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Robin Mooney
The Path to Your Success!
Presenter: Robin A. Mooney
GarityAdvantage Agencies◦ National FMO◦ Focused on the Senior Market
Medicare Advantage Medicare SupplementGroup Retiree Medical PDPHospital Indemnity DentalFinal Expense Funeral TrustShort Term Care Life
GarityAdvantage Agencies offers◦ Competitive Nationally recognized products◦ Comprehensive Training◦ Market Expertise◦ Ask us about our Lead Programs
www.garityadvantage.com
800-234-9488
Creating Special Election Period (SEP) using:• Low Income Subsidy (LIS)/Extra Help • Medicare Savings Programs (MSP)• State Pharmaceutical Assistance Programs (SPAP)
Dual Eligible Plans
Medicare Supplement Plans
Additional Year Round Opportunities
Lead Generation
Ways to create an SEP ◦ Qualify for Medicaid◦ Qualify for LIS/Extra Help through Social Security◦ Qualify for MSP/SPAP through the state
SEPs allow the beneficiary to enroll in a MAPD plan or a PDP during the “lock-in.”
Qualifying Income levels can be surprisingly high Possibly free up money for other products Assisting in completion of the application will
◦ Provide a great benefit to the beneficiary◦ Make it much more likely you will be able to make the
sale◦ Cut down on the time of the sales cycle
Provides assistance with Part D premiums, deductibles and co-insurance or co-pays
Apply through Social Security Administration directly Dependent on both Income (150% of poverty level) and
Assets
◦ Single less than $1,361.25/$16,355 Income, $13,070 in Assets ◦ Married less than $1,838.75/$22,065 Income, $26,120 in Assets
Valid, completed applications are usually processed within 10-14 days
In order to utilize the LIS award, they must be enrolled in a MA plan or stand-alone PDP
Some states have SPAPs to help residents pay for prescription drugs:
◦ Colorado Connecticut DelawareIdaho
◦ Illinois Indiana Maine Maryland◦ Massachusetts Missouri Montana Nevada◦ New Jersey New York Oregon
Pennsylvania◦ Rhode Island Texas US Virgin Is. Vermont◦ Virginia Washington Wisconsin Colorado
Each program works differently:
◦ Programs for people with Certain Conditions: Renal Disease, AIDs, Cystic Fibrosis, Hemophilia
◦ Programs for Seniors◦ Programs for people with Disabilities◦ Depending on financial status, may pay:
Part B Premiums Deductibles Co-pays Percentage of cost of prescriptions
Eligibility requirements require prospect lives in the state they are applying for assistance in.
May also have requirements for:◦ Age◦ Medicaid Ineligible◦ Enrollment Fees◦ Income◦ Enrollment in Medicare Part D plan
*Income levels can be quite high – couples as mush as $52,000 in MA
Federal/State Partnership helps with Part A and/or Part B premiums
Available in 50 States plus Washington DC
Limited income and assets may qualify prospects for MSP*:◦ Qualified Medicare Beneficiary (QMB):
Pays Medicare premiums (Part A, if applicable, and Part B), deductibles, copayments, and/or coinsurance.
◦ Specified Low-Income Beneficiary (SLMB): Medicare part B premium
◦ Qualified Individual (QI)/Additional Low-Income Beneficiary (ALMB) Medicare Part B premium (limited # people admitted)
*Income levels and asset requirement vary by state – example – CT $1,950-$2,270 single, $2,630-$3052.74 couple
Enrollment open to Duals year round
Provide additional services traditional Medicaid might not:◦ Transportation – 20 one way trips◦ Monthly allowance for over-the-counter items◦ Silver Sneakers◦ Dental, Hearing, Vision
Includes Medical & Prescription drug coverage
Coordinates with Medicaid to provide plan with little or no out-of-pocket cost
Just under 25% of the Medicare population has purchased a Medicare Supplement Plan.
This is the coverage many of your prospects want!
• Most comprehensive care
• No networks of providers
• No Primary Care Physician required
• No referrals required
• Benefits do not change from year to year
• Sell it at any time during the year.
• No Scope of Appointment or permission to call required.
• Build a larger book of business without having to constantly roll block.
• Commissions generally higher than the $200 MA renewal. Add a separate PDP sale and increase commissions further. Ultimately more profitable.
Supplement◦ Enrollee remains on Original Medicare (A & B)◦ Medicare pays the bulk of the claim ◦ Supplement pays what Medicare leaves unpaid per
plan design selected◦ Client may see any provider (in the US) providing they
accept Medicare◦ Does not cover PDP
Medicare Advantage◦ Enrollee leaves Original Medicare for Part C◦ Medicare never gets the claim◦ Private insurer is responsible for the claim minus plan
cost share◦ Client is restricted to network providers or will pay
higher cost◦ May cover PDP
AARP Anthem Mutual of Omaha Genworth/Continental Life/American
Continental GPM Humana And more
• Supplement◦ Enrollee remains on Original Medicare (A & B)◦ Medicare pays the bulk of the claim ◦ Supplement pays what Medicare leaves unpaid per
plan design selected◦ Client may see any provider (in the US) providing they
accept Medicare◦ Does not cover PDP.
Lower premium than some other options Covers
◦ Part A deductible, coinsurance, & hospital benefits◦ Part B coinsurance after insured pays Part B
deductible $20 co-pay for an Office Visit $50 co-pay for Emergency Room
Does not cover◦ Part B deductible◦ Part B excess charges
Must satisfy the Part B deductible before any eligible Part B benefits will begin.
Office Visit co-pay is the same for a PCP or Specialist.
Emergency Room co-pay is waived if admitted
One ER co-pay covers all physician, professional fees, and facility fees for ER visit.
Urgent Care Centers are not considered an Office Visit or ER visit by Medicare. Medicare would pay 80% and Plan N would pay 20% of Medicare Approved Amounts.
Guarantee Issue States – Enroll any time, no health questions asked
Non-Guarantee Issue States:• Open Enrollment
No Medical Questions Required Available within the 1st 6 months of the Part B effective
date
Guarantee Issue◦ Loses or drops employer coverage◦ Enrolled in a MA, PACE, or Medicare Select Plan &
Plan stops coverage in the area Applicant moves out of the service area
◦ Company violates the contract◦ Involuntary termination i.e. market exit◦ Dropped a supplement in enroll in a MA plan and
wants to return to a supplement within 2 years◦ Initially enrolls in a MA plan and wants to get a
supplement within 2 years
Medical Underwriting if Open Enrollment or Guarantee Issue is not available◦ Deny if
ESRD or requires dialysis Hospital admission within the last 90 days Medical professional has recommended or discussed
treatment options that have not been completed
Must enroll within 63 days of qualifying event Must include proof of credible coverage with
application* Varies by state
• Rates can be based on:• Age• Tobacco vs. non-Tobacco• Gender• Zip Code• Rate Guarantees• Discounts:
• Enrollment • Auto pay• Multiple enrollee• Annual pay
Age Ins Existing Clients Group Terminations/Retirees
◦ Work with HR personnel at companies to offer your expertise to those aging in or retiring.
Other Senior Products:◦ GTL Hospital Indemnity◦ Cancer Heart Attack and Stroke◦ Short Term Care◦ Funeral Trust◦ Final Expense◦ Seniors Choice Group Retiree◦ Seniors Choice Creditable Part D
Community Meetings – Sales/Educational Employer Benefit Groups Commercials, Radio Shows Relationships with Senior Centers, Housing
Projects, Churches, Groups (Chamber of Commerce, Rotary)
Internet Mailing
Webinars:◦ Short Term Care◦ Final Expense◦ Funeral Trust◦ Medicare 101/102◦ GTL Hospital Indemnity◦ Creditable Part D Coverage◦ Seniors Choice Group Retiree
800.234.9488
AL, AR, FL, LA, MA, MO, MS, NC, RI, SC, VA Julie St Onge
Ext. [email protected]
CT, GA, IL, IN, KY, MI, NJ, OH, PA, TN, TX, WV Andrew Geller
Ext. [email protected]
All other states -Robin A. MooneyExt 1453
