Medicare Advantage_ did you know

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					1.   Do you recognize and understand the differences among the
     following terms? Initial Coverage Enrollment Period, Special
     Election Period, Annual Enrollment Period, Open Enrollment
     and Lock-in?

2.   These terms all refer to eligibility periods for Medicare
     beneficiaries to enroll in a Medicare Advantage plan. If these
     concepts are foreign or you are not well-versed in their
     differences, the market may be passing you by while clients get
     their education and information through other sources.
: Initial Coverage Enrollment
 •Initial Coverage Enrollment Period typically comes
 about due to “aging in” (turning 65) or coming off a
 group plan. This is the first time a person may enroll in
 a Medicare Advantage Plan. Clients in their initial
 enrollment period due to “aging in” have three months
 before the month of their birthday, the month of their
 birthday, and three months after their birthday to
 enroll in a Medicare Advantage plan. Clients within
 their initial enrollment period may enroll within the
 window of their birthday and do not need to wait until
 November 15th to enroll.
       Special Election Periods
 •Special Election Periods permit entry into the
 Medicare Advantage plan for enrollment if a person is
 receiving any assistance from Medicaid, moving
 permanently outside the service area, canceling from a
 group plan involuntarily or going through HMO dis-
 enrollment Once again, the client doesn’t have to wait
 until November 15th to enroll.
             Annual Enrollment
 •Annual Enrollment Period for the 2007 plan year is
 November 15th – December 31st. Late each year, your
 client can exercise their Annual Enrollment Period to
 select a Medicare Advantage plan for the following
   Open Enrollment to Lock-in
 •Open Enrollment Period for 2008 is January 1st –
 March 31st. This period allows a client to make a
 change to their Medicare Advantage health plan.

 •Lock-in is the period of time once the Open
 Enrollment Period is over, where no further changes
 are permitted until the next Annual Enrollment
Medicare Advantage, did you
 The Medicare Modernization Act signed into law in 2003
  by President Bush signaled the most sweeping changes in
  Medicare in 40 years. Not only did the act create Medicare
  Part D, the prescription drug plan, it also ushered in
  Medicare Part C, Medicare Advantage plans. Many agents
  have sat on the sidelines while Medicare Advantage plans
  multiplied. If you are active in the market, you may have
  lost clients to Medicare Advantage plans.
 Are Medicare Advantage plans new competition for the
  traditional Medicare Supplement producer or an
  opportunity? At Senior Market Sales, we view Medicare
  Advantage as a new product, a new market and an
Consider the following differences:
 Medicare Advantage                         Medicare Supplement
 Low monthly premiums, some as low as       Monthly premiums that typically range
  $0 and others as high as $60                from $85-$150
 All rates are the same per service area    Rates are frequently attained age
  (normally county) regardless of age or      meaning rates increase as the client
  sex                                         grows older; sex distinct rates are
 Guaranteed Issue                            common
 Co-pays when receiving treatment and       Underwritten with turning 65 and MA
  maximum out-of-pocket expenses              disenrollment's as notable exceptions
  typically ranging from $2,500 to $5,000    Covers remainder of provider bill after
 Benefit structure varies by plan            Medicare pays on most popular Plan F,
 Annual plans that must be approved by
                                              with variations depending on the plan
  CMS                                        Standardized benefit plans
 Open enrollment periods and lock-in        Guaranteed renewable plans that fall
  periods restrict when sales can be made     under state insurance department
 Can have networks such as HMO and
  PPO plans or no networks such as           Sales can be made throughout the year
  Private Fee-for-Service plans              Typically can go to any doctor or
                                              hospital; select plans provide lower rates
                                              for hospitals under contract
     The senior population
 With the senior population expected to grow from
    42.4 million in 2005 to 61.3 million in 2020 , sales of
    both Medicare Supplement and Medicare
    Advantage plans will grow. Clients have more
    options available today than ever before.†

   †CMS DATA/Trustees Report
Medicare Advantage. . . Something for nothing can't be a good deal. . . or is it?
                                                                       To the extent that co-pays and consumer
         You may have wondered how a Medicare                          education help control utilization, it is
          Advantage insurer can charge $30 - $70.00                     conceivable that a carrier can offer better benefits
          premium for a plan and make money. Intuitively,               than Original Medicare at little or $0 monthly
          something for nothing creates doubt in the mind               premium and turn a profit.
          of an agent and consumer.
                                                                       The carrier must offer a benefit program that is as
         Here’s how it works. Medicare Advantage plans                 good as or better than Original Medicare.
          are health options that are part of the Medicare              Prescription drug programs, preventative care and
          program. By joining one of these plans, a person              other discounts programs are commonly offered
          receives all Medicare-covered health care through             to make Medicare Advantage plans more
          an insurance carrier. Insurers are reimbursed                 attractive. In addition, caps on maximum out-of-
          generally in a range of nearly $10,000 per enrollee           pocket costs to seniors can make the plans more
          based on a complicated formula based upon a                   appealing.
          member’s gender, geographic location, the cost of
          care the person is likely to receive, etc. By 2008,
          Medicare will adjust payment to carriers based on            Propelling the growth of Medicare Advantage
          an enrollees’ risk profile.†                                  plans are Private Fee-for-Service plans. These
                                                                        plans are increasing in availability in rural areas
                                                                        and allow the client to go to any provider as long
         Any premium the carrier charges the customer,                 as the provider accepts Medicare Assignment and
          even if it is $0, is in addition to the income it             accepts the payment plan terms.
          received from the federal government. Remember,
          it is against federal law to describe the plan as
          “free” or “no cost”. It is acceptable to describe it as
          a zero dollar premium plan.
    Medicare Advantage. . . Something for nothing can't be a good deal. . . or is it?

 Truly, there is no “free lunch” although many plans are marketed using
    seminars at a local restaurant. The reality is that Medicare Advantage
    plans receive a significant portion of their funding not in the form of
    monthly premiums but in federal government reimbursements. The
    level of reimbursement to the Medicare Advantage plan is determined
   RLSLHS LLC.. believes that having a solid Medicare Advantage plan in
    an agent’s portfolio is just good business. The privatization of Medicare
    has roughly doubled the available market for health products to
   These plans aren’t for everybody but combined with a solid Medicare
    Supplement portfolio, agents have more products that meet the needs
    of more seniors than ever before.
   The market has changed and opportunity awaits the agent who
    understands the changes in Medicare and masters Medicare Parts C
    and D.
   At RLSLHS LLC.we are experts in Medicare Solutions. We can help you
    make more money, save time and place your business in a position of
In November, when the annual enrollment for Medicare
Advantage plans begins, 98% of the U.S. counties will have a
Medicare Advantage plan available
Consider the following:
 Low premium and $0 premium plans are attractive to seniors. Limits on maximum out-
  of-pocket expenses are common and range from $1,000 to $5,000.

 Co-pays are generally affordable for hospital stays and primary care physicians. Plans
  range from $150 per hospital stay to $265 per day for the first few days in a hospital.
  Primary Care Physician co-pays range from $5 to $15 for most plans.

 Value-added benefits are provided such as physical fitness programs and additional
  benefits for vision, dental and hearing are offered by some plans.

 Private Fee-For-Service plans are growing rapidly, allowing seniors access to any doctor or
  hospital in rural areas.†

 Plans are guarantee issue with only End Stage Renal Disease questions permitted.

 Commission rates have increased making the market more attractive to an agent. Agents
  can earn from $250 to $330 per issued case, depending on the carrier.
•So, is Medicare Supplement dead? Absolutely not. Medicare Advantage
plans must be equal to or better than Original Medicare. They are unlike
Medicare Supplement plans that pay after Original Medicare pays in
exchange for a monthly premium.

•RLSLHS LLC. believes that the growth of Medicare Advantage plans
allows agents to serve seniors not previously likely candidates for Medicare
Supplement. Combined with the demographic shift to a growing senior
market from 41.1 to over 60 million seniors by 2020, the health insurance
market place is bigger than ever before.

•The agent that is trained and equipped with a full line of Medicare
Solutions products to include Prescription Drug, Medicare Supplement
and Medicare Advantage is in a position to make more sales than ever
Group Medicare Advantage can save employers 30-40%
on their retiree health costs       .
 Did you know? Over 10 million seniors have retiree health coverage
  from their former employer or union? That’s roughly 25% of all
  Medicare-eligible seniors!
 Ford Motor Company, Chrysler and other large companies are either
  dropping health coverage for retirees altogether and providing a
  monthly stipend or switching from a self-insured group plan to a fully
  insured group Medicare Advantage plan. Further, regulations for
  accounting standards, Financial Accounting Standards Board (FASB) or
  Governmental Accounting Standards Board (GASB) require accounting
  and disclosure of post-retirement liability for commercial businesses
  and municipalities. This accounting requirement hurts the balance
  sheet and encourages employers to seek more affordable options, like
  group Medicare Advantage
 Okay, you don’t know the top brass at Ford or Chrysler or any of the Fortune
  500 companies for that matter. So what other groups might consider changes in
  retiree health coverage? Try municipalities, unions and larger employers in
  your community. You can also find out who advises them on their health plan
  and work with that consultant who is usually paid on a fee basis. Since
  consultants have not had to be experts in Medicare, here’s your chance to make
  a splash in the group market or partner with a consultant who hasn’t a clue how
  Original Medicare works. You should be confident because when large
  employers have dropped their retiree health plans, Medicare Advantage was the
  retirees’ plan of choice.

 Group Medicare Advantage carriers are targeting groups as small as two
  retirees. Most plans are seeking retiree lives (including spouses) of 100 or more.
  A group census, that includes each retiree and spouse, is needed to obtain a
  group quote. Standard shelf plans are generally used for retiree lives below 500
  and custom plans are developed for groups above 500 lives. Plans can be with
  or without prescription drug coverage.
Here is how a group Medicare Advantage plan works
 : The employer, not CMS, determines the enrollment period. There are no
    AEPs, OEPs and SEPs to worry about like with individual plans.
   There are no service areas either. Coverage is available in all 50 states.
   Enrollment is usually done by the carrier through the mail to each retiree.
   A key selling feature is the Maximum-out-of-Pocket and low co-pays when
    seeking treatment.
   Plans can be sold with or without employer contribution. Most plans sold have
    some level of employer contribution to the premium.
   Recent groups that we sold to have realized substantial savings of 30-40%. One
    group reported cutting their retiree health cost by 50%!
   First year commissions are lower than individual plans and average from $100 to
    $150 per member per year for larger groups. Some carriers offer higher
    commissions on small cases.
   Certification is required for the individual product and some carriers have a
    simple certification on the group product too.
   Need a quote? No problem. You can get a quote prior to being contracted.
                   RLSLHS LLC
 , Penn Life – Senior Solutions offers product and
  marketing support for our agents in the individual and
  Group Medicare Advantage market.

 Give us a call toll-free at 1-866-485-5548

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