Medicare Rules for Higher Income Beneficiaries

Changes in Medicare law affect how monthly premiums are calculated for both Medicare Part B premiums, as well as Medicare Prescription Drug (Part D) premiums. To determine if the member will pay higher premiums, Social Security will use the most recent federal tax return information (so generally, for the 2011 premium, the 2010 filing is used, using income earned in 2009.) A sliding scale will be used to make the adjustments.

Higher Part D premiums will be calculated by, and collected by, Social Security (NOT the Plan Sponsor.) The premium surcharge will be withheld from the beneficiary's Social Security payments.

Depending on income, the premium surcharge could be as high as $69.10 per month, on top of the plan premium. For more information, click here.

Here’s the link to the “click here”, if you need to use it in this form. http://www.thebrokerageinc.com/admin/document_administration/document.cfm?DocumentID=608

If you are reading this blog, you probably were influenced by the personalized websites we offer our Marketing Partners, the independent agents we serve.

To check out your site, login in to www.TheBrokerageInc.com using your first name as the user name and your last name as your password.

We will be updating your personal website during specific months to feature specific products like life insurance during "Life Insurance Awareness Month", or DI, or LTCi...and so on.

Our goal has been and will continue to be to increase your income using The Brokerage's products and services. If there is something we can do to help you in this joint venture (at our cost to you!) please do not hesitate to contact us at 800-442-4915.

New CMS Head: Another Obama Puppet?

The White House’s announcement that President Barack Obama will bypass the nomination process of the United States Senate to recess appoint Donald Berwick as head of the Centers for Medicare & Medicaid Services (CMS) is an act of unconscionable hubris.

The White House claims this move is in response to “Washington game-playing,” accusing Republicans of planning to “stall the nomination” as long as possible. That is nothing more than a boldfaced lie. Republicans cannot stall this nomination and never could--it is impossible for them to do so under Senate rules--as not one hearing has been called or scheduled.

It is the White House that is playing games with the health policy of the nation and the welfare of the American people. In bypassing the traditional process through which the Senate advises and consents to nominees, the president is preventing senators and the people they represent from obtaining any answers from Mr. Berwick, who has repeatedly made statements that raise numerous questions about his suitability for this critical position.

The public needs to know whether he still endorses his remarks attacking private-sector solutions to health care problems, in support of “rationing with our eyes open” [link: http://www.healthpolicy-news.org/article/27717/], and expressing his affection for the United Kingdom’s notoriously slow and rationing-plagued National Health Service as “romantic.” [link: http://www.healthpolicy-news.org/article/27705/]
The public would want to hear Berwick’s comments on the video footage discovered and highlighted by The Heartland Institute in May [http://www.healthpolicy-news.org/article/27630/], in which he made the statement, “Any health care funding plan that is just, equitable, civilized, and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional.”

Senators have expressed concerns about statements such as these, as well as Berwick’s background. He is a nominee with little management experience poised to head the second largest insurer on the planet, an agency with more funding to disburse than all but the top 15 economies in the world. The White House’s decision to make this recess appointment is as much a demonstration of the president’s unwillingness to engage in public debate about Berwick’s views as it is of his concern that some in his own party have privately questioned whether the nominee is outside the mainstream.

Such questions are of course appropriate. The White House’s decision, however, means they will not be answered. Understand: Berwick’s position as head of CMS will give him unprecedented power to apply his extremely unpopular views on health care policy under the president’s new health care regime. And thanks to the White House’s game-playing, he will not answer one question, not one, before he is ensconced in a position where his radical views will affect the life and health care of every American.

As we saw in the process by which Obamacare was rammed through Congress despite immense public opposition, there is nothing--not precedent, not tradition, not even the most basic notions of fairness or responsible governance--that will stop Obama and his allies in their quest to remake American social policy in their image.

Contributed by The Heartland Organization, Benjamen Domenech

“New Twist on an Old Product”

Selling Medicare Supplements has been the same old game for the past two decades. Not anymore, thanks to Plans M and N. Since the early 90’s when Medicare Supplements (also known as “Medi-Gap plans) became Standardized Plans A-J under the TEFRA legislation, the same exact plans have been available.

In 2003 Congress passed the Medicare Modernization Act. Under the MMA, several new Medicare benefits were introduced, the most notable being Part D, the prescription drug benefit plans. Americans were also introduced to new Medi-Gap Plans K and L. Another phase of the MMA begins June 1, 2010 when certain “standardized” plans are dropped (E, H, I and J) and two “modernized” plans roll out (Plans M and N).

Get the new terms memorized. “Standardized plans” refer to Plans A-J. “Modernized” plans refer to the new Medicare Supplement plan grid. Plan F has been the most popular plan, but the new Plan N could become the new “Medi-Gap Darling”. For the first time, Medicare Beneficiaries will have an office copay option with Plan N. The office copay could be up to $20, and the Emergency Room copay could be up to $50. The initial Plan N premiums appear to be as much as 30% less than the most popular Medi-Gap plan, Plan F.

While a respectable premium savings is attractive, note that Plan N does not cover the Part B deductible ($155 in 2010). This is easy to look past considering you will save far more than $155 in premium. However, the “excess charge” of 15% a Provider may add to the current Medicare reimbursement level is not covered (Plan F covers “excess charges”.) Assuming a person sees the doctor once a month, and the average office charges over a one year period are $2400, the “excess charges” will equal $360. If the doctor collects a $20 office copay, add another $240.

If the Medicare Beneficiary incurs a $100,000 Part B claim (say, for six weeks of chemotherapy and radiation for prostate cancer) and the outpatient facility adds 15% to the bill, losing the “excess charges” benefit begins to impact one’s financial statement with a new $15,000 out of pocket expense. Weigh the risk of premium savings vs. the new “excess charge” exposures carefully when comparing Medicare Supplement policies.

Plans H, I and J are eliminated May 31, 2010. These three plans carried the only prescription drug benefits, but due to Part D on January 1, 2006, the Plan’s Rx benefits were eliminated. Plan E is also being dropped due to benefits being mandated, making Plan E & F virtually the same.

With funding cuts coming to Part C of Medicare (The Medicare Advantage program), Medicare Advantage plans will be forced to cut benefits and raise premiums. Look for “Med Sups” to gain popularity.

Finally, the Provider community prefers patients have a Medi-Gap plan, making access to healthcare easier for the patients.

It has been a week since President Obama signed the sweeping health care bill into law. “Now what?!” That’s a question we’re all being asked multiple times per day…by our families, our staff, our clients, our friends, and anyone else who knows we are in the “insurance business.”

This might be risky, but here are a few of my predictions that I wanted to share with you. Remember, these are for you as professional agents and advisors:

•Don’t risk assuming that folks will figure it out on their own. Left to your own opinions, you could make mistakes with interpretations about impact. Don’t do that to yourself, and don’t let your clients make the same mistake….network, network, network for idea sharing.
•You can count on The Brokerage to continue to be a great “resource hub” of knowledge and input to you. We have the benefit of working with more then 1000 agents/advisors a year, so I feel comfortable saying we have a good pulse on how your fellow agents/advisors are seeking and distributing information.
•No one source of information will be the “tell all”….not the media, not any carrier, not buddies at the golf course or fellow patients in doctors’ waiting rooms.
•Expect EVERYONE to pitch it to best suit their perspective.
•Your clients will be confused and overwhelmed.
•YOU are best positioned to be a source of calm and reason.
•Smart advisors will “make hay” – crisis and confusion creates opportunity.
•Doing the business the same old way is a recipe for mediocrity, if not failure. Don’t wait for a group insurance renewal to talk to your clients.
•Employees will be even more confused than employers. Offer yourself as a resource.
•Most folks believe a compression of compensation is coming. Mandatory minimum loss ratios and tighter rules almost assure that. How will you adapt?
•Charging a fee sounds great, but is your advice worth paying for?
•Diversification of your income is probably a good strategy to pursue. In fact, hundreds of advisors have already accelerated how they work with our staff and resources to help them expand their practices.
•Don’t count on the carriers to deliver your message for you. They will do what they need to in order to keep who they believe is their client…..position yourself squarely between your client and the carrier as the reasoned voice of experience and expertise.
•Other product relationships you have with your clients (life insurance, annuities, LTC, DI, etc.) affirms their confidence in you. Assert yourself by reminding them how you have previously helped them and can help them in the future.

Call me at (800)442-4915 or if you want to talk or email me at mike@thebrokerageinc.com. We can help with access to our knowledgeable staff, top products and services. We are here to help you provide, prosper and succeed.

Good selling,
Mike Smith, President
The Brokerage, Inc.

America’s Health Insurance Plans says the extra services its members provide for Medicare beneficiaries through the Medicare Advantage program really do improve patients’ health.
President Obama and other Democrats argued during the recent health reform summit in Washington that the Medicare Advantage program – which gives private carriers a chance to offer alternatives to the basic Medicare plan, rather than Medicare supplement insurance products that simply fill in the many the gaps in Medicare coverage – costs more than the traditional Medicare plan without doing much to improve participants’ health. Medicare Advantage plans usually offer lower deductibles, extra coverage for preventive care services and care coordination in exchange for members agreeing to use in-network care providers.

The Obama administration has been pushing for a shift back toward traditional Medicare – which imposes relatively high deductible requirements on enrollees who do not pay extra for Medicare supplement insurance – while supporting requirements that plans offered to working-age patients through a proposed health insurance exchange system provide richer benefits, with fewer gaps than many individual health insurance policies now leave in coverage.

AHIP, Washington, has responded to the Democrats’ allegations about Medicare Advantage plans with a “fact check” report full of statistics suggesting that comprehensive Medicare Advantage can help participants live longer, more comfortable lives than the less comprehensive traditional Medicare plans do.

AHIP analysts originally published the statistics in October 2009. They drew on 2006 California and Nevada hospital admissions data compiled by the federal Agency for Healthcare Research and Quality.

After adjusting for factors such as age, sex, and medical condition, the analysts found that Medicare Advantage plan enrollees in California spend 30% fewer days in the hospital than patients in traditional Medicare plans do.

In Nevada, Medicare Advantage plan enrollees spend 23% fewer days in the hospital than traditional Medicare plan enrollees do, the analysts report.

Similarly, Medicare Advantage enrollees were re-admitted to the hospital in the same quarter for the same condition 15% less often than traditional Medicare enrollees in Nevada and 33% less often than traditional Medicare enrollees in California.

In both California and Nevada, Medicare Advantage enrollees were 6% less likely than traditional Medicare enrollees to be admitted to the hospital for “potentially avoidable” conditions such as dehydration, urinary tract infection or uncontrolled diabetes, the AHIP analysts report.

"A recent comprehensive study on [traditional plan fee-for-service plan] readmissions noted that in half of the re-admissions studied among FFS patients, there was no physician contacted billed to Medicare prior to re-admission," the AHIP analysts write in the October 2009 commentary. "We assume that the [Medicare Advantage] plans are able to lower re-admission rates precisely because of their emphasis on discharge planning and coordinated care follow-up."

An earlier AHIP study found that Medicare Advantage enrollees had 27% fewer emergency room visits than traditional Medicare plan enrollees did and spent 18% fewer days in the hospital, the analysts report.

AHIP also has come out with a commentary reminding policymakers about the sharp cuts in Medicare alternative plan enrollment that occurred in the late 1990s, when Congress less tried the shift the country back toward relying on traditional Medicare and Medicare supplement insurance.

Health Care Summit Leads to Reconciliation

White House Healthcare Summit Said To Set Stage For Democrats-Only Bill.

Coverage of yesterday's White House summit on healthcare reform (including the lead stories on all three networks) tends to highlight partisan sniping and broad policy disagreements. Ultimately, most analysts agree that yesterday's failure to reach a bipartisan deal sets the stage for Democrats to enact their bill through the tactic known as "reconciliation."

The AP's Ron Fournier (2/26), for example, says that "from its conception, Thursday's healthcare 'summit' was destined to be little more than a stage where Democrats and Republicans would recite their lines and further their political agendas." Thus Obama's was "to cast the Republicans as obstructionists," because he "hopes to ram his proposal past a GOP filibuster." And by "that narrow and cynical scale, the summit was a success."

Along similar lines, on the CBS Evening News (2/25, story 3, 1:00, Couric), reporter Chip Reid was asked whether Obama accomplished "what he needed to do" at the summit. Reid said, "He really did. ... What he really wanted to do was convince the American people...and, wavering Democrats in Congress, that the Republicans are the party of no," and that "he now has no choice but to move ahead with Democrats alone."