Be Part of the Solution: New Medicare Advantage Regulations

Phoebe Shagan, RN, CCM (retired), has more than 50 years' experience in the medical field and has been an independent licensed and certified insurance agent/broker since 2006. Phoebe earned her diploma in nursing from St. John's Episcopal School of Nursing and her Bachelor of Science Degree, with a major in Health Education, from East Tennessee State University. Phoebe is a proud member of the National Association of Benefits and Insurance Professionals (NABIP), the professional organization for insurance professionals, several Chambers of Commerce and other networking groups. To maintain her certification each year, Phoebe passes the insurance requirements for each product and company prior to being able to discuss the insurance products. Phoebe believes that health insurance can be very confusing and intimidating to her client population and therefore works with individuals most in need, to ensure they get the most appropriate health plan for individuals, not groups. Phoebe believes people should be their own health advocates or have someone else whom they can rely upon, for that reason education is a very important aspect of her work. She has taken her years of professional case management experience and transitioned where she felt her skills and experience could benefit her clients. Phoebe works to eliminate confusion and misunderstandings when individuals qualify for Medicare, turn 65, retire, or move from one county or state to another. Phoebe is licensed in 14 states: mostly on the east coast of the United States of America. The Centers for Medicare & Medicaid Services (CMS) does not want people to believe that the agents who are “selling” or “educating” people work for the CMS. Once certified and “ready to sell” for the various products that an insurance company offers yearly, a licensed agent/broker is then able to discuss and offer the plans available.

Lynn S. Muller, JD, BA-HCM, RN, CCM, is a nurse attorney, independent professional case manager, and managing partner of Muller & Muller. She is an adjunct professor in the MSN and DNP programs at Saint Peter's University of New Jersey. Lynn is a registered nurse and a board-certified case manager with extensive nursing and case management experience. Her law practice includes defense of health care professionals before the state licensing boards, consultant on such issues as regulatory compliance and accreditation, civil litigation, Wills, Trusts and Estates, and Family law. Lynn is the author of more than 60 articles and the legal chapters of the fourth edition of Case Management: A Practical Guide for Education and Practice and the second and third editions of the CMSA Core Curriculum for Case Management. Lynn is a contributor to the CCM Body of Knowledge (CMBOK), CMSA Career & Knowledge Pathways Project, and CMSA Standards of Practice for Case Management and is the contributing editor of Professional Case Management. She is a former commissioner for the Commission for Case Management Certification (CCMC), serves on the Professional Development and Education Committee, and is a facilitator for CCMC's 360, the immersion study course.

Address correspondence to Lynn S. Muller, JD, BA-HCM, RN, CCM, Muller & Muller, P.O. Box 164, Bergenfield, NJ 07621 ([email protected])

Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can only be given by an attorney admitted to practice in the jurisdiction/state(s) in which you practice.

Do you have a question, issue, or idea you would like addressed here? Questions are always welcome. We encourage ALL readers to submit questions and/or manuscripts, as well as topics you would like to see addressed in this department. Questions and other inquiries are accepted by e-mail at: [email protected]. If you have an idea you would like to discuss, send your contact information by e-mail and you will be contacted via your preferred method.

The authors report no conflicts of interest.

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