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Part 1: Healthcare Options for Medicare-Eligible Seniors
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What is Premier Senior Health Plan?
Premier Senior Health Plan (PSHP) is a group Medicare plan designed to cover most out-of-pocket expenses approved but not paid in full by Medicare. This rich benefit, combined with an exceptional level of service, makes it the perfect product for the over age 65 business owner and their over-65 retirees, actives and spouses.
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Marketing Senior Healthcare in 2018
Agenda – Part I Senior Market Opportunity Market Choices Small Businesses and TEFRA Group Retiree Medical Plans The Premier Senior Health Plan
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Senior Market Opportunity
55 million seniors enrolled in Medicare and growing 2011—first Baby Boomers became Medicare-eligible with 10,000 turning 65 every day USA population is aging – by the year 2020: The 65+ Market will have grown twice as fast as the market (increasing by 29 million vs. 14 million) 1 out of 4 Americans will be 65+ Above data compiled by the U.S. Administration on Aging and based 2010 census.
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Small Business Market Opportunity
6 million small businesses have under 100 employees 3.2 million are owned by a person over 55 1 million are owned by a person over 65 Many post-65 Americans continue to work full- and part-time Business owners want: Rich benefits Reliable service and support Corporate write-offs
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Why Market PSHP?
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Why Market PSHP? Barlow Research 2015
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Small Business Market Opportunity
PSHP offers a unique opportunity to sell directly to the business owner year-round PSHP is business that stays on the books Business owners want high quality, high service health care benefits Business owners are accustomed to belonging to a group
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PSHP PSHP Illustrated - No Medical Questions Tax-Deductible Premiums
Employer-Sponsored Group Health Plan Medicare Supplement & Part D Rx PSHP No Medical Questions Tax-Deductible Premiums Plans Down to One Life Year-Round Enrollment Available Nationwide
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TEFRA & Medicare TEFRA rules help determine whether a post-65 employee has Medicare or private insurance as their primary insurer. <20 Non-TEFRA ≥20 TEFRA Applies
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TEFRA & Medicare Non-TEFRA Groups
Under 20 Employees (6-month look-back) Make sure the company has a Federal Tax ID Medicare Parts A (and usually B) are primary Enrollment in Part B should lower group premium Employee’s group insurance is secondary Group policy should bill Medicare
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TEFRA & Medicare Post-65 employees of TEFRA groups (20+) may still be eligible for Group Medicare Supplements if: They are ineligible for the active employee medical plan They are a part-time, seasonal or permanent part-time employee Owners often meet these criteria Often applies to board members, of counsel, etc. If an employee is retired, they can take a group Medicare plan on an employer-paid or voluntary (member-paid) basis.
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Market Choices for Retirees
Medicare Advantage Plans Individual Medicare Supplements Group Medicare Supplement Plans
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Business Case Partner-Owned Doctor’s Office in Hartford, CT
11 total employees, 3 spouses 3 post-65 employees, 2 post-65 spouses Doctors and Partners Currently paying $900 single rate for Major Medical Plan for post-65 members.
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Medicare Advantage Plans
$132 Billion reduction in subsidy to carriers over the next 10 years—voted on by Congress in 2010— expected to cause: Increased premiums Reduced benefits Limited PPO and HMO networks Decreased commissions Plans require annual agent training Many marketing rules Creates additional work for agents
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Individual Medicare Supplements
Some underwriting Marketing rules apply No group support Donut hole coverage generally not available Business cannot deduct premiums
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Effects on the Small Business
Keeping the Seniors on the group medical plan with all employees Higher rates for employees Tax deductible Individual Medicare Plans (Advantage and Supplement) Employee off the plan Must be very careful not to incent employee
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Effects on the Employee
Keeping the Seniors on the group medical Retain group benefit and support Benefit may be less comprehensive than Medicare Individual Medicare Plans (Advantage and Supplement) Premium cannot legally be covered by employer Premium for employee is paid after tax No donut-hole RX solution available
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Group Medicare Supplement Plans
Guaranteed issue—no underwriting Agent and client receive full support as with any group plan Premiums are tax deductible to the company Section 125 available for these plans Agent certification not required
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Group Medicare Supplement Plans
Comprehensive plan designs Members can self-refer to any medical provider in the country that accepts Medicare Plans can be customized to meet group needs Rx plans available with Donut Hole coverage for generic and/or brand name drugs Group sizes of 1 to 1,500+ retirees Plans can be member or employer paid Medical and Part D Group enrollment allowable throughout the year
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Effects on the Small Business
Group Medicare Supplement Plan Group support for claims/billing issues Tax deductible like any other group plan Employee can move to new plan (as long as coverage is equitable) Lower total healthcare spend
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Effects on the Employee
Group Medicare Supplement Plans Group service and support Collaborative problem solving Remains employer paid Portable into retirement Benefit matches prior employer plan
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Effects on the Agent Group business stays on the books
Individual products are typically shopped every year and are very price-sensitive Members are used to group benefits and don’t leave Unique product to offer that appeals to business owners Great cross-sell opportunity Most individual product agents are unaware of this product Agent receives direct support from carrier/administrator
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Effects on the Agent No annual training requirements
Can be written year round Group support makes your job easier Lifelong commission w/ high client retention
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Premier Senior Health Plan Overview
Administered by Benistar Administrative Services in Simsbury, CT One of the Nation’s largest administrators of Group Retiree Medical Plans Underwritten by: United American, McKinney, TX Insurer of 1.2 million seniors, Rated A+ Superior Express Scripts, St. Louis, MO Nation’s largest Pharmacy Benefit Manager
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Premier Senior Health Plan Overview
PSHP national sales office provides: Marketing Materials Proposals Enrollment support Member services, including medical and Rx claims support We are the voice behind the Plan!
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Medicare Part A Benefits
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Medicare Part A Benefits, continued
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Medicare Part B Benefits
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Medicare Part B Benefits, continued
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How the Deductible Works
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The Prescription Drug Plan
Multiple Plan Designs Plans available with and without name brand coverage in the “donut hole” Over 67,000 participating pharmacies 90 day mail order available “Grandfather Clause” prevents Rx interruption Members can continue receiving currently prescribed drugs
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Medicare Part D Benefits
All plan designs available with and without brand name coverage in the donut hole Plans Also available with or without a $400 deductible
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Plan Eligibility and Administration
Guaranteed acceptance for age 65+ members enrolled in Medicare Parts A and B The Plan is offered through a sponsoring entity (corporation, union, municipality, sole proprietor, non- profit, etc.) Plan can be member or employer-paid
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Plan Eligibility and Administration
PSHP staff provides support throughout the enrollment process: Mailing to Retiree Phone enrollment support available PSHP will take retiree calls concerning medical and/or Rx issues and questions
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Part 2: Getting in front of Business Owners with PSHP
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Selling PSHP in 2018 Agenda – Part II Broker Resources Prospecting
Overcoming Objections Sales Support Enrollment Ongoing Support Questions from Attendees
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Broker Resources- Marketing & Education
Customized marketing flyers & whitepaper Physical kits Short introductory slide show Phone and support
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Customizable Marketing Pieces
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Client-Centric Presentation
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Prospecting – Ideal Industries
Small professional businesses: Doctors & dental practices Law practices / CPAs Insurance agencies / Real estate agents Engineering firms Plumbers/ Electricians/ HVAC Others: Small local governments Unions Non-profits Churches Retail shops
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Qualifying Are you a business owner? Under 20 actives or over?
Are you covered under a major medical plan, or an individual Medicare Supplement / Advantage plan? Any 65+ employees, retirees, or spouses on the group plan or individual plans?
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Qualifying
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Overcoming Objections
I can buy myself an individual Medicare Supplement or Advantage plan for less premium. I don’t want to leave my carrier / network. I make too much money to be considered part-time. Higher income will influence the part B premium.
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Overcoming Objections
I will simply gross up my employees’ wages or buy them individual Medicare plans. Who is United American? I’ve never heard of them. Will I lose the plan when I quit or retire? We’ll wait until the 1st of next year to sponsor this.
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Quoting Needed to Quote Helpful to know Date(s) of birth Entity Name
20+ or under-20 group Current plan design(s) Past, current and renewal rate(s)
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Closing Assistance Conference Call or Meeting Benefit Comparisons
Prospect / client can ask us questions and express concerns with you on the line Benefit Comparisons Apples-to-apples comparison of current plan to PSHP Core or detailed benefit comparison PSHP is typically the winner Savings Analysis
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Sample Core Benefit Comparison
Core Benefits 2016 Current PPO Plan Proposed Premier Senior Health Plan UPGRADE Medical In-Network Deductible $1,500 Individual / $3,000 Family $0 per individual Medical Out of Network Deductible $3,000 Individual / $6,000 Family Network Yes No Network: Members can self-refer to any doctor in the country that accepts Medicare (94% of doctors & 99% of hospitals) Inpatient Hospital Coverage 20% after deductible Covered 100% Office Visit for Non-Specialist $40 copay No Copay Office Visit for Specialist $45 Copay Emergency Room Visit $150 copay Rx CoPays (Tiers 1-5) $20 / $20 / $40 / $70 / $70 $0 / $0 / $30 / $60 / $33% Medicare Part B - Approved Excess Charges Not covered Medical - Foreign Travel North America ONLY Worldwide
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Sample Savings Analysis
Savings Analysis for 4 Lives: Coverage Period Current Composite Rate PMPM** Proposed Composite Rate PMPM** Savings PMPM** Total Savings 1/1/ /31/2016 $732.15 $511.60 $220.55 $10,586.40 **PMPM = Per member per month
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Enrollment No underwriting
Effective Date Expectations for Group Enrollment Medical Only: 30 days Medical & Rx (or Rx only): 45 days
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Enrollment – Group Application
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Enrollment – Other Required Group Forms
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Enrollment - Part D (Rx)
Required only if group enrolling in the Rx plan:
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Enrollment – Individual Application(s)
One per enrollee required for Supplement and/or Rx:
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Ongoing Support- One Number to Call
To you the Broker: Enrollment assistance Questions Renewal info for January 1st (888) To your Client: General questions Temporary or replacement member card Billing and claims questions Three-way calls with CMS
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Plan Overview Sell a rich benefit directly to business owners Guaranteed issue coverage that stays on the books Retiree-centric service and expertise Rx solutions with full donut hole coverage Secure your stake in the fastest growing marketplace with Premier Senior Health Plan!
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Additional Opportunities in the Senior Marketplace
Many large groups offer retiree healthcare benefits Governments Municipalities Private Companies Unions/Associations Legacy costs continue to grow for these groups—they need solutions
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Questions?
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