Insurance Agent Forum

[dier51]

I would sell the WELLCARE Duet Plan........ It is much better in my opinion. I have a lot of experience dealing with both companies. You'll thank me later.


P.S. I'm new here today and wanted to say Hi to everyone.

Good Selling

[arnguy]

Hey, jereri, have you ever heard of the rules regarding capitalization? This not an instant messaging board. It is a professional forum.

[GreenSky]

Originally Posted by dier51

I would sell the WELLCARE Duet Plan........ It is much better in my opinion. I have a lot of experience dealing with both companies. You'll thank me later.


P.S. I'm new here today and wanted to say Hi to everyone.

Good Selling

The problem with the Duet Plan is that IT IS NOT A SNP. There is no advantage for the doctor to take this plan as he/she is still only getting paid 80% of Medicare - not the 100% WellCare told me they pay.

So now you have a low income person who may or may not be able to continue to see their doctor since the plan is really just a terrible PFFS (and I mean terrible because of their benefits). The doctor still has to bill Medicaid.

In some states the plan does add some dental and it given them a few bucks worth of OTC stuff, but the risk is that they lose their doctor and hospital.

As I said, I won't sell this because I don't want to restrict anyone's ability to see their physician. A true SNP is a managed care plan like an HMO. With this, both the client and the doctor should understand the restrictions which should not change during the year. With the PFFS, if the doctor decides not to see the patient, then the patient is out of luck.

Hope all this makes sense.

Rick

[IFS_Edge]

How does EverCare compare to Care Improvement Plus' Special Needs Plans?
Are there anymore Special Needs Plans you guys can tell us about?

[scottfree]

Originally Posted by IFS_Edge

How does EverCare compare to Care Improvement Plus' Special Needs Plans?
Are there anymore Special Needs Plans you guys can tell us about?

From what I know, the Evercare plan is a special needs plan but it is in that catagory because it is a SNP for low income or rather Dual eligibles.

Care Improvement Plus is as far as I am concerned a true SNP. You have to have Diabetes, COPD, CHF or ESRD(I don't think it is something I would sell to this group-no real benefit I can see). I am waiting to hear on the CIP plans for 08. I heard that they had a lot more people enrolled than they expected and that has I think almost overwelmed them. I have about 25 clients and they do like it, but they have been a little slow in paying claims the last month or so and I have gotten calls from clients wondering why they have gotten a bill. The bills have gotten paid.

Another thing on CIP is I have "heard" that the premiums may go up and the benefits may go down on the Gold Plan. Waiting to see it in writing first. I believe that the Platinum Plan premium may go up but benefits will stay the same. "This is what I heard"

My FMO said that Coventry may come out with a SNP, but they have not seen it.

Humana has one for osteoperosus, but what they said at a meeting didn't sound to impressive. Humana says 80% of seniors have this, so think it is a way to sell year round. I can't wait to be dissapointed with their SNP, and will be surprised if it is any good at all!

Hope this helps a little...

Scott

[GreenSky]

Originally Posted by scottfree

From what I know, the Evercare plan is a special needs plan but it is in that catagory because it is a SNP for low income or rather Dual eligibles.

Actually, Evercare has plans for both dual eligible and chronic illness, the latter in selected areas for 2007.

I understand the chronic SNP will be expanded for 2008 and from what I can see, might be the plan to beat - especially if they brand it with AARP.

Their plan will include HBP as a qualifying "event". Like all chronic SNP plans, a beneficiary will have a one time, lifetime open enrollment in addition to the OEP effective Janaury 1.

Rick

[OneMorePolicy]

I'm reading some of the brochures about Evercare for medi-medi. Are the telemarketers\appointment-setting companies allowed to ask on the phone if the client has medicaid?

Originally Posted by jereri

my understanding is that Evercare has a product designed specifically for medicaid/medicare clients. like traditional medicaid there are no copays for the client but they are given additional benefits medicare/medicaid doesnt provide, for example, transportation, dental benefits, eyeglasses, hearing aids, a nurse care manager etc... seems like a no lose situation for the medicaid client but perhaps i am missing something

[Winter]

Originally Posted by GreenSky

Actually, Evercare has plans for both dual eligible and chronic illness, the latter in selected areas for 2007.

I understand the chronic SNP will be expanded for 2008 and from what I can see, might be the plan to beat - especially if they brand it with AARP.

Their plan will include HBP as a qualifying "event". Like all chronic SNP plans, a beneficiary will have a one time, lifetime open enrollment in addition to the OEP effective Janaury 1.

Rick

Yep. It looks like a good plan and yes diabetes and high blood pressure will make you eligible and apparently there is no acuity threshold or anything. If you are being treated for either of those then that is good enough. Its zero premium in my state. $1800 moop and coverage for all preferred generics through the donut hole. Plus it has goodies. Wellness products and vitamins and fluffy stuff like that that you can get each quarter for no additional charge so that people know that the plan still loves them. The other little thing that is strange but helpful is that if the spouse is medicare eligible but does not have any chronic illness then they qualify too.

I like the looks of those plans. The plus side is that they are year round. The downside is that even if they are ppo, your primary care physican must be in the network because the plan hinges on care coordination. You can still go outside with a higher copay for other docs who are not your primary. So your success depends on how strong your network is or how much heartburn is required to get the patients doc in- whether that is just a phone call from the company or a bigger and longer go around.

I think that it is an honorable product. If anyone is having luck with it and has a marketing strategy that is working- do tell. I doubt (but am not really knowledgeable here) that AARP will brand it because it is a little too specific for their one size fits all approach but dunno.

As an aside, if MA's survive which they will, I imagine at some point the chronic illness plans will really be more the model for the future because Congress will put more and more pressure on the MA's to demonstrate that they actually increase care coordination and achieve costsavings rather than the current unmeasured gravy train. My uninformed view anyway.

Winter

[OneMorePolicy]

Also wondering if an agent selling the plan to someone who has dementia (one of the 8 chronic illnesses) would automatically need to have the client's representative sign the enrollment form? Seems so since the client is medically considered not to have their full mental abilities?

[mcleanbr]

If the enrollee has a power of att. then you should include them. You will be held accountable if you meet with a senior and they appear to not be together. Dementia comes in stages. Some people with a mild form of dementia are ok most of the time. An important question is to ask who helps them with their medicare decision. i have signed up several people on Evercare with Dementia but always had a family member involved.

[retread]

Just an update since I posted last May on this subject:

Ovations (subsidiary of UHG) offered a seminar here in KC last fall, which I attended. The main offering was the AARP co-branding of products for 2008. Agents are allowed to contract through an FMO, which I did.

AARP co-brands UHC's Med Supp, UHC/SecureHorizons Medicare Complete and Medicare Direct plans, and a PDP (as well as an under-65 indemnity plan).

NOT co-branded is UHC's SecureHorizons' MA and MAPD plans or Evercare's SNPs.

Evercare has a Dual Eligible SNP (DP) and a Chronic Illness SNP (MP) in my area. Other areas have additional/other offerings. The DP is fully co-ordinated with Medicaid. The MP covers 8 chronic illnesses this year, which the prospect must have at least one.

Commission is set by contract through your FMO: mine is $400.

SNPs can be sold year round. I call on assisted living facilities, as well as use telemarketing.

I also sell Care Improvement Plus, but it is Missouri only (for me). Additionally, I carry Coventry's SNP, which is new this year, but limited to just several counties in KS and MO (for me). Evercare covers both Kansas and Missouri (for me). There are some advantages of one over the other in different situations. Having 3 SNPs lets me offer the best one for that individual. All are managed-care plans. Yes, I agree we are going to see more of these each succeeding year. This was part of the plan in the 2003 MMA.

I also sell Med Sups, MA/MAPDs, and other health insurance and PDPs through about 9 different carriers. The smorgasborg I offer allows me to find the best fit for the prospect. This is the goal of an independent agent.

[Winter]

Originally Posted by retread

Evercare has a Dual Eligible SNP (DP) and a Chronic Illness SNP (MP) in my area. Other areas have additional/other offerings. The DP is fully co-ordinated with Medicaid. The MP covers 8 chronic illnesses this year, which the prospect must have at least one.

SNPs can be sold year round. I call on assisted living facilities, as well as use telemarketing.

Can you give us a sense of how you work with assisted living facilities. In my state Evercare also has an institutional SNP in addition to the chronic care SNP but I gather that you are talking about just the chronic care one. How do you work with the assisted living facilities logistically. You set up a meeting and you have family members as well to help with those who are moderately impaired? How do you work it when their primary care physician is not in the network. Is that a showstopper or you are able to get them in or what?

Thanks.

Winter

[retread]

I work through the person responsible for event scheduling. You have to know the facility's residents. By that I mean that they vary widely in mental awareness.

Some are full of savvy seniors, others are barely conscious. If the facility has mentally impaired residents, I ask that we schedule a seminar and invite the adult children of the residents (they are the ones making health care decisions for their parents), and while presenting Medicare plans, speak to some issues of LTCi. Usually the adult children are much more interested in LTCi for themselves, since they are witnessing what is happening to their parents. Also, they want to know how they can cut costs for their parent's health care, so they listen to the SNP offer.

[Winter]

Originally Posted by retread

I work through the person responsible for event scheduling. You have to know the facility's residents. By that I mean that they vary widely in mental awareness.

Some are full of savvy seniors, others are barely conscious. If the facility has mentally impaired residents, I ask that we schedule a seminar and invite the adult children of the residents (they are the ones making health care decisions for their parents), and while presenting Medicare plans, speak to some issues of LTCi. Usually the adult children are much more interested in LTCi for themselves, since they are witnessing what is happening to their parents. Also, they want to know how they can cut costs for their parent's health care, so they listen to the SNP offer.

Thanks. So how is it going in general with the assisted living market? Is this highly labor intensive for a onesy -twosy sale or is it better than that. You try to come back once every six months or so or how do you work that? Also, what has your experience been in getting a doc into the network. Is that a long cycle or can Evercare just call them up and give them the info and make it happen if they are interested.

Thanks again.

Winter

[fostever]

Why would anyone sell these lousy benefits? For instance, Inpatient Hospital days 1-16 $250 co-pay per day NO ANNUAL MAX. ARE you out of your mind? Medicare deductible $1024 days 1-60. O.K. maybe this would help someone who is inpatient for 4 days or less or in a coma over 60 days but that's it. Isn't the whole idea of an MA plan to cut down on OOP costs? They have to stay in network and have a possible huge bill for a 2 week stay. My plan is $175 for 3 days and $1500 oop Max/year. We have a former agent who is selling this and just telling them he needs to update their file for 2008. He also tells them our plan was bought out by Evercare and he needs to sign them with the new company. He's a rogue agent that gives everyone in this market a bad name.