The Shifting Medicare Health Insurance Rules Baffle Agents

SAN DIEGO -- As health care delivery in general gets more complicated, it is doubly so for those relying on Medicare and its associated government rules and regulations.

That makes the health agent an important conduit to helping people get the best coverage for the best price. A panel today at the National Association of Health Underwriters' 2019 convention will present some options to supplement Medicare coverage and tips for remaining in compliance.

Many agents are apprehensive about selling Medicare-related benefits, in part, because "65 isn't what it used to be," said Jessica Waltman, principal of Forward Health Consulting. Some people remain working, some are retired, and those in between might be working part-time,filling some role in the gig economy or doing some combination of things to generate income.

That can leave the agent skittish about even offering Medicare supplement products, Waltman said.

"Each one of those categories have compliance responsibilities within it," she explained. "You might just say ‘I don’t know enough about this.’ But there are ways to work through this and the compliance responsibilities that are in place are largely in place for consumer protection.

"It’s really about learning when you might approach things one way and where you need to make sure that consumers are protected in another way."

Reading The Regulations

Understanding where the regulatory landscape is heading can prepare agents to nimbly fill those Medicare coverage gaps, Waltman said.

"We’re just trying to provide agents with that opportunity because we do think that the older population does have insurance needs that are ideally suited to these types of products and we want to make sure agents understand that and can reach them in a legal, compliant way," she added.

In a nod to how quickly regulations can change, Waltman had to insert some last-minute slides to her presentation after the Trump administration announced new Health Reimbursement Arrangement (HRA) rules last week.

HRAs are generally account-based group health plans funded solely by employer contributions that reimburse employees for health care costs.

The regulations were issued to increase the usability of HRAs, to expand employers’ ability to offer HRAs to their employees, the administration said, and to allow HRAs to be used in conjunction with nongroup health insurance coverage, typically on the individual market.

'You Kinda Missed Something'

But the administration did not factor in the Medicare population, Waltman said, which entail a different set of rules and regulations than market-based insurance. There are more rules to come and administration officials vowed to address Medicare, she added.

"I think it’s a good example of how the market shifted and population needs shifted and people like agents and brokers went to the central government and said ‘Look, you kinda missed something here. And if you’re going to have this thing to serve one aspect of the market, you’re going to need to serve this other aspect, too,'" Waltman said.

"They at least attempted to make an accommodation (for Medicare). They wouldn’t have done that if the agents hadn’t presented to them the market need."

InsuranceNewsNet Senior Editor John Hilton has covered business and other beats in more than 20 years of daily journalism. John may be reached at [email protected]. Follow him on Twitter @INNJohnH.

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