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Medicare Made Simple, LLC
Theresa Cangemi CSA, CLTC
Office: 315-676-4933
Fax: 866-476-1211
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Greetings!
This week, Iāll be going over some great information about staying safe this Medicare Enrollment Season.
I will also share the Medicare Annual Enrollment Period (AEP) and the Medicare or CMS (Centers for Medicare and Medicaid) rules during enrollment season.
AEP: October 15
th
to December 7
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.
ļ»æIn the Health Corner, I will be sharing what the Purpose of Health Insurance really is.
Keep reading!
Theresa Cangemi CSA, CLTC
The Medicare Lady
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S
taying Safe this Medicare Enrollment Season
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The Purpose Of Health Insurance
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Staying Safe this Medicare Enrollment Season
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Centers for Medicare and Medicaid Services (CMS) have published rules about how agencies who offer or sell Medicare plans and agents who sell those plans are supposed to conduct themselves when working with Medicare eligibles.
Just so you know:
- CMS refers to a Medicare eligible person as a ābeneficiary.ā
ļ»æHere are some guidelines for āstaying safeā during the Medicare Annual Enrollment Seasons.
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MAILINGS:
- Agents are allowed to mail a Medicare eligible person ļ»æinformation by certified mail.
EMAILS:
- For 2019, agents are now permitted to make unsolicited direct contact with potential enrollees via email. However, the email must have an opt-out option in order to remain compliant.
- The content of unsolicited emails cannot intend to steer a recipient into choosing or retaining a plan. A compliant email would promote services rather than any specific plans.
IN PUBLIC:
- Agents are not allowed to approach potential enrollees in common areas in public.
PHONE CALLS:
- Agents need permission to contact a Medicare eligible and are not allowed to make unsolicited phone calls. A Medicare eligible needs to reach out and initiate contact with an agent.
CONTACT WITH MEDICARE ELIGIBLES:
- In order to have contact with a potential Medicare enrollee, the agent must obtain a Permission to Contact (PTC). PTCs are event specific and not open-ended permission for future contact.
ONLINE ā SOCIAL MEDIA:
- If a Medicare eligible ālikes or sharesā on social media, does not give an agent permission to contact (PTC) a Medicare eligible for sales purposes.
SCOPE OF APPOINTMENT FORM
ā What is this form and why does an agent need to obtain it?
- A Scope of Appointment (SOA) form is a form outlining exactly what an agent will be presenting to a client during a meeting. The SOA ensures that potential enrollees will not be pitched plans other than those they originally requested or agreed to. The Medicare plans that can be agreed to are Medicare Advantage plans, Medicare Supplement (Medigap) plans, Prescription Drug plans, Dental/Vision/Hearing plans, Hospital Indemnity plans. Every face-to-face meeting requires a Scope of Appointment. The SOA forms can be filled out and signed prior to a meeting with an agent or just as you sit down with an agent to discuss Medicare plans. These SOA forms need to be kept for 10 years and also submitted with the enrollment forms. Additionally, SOAs must be filled out for one-on-one phone conversations.
- If a Medicare eligible is interested in discussing non-health related products, an agent must schedule a future appointment to discuss.
EDUCATIONAL MEDICARE EVENTS:
- An educational event is an event designed to inform Medicare beneficiaries about Medicare Advantage, Prescription Drug or other Medicare programs and does not include sales or marketing (such as the distribution of marketing materials or the distribution and collection of plan applications; including plan-specific information such as premiums, co-payments, or contact information).
MARKETING EVENTS:
- Sales events and appointments, which are designed to steer or attempt to steer, potential enrollees toward a plan or limited set of plans can be formal (public meeting) or informal (face to face). Agents can discuss plan-specific information such as premium, cost sharing, and can distribute brochures and enrollment materials.
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The Purpose Of Health Insurance
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You might ponder, āI am healthy, why do I need health insurance anyway?ā
The purpose of health insurance is to cover catastrophic or rare events. We also need insurance to provide good primary care and preventative screenings.
Most of us pay into the healthcare system, through premiums and cost sharing (copays, coinsurance, and deductibles). But, not all of us need a lot of healthcare and some need more.
The foundation or theory behind (health) insurance is that when we all buy into health insurance, it is the healthy population (paying premiums that donāt need care or very little care) who pay for those who need more care. If only the chronic or ill population purchased health insurance, then the health insurance companies would not be able to ākeep their doors openā or stay solvent.
So, be a smart consumer! When purchasing a health insurance plan, some questions about plan benefits should include:
- What are the plan benefits? Any dental, vision, hearing, gym membership options?
- What is covered and what is not covered. Read the fine print.
- Are there any coverage limits to the insurance coverage? Will my care get cut off after a certain amount of visits?
- Where and who are the in-network doctors?
- What are my choices: PPO plans, HMO plans, PFFS plans, and how do these plans work?
- What emergency care, urgent care, and hospitals can I go to that are in-network?
- How helpful and responsive can I count on the plans customer service to be?
- Is there an annual maximum out of pocket limit with the plan?
- Are my medications covered by the plan? What will I pay in copays or coinsurance for my medications?
- Medicare has a āDonut Hole.ā Will I reach the medication Donut Hole?
- What is the Medicare āStar Ratingā for the plan or plans I am considering?
- Consider whether a Medicare Advantage plan or a Medicare Supplement (Medigap) plan would be a better option.
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As the Medicare Annual Enrollment Period (AEP) approaches, I hope you found this helpful!
AEP: October 15
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to December 7
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Contributing Thoughts/ Guest Corner
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I am looking for writers or businesses who are
interested in writing relevant articles and would like to contribute to this newsletter. The articles will be reviewed for relevancy and content and geared towards the Medicare eligible demographic.
There is a $50 fee to contribute to this newsletter which can be seen by over 1,000 Medicare eligibles, financial service, healthcare, and insurance professionals combined. Please call Theresa at office or email to find out more.
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to join our mailing list!
Have a Blessed Day!
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PO Box 757
Brewerton, NY US 13029
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