tag:blogger.com,1999:blog-3776711847158061262024-02-20T20:41:44.695-05:00Healthcare, Health Insurance, & Medicare NewsCurrent events affecting Healthcare, Medicare, and Health Insurance related reform issues.Unknownnoreply@blogger.comBlogger15125tag:blogger.com,1999:blog-377671184715806126.post-20504683777271489732013-02-19T12:01:00.001-05:002013-02-19T12:01:12.329-05:00Rate Increases to Medicare Advantage in 2014New rates proposed by the Centers for Medicare and Medicaid Services, a.k.a. CMS, will be “enormously disruptive” according to Forbes Magazine. <br />
<br />
According to Forbes and Citibank managed care analyst Carl McDonald the proposed changes to MA reimbursement will “have the net effect of reducing payments to Medicare Advantage plans by 7 to 8 percent in 2014”. “This includes the 2.3% reduction in per capita growth rate announced by CMS on Friday, and estimated 2-3% drop as rates move to parity with fee for service…a 1.5% reduction associated with the change in coding intensity adjustment” and the 2% health insurance premium tax. “These negatives are partially offset by an estimated 1% benefit from improved Star quality ratings, re-basing, better risk scores, and fee for service normalization, resulting in an overall decline of 7-8%,” wrote McDonald yesterday in a note to clients.<br />
<br />
We’ve been recommending for several years now (to those who can afford the additional cost) is a traditional <a href="http://www.mysenioradvisorsgroup.com/index.html" title="Medicare Supplemental Insurance">Medicare Supplemental Insurance</a> plan a.k.a. “Medigap”. For those where cost is a significant factor in their choice consider <a href="http://www.medicaresupplementn.com/">Medicare Supplement Plan N</a> vs <a href="http://www.mysenioradvisorsgroup.com/MedicareMedigapPlanF.html">Medicare Supplement plan F</a> or G All of these will provide more flexibility in the doctors you can see and lower out of pocket cost if/when you get sick and need it most. For assistance making your choice whether it’s Medicare Advantage or Medicare Supplemental insurance you can get advice from the <a href="http://www.mysenioradvisorsgroup.com/Request-MedicarePlans.html">Senior Advisors Group</a>.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-377671184715806126.post-54120859900991349052013-02-14T14:43:00.002-05:002013-02-14T14:43:57.466-05:00Medicare’s Annual Disenrollment Period Ends February 14th
<br />
<div style="line-height: 140%;">
<span style="color: black; font-family: "Georgia","serif"; font-size: 10pt; line-height: 140%;">Medicare’s Annual Disenrollment
Period for <span class="yshortcuts"><span id="lw_1360870554_2">Medicare advantage</span></span>
will end tomorrow, February 14th, 2013. From January 1<sup>st</sup> until
February 14<sup>th</sup> each year Medicare advantage members are permitted to
dis-enroll from their Medicare Advantage (MA) plan and go back to Original
Medicare and get a <span class="yshortcuts"><span id="lw_1360870554_3">Medicare
Part D</span></span> plan. Individuals are not permitted to change MA plans
only exit back to original Medicare and add a Part D. At this time many members
choose to add <a href="http://www.mysenioradvisorsgroup.com/">Medicare Supplemental Insurance</a> and are permitted to make this
adjustment. <o:p></o:p></span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-377671184715806126.post-39030122916592807782010-05-06T17:50:00.000-04:002010-05-06T17:50:45.351-04:002010 Medicare Prescription Drug (Part D) RebateStarting in 2010 Medicare Beneficiaries enrolled in a stand-alone Medicare Prescription drug plan (PDP) or Medicare Advantage Plan that includes prescription drug coverage (MAPD) who reach the prescription drug coverage gap (the "donut hole") may be eligible to receive a one-time $250 rebate from the U.S. Department of Health and Human Services (HHS). <br />
<br />
Beginning on June 15th, beneficiaries who have reached the prescription drug coverage gap ("donut hole") will get a $250 rebate check. In 2010 the “donut hole” is attained at or above $2,830 in Covered Medicare Part D costs. (Exclusions do apply and are explained below).<br />
<br />
Those who have reached this point prior to June 1st (and are eligible for the rebate) will receive their $250 rebate check later in June. Beneficiaries who enter the coverage gap after June will be issued the payment based on the quarter in which they hit the coverage gap. In the event that a beneficiary enters the Coverage Gap at the end of a quarter during 2010, the refund may be processed/mailed during the following quarter.<br />
<br />
Beneficiaries should be aware that the rebate checks will be processed and issued by HHS, not by their insurance provider, and HHS will issue rebates based on a beneficiary's qualifications at the time that they reach the coverage gap. <br />
<br />
Of course there are some who are not eligible and will be excluded from receiving the rebate. Specifically,<br />
<br />
<ol><li>Dual eligible beneficiaries who receive subsidies ("low income subsidy;" LIS) from both Medicare and Medicaid.</li>
<li>Beneficiaries with annual income exceeding the Part B income thresholds. This means that they have annual adjusted individual income above $85,000 or annual adjusted joint income above $170,000.</li>
<li>Beneficiaries receiving Retiree Drug Subsidy (RDS)</li>
</ol>For more information about the $250 Part D 2010 rebate go to www.medicare.gov or phone Medicare directly at 1-800-Medicare (1-800-633-4227), 24 hours a day/7 days a week. TTY/TDD users should call 1-877-486-2048. <br />
<br />
For those needing assistance selecting a <a href="http://www.mysenioradvisorsgroup.com/">Medicare Supplement Insurance</a>, <a href="http://www.mysenioradvisorsgroup.com/Medicare-Advantage-Basics.html">Medicare Advantage</a>, and/or a Medicare Prescription Drug coverage is advised to contact the Senior Advisors Group at 610-399-8700 or follow any of the links in this article to their website.<br />
<br />
<div> </div>Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-377671184715806126.post-62990411063779318542010-03-15T10:10:00.004-04:002010-03-19T18:23:07.721-04:00Healthcare Reform Bill – The Un-heard SolutionPolitical rhetoric thrives as we get close to a vote on the colossal Healthcare reform bill. Republican, Democrats and Independents, all agree that something needs to be done. The debate is whether the proposed Healthcare bill actually solves any of the issues; and if so, at what cost in dollars, deficits, and personal sacrifice by the majority to satisfy a few uninsured Americans. <br />
<br />
<strong>The broad issues</strong> - stabilize health care <strong><em>cost</em></strong> and make Health Insurance premiums more affordable. <strong>The dilemma</strong> - these are two separate issues; the current healthcare reform bill is so wrought with special interest favors that congress won’t even show Americans, and; the cost, and benefit is so obscure that it is easily distorted. This is a disgraceful, malicious process and we should be as concerned about government processes as we are Healthcare. But I digress. Sure, maybe a few million people will get a break at the expense of the remaining 90% of Americans and maybe the few deserve a break. Unfortunately, with 300+ million Americans, a solution for 5-10 million at a cost of 1 trillion is outrageous.<br />
<br />
Fortunately there is a solution that benefits ALL Americans and addresses a large portion of the uninsured. With a few modification down the road we could create a Healthcare and Health Insurance formula for the world. Further, this solution solves both the health care cost issue as well as the health insurance cost issues defined by both parties. NAd provides economic stimulasd to the economy as a side effect.<br />
<br />
It is so simple that it is no wonder that it could never have been devised by Congress. Ready? ...<br />
<br />
All “Tax Filers” age 18-65 get a $1 for $1 tax credit – up to $2500 – for every dollar spent on health care and/or health insurance premiums. Another $500 credit for every dependent child under 18. <br />
<br />
<strong>Total cost – $507 Billion</strong> (Before any economic benefit)<br />
<br />
Effect/Result:<br />
<br />
1) At least 25 Million Americans get Healthcare and Health Insurance coverage with ZERO negative impact on premiums for everyone else.<br />
<br />
2) The 17 Million uninsured (include in 25m above) who make over $50K and choose not to buy insurance essentially can’t refuse. High Deductible plans cost less than $2500 in most cases they all become insured at no cost to them. And no burden to responsible Americans.<br />
<br />
3) Those w/o insurance can get coverage with the first $2500 essentially paid by government. ($6,000 for a family of 4). <br />
<br />
4) Those making more than Medicaid level but less than $50K get most if not all of premiums covered, for at least basic helth coverage. Premium will be less than $2500 for most; more for those who want cadilac plans, smoke or lead unhealthy lifestyles. All of which is their choice.<br />
<br />
5) Insurance companies get 25 million more customers helping insurance rates for everyone overall. <br />
<br />
6) <strong>U. S. Business “Stimulus”</strong> - Across the country business will be "stimulated" as they raise employee contributions to employer based healthcare premiums up to the $2500 level or even slightly higher having no impact on those who get coverage via employer plans, but does help their employer, providing further economic benefit to the country.<br />
<br />
A few issues still remain which could be added as we dissect impact of Tax Credit. The largest with any real substantive moral value, is that of the uninsurable. A national high risk pool should be created with all insurers contributing proportionately based on some % of gross premiums collected. Result – Fair distribution of risk; insurability for the uninsurable and premium savings of the same $2500 enjoyed by all Americans.<br />
<br />
Layering in other ideas like buying/selling <a href="http://www.insurance-wholesalers.com/index.html">Health Insurance</a> across state lines, and other reforms could be added in over time as these are complicated and involve state and federal insurance reforms. <br />
<br />
Finally, any ACTUAL savings derived from fraud and abuse reduction (in Medicare) should be used to improve the Medicare program, not pay for something else. (It's uncertain how much if any savings will actually occur) And, every dollar in saving not actually realized adds $1 for $1 to the cost of the current proposed healthcare bill. Furthermore, Medicare <strong><em>will</em></strong> require additional funds later - either through higher payroll taxes or added deficit spending. This is probably the biggest smoke screen in this frudulent healthcare bill. That is, subsequent bills to support Medicare, fund the "Medicare Doctor Fix" to make up for these reallocated, questionable savings are forthcoming. All American support some healthcare reform but stand against the fraud perpetuated by this bill.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-377671184715806126.post-45552310519769542572009-10-09T20:08:00.011-04:002009-10-31T07:25:20.792-04:00Aetna and Blue Cross Dropping some Medicare Advantage Subscribers<span style="color:#ffffff;">-<br /></span><strong>All is not lost when your Medicare Advantage plan terminates your coverage. </strong><br /><br />Recently, thousands in the Philadelphia area (and other areas) have been notified that their Medicare Advantage plan will terminate as of 12-31-09. While this may be particularly harsh to those on some low premium plans, subscribers in PPO's are finding they may actually be better off.<br /><br />Depending on you age, and where you live, Medicare Advantage PPO subscribers are finding that a Medicare Supplement plan, also called "Medigap" may be comparable in price, have no co-pays, no doctor networks, and better out of network coverage than they had before. Many are actually saving money when combined with the proper Medicare prescription drug plan.<br /><br />While it's not true in every case most people we've talk to have been satisfied if not thrilled at the outcome. We would recommend calling the <a href="http://www.mysenioradvisorsgroup.com/index.html">SENIOR ADVISORS GROUP</a> for help and more details. They operate in 11 states with more being added to accommodate terminated Medicare Advantage subscribers. And, since they offer all the top Medicare supplement providers they can reccommend the lowest cost Medicare Supplement plan available in your area. They have also indicated that a new – major - Medicare Supplement provider will launch its <a href="http://www.mysenioradvisorsgroup.com/MedicareSupplementalInsuranceCenter.html">Medicare Supplemental Insurance </a>in 32 states on November 1st. I’m told it will be a well recognized brand providing Medigap insurance at - or near - the low end of Medicare supplement premiums in most areas. So with all the stress over terminated Medicare advantage plans, there may be a silver lining, and change in your pocket.Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-377671184715806126.post-86181699909548921902009-10-03T18:42:00.013-04:002009-10-04T16:54:08.264-04:00Medicare Supplemental Plans for 2010<span style="color:#ffffff;">-<br /></span>Beginning June 1st, 2010 <a href="http://www.mysenioradvisorsgroup.com/MedicareSupplementalInsuranceCenter.html">Medicare Supplemental Insurance </a>(Medigap) will include two new choices for consumers - <a href="http://www.medicaresupplementn.com/">Medicare Supplement Plan M </a>and <a href="http://www.medicaresupplementn.com/">Medicare Supplement Plan N</a>.<br /><br />At that time Medigap will eliminate plans E, H, I, and J as the "Preventive Care Benefit" and the "At-home-Recovery" benefit are removed. Once removed these plans – E, H, I, And J – will become identical to other lettered Medicare Supplement plans and thus redundant. Medicare has deemed these two benefits unnecessary in the current Medicare structure. In addition to these changes, a hospice care benefit Co-insurance coverage will be added to all new Medicare Supplement Plans.<br /><br />Current Medicare Supplement policy holders will be permitted to keep existing <a href="http://www.mysenioradvisorsgroup.com/MedicareSupplementalInsuranceCenter.html">Medicare Supplement Insurance </a>policies, however as of June, 2010 enrollment will cease into ALL current plans. It is not necessarily beneficial to purchase one plan over another (purchase the one that fits) because all plans purchased after June 1st will be in the "New" Medicare Supplement Plan policy design. Existing Medicare Supplement policies (Policy holders) will be partitioned into one group and plans purchased after June will be partitioned into new policy groups. However, it is not certain that all Medicare Supplement (Medigap) providers will offer the new plans N and M, so a qualified, independent, advisor is suggested. Since most insurance carriers offer several plans it is important to shop around for the best price. (For more help go to Medicare Advisor)<br /><br />An independent Medicare Supplement Advisor can assist you in finding a plan now; as well as help in 2010 when the new plans roll out. For individuals turning 65 before June 2010 the independent Advisor will be able to suggest a plan today as well as provide service and alternatives next year when the new plans and premiums become available. Company employed agents may not be the best solution as they can only suggest their companies plans. The Senior Advisors Group (<a href="http://www.mysenioradvisorsgroup.com/">Link</a>) represents most plans in a given area and is very helpful in explaining the various options available today and the new plans coming next year. (including <a href="http://www.mysenioradvisorsgroup.com/Medicare-Advantage-Basics.html">Medicare Advantage</a>) <a href="http://www.mysenioradvisorsgroup.com/Request-MedicarePlans.html">Search Medicare Plans</a> in your area<br /><br /><strong><strong><strong>New Medigap Plan Design</strong></strong></strong><br /><br />Medicare Supplement Plan N will have similar benefits to Plan D, but there will be a $20 co-payment for doctor visits and a $50 co-payment for emergency room visits. It is believed that this co-pay will apply after the $135 deductible is paid. But there is some uncertainty as to how the deductible and co-pay will be applied. The good news is the cost of these plans is expected to have premiums around 70% of the cost of Plan F or about 77% of current plan D. Medicare Supplement Plan M will also offer similar benefits to Plan D, but will only cover 50% of the part A deducible and none of the part B deductible. The cost of Plan M is expected to price at approximately 85% of Plan F (or 92% of current plan D).<br /><br />Industry experts are enthusiastic about these changes as consumers will be attracted by the lower premiums. As usual these plans were designed by academics’ with zero understanding of what consumers want and we're not certain the design fits exactly what consumers’ desire. I.e. these plans (M & N) don't include the $135 deductible nor do they include excess charges allowed by most states. However, we do expect the introduction of <a href="http://www.medicaresupplementn.com/">Medicare Supplement Plan M</a> and <a href="http://www.medicaresupplementn.com/">Medicare Supplement Plan N</a> along with other changes to provide a real opportunity for consumers. For plan information in your area go to Find <a href="http://www.mysenioradvisorsgroup.com/Request-Medicare-Supplement-Insurance.html">Medicare Supplemental Insurance </a>Plans. An internal consultant from the Senior Advisors Group will provide information on available plans, and answer questions about the best options and lowest premiums available in your area. (No salesman will visit your home)Unknownnoreply@blogger.com4tag:blogger.com,1999:blog-377671184715806126.post-80783745492498830932009-09-26T08:45:00.008-04:002009-09-29T10:25:18.635-04:00Health Care Reform - A Viable SolutionI have written in some length about the issues of the U.S. healthcare system and have attempted to cut through some of the rhetoric. You can read the preamble to this solutions only article at <a href="http://www.articlesbase.com/politics-articles/healthcare-compromise-the-uninsured-and-problems-facing-healthcare-1091386.html">Healthcare Reform Compromise</a>. For now a healthcare solution that is understandable and summarized in just a few short concepts. (Not 1,000 or so pages)<br /><br />The following concepts specifically address the major issues facing the U.S. health delivery system. I have defined the major categories as: 1) Cost control 2) Minimize provider loss, 3) Reduce Insurance premiums 4) Provide catastrophic coverage for every American 5) Create an environment of affordable, manageable health delivery 6) Minimal added cost.<br /><br />What follows is a 21st century, free market based, leadership solution. It is a foundation for a real solution, a place I believe many of us can agree.<br /><br /><strong>Reform/Solutions:<br /></strong><br /><strong>1)</strong> A system that <strong>"Insures displaced workers"</strong> for up to one year. Most individuals look at COBRA through the lens of unemployment and conclude that it’s unaffordable. Of course they do; they’re unemployed. Employers should be required to provide a minimum level of health insurance for 12 months after unemployment. After year 1 the displaced employee could choose to buy the minimum coverage in that employer group for an unlimited time frame. <em>Result</em>, an individual will always have access to a group plan as long as premiums are paid. No pre-existing condition discrimination, and this specifically addresses the problem of the temporary uninsured and uninsurable.<br /><br />The minimum standard coverage would include 2 parts: First, some preventative and basic health care. i.e. 2 doctors visits annually plus some diagnostic coverage benefit. This minimum required employer coverage would provide health insurance to roughly $500 per recipient or family member. This keeps the unemployed going to doctors and minimizes future catastrophic needs. The second part of the minimum requirement would be catastrophic coverage over $100,000 to the $250,000 threshold. Individuals could have the option to purchase “gap” coverage to fill in between $500 and $100,000 if they choose. Once employed again the individual would be transferred to the new employer group and responsibility reassigned. (This would only apply to groups over some predetermined level i.e. 50 members) This would give the unemployed or those doing other work access to a group health plan. Anyone who has at least one job in life would have coverage as long as the premium was paid.<br /><br /><strong>2)</strong> <strong>Minimize provider loss</strong>/Catatrophic Coverage for Every American: Specifically addressing a major burden on hospitals, and other providers by the uninsured. This is one of the major issues driving up the cost for the insured. I would impose an off budget, segregated, “Lock box” type trust fund that could not be borrowed from EVER. A small tax on wages would provide for catastrophic coverage over a $250,000 threshold for every American. Since this would be a separate tax on income (over federal poverty level) it would bring every worker into the system including those wage earners with sufficient income to afford some coverage but skate by without health insurance. These individuals currently add cost by increasing risk, and utilizing expensive ER services for care. Those who have insurance end up covering this added cost with inflated cost of care, and higher premiums. This concept would be a positive revenue mechanism by bringing in those who currently pay nothing. (Specifically those 17 million who earn over $50,000/year but do not buy health insurance)<br /><br /><em>Important:</em> Those currently insured will be rewarded as their new tax will be significantly offset by the reduction in their health insurance premiums. This will occur as the artificial inflation of services is reigned in, provider loses are mitigated, and the cost to insurance companies is reduced. With no risk above 250K insurers will be able to lower premiums as the liability above 250K is transferred from insurance companies to the trust fund (could be phased in once the trust fund is in place). Note: Most insurance policies cover up to 2 million, 5 million, or even have unlimited benefit limits.<br /><br />The total tax to those already insured would be offset - in time - by the savings. I'm confident this would be close to neutral in cost for those currently insured and it could exceed 100% offset as the added costs are borne predominately by those who can afford health insurance in the first place but choose to ignore the need.<br /><br />As the individuals who ignore health insurance are brought into the system they can still avoid other coverage but the high burden they place on the system will be mitigated. Their newly captured tax pays for catastrophic coverage, and hospitals are relieved of the burden of losses above the 250k. In addition catastrophic costs and shared by every American and more important; Every foreign workers, illegal workers, and those irresponsible Americans earning sufficient wages but not contributing are integrated into the system.<br /><br /><em>Additional Results:</em> Relaxed underwriting standards, (insurer would be more willing to accept some riskier applicants since exposure is limited). This expands the availability of reasonably priced health insurance for those with preexisting conditions and/or elevated risk profiles. This point further addresses the uninsured however many would eventually become tied to some group plan. (above)<br /><br /><strong>3)</strong> We need <strong>A National health Insurance Regulatory Agency</strong> so insurers who provide policies over several states could meet ONE regulatory requirement recognized by all 50 states. Large insurance plans would be overseen by 1 regulator instead of contending with up to 50 regulators in every state they do business. Regional providers that can do better on a local level would remain to drive out cost on a regional level. This would create an compettitive environment in which national plans would emerge strengthening competition, reducing overhead, exploiting synergies, and exploiting internal technology and infrastructure. This would ultimately reduce insurance cost. I can foresee consolidation potentially reducing options for individual so I would forbid any consolidation that would reduce the number of choices in any given area below 5 or more.<br /><br />I would make the financial requirement significant in areas of capitalization, loss reserve, as well as other necessary standards. It would and should be tougher than any state so that there is no “systematic risk” in the event of any national provider failure. Essentially, it should be tough enough to almost eliminate the possibility of failure.<br /><br />An insurance "exchange" as is currently being discussed would be a sufficient alternative but I don't believe it will work. It is irrational to allow New Yorkers to buy insurance in Georgia or Indiana. How will an insurer be regulated in NY that may be based in Tennessee? It seems like it adds more – not less – bureaucracy, but I am open to suggestions.<br /><br /><strong>4)</strong> <strong>“Cost control”</strong>: (The ugly and anti-free market dilemma) - The government could create a reimbursement rate for services provided above the catastrophic amount controlling expenditures at the high end. This would be applied to high cost treatment and procedures only. It has been demonstrated that this is an area where we could realistically apply responsibility over a group of multiple providers (Physicians, hospitals, and pharmaceutical providers) for the package treatment and healthcare. (Although not necessary.) The plan could include BONUSES for quality of care, outcomes, and other health performance criteria that many advocate.<br /><br />I would allow providers and hospitals to balance bill (up to 15%) and/or opt out of the catastrophic coverage system altogether (not likely since they would be exposed to loses when any uninsured presented in their emergency room and they were mandated to provide service) ALL group plans would have to include excess charges. However, “Gap” plans available to only unemployed individuals would not. Further, Individual plans would be available as including excess charges OR as HSA accounts and would require a minimum ($50/month) HSA contribution as a trade off. The benefit; The HSA contribution would belong to the specific individual but could only ever be used for healthcare. This is the obligation for purchasing individual coverage without the “excess” coverage feature. Theoretically the HSA owner would be saving for future catastrophic expenses that entered the "excess" dimension. The insured would have the option to purchase these HSA plans or purchase plans that included the additional excess coverage.<br /><br /><em>Result:</em> Under The new reform everyone but especially the younger American’s could accumulate (with HSA’s) 10's of thousands of dollars in their 20's, 30's, and 40's. This account could then be used later in life as health care needs become more likely. Additionally, the HSA could be used for the individual owner or family healthcare requirements. Eventually it could be applied toward LTC premiums after age 55. That would solve ANOTHER problem facing the U.S. healthcare system. So individuals are now in control, saving for their own of family healthcare needs and in addition have an account that could pay LTC premiums later in life.<br /><br />As many have wisely pointed out, when individuals use there own accounts they spend more wisely. Having ownership of a health plan from the age of 18, 21, or even later in life keeps individuals involved. Ultimately we’ll create an environment were everyone pays something, everyone gets something, and everyone has some level of affordable healthcare insurance. No excessive government intrusion necessary.<br /><br />Some additional Details: Similar to our current environment HMO’s, PPO's, and other plan providers would still negotiate reimbursement of charges above the 250K catastrophic limit. The insurance provider would manage and make payments to facilities and others but would be reimbursed at the scheduled rates from the healthcare trust. This will control excessive inflation for high end health services but does not completely communize and thwart our free market system. Further we need to also reform HSA account use and expand premium tax deductions to individuals. Employer provided versions require users to spend down accounts each year. This is Dumb. We need to allow employer based MSA’s to accumulate over years.<br /><br />Although the “excess” billing option creates an environment of complexity to this solution it allows some sensible variations in pricing and regional cost variations. At the same time it does not create a system that encourage providers to “excess bill” and individuals to avoid the coverage. The result may be some high end clinics, hospitals and providers, but this is no different to the free-market environment present in the current hospital and provider system. Some providers will always be better than others. Experience and expertise will naturally accumulate in “pools” this is Nature at work and a working plan will have to accommodate the laws of nature.<br /><br />In a later phase I MIGHT require all insurers to cover all applicants at some maximum rate. Say, 2x the base rate. Or, create some sort of national high risk pool and assign applicants to plans based on size and other factors. This would make health care coverage attainable to those few remaining high risk individuals. I would only consider this after several years and the impact of phase one of the health care reforms is evaluated. Another option is a “High risk” reimbursement for those who have been denied coverage from 2 of more insurance providers. They would pay 2x the base rate from a provider of their choice and the government would kick in the balance necessary for the provider to take in the previously denied applicant. Details on this portion world need to be worked out. Ultimately, most every worker would have access to a group plan from point 1<br /><br />finnally, many readers might retort that I overlooked items such as Malpractice Insurance and caps on lawsuits. I trust you I did not. Certainly there are additional issues that need addressing but healthcare reform should not be confused with other reform. We must find common ground and that sometimes means shrinking the ground to be covered. (Pay attention Washington)<br /><br />Before we continue on any such reform we should keep a few simple principles at the top of any government reform package including healthcare:<br /><br />1) Do no harm<br /><br />2) Minimize government involvement (infrastructure, regulatory platforms, and technology platforms like online records etc. are the role of government - Not biased competition, or industry manipulation) You can apply for insurance online Example <a href="http://www.insurance-wholesalers.com/AetnaHealthInsurance.html">Aetna Health Insurance </a>, but your doctor can't get test results or health history.<br /><br />2) Improve the system for everyone. Society should provide a safety net for everyone including themselves. But it should be simple and just - No excessive burden on any class.<br /><br />4) Find Common Ground – Effective legislation can only be accomplished when we find areas of agreement and commit to legislation directed to only those specific areas on which we agree. If you don't understand the hidden costs of government involvement see <a href="http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf">Medicare’s Hidden Administrative Costs</a>: by The Council for Affordable Health Insurance<br /><br />Responsible government means specifically defining problems, outlining solutions, and analyzing reasonable outcomes. There needs to be sufficient time for review, withtime for debate and analysis.(30-60 days seems rational) Anything less is irresponsible.<br /><br />Our Constitution was not completely ratified for 9 months and it took 3 months before the first state put its signature on the plan. The current rush into new programs is our current governments attempt to cloak the truth from the public. Our Government is a disgrace, and the absence of these principles is destroying our great country. We need to return to the place our founders created. (1, large page I might add)Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-377671184715806126.post-52776603222407932242009-06-18T08:57:00.056-04:002009-08-03T14:04:38.993-04:00Healthcare Compromise - The Uninsured and Problems Facing Healthcare<span style="color:#ffffff;">-</span><br />Although there is room for improvement in our health care system, our current path will not solve the underlying problems and the facts don’t support the proposed solutions. We need reform but we don't need the confluence of bureaucracy and regulations currently under construction. <br /><br />First let's examine some facts: It seems everyone agrees there are around 47-48 Million uninsured. Of that total the White House includes 9.7 million foreigners, (Many of those illegal). And, according to the same Census report, 8.3 million uninsured people earn between $50,000 and $74,999 per year, and 8.74 million make more than $75,000 a year. That’s roughly 17 million people who ought to be able to “afford” some health insurance, (they make substantially more than the median household income of $46,326). Further dissected: A 2003 Blue Cross/Blue Shield Association study estimated that about 14 million of the uninsured were eligible for Medicaid and/or SCHIP and would be signed up automatically if they went to the hospital. Technically these people have health insurance.<br /><br />All-in that leaves 6.26 million Americans who are truly without health insurance. Hmmm, Should we spend 1 trillion dollars and completely alters the health care delivery, payment, and responsibility to satisfy 2% of the entire U.S. population? Along the way should we cut physician and hospital reimbursement for care. Does anyone believe cutting compensation will improve care? That's what is proposed.<br /><br />Examining the uninsured population Further; 45% of the uninsured are "temporary". It's unclear which of the above categories they fall into. However, statistics show that these 20 million “temporary uninsured” are without insurance for an average of only 4 months. Sure "temporarily uninsured" is dangerous. Many go longer than 4 months, and if care is required during the temporary period it can cause significant financial damage to families and the institutions obligated to provide their care. This point needs to be addressed. However, the current solutions don’t specifically address these problems.<br /><br />The unintended consequences of the proposed solution will be enormous. To rush into a social experiment of this magnitude without every reasonable outcome fully vetted and addressed is an experiment with potentially dire consequences with little chance of doing it again - properly.<br /><br />Lastly; the issue of quality of care in the U.S. verses other countries. Anyone who doesn't inherently suspect this delusion should check their pulse; better yet their gut. This propaganda is distorted information from a study performed by the World Health Organization (WHO). Since my goal is facts and solutions I will sum up the report for the otherwise misinformed. The WHO report has several major factors that contribute to country rankings. One major factor is individual financial contributions to healthcare. The scoring method benefits those countries with higher levels of social (government) contributions. The result is a penalty effect on those countries with lower government expenditure. The bottom line is it would be nearly impossible for a country like the U.S. with a "free-market" health system to score high in the overall ranking.<br /><br />The report is not an analysis of care (The U.S. ranks #1 in outcomes for 14 of 16 cancer treatments) but more an analysis of social contributions towards healthcare. The method used further penalizes the U.S. for higher homicide and motor vehicle deaths which have nothing to do with healthcare delivery. Bottom line the U.S. is #1 in healthcare not so high in government financial intrusion.<br /><br />Now that we have some facts let’s examine where there may be some legitimate concerns, and address some specific areas for improvement.<br /><br /><strong>The problems:</strong><br /><br /><em><strong>Rapidly rising cost</strong>,</em> A growing burden on individuals, families, and employers to maintain premium payments, the inability of those with health issues to get health insurance, the temporary uninsured, and the 6.2 million that may require some legitimate support and safety net.<br /><br />For the benefit of society we need some way to manage this group (33M) for the greater good of society as a whole. However, the reality is that there are options available today that would resolve a big chuck of these obstacles. What we need is reasonable fine tuning to maintain relevance to the modern economic environment - Not the 1950’s environment. For one, there are high deductible health saving accounts which have not been embraced by individuals. Millions of uninsured could afford these premiums ($75-100/month for average 40 year old) yet they opt for nothing. This is just irresponsible on the part of many and it affects us all when these people (earning over 50K/year) become ill, and transfer their burden to society.<br /><br />Another significant factor driving up cost is the <strong><em>fragmented system of regulation</em></strong> on our current health insurance market. Simplifying this system, providing new health technology, modernized regulatory and oversight, and standardized infrastructure including claims forms etc. would drive out significant overhead, create synergies, improve productivity, increase competition, and further drive out waste and unnecessary spending. This is the only area where we should ever see government involvement in a capitalistic society. Creating infrastructure and a platform on which capitalism can thrive. (i.e. interstate transportation system)<br /><br />Next; The high <strong><em>burden associated with the uninsured entering a hospital/emergency room</em></strong> that require treatment for life threatening injuries, or other high cost healthcare. Hospitals account for these services under the indigent care expense line in there budget and make up the loss by overcharging the insured.<br /><br />The final factor is addressing the <strong><em>reality of the "truly uninsured"</em></strong>. The burden (financial or otherwise) regardless of whether they are temporary, illegal, foreign, or have sufficient income - they must be dealt with. A real solution does not ignore reality nor should it jeopardize 250 million people to fix the problems of 6 million.<br /><br /><strong>Solutions:</strong><br /><br />The following solutions will control cost, minimize lose expose, lower premiums, provide catastrophic coverage for every American, and create an environment of affordable health coverage to nearly every American with minimal added cost to existing insured individuals or business. What follows is a 21st century, free market based, U.S. world leadership solution.<br /><br /><strong>1)</strong> A system that insures displaced worker for up to one year. Most individuals look at COBRA through the lens of unemployment and conclude that it’s unaffordable. Of course they do; they’re unemployed. Employers should be required to provide some minimum level of health insurance for 12 months after unemployment. After year 1 the displaced employee could choose to buy at least the minimum coverage in that employer group for an unlimited time frame. Result, they are able to stay in that group as long as premiums are paid!<br /><br />The minimum standard coverage would include some preventative and basic health care. i.e. 2 doctors visits annually plus some diagnostic coverage benefit. I would limit this coverage to $500-$1000 per recipient or family member. This would keep people going to doctors and minimize future catastrophic needs. Also it gives the unemployed or those doing other work access to a group health plan. Anyone who has at least one job in life would have coverage as long as someone paid a reasonable premium. The second part of the minimum requirement would be catastrophic coverage over $100,000 to the $250,000 threshold. Individuals could have the option to purchase “gap” coverage to fill in between $500 and $100,000 if they choose. Once employed again the individual would be transitioned to the new employer group and responsibility transferred.<br /><br /><strong>2)</strong> We need a <strong>National health Insurance Regulatory Agency</strong> so insurers who provide policies over several states could meet ONE regulatory requirement that would be recognized by all states. I would make this requirement significant in areas of financial capitalization, loss reserve, as well as other necessary standards. It should be as tough or tougher as any state so that there is no “systematic risk” in the event of one national provider failure. Essentially, it should be tough enough to almost eliminate the possibility of failure. This would create an environment in which national plans would emerge strengthening competition and reducing cost. Large insurance plans would not have to contend with 50 regulators, and regional providers that can do things better on a local level would remain and drive out cost on a regional level. An insurance "exchange" as is currently being discussed would be a sufficient alternative.<br /><br /><strong>3)</strong> The burden of the uninsured on hospitals, and other providers. I would impose an off budget, segregated, “Lock box” type trust fund that could not be borrowed from EVER. A small tax on wages would provide for catastrophic coverage over a $250,000 threshold for every American. Since this would be a separate tax on income (over federal poverty level) it would force every worker into the system including wage earners with sufficient income to afford some coverage but do not. These individual currently skate by increasing risk and cost to the system and every other insured American.<br /><br />As these individuals are forced into the system, at least they have coverage above 250,000. Hospitals are relieved of the burden of losses above the 250k. The catastrophic burden is shared by every Americans and foreign workers. Those currently insured are rewarded when the artificial inflation of services is reigned in and provider loses are mitigated. This will result in some reductions in health insurance premiums, offsetting at least some portion of the tax paid. Additional premium reductions would occur since most insurance policies cover up to 2 million, 5 million, or more. Those who currently have health insurance would see further premium reductions as the liability above 250K is transferred from insurance companies to the trust fund (could be phased in once the trust fund is in place). The total tax to those already insured would in theory could be offset in time by the savings. But I’m not banking on 100% return. Their will be technology cost but the added costs will be borne predominately by those who can afford the coverage in the first place but choose to ignore the need.<br /><br />Additional benefits: relaxed underwriting standards, (insurer would be more willing to accept some riskier applicants since exposure is limited). This expands the availability of reasonably priced health insurance for those with preexisting conditions and/or elevated risk profiles.<br /><br />“Cost control” - The government could create a reimbursement rate for services provided above the catastrophic amount controlling expenditures at the high end. This would be applied to high cost treatment and procedures only. An area where we could realistically apply responsibility over a group for the treatment and healthcare of one. The plan could (And should) include BONUSES for quality of care, outcomes, and other health performance criteria that many advocate.<br /><br />I would allow providers and hospitals to balance bill (up to 15%) and opt out of the catastrophic coverage system altogether (not likely since they would be exposed to loses when any uninsured presented in their emergency room and they were mandated to provide service) ALL group and individual “comprehensive” plans would have to include excess charges. However “Gap” plans (one that paid up to the 250K cat coverage) would not. These plans would only be available as HSA accounts and would include a minimum ($50/month) HSA contribution. The trade off here is the HSA contribution would belong to the specific individual but could only ever be used for healthcare. This is the trade off for purchasing individual coverage without the “excess” coverage feature. Theoretically the HSA owner would be saving for catastrophic expenses that went into the "excess" dimension. The insured would have the option to purchase these hybrid HSA plans or purchase plans that included the additional excess coverage.<br /><br />I would find ways to stimulate HSA account use and expand premium tax deductions to individuals. The employer provided version requires users to spend down these accounts each year. This is Dumb. If we allow HSA plans (like the individual purchased version) to accumulate over years. Then (under new reform) the 20 somethings forced into the system with HSA could accumulate 10's of thousands of dollars in the 20's and 30's which could be used later in life as health care needs become more likely. As many have stated when individuals use there own accounts they spend more wisely. Having ownership of a plan from the age of 18 or 21 would keep people involved. This could be used for health care not covered under catastrophic plans, or other low cost high deductible options. Later in life it could be used for individual or family healthcare and eventually it could be applied toward LTC premiums after age 55. That would solve ANOTHER problem facing the U.S. healthcare system. ultimately we have created an environment were everyone pays in something, everyone gets out something and everyone has some level of affordable healthcare insurance. No government intrusion necessary.<br /><br />Similar to our current environment HMO’s and other insurers would still negotiate reimbursement of excess charges above the 250K catastrophic limit. This would look similar to the way private plans negotiate and reimburse providers under Medicare.<br /><br />Although the “excess” billing option creates an environment of complexity to this solution it allows some sensible variations in pricing and regional cost variations. At the same time it does not create a system that encourage providers to “excess bill” and individuals to avoid the coverage. The result may be some high end clinics, hospitals and providers, but this is no different to the environment present in the current hospital and provider system. Some providers will always be better than others. The major difference would be some might have the insurance coverage to pay the excess bill were others would be responsible to pay some out of pocket or get treatment from another high quality provider.<br /><br />In a later phase I MIGHT require all insurers to cover all applicants at a maximum of 2x the base rate. Or create some sort of high risk pool. This would make health care coverage attainable to those remaining high risk individuals. I would only consider this after 5 years and the impact of phase one of the health care reforms I have proposed is evaluated. The other option is a High risk reimbursement for those who have been denied coverage from 2 of more insurance providers. They would pay 2x the base rate from a provider of their choice and the government would kick in the balance necessary for the provider to take in the previously denied applicant. (Details on this portion another time)<br /><br />Many readers might retort that I overlooked items such as Malpractice Insurance and caps on lawsuits. I trust you I did not. Certainly these are issues that need addressing but healthcare reform should not be confused with other reform. We must find common ground and that sometimes means shrinking the area to be covered.<br /><br />The bottom line for Americans...Cuts to <a href="http://www.mysenioradvisorsgroup.com/">Medicare</a>. Seniors should be outraged! Taxes on Premiums, Families should be outraged! Penalties (taxes) on business hurting the heart of the countries economic engine. Everyone should be outraged! Obama lied to us about taxes. He is going to wipe out economic growth and bankrupt this country. Wake up America. This plan will not solve any of the challenges facing the health care industry. It we be just another tax hike that we were assured would not occur. 1st the cigarette tax, next, the proposed energy tax, and now the healthcare tax. You can be sure that there will be some hidden and some not so hidden taxes paid by every American. Don't believe that some Voodoo savings over there will pay for this new program over here. They are misleading you. These are mostly outright lies and deception because they don't want you to know the truth.<br /><br />Before we continue on any such reform we should keep a few simple principles at the top of any government reform package including healthcare:<br /><br />1) Do No Harm<br />2) Improve the system for everyone in it. Society should provide a safety net, but it should be simple and just - No excessive burden on any class.<br />3) Minimize government involvement (infrastructure, regulatory platforms, and technology platforms are the role of government - Not biased competition) If you don't understand the hidden costs of government involvement you're in over your head - <a href="http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf">Read this next.</a><br />4) Find Common Ground – Horse trading does not work in Politics. Effective legislation can only be accomplished when we find areas of agreement and commit to legislation directed to specific areas on which there is agreement.<br /><br />Responsible government means specifically defining problems, outline solutions, and analyze every reasonable outcome. There needs to be sufficient time for review before instituting reform. 30-60 days seems rational time for debate and analysis. Anything less is irresponsible. The current rush into new programs is our governments attempt to cloak what is happening from the public. It is a disgrace, and the public is lazily culpable for allowing this to occur.<br /><br />The absence of these principles is destroying our great country.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-377671184715806126.post-39937852055907372052009-03-09T12:03:00.002-04:002009-03-09T12:25:39.186-04:00Doylestown nonprofit helps Medicare reduce costsThis post is merely a comment on the article referenced above. To read article following link to the York Daily record.<br />-<br />It sounds clear that it’s not “Managed Care” that has been the problem it has been “Management”. Clearly a properly designed, implemented and managed program can reduce cost.<br />We don’t need a new system, just a few improvements to our current system. I’ve been advocating for improvements we can believe in, not change for change sake. That will just add cost as we find new problems that they themselves need improving. And nothing has really gotten better, just different.<br />Take <a href="http://www.mysenioradvisorsgroup.com/Medicare-Advantage-Basics.html">Medicare Advantage</a>. Many of these plans are providing improved benefits, lower cost, and small co-pays for doctors’ visits and hospitalization. They are a great improvement over the old, tired, Original Medicare plan. Plans in many areas have very low co-pays for PCP visits. This low co-pay encourages low, middle income beneficiaries to see a doctor early and more often - improving the likelihood of catching a costly ailment early, saving money, and improving overall health. I we could take some of the lesson learned from this program and apply them to private Medicare, or Medicare Advantage we could really make health care better. Sure I hear the argument that these plans cost more. Well this program shows that it doesn’t have to be that way. We can do it for less.<br /><br />Eliminating MA would just hurt low and middle income beneficiaries who in many cases can’t afford a <a href="http://www.mysenioradvisorsgroup.com/Medicare-Supplement_Center.html">Medicare Supplement Insurance </a>. Let’s fix the problems say 1:1 reimbursement and let Capitalism and programs described in this article decide which is better.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-377671184715806126.post-66133969787358570902009-01-19T09:12:00.010-05:002009-01-19T12:30:56.048-05:00Medicare Supplemental Insurance<span style="color:#ffffff;">-</span><br />Many people ask me "What is the best <a href="http://www.blogger.com/ww.mysenioradvisorsgroup.com/Medicare-Supplement_Center.html">Medicare Supplemental Insurance</a>"? My answer is always buy what you can afford.<br /><br />The reason I say this is because the best plan is one that is affordable and will be affordable to maintain for the balance of ones life. If the premium is a burden at 65 then it's likely to be worse at 85 when it is likely you will need it most. So my first bit of advice is purchase a plan that you expect to comfortably maintain the premium payments for the rest of your life.<br /><br />That said a cost/benefit analysis of some different options might be in order. One basic yet common analysis between a plan "A" vs. plan "J" for a specific (undefined) zip code for a Male turning 65. (<a href="http://www.mysenioradvisorsgroup.com/Medicare-Supplement_Center.html">Medicare Supplemental Insurance </a>Comparison Chart) Your specific zip code will be different.<br /><br />Premium Plan "A" = $ 99.79<br />Premium Plan "J" = $143.11<br />_____________________<br />Annual Savings $519.84<br /><br />Painting with a broad brush assume you will have $150 in out of pocket cost each year by choosing "Plan A" over "Plan J". Your savings is reduced to $369.84/year. This also assumes no significant illness or hospitalization. Over 10 years thats ONLY $3,698.40 in saving. One hospital stay or significant illness would cost at least half that (<a href="http://www.blogger.com/www.mysenioradvisorsgroup.com/Supplement-Comparison-Chart.html//">2009 medicare deductibles</a>)<br /><br />So, my conclusion and answer is if it's affordable, purchase a <a href="http://www.mysenioradvisorsgroup.com/Supplement-Comparison-Chart.html">Medicare Plan J</a> as soon as possible. Ideally this would be obtained as you are enrolled in <a href="http://www.mysenioradvisorsgroup.com/Medicare_Info_Center.html">Medicare Part B</a>, (Age 65 unless covered under an employer plan). During the first 6 month of obtaining <a href="http://www.mysenioradvisorsgroup.com/Medicare_Info_Center.html">Medicare Part B</a> you have guaranteed acceptance in a <a href="http://www.mysenioradvisorsgroup.com/Medicare-Supplement_Center.html">Medicare Supplement </a>plan regardless of your health.<br /><br />You will also need to add a Medicare Rx plan to cover your prescription drugs, which will add roughly $25-$50/month. If this starts to get dauting call a Advisor<br /><br />You can also request quotes and free consultation on Medicare Supplement plans at <a href="http://www.mysenioradvisorsgroup.com/Request-Medicare-Consultation.html">Medicare Supplement Consultation</a>, or get <a href="http://www.mysenioradvisorsgroup.com/Request-Medicare-Supplement-Insurance.html">Medicare Supplemental Insurance quotes </a>for your zip code.<br /><br />Happy Retirement!Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-377671184715806126.post-9004092875405999382008-12-21T15:40:00.012-05:002009-01-14T09:59:49.239-05:00Medicare Beneficiaries May See a Dearth of Advice in 2009<span style="font-size:78%;color:#ffffff;">-</span><br /><span style="font-size:78%;color:#ffffff;">-</span><br />Medicare beneficiaries should be aware (if not angry) that getting advice on Part D and <a href="http://www.mysenioradvisorsgroup.com/Medicare-Advantage-Basics.html">Medicare Advantage Plans</a> will be much tougher in 2009.<br /><br />Just 4 days prior to the Annual Enrollment Period (<span class="blsp-spelling-error" id="SPELLING_ERROR_0">AEP</span>) the Center for Medicare and Medicaid (<span class="blsp-spelling-error" id="SPELLING_ERROR_1">CMS</span>) mandated a cut in compensation to independent <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">advisers</span> educated and certified to assist Medicare beneficiaries in their enrollment. For help and qualified advice in PA NJ or DE try this organization: <a href="http://www.mysenioradvisorsgroup.com/">http://www.mysenioradvisorsgroup.com/</a><br /><br />In this stroke of socialist and anti-business policy making <span class="blsp-spelling-error" id="SPELLING_ERROR_3">CMS</span> has forced independent <span class="blsp-spelling-corrected" id="SPELLING_ERROR_4">advisers</span> out of the business. Come 2009 many of the better qualified, and most experienced agents will re-focus their business efforts into business segments where they are fairly compensated. Having committed resources many professionals were already committed to the 2008 Annual enrollment season but this has turned into a losing proposition. (<span class="blsp-spelling-error" id="SPELLING_ERROR_5">CMS</span> change came days before in a most unprofessional implementation – Credit card companies by example have been given 18 months before their industry modification takes effects) Many professional, qualified <span class="blsp-spelling-error" id="SPELLING_ERROR_6">advisors</span> had no other choice but to remain involved for the 2008 Annual Enrollment Period in hopes to recoup already sunk cost. Even more troubling, this ruling did not apply to the single choice, biased, insurance company employees – (Can you say “political contributions”) - they will be compensated at about 10x the amount of independent <span class="blsp-spelling-corrected" id="SPELLING_ERROR_7">advisers</span> (when you include reasonable overhead, costs, and expenses required for normal business operations).<br /><br />So buyer beware; the less objective insurance company salesmen will gladly enroll you in their company policy. But don’t expect them to tell you if there is a better choice available. How’s that for looking out for the senior population? Nice work <span class="blsp-spelling-error" id="SPELLING_ERROR_8">CMS</span>.<br /><br />Medicare beneficiaries are strongly encouraged to contact their representative and tell them:<br />a) That <strong>advice on Medicare Advantage and Medicare Rx plans is extremely important!</strong><br />b) That in a democratic, capitalist society <strong>compensation should not be regulated</strong>, free markets are part of this countries foundation and have worked until now.<br />c) That these new regulations will create <strong>a vacuum of advice</strong> that will likely be filled by less qualified, biased, and/or unethical individuals.<br />d) That we have recommended and <strong>support additional oversight</strong> but not unfair market regulations.<br />e) Agencies should be held accountable for bad agents and that excess complaints should result in license revocation.<br /><br />Every industry wants to weed out the bad apples, and rein in excess cost, however <span class="blsp-spelling-error" id="SPELLING_ERROR_9">CMS's</span> current <span class="blsp-spelling-corrected" id="SPELLING_ERROR_10">guidelines</span> are just unsophisticated and archaic. They were poorly devised, and poorly implemented. Those in the business between fits of frustration are stunned by the lack of <span class="blsp-spelling-corrected" id="SPELLING_ERROR_11">intelligence</span> and sophistication in the newest guidelines. Medicare beneficiaries should be as well.<br /><br />We encourage everyone on Medicare, who knows someone on Medicare, or is simply insulted by the poor performance of our government and government agencies should contact your local representative and/or these additional Representatives: Stark, <span class="blsp-spelling-error" id="SPELLING_ERROR_12">Grassley</span>, <span class="blsp-spelling-error" id="SPELLING_ERROR_13">Baucus</span>, Hatch, and Rockefeller. For additional comments and contact information see November blogs....<br /><br />Let them know how you feel and that incompetence will no longer be tolerated.<br /><br /><span style="color:#ffffff;">-</span>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-377671184715806126.post-32162525882589593442008-11-22T19:46:00.008-05:002009-01-18T11:20:43.584-05:00What is a Medicare Advantage Plan?<span style="font-size:78%;">-</span><br /><span style="font-size:78%;">-</span><br /><a href="http://www.mysenioradvisorsgroup.com/Medicare-Advantage-Basics.html">Medicare Advantage Plans</a> are health plan options (like an HMO or PPO) approved by Medicare and offered by private companies. These plans are part of Medicare and are sometimes called “Part C” or “MA Plans.” Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. Medicare Advantage Plans provide your Medicare health coverage and usually Medicare drug coverage. They aren’t <a href="http://www.mysenioradvisorsgroup.com/Medicare-Supplement_Center.html">Medicare Supplement </a>Insurance.<br /><br />Not all <a href="http://www.mysenioradvisorsgroup.com/Medicare-Advantage-Basics.html">Medicare Advantage Plans</a> work the same way, so find out the plan’s rules before joining. In all plan types, you are always covered for emergency and urgent care.<br /><br />For more information on plans in your area contact the <strong><a href="http://www.mysenioradvisorsgroup.com/">Senior Advisors Group</a>. You can find a <a href="http://www.mysenioradvisorsgroup.com/Medicare-Supplement_Center.html">Medicare Supplement Comparison Chart </a>and information about <a href="http://www.mysenioradvisorsgroup.com/Medicare-Advantage-Basics.html">Medicare Advantage Plans</a>, <a href="http://www.mysenioradvisorsgroup.com/Medicare-Supplement_Center.html">Medicare Supplement </a>Insurance, and <a href="http://www.mysenioradvisorsgroup.com/Medicare_Info_Center.html">Medicare Parts A, B, C, and D</a> on their website.</strong> <a href="http://www.mysenioradvisorsgroup.com/Aetna-Medicare.html"><strong><span style="color:#3333ff;">Aetna Medicare plans</span></strong></a> as well as many others available.<br /><br />References<br />1) http://www.medicare.gov<br />2) Medicare and You 2009; Published by U.S. Department of Health and Human Services;<br />Center for Medicare and Medicaid Services<br /><br /><span style="font-size:78%;">-</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-377671184715806126.post-9484376247121222262008-11-12T19:16:00.031-05:002009-06-27T15:51:19.318-04:00Response to CMS latest Interim Ruling (CMS-4128-IFC2 on 10-10-2008)<div align="center"></div><div align="center">.<br /><span class="blsp-spelling-error"><span class="blsp-spelling-error"><span class="blsp-spelling-error"><span class="blsp-spelling-error"><span class="blsp-spelling-error"><span class="blsp-spelling-error"><span class="blsp-spelling-error"><span class="blsp-spelling-error"><span id="SPELLING_ERROR_0" class="blsp-spelling-error" style="color:#ff0000;">Letter with plans and solution follows this brief introduction</span></span></span></span></span></span></span></span></span><span style="color:#ff0000;">.</span></div><div align="center"><span style="color:#ffffff;">-</span></div><div align="left"></div><div align="left"><strong><span style="font-size:130%;"><span class="blsp-spelling-error"><span class="blsp-spelling-error"><span class="blsp-spelling-error"><span class="blsp-spelling-error"><span class="blsp-spelling-error"><span class="blsp-spelling-error"><span class="blsp-spelling-error"><span class="blsp-spelling-error"><span class="blsp-spelling-error" style="color:#000000;">CMS</span></span></span></span></span></span></span></span></span> </span></strong>issues interim final rule, the 3rd revision in as many weeks. It seems it would be much more efficient if <span id="SPELLING_ERROR_1" class="blsp-spelling-error"><span id="SPELLING_ERROR_1" class="blsp-spelling-error"><span id="SPELLING_ERROR_1" class="blsp-spelling-error"><span id="SPELLING_ERROR_1" class="blsp-spelling-error"><span id="SPELLING_ERROR_1" class="blsp-spelling-error"><span id="SPELLING_ERROR_1" class="blsp-spelling-error"><span id="SPELLING_ERROR_1" class="blsp-spelling-error"><span id="SPELLING_ERROR_1" class="blsp-spelling-error">CMS</span></span></span></span></span></span></span></span> would just dictate to the MA providers exactly how much commissions they can pay to agents. It would be a shame to stop at merely violating the first amendment rights of every agent as well as those of every American over age 65. Imagine, someone asks an agent to explain Medicare Advantage and the agent responds "I can tell you everything you want to know, I am trained and certified to present many of the available plans, but I'm not allowed to tell you right now. You will need to sign this document stating what we are going to discuss, then I will come back in 48 hours and tell you everything you'd like".<br /><br />Just writing this makes me laugh at the lunacy and lack of sophistication at <span id="SPELLING_ERROR_2" class="blsp-spelling-error"><span id="SPELLING_ERROR_2" class="blsp-spelling-error"><span id="SPELLING_ERROR_2" class="blsp-spelling-error"><span id="SPELLING_ERROR_2" class="blsp-spelling-error"><span id="SPELLING_ERROR_2" class="blsp-spelling-error"><span id="SPELLING_ERROR_2" class="blsp-spelling-error"><span id="SPELLING_ERROR_2" class="blsp-spelling-error"><span id="SPELLING_ERROR_2" class="blsp-spelling-error">CMS</span></span></span></span></span></span></span></span>.<br /><br />I am disgusted at the ignorance and incompetence at <span id="SPELLING_ERROR_3" class="blsp-spelling-error"><span id="SPELLING_ERROR_3" class="blsp-spelling-error"><span id="SPELLING_ERROR_3" class="blsp-spelling-error"><span id="SPELLING_ERROR_3" class="blsp-spelling-error">CMS</span></span></span></span>, and I do not intend to sit back quietly. I am supportive of rational oversight to address the issue of mistreated, misguided, or otherwise exploited seniors. I support better supervision of agents and sanctions for those who prey on and/or take advantage of anyone --young or old. But the regulations imposed on good agents to clean up the abuse of a few has gone way to far. IMAGINE if those in charge of civil protection cut the pay to police officers because a few were involved in inappropriate and/or criminal activities. Who would remain? That's <span id="SPELLING_ERROR_4" class="blsp-spelling-error"><span id="SPELLING_ERROR_4" class="blsp-spelling-error"><span id="SPELLING_ERROR_4" class="blsp-spelling-error"><span id="SPELLING_ERROR_4" class="blsp-spelling-error">CMS</span></span></span></span> <span id="SPELLING_ERROR_5" class="blsp-spelling-corrected">brilliance</span>.<br /><br />The following letter is being sent to my local Congressperson and Senator, however I wanted to share it with others. It's not perfect and potentially flawed in places, but it is a better starting point in 2 hours then what <span id="SPELLING_ERROR_3" class="blsp-spelling-error"><span id="SPELLING_ERROR_6" class="blsp-spelling-error"><span id="SPELLING_ERROR_6" class="blsp-spelling-error"><span id="SPELLING_ERROR_6" class="blsp-spelling-error"><span id="SPELLING_ERROR_5" class="blsp-spelling-error"><span id="SPELLING_ERROR_6" class="blsp-spelling-error"><span id="SPELLING_ERROR_5" class="blsp-spelling-error"><span id="SPELLING_ERROR_5" class="blsp-spelling-error"><span id="SPELLING_ERROR_5" class="blsp-spelling-error">CMS</span></span></span></span></span></span></span></span></span> failed to accomplish all year. I encourage you to post comments at its conclusion.<br /><em><span style="color:#ff0000;"></span></em><br /><em><span style="color:#ff0000;">Draft to be finalized and sent by 10:00am on 10-17-08.<br /><br />Comments are strongly encouraged.</span></em><br /><br />November XX, 2008<br /><br />Representative Joe <span id="SPELLING_ERROR_4" class="blsp-spelling-error"><span id="SPELLING_ERROR_7" class="blsp-spelling-error"><span id="SPELLING_ERROR_7" class="blsp-spelling-error"><span id="SPELLING_ERROR_7" class="blsp-spelling-error"><span id="SPELLING_ERROR_6" class="blsp-spelling-error"><span id="SPELLING_ERROR_7" class="blsp-spelling-error"><span id="SPELLING_ERROR_6" class="blsp-spelling-error"><span id="SPELLING_ERROR_6" class="blsp-spelling-error"><span id="SPELLING_ERROR_6" class="blsp-spelling-error">Sestack</span></span></span></span></span></span></span></span></span><br />600 N. Jackson <span id="SPELLING_ERROR_5" class="blsp-spelling-error">Street</span> <span class="blsp-spelling-error">Suite</span> 203<br />Media, PA 19063<br />Phone: (610) 892-8623<br />Fax: (610) 892-8628<br /><br />RE: Comments on to <span id="SPELLING_ERROR_6" class="blsp-spelling-error"><span id="SPELLING_ERROR_8" class="blsp-spelling-error"><span id="SPELLING_ERROR_8" class="blsp-spelling-error"><span id="SPELLING_ERROR_8" class="blsp-spelling-error"><span id="SPELLING_ERROR_7" class="blsp-spelling-error"><span id="SPELLING_ERROR_8" class="blsp-spelling-error"><span id="SPELLING_ERROR_7" class="blsp-spelling-error"><span id="SPELLING_ERROR_7" class="blsp-spelling-error"><span id="SPELLING_ERROR_7" class="blsp-spelling-error">CMS</span></span></span></span></span></span></span></span></span>-4138-<span id="SPELLING_ERROR_7" class="blsp-spelling-error"><span id="SPELLING_ERROR_9" class="blsp-spelling-error"><span id="SPELLING_ERROR_9" class="blsp-spelling-error"><span id="SPELLING_ERROR_9" class="blsp-spelling-error"><span id="SPELLING_ERROR_8" class="blsp-spelling-error"><span id="SPELLING_ERROR_9" class="blsp-spelling-error"><span id="SPELLING_ERROR_8" class="blsp-spelling-error"><span id="SPELLING_ERROR_8" class="blsp-spelling-error"><span id="SPELLING_ERROR_8" class="blsp-spelling-error">IFC</span></span></span></span></span></span></span></span></span>2<br /><br />Dear Representative <span id="SPELLING_ERROR_8" class="blsp-spelling-error"><span id="SPELLING_ERROR_10" class="blsp-spelling-error"><span id="SPELLING_ERROR_10" class="blsp-spelling-error"><span id="SPELLING_ERROR_10" class="blsp-spelling-error"><span id="SPELLING_ERROR_9" class="blsp-spelling-error"><span id="SPELLING_ERROR_10" class="blsp-spelling-error"><span id="SPELLING_ERROR_9" class="blsp-spelling-error"><span id="SPELLING_ERROR_9" class="blsp-spelling-error"><span id="SPELLING_ERROR_9" class="blsp-spelling-error">Sestak</span></span></span></span></span></span></span></span></span>:<br /><br />Before I address the specifics of the new <span id="SPELLING_ERROR_9" class="blsp-spelling-error"><span id="SPELLING_ERROR_11" class="blsp-spelling-error"><span id="SPELLING_ERROR_11" class="blsp-spelling-error"><span id="SPELLING_ERROR_11" class="blsp-spelling-error"><span id="SPELLING_ERROR_10" class="blsp-spelling-error"><span id="SPELLING_ERROR_11" class="blsp-spelling-error"><span id="SPELLING_ERROR_10" class="blsp-spelling-error"><span id="SPELLING_ERROR_10" class="blsp-spelling-error"><span id="SPELLING_ERROR_10" class="blsp-spelling-error">CMS</span></span></span></span></span></span></span></span></span> guidelines issued 10-10-08 (<span id="SPELLING_ERROR_10" class="blsp-spelling-error"><span id="SPELLING_ERROR_12" class="blsp-spelling-error"><span id="SPELLING_ERROR_12" class="blsp-spelling-error"><span id="SPELLING_ERROR_12" class="blsp-spelling-error"><span id="SPELLING_ERROR_11" class="blsp-spelling-error"><span id="SPELLING_ERROR_12" class="blsp-spelling-error"><span id="SPELLING_ERROR_11" class="blsp-spelling-error"><span id="SPELLING_ERROR_11" class="blsp-spelling-error"><span id="SPELLING_ERROR_11" class="blsp-spelling-error">CMS</span></span></span></span></span></span></span></span></span> -4138-<span id="SPELLING_ERROR_11" class="blsp-spelling-error"><span id="SPELLING_ERROR_13" class="blsp-spelling-error"><span id="SPELLING_ERROR_13" class="blsp-spelling-error"><span id="SPELLING_ERROR_13" class="blsp-spelling-error"><span id="SPELLING_ERROR_12" class="blsp-spelling-error"><span id="SPELLING_ERROR_13" class="blsp-spelling-error"><span id="SPELLING_ERROR_12" class="blsp-spelling-error"><span id="SPELLING_ERROR_12" class="blsp-spelling-error"><span id="SPELLING_ERROR_12" class="blsp-spelling-error">IFC</span></span></span></span></span></span></span></span></span>2), I first want to note the irresponsible and reckless timing of the this new interim release. Issuing such guidelines at the last minute by <span id="SPELLING_ERROR_12" class="blsp-spelling-error"><span id="SPELLING_ERROR_14" class="blsp-spelling-error"><span id="SPELLING_ERROR_14" class="blsp-spelling-error"><span id="SPELLING_ERROR_14" class="blsp-spelling-error"><span id="SPELLING_ERROR_13" class="blsp-spelling-error"><span id="SPELLING_ERROR_14" class="blsp-spelling-error"><span id="SPELLING_ERROR_13" class="blsp-spelling-error"><span id="SPELLING_ERROR_13" class="blsp-spelling-error"><span id="SPELLING_ERROR_13" class="blsp-spelling-error">CMS</span></span></span></span></span></span></span></span></span> and anyone responsible for the development of these regulations is derelict in their duties and they should be expelled from their respective positions -- Congress, <span id="SPELLING_ERROR_13" class="blsp-spelling-error"><span id="SPELLING_ERROR_15" class="blsp-spelling-error"><span id="SPELLING_ERROR_15" class="blsp-spelling-error"><span id="SPELLING_ERROR_15" class="blsp-spelling-error"><span id="SPELLING_ERROR_14" class="blsp-spelling-error"><span id="SPELLING_ERROR_15" class="blsp-spelling-error"><span id="SPELLING_ERROR_14" class="blsp-spelling-error"><span id="SPELLING_ERROR_14" class="blsp-spelling-error"><span id="SPELLING_ERROR_14" class="blsp-spelling-error">CMS</span></span></span></span></span></span></span></span></span>, or otherwise.<br /><br />As any competent individual understands – business planning is essential to survive and establish a stable, healthy business. For many of my colleagues four months or more of planning and preparation has been expelled for the 2009 A<span id="SPELLING_ERROR_14" class="blsp-spelling-error"><span id="SPELLING_ERROR_16" class="blsp-spelling-error"><span id="SPELLING_ERROR_16" class="blsp-spelling-error"><span id="SPELLING_ERROR_16" class="blsp-spelling-error"><span id="SPELLING_ERROR_15" class="blsp-spelling-error"><span id="SPELLING_ERROR_16" class="blsp-spelling-error"><span id="SPELLING_ERROR_15" class="blsp-spelling-error"><span id="SPELLING_ERROR_15" class="blsp-spelling-error"><span id="SPELLING_ERROR_15" class="blsp-spelling-error">EP</span></span></span></span></span></span></span></span></span> and O<span id="SPELLING_ERROR_15" class="blsp-spelling-error"><span id="SPELLING_ERROR_17" class="blsp-spelling-error"><span id="SPELLING_ERROR_17" class="blsp-spelling-error"><span id="SPELLING_ERROR_17" class="blsp-spelling-error"><span id="SPELLING_ERROR_16" class="blsp-spelling-error"><span id="SPELLING_ERROR_17" class="blsp-spelling-error"><span id="SPELLING_ERROR_16" class="blsp-spelling-error"><span id="SPELLING_ERROR_16" class="blsp-spelling-error"><span id="SPELLING_ERROR_16" class="blsp-spelling-error">EP</span></span></span></span></span></span></span></span></span> Medicare enrollment periods. A ruling that so severely impacts businesses and individual livelihoods four days prior to a regulated selling season is careless and reckless. I demand better from my government officials or votes will be redirected.<br /><br />As a result of this new ruling, I will be scaling back my efforts to sell and advise seniors about Medicare related products. I am cancelling advertising campaigns and will be excusing two agents from their commitments. If <span id="SPELLING_ERROR_16" class="blsp-spelling-error"><span id="SPELLING_ERROR_18" class="blsp-spelling-error"><span id="SPELLING_ERROR_18" class="blsp-spelling-error"><span id="SPELLING_ERROR_18" class="blsp-spelling-error"><span id="SPELLING_ERROR_17" class="blsp-spelling-error"><span id="SPELLING_ERROR_18" class="blsp-spelling-error"><span id="SPELLING_ERROR_17" class="blsp-spelling-error"><span id="SPELLING_ERROR_17" class="blsp-spelling-error"><span id="SPELLING_ERROR_17" class="blsp-spelling-error">CMS</span></span></span></span></span></span></span></span></span>’s intention was to drive out good agents, then they have succeeded.<br /><br />This ruling, if allowed to stand, will induce the exit of qualified agents from consulting, advising, and servicing Medicare beneficiaries. The effort required to analyze, certify, and then explain the choices available under the MA program is substantial. This is before one has to navigate and understand the <span id="SPELLING_ERROR_19" class="blsp-spelling-corrected">absurd</span> and ill-suited guidelines. Personally, I spent over 100 hours my first year just reviewing and grasping the nuances of all the plans in my area (The 5 county Philadelphia region). This year I spent about one-half that time getting re-certified and reacquainted with all the changes. With 12 years of Financial and insurance related experience, I was initially overwhelmed – imagine what a senior is confronted with.<br /><br />To the specific remuneration impact: I can no longer justify any significant attention or investment in Medicare Advantage related products. <span id="SPELLING_ERROR_17" class="blsp-spelling-error"><span id="SPELLING_ERROR_20" class="blsp-spelling-error"><span id="SPELLING_ERROR_19" class="blsp-spelling-error"><span id="SPELLING_ERROR_19" class="blsp-spelling-error"><span id="SPELLING_ERROR_18" class="blsp-spelling-error"><span id="SPELLING_ERROR_19" class="blsp-spelling-error"><span id="SPELLING_ERROR_18" class="blsp-spelling-error"><span id="SPELLING_ERROR_18" class="blsp-spelling-error"><span id="SPELLING_ERROR_18" class="blsp-spelling-error">CMS</span></span></span></span></span></span></span></span></span> and others clearly do not understand the structure of the insurance sales world. Most agents work without financial or other support from providers. For me, marketing costs in 2008 was nearly $100 per new MA enrollment. At the bare minimum, if I do everything realistic under the new – restrictive – marketing guidelines, I can enroll maybe 40 – 50 people a year. (I could do many times that previously with telemarketing and other universally accepted practices, but they have been eliminated.) The total I can now expect to earn in 2009 is $5,000 profit. Where do I sign up for public assistance and state foreclosure assistance? Where’s my bailout?<br /><br />If I want to add agents (which I had previously contracted) and pay them a decent wage ($250 last year), my cost go up to $350. Add in support staff, and we are easily at $400-$450 before I - as a business owner - can make a profit. Insurance companies understand this, and that’s why they pay 400-$500 in commissions. The people so inclined can create a business and employ others, and those wishing to do it alone can make a little extra income for their independence and initiative.<br /><br />Additionally, there are hierarchy levels above the agent (i.e. G.A. and <span id="SPELLING_ERROR_19" class="blsp-spelling-error"><span id="SPELLING_ERROR_21" class="blsp-spelling-error"><span id="SPELLING_ERROR_20" class="blsp-spelling-error"><span id="SPELLING_ERROR_20" class="blsp-spelling-error">F.M.O.</span></span>)</span></span> which earn more but they are organizations that are in place as intermediaries between agent and insurance company. (Many use this system some do not.) These classifications are somewhat difficult to attain, but many top agents like myself can get bonuses which help get them close to the compensation at these levels.<br /><br />The point, however, is that many of these organizations do little more than recruit agents, consolidate order flow, and disseminate information out to agents. Their commissions do not seem to have been effected by the ruling and furthermore the excess now being retained by the insurance companies will now just funnel to excess profits and bonuses for executives. Some attention to these relationships should be understood and reviewed for MA. The more logical solution (assuming free markets are dead) might be a higher cap on the total compensation at the <span id="SPELLING_ERROR_20" class="blsp-spelling-error"><span id="SPELLING_ERROR_19" class="blsp-spelling-error"><span id="SPELLING_ERROR_19" class="blsp-spelling-error"><span id="SPELLING_ERROR_19" class="blsp-spelling-error">FMO</span></span></span></span> level and let business owners allocate capital and pay commissions as they see fit. The new guidelines simply restrict higher compensation to dedicated and motivated agents. Those who want to help senior citizens, and are inclined to do more are the ones who have been most adversely affected.<br /><br />Without going over all the details of running a small insurance business the bottom line is there will be no way to market, hire, train, educate oneself and others every year without significant scale. Only the carriers who have the scale and cash flow of huge government MA premiums will be able survive and sell and market MA plans. In fact, because <span id="SPELLING_ERROR_21" class="blsp-spelling-error"><span id="SPELLING_ERROR_20" class="blsp-spelling-error"><span id="SPELLING_ERROR_20" class="blsp-spelling-error"><span id="SPELLING_ERROR_20" class="blsp-spelling-error">CMS</span></span></span></span> has intentionally <span id="SPELLING_ERROR_22" class="blsp-spelling-error"><span id="SPELLING_ERROR_21" class="blsp-spelling-corrected">omitted</span></span> any compensation guidelines for directly employed agents - with zero objectivity - these individuals are now getting compensated at between 4-10 times (including salaries and benefits) that of the independent agent. This is an outrage and a clear bias toward those with financial and political influence.<br /><br />The result; no independent advice for seniors as insurance carriers negligently and maliciously promote their own products as the best available. The most egregious and exploitative of these behemoths has massive television advertising campaigns, and all spend Millions of dollars in direct mail and other marketing programs. One giant in particular has the worst benefits – by far – of any plan available in my region. Do they tell seniors about the competitors lower out of pocket expenses? Do they point out that others offer additional benefits that they do not offer? I don’t think so. Only independent advisers can provide this level of product impartiality.<br /><br />I understand the point of this whole initiative, but its implementation is severely flawed. Seniors are encouraged (By <span id="SPELLING_ERROR_21" class="blsp-spelling-error"><span id="SPELLING_ERROR_22" class="blsp-spelling-error"><span id="SPELLING_ERROR_19" class="blsp-spelling-error"><span id="SPELLING_ERROR_23" class="blsp-spelling-error"><span id="SPELLING_ERROR_22" class="blsp-spelling-error"><span id="SPELLING_ERROR_21" class="blsp-spelling-error"><span id="SPELLING_ERROR_21" class="blsp-spelling-error">CMS</span></span></span></span></span></span></span>) to review their plans each year. With poor design and pricing (adverse claims history) many plans adjust premiums and benefits each year and change is clearly prudent, not malicious. Over time, the free market will establish a more stable and competitive environment but that may take some time especially as providers get a <span id="SPELLING_ERROR_24" class="blsp-spelling-error"><span id="SPELLING_ERROR_23" class="blsp-spelling-corrected">handle</span></span> on claims experience and the industry grows and matures.<br /><br />The problem is not beneficiaries moving out of plans it is finding ways to keep them in plans. Reasonable compensation assures continued support from agents to clients and compels enrolling agents do everything not to lose their clients to other agents. The level commissions released last week by insurers at $400-$500 did just that. The problem with churn was not too high a commission; it was exactly the opposite; to low of a commission for agents to concern themselves with existing clients. (See attached letter to <span id="SPELLING_ERROR_20" class="blsp-spelling-error"><span id="SPELLING_ERROR_22" class="blsp-spelling-error"><span id="SPELLING_ERROR_22" class="blsp-spelling-error"><span id="SPELLING_ERROR_23" class="blsp-spelling-error"><span id="SPELLING_ERROR_20" class="blsp-spelling-error"><span id="SPELLING_ERROR_25" class="blsp-spelling-error"><span id="SPELLING_ERROR_24" class="blsp-spelling-error"><span id="SPELLING_ERROR_22" class="blsp-spelling-error"><span id="SPELLING_ERROR_22" class="blsp-spelling-error">Baucus</span></span></span></span></span></span></span></span></span>, <span id="SPELLING_ERROR_21" class="blsp-spelling-error"><span id="SPELLING_ERROR_23" class="blsp-spelling-error"><span id="SPELLING_ERROR_23" class="blsp-spelling-error"><span id="SPELLING_ERROR_24" class="blsp-spelling-error"><span id="SPELLING_ERROR_21" class="blsp-spelling-error"><span id="SPELLING_ERROR_26" class="blsp-spelling-error"><span id="SPELLING_ERROR_25" class="blsp-spelling-error"><span id="SPELLING_ERROR_23" class="blsp-spelling-error">Grassley</span>, Hatch, and Rockefeller</span></span></span></span></span></span></span> with details)<br /><br />The premise of more time spent explaining to a client in year one is also flawed. The extra time once an agent actually gets in front of a Medicare beneficiary is paltry compared to the overhead, time, and resources exhausted to get there. It is the ongoing support, service, and attention to client issues that the new compensation does not address.<br /><br />If the government feels like it is footing the bill for all these commissions they need look no further than the CEO’s of the insurance companies. $16 million last year to the CEO at <span id="SPELLING_ERROR_23" class="blsp-spelling-error"><span id="SPELLING_ERROR_25" class="blsp-spelling-error"><span id="SPELLING_ERROR_25" class="blsp-spelling-error"><span id="SPELLING_ERROR_26" class="blsp-spelling-error"><span id="SPELLING_ERROR_23" class="blsp-spelling-error"><span id="SPELLING_ERROR_27" class="blsp-spelling-error"><span id="SPELLING_ERROR_26" class="blsp-spelling-error"><span id="SPELLING_ERROR_24" class="blsp-spelling-error">Humana</span></span></span></span></span></span> -- </span></span>and they (<span id="SPELLING_ERROR_28" class="blsp-spelling-error"><span id="SPELLING_ERROR_27" class="blsp-spelling-error"><span id="SPELLING_ERROR_25" class="blsp-spelling-error">Humana</span></span></span>) want to restrict agent compensation -- Shameless.<br /><br />What CMS and regulators need to focus on is the structure, cost and supervisory, and the authorization and knowledge base of agents. Create an FMO’s and GA’s accreditation – One that could be lost with excessive complaints and abnormal enrollment patterns. This would force GA’s and FMO’s to take responsibility for everyone under them. The GA level could be a break point for an FMO and GA for agents. Force individual agent accreditation – i.e. next year an additional 8 hours of CE are required in PA to sell Long Term Care. CMS should provide or require similar education on Medicare, along with a knowledge base requirement for every county or market.</div><div align="left"><br />This could easily be implemented via the FMO and GA’s organization and in some fashion funded by every carrier authorized in a given county. This could be done for minimal additional cost to carriers. The truth is the capital necessary is likely already there. CMS has required PFFS to have networks of doctors (which is another misdirected and naive ruling) how much harder would it be to require localized Medicare and product training for all carriers. (Many carriers already provide training on their own products.) I have seen the formula work where numerous providers are consolidated over two days and agents are provided intense training. It’s rare, but it does happen. Too much training has been pushed online absolving the insurance companies of providing any real education and training. I believe this (online programs) are a good start but they are too simple and require very little commitment to get appointed with one or two companies. Not to mention the "gaming the system" that is done by exactly those we are trying to eradicate from the system</div><div align="left"><br />Additionally, a mandate for open access of all plans to all qualified agents (All plans must be available to agents) and require a <em><strong>minimum</strong></em> standard and level commission. (Note: some plans are not offered via agents and thus can not be offered and can be targets for replacement.)<br /><br />In summary <span id="SPELLING_ERROR_34" class="blsp-spelling-error"><span id="SPELLING_ERROR_35" class="blsp-spelling-error"><span id="SPELLING_ERROR_32" class="blsp-spelling-error">CMS</span></span></span> should institute:<br /><br />1) GA and <span id="SPELLING_ERROR_32" class="blsp-spelling-error"><span id="SPELLING_ERROR_34" class="blsp-spelling-error"><span id="SPELLING_ERROR_35" class="blsp-spelling-error"><span id="SPELLING_ERROR_36" class="blsp-spelling-error"><span id="SPELLING_ERROR_33" class="blsp-spelling-error">FMO</span></span></span></span></span> Supervisory accreditation's.<br />2) Enhanced Agent accreditation. 4-8 hour of in class Original Medicare training. Forget online or similar, these efforts are constantly being gamed by agents and carriers.<br />3) 4-8 hours of training pertaining to county offerings. Agents would be required to know the basics of every plan in a given county.<br />4) Agents would have to demonstrate a level of competence in assessing a clients needs and recommending a plan. This will bring additional benefits to those with Special needs and compel providers to develop plans specific to those needs.<br /><br /><span id="SPELLING_ERROR_33" class="blsp-spelling-error"><span id="SPELLING_ERROR_35" class="blsp-spelling-error"><span id="SPELLING_ERROR_36" class="blsp-spelling-error"><span id="SPELLING_ERROR_37" class="blsp-spelling-error"><span id="SPELLING_ERROR_34" class="blsp-spelling-error">FMO</span></span></span></span></span>’s could consolidate and coordinate the training from carriers and facilitate regional meetings through GA’s down to the independent agents. Carriers and <span id="SPELLING_ERROR_34" class="blsp-spelling-error"><span id="SPELLING_ERROR_36" class="blsp-spelling-error"><span id="SPELLING_ERROR_37" class="blsp-spelling-error"><span id="SPELLING_ERROR_38" class="blsp-spelling-error">FMO</span></span></span></span> would have to open and appoint a few more GA's but the reality is people would be well trained and supervised.<br /><br />In the end a well trained agent is certified after 2 days of training and an adjunct army is created to advise, consult and service seniors. Of course, we then get compensated for our efforts to support, service, and advise Medicare beneficiaries. For qualified independent agents, $400-$500 for the first 6 years and then something nominal - ongoing ($75-$100/year). For a GA $600-$700 and another $50-$100 for the <span id="SPELLING_ERROR_37" class="blsp-spelling-error"><span id="SPELLING_ERROR_38" class="blsp-spelling-error"><span id="SPELLING_ERROR_39" class="blsp-spelling-error">FMO</span></span></span> seems reasonable. These costs are already baked in -- it’s the management and lack of supervision that has created any problems that exists. This structure is essentially the foundation of most good agencies anyway it just needs to be standardized and then managed. I reiterate; in a world where service, qualification, and benefits for medicare beneficiaries are improved churn will come down and what remains will be prudent, not malicious.<br /><br />Believe me, <span id="SPELLING_ERROR_36" class="blsp-spelling-error"><span id="SPELLING_ERROR_38" class="blsp-spelling-error"><span id="SPELLING_ERROR_39" class="blsp-spelling-error"><span id="SPELLING_ERROR_40" class="blsp-spelling-error">FMO</span></span></span></span>’s and GA’s spend considerable time and effort recruiting agents and signing them up to sell, and then do little to train and educate. Agents are signed then forgotten because supervision is not required. Agents do training and certifications on their own and rouge unsupervised agents with little knowledge prey on seniors in low income and other stressed environments. These agents enroll beneficiaries in whatever they can. This is similar to the direct employed agent who enrolls beneficiaries in plans that don’t quite fit, but it was what they had to offer. Qualified independent agents who are properly screened and supervised would be able to ascertain and service these scenarios much better.<br /><br />To protect agents, clients should be required to sign a replacement form (already used in the industry) that boldly states that the client understands they are replacing their policy, and that the new policy offers benefits that exceed that of their current plan. Further, it would state that they informed the agent of any special needs that should be considered. The scope of appointment form is a joke -- it’s naive, elementary, and only a bureaucrat could have created such a form. American Progressive has a good form that requires clients’ initial in about 10 places – that would be a place to start. They also require a conformation telephone appointment to make sure the beneficiary understands everything. This requires a lot more effort on sales people and providers but I bet their enrollments and turnover are reflective of the additional requirements. I would bet my career this simple call prevents a boatload of churn and resolves a lot of the issues on it's own. If carriers were all mandated to take this extra step we could solve most of the problems without all these, clumsy, misdirected restrictions and anti capitalist regulation.<br /><br />I would further require that the Medicare beneficiary be provided the toll free number from a surrendering carrier. A new participant could call <strong>IF</strong> they have second thoughts on there decisions. Surrendering companies will gladly and expeditiously take those calls. In this requirement, some method to block dis-enrollment could easily be established.<br /><br />Further requirements might include carriers printing the name and telephone numbers of agents or agencies somewhere on an beneficiaries card each year. This would keep beneficiaries connected and in touch with the agent/agency with whom they enrolled. Should an agent lose their MA certification, that information could easily be dropped, changed or omitted. Agents could (potentially) assume beneficiaries that have been orphaned.<br /><br />The overall point is to manage and regulate via education, enhanced qualifications for agents and increase responsibility from insurance companies and FMO's. In its entirety a substantial certification will require commitment -- two days of training to be certified is minimal for committed agents. Monitored education and testing, and ongoing supervision will be an obstacle for <span id="SPELLING_ERROR_40" class="blsp-spelling-error">rogue </span>agents motivated only to manipulate exiting MA participants. Furthermore, with FMO's and GA's at risk for non-conforming agents they will quickly dismiss criminal elements. Beneficiaries with involved agents will not switch plans without consulting their agent beforehand.<br /><br />I’m sure I could elaborate further but I believe my overall position is well established…<br /><br />Commissions that are insufficient will simply create a vacuum were Medicare beneficiaries get minimal if any advice and or service. Alternatively an environment of educated and committed independent agents (that can earn a living that compensates for the time effort and capital) will foster and industry segment of dedicated senior advisers.<br /><br /><br /><br />Respectfully,<br /><br /><br />-<br /><strong><span style="color:#ff6600;">TO POST A COMMENT SIMPLY CLICK COMMENT LINK BELOW</span></strong><br /><br /><br /><br /></div><strong><span style="color:#ff6600;"></span></strong>Unknownnoreply@blogger.com7tag:blogger.com,1999:blog-377671184715806126.post-12552837486066749262008-11-01T13:36:00.000-04:002009-01-19T10:52:18.380-05:00Humana trys to Mislead Regulators and Distort Commission Reality.-<br /><strong>(This post is a response sent to the recipients of Humana's Letter. Click here to view the Humana letter <a href="http://www.bestmedicare4seniors.com/humana.pdf">http://www.bestmedicare4seniors.com/humana.pdf</a>.</strong><br /><br /><strong></strong><span style="font-size:85%;"><br /></span>Response sent November 2nd, 2008 to:<br /><br />The Honorable Max Baucus<br />Chairman, Committee on Finance<br />United States Senate<br />511 Hart Senate Office Bldg. Washington, D.C. 20510<br />(202) 224-0515 (Fax)<br /><br />The Honorable Charles Grassley<br />Ranking Member, Committee on Finance<br />United States Senate<br /><br />The Honorable John D “Jay” Rockefeller<br />United States Senate<br />531 Hart Senate Office BuildingWashington D.C. 20515<br />(202) 224-6472<br />(202) 224-7665 Fax<br /><br />The Honorable Orrin Hatch<br />United States Senate<br />104 Hart Office BuildingWashington, DC 20510<br />Tel: (202) 224-5251 Fax: (202) 224-6331<br /><br />Dear Chairman Baucus,<br /><br />I am writing to express my grave concern over the letter written to you from Humana’s Peter O’Toole, Vice President, Medicare Sales, regarding Medicare Advantage (MA) sales commissions.<br /><br />I find the positions represented in his letter to be misleading, bias, self serving, and one that could potentially place all Medicare beneficiaries at risk of poor service and the behest of arrogant insurance companies.<br /><br />Humana, in the letter penned by Patrick O’Toole (October 24th, 2008) puts forth an ideology that their direct employed sales force is better at serving Medicare beneficiaries than independent agents. The reality is that captive or direct sales forces are part of the problem. Since by definition, captive or direct employee agents represent only one company theses agents can’t offer a beneficiary choice outside the employers offering spectrum. Imagine a sales representative advising an enrollee to pick something other than what their employer provided. Not producing (read - not selling what they offer) would inevitably lead to employment termination, a precarious position to place an employee. Imagine the representative faced with better designed products and richer features offered by the competition, and then not able to present this to a Medicare beneficiary. Clearly this is not the solution for better service and better benefits for seniors.<br /><br />Regarding the commission cap suggested by Mr. O’Toole in his letter, I find this particularly appalling. They (Humana in this case but can apply to all direct sales) want to pay their own employed sales force a fair commission, provide millions of dollars in marketing, base salaries, benefits, expense accounts, overhead such as office space, telephone, office supplies and equipment, cell phone, car allowances (fuel etc.), and oh yea did I mention millions of dollars in marketing. And then they tell congress with a straight face that independent agents should be paid $338.00 per new enrollee, and less to advice, and service that client over time. THIS IS AN OUTRAGE! It cost that much just to enroll a beneficiary.<br /><br /><br />I’m insulted that Humana believes they can distort reality in an attempt to pull the wool over the eyes of regulators. Is there anyone that believes what they are suggesting represents a level playing field? Maybe Humana is frightened by competition? Maybe they will no longer be able to retain beneficiaries in an inferior product line? Having represented nearly every available carrier in my market last season – at a considerable cost in time and expense – I choose not to bother with Humana because I found, zero instances where there wasn’t something better.<br /><br />What officials should understand; capping commissions will not reduce churn. Just drive out independent agents that are not adequately funded to market and compete with the Millions of dollars spent by carriers like Humana. That lower commissions is exactly what creates churn -- High commissions first year and lower commission in subsequent years -- That under the old commission structure (approximately $400/$100 in ‘08) there was no incentive for agents to maintain and service existing clients, and a strong incentive to churn. Factoring in overhead, marketing cost, expenses (fixed and variable); the ROI for an independent agent to acquire a new client at $400/$100 is marginal at best, certainly not enough to provide a high level of service to existing beneficiaries. Good agents are forced to focus on acquiring new at the expense of servicing existing.<br /><br />With a level compensation somewhere between $400 -$500 it becomes as profitable and equally as rewarding to service, consult, and maintain existing clients as it is to add new clients – with no incentive to churn an existing client base. This will nurture an environment where agents will service, consult, and inform seniors about health benefits and Medicare related products. I can see a multitude of benefits to seniors in this environment, one where beneficiaries are treated fairly and provided competent, ongoing support.<br /><br />Under the old method it was 4 times more profitable (in most areas) to get a new client than to keep an old. Under Mr. OToole’s proposal only the insurance companies get to make millions in profits. And we all know what that means – Government money flowing into big bonuses and ZERO service for Medicare beneficiaries. On top of that, in the past the renewal commission was so minuscule that it wasn’t cost effective to allocate time, energy or financial resources to service existing clients. Agents were forced to bring in new clients and beneficiaries were left to figure out the complex and multitude of choices on their own. Anyone who has spent time trying to decipher the numerous selections in a given area knows; learning the available plans, premiums, benefits, co-pays, etc. is not simple. The result is that Medicare beneficiaries are left confused and uncertain of the best choice for their situation. In the face of uncertainty and a vacuum of good advice beneficiaries made decisions to change plans based on something that sounded good and met there needs. Certainly the industry needs stability to thrive, and churn makes forecasting difficult, but not all churn is malicious. In fact, most is certainly not.<br /><br />The new – level commission -- structure will pay agents and brokers to keep clients on the books. Provide reasonable compensation for agents to allocate resources, spend time, advise, and service existing clients. This structure will eventually reduce migration, and in time establish an industry segment of informed agents servicing seniors.<br /><br />In Rep Stark’s letter to CMS (October 2008) while Rep Stark was naive, one point that was correct; in 2009 churn will be high, but not because commissions are going up, conversely, because they are not going up – for clients currently on the books. Once commissions are level (in 2 years) the churn problem will diminish and resolve the problem it was intended to address. Unless of course commissions are obliterated then there will be no one to service seniors at all.<br /><br />What needs addressing is to direct insurance companies to pay the new renewal level commission on existing clients. This will provide the incentive for agents to KEEP existing beneficiaries IN plans. This will reduce churn immediately. However, in order to do this a reasonable commission must be paid which compensates agents/brokers and allows profitability. Clearly the remuneration from the government and profitability is there for the insurance companies (they are paying it on all 2009 new beneficiaries) so direct them to pay it on existing beneficiaries. Otherwise we will have one more year of significant churn. And after that who knows.<br /><br />My fear, next years churn will be high and Rep. Stark will believe he was correct when clearly the proper factors were not clearly identified. This will result in another year of turmoil and another abomination where CMS can't get their act together until days before the enrollment period. I can see next years mess coming already.<br /><br />Two quick final recommendation; CMS need to be professional and get their guidelines together before September 1st. Business professionals in any business need more that 2 weeks to assess profitability and finalize business plans. Two months is not much to ask, and two weeks is shameful.<br /><br />Second in an effort to improve service to Medicare beneficiaries a requirement of a certain number of CE credits for overall Medicare competence (similar to the AHIP course in place by some carriers) plus a certain level of specific market competence. This subsequent piece may be difficult given each county has different plans but it should be considered. My reasoning - I have personally been provided inaccurate information by carrier representatives that didn’t fully or competently understand the offerings of competitors. I find this to be disgraceful, that a carrier provides inaccurate information about direct competitors.<br /><br />I’ve gone on at some length and appreciate your taking the time to consider these positions.<br /><br /><br />A very concerned citizen, and career professional insurance agent,<br /><br /><br />CJB<br /><br />-Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-377671184715806126.post-70974284867156940852008-10-26T21:00:00.001-04:002009-01-19T10:52:18.380-05:00Rep. Pete Stark calls for Medicare Advantage Commissions Cap-<br />It has been widely reported that Rep. Pete Stark (D-CA), chairman of the House Ways and Means Health Subcommittee, called on the” Centers for Medicare & Medicaid Services (<span class="blsp-spelling-error" id="SPELLING_ERROR_0">CMS</span>) “to cap Medicare Advantage sales commissions "...<br /><br />A recent check the House of Representative site provides a complete copy of the letter sent to <span class="blsp-spelling-error" id="SPELLING_ERROR_1">CMS</span>... <a href="http://www.house.gov/stark/news/110th/letters/20081023-madoc.pdf">http://www.house.gov/stark/news/110th/letters/20081023-madoc.pdf</a><br /><br /><br /><em><span style="color:#ff0000;">The following letter was sent via e-mail to Rep. Stark Essentially it mimics the letter (<span class="blsp-spelling-error" id="SPELLING_ERROR_2">Humana</span> Post) sent to <span class="blsp-spelling-error" id="SPELLING_ERROR_3">Baucus</span>, <span class="blsp-spelling-error" id="SPELLING_ERROR_4">Grassley</span>, Rockefeller, and Hatch with a few personal opinions about Mr Stark and his competence.</span></em><br /><em><span style="color:#ff0000;"></span></em><br />Mr. Stark:<br /><br />What you are ignoring is that under the 300/100 commission structure (which was more like 400/100) there was no incentive for agents to maintain and service existing clients, and a strong incentive to churn. With a level compensation at $400, it will be equally rewarding to service, consult, and maintain existing clients as it is to add new clients, and no incentive to churn ones existing client base. This will create an environment where agents can, and will, service, consult, and inform seniors about health benefits and Medicare related products. I can see a multitude of benefits to seniors in this environment. Can you?<br /><br />Under the old method it was 4 times more profitable (in most areas) to get a new client than to keep an old. The renewal commission was so minuscule that it made little, if any sense to allocate time, energy or financial resources to service existing clients. The new – level commission -- structure will pay to keep clients on the books and provide incentive for agents to allocate resources, spend time, advise, and service existing clients (seniors). This structure will eventually reduce migration, and in time establish an industry segment of informed agents and well advised senior citizen. Once commissions are level (in 2 years) the churn problem will diminish and provide a network of agents that each year look to service their existing senior base. Unless of course commissions are obliterated then you will have no one to service seniors at all.<br /><br />Mr. Stark, the points you should be addressing is to provide a rational level commission which allows profitability, (about the average ($400) of this years level compensation) and obligate insurance companies to pay the new renewal level commission to existing clients -- otherwise we will have one more year of significant churn.<br /><br />My fear, next years churn will imply you were correct when clearly the proper factors were not clearly illuminated. This will result in another year of turmoil and another abomination where <span class="blsp-spelling-error" id="SPELLING_ERROR_6">CMS</span> can't get their act together until days before the annual enrollment period. I can see next years mess coming already<br /><br />If the problem is cost to the system, then cap the insurance company compensation to 5% below current Medicare costs. If insurance companies can’t provide more for less then maybe Medicare Advantage is not a reasonable solution. That I can accept. Furthermore, if insurance companies can't out service and out price the federal government then they should be ashamed of themselves.<br /><br />Like most politicians Mr. Stark you have no understanding of what happens on Main Street and the real world. Blindly attacking something without understanding it is irresponsible and negligent. You should retire because you are out of touch.<br /><br /><br />A very concerned citizen.<br /><br /><br />CJB<br /><br /><a href="http://www.mysenioradvisorsgroup.com/Medicare-Advantage-Basics.html">Medicare Advantage</a> information from independent <a href="http://www.mysenioradvisorsgroup.com/">Senior Advisors</a><br /><br />-Unknownnoreply@blogger.com0