HME Industry Q&A with Tyler Poole

HC: Give us a synopsis of the Medicare Advantage program.

TP: The Medicare Advantage program was established in 1997 as an alternative to traditional Medicare benefit administration. Instead of receiving Medicare Part A and B benefits from the federal government, Medicare Advantage—also known as Medicare Part C—enables enrollees to receive their benefits through a private insurance carrier like United Healthcare, Anthem Blue Cross Blue Shield and many others. These plans are first approved by Medicare before being offered to Medicare recipients, ensuring that they meet requirements for quality, benefit richness and value. Simply put, those with a Medicare Advantage product still have their Medicare entitlement, their rights and protections under Medicare and access to Medicare grievance processes, etc. Their benefits, however, are administered by a private insurance company. That insurance carrier is responsible for their benefits package and pays their bills, not Medicare Part A and B. Medicare Advantage plans are actually quite robust benefit packages, offering all original Medicare benefits, and also typically offering other services that Medicare A and B alone would not offer such as prescription coverage, preventative dental care and/or vision care services. The premium, or monthly cost associated with these plans, can also be quite astonishing, and in many areas these plans can be received for $0 monthly, meaning the Medicare recipient would only need to continue paying the Part B premium they were already paying. So these programs are frequently a good deal for beneficiaries, for Medicare and, since the private insurance company is paid directly by Medicare each month for caring for each of these Medicare recipients, it is also a good deal for the carriers.

HC: How will you work with HME/DME providers?

TP: Truth be told, the discovery of this solution to competitive bidding might not have been stumbled upon and Benefits365 might not have been founded if it weren’t for the overlap of a career insurance agent like myself and someone like our president, Tom Ivany, who spent the last three decades in HME. Tom saw the answer to the bidding crisis that the industry is facing, but lacked the insurance background to know how to compliantly make it work. First, our service is free. We do not charge a fee of any kind to the HME provider nor to the Medicare recipient. Our model is simple. We provide mail flyers, which meet CMS regulations for compliance, for HME companies to place in their monthly statements to patients. These flyers would state that they can contact us to discuss the changing health care climate and the options that may be available to them. We provide a free needs analysis to each beneficiary, and if there is a product available that they are eligible for and interested in we will help them complete enrollment into that plan. Further, we continue to service those clients on a yearly basis as the landscape of Medicare coverage is constantly evolving. With HME reimbursements estimated to have been cut by 45 percent under this second round of competitive bidding, it is clear that whether you were awarded bids or not, all HME providers lost. We offer an education to patients on Medicare Advantage that could greatly improve the bottom line for HME providers. No, we do not and cannot steer patients to any particular plan or group of plans, but the truth is that many beneficiaries I’ve spoken to have not ever been properly educated on what a Medicare Advantage plan is and how it works. These plans can offer substantial value to many Medicare beneficiaries, and can significantly grow the bottom line for oxygen providers, diabetic supply providers and all other HME providers. CMS has very specific guidelines that we must adhere to in order to meet their requirements. Much like the HME industry, the insurance industry is open to stringent penalties if we do not. You could not simply contact the local Humana agent, for instance, and ask him to enroll your patients in a Humana Medicare plan. That is completely in violation of Medicare marketing law. So this is a very sensitive process, and the penalties for not being compliant are huge. Our program is simple, CMS-compliant and free.

Tyler Poole is vice president of operations at Benefits365. Call 330-259-8813 or visit www.benefits-365.com.