- Hi, I'm Sylvia Gordon.
- And I'm Rebecca Gordon.
- In this episode, we're talking about DNSPs
Medicare Advantage, uh, reimbursement rates for
this year and drug changes in Part D, stay tuned!
(rock music)
- I hate DSNP look-a-likes.
I consider these fake plans and I'm probably
going to have a lot of people hit my -- hit the
comments saying that I'm wrong. But, it's looking
like they're gonna get pulled because
CMS is refusing
to contract look-a-like plans in states where
there are true DSNP plans available.
- (Sylvia) So let's back up
What is look-a-like?
- A look-a-like is, it's uh, it's a plan
trying to attract, uh, Medicare and Medicaid.
The problem with these is that people think
that they're going to get the coordination of benefits
- (Sylvia) With Medicaid
- As, as well as all the other benefits that a true
DSNP would offer and they're not.
- Spoiler alert, they don't.
- They don't.
- It doesn't coordinate because it's not a DSNP.
Why would a carrier file a look-a-like instead of
filing a true DSNP?
- Because they can't qualify and get their DSNP approved.
- So I had agents that, for years, they're called in
then like "Hey, we don't have a DSNP, my client wants
this plan, should I sell it? Can I sell it?
- Mhmm.
- Because they're on Medicaid, and they're on
Medicare, and there's no DSNP, so the answer was
"you can"
- Right.
- But this is one of the op-- one of the drawbacks
and people bought it.
- Yeah
- But then that coordination is not a benefit for
your client
- Yeah
- In many cases.
So, CMS is finally stepping in
- And they're -- it's looking like they're going to
get pulled, which I think is great, because DSNPs
in general are kind of confusing, and then to throw on
a look-a-like and trying to understand....
both of these different entities I think is just
way too confusing, so I hope they go.
- And if you sold DSNP look-a-likes, tell us about
your experience in the comments
- Yeah
- Because I know a lot of agents didn't have a true
DSNP, so they sold that because their client
was on Medicaid, and some of people had very good results.
- Right, so I shouldn't be a total
- Right
- Debby-downer
So this is what I'm hearing, that Medicare Advantage
payments are only going up by 1%
- (Sylvia) I always
get a one, I have a five this time.
- Dang, that's my five.
Only going up by 1% this year, is this a big deal?
- The Medicare reimbursement from CMS goes up
every year, which is needs to, because medical inflation
goes up every year.
So it normally goes up about 2.5%, so that fact that
it's only going up 1%
- (Rebecca) Sounds bad
- A bummer
- Yeah
- However, take into consideration
- The hit tax
- The hit tax was repealed, so that gave them
an effective, like a 5% bump, so they're good.
They're making more every year, they have -- they make
more money they put it into benefits, that good news
rolls downhill
- (Sylvia) They can have richer plans
more plan selection for your consumer.
So even though it's only a 1% increase
- The backstory is pretty far.
- We're still looking good for next year.
- Awesome.
- Okay, let's talk about, uh, something that I've been
hearing a little in the news a lot lately, about
some of these health-shares getting in trouble by
the state of Texas, state of Tennessee, Utah,
Aliera, we talked about that briefly last year
they got pulled.
- Mhmm
- I think another one got pulled recently.
- And I know agents wonder why do we market these.
- Right, because it's not insurance.
- Yeah, and we're totally straight-up with that
that it's not insurance.
I look at health-share ministries like this.
I had my own client, several years ago, buy one
because what I was showing them was four times
the amount and she said "Well, I'm just gonna go to blank"
And I thought "Holy c-- Oh my gosh!"
I think it's prudent for all agents --
- And I like -- I like that she tried, she was going to
cuss there but she
- I did
- Pulled back her natural inclination.
(Rebecca making slurping noises)
I love this, good -- great self control.
- And I am a natural cusser if you didn't know,
I am a huge cusser.
But I think it's prudent for agents, and I think it's
responsible for all of us to know what products
and plans are out in the market.
We have never once said these are health insurance plans.
Uh, they are an alternative and I think that there are
good ones out in the market for the right client.
- And I'm getting a lot of pushback from Jay.
Jay, if Jay you're watching, I appreciate the dialogue
that you've initiated over this, like why would we
offer this if it's not insurance?
Well, I mean, my job is to give you guys
- Options.
- Options! And your j--
- And to know what's going on in the market.
- And your job is to do that for your clients.
Say, okay, here's what's out there and then to
make a recommendation
- Yep
- Based on their needs, their location, their budget,
you know.
- And if you don't do that, clients are going to find them.
They will find them without your help and they will
make a purchase, and it could be an informed purchase,
right.
Because if you go on to the Internet, which everybody
does, and if you type in "Affordable health insurance",
- (Sylvia) Pops up.
- Plans will pop up and consumers are going to look at
the bottom line and hit buy.
- Like I said, one of the reasons we felt like we added it
to our portfolios is because we had one of our
close neighbors, they were a family of four, very healthy,
and they said "Our ACA premium would be as much as our
mortgage
- Oh, for sure.
- We can't afford it. So we've gone without insurance"
for a year
- Right
- The penalty wasn't very much back then. "We don't want to
have nothing, and so we bought this health-share. Why
don't you offer it? Why can--?"
And so we're like, "It's not, yeah, (inaudible)."
And they're like "Yeah, I-I know, I've read it, I understand
it, I'm cool with that, it's better than no insurance."
- And there are some that I think are, um, a little weak
in benefits.
But then there are some that I think are very good
especially when you package and you identify the holes
and you fill the holes.
- The bottom line is we don't want you to buy that either.
We want you to buy health insurance with all the
protections of health insurance.
So, short-term was getting squeezed.
They were -- it was, what?
What did the government call it?
- Well, they called it garbage.
- Garbage plans.
- They use terrible, terrible words like "garbage"
- So...
- Short-term is not garbage.
- Short term was getting squeezed so that you could
renew it
- Could not renew it, you could only have it for maybe
3-6 months depending in your state, and that was it.
And there was the threat it was completely going away.
It was supposed to completely vanish.
- And here we've pulled up on our website our short-term
offerings and we do a lot of short-term medical.
If you cannot afford the ACA, our first leap is going to
be into a short-term.
- Look at short-terms, absolutely.
- And that's when it expanded
- Oh gosh, yeah.
- Because now you can write it --
- You can write it up to three years and those states
- You can renew it
- Are, are, are becoming more and more.
They're adding states and it's really a viable, very healthy
program backed by major medical carriers
- Like United Health One which is United health care and
National General
- Which was Assurant
- Fortis
- And Fortis, the oldest insurance company in the country.
- So we -- that is our preference.
- But health-shares do serve a good, a good, uh,
they'll fill a great hole and they're for the right client.
So any additional information you want on any of these,
we're very active in doing webinars and we integrate these
into our meetings and Jackie Byrd is the guru in our office.
- I wanna talk about our
Life and Annuity expo which is happening tomorrow.
- (sing-song) Tomorrow!
- (sing-song) Tomorrow, I love you
- (together) Tomorrow!
- (singing) You're always
- (singing together) A day away
- So, if you don't already have plans to go, chances are
you're not going but we just wanted to add a little bit
about life and annuity fraud which is kind of a new
- Oh, my God.
- Blip on the radar of fraud.
You know the whole thing where a student loan fraud...
- I get those
- (together) Nonstop.
- Last year
- Student loans.
- Nonstop, I had all my family members call me saying
"Hey, Social Security called me. What should I do?"
I'm like "it's fraud, hang up! Don't call back!"
- (Rebecca sneezes) Excuse me.
- This is a new fraud
- (Rebecca sneezes again)
- That's on the radar.
- (Rebecca sneezes again, louder) Achoo!
- I am allergic to fraud and this is what happens
when I hear that word.
- (Sniffling)
New fraud that's on the radar and that is
- Crooks are calling people posing to be
from their insurance company
- Their life insurance company.
- Or annuities
- Or their retirement plans
- And, and
- And say "I need your account number" or "I have this
and I need this"
- I need information
- And people are falling for it
- (Rebecca makes sucking sound) Sucking out their stuff.
- So that's one of the things, that's what the power
of social media is for you to get out there
ahead of these frauds and warn your clients.
- (Rebecca) This is happening.
- Saying "if you get this call, call me first."
You know "if you get this email, if you-- call me first!"
Make yourself, insert yourself, into their lives
so they can turn to you.
You're they're trusted advisor when they're a little iffy
if they should call this.
If the IRS is really going to foreclose on them.
- The IRS will never call you.
- A couple years ago there was one, it was from the sheriff,
and they were gonna --
- Oh my God, I get those. I'm gonna get a (stammers)
a warrant
- An outstanding warrant for you, and they're gonna
send a deputy to your house right now.
- I love that one.
- They're freaking people out.
You want to get out there and tell people about these scams.
Tell them to call you, their trusted advisor, you can
advise them on this.
- Yeah.
- So, it's terrifying for older people.
They're isolated, a lot of them don't have anybody
to turn to.
- No doubt.
- Be that person.
- Be their advocate.
- Methadone.
What is methadone?
- Well now I know what methadone is.
Methadone is a drug that has just been approved for people
who are trying to come off heroin.
So from what I understand, it's a lower dose of heroin
to help wean people off heroin.
- Which we're not supposed to say heroin, we're supposed
to say "opiates"
- Okay, opioids.
- But it's, it's heroin, which is a poppy, which is
one of my favorite flowers that I grow that bloom in May.
- Well you like poppy seed cake.
- I love poppy seed cake, which you will not pass
a drug test if you eat poppy seed cake.
But methadone, I mean you already heard about
methadone clinics for addicts, CMS just approved it
for seniors starting in January.
So that's new, hopefully you won't have much cause
- Yeah.
- To know that or use it with your clients, but that is
an advantage for people
- Yeah
- That are addicted to opiates.
- Well, that's good to know.
Hey, I've got a question.
If you weren't selling insurance what would you be doing?
(silence)
What do you think you'd be doing?
- (Clicks tongue) Um...
I would love to be an Annie Lennox impersonator
and be hired out for weddings and...
- Are you kidding?
- Bachelorette parties.
I love Annie Lennox.
- So, quick story.
- Which she never asked me or she would've known that.
- This is so funny.
My husband and I were at, uh, the bowling alley many
years ago which is kind of weird in itself.
We were doing karaoke.
I got up and I requested an Annie Lennox song.
- Oh, my god!
- So I was feeling feisty!
- (singing) sweet dreams are made of this...
- I was feeling feisty so to get the crowd going I said
"Hey! This is for all you women who've been screwed over
by your man!"
Thinking that people would go insane
and it'd be like, real--
It was crickets.
My husband wanted to grab me off the stage.
It was an epic fail.
Horrible.
- So comedian won't be in your list of alternative jobs.
So put in the comments what your alternative job would be
if you were not an insurance agent.
We grew up outside of Fort Wayne, Indiana, so this caught
my attention.
It was in the news.
That this elderly couple, and yes this was on Fox News, for
those of you that are super--
- This is big news.
- Super awesome into Fox, elderly couple visited
644 out of the 645 Cracker Barrels in the nation.
That is their couple's goal.
- So--
- Hashtag couples goal.
- What's the last one?
- I don't know, but I was just like "those are our people."
- Yeah, I love that.
- Fort Wayne, Indiana, shout out
- Hello!
- To Fort Wayne Indiana
- Holla!
- Thank you for watching this week.
Stay tuned next week.
- Good selling!
(Rock music)
(Rock music continues)
(Rock music fades out)