Medicare Supplement Insurance 101. Agent Webinar January 2013

Transcription

1 Medicare Supplement Insurance 101 Agent Webinar January 2013

2 Plans Overview Sold by private insurance companies to help fill the gaps in Original Medicare Medicare generally pays approximately 80% leaving 20% up to the member Nationally standardized plans Model laws developed nationally and regulated by the State Governments NAIC State Departments of Insurance (DOI) Guaranteed renewable Not subject to election periods Pricing varies by state Non-network based 2

3 Plans Overview Standardized plans Standardized plan menu: A, B, C, D, F, High Deductible F, G, K, L, M, and N Humana offers Plans A, B, C, F, High Deductible F, K, L and N in most states Humana Healthy Living Plan offering consists of Plans A, F, High Deductible F, K, and N In most states this offering includes Dental and Vision Innovative Benefits Waiver States: MA, MN, WI Non-standard plans containing the same basic benefits MN and WI offer base plan with optional riders MA offers a Core plan and Supplement 1 No networks Coverage nationwide International coverage available with certain plans Medicare SELECT Humana Plan F Select offered in LA Hospital network only, Part A deductible waived if Participating Hospital is used Value Added Services HAO, Hearing Discount, Rx Discount, Vision Discount, Silver Sneakers (Gym Membership), WellDine, QuitNet, Humana First (24-hour nurse line) 3

4 Filling the Gaps How to read the chart: Medigap Plans If a check mark appears in a column of this cart, the Medigap policy covers 100% of the described benefit. If a row lists a percentage, the policy covers that percentage of the described benefit. If a row is blank, the policy doesn't cover that benefit. Note: The Medigap policy covers coinsurance only after you have paid the deductible (unless the Medigap policy also covers the deductible). Medigap Plans Medigap Benefits A B C D F* G K L M N Medicare Part A Coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up Medicare Part B Coinsurance or Copayment 50% 75% *** Blood (First 3 Pints) 50% 75% Part A Hospice Care Coinsurance or Copayment 50% 75% Skilled Nursing Facility Care Coinsurance 50% 75% Medicare Part A Deductible 50% 75% 50% Medicare Part B Deductible Medicare Part B Excess Charges Foreign Travel Emergency (up to Plan Limits) Out-of-Pocket * Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Limit** Medicare-covered costs up to the deductible amount of $2,110 in 2013 before your Medigap plan $4,800 $2,400 pays anything - deductible indexed annually. Source: Choosing a Medigap Policy, CMS, 2012 ** After you met your out-of-pocket yearly limit and your yearly Part B deductible ($147 in 2013), the Medigap plan pays 100% of covered services for the rest of the calendar year. Maximum Out of Pocket Limits indexed annually. *** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in an inpatient admission. 4

5 Medicare and Medicare Supplement Work Together Original Medicare: Member must pay deductibles Part A ($1,184 for 2013) - Medicare pays for hospital cost up to 60 total days without a 60-day or more interruption between admissions (lifetime maximum of 365 days per enrollee) after deductible. Deductible may be paid multiple times during any given calendar year. Part B ($147 for 2013) Coinsurance of 80/20 - Medicare pays 80% of all Part A and B costs, beneficiary is responsible for 20% of allowable amount; excess charges for Part B may apply. Skilled Nursing Care Beneficiary gets 20 days free following 3 or more day hospital admission and is meant to assist in rehab. Foreign Travel Emergencies Not covered under Medicare; only domestic, medically necessary procedures are covered. Medicare Supplement Plan F: Pays the Part A deductible each time it is incurred and provides an additional 365 days to members total lifetime days. Pays the Part B deductible each calendar year. Pays the 20% coinsurance amount not paid by Medicare. Pays excess charges to providers not accepting Medicare Assignment up to 15% above the approved amount. Pays for anther 80 days (lifetime) of skilled nursing care following hospital admittance lasting 3 or more days. Requires member to pay a $250 deductible before it pays 80% of costs, up to $50K of coverage outside the US. Does not cover Part D drugs. 5

6 Enrollment Periods and Eligibility Applicant must be enrolled in Medicare Parts A and B Medicare eligibility prior to age 65: ~50% of states require a Med Supp plan offering Cannot duplicate coverage Medicare Supplement Open Enrollment Period (OEP) Begins with Part B effective date and/or 65 th birthday and lasts 6 months Year round enrollment (not subject to AEP, SEPs, etc.) Guaranteed Renewable Guaranteed Acceptance/Issue Cannot deny coverage Eligibility due to involuntary loss of coverage (see pages of the 2012 Choosing a Medigap Policy Guide) Varies by state 6

7 Enrollment Periods and Eligibility Medical Underwriting Determines applicant eligibility All applications eligible for underwriting will be reviewed by Humana s Underwriting Department - IntelliScript used for Rx search and telephonic interviews conducted Applications can be denied at the field level for excessive/deficient BMI or Rx At state s discretion: 4 states prohibit Medical Underwriting (CT, MA, NY, VT) Not applicable during Med Supp OEP or GI 7

8 Pricing Premium Types Attained Age rate increases with age Community Age age is not considered a rate factor, prices do not vary by age Issue Age rate is determined by age at time of enrollment, member remains in the same age bracket for the life of the policy Standard vs. Preferred Tobacco use Medicare eligibility prior to age 65 Area rating Plans offered statewide, rates can vary by county Rate renewals filed annually Inflationary increases subject to state approval State/national MERs used to determine annual rate increases Household and Early Enrollment Discounts 8

9 Summary 8 Great Reasons to Sell Humana Medicare Supplement Plans 1. Humana s national brand and reputation as being a leader in the senior products market. 2. Peace of Mind - Provides specific benefits that fill the gaps in traditional Medicare for predictable monthly premium payments. 3. Committed to Stable Rate Increases We won t be the lowest price in the market, but we expect to provide low, stable rate increases over the lifetime of our member relationships. 4. Access to Value-Added Services Provide gym memberships through Silver Sneakers, HAO, WellDine, QuitNet, Hearing, Vision and Rx Discounts, Humana First (24-hour nurse line). 5. Broad Plan Offerings Humana offers up to 8 different Med Supp plans in 50 states (plus DC and PR) to meet the unique needs of its members. Healthy Living plans offer innovative benefits - preventive dental and vision coverage for those wanting these non-medical benefits Compliments Part D and Other Standalone Coverage For those who want traditional Medicare, Humana s Med Supp plans are great to cross-sell with other products 7. Focus on Customer Service Dedicated unit to service calls for Med Supp members. This enables us to provide customer service excellence by leveraging representatives with specific expertise on plan options, benefits and the nuances that are uniquely related to Medicare Supplement. 8. Flexibility, Freedom, Choice - Members have the freedom to choose any doctor or hospital accepting Medicare assignment. There are no network restrictions, no gatekeepers or referrals needed to see specialists. The insurance goes wherever our members travel in the US. 1 Note: Where approved, preventive dental and vision benefits are available. 9