web01.fireside.fm Wed, 29 Apr 2026 15:23:37 -0500 Fireside (https://fireside.fm) Mastering Medicare - Episodes Tagged with “Insurance” https://www.masteringmedicare.net/tags/insurance Wed, 21 Jun 2023 12:00:00 -0400 What's the difference between Home Health and Home Care? How do Medicare Part A and Part B work? How do you order DME for your patient? When and how should you order home oxygen? What's new in the eldercare space? For physicians, other healthcare professionals, and senior-serving professionals, interacting with Medicare can be complicated and wrought with pitfalls, which, if not understood and managed, will mire your practice in endless paperwork and frustration. We interview industry experts in every aspect of healthcare, from insurance companies, DME companies, home health agencies, medical providers, and many others, to bring you their real world expertise in the American healthcare system. Your hosts are Dr. Amy Schiffman and Dr. Alex Mohseni, two Emergency Medicine physicians who have branched off from traditional Emergency Medicine to explore and build solutions with a particular focus on eldercare and population health. Join our Facebook group: https://www.facebook.com/groups/602747270479020/ Join our Subscriber List and get exclusive access to our Mastering Medicare Cheat Sheet and other goodies: https://www.masteringmedicare.net/subscribe en-us episodic Demystifying healthcare and Medicare for senior-serving professionals and providers. Mastering Medicare What's the difference between Home Health and Home Care? How do Medicare Part A and Part B work? How do you order DME for your patient? When and how should you order home oxygen? What's new in the eldercare space? For physicians, other healthcare professionals, and senior-serving professionals, interacting with Medicare can be complicated and wrought with pitfalls, which, if not understood and managed, will mire your practice in endless paperwork and frustration. We interview industry experts in every aspect of healthcare, from insurance companies, DME companies, home health agencies, medical providers, and many others, to bring you their real world expertise in the American healthcare system. Your hosts are Dr. Amy Schiffman and Dr. Alex Mohseni, two Emergency Medicine physicians who have branched off from traditional Emergency Medicine to explore and build solutions with a particular focus on eldercare and population health. Join our Facebook group: https://www.facebook.com/groups/602747270479020/ Join our Subscriber List and get exclusive access to our Mastering Medicare Cheat Sheet and other goodies: https://www.masteringmedicare.net/subscribe no elder care, eldercare, Medicare, Medicaid, healthcare, senior care, senior, seniors, senior-serving professionals, medical care, insurance company Mastering Medicare alex@masteringmedicare.net Episode 23: Medicare broker deep dive - interview with Matt Gibson from 90 Days From Retirement https://www.masteringmedicare.net/23 bd0d716a-3993-4681-9b5b-a5f1f2b2c9e5 Wed, 21 Jun 2023 12:00:00 -0400 Mastering Medicare full Mastering Medicare Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. 43:57 no Introduction of the guest Matt Gibson from 90 Days from Retirement, a platform educating about insurance post-retirement. Discussion about the prevalence of insurance agents buying leads of people turning 65 and how 90 Days from Retirement differs by providing education instead. People turning 65 often receive unsolicited mail and phone calls offering help with Medicare, which can be overwhelming. Explanation that data about people turning 65 is publicly available, and some businesses generate leads by buying and selling this data. Mention of the lack of enforcement of rules against unsolicited phone calls to sell certain Medicare products. Brief explanation of the main products sold by Matt's agency, including Medicare supplement plans also known as Medigap plans. Medicare and Medigap: Medigap plans supplement Medicare by covering deductibles and co-insurance that Medicare doesn't cover. This is one path individuals can take when they start Medicare. Medicare Advantage (Part C): Contrary to Medigap, Medicare Advantage acts as a replacement policy for Medicare. When someone signs up for a Medicare Advantage plan, their Medicare parts A and B are essentially turned off and the responsibility for payment and administration is transferred to the insurer. In exchange, Medicare pays the insurer a monthly fee. Medicare Advantage Plan Payment: Most Advantage plans have zero monthly premium for the individual because the insurer receives payment from Medicare, which can be a substantial sum. Becoming a Medicare Broker: To become a broker, one must be health insurance licensed, contract with specific insurance companies, and pass carrier-specific training and certification. The process can be time-consuming and complex. Commission Structure: Brokers must contract with insurance companies to earn commission. The commission rates are standardized and set by CMS. They do not directly negotiate these commissions but rather work under the structures set by larger field marketing operations (FMOs). Medicare Advantage (MA) plans and Part D drug plans are highly regulated, and insurance carriers cannot incentivize brokers to sell more products through bonuses or rewards. When a broker facilitates the signup of a client for an MA plan, their name and broker ID number are included in the application (paper or electronic), enabling the insurance carrier to attribute the commission. Brokers must be certified and part of the network of the plan they are selling. They can't start selling a plan for which they haven't taken certification. The availability of MA plans varies by zip code, influenced by factors such as population and medical resources. Brokers are licensed by state and may not have access to marketing materials or sell plans in states where they are not licensed. If a broker is certified with a limited number of MA plans available in a client's region, they are expected to inform the client about the existence of other plans, even if they don't earn a commission on them. Brokers often have to narrow down the choice of plans based on the client's needs, including preferred doctors, medications, and hospital networks. All telephonic or online consultations have to be recorded, and brokers are required to inform clients that they might not be licensed with every product in the area, even if they are. There were approximately 60,000 complaints to Medicare from call centers in the previous year, likely because brokers were not fully representing all available products in their market. Brokers use tools to compare the cost of medications across carriers and to search for doctors within each carrier's network. However, some carriers choose not to participate with certain tools, requiring brokers to go directly to the carrier's website. The discussion involves health insurance, Medicare Advantage (MA) plans, and how insurance agents/brokers operate. The speaker mentions a preference for checking a carrier's site when looking for doctors or dentists. Agents often receive an upfront commission when clients sign up, followed by smaller, ongoing commissions for renewals. After signing clients, the speaker’s office offers full service, assisting with claims, billing, and more. They provide quarterly newsletters and communicate regularly, especially during annual election periods. If a client's MA plan is changing significantly, the agent may recommend exploring other options. However, if the plan remains largely the same, clients are advised to continue with it. Not many clients switch from one MA plan to another, or from MA to original Medicare, or vice versa. Changes typically occur due to network alterations, alteration in benefits, or advertisements. Switching from an MA plan to a supplement plan is not always easy and may involve health questions and underwriting. Outside of specific open enrollment windows, clients cannot switch. Churn within the MA system does occur, though it doesn't benefit the speaker's agency financially to regularly switch clients' plans. Other agents, however, may benefit from such churn. There is no cost to the consumer to work with an agent. Agents are also not allowed to buy meals or gifts for potential clients, though smaller items such as coffee or appetizers are permitted. There is no underwriting process for MA plans. Once you have Medicare and live within the service area, you are eligible. For more information or assistance, the speaker invites people to visit their website, 90daysfromretirement.com. Medicare, healthcare, physician, medical, senior care, eldercare, elder care, elder, seniors
  • Introduction of the guest Matt Gibson from 90 Days from Retirement, a platform educating about insurance post-retirement.
  • Discussion about the prevalence of insurance agents buying leads of people turning 65 and how 90 Days from Retirement differs by providing education instead.
  • People turning 65 often receive unsolicited mail and phone calls offering help with Medicare, which can be overwhelming.
  • Explanation that data about people turning 65 is publicly available, and some businesses generate leads by buying and selling this data.
  • Mention of the lack of enforcement of rules against unsolicited phone calls to sell certain Medicare products.
  • Brief explanation of the main products sold by Matt's agency, including Medicare supplement plans also known as Medigap plans.
  • Medicare and Medigap: Medigap plans supplement Medicare by covering deductibles and co-insurance that Medicare doesn't cover. This is one path individuals can take when they start Medicare.
  • Medicare Advantage (Part C): Contrary to Medigap, Medicare Advantage acts as a replacement policy for Medicare. When someone signs up for a Medicare Advantage plan, their Medicare parts A and B are essentially turned off and the responsibility for payment and administration is transferred to the insurer. In exchange, Medicare pays the insurer a monthly fee.
  • Medicare Advantage Plan Payment: Most Advantage plans have zero monthly premium for the individual because the insurer receives payment from Medicare, which can be a substantial sum.
  • Becoming a Medicare Broker: To become a broker, one must be health insurance licensed, contract with specific insurance companies, and pass carrier-specific training and certification. The process can be time-consuming and complex.
  • Commission Structure: Brokers must contract with insurance companies to earn commission. The commission rates are standardized and set by CMS. They do not directly negotiate these commissions but rather work under the structures set by larger field marketing operations (FMOs).
  • Medicare Advantage (MA) plans and Part D drug plans are highly regulated, and insurance carriers cannot incentivize brokers to sell more products through bonuses or rewards.
  • When a broker facilitates the signup of a client for an MA plan, their name and broker ID number are included in the application (paper or electronic), enabling the insurance carrier to attribute the commission.
  • Brokers must be certified and part of the network of the plan they are selling. They can't start selling a plan for which they haven't taken certification.
  • The availability of MA plans varies by zip code, influenced by factors such as population and medical resources. Brokers are licensed by state and may not have access to marketing materials or sell plans in states where they are not licensed.
  • If a broker is certified with a limited number of MA plans available in a client's region, they are expected to inform the client about the existence of other plans, even if they don't earn a commission on them.
  • Brokers often have to narrow down the choice of plans based on the client's needs, including preferred doctors, medications, and hospital networks.
  • All telephonic or online consultations have to be recorded, and brokers are required to inform clients that they might not be licensed with every product in the area, even if they are.
  • There were approximately 60,000 complaints to Medicare from call centers in the previous year, likely because brokers were not fully representing all available products in their market.
  • Brokers use tools to compare the cost of medications across carriers and to search for doctors within each carrier's network. However, some carriers choose not to participate with certain tools, requiring brokers to go directly to the carrier's website.
  • The discussion involves health insurance, Medicare Advantage (MA) plans, and how insurance agents/brokers operate.
  • The speaker mentions a preference for checking a carrier's site when looking for doctors or dentists.
  • Agents often receive an upfront commission when clients sign up, followed by smaller, ongoing commissions for renewals.
  • After signing clients, the speaker’s office offers full service, assisting with claims, billing, and more. They provide quarterly newsletters and communicate regularly, especially during annual election periods.
  • If a client's MA plan is changing significantly, the agent may recommend exploring other options. However, if the plan remains largely the same, clients are advised to continue with it.
  • Not many clients switch from one MA plan to another, or from MA to original Medicare, or vice versa. Changes typically occur due to network alterations, alteration in benefits, or advertisements.
  • Switching from an MA plan to a supplement plan is not always easy and may involve health questions and underwriting. Outside of specific open enrollment windows, clients cannot switch.
  • Churn within the MA system does occur, though it doesn't benefit the speaker's agency financially to regularly switch clients' plans. Other agents, however, may benefit from such churn.
  • There is no cost to the consumer to work with an agent. Agents are also not allowed to buy meals or gifts for potential clients, though smaller items such as coffee or appetizers are permitted.
  • There is no underwriting process for MA plans. Once you have Medicare and live within the service area, you are eligible.
  • For more information or assistance, the speaker invites people to visit their website, 90daysfromretirement.com.
    • ]]>
  • Introduction of the guest Matt Gibson from 90 Days from Retirement, a platform educating about insurance post-retirement.
  • Discussion about the prevalence of insurance agents buying leads of people turning 65 and how 90 Days from Retirement differs by providing education instead.
  • People turning 65 often receive unsolicited mail and phone calls offering help with Medicare, which can be overwhelming.
  • Explanation that data about people turning 65 is publicly available, and some businesses generate leads by buying and selling this data.
  • Mention of the lack of enforcement of rules against unsolicited phone calls to sell certain Medicare products.
  • Brief explanation of the main products sold by Matt's agency, including Medicare supplement plans also known as Medigap plans.
  • Medicare and Medigap: Medigap plans supplement Medicare by covering deductibles and co-insurance that Medicare doesn't cover. This is one path individuals can take when they start Medicare.
  • Medicare Advantage (Part C): Contrary to Medigap, Medicare Advantage acts as a replacement policy for Medicare. When someone signs up for a Medicare Advantage plan, their Medicare parts A and B are essentially turned off and the responsibility for payment and administration is transferred to the insurer. In exchange, Medicare pays the insurer a monthly fee.
  • Medicare Advantage Plan Payment: Most Advantage plans have zero monthly premium for the individual because the insurer receives payment from Medicare, which can be a substantial sum.
  • Becoming a Medicare Broker: To become a broker, one must be health insurance licensed, contract with specific insurance companies, and pass carrier-specific training and certification. The process can be time-consuming and complex.
  • Commission Structure: Brokers must contract with insurance companies to earn commission. The commission rates are standardized and set by CMS. They do not directly negotiate these commissions but rather work under the structures set by larger field marketing operations (FMOs).
  • Medicare Advantage (MA) plans and Part D drug plans are highly regulated, and insurance carriers cannot incentivize brokers to sell more products through bonuses or rewards.
  • When a broker facilitates the signup of a client for an MA plan, their name and broker ID number are included in the application (paper or electronic), enabling the insurance carrier to attribute the commission.
  • Brokers must be certified and part of the network of the plan they are selling. They can't start selling a plan for which they haven't taken certification.
  • The availability of MA plans varies by zip code, influenced by factors such as population and medical resources. Brokers are licensed by state and may not have access to marketing materials or sell plans in states where they are not licensed.
  • If a broker is certified with a limited number of MA plans available in a client's region, they are expected to inform the client about the existence of other plans, even if they don't earn a commission on them.
  • Brokers often have to narrow down the choice of plans based on the client's needs, including preferred doctors, medications, and hospital networks.
  • All telephonic or online consultations have to be recorded, and brokers are required to inform clients that they might not be licensed with every product in the area, even if they are.
  • There were approximately 60,000 complaints to Medicare from call centers in the previous year, likely because brokers were not fully representing all available products in their market.
  • Brokers use tools to compare the cost of medications across carriers and to search for doctors within each carrier's network. However, some carriers choose not to participate with certain tools, requiring brokers to go directly to the carrier's website.
  • The discussion involves health insurance, Medicare Advantage (MA) plans, and how insurance agents/brokers operate.
  • The speaker mentions a preference for checking a carrier's site when looking for doctors or dentists.
  • Agents often receive an upfront commission when clients sign up, followed by smaller, ongoing commissions for renewals.
  • After signing clients, the speaker’s office offers full service, assisting with claims, billing, and more. They provide quarterly newsletters and communicate regularly, especially during annual election periods.
  • If a client's MA plan is changing significantly, the agent may recommend exploring other options. However, if the plan remains largely the same, clients are advised to continue with it.
  • Not many clients switch from one MA plan to another, or from MA to original Medicare, or vice versa. Changes typically occur due to network alterations, alteration in benefits, or advertisements.
  • Switching from an MA plan to a supplement plan is not always easy and may involve health questions and underwriting. Outside of specific open enrollment windows, clients cannot switch.
  • Churn within the MA system does occur, though it doesn't benefit the speaker's agency financially to regularly switch clients' plans. Other agents, however, may benefit from such churn.
  • There is no cost to the consumer to work with an agent. Agents are also not allowed to buy meals or gifts for potential clients, though smaller items such as coffee or appetizers are permitted.
  • There is no underwriting process for MA plans. Once you have Medicare and live within the service area, you are eligible.
  • For more information or assistance, the speaker invites people to visit their website, 90daysfromretirement.com.
    • ]]>     Episode 15: Medicare Advantage (MA plans) - a deep dive with Michael Hughes https://www.masteringmedicare.net/15 141c7ce5-c8f3-4acf-a981-3ca94fc1a458 Mon, 12 Oct 2020 06:00:00 -0400 Mastering Medicare full Mastering Medicare Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. 1:04:51 no Dr. Amy Schiffman and Dr. Alex Mohseni interview Michael Hughes, principal at Mitchell-Lowey, LLC, and do a deep dive into Medicare Advantage plans, especially as they relate to supplemental benefits like private duty home care services. We discuss: What is Medicare Advantage MA plans offer supplemental benefits CMS is realizing that SDOH determine health and cost outcomes Who costs the system the most Examples of supplemental benefits include things like home care and pest control How many MA plans are there SSBCI - special supplemental benefits for the chronically ill How does an MA plan measure effectiveness of supplemental benefits How do physicians order supplemental benefits for members VBID model Conversion rate from MA plan to private pay What are the downsides of choosing an MA plan Why MA plans care about the quality of supplemental benefits MA plans as a percentage of total Medicare population by state (Link (https://www.kff.org/medicare/state-indicator/enrollees-as-a-of-total-medicare-population/?activeTab=map&currentTimeframe=0&selectedDistributions=overall&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D)) Link to Michael Hughes: https://www.linkedin.com/in/michael-hughes-7010221/ Video version: https://www.youtube.com/watch?v=7NrtiqkkHtQ Medicare, healthcare, physician, medical, senior care, eldercare, elder care, elder, seniors, medicare advantage, home care, private duty Dr. Amy Schiffman and Dr. Alex Mohseni interview Michael Hughes, principal at Mitchell-Lowey, LLC, and do a deep dive into Medicare Advantage plans, especially as they relate to supplemental benefits like private duty home care services. We discuss:
    What is Medicare Advantage
    MA plans offer supplemental benefits
    CMS is realizing that SDOH determine health and cost outcomes
    Who costs the system the most
    Examples of supplemental benefits include things like home care and pest control
    How many MA plans are there
    SSBCI - special supplemental benefits for the chronically ill
    How does an MA plan measure effectiveness of supplemental benefits
    How do physicians order supplemental benefits for members
    VBID model
    Conversion rate from MA plan to private pay
    What are the downsides of choosing an MA plan
    Why MA plans care about the quality of supplemental benefits
    MA plans as a percentage of total Medicare population by state (Link)
    Link to Michael Hughes: https://www.linkedin.com/in/michael-hughes-7010221/
    Video version: https://www.youtube.com/watch?v=7NrtiqkkHtQ

    ]]>     Dr. Amy Schiffman and Dr. Alex Mohseni interview Michael Hughes, principal at Mitchell-Lowey, LLC, and do a deep dive into Medicare Advantage plans, especially as they relate to supplemental benefits like private duty home care services. We discuss:
    What is Medicare Advantage
    MA plans offer supplemental benefits
    CMS is realizing that SDOH determine health and cost outcomes
    Who costs the system the most
    Examples of supplemental benefits include things like home care and pest control
    How many MA plans are there
    SSBCI - special supplemental benefits for the chronically ill
    How does an MA plan measure effectiveness of supplemental benefits
    How do physicians order supplemental benefits for members
    VBID model
    Conversion rate from MA plan to private pay
    What are the downsides of choosing an MA plan
    Why MA plans care about the quality of supplemental benefits
    MA plans as a percentage of total Medicare population by state (Link)
    Link to Michael Hughes: https://www.linkedin.com/in/michael-hughes-7010221/
    Video version: https://www.youtube.com/watch?v=7NrtiqkkHtQ

    ]]>     Episode 14: Hospice and Secrets of the Hospice Industry https://www.masteringmedicare.net/14 6ae3508f-565d-4423-8c45-960ba761fac1 Fri, 11 Sep 2020 06:00:00 -0400 Mastering Medicare full Mastering Medicare Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. 1:23:38 no In this episode we do a deep dive into Hospice with our guest, Cathy Gurson. She teaches us everything we ever wanted to know about Hospice. Here are some of the topics we cover: How do people get referred to hospice Hospice is covered 100% by Medicare part A What does hospice cover How to get Part B medical care covered while under hospice Hospice reimbursement model Hospice per diem Three levels of hospice care Pier diem changes at the higher levels of care For profit vs non-profit hospice Hospice certificate of need requirements What questions you should ask about when interviewing a hospice CHAP certification for hospice Transitioning - what does transitioning mean in the context of hospice? How to know when a hospice patient is dying Does hospice pay for food and nutrition Tube feeding hospice patients Measuring mean arm circumference (MAC) as a measure of nutritional decline Who is making the hospice recertification? Hospice patient’s relationships with their their PCP and hospice medical director DNR status and resuscitating hospice patients Most common reasons somebody leaves hospice status What is the role of PCPs for patients in hospice status What a PCP can bill for care plan oversight for a hospice patient Retroactive hospice status changes What happens if you don’t requalify for hospice recertification? Graduating from hospice Video version: https://youtu.be/qat1HZicdrA Medicare, healthcare, physician, medical, senior care, eldercare, elder care, elder, seniors, hospice, hospice care, palliative care In this episode we do a deep dive into Hospice with our guest, Cathy Gurson. She teaches us everything we ever wanted to know about Hospice. Here are some of the topics we cover:
    How do people get referred to hospice
    Hospice is covered 100% by Medicare part A
    What does hospice cover
    How to get Part B medical care covered while under hospice
    Hospice reimbursement model
    Hospice per diem
    Three levels of hospice care
    Pier diem changes at the higher levels of care
    For profit vs non-profit hospice
    Hospice certificate of need requirements
    What questions you should ask about when interviewing a hospice
    CHAP certification for hospice
    Transitioning - what does transitioning mean in the context of hospice?
    How to know when a hospice patient is dying
    Does hospice pay for food and nutrition
    Tube feeding hospice patients
    Measuring mean arm circumference (MAC) as a measure of nutritional decline
    Who is making the hospice recertification?
    Hospice patient’s relationships with their their PCP and hospice medical director
    DNR status and resuscitating hospice patients
    Most common reasons somebody leaves hospice status
    What is the role of PCPs for patients in hospice status
    What a PCP can bill for care plan oversight for a hospice patient
    Retroactive hospice status changes
    What happens if you don’t requalify for hospice recertification?
    Graduating from hospice
    Video version: https://youtu.be/qat1HZicdrA

    ]]>     In this episode we do a deep dive into Hospice with our guest, Cathy Gurson. She teaches us everything we ever wanted to know about Hospice. Here are some of the topics we cover:
    How do people get referred to hospice
    Hospice is covered 100% by Medicare part A
    What does hospice cover
    How to get Part B medical care covered while under hospice
    Hospice reimbursement model
    Hospice per diem
    Three levels of hospice care
    Pier diem changes at the higher levels of care
    For profit vs non-profit hospice
    Hospice certificate of need requirements
    What questions you should ask about when interviewing a hospice
    CHAP certification for hospice
    Transitioning - what does transitioning mean in the context of hospice?
    How to know when a hospice patient is dying
    Does hospice pay for food and nutrition
    Tube feeding hospice patients
    Measuring mean arm circumference (MAC) as a measure of nutritional decline
    Who is making the hospice recertification?
    Hospice patient’s relationships with their their PCP and hospice medical director
    DNR status and resuscitating hospice patients
    Most common reasons somebody leaves hospice status
    What is the role of PCPs for patients in hospice status
    What a PCP can bill for care plan oversight for a hospice patient
    Retroactive hospice status changes
    What happens if you don’t requalify for hospice recertification?
    Graduating from hospice
    Video version: https://youtu.be/qat1HZicdrA

    ]]>