News to Use for Agents in the Senior Market

A Publication of Senior Marketing Specialists
Week of July 17, 2017

  Opioid Drugs

Opioid drugs can treat both acute and chronic pain. While these types of drugs can have benefits for many patients with serious pain-related conditions, these drugs cause serious and substantial harm when used improperly. Even when used as directed, they contribute to overdose or lead to development of substance use disorder in some individuals. CDC looks at four categories of opioids:

1. Natural opioid analgesics, including morphine and codeine, and semi-synthetic opioid analgesics, including drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone

2. Methadone, a synthetic opioid

3. Synthetic opioid analgesics other than methadone, including drugs such as tramadol and fentanyl

4. Heroin, an illicit (illegally-made) opioid synthesized from morphine that can be a white or brown powder, or a black sticky substance

“We now know that overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths. Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled, yet there has not been an overall change in the amount of pain that Americans report. Deaths from prescription opioids—drugs like oxycodone, hydrocodone, and methadone—have more than quadrupled since 1999.”  https://www.cdc.gov/drugoverdose/epidemic/index.html

In 2015 there were over 22,000 deaths involving prescription opioids, equivalent to about 62 deaths per day.

Why is this important? Due to this epidemic you can expect insurers to respond to CMS requests by removing some drugs from formularies, prior authorization, quantity limits, and drug utilization review.

  Health Savings Accounts

Some employees may want to have premium-free Part A start when they stop working; however, premium-free Part A coverage begins 6 months back from the time the person enrolls (but no earlier than the first month of eligibility). People must stop contributing to their HSA 6 months before applying for Medicare in order to not be penalized by the IRS. https://www.medicare.gov/Pubs/pdf/11036-Enrolling-Medicare-Part-A-Part-B.pdf See Page 27

Why is this important? HSA plans are among the most popular health plans for individuals under 65, therefore, you will encounter many individuals who have questions about HSA’s.

Note: You can’t contribute to your HSA once you’re enrolled in Medicare.

  Filing a Medicare Claim

Medicare claims must be filed no later than 12 months (or 1 full calendar year) after the date when the services were provided. If a claim isn’t filed within this time limit, Medicare can’t pay its share. Fill out the claim form, called the Patient Request for Medical Payment form: https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms1490s-english.pdf

Follow the instructions for the type of claim you’re filing. Find Instructions here: https://www.medicare.gov/claims-and-appeals/file-a-claim/file-a-claim.html

Why is this important? Although it is rare to have to file your own claim you need to be prepared to assist your client if the occasion occurs. Future changes in Medicare numbers could increase the likelihood you will run into this type of situation.

  Carrier Sneak Peeks

Carriers have started releasing their 2018 plan sneak peeks. These allow you, as an agent, to have an early preview of the plans you can market in October. Many carriers like UHC have already released theirs. Remember you cannot share this confidential information with the public in any way. Call Senior Marketing Specialists at 1-800-689-2800 to get all the details.

Why is this important? Early AEP planning and certification are keys to a successful AEP.

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