Are You Ahead of the Game?

Marilyn Schultz

Marilyn Schultz | Vice President, Corporate Strategy

Frequent changes and upheaval in the health insurance industry may necessitate a revamping of existing business strategies to reduce stagnation. Modifying your existing business plan and updating your brand can refocus efforts to stimulate business growth and aid in retention.

Expand. Update or improve your product offerings to include new products or lines.

  • With an average of 10,000 baby boomers turning 65 daily, and with this trend expected to continue for many years, it is an ideal time to begin selling in the senior market. AHIP and carrier certifications for the next annual enrollment period typically start in July. The time is ripe to update your portfolio to include this market segment and its product offerings.
  • Incorporate focused selling to special client segments, such as dual-eligible special needs beneficiaries (D-SNP), or increase your understanding of the Medicare Supplement (Med Supp) Plans D and G. New Medicare enrollees won’t have the option to choose the Med Supp Plans C or F beginning in 2020.
  • Add more value to your product line with packaged sales that include hospital indemnity products, health and wellness solutions, and identity theft safeguards.

Modify. More and more clients rely upon their broker to navigate them through a myriad of legislative changes and compliance updates resulting from healthcare reform. While one of the many hats a broker must wear has always been as consultant, this is evident today more than ever. Modifications to business strategies may be necessary to accommodate increased time demands from your clients and to adjust for reduced or eliminated commissions and shortened enrollment periods.

  • Incorporate charging a service fee to your business model. In most states, agents can charge their clients a fee as long as certain requirements are met and certain disclosures are made.
  • Revise networking practices where clients outside your business scope are handed off to industry colleagues and investigate using the services of a trusted agency that offers a program that pays you for your referrals.
  • Partner with a general agency for access to superior carrier contracts, back-room administrative service, and training opportunities, structured to save you precious time and resources.

Refresh. Is your image outdated? Are your marketing efforts yielding the expected return? Is it time for a different approach? Online lists with hundreds of marketing ideas to grow your business are only a click or two away. Most business plans include a marketing strategy and detailed annual marketing goals. The key is to continually revisit and reframe these goals, making the necessary changes to ensure they remain viable.

  • Consider updating your image. Modernize your logo and your website to entice prospects with a fresh brand and avoid your existing clients seeing you as passé.
  • Try creative new ways to reach your clients and prospects. Start a newsletter and use email or social media to market your efforts.
  • Use referral tactics, including adding a refer-a-friend page to your website.
  • Refresh your data. Your existing book of business presents additional marketing opportunities. Find commonalities with your clients, such as using the same financial planners, accountants, or blue collar services. Reach out to these businesses using your client connections and become the broker they refer their customers to in the future.

With the bulk of 2017 enrollments on the books, 2018 product updates on the horizon, possible legislation changes on the way, and certification periods looming, this is a great time to revisit and revise marketing strategies to your advantage.

Cornerstone is available to assist you with incorporating any sales or marketing changes you may undertake to your business plan. Call today to speak with any of our Employee Benefits, Individual, or Senior Marketing advisors and ask about access to Centric, our broker-exclusive marketing and knowledge base repository.

Medicare Supplement Changes on the Horizon

Ryan Carroll, Director Medicare/Individual

Ryan Carroll | Director, Medicare/Individual

By now, the majority of agents in the Medicare Supplement (Med Supp) market are aware of the looming changes to plans C, D, F, and G. Many agents are still confused with what is happening, the reasons for the change, and what plans to select for their Med Supp clients. The market is changing and so is the availability of plans, but this is not a cause for panic. The Med Supp market will be stronger than ever and you will not be forced to move all your of clients to a new plan. As long as you understand the changes and how to prepare for them, the transition will be seamless and, most importantly, your clients will continue to have the coverage they need.

What is Happening?

Because of a bill recently passed limiting first dollar coverage, individuals who are newly eligible for Medicare after January 1, 2020 will no longer be able to enroll in plans C or F. As a result, plans D & G were introduced. These new plans provide identical coverage to plans C and F respectively, without including the coverage of the part B deductible. This does not mean that plans C and F will be going away completely, nor does it mean all of your clients in plans C and F will have to find new plans after 2020. This change only affects people who are newly eligible for Medicare after 2020. This means all of your clients born prior to 1955 can keep plans C or F and can even enroll in these plans, but would be subject to underwriting after January 1, 2020. For someone born after January 1, 1955, plans C and F will never be an option.


In an era where healthcare costs are rapidly increasing, it is widely known that first dollar coverage does not promote efficient use of health care by the provider or the consumer. As a result, on April 16, 2015, President Obama passed the Medicare Access and Chip Reauthorization Act (MACRA), restricting first dollar coverage on a Med Supp plans effective January 1, 2020. This effectively removed Med Supp plans that covered the part B deductible and eliminated plans C and F.

What About the Rates?

Because the only difference between the new and old plans is the removal of coverage for the part B deductible, plans D and G are typically cheaper than plans C and F. Currently, the Medicare part B deductible is $183. Therefore, if the difference in annual premium from plan C to plan D or plan F to plan G is greater than $183, you can save clients money by enrolling them into plan D or G (assuming they use the plan a few times and meet their annual deductible). With plans D and G being relatively new, more and more carriers are introducing these options and pricing them for the first time. There are carriers that have still have plan C or F priced to be the more cost effective option, so be sure to evaluate them carefully.

Carrier Plan F Plan G Difference What to Sell
AARP / UHC             (Effective 7/1/2017) $1,666.56 $1,420.80 $245.76 Plan G
Aetna             (Effective 3/1/2017) $1,979.00 $1,368.00 $611.00 Plan G
Anthem         (Effective 7/1/2017) $1,882.56 $1,307.16 $575.40 Plan G
Cigna               (Effective 10/01/2016) $1,538.13 $1,278.75 $259.38 Plan G

*Zip: 45206, Age 65, Gender: Female, Non-Smoker

Expected Trends?

Of course, the million dollar question is: what will happen to the rates of the plans as we get closer to 2020 and thereafter? There is no way to tell exactly what will happen to the rates or which plans will be the most cost effective long term. Due to the proportion of underwritten business in each plan as plan G becomes guarantee issue, plans C and F  gravitate towards an older, healthier population, while plans D and G gravitate towards a younger, sicker population. Both scenarios have a positive outlook of maintaining stable rates into the foreseeable future. There is a lot speculation around how the rates will react and when to start selling one plan over the other, but again, at this point it is only speculation. Since there is no definitive answer available, my advice is to stay up to date on any changes and present the options to your clients as accurately and thoroughly as possible.

How Can You Prepare?

As we get closer to 2020, the best way for an agent to prepare is to ensure you are set up with the most competitive carriers available for plans C, D, F, and G so you are ready to react as things begin to change more drastically. It is also important to stay current with all legislation and changes to laws that may have an effect on your business. Partnering with the right FMO can help streamline the process, as they will ensure you are informed, trained, and appointed with the best products in the market to remain ahead of the competition. Through partnerships with NAHU and organizations throughout the industry, Cornerstone provides comprehensive summaries and updates to changes in legislation and how it will affect our industry.

Contact Cornerstone today for a free evaluation of your Medicare supplement portfolio to ensure you are appointed and earning top commissions with the most competitive in the market.

CMS Issues Finalized Rule to Encourage Market Stability

With Open Enrollment right around the corner, we wanted to take a moment and address some of the changes we will see taking place this year. Below is an outline of changes created by a CMS-issued Final Rule (CMS-9929-F) that will go into effect on June 19, 2017, 60 days after the initial publication in the Federal Register on April 18, 2017.


The rule addresses:

  • Standards related to special enrollment periods (SEPs)
  • Guaranteed availability
  • Timing of AEP and OEP for 2018
  • Standards related to network adequacy and essential community providers for qualified health plans
  • Actuarial value requirements
  • SEPs

Health insurers frequently raise the issue of the abuse and misuse of SEPs, which may enable sick enrollees not entitled to an SEP to join plans outside of open enrollment. To combat this perceived abuse, CMS is requiring pre-enrollment verification of all SEP enrollments for states served by


Open Enrollment
The open enrollment period for 2018 has been shortened to run from November 1 through December 15, 2017. While CMS states that this change will reduce opportunities for adverse selection, it will likely create significant challenges for brokers who are attempting to help a large, diverse book of business in a shorter period of time.


Guaranteed Availability
CMS is changing its interpretation of the guaranteed availability requirement to allow insurers to apply a premium payment to an individual’s past debt owed for coverage from the prior 12 months before applying the payment toward a new enrollment. This change is intended to encourage individuals to maintain continuous coverage throughout the year. Previously, insurers have provided anecdotal examples of individuals who paid premiums for 2–3 months while obtaining services, and then subsequently stopped paying their premiums, allowing their coverage to lapse. These individuals later re-enrolled with no consequence during the following OEP.


Network Adequacy
CMS will defer to individual state review of network adequacy, which will eliminate a duplicative review by the federal government.


Actuarial Value Requirements
CMS issued changes to the de minimis allowable variation in the actuarial value of a health plan. This change is intended to give insurers greater flexibility in creating lower cost plans, in an effort to attract younger and healthier enrollees.

Cornerstone will continue to provide updates on the implementation of these rule changes. Brokers should be aware that, while these changes are intended to stabilize the individual market, a great deal of uncertainty still surrounds the administration’s intent to pay and preserve cost-sharing subsidies.

CMS Issues Pre-Enrollment Verification Process for SEP Eligibility

On April 18, 2017, CMS released Patient Protection and Affordable Care Act; Market Stabilization, which finalizes changes designed to stabilize the individual and small group markets. This final rule amends standards regarding SEPs, guaranteed availability, and the timing of OEP for 2018.

Beginning in June 2017, HHS will implement a pre-enrollment electronic verification process for SEP in all states that use the  platform. The pre-enrollment verification process will fall into two phases:

  • Phase 1 (June 2017): CMS will verify SEPs, including Loss of MEC and Permanent Move
  • Phase 2 (August 2017): CMS will verify SEPs including Marriage, Medicaid/CHIP Denial, and Addition of a Dependent through Birth, Adoption, Foster Care, or Court Order

This pre-enrollment verification process is designed to promote continuous coverage, protect the risk pool, and stabilize rates.

Once the enrollee completes the application and makes a plan selection, they will have 30 days to provide documentation and prove eligibility.

Questions? Contact a Cornerstone expert today.

Read through Cornerstone’s write up of the final rule here.



Market Stabilization Final Rule

Medical Mutual Updating Step Therapy Programs Beginning July 15

Medical Mutual’s step therapy programs for prescription drugs, which promote clinically effective alternative drugs to improve cost savings and quality of care, will be updated effective July 15, 2017. In early May, Express Scripts will send out a letter to members who have filled a alternative drug prescription in the last month about the new requirements, which will be specific to the drug(s) that the member takes. Medical Mutual expects that the updates will effect up to 9,600 members.

These updates do not apply to Medicare Advantage and Medicare Supplement plans.


Not appointed with Medical Mutual? Contact your Cornerstone representative today to get started!


Updates to Step Therapy Programs Begin July 15, 2017; Express Scripts to Notify Members

Anthem Releases Updated Medicare Supplement Rates

Anthem has released their updated Medicare Supplement rates effective July 1, which includes the introduction of Plan G to their portfolio. Like Plan F, Part G covers Medicare Part B Excess Charges, however, it does not cover the annual Part B deductible. And remember, all Modernized Anthem Medicare Supplement members are also now eligible for the Silver Sneakers Fitness program which offers members a basic membership at no extra cost*.

The new rates for Anthem’s Medicare Supplement plans are below.

Please be aware that with this release Anthem has also updated their Medicare Supplement application.  The new application as well as the updated kits will be available to order through custom point on May 16. Old applications will may be rejected.

Interested in getting appointed with Anthem? Contact your Cornerstone representative today.



Ohio Anthem BCBS July 2017 Supplemental Rates


*SilverSneakers is a value-added program. It is not insurance and not part of the Medicare Supplement insurance plans. It can be changed or withdrawn at any time.


Have you registered for Senior Expo 2017?

IRS Announces 2018 Indexing Adjustments

The IRS recently announced the 2018 indexing adjustments for two percentages under the ACA, as well as a reminder that the required contribution percentage used to determine whether individuals are exempt from individual shared responsibility penalties also decreased to 8.05 percent for 2018. The first percentage under the ACA, which is the percentage required to determine whether employer-sponsored health coverage is “affordable” for purposes of employer-shared responsibility, has decreased from 9.69 percent in 2017 to 9.56 percent for 2018. The second percentage, which is the percentage required to determine the amount individuals eligible for premium tax credits must contribute toward the cost of Exchange coverage, will decreases slightly.

For more information, refer to the full text of the announcement below.

Questions? Contact your Cornerstone representative for answers!



Refundable credit for coverage under qualified health plan—indexing adjustments.

HSA Contribution and Coverage Limits for 2018 Announced

The IRS recently released Revenue Procedure 2017-37, which outlines the 2018 cost-of-living contribution and coverage adjustments for HSAs, as required under Code Section 223(g). The procedure also includes the minimum deductible and maximum out-of-pocket expenses for the high-deductible health plans (HDHPs).

According to the procedure, the amount that individuals may contribute to their HSAs for self-only coverage will increase by $50 (from $3,400 in 2017 to $3,450 in 2018) in 2018, while HSAs linked to family coverage will rise by $150 (from $6,750 in 2017 to $6,900 in 2018). Rate changes reflect cost-of-living adjustments.


Contribution and Out-of-Pocket Limits for Health Savings Accounts and High-Deductible Health Plans
2018 2017 Change
HSA contribution limit (employer + employee) Self-only: $3,450
Family: $6,900
Self-only: $3,400
Family: $6,750
Self-only: +$50
Family: +$150
HSA catch-up contributions (age 55 or older)* $1,000 $1,000 No change**
HDHP minimum deductibles Self-only: $1,350
Family: $2,700
Self-only: $1,300
Family: $2,600
Self-only: +$50
Family: +$100
HDHP maximum out-of-pocket amounts (deductibles, co-payments and other amounts, but not premiums) Self-only: $6,650
Family: $13,300
Self-only: $6,550
Family: $13,100
Self-only: +$100
Family: +$200
* Catch-up contributions can be made any time during the year in which the HSA participant turns 55.
** Unlike other limits, the HSA catch-up contribution amount is not indexed; any increase would require statutory change.


Revenue Procedure 2017-37

IRS Sets 2018 HSA Contribution Limits


Questions? Contact your Cornerstone representative today for more information!

Aetna Will Exit Obamacare Individual Insurance Market (Virginia)

Aetna will exit the Obamacare individual insurance market in Virginia because of the “financial risk” and “growing uncertainty in the marketplace.”  The move only affects individual plans sold on and off the federal Obamacare exchange at

T.J. Crawford, Aetna’s spokesman, said in an email, “Despite significantly reducing our exchange footprint, our individual commercial products could potentially lose more than $200 million in 2017.”

Source: CNBC (

Customers covered by Aetna through employers or Medicaid and Medicare Advantage plans will not be affected by this change.


Questions? Contact your Cornerstone representative today.


Aetna Will Exit Obamacare Markets in Virginia in 2018

Aetna to Exit Virginia Obamacare Individual Insurance Market

GOP Health Care Bill Passed by the House

A Republican-drafted health care bill that would eliminate many provisions of the Affordable Care Act was passed by the House with a 217–213 vote on Thursday. The bill still awaits the Senate’s final approval.

The vote came only 6 weeks after House leaders failed to pass an earlier version of the bill. The bill includes last-minutes amendments that were written to appeal to the most conservative House Republicans and eliminates tax penalties for people that do not have health insurance. The bill will also offer tax credits between $2,000 and $4,000 per year, depending mainly on age, and provides $8 billion for states to set up high-risk pools to cover those with pre-existing conditions who are unable to find coverage on the open market. A number of Republicans in the Senate have expressed concern over how the bill would affect states that expanded Medicaid and how much it would drive up premiums for seniors.

The bill is expected to be significantly altered by the time it reaches the Senate chamber.

This is a developing story. We will continue to provide details as they come.


House Passes GOP Health Care Bill

House Passes Measure to Repeal and Replace the Affordable Care Act