News to Use for Agents in the Senior Market

A Publication of Senior Marketing Specialists
Week of January 23, 2017


tmbubble   Have You Asked an Underwriting Health Question This Week?

If you are not asking individuals health questions you are probably not offering your clients all of the plans you need to. Many of the base health plans do not require you to ask health questions. Base plans like Medicare Advantage and Medicare Supplements being sold during a guarantee issue period or open enrollment are examples of that. The ancillary plans that can add much needed benefits for your clients and much needed profit for you usually ask health underwriting questions. If it has been more than a few days since you have asked a health question, consider it a red flag to your business.

Why is this Important? To stay in business and be there when your clients need you, you must generate a profit. Base insurance plans like Medicare Advantage and Medicare Supplements help to fund your business operations and pay your client acquisition cost. The true profit of your business comes from building comprehensive benefit packages for your clients that include all needed coverages not just the base plans.


tmbubble   QMB versus QMB Plus

Qualified Medicare Beneficiary (QMB Only)

A “QMB” is an individual who is entitled to Medicare Part A, has income that does not exceed 100% of the Federal Poverty Level (FPL), and whose resources do not exceed twice the Supplemental Security Income (SSI) limit. A QMB is eligible for Medicaid payment of Medicare premiums, deductibles, co-insurance and co-pays (except for Part D). QMBs who do not qualify for any additional Medicaid Benefits are called “QMB Only.”

For the QMB Only population, Medicaid does not pay for services not covered by Medicare Part A or Part B.

Qualified Medicare Beneficiary (QMB):    Monthly Income Limits: (100% FPL + $20*)

*$20 = Amount of the Monthly SSI Income Disregard

QMB Plus

A “QMB Plus” is an individual who meets all of the standards for QMB eligibility as described above, but who also meets the financial criteria for full Medicaid coverage. Such individuals are entitled to all benefits available to a QMB, as well as all benefits available under the State Plan to a fully eligible Medicaid recipient. These individuals often qualify for full Medicaid benefits by meeting the Medically Needy standards, or through spending down excess income to the Medically Needy level.

List and definition of dual eligibles:  https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/medicareenrpts/downloads/buy-indefinitions.pdf

Federal Poverty Levels: https://aspe.hhs.gov/poverty-guidelines

Why is this important? The dual eligible market is one of the largest populations available to the senior agent for Medicare advantage sales.


tmbubble   Medicaid Spend Down

Even if your income exceeds Medicaid income levels in your state, you may be eligible under Medicaid spend down rules. Under the “spend down” process, some states allow you to become eligible for Medicaid as “medically needy,” even if you have too much income to qualify. This process allows you to “spend down,” or subtract, your medical expenses from your income to become eligible for Medicaid.

To be eligible as “medically needy,” your measurable resources also have to be under the resource amount allowed in your state. Call your state Medicaid program to see if you qualify and learn how to apply.

List of State Medicaid Offices – Contact Information: https://www.medicaid.gov/about-us/contact-us/contact-state-page.html

Why is this important? Individuals often need to decide if they want to continue to carry their Medicare supplement coverage when they become eligible for spend down. Understanding spend down is necessary to help your clients make this important decision.


tmbubble   Using MedicareInteractive.org to Understand the Types of Advantage Plans (HMO’s, PPO’s, PFFS, SNP’s etc.)

This section of Medicare Interactive gives you an in-depth look at the types of Medicare Advantage plans available. It also gives you information on how Medicare works with HSA plans.

https://www.medicareinteractive.org/get-answers/types-of-medicare-advantage-plans-hmos-ppos-and-more

Why is this important? Studying the basics gives you a solid foundation for your Medicare education. Making sure you thoroughly understand the types of plans available enables you as an agent to make a proper recommendation to your client.


For on the go and printable version – try the talkingMEDICARE Downloadable Edition!