Brokers/agents: Things you might not know about Medicare Supplement (Part 2)

By Fred Roth, President of Medicare Supplement, Humana

In Part 1 of this two-part series, I addressed six questions I often get asked about Medicare Supplement as I travel or participate in discussions with brokers and agents across the country – everything from deciding which company to sell to excess charges associated with Plan N.

As I mentioned previously, Medicare Supplement plans typically have the same benefits regardless of issuer, so it’s important to fully understand the company you are selling as well as the value-added and extra services available.

Your knowledge matters to your clients and could mean the difference between them sticking with you or seeking support elsewhere.

Here are some additional questions I regularly hear from brokers and agents seeking to understand more about Medicare Supplement plans:

1. Does an issuer pay a commission on guaranteed issue sales?

Commission structures vary from one Medicare Supplement issuer to another and may vary based on products sold. A commission is typically paid on guaranteed issue sales but in some states may be permitted to be less than what is paid on open enrollment and underwritten sales.

2. How do I find out what are guaranteed issue rights?

The standard guaranteed issue rights, under federal law, are outlined in “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare’ developed jointly by the Centers for Medicare and Medicaid Services (CMS) and the National Association of Insurance Commissioners. Each state may adopt regulation expanding beyond these rights. Many Departments of Insurance provide information regarding their unique rights on their websites in addition to being available in agent resources provided by an issuer.

3. How do I manually file claims or help a client file an appeal?

It is typically not necessary to file claims manually, and any provider should submit claims directly to CMS. Once Medicare has processed the claim, it will be sent to the Medicare Supplement issuer to pay its share. If a provider is not submitting claims in a timely manner or on behalf of the patient, instructions are located on Medicare.gov on how to file manually. If Medicare should deny a claim, an appeal must be filed with Medicare.

4. If my clients travel internationally and need medical care, how do foreign claims work?

If Medicare doesn’t cover the care, Medicare Supplement plans C, D, F, G, M and N provide foreign travel emergency health coverage. The emergency care must occur during the first 60 days of the trip and the plan will pay 80% of the billed charges for certain medically necessary emergency care after the $250 annual deductible is met up to a lifetime limit of $50,000. Your client should submit an itemized bill manually to Medicare, if covered, and if not, to their Medicare Supplement issuer if they have a plan that includes this benefit.

5. What is the primary difference in Skilled Nursing Facilities that Medicare Advantage clients often get released at day 21 versus clients on Original Medicare with a Medicare Supplement plan?

The big thing with skilled nursing is understanding the required three hospital inpatient days for it to be covered by Original Medicare. I would start with the difference of rehabilitation. When enrolled in a Medicare Advantage plan, you are almost always sent to a nursing home for rehab. With a Medicare Supplement plan, you get your choice of rehab centers. Medicare pays for 100% of skilled nursing care for the first 20 days, and then a coinsurance applies for the following 80 days. But with most Medicare Supplement plans, 50-100% of the remaining cost is covered, depending on the specific plan.  

Click here to view part 1 of this two-part series, for six other questions I am often asked about Medicare Supplement.

The more you know, the better you will be at helping your clients navigate Medicare. Message me if you have thoughts on future topics you'd like to see addressed!