Download pdf - Texas Farm Bureau Insurance sponsored Medicare Supplement ... · Texas Farm Bureau Insurance sponsored Medicare Supplement Insurance Notes for Agents Updated May 1, 2018 Getting started

Texas Farm Bureau Insurancesponsored

Medicare Supplement InsuranceNotes for Agents

Updated May 1, 2018

Getting startedAgents Logon to STAR (star.gilsbar.com)

• Every month more than 1,000 Texas Farm Bureau members turn 65 …and a Medicare Supplement policy sponsored by Texas Farm Bureau might be exactly what they need!

• Medicare was never designed to pay all health care costs.

• Medicare is valuable, but, individuals could be responsible for thousands of dollars a year out of pocket with deductibles and coinsurance amounts.

• What’s more, out-of-pocket costs are expected to rise in the coming years to accommodate a growing number of seniors who need medical care.

• That’s why a Medicare Supplement policy sponsored by the Texas Farm Bureau Insurance and underwritten by Transamerica Life Insurance Company is so important.

Agents Logon to STAR (star.gilsbar.com)

And then click on the link for Transamerica Medicare Supplement Application

Texas Farm Bureau Proprietary and Confidential for Internal Use Only2 April 9, 2018

STAR Logon Information(star.gilsbar.com)


Rating OptionsTFB Business –Issue Age Rated

Medicare supplement plans are standard for all insurance companies, but companies can choose to price (or rate) their policies in three different ways.

1. Issue age rated – The premium is based on your age when you first buy (issued) the policy. Premiums won’t change as your get older.

2. Attained age rated – The premium is based on your current age, so the premium increases as you get older.

3. Community rated – Generally the same premium is charged, regardless of age.

All three pricing platform can have rate increases due to inflation and other factors (such as the overall experience of everyone in the group or changes in Medicare) and these increases are for all policy holders.


OLD TFB Attained-Age Rates(no rate increase in 2018, rates since April 2017)


Age banded (5 years)• Age determined by

ATTAINED AGE on premium due date

• Highest age band is 80+ (many other companies have annual age increases through age 98)

Mode of payment• Monthly (EFT)• Quarterly• Semi-annual• Annual

TFB had previously sponsored an Attained-Age policy with 5-year age bands. Attained Age Plan A Plan F Plan N

Under 65 $361.43 ** **

65-69 $126.08 $179.47 $133.28

70-74 $145.29 $208.74 $154.90

75-79 $157.30 $230.38 $170.51

80+ $165.71 $246.93 $183.72

* Paid Endorsement TX

** Plans available only to those age 65 and over.

To calculate rates other than Monthly, multiply the monthly rate by:

3.08 for Quarterly, 6.05 for Semi-Annual, 11.63 for Annual

Medicare Supplement Plans – Monthly Rates

Current 2018 Rates (no rate increase in 2018, rates since April 2017) –ISSUE-AGE Policies


Rates by ISSUED Age• Rate determined by the age of the

member when the policy is issued.

• The rate by age when the policy is ISSUED is the rate the member will have for the duration of the policy.

• Rates do not increase each year just because you do. You lock-in the rate for your age when your coverage is issued. However, if needed, Transamerica (just like all other carriers) can ask the Texas Department of Insurance for a rate increase. The issued-age rate will only increase for state approved changes that apply to everyone.

• All new policies have a minimum 12 month rate guarantee.

Mode of payment• Monthly (EFT), Quarterly, Semi-annual, or Annual

ISSUED AGE PLAN A PLAN F PLAN G PLAN N

Under 65 $355.31 ** ** **

65 $123.35 $177.33 $161.33 $131.62

66 $126.20 $181.43 $165.43 $134.66

67 $129.05 $185.53 $169.53 $137.70

68 $131.90 $189.63 $173.63 $140.74

69 $134.75 $193.73 $177.73 $143.79

70 $137.61 $197.83 $181.83 $146.83

71 $140.46 $201.93 $185.93 $149.87

72 $143.31 $206.03 $190.03 $152.92

73 $146.16 $210.13 $194.13 $155.96

74 $149.01 $214.23 $198.23 $159.00

75 $152.58 $219.35 $203.35 $162.81

76 $155.43 $223.45 $207.45 $165.85

77 $159.00 $228.58 $212.58 $169.65

78 $162.56 $233.70 $217.70 $173.46

79 $166.13 $238.83 $222.83 $177.26

80 $169.69 $243.95 $227.95 $181.07

81 $172.54 $248.05 $232.05 $184.11

82 $175.39 $252.15 $236.15 $187.15

83 $178.25 $256.25 $240.25 $190.20

84 $180.39 $259.33 $243.33 $192.48

85+ $180.39 $259.33 $243.33 $192.48

Rates are the same regardless of gender or tobacco use.

Rates Effective April 1, 2018

Underwritten by Transamerica Life Insurance Company, Cedar Rapids, IA

The Value of “Issue Age”

Issue age rates = stability and savings

Issue age rates are based on your age when you first buy (issued) the Medicare supplement insurance coverage. For example, if you purchase a policy at age 65, it costs less than if you were buying it at age 75. Once you own the policy, the premium will not increase just because you get older.

It will always be based on your age at the time of purchase with rate adjustments only for state approved rate changes.

With an attained age policy, your rates will increase as you get older andyou may also have state approved rate changes.

Issue age pricing can help produce lifetime value by providing rate stability and savings. While issue age rates may be a little more in the beginning, they can be a lot less in the long run. The earlier you enroll the lower the initial rate and the greatest potential for savings over the lifetime of the policy.


MEDICARE

• Medicare General Information

– www.medicare.gov

– 1-800-MEDICARE (1-800-633-4227)

– Medicare & You Handbook (www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf)

– Social Security office handles enrollment for Medicare

– Medicare Basics(http://www.medicare.gov/what-medicare-covers/index.html)

• Part A - Hospital - No additional premium(www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html)

• Part B - Physician - Additional Premium(www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html)(www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html)

• Part C - Medicare Advantage (like an HMO)(http://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/how-medicare-advantage-plans-work.html)

• Part D - Drugs - Additional Premium(http://www.medicare.gov/part-d/index.html)

• No premium for Part A if member has worked in Medicare covered employment for 40 quarters, age 65, US citizen and permanent resident of US.

• Many school and hospital systems do not participate in Medicare/SS, so those employees may have to pay premium for Part A.


MEDICARE continued…

• Medicare Part A

– Inpatient hospital coverage• Deductible imposed for each confinement

– Member co-payment days 61-90

– Member pays full payment after day 90

• Medicare Part B

– Physician and outpatient coverage

– Deductible per year (2018 is $183)– www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html

• Cannot have a Medicare Supplement unless enrolled in both Part A and Part B of Medicare


How do Medicare eligible members sign up for Medicare Part A, Medicare Part B, and Medicare Part D?

• Your eligible member must call Medicare or visit a Social Security office to sign up for each of the Medicare benefits

– Medicare Part A (Inpatient hospital coverage)

For most eligible people, Part A is no additional cost and they should sign up as soon as they are eligible at age 65

– Medicare Part B (Physician and outpatient coverage)

For most eligible people, Part B is additional cost and deducted from their monthly Social Security check.

Because many people work past age 65 and have an employer sponsored medical plan, they don’t need Part B until they stop working. But, when they stop working, and need Part B, they will need to call or visit the Social Security office again.

– Medicare Part D (Prescription Drug Coverage)

Part D is additional cost and deducted from their monthly Social Security check.

Here are two recommendations for agents with regard to Part D:1. When people sign up for Medicare Part B, they should sign up for Medicare Part D at this same time.

Medicare is very helpful with Part D and will assist your member in selecting the best available Part D plan that specifically meets their individual prescription drug needs.

2. Members can ask their pharmacist what they recommend.


Medicare Supplement

• Choosing a Medigap Policy– (www.medicare.gov/Pubs/pdf/02110-Medicare-Medigap.guide.pdf)

• Med Supp Open Enrollment Period

– Begins the date you are enrolled in Medicare Part B and age 65 or older

– Lasts for 6 months

– Can purchase any plan offered regardless of health

– Cannot be denied coverage

• If working beyond age 65 and have health coverage through employer, generally do not want to enroll in Medicare part B until retired because open enrollment period will begin.


ELIGIBILITY and UNDERWRITING

Eligibility• Must be TFB member

• Age 65+

• Enrolled Medicare Part A and B

• Not entitled to Medicaid

• All Medicare Supplement policies have the same benefits and only differ in premium, quality of the insurance company, and the quality of service.

Texas Farm Bureau Proprietary and Confidential for Internal Use Only12 April 9, 2018Texas Farm Bureau Proprietary and Confidential for Internal Use Only 12

Underwriting• Guaranteed Issue (No underwriting)

• If Medicare Part B effective date is within 6 month window of enrolling in Medicare Part B.

• Change plans during 6 month window

• Lost employer coverage and 65+

• Underwriting required• If not within 6 month window

• Upgrade med supp plan and not within 6 month window

Reminders regarding Open Enrollment

Texas Farm Bureau Proprietary and Confidential for Internal Use Only13 April 9, 2018Texas Farm Bureau Proprietary and Confidential for Internal Use Only 13

Open Enrollment for

Standard Medicare Supplement

for people with

Original Medicare Part A and

Original Medicare Part B

Regarding “Annual Open Enrollment”

for

Medicare Part C and/or

Medicare Part D

* Medicare Supplement (aka Medigap) Open Enrollment Period

Begins the date you are enrolled in Medicare Part B and age 65 or older

Lasts for 6 months

Can purchase any plan offered regardless of health

Cannot be denied coverage

* If working beyond age 65 and have health coverage through employer, generally

do not want to enroll in Medicare part B until retired because open enrollment

period will begin.

Does this “Annual Open Enrollment” apply to a standard Medicare Supplement

Plan?

* No. The “Open Enrollment” period for a standard Medicare Supplement policy is

the 6‐month window around age 65 and signing up for Medicare Part B.

People can move at any time during the year from one standard Med Supp

company to another with underwriting. (not restricted to October 15 – Dec 7).

* Medicare Part C – Medicare Advantage Plans

Between October 15–December 7 anyone can join, switch, or drop a Medicare

Advantage Plan. This open enrollment period has changed to give more time to

choose and join a plan. Your coverage will begin on January 1, as long as the plan

gets your request by December 7.

* Medicare Part D – Medicare Drug Coverage Plans

Between October 15–December 7, anyone can join, switch, or drop a Medicare

drug plan. The change will take effect on January 1 as long as the plan gets your

request by December 7.

BASIC BENEFITS

• All Med Supp plans cover Basic Benefits

– Hospitalization• Covers Part A coinsurance plus coverage for additional 365 days after

Medicare benefits end

– Medical Expenses• Covers Part B coinsurance

– Blood• Covers first 3 pints of blood annually


GENERAL INFO

• 30 day free look

• Only 1 Med Supp can be in force at a time

• Replacement

– Must be less expensive or more benefits offered

– Application required

• Conversion privilege

– If policyholder cancels policy, covered persons can convert to an individual policy.

– Must apply within 31 days after insurance under previous policy ends

– Benefits provided by individual policy will be same as those provided by previous policy.

• Insured can choose any physician who accepts assignment

– No Networks and no referrals needed


PRE-EXISTING CONDITION LIMITATION

• No Pre-x if member enrolls during open enrollment period.

• If policy replaces creditable coverage such as an in force Med Supp or primary hospital and medical insurance that has been in force within the past 63 days, then the pre-ex condition limitation will be waived (no pre-x) to the extent it was satisfied under the prior creditable coverage.

• If not during open enrollment or replacing other coverage, no benefits paid for first 6 months following effective date of coverage. After that, no pre-x.


KEY POINTS SELLING MED SUPP

• Freedom of choosing your own doctors and hospitals No networks and no referrals needed.

• No waiting periods for pre-existing conditions • Hassle-free claims processing• Excellent service from a company with an A+ (Superior)

A.M. Best rating for financial stability. Financial stability of Transamerica – no difference in policies offered

among companies Apply today for the peace of mind you want, at affordable Texas Farm

Bureau member rates.

• Do you already have other insurance on member? Most people prefer keeping insurance all in one place.

• Local, personal service provided• Send pre-approach letters to your clients who will be

turning 65.• Value of an Issue-Age policy


Medigap 2018 PlansIf a check mark appears in a column of this chart, the Medigap policy covers 100% of the described benefit. If a row lists a percentage, the policy covers that percentage of the described benefit. If a row is blank, the policy doesn’t cover that benefit. Note: The Medigap policy covers coinsurance only after you have paid the deductible (unless the Medigap policy also covers the deductible).


* Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,180 in 2018 before your Medigap plan pays anything.

** Plans K & L After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($183 in 2018), the Medigap plan pays 100% of covered services for the rest of the calendar year.

*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.

$5,120 $2,560

PLAN A

• Basic Benefits

• Only policy offered to members under age 65

– If disabled, the 6 month window applies without underwriting• When they turn 65, 6 month open enrollment applies and

they can select any plan we offer.


PLAN F

• Basic Benefits

• Medicare Part A deductible

• Skilled Nursing Facility Coinsurance

– 3 consecutive days in hospital

– Entered facility within 30 days of hospital stay

• Medicare Part B deductible

• Foreign Travel

– Insured pays deductible (currently $250)

– Plan pays 80% of costs incurred during first 60 days of travel up to $50,000 lifetime max.


PLAN G

• Basic Benefits

• Medicare Part A deductible

• Skilled Nursing Facility Coinsurance

– 3 consecutive days in hospital

– Entered facility within 30 days of hospital stay

• Plan G does NOT cover the Medicare Part B deductible – Member is responsible for paying the $183 Part B deductible (in 2018)

• Foreign Travel

– Insured pays deductible (currently $250)

– Plan pays 80% of costs incurred during first 60 days of travel up to $50,000 lifetime max.


PLAN N

• Basic Benefits• *** Plan N pays 100% of the Part B coinsurance, except

– co-pay applies after the $183 deductible (2018)– $20 co-payment for doctor visits – $50 co-payment for emergency room visits.

• Does not cover Part B Deductible• Does not cover Part B Excess Charges• Lower premiums (about 28% cheaper than Plan F)

• We do not recommend Plan N, we recommend Plan F. Moving to Plan F after the open enrollment (guarantee issue) period will require underwriting


Why TFB recommends PLAN F

• Plan A

Texas requires all companies selling Med Supp offer Plan A

Only plan available to under age 65 (must be disabled) enrollees

• Plan F

Has the most benefits and/or lowest cost share

All other plans require a decision

“what am I giving up” “what could it cost me in the future”

• Some companies offer a high-deductible Plan F option. The TFB does NOT offer this option. That option requires your member to pay for Medicare-covered costs up to the deductible amount of $2,180 in 2018 before your Medigap plan pays anything.


Why recommend Plan F…Skilled Nursing Facility Coinsurance

• Skilled Nursing Facility Care Coinsurance Medicare Part A covers skilled care in a skilled nursing facility (SNF) under certain conditions for a

limited time. Skilled care is health care given when you need skilled nursing or rehabilitation staff to manage, observe, and evaluate your care. Medicare covers certain skilled care services needed daily on a short-term basis (up to 100 days).

Without a Medicare Supplement policy, in 2018, YOU pay the following for each benefit period (following at least a 3-day covered inpatient hospital stay for a related illness or injury):

• Days 1–20: $0 each day• Days 21–100: up to $164.50 each day• Beyond 100 days: 100%

There’s a limit of 100 days of Medicare Part A SNF coverage in each benefit period.

• With a Medicare Supplement Plan F policy, the policy pays everything covered that Medicare doesn’t pay

• Days 1–20: $0 each day – Medicare is paying everything• Days 21–100: up to $164.50 each day – Plan F policy pays this ... 80 days would be $13,160 • Beyond 100 days: 100% -- Plan F policy pays this ... the daily charges could be thousands per day


Why recommend Plan F… Medicare Part A Deductible

• Medicare Part A Deductible

• Medicare Deductible and Coinsurance Amounts for 2018

• Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2018 = $1,340) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.

• Without a Medicare Supplement policy, in 2018, for each benefit period* YOU pay:

• A total of $1,340 for a hospital stay of 1-60 days.• $335 per day for days 61-90 of a hospital stay.• $670 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).• All costs for each day beyond 150 days

* Benefit Period —A benefit period begins the day you go into a hospital or skilled nursing facility. The benefit period ends when you haven’t received any inpatient hospital care (or skilled care in a SNF) for 60 days in a row. If you go into a hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. You could be responsible for paying a benefit period deductible more than once per year!

• With a Medicare Supplement Plan F policy, the policy pays the Part A Deductible(s)


Why recommend Plan F… Medicare Part A Deductible … continued

• With a Medicare Supplement Plan F policy, the policy pays the Medicare Part A Deductible that Medicare doesn’t pay

• Days 1–60: $0 each day – Plan F policy pays this $1,340 Part A Deductible (for each benefit period)

• Days 61–90: up to $335 each day – Plan F policy pays this ... 30 days would be $10,050 • Days 91 - 150 days: $670 each day – Plan F policy pays this ... 60 days would be $40,200• Beyond 151 days: Plan F policy pays this! …imagine another 60 days …


What is the average cost of a night in a hospital?Depending on the actual hospital services, 3-5 thousand dollars is typical. The cost would include the nursing care, medications, diagnostic tests, food, and other related costs like that. For a typical week, a minimum of 50,000 dollars.

Why recommend Plan F… Medicare Part B Deductible

• Medicare Part B Deductible • Part B covers Medicare eligible physician services, outpatient hospital

services, certain home health services, durable medical equipment

• Medicare Part B Deductible and Coinsurance Amounts for 2018:• Deductible: $183.00 per year. • Coinsurance: You pay 20% of the Medicare-approved amount for services after you meet

the $183.00 deductible.

• With a Medicare Supplement Plan F policy, the policy pays everything covered that Medicare doesn’t pay

• Deductible: Plan F policy pays this $183.00 Part B Deductible• Coinsurance: Plan F policy pays this 20%


Why recommend Plan F… Medicare Part B Excess Charges

• Medicare Part B Excess Charges• Some doctors do not accept assignment. This means they will treat

you, but, they will bill you directly for the difference between the Medicare approved amount and the doctor’s charges.

• With a Medicare Supplement Plan F policy:• the policy pays 100% of the difference between your doctor's charge

and the Medicare approved amount, if your doctor does not accept assignment


Why recommend Plan F… Foreign Travel Emergency • Foreign Travel Emergency (Up to Plan Limits)

(https://www.medicare.gov/supplement-other-insurance/medigap-and-travel/medigap-and-travel.html)

• Except in limited situations, Medicare doesn’t pay for health care services you get outside the U.S. If your circumstances don’t meet these limited exceptions, you pay the full cost to the health care provider.

• In most situations, Medicare won’t pay for health care or supplies you get outside the United States (U.S.). The term “outside the U.S.” means anywhere other than the 50 states of the U.S., the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.

• With a Medicare Supplement Plan F policy, the policy pays

• 80% of the billed charges for certain medically-necessary emergency care outside the U.S. after you meet a $250 deductible for the year. Plan F policies cover foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn’t otherwise cover the care.

• Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000.


Rate Change History


Effective Date 4/14 4/15 4/16 4/17 4/18Avg Annual

Inc (5-years)

Plan A Sold since 1/1/2016 (Issue-Age) 0.0% 2.5% 0.0% 0.8%

Plan F Sold since 1/ 1/ 2016 (Issue-Age) 0.0% 2.5% 0.0% 0.8%

Plan N Sold since 1/1/2016 (Issue-Age) 0.0% 2.5% 0.0% 0.8%

Plan A Sold since 6/1/2010 (MIPPA) 4.7% 6.5% 2.0% 2.5% 0.0% 3.1%

Plan F Sold since 6/ 1/ 2010 (MIPPA) 4.7% 6.5% 2.0% 2.5% 0.0% 3.1%

Plan N Sold since 1/1/2012 (MIPPA) 4.7% 6.5% 2.0% 2.5% 0.0% 3.1%

Plan A Sold 1/1/2003 to 6/1/2010 4.7% 6.5% 2.0% 2.5% 0.0% 3.1%

Plan F Sold 1/ 1/ 2003 to 6/ 1/ 2010 4.7% 6.5% 2.0% 2.5% 0.0% 3.1%

Plan J Sold 1/1/ 2003 to 6/1/2010 4.7% 6.5% 2.0% 2.5% 0.0% 3.1%

Plan A Sold Before 1/ 1/ 2003 9.0% 6.5% 0.0% 8.0% 0.0% 4.7%

Plan C Sold Before 1/ 1/ 2003 9.0% 6.5% 0.0% 8.0% 0.0% 4.7%

Plan F Sold Before 1/1/2003 9.0% 6.5% 0.0% 8.0% 0.0% 4.7%

Plan J Sold Before 1/1/2003 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

Texas Farm Bureau - Medicare Supplement Rate History

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ISSUE-AGE new sales

began 4/ 1/ 2016

Regarding “Annual Open Enrollment” for Medicare Part C and/or Medicare Part D

• Does this “Annual Open Enrollment” apply to a standard Medicare Supplement Plan?

• No. The “Open Enrollment” period for a standard Medicare Supplement policy is the 6-month window around age 65 and signing up for Medicare Part B.

• People can move at any time during the year from one standard Med Supp company to another with underwriting. (not restricted to October 15 – Dec 7).

• Medicare Part C – Medicare Advantage Plans• Between October 15–December 7 anyone can join, switch, or drop a Medicare

Advantage Plan. This open enrollment period has changed to give more time to choose and join a plan. Your coverage will begin on January 1, as long as the plan gets your request by December 7.

• Medicare Part D – Medicare Drug Coverage Plans• Between October 15–December 7, anyone can join, switch, or drop a Medicare

drug plan. The change will take effect on January 1 as long as the plan gets your request by December 7.


Medigap 2010 PlansWhat 1990 Plans were eliminated? E, H, I, J, J*

• Many of the 1990 Plans were dropped. • After eliminating certain benefits, the revised Medigap

Model Reg would have contained duplicate plans.– Plan E—would have duplicated Plan D.

• D dropped At-Home Recovery.• E dropped Preventative Care.

– Plan H—would have duplicated Plan D.• D dropped At-Home Recovery.

– Plan I—would have duplicated Plan G.• I dropped At-Home Recovery. • G increased Part B Excess Charges to 100%.

– Plan J—would have duplicated Plan F.• J dropped At-Home Recovery and Preventive Care. • Both Plans F and J offer a high-deductible option.

• Plan letters were kept in effort to avoid confusion.

32 Texas Farm Bureau Proprietary and Confidential for Internal Use Only April 9, 2018

Medigap 2020Regarding Plan FCongress Schedules End to Insurance Coverage of Medicare Part B Deductible

33

• Beginning in 2020• Members applying who are not 65 as of 1/1/2020, new sales of Plan F policies will no

longer be allowed.

• Members who were age 65 before 1/1/2020, new sales of Plan F policies will still be allowed.

• Congressional Reasoning: • Making Medicare beneficiaries pay the deductible themselves will cause them to think twice before

going to a doctor and perhaps costing the Medicare system unnecessary money

• Impact:• Possibly encourage more beneficiaries to abandon regular Medicare and join Medicare Advantage

plans, which will still be able to cover the deductible• Plan F—Plan F sales only allowed for people who were at least 65 on 1/1/2020• Plan G—Plan for Transamerica to file and make available in 2018

Google: Congress Schedules End to Insurance Coverage of Medicare Part B Deductible

Texas Farm Bureau Proprietary and Confidential for Internal Use Only April 9, 201833

Medigap 2010

• Medicare Supplement Plan N

– $20 co-payment for doctor visits

– $50 co-payment for emergency room visits.

– Expect the co-pay applies after the $135 deductible, however there is still uncertainty as to how the deductible and co-pay will be coordinated.

– Estimated premiums around 73% of the cost of Plan F

• For comparison, new Medicare Supplement Plan M

– Covers 50% of the Part A deducible

– Covers None of the Part B deductible, but no co-pays

– Estimated premiums around 85% of Plan F


What is Part B ExcessPhysicians and Medicare

• First, the term “Assignment” means…

– The person receiving medical benefits assigns the payment of those benefits to a physician or hospital.

• Here are three ways physicians deal with Medicare.

– Physicians who accept Medicare patients and accept “assignment”• These providers have agreed to accept Medicare payment as full payable amount.

• Medicare typically pays 80% of the amount covered leaving a balance due from the Medicare beneficiary of 20% (which is why people need a Medigap policy).

• These doctors do not have to accept every Medicare-eligible person.

– Physicians who are Non-participating physicians• These providers do submit claims to Medicare; the beneficiary would need to send claims to Medicare.

• Medicare will send payment (i.e. 80% of allowable charges) to the beneficiary and the beneficiary must pay the physician.

• A Medicare Supplement (Medigap) policy is used to help cover the 20% that Medicare doesn’t pay.

• Non-participating providers are allowed to add up to 15% more than the Medicare-approved amount. The beneficiary is responsible for this Part B Excess. If the Medigap policy has an excess charges benefit, the policy will cover the additional amount.

– Physicians who have formally opted out of Medicare• These providers have gone through a process to sever ties with Medicare.

• They do not have to follow Medicare regulations and do not submit claims to Medicare. If a Medicare beneficiary sees a physician who has opted out, he/she is responsible for the entire bill.

• The physician can charge whatever and will likely present a contract in advance of the visit.


36Texas Farm Bureau Proprietary and Confidential for Internal Use Only April 9, 201836

Notes regarding “Changing Med Supp Plans”

Participant is currently in Issue‐Age TFQA

Plan A

Issue‐Age TFQF

Plan F

Issue‐Age TFQN

Plan N

Issue‐Age Plan A (TFQA) N/A New App & UW New App & UW

Issue‐Age Plan F (TFQF) Approved N/A Approved

Issue‐Age Plan N (TFQN) Approved New App & UW N/A

Attained‐Age Plan A (TFI, TFM, TFMYA)

Past their Open Enrollment period

Attained‐Age Plan C (TFJ)

Attained‐Age Plan N (TFOYN)

Attained‐Age Plan J (TFK/X, TFO/X)

Attained‐Age Plan F (TFL, TFN, TFNYF)

Attained‐Age or Issued‐Age Plan A

(TFI, TFM, TFMYA, or TFQ)

Age 65 Open Enrollment (OE)

New application required from the member or agent,

but, APPROVAL is guaranteed for any plan during Open Enrollment (OE).

New application and

approve. It's okay to

move from Plan J/F to

Plan F.

Transamerica ‐ Texas Farm Bureau

Med Supp Change Guidelines

Request to Move (change plans)

to one of the currently marketed plans

New Application required

and approval is

guaranteed.


and Plan A or Plan C to

Plan N approval is NOT

guaranteed.


and Plan N, or J, or F to

Plan N approval is

guaranteed.

New Application is

required and and Plan A,

or C, or N to Plan F

approval is NOT

guaranteed. UW approval

is required.

The Mobias Report #P3270


• Mobias Report #P3270 is still available.

• This report helps to identify members in your county(s) who are about to turn 65.

• Very handy!!!

MIPPA Provisions (H.R. 6331) 2010Medicare Improvements for Patients & Providers Act

• Section § 103• Prohibitions, limitations on Sales & Marketing under Medicare Advantage and

Part D plans.

• Section § 104– Directs HHS Secretary to implement Medigap Model

Regulation as approved by NAIC on March 11, 2007 and as modified by:

• This Act (MIPPA); and • The Genetic Information Nondiscrimination Act of 2008 (GINA).

• Sections §§ 161-169

– Amendments to Medicare Advantage plans, restrictions on MA-PFFS plans, MedPAC to study MA plan quality, payments.

• Sections §§ 171-176

– Amendments to Medicare Part D drug benefit and use of Part D data.


Medigap 2010 PlansTransition Dates

June 1, 2010 Effective Date.

Old policies can be renewed.

2010 Plans can be issued with an effective date on or after 6/1/10, if the state insurance department* has approved the policy forms, rates and advertising. And if carrier is offering Plan A, and either C or F.

* Texas Department of Insurance has approved the Medigap 2010 Plans, but, the TDI is inundated with policy forms, rates, and advertising materials and as of April 2010 have not provided final approval of our materials.


MIPPA Provisions (H.R. 6331)Summary of Modernization Changes

• Summary of changes approved by NAIC in March 2007: – Overall = Reduces number of plans from 14 to 11. – Eliminates Plans H, I, and J. (Became duplicative, after MMA.) – Eliminates Plan E. (Became duplicative, after MIPPA)– Creates new plans M and N. (New options with higher

beneficiary cost-sharing and lower anticipated premiums.) – Benefit Changes:

• Eliminates outdated “At-Home Recovery” benefit. • Eliminates outdated and underutilized “Preventative Care” benefit. • Creates a new “Hospice” benefit, which is added to every plan as

part of Basic (Core) benefits. • Replaces the 80% Part B Excess Charges Benefit (Plan G) with 100%

benefit. (Plan F already had 100% benefit)


Medigap 2010 PlansChanges to the 1990 Plans:

Eliminated: • At Home Recovery• Preventative Care NOT

covered by Medicare

Created: • “Hospice” benefit to

all plans• New Plans M & N


Medigap 2010 Plans

Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010

* Plan F also has an option called a high deductible plan F. This high deductible plan pays the same benefits as Plan F after one has paid a calendar year [$1900] deductible. Benefits from high deductible plan F will not begin until out-of-pocket expenses exceed [$1900]. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan’s separate foreign travel emergency deductible.

A B C D F F* G K L M N

Basic, including 100% Part B coinsurance




Basic, including 100% Part B coinsurance*


Hospitalization and preventive care paid at 100%; other basic benefits paid at 50%

Hospitalization and preventive care paid at 100%; other basic benefits paid at 75%


Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER

Skilled Nursing Facility Coinsurance




50% Skilled Nursing Facility Coinsurance

75% Skilled Nursing Facility Coinsurance



Part A Deductible

Part A Deductible

Part A Deductible

Part A Deductible

Part A Deductible 50% Part A

Deductible 75% Part A Deductible

50% Part A Deductible

Part A Deductible

Part B Deductible

Part B Deductible

Part B Excess (100%)

Part B Excess (100%)

Foreign Travel Emergency






Out-of-pocket limit $[4440]; paid at 100% after limit reached

Out-of-pocket limit $[2220]; paid at 100% after limit reached


Agent Compensation


First Year Renewal

10.00% 5.50%Agent

Compensation

Schedule #1

Compensation Schedule

Rate Comparisons

Age 65,

Male,

Non-Tobacco

44

A-Rated CompaniesTFB rates effective April 2017Competitors as-of January 2017

Dallas Houston Midland San Antonio

Transamerica ‐ TFB $177 $177 $177 $177

BCBS $156 $156 $143 $143

Thrivent ‐ Attained Age $185 $201 $170 $170

Thrivent ‐ Issue Age $246 $267 $226 $226

Aetna $202 $213 $192 $192

Bankers Life $180 $198 $161 $323

Central States $188 $205 $163 $188

CIGNA $144 $174 $130 $144

Colonial Penn $205 $222 $205 $205

Combined $181 $199 $159 $181

Companion $178 $190 $145 $178

Continental $189 $199 $165 $189

Gerber $273 $273 $228 $273

Globe $157 $157 $157 $314

Humana $199 $220 $199 $180

Medico $181 $190 $168 $165

Oxford $165 $187 $165 $165

Pekin $150 $171 $126 $150

State Farm $166 $172 $159 $166

United Healthcare $164 $168 $153 $153

United America $184 $223 $175 $175

USAA $140 $155 $140 $127

Non‐TobaccoMale Age 65


Rate Comparisons

Age 65,

Male,

Tobacco

45



BCBS $156 $156 $143 $143



Aetna $223 $234 $211 $211

Bankers Life Standard $180 $198 $161 $323

Central States $209 $228 $181 $209

CIGNA $158 $191 $143 $158

Colonial Penn $227 $247 $227 $227

Combined $200 $219 $175 $200

Companion $196 $208 $160 $196

Continental $210 $221 $183 $210

Gerber $314 $314 $262 $314

Globe $157 $157 $157 $314

Humana $298 $329 $298 $269

Medico $213 $224 $197 $194

Oxford $190 $215 $190 $190

Pekin $172 $196 $145 $172

State Farm $182 $189 $175 $182


United America $212 $257 $201 $201

USAA $154 $171 $154 $140

TobaccoMale Age 65



Rate Comparisons

Age 67,

Male,

Non-Tobacco

46



BCBS $180 $180 $162 $162



Aetna $217 $229 $206 $206

Bankers Life $180 $198 $161 $161

Central States $188 $205 $163 $188

CIGNA $144 $174 $130 $144

Colonial Penn $221 $240 $221 $221

Combined $194 $213 $170 $194

Companion $178 $190 $145 $178

Continental $189 $199 $165 $189

Gerber $280 $280 $234 $280

Globe $171 $171 $171 $171

Humana $215 $238 $215 $194

Medico $181 $190 $168 $165

Oxford $174 $197 $174 $174

Pekin $150 $171 $126 $150

State Farm $187 $195 $180 $187


United America $203 $245 $192 $192

USAA $146 $162 $146 $132



Rate Comparisons

Age 67,

Male,

Tobacco

47



BCBS $180 $180 $162 $162



Aetna $239 $252 $227 $227


Central States $209 $228 $181 $209

CIGNA $158 $191 $143 $158

Colonial Penn $245 $266 $245 $245

Combined $213 $234 $186 $213

Companion $196 $208 $160 $196

Continental $210 $221 $183 $210

Gerber $322 $322 $268 $322

Globe $171 $171 $171 $171

Humana $322 $356 $322 $291

Medico $213 $224 $197 $194

Oxford $200 $226 $200 $200

Pekin $172 $196 $145 $172

State Farm $206 $214 $198 $206


United America $233 $282 $221 $221

USAA $160 $178 $160 $146

TobaccoMale Age 67


Rate Comparisons

Age 70,

Male,

Non-Tobacco

48



BCBS $211 $211 $191 $191



Aetna $248 $261 $235 $235

Bankers Life $201 $221 $180 $180

Central States $212 $231 $183 $212

CIGNA $155 $188 $141 $155

Colonial Penn $248 $269 $248 $248

Combined $214 $235 $187 $214

Companion $187 $199 $153 $187

Continental $214 $225 $186 $214

Gerber $308 $308 $257 $308

Globe $192 $192 $192 $192

Humana $242 $268 $242 $219

Medico $181 $190 $168 $165

Oxford $196 $222 $196 $196

Pekin $167 $191 $141 $167

State Farm $209 $217 $201 $209


United America $230 $279 $218 $218

USAA $164 $182 $164 $149



Rate Comparisons

Age 70,

Male,

Tobacco

49



BCBS $211 $211 $191 $191



Aetna $273 $287 $259 $259


Central States $235 $257 $203 $235

CIGNA $171 $207 $155 $171

Colonial Penn $275 $299 $275 $275

Combined $236 $258 $206 $236

Companion $206 $219 $168 $206

Continental $238 $250 $207 $238

Gerber $354 $354 $295 $354

Globe $192 $192 $192 $192

Humana $362 $401 $362 $327

Medico $213 $224 $197 $194

Oxford $225 $255 $225 $225

Pekin $192 $219 $162 $192

State Farm $230 $239 $221 $230


United America $265 $321 $251 $251

USAA $180 $200 $180 $164

TobaccoMale Age 70
