Medicare Industry Insider

DVH Plans

Many people are used to having DVH plans from their group plans, but are they worth it? We will dive into what Medicare does and does not cover in a DVH plan, costs, and discuss the pros and cons of dental insurance.
 
Informational Sources
Why is DVH health is important: https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475  
 https://www.hopkinsmedicine.org/health/conditions-and-diseases/hearing-loss  
https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-hidden-risks-of-hearing-loss  
https://www.kff.org/medicare/issue-brief/recent-changes-to-medicare-coverage-of-dental-services-from-the-2023-and-2024-medicare-physician-fee-schedule-final-rules/
https://www.kff.org/medicare/issue-brief/medicare-and-dental-coverage-a-closer-look/
https://www.nidcd.nih.gov/health/hearing-aids
https://www.medicalnewstoday.com/articles/cost-of-hearing-aids#:~:text=Hearing%20aids%20vary%20in%20price,the%20hearing%20aid

2024 Client Experience: Special Edition

This year’s AEP is going to be different than we’ve ever seen before! EVERY client on an agent’s book of business will need a conversation this year—and with 73% of seniors saying their health insurance coverage is the most important financial decision they will make it’s critical that agents are seen as trusted advisors. 
 
Informational Sources - Statistics:
- https://www.statista.com/statistics/271501/us-email-usage-reach-by-age/#:~:text=Share%20of%20U.S.%20e%2Dmail%20users%202021%2C%20by%20age%20group&text=Email%20usage%20interested%20over%2093.4,reported%20using%20this%20communication%20method
- https://www.statista.com/statistics/187549/facebook-distribution-of-users-age-group-usa/
- https://artera.io/blog/seniors-texting/
 

Off Label Drug Use and Medicare Underwriting

We see more and more clients with mile-long drug lists every year. Listen in as Rachel and Chalen discuss off-label drug use in the Medicare space and how to can affect underwriting.
 
Informational Sources:
- https://www.pharmacytimes.com/view/10-surprising-off-label-uses-for-prescription-medications
- https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538391/
- What is an Off-Label drug: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538391/  
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538391/#bib8
 

DME Coverage

Listen in as Rachel and Chalen discuss Durable Medical Equipment (DME) Coverage. See how you can keep your clients from getting scammed and give them all the details on what is covered and what they will be paying out of pocket.
- https://www.aarp.org/health/medicare-qa-tool/does-medicare-cover-medical-supplies/
- https://www.grandviewresearch.com/industry-analysis/us-durable-medical-equipment-dme-market
- https://www.medicare.gov/coverage/durable-medical-equipment-dme-coverage
- https://www.cms.gov/blog/transforming-medicare-coverage-new-medicare-coverage-pathway-emerging-technologies-and-revamped
- Smart watch emergency features: https://www.forbes.com/health/healthy-aging/best-smartwatches-for-seniors/ 
- https://www.medicareinteractive.org/get-answers/medicare-covered-services/durable-medical-equipment-dme/equipment-and-supplies-excluded-from-medicare-coverage
- http://www.medicare.gov/media/publication/11045-medicare-coverage-of-dme-and-other-devices.pdf
 
Finding Vendors:
- https://www.medicare.gov/medical-equipment-suppliers
- https://smpresource.org/medicare-fraud/fraud-schemes/durable-medical-equipment-fraud/
- https://www.justice.gov/opa/pr/federal-indictments-and-law-enforcement-actions-one-largest-health-care-fraud-schemes
 
 
 

Insurance and Mental Health

Mental health has not always been viewed as a medical condition. However, in recent years, it has gained significant recognition and visibility. Listen in to learn how changes in insurance have provided agents with increased resources, networking opportunities, and services that they can offer to clients.
 
Informational Sources:
- https://www.mayoclinic.org/diseases-conditions/mental-illness/symptoms-causes/syc-20374968
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480686/
- The Yellow Wallpaper: https://www.nlm.nih.gov/exhibition/theliteratureofprescription/exhibitionAssets/digitalDocs/The-Yellow-Wall-Paper.pdf
- Asylums and lobotomy: https://www.medicalnewstoday.com/articles/what-is-a-lobotomy#history
- https://www.npr.org/templates/story/story.php?storyId=5014576
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181586/#:~:text=Earlier%20conflicts%20had%20given%20birth,French%20and%20German%20scientific%20literature
https://www.ptsd.va.gov/understand/what/history_ptsd.asp#:~:text=At%20that%20time%2C%20some%20symptoms,and%20sleep%20problems%2C%20among%20others
Stats: https://adaa.org/find-help/by-demographics/mens-mental-health
- https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide
- https://covid19.nih.gov/covid-19-topics/mental-health
Trends:
- https://www.nbcnews.com/pop-culture/viral/elmo-social-media-question-sparks-existential-dread-despair-rcna136477
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214398/#:~:text=Excessive%20Internet%20use%20may%20create,low%20family%20relationships%20and%20anxiety
- https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-023-01243-x#:~:text=Excessive%20use%20has%20increased%20loneliness,self%2Desteem%20%5B9%5D
- https://www.healthline.com/nutrition/blue-zones#TOC_TITLE_HDR_9
- https://www.cdc.gov/aging/publications/features/lonely-older-adults.html
- https://www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/marriage-and-family-therapists-mental-health-counselors#:~:text=Effective%20January%201%2C%202024%2C%20MFTs,the%20Medicare%20Physician%20Fee%20Schedule
- https://www.kff.org/medicare/issue-brief/how-many-physicians-have-opted-out-of-the-medicare-program/

Lifecycle of an MA Plan Design

It takes 18 months to build a Medicare Advantage plan, and carriers are using past data to make future decisions well before plan launches. While there is a lot of science to this process, some of it is still speculatory. If agents know what to look for, they can read the tea leaves of plan design to better prepare their business for the future.
 
Informational Sources:
- https://www.cms.gov/files/document/cy2023medicarepartscanddannualcalendar.pdf  
- Star Ratings: https://www.cms.gov/files/document/2023-medicare-star-ratings-fact-sheet.pdf  
- How to see 65+ population in a state/county/city etc.: https://www.census.gov/quickfacts/fact/table/boonecountymissouri,MO,US/PST045216 
- Medicare Enrollment Dashboard: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Dashboard/Medicare-Enrollment/Enrollment%20Dashboard.html 
- Crosswalk: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-422/subpart-K/section-422.530#p-422.530(a)(1
- Pull this list here: https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/plan-crosswalks  
 

Caregivers Part 2

Insurance and care decisions are often influenced by caregivers. This week, we’re diving back in for part 2 of our discussion on caregivers in the Medicare space. Join us for details on how you can make sure your clients have a plan in place.
 
Informational Sources:
- https://www.usatoday.com/story/opinion/voices/2023/12/06/rosalynn-carter-caregiver-support-mental-health/71782211007/ 
- https://www.aplaceformom.com/senior-living-data/articles/caregiver-statistics
- Resources- like respite care, doctors get paid to train the caregivers: https://www.nia.nih.gov/health/caregiving/what-respite-care  
-  https://press.aarp.org/2023-11-02-AARP-Applauds-CMSs-Final-Rule-to-Pay-Physicians-to-Train-Family-Caregivers#:~:text=%E2%80%9CAARP%20commends%20CMS%20for%20issuing,care%20for%20their%20loved%20ones. 
- www.medicare.gov/medicareonlineforms/publicforms/cms10106.pdf 
- https://www.forbes.com/sites/dianeomdahl/2020/08/04/for-medicare-having--a-power-of-attorney-is-not-enough/?sh=6cfad77fe680 
- https://archrespite.org/resource-library/arch-products-and-publications/?_sft_library_type=fact-sheets&sf_paged=3  

NABIP Capitol Conference

It's important to be a knowledgeable and informed agent and be involved in the rule making process and legislative changes. The National Association of Benefits and Insurance Professionals (NABIP) is a great way to be involved, informed, and make an impactful difference in our healthcare legislation changes. Chalen and Rachel attended the 2024 NABIP Capitol Conference and are excited to share the overall feel, the talking points, and how to get involved.
 
NABIP Talking Points: https://nabip.org/media/9184/cap_con_talking_points_2024_022424-final-final.pdf  

Becoming An Expert On Chronic Conditions

CMS has 21 classified chronic conditions and some of these may surprise you. Knowing what resources, services, and benefits are available to people with these chronic conditions will position you as an expert in your community.
 
Informational Sources:
- https://www.aha.org/system/files/content/00-10/071204_H4L_FocusonWellness.pdf
- https://news.bloomberglaw.com/health-law-and-business/worlds-most-expensive-drug-revives-push-for-new-payment-models
Opioid Epidemic-Treating Side Effects: https://pubmed.ncbi.nlm.nih.gov/18443635/
- https://www.cms.gov/data-research/statistics-trends-and-reports/chronic-conditions/chronic-conditions
- https://healthpayerintelligence.com/news/what-non-medical-supplemental-benefits-will-ma-plans-offer-in-2024/
Pre-authorizations and Step Therapy: https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-prior-authorization-and-step-therapy-part-b-drugs  
 

How to Scale Your Agency as Your Book of Business Grows

What do you do when your sales efforts work and now you have to run a whole business? Join Rachel and Chalen as they discuss how you can scale your agency as your book of business grows.
 
Informational Sources:
Resources for Business Owners: https://www.uschamber.com/co/start/strategy/free-resources-for-small-businesses