From Washington DC – Potential Changes For Us

Updates from this week that we spent in Washington, DC and what to expect in Medicare for this AEP and beyond.. NAHU is working on several legislative initiatives. If you’re not a member, consider joining www.nahu.org Some things they are working on include: Scope of Appointment Relief OEP for Part D Ability to continue to contribute to HSA See: https://bera.house.gov/media-center/press-releases/reps-bera-smith-introduce-bill-to-expand-health-savings-accounts-to Remove Excess Charges Altogether (this project is in its infancy) Delay the HIT https://www.ahip.org/house-vote-to-repeal-burdensome-health-care-tax-is-a-win-for-americans/ COBRA to be considered creditable coverage for joining Part B late. Updates: Medicare.gov will no longer (after September 1) have the ability to create a unique drug plan ID number. The new system will be part of the new Medicare Blue Button. See: https://www.medicare.gov/manage-your-health/medicares-blue-button-blue-button-20 A reminder that our system (for contracted agents) still looks up drugs for the client using the same database they have, yet keeps it all for you. It can also import all of their drugs from the pharmacy databases. See: https://medicareagenttraining.com/training_modules/medicare-advantage/ Analysis: Silverscript will not be good for this coming AEP, in our opinion. Seniors online continue to grow, fast: https://www.pewresearch.org/fact-tank/2018/07/17/use-of-mobile-devices-for-news-continues-to-grow-outpacing-desktops-and-laptops/ New Carrier Coming: Capitol Life (we will have it at www.SellMedicareByPhone.com ) Unique underwriting procedure (Red Light, Yellow Light, Green Light) Administered by Aetna home office B++ Rating Started business in 1905, headquarters in Dallas, TX, owned by Liberty Bankers Transcript: Hey, it's Chris Westfall. I'm in town, in Washington D.C., meeting with some people here about what's going on with Medicare and some changes coming up for the Medicare season of 2020, and I want to share with you what some of our members of NAHU are working on here in Washington, D.C. for us. It's a quite incredible, if you're not a member of NAHU I'm going to have a link here where you can join it. What is NAHU? It's the National Association of Health Underwriters. It's really an organization that lobbies Congress to get things changed for us, and if I can ... There it is, I found my notes. Here are some things that NAHU is trying to get done, whether it'll get done for this AEP or not remains to be seen. Some of these things can be done by simply changing the rules within CMS, and some of these things have to have an actual act of Congress, a whole bill passed, and we know how easy that is to get something done in the House and the Senate. There are a couple of things that they do agree on, and we'll talk about that, but some of the other things we're trying to get done through regulatory changes, and again, that's right at CMS. First, is Scope of Appointment relief. What would it be like if we could attack the world of Medicare Advantage where we did not have to get a Scope of Appointment, therefore stopping the entire conversation and sales process to say, "Wait, let's put the brakes on. Let me get your permission slip signed, so that I can have an actual adult conversation with you." Hopefully that's going to be eliminated, and this administration has done more than any other in striking down regulation that's unnecessary. Hopefully that's going to be happening soon. We'll keep you informed. The other one is the Open Enrollment Period for Part D, so you can change your Part D plan in the first quarter of the new year. If you find out that you didn't like it, you can just leave that and go to another one. That'd be awesome. Also, the ability to continue to contribute to an HSA. So many employer groups right now have a healthcare spending account where you can put money into a savings program and you can use that money, it's a pre-tax, tax-free money you can put aside. You don't have to pay taxes on it. Use that for copays. Use that for the hospital admission. Use that for the high-deductible plans that everyone in the individual space, and employer space, are so used to right now. The problem is six months before you go on Medicare, you have to stop contributing to the HSA or you could suffer penalties right now with the IRS. The goal is to have the HSA continue, especially as they've eliminated Plan F for new members to Medicare, so the goal is to have everyone have this deductible, at least the Part B deductible, right? It only makes sense to help those people out, especially even on the Medicare Advantage side. You go into the hospital, you could be facing $200 to $500 per day on the admission to the hospital. Why not allow seniors to save that money pre-tax and then use that money as they go into the senior world to pay for those high deductible costs, and even copays, even premiums for Medicare Supplement, which right now you cannot use your HSA money for Medicare Supplement premium. You have to stop contributing to it six months before you start Medicare and you can't use that for your premium. What if we changed all that to make it more beneficial and put seniors in the driver's seat there with their money? Here's an interesting proposal. They're fighting to remove the ability for providers to charge excess charges altogether. What do I mean by that? In eight states right now, they're the Medicare Overcharge Measure States, we call them the MOM States, and in those states the state legislatures have made it illegal to charge excess charges. Well, we talked about, we'll talk about here further, Plan N and how it's going to skyrocket in sales. It already has in my office in the last 18 months, as I talked about in Nashville in 2018, but if we remove the whole conversation of excess charges, and right now they only represent 3% of when people go to the doctor, but what if we just eliminate them on a national basis? And this it's thought we'll take an act of Congress to do that, but we could also start on the state level at the state, like the South Carolina Association of Health Underwriters, start them lobbying our State Houses and Senate to get them to eliminate excess charges like they have in the other states like Pennsylvania and all these states where excess charges are completely illegal. That's the goal, is to do it on the national level, but at the state level we could do that at any time. And then, the last one is a further delay in the health insurance tax that was part of the Affordable Care Act. Every year they've been kicking that down the road, that can down the road, so that we don't have to pay a tax on what they consider to be Cadillac insurance. Well guess what? That would affect Medicare Advantage premiums. If it actually comes in at the end of 2019, and by the time you watch this video, hopefully that's not already been addressed so this is not news, but the goal is right now they're really fighting hard to delay or eliminate that health insurance tax because it could be over $300 annual impact on a Medicare Advantage premium that the company can benefit from, and $17 on a Part D plan. We have sirens in the background, I hope we're not having a massive thing happening here in Washington DC. Some other things that are happening, a lot of agents are freaking out about what I talked about last week and that is that CMS is going to eliminate the current version of the Plan Finder tool. In times past, agents have gone to the Plan Finder tool on Medicare.gov, type in the drugs of the senior, then they get an identification number and the date that that was run. You can always go back and put in that ID number and the date and pull it up again. We've saved it in our CRM for years. That number and that date we can pull up that list of drugs again. Well, Medicare has gone to a different vendor. The different vendor is making them Medicare Blue Button, where all of your claims data for the last three or four years can be pulled up and you can take your medical records with you. It's kind of a neat thing, but that vendor does not integrate with the old system. The theory is right now, what HHS has put out, is that for the month of September, 2019, they'll have both systems in place, the old and the new, but after that the person has to create a username, a username and password with Medicare. Now here's the rub. Industry insiders say that you cannot go and create a username and password for somebody that's already been on Medicare for the MyMedicare or MedicareBlue. Why? Because that is going to give you access to all of their claims information. All Medicare claims that have been paid for them, and so that's a HIPAA violation if you don't have the proper disclosures in place. Now, what is the proper disclosure? That's not been determined yet. If you're going to make up your own HIPAA disclosure to cover yourself, you're treading in, you know, new territory and it could be quite scary if you're just going to go create a username and password and tell a Mama Sue, "Hey, this is the your username and password if you ever want to go back in there, but I took the liberty of creating one for you, and now I can always access your claims and everything." That's kind of scary. What we have, and we've been using a system where we can already run their quotes for drugs and it saves it in there. We can send the Scope of Appointment with the push of a button. It goes to their email, they click, it comes back, the system retains their drug list year-over-year. The system retains the Scope of Appointment, and with the push of a button we can sign them up with that drug plan. It actually pre-fills everything out, sends that to them for a verification, and they complete the enrollment. Very interesting system because they're both tied into the same database, so you're going to get essentially the same results as you would if you use Medicare.gov's Plan Finder, except you don't have to go to Medicare.gov and create anything there. This is all in your back office system. Also with the system that we've been using called RxImport, you can import all the drugs from a person. If you find out that a person says, "Oh my gosh, I take 20 or 30 different drugs," well, you can sit there and type them all in or you can literally import them from the pharmacy database of all the drugs that they've been taking, and it's very, very accurate. All you need to do at that point is then confirm what they've been taking as opposed to typing it all in or going to an old drug list. It's a very easy program, and all of my agents that are contracted with me get that program for free. For everyone else, I think it's $3 or $5 per lookup, but that's a really neat tool that we have access to, and there's more on that under the Medicare advantage tab on medicareagenttraining.com and you can watch the full video on how that process works. Medicare.gov, the Plan Finder tool, as it's current version right now, the current information, and this is subject to change, is that you can no longer after September of 2019 just go in there and get an ID number and then plug that in and pull up their rates anymore, or their existing drugs. A lot of changes happening with the companies, Aetna, CVS, WellCare, all of it has changed so rapidly. Aetna and SilverScript are integrating with each other and it's not been going very smoothly from what I hear behind the scenes. It does not look like SilverScript is going to be a real good player for this Medicare season, and that's kind of disappointing cause two years ago we love SilverScript. Their application enrollment process was so easy, people loved it, but now with the integration it's really not going that smoothly at all. If you'll recall at covered this from Tucson last year, Aetna, Part D, which we read a lot of last year, they have had to divest themselves of the Part D program before they joined with CVS, and in doing so, they sold that entire block to WellCare. WellCare, between you and me, has had a notorious reputation for horrible customer service in the past. They say that they're addressing that now, and they're having to literally bring on millions of customers that were Aetna customers and bringing them into WellCare. The problem is which plan are they going to go into on WellCare? That remains to be seen. See, Well Care is going to have six different plans for next year, so if these people do nothing, they're going to be reacclimated into a WellCare program that's just going to be one of the six. Which one is it going to be? We don't really know that yet. If you had business under Aetna Part D, you have to get contracted with WellCare and you can reach out to our people if you've had that with us, and switching over to us with WellCare is an easy process, that's what we're told, but they're literally bringing on tens of thousands of agents that used to do Part D with Aetna, some of which had sworn that they'd never do business with WellCare again in their lives, now they're having to just to maintain those people that they had written Aetna Part D with last year. That's interesting. If you're not going to do part D, you can skip all this stuff. The Pew Research Foundation, I've cited this many times, has said that seniors in the last five years have quadrupled the use of mobile digital devices, that's cell phones and everything. It used to be about 60% of seniors were online, now we're pushing 80% of the people that we're talking to, and it's just incredible. Let's see. We're talking about API functionality. We're gonna use this, our behind-the-scenes stuff. Our lead management system that sends a Scope of Appointment, that does the application by email system, is going to be, again, so critical this year because of the fact that we can use the Part D drug plan information without having to go to Medicare.gov. That's going to be neat. The AEP outlook looks like this. These companies are trying more and more to integrate extra benefits under their Medicare Advantage plans, driving people to appointments and all that kind of thing. There's even one that's filed to have air conditioning installed in people's homes who have COPD, so some really nice things that they're going to try to beef up that Medicare Advantage enrollment, and it's going to be interesting as those things get flushed out. This is the first year of testing all those different things. Next year, it's gonna be even more interesting. The sad part about Medicare supplements right now is that the inflationary trend is showing 13% higher losses on Medicare Supplement in the last 12 months than before, so we are starting to see some double digit rate increases. I spoke with Randy Mousel, Vice President of Brokerage Distribution for Medicare specifically about, I wanted to talk about this 15% rate increase that we had in Plan G in Texas recently announced, and his family's involved in that too, I mean, they're feeling the brunt of it, but he says it directly resulting from the claims. I mean, you can't have that kind of a of a rate increase anyway if it's not justified based on claims as they're just seeing Part B claims through the roof in Texas right now. Sometimes we have an ebb and flow of that. For a few years it was 2% and 3%, especially on Plan G, but now as my research has shown with the rate increases that we've been seeing over the last 18 months, because of MACRA's implementation happening January 1, 2020, these companies are pre-positioning themselves to have a drastic rate increase on Plan G business for new business after January 1, so we're already seeing those rate increases starting right now because Plan G will have to accept guarantee issue people after January 1. We're seeing Plan F through the roof, as always. We're seeing Plan G about halfway there and trending up. We're doing a heavy focus on plan N. All the Plan N rate increases we've been seeing across the carrier or across the country have been very, very low rate increases and the term here was Plan N enrollment are going to explode. If you're not there yet because you think it's too complicated to explain Plan N, you might be losing that business to somebody like my outfit because we're going all-in on Plan N, and I think you really should too if you don't want to have people freaking out about their rate increases. Now there's a new Medicare supplement coming to the marketplace, and normally we like to investigate them just to the point that we've conducted our due diligence so that we can address it in a competitive situation. But me personally, when choosing plans to represent, I don't like to represent a plan that's zero-day in the market, that's brand new, limited or horrible AM Best ratings, no experience with a parent company, maybe that's in the direct to consumer space. Also, we look at their reinsure, and most importantly to me, who's gonna administer that plan, which e-App platform, who's doing the customer service? And with so many of these brand new, fly-by-night I call them, they just started in the Medicare space with no experience, outsourced to the TPA that we don't enjoy doing business with in Florida and the rest, we just put them on the shelf. We have the information so we can address that conversation if it comes up with someone, but we don't sell for that company. Now, there's one that we're looking at right now called Capitol Life. It's about to launch in the Medicare space. They're about to blow up your phones with every IMO out there telling you about them. The reason I think it's interesting is we have more due diligence to do on that. It just came out, but they're backed by Liberty Bankers Life and they've been in the Medicare space for a little while now, but they've been outsourcing most of their stuff to the other TPA. This one, however, is unique. It's going to be administered by Aetna at the home office. So Aetna is going to be behind-the-scenes doing the ID cards, doing the customer service, and doing their e-App, which we enjoy, and making sure that things go right with the new launch of Capitol Life. The interesting thing is, though, if you have an existing contract with Liberty Banker's Life, that may preclude you from getting a contract with Capitol Life unless you go through the organization that you had Liberty Bankers with. There are some ways that we're looking at that may be around that and we can look up the name to make sure, but as we continue to do the research on this company and whether it's going to be, you know, something that we want to get behind and push, we're definitely going to let you know that, and I think that's something to watch. Since we're in Washington DC, a couple of more updates I want to let you know. Both the Republicans and the Democrats are centered around one item that they can agree on, and that is reducing the price of prescription drugs to the seniors. Alex Azar, the HHS secretary is proposing, using within his regulatory discretion, allowing the importation of drugs, not narcotics, but typical maintenance drugs, like Lipitor and the rest, from countries like Canada, and a lot of the drug manufacturers will say, "You don't have a contract with a pharmacy benefit manager for that drug and I can't do that. That would violate my contract." What he's talking about doing is something creative in making that drug the same drug but slightly different in the naming of it so they can be brought in with a different name, and maybe, maybe, bypass that contractual obligation that they've got to go through the pharmacy benefit manager, like CVS or Express Scripts or whatever, so that the cost can be lower and that can be passed on the seniors. It's something that the Trump administration is looking at doing to, again, reduce regulation and bring costs down to seniors. It remains to be seen if that'll actually happen or not, but that's kind of interesting. That's what they're talking about up here. Another one is H.R. 1788, that's a House resolution trying to get into a bill. Nay, who's really pushing this hard, that would allow COBRA to be considered creditable coverage. A lot of people don't understand that if they're on an employer plan and they select COBRA, from the time that their COBRA starts going forward, they're out of compliance with Medicare. That's not considered creditable coverage right now. It seems crazy because their benefits in all reality have not changed whatsoever. It's the same benefits that they had when they were only employer plan. What's different is it's not considered credible anymore because when the employer gets that form to fill out, when there are new to Part B, their credible coverage stops the minute that COBRA started, so that's got to change because that's hurting seniors and the bill would hopefully retroactively eliminate any lifetime penalties on Part B for late enrollment for those people who did have coverage coverage under COBRA. Hopefully that's going to be actually done. MACRA is known as the permanent doc fix. It happens January 1, 2020, and it's going to be a whole slew of changes. One of the theories is, this is kind of interesting, one of the theories is that after January, and all the companies are right now struggling to get their footing, they don't know exactly how MACRA is going to impact their numbers, and just one of the theories that they're floating up here is this: Plan F, after January 1, Plan F can only be sold through an underwritten model, and that is all the 60 million people that are currently on Medicare right now, they still can buy Plan F and Plan C. Plan C is the version of Plan F that has no excess charge coverage, but it's slightly lower. Not all companies even offer Plan C, but here's the theory. After January 1, when Plan F can no longer accept any new guarantee issue people, then it's going to have a healthier risk pool for the new paper, for the new people that are on Plan F after January 1, so the theory is if they close off their old book of Plan F, which is going to be the one that we call "dying on the vine" when no people can come into it and it's already accepted all the people under guarantee issue that it's going to. Then the new version of Plan F, if it's under new paper, will have just underwritten people, and it could potentially be lower rates than Plan G. Why? Because Plan G has the tiny deductible for Part B, so Plan G has to accept the people with guarantee issue as well, and so that is going to have such an amazing impact, amazing in a bad way, on Plan G rates going forward, that Plan F might actually be attractive. It can even level off, and we're talking about the new version of Plan F, next year's version. It could actually level off in potentially, their thinking, could have a trend down because the trend line for Plan F so long has been predicated on the fact that it has guarantee issue. Now it's only going to be predicated on the fact that the people are getting older, but when they buy it they have to have come in using underwriting. One of the worst things that the company has, an insurance carrier, is guarantee issue business. They absolutely hate it. This is the interesting thing. The second worst thing that they can have is Open Enrollment people. Turning 65 with no screening whatsoever for who can and who cannot get it. You know, believe it or not, a lot of people coming into Medicare were disabled, or already have chronic illnesses, or already have high claims experience in the healthcare world, and when they're 65 the insurance company cannot do one thing about it. They have to take them all, just like guarantee issue. Guarantee issue and open enrollment are two different terminologies that are used interchangeably in our world but they are different. But to the actuaries, the actuaries see that this the same thing. They had no choice in taking that person. The cleanest, the best person they could possibly have, and why they try to incentivize with their bonuses so many times, underwritten businesses, because the underwritten business is the only thing that's going to control future claims. To the extent that somebody went through some kind of a screening process, that's going to keep playing low. Again, the theory is we'll see this bear out over the next three years, whether the new paper, the new Plan Fs that come out after January 1, 2020, are going to have either a flattening or a lowering of the trend line of claims because of the people going in there are all fully underwritten. That's going to be interesting. I think I've covered here, the Bera Bill, is going to address the HSA situation that's proposed right now, has not made it through committee. Trying to remove the lifetime ban on, or lifetime penalty on Part B for the people who had COBRA. The F, new block, yeah, G is expected to have very high rate increases. Experts say that Plan N sales to go up sharply. I covered that. We covered the drug importing into our program that we're using. I'm just making sure I covered, let's see, everything. Oh, the new Medicare.gov Plan Finder tool is expected to also show Medicare Supplement rates. Are they going to be up to date on that? We don't really know. They've not done a very good job on the federal side of doing that. If you've not had the What's Covered app downloaded to your smartphone, you should probably do that. Why? Because seniors say, ""Hey, is this covered or is that covered?" You can type it into your smartphone on the What's Covered app and you can literally find out if Medicare, original Medicare, not the Medicare Advantage Company and to what extent they would, but original Medicare would cover that procedure. It's a very clunky app right now, but it's getting better. Let's see. I think that is pretty much it. If there's other updates, I'll bring it to you. Oh, one more thing. As we're getting into AEP, this is just a personal opinion. This is not the opinion of any other FMO marketing organization, agency, or government entity. Just to let you know, this is the opinion of Chris Westfall. They have these AEP retail programs every year where you can go sit in a pharmacy, you can go sit in a store like a Walmart and you can have a a desk there with a banner behind you that says, "Ask me questions about whatever Medicare advantage plan." They have to approach you. I've never been a fan of that because it's, to me it's like working on a car lot, a used car lot, a new car lot, and you have no control whatsoever over the marketing that's bringing these people in. Similarly, we literally have about seven weeks that we can take advantage of the huge harvest that is the Annual Election Period, and for anyone to give up that finite period of time to the exclusive location of sitting your butt in a chair, Their minimums are you have to sit there three days per week, minimum 20 hours per week. You can trade off with other agents. But here's the theory, the theory is you're wasting your time that you could be elsewhere doing other things. I mean, you can be door knocking for Medicare Supplement rates. You could be working direct mail because the response rate on direct mail, telemarketing, Facebook, everything on Medicare goes through the roof during that period. But you're going to sit in a retail location, and I'm just, I don't do that. I don't recommend any of my agents do that and never have, Here's the actual numbers. In 2018 on this program, agents reported 10 Medicare Advantage sales each, 10, during the entire Medicare season. So if you want to limit your enrollments during an entire Medicare season to just 10, only 10, then go do that AEP retail program, but I really don't recommend any agent do that. You should get your footing on marketing. I think you should get your marketing program down before it starts AEP. But, and at any event, don't go sit in the store. Let somebody else that has no game do that. From Washington, we've had a great time here. We've gone to the Smithsonian Museum, we did the tour of the monuments. We saw them at night. We spoke with a lot of people that are on the inside of Medicare, what's happening. We visit the Capitol tomorrow. Nicole, look at that white squirrel behind you, how weird that looks. Oh, wow. . Get a picture of it. It's been an interesting time. Met some new friends and got reacquainted with some old ones. It's gonna be a really good time in Medicare going forward, and I would just reiterate that if you've not started picking up Medicare Advantage by, at least by next year, you have to have your system down pat so that you can do that. We have a way with Medicare Advantage that you can do the entire presentation in a compliant way over the phone. You can do the application process over the phone in a fully compliant way, and now with our system, that has always been able to, but we can look up the drugs, make that recommendation based on their drugs, and on a Medicare Advantage based on their drugs and their doctor, and then see everything side-by-side, make that recommendation in the easy enrollment. There's never been a better time to start adding that to your repertoire as it were. But the old days of sending somebody to call Medicare, you have to be aware of the fact that when they do that, when you do that, somebody's gonna reach out to that person and say, "Why don't you just come onto the Medicare Advantage program? You know, you're with my Humana, Cigna, Aetna, whatever Part D plan. Why don't you just go ahead and get the whole thing and you can do it at zero premium?" You have to be aware that that happens all the time. To the extent that you're ever recommending, or that is recommended to your client, that they get one of these Part D stand-alone plans. That's also with the company that has a Medicare Advantage component to it, they are going to try to make that up so they're going to try to take that person from you, so you need to educate your client that that's going to happen. It happens every year. We try to focus on some companies that don't have a Medicare Advantage component because we know that that's not going to be pushed at them, companies like Envision, for instance and SilverScript in the past has been good for that, but now they're owned by Aetna, so it's an interesting marketplace. Things are always changing and it's important that you stay up to speed on what's happening with Medicare. Make sure to stay tuned as things develop and as things change, I certainly will bring it to you as these laws that are proposed now, regulatory changes are implemented. You will be, trust me, you'll be the first to know it. Thanks for watching the video and as things develop, stay tuned. Thanks from Washington, Chris Westfall, signing off. Bye-bye.

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