Is a Medicare Supplement Considered a QHP?

[bworthey]

Under ACA with the definitions of qualified health plans (QHPs) and non-QHPs, are Medicare supplements anywhere under those guidelines? I feel like I know the answer to this but I have a crazy situation that I'm trying to get some clarification on. Thanks.

 

[Tkruger]

Short answer is yes.

Outline the situation rather than fishing for an answer.

 

[bworthey]

Short answer is yes.

Outline the situation rather than fishing for an answer.

I work for a hospital, in addition to holding life and health license, and sell insurance on side (life and med supps). With the company I work for at the hospital, I am supposed to be a certified application counselor and sign people up for health plans through the marketplace. Well, I just found out today this is a conflict of interest and could impact my employment with this company. I wasn't sure if the Medicare supps fell under this designation as QHPs or non-QHPs because this seems to be the crux of the conflict - if I receive compensation from enrolling people in these. I'm trying to figure out how to keep my job basically. It's not looking great!

 

[Tkruger]

Ok....so Med Sups are QHP's....period.

If you have a conflict of intrest with your job and you want to keep it, simply cave to their rules and stop that part of what you are doing.

It sounds like you have an FMO who doesn't want you to work the under 65 market...

Honestly, I can't blame them. No comp for many states.

That said if you want to keep the hospital job try to explain what you are doing day to day and see if you can get if fixed.

If it's the hospital that has the issue and you want to keep that gig then cease production with the FMO..

Those are your 2 choices....


****...forgot...Go independant.

 

[bworthey]

Yeah, the issue is with the hospital job. Signing people up through the marketplace is just one part of my job duties. And yeah, I'm an independent agent. And yeah I'm feeling like those are my options at this point. Thanks for the clarification. I just find it odd that it is a conflict of interested based on what I've read - I would have thought having a license would be more of an asset actually. Guess not!

 

[Tkruger]

Yeah, the issue is with the hospital job. Signing people up through the marketplace is just one part of my job duties. And yeah, I'm an independent agent. And yeah I'm feeling like those are my options at this point. Thanks for the clarification. I just find it odd that it is a conflict of interested based on what I've read - I would have thought having a license would be more of an asset actually. Guess not!

It's a silver lining...what are you confused about?

Carriers are NOT PAYING COMMISSION on MANY 2017 plans.

Count your blessings....you have a gig. Focus on that.

 

[goillini52]

Yeah, the issue is with the hospital job. Signing people up through the marketplace is just one part of my job duties. And yeah, I'm an independent agent. And yeah I'm feeling like those are my options at this point. Thanks for the clarification. I just find it odd that it is a conflict of interested based on what I've read - I would have thought having a license would be more of an asset actually. Guess not!

Sounds like you're a captive agent to me...captive to the hospital.

 

[FLM2]

Let's put some clarification here-a Medicare supplement isn't a QHP because it doesn't provide comprehensive coverage for the Essential Health Benefits that are part of the Affordable Care Act, it simply supplements Medicare, which is a Qualified Health Plan.

As for your employee status, that is another question that I am not qualified to answer.

 

[somarco]

I am going to muddy the water a bit and ask for a clarification on the original question, is a Medigap a QHP?

I have written very little U65 health insurance since 2014 and never wrote a single subsidized plan. So I am not really "up" on all the definitions, but I didn't think a Medicare supplement was a QHP.

Under the ACA, the designation of qualified health plan (QHP) is given to health insurance plans that are sold in the marketplace (exchange).* The same basic rules apply to plans sold both in and out of the exchanges:* they must be guaranteed issue, follow the ACA’s cost-sharing guidelines, and cover “essential health benefits” with no lifetime or annual maximums.

https://www.healthinsurance.org/glossary/qualified-health-plan/

Medigap plans are not always guaranteed issue.

Medigap plans do not cover Rx, which is one of the essential health benefits.

Seems to me Medigap plans do not meet the definition of QHP. OTOH Medicare would meet the definition of a QHP. You can't buy Medigap unless you have Medicare but the Medigap plan itself doesn't seem like it is a QHP.

Regarding the OP question about conflict of interest, on the surface it would appear there is a conflict. But I have not seen his employment agreement so cannot say what is a violation and what isn't.

My reading of the OP posts seems to indicate he is employed by someone other than the hospital. Perhaps a carrier, or (more likely) an agency.

As Ted pointed out, he is in a good position (at least for now) since many carriers are no longer paying commission on Obamacare plans. Given that, I would wonder how he validates his agreement since many policies no longer pay a commission. How does an employer continue to pay a salary when the item sold does not pay a commission?

FWIW I knew a guy, years ago, that was an independent agent with an office in a hospital. He mostly wrote non-can DI on the staff and his "service" was promoted as an extension of the hospital benefit program.

As I recall, he paid them rent and they funneled employees to him when they were interested in the hospital disability program.

Sweet deal for him.

 

[pfg1]

My initial thought is that med supp is not either, in and of itself. But I'm certainly not a health expert, just seems to me that a supplement couldn't/shouldn't be considered on its own.