Every 12-year-old that can create a Web page seems to want to create a private Medicare exchange these days.
Every drug store seems to have a table of staffed Medicare plan sales reps.
See also: Medicare annual enrollment period starts
What can you do to stand out, especially given the tight marketing restrictions on agents who want to sell Medicare Advantage plans and Medicare Part D prescription drug plans?
You can smile a lot more brightly than a website, and you are much less likely to freeze up because software has decided that it ought to update itself.
You can weave your Medicare advice into a comprehensive plan that includes disability insurance, long-term care insurance and more.
You can also know more. You might feel as if others have a huge head start, and they may, but the Centers for Medicare & Medicaid Services (CMS) website complex is complicated enough that even professionals may miss documents of keen interest, and newcomers may click on the right link at the right time and discover major, embarrassing changes buried in footnotes.
See also: 3 top Medigap sales tips
For a look at 12 interesting facts we’ve gleaned from CMS websites, read on.
1. Who runs Medicare?
The Center for Medicare is part of CMS, which is, in turn, part of the U.S. Department of Health and Human Services (HHS).
Sylvia Mathews Burwell is the HHS secretary.
Andy Slavitt is the acting administrator for CMS.
Sean Cavanaugh is the director of the Center for Medicare.
Before Cavanaugh took over as head of Medicare, he was the head of the programs and policy operation at the Center for Medicare and Medicaid Innovation. He also has been director of health care finance at the United Hospital Fund in New York and an official in the New York City Mayor’s Office of Health Insurance Access.
Cavanaugh succeeded Jonathan Blum, who left in 2014. Blum is now executive vice president of medical affairs at CareFirst BlueCross BlueShield in Baltimore and a member of the board of the Medicare Rights Center.
2. Who runs Medicare’s private plan programs?
CMS relies heavily on private health insurers to run the traditional fee-for-service Medicare program.
But the agents and brokers who sell Medicare plans typically offer Medicare supplement (Medigap) insurance products, which fill in the gaps left by Medicare Part A hospitalization coverage and Medicare B physician services coverage; Medicare Advantage plans, which are also known as Medicare Part C plans; and Medicare drug plans.
Elizabeth Richter is the Center for Medicare deputy director in charge of the traditional fee-for-service Medicare program. She has been working for CMS since 1990.
In Medigap announcements for 2016, CMS has identified Derrick Claggett as a Medigap policy specialist.
Cynthia Tudor is the acting deputy director in charge of the Center for Medicare’s Medicare Advantage and Medicare Part D prescription drug plan programs. Earlier, she helped run the Medicare Advantage risk-adjustment program. She has a doctorate in sociology from Johns Hopkins University and received post-doctoral training in epidemiology at the University of Maryland.
CMS lists Arrah Tabe-Bedward as director of the Medicare Enrollment and Appeals Group, and Maria Ramirez as director of the group’s Division of Appeals Operations. Tabe-Bedward has a master’s degree in public service management from DePaul University and a law degree from the University of Maryland.
See also: Big Medicare Changes Ahead
3. Who in the CMS private plans operation might, possibly, actually read a plea for help from an agent?
One sign that some of the highest-level Center for Medicare officials may be unexcited about seeing your emails about enrollment or administration problems is that they seem to have worked hard to keep themselves off Google.
If they have any LinkedIn entry at all, they may have one connection, or no connections at all.
James Kerr, the administrator at the CMS Consortium for Medicare Health Plans Operations, seems to be more open to the possibility of communicating with members of the public. His LinkedIn entry shows that he has a bachelor’s degree from Renssalaer Polytechnic Institute and a master’s degree from the City University of New York’s Baruch College.
Before he got involved with CMS, he was the deputy executive director at a health plan owned by New York Life and vice president for government health at a unit of UnitedHealth Group (NYSE:UNH). He manages about 400 field staff members in 10 CMS regional offices.
On the CMS regional offices website, CMS provides PDFs that give the name, e-mail address and telephone number of the associate regional administrator in charge of the Medicare Advantage and Medicare drug plan programs in each region. The associate regional administrators’ functions include “managing beneficiary and provider casework.”
Atlanta: Jabel Chase (acting).
Boston: Douglas Edwards.
Chicago: Heather Lang.
Dallas: Julie Kennedy.
Denver: Tod Anderson.
Kansas City: Judith Flynn.
New York: Reginald Slaten.
Philadelphia: James McCaslin.
San Francisco: Ann Duarte.
Seattle: Brenda Suiter.
4. Can a Medicare client use the PPACA public exchange system to get dental coverage?
Even if you’ve been advising clients about Medicare since Harry Truman got his Medicare card, you may have trouble answering the many questions clients have about how traditional Medicare coverage, Medigap plans, Medicare Advantage plans and Medicare drug plans do (or don’t) relate to the rules and programs created by the Patient Protection and Affordable Care Act of 2010 (PPACA).
One obvious question is: Why can’t your clients use PPACA exchange coverage to overcome the shortcomings of Medicare and Medicare-related plans?
Example: The traditional Medicare program, typical Medigap plans and typical Medicare Advantage plans do not provide dental benefits.
The PPACA public exchange programs can sell stand-alone dental plans.
Can your Medicare clients get their dental coverage from the PPACA public exchange system?
The fact is that the answer to this question depends on where you live. HHS requires residents of the states that use its HealthCare.gov enrollment system to buy qualified health plan (QHP) medical coverage through the system before they can sign up for stand-alone dental coverage. Consumers are not supposed to have Medicare coverage and QHP coverage at the same time. Because Medicare enrollees cannot have Medicare coverage together with QHP coverage, and they need HealthCare.gov QHP coverage to get HealthCare.gov dental coverage, they cannot get HealthCare.gov dental coverage.
Because of all of these rules, in the HealthCare.gov states, the only Medicare-eligible adults who can get dental coverage from the exchange system are those who use exchange QHP medical coverage in place of basic Medicare coverage.
The HealthCare.gov QHP-first requirement for dental coverage purchases does not apply to the state-run exchanges.
Several state-based exchanges we checked apply the QHP-first requirement to would-be dental coverage purchasers.
Covered California, for example, says, “Adults with and without children can enroll in family dental plans, but they must purchase a health plan through Covered California in order to be eligible.”
But Connect for Health Colorado does let adults buy dental coverage without QHP coverage. “You can purchase a stand-alone dental plan even if you don’t plan to purchase a health insurance plan through the Marketplace,” that exchange says.
Another important point is that we found this answer in Frequently Asked Questions Regarding Medicare and the Marketplace, a batch of guidance that CMS posted in August 2014 and updated earlier this year. CMS officials answer many other interesting questions in that set of frequently asked questions (FAQ) answers, ranging from, “Is having Medicare Part B coverage all by itself enough to protect a taxpayer from the penalties now imposed on people who fail to have “minimum essential coverage” (MEC)?” (the answer: no) to whether consumers with QHP coverage who become eligible for Medicare have to drop their QHP coverage (the answer: no, but any premium tax credits will go away).
Anyone who’s selling Medicare-related products will want to bookmark that FAQ set, print it out and read it carefully.