaceful & prosperous week!                         

Welcome Medicare Nation! We have a question today and I know many of you need this information!   MEDICARE SPECIAL ENROLLMENT PERIOD SHOW NOTES Here’s quick guide to when you can make changes to your Medicare Advantage Plan:   You can make your initial selection of a Medicare Advantage Plan when you enroll in Medicare at age 65. During the Annual Enrollment Period which is between October 15th through Dec 7th every year. You can dis-enroll from a Medicare Advantage Plan between January 1- Feb 14th, but you would have to go back on to Original Medicare because you cannot switch to another Medicare Advantage Plan at this time. You may have a “Special Election” that qualifies you to change your plan.   The Special Election Period that qualifies you to change your Medicare Advantage Plan, is what we want to focus on today.  There are certain circumstances which allow you to qualify for this option. If You Move If you move and your new residence is not in your plan service area. You would need to notify Medicare as soon as possible, because you have the rest of the current month you are moving and the following 2 full months as the Special Election Period.  If you move to a new address and your plan is still in your service area, but by moving you now have new options available to you that you didn’t previously have, then you would have a Special Election Period to change to one of the new option plans. Snowbirds that live in 2 locations, have to determine which of those residences is your primary residence. Where you vote and where you pay taxes are going to determine which is your primary residence. If you move out of the country for a period of time and now you are coming back to live in the US,  that will trigger a Special Election Period. If you are moving into a long term care facility or a Skilled Nursing Facility with round the clock skilled nursing care, you would have a Special Election Period when you move into the facility, while you are residing in the facility and when you move out of the facility.  Losing Coverage: If you leave your Employer's Insurance Plan, or union through retirement, turning 65, etc. If you had an involuntary loss of drug coverage that was as good or better than Medicare drug coverage(credible coverage), that triggers a SEP. Or if you have had drug coverage through a Medicare Cost Plan and you leave the Cost Plan. If you leave a PACE (Program All-Inclusive Care for the Elderly) Program. If you had Medicaid and lost eligibility because of income requirements.   When there are plan changes with Medicare Contracts: If your Medicare Advantage Plan was sanctioned by CMS, then you would be able to contact Medicare directly to request a Special Election Period  to choose another Medicare Advantage Plan. If Medicare terminated a contract with your Medicare Advantage Plan, that will trigger a Special Election Period and CMS will notify you.   Special Circumstances You qualify as a Medicare & Medicaid recipient, you may change Medicare Advantage Plans as often as you'd like! If you qualify for LIS (Limited Income Sources) you may get extra help with prescription drug coverage and a Special Election Period to enroll in a different Medicare Advantage Plan. During your Initial Enrollment Period for Medicare, you may have enrolled in a Medigap plan, and decided to change to a Medicare Advantage Plan during your first enrollment year. If you decide you want to change back to a Medicare Supplement Plan during your first year of coverage, you qualify. SNP Plan - for chronic conditions (Diabetes, Heart Disease, COP) - may change your current Medicare Advantage Plan to enroll in a SNP plan, or you may no longer qualify for a SNP, so you can choose another Medicare Advantage Plan. f an error was made by a federal employee when you signed up for Medicare, and you can prove it, you may be granted an SEP.   *****You cannot get an SEP because your Doctor left the network******** If you have a Medicare Supplement - a Medigap plan, you can change plans whenever you want because there is no SEP for Medicare Supplement Plans.     Precautions: If you have a chronic illness, cancer, cardiovascular disease or other medical conditions, a Medicare Supplement (MediGap) plan does not have to enroll you after your first year of enrollment. You need to be careful and make sure you are going to be able to get coverage when you change plans. The Medicare Supplement carrier may not take you due to pre-existing conditions and once you drop your Medicare Advantage Plan, you may be "locked out" and not able to re-enroll until the next open enrollment period..Medicare Supplement Carriers can discriminate due to pre-existing conditions! The price of Medicare Supplement plans do change as you age, and where you live. Keep that in mind.   Need more information on "Special Enrollment Periods?" www.callsamm.com - has all of this information available for you. Download the Quick PDF List for Special Election Periods.   Do you have questions or feedback? I’d love to hear it! I may answer one of your questions on the air! email me: support@themedicarenation.com Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)     Find out more information about Medicare on Diane Daniel’s website! www.CallSamm.com  

Welcome Medicare Nation! It’s tax season! Today is April 15th and it’s the dreaded tax deadline day! It’s this time of year that people realize they need to make some changes to their Medicare plan. However, many people don’t realize that you can’t just make changes anytime you want to a Medicare Advantage Plan. There are specific times that you can make changes, and then you have to live with them until the opportunity arises to make changes again.   Here’s quick guide to making changes to your Medicare Advantage Plan:   You make your initial selection of your Medicare Advantage Plan when you enroll at 65. During annual enrollment from October 15 to Dec 7th. You can dis-enroll from January 1- Feb 14th, but you would have to go on to original Medicare because you cannot switch to another Medicare Advantage Plan at this time. You may have a “Special Election” that allows you to change your plan.   That Special Election for Medicare Advantage is what we want to focus on today.  There are certain circumstances that can qualify you to have this option.     Moving Your Residence:   If you move your home and your new location is not in your plan service area. You would need to notify Medicare as soon as possible, because you only have the rest of the current month and the following 2 full months from your move as the Special Election Period. If you move to a new address and your plan still is in your service area, but by moving you now have new options available to you that you didn’t previously have, then you would have a Special Election Period to change to one of those previously unavailable plans. Snowbirds that live in 2 areas have to determine which of those places is your primary residence. Where you vote and where you pay taxes are going to determine your primary residence. If you are out of the country for a period of time and now you are coming back to the US, then that could trigger a Special Election Period. If you are moving into a longer term care facility or rehab facility with round the clock skilled nursing care, you would have a Special Election Period when you move into the facility, while you are at the facility and when you move out of the facility.        Losing Coverage:   If you leave a job, or the union through retirement, etc. If you had an involuntary loss of drug coverage that was as good or better than Medicare drug coverage, that triggers an SEP. Or if you have had drug coverage through Medicare Cost Plan and left that job. If you lost coverage through the PACE Plan. If you had Medicaid and lost eligibility because of the income requirements.       You have a chance to get other coverage: If you had coverage from an employer and it was better than Medicare, you could go on it. If your employer had better plan coverage and you wanted to get on that plan. If you wanted to get into a PACE Plan   When there are plan changes with Medicare Contracts:   If a provider was sanctioned by CMS, then you would be able to choose another plan. If Medicare terminated a contract     Dual Member (Medicare and Medicaid)   You may get extra help with drug coverage May have been on a Medigap plan, changed to a Medicare Advantage Plan and then wanted to change back, you can change to a Medicare Supplement plan during your first year of coverage. SNIP Plan - for chronic conditions - may leave Medicare Advantage to go on the SNIP, or yu no longer qualify for a SNIP, so you can choose another plan.       If an error was made by a federal employee when you signed up for Medicare, and you can prove it, you may be granted an SEP.     *****You cannot get an SEP because your Doctor left the network********       If you have a Medicare Supplement - a Medigap plan, you can change plans whenever you want because there is no SEP.   Precautions:   If you have a chronic illness, cancer, cardiovascular disease, a plan does not have to take you after your first year of enrollment. You need to be careful and make sure you are going to be able to get coverage when you change plans. The other company might not take you due to pre-existing conditions and your old plan may not take you back. They can discriminate due to pre-existing conditions.   The price of these plans do change as you age, so keep that in mind.   Original Medicare:   Part A, B and D - you are on all the time, so you don’t make changes unless it is open enrollment or an SEP.      www.callsamm.com - has all of this information available for you.   Do you have questions or feedback? I’d love to hear it! I may answer one of your questions on the air! email me: support@themedicarenation.com Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)     Find out more information about Medicare on Diane Daniel’s website! www.CallSamm.com