To help us understand what Medicare Advantage plans are currently doing to attract and retain members and what they might do better is Betsy Seals, CEO, and Co-founder of Rebellis Group.
A consulting firm with deep expertise in health plans, PBM, and government regulations. Betsy has 20-years’ experience in the healthcare industry and has worked for notable companies such as Scan Health Plan, Anthem, and Gorman Health Group.
Transcription of Podcast
Betsy Seals, Beth Bierbower
Supplemental Benefits In Medicare Advantage With Betsy Seals
Beth Bierbower 00:03
Welcome to B-Time, everybody. I'm Beth Bierbower, healthcare executive author and hosts of the B-Time podcast each week on B-Time, I have the privilege of interviewing a seasoned executive, company founder or other health care industry expert and we talk about a variety of business matters. Whether you're a large company or small, inside the industry or out anytime is something for you to help you stay on top of your game. Before we get started with today's episode, I want to let you know that this is the last episode for 2021. We will be back after the new year with a great number of terrific guests. In the meantime, I wish everybody a very happy holiday and see you in 2022.
Beth Bierbower 00:47
Now let's get started. It is December and before we wrap up the new year, I wanted to get a perspective on Medicare Advantage open enrollment for 2022. Specifically, I wanted to better understand what types of new plan designs Medicare Advantage health plans are offering to existing and potential members. Each year Medicare Advantage Health Plans offer some new benefit or service to cover to be more attractive than the competition and to induce member switching. However, in October of this year, that Kaiser Family Foundation released a study that said 7 in 10, Medicare beneficiaries did not shop plans during the 2018 open enrollment period. If this is the case, then why all the focus on plan design.
Beth Bierbower 01:38
To help us understand what Medicare Advantage Plans are currently doing to attract and retain members. And what they might do better is Betsy Seals. Betsy is the CEO and co-founder of the Rebellis Group, which is a consulting firm with deep expertise in health plans, PBMs, and government regulations. And the Rebellis Group helps organizations with strategy and operational processes to help them optimize their business models. Betsy has 20 years of experience in the health care industry and his work for notable companies such as Scan Health Plan, Anthem, and the Mormon Health Group.
Beth Bierbower 02:17
Betsy, welcome to B-Time.
Betsy Seals 02:19
Thank you. Glad to be here.
Beth Bierbower 02:21
Oh, we're very, very happy to have you here, Betsy. Now Betsy, let's start out with talking about Medicare Advantage Health Plans. This is a time of year where folks are out looking at their plan designs saying should I stick with my Medicare Advantage Plan? Should I go to a new plan? And we know it's a very busy time of year. But back in October, The Kaiser Family Foundation released a study that said back in 2018, that's 7 out of 10 Medicare beneficiary said they didn't shop health plans. Why not? Let's see what are your thoughts? Why aren't people shopping?
Betsy Seals 02:55
You know, it's interesting, right? And data can look different depending on how you view it. So if we say we have about 26 million beneficiaries in Medicare Advantage, 3 out of 10 switching during the AAP is still a pretty good amount. And especially when you consider that Medicare advantages, always, based on my experience the most lucrative line of business. And that's why there's so much focus right roughly a six-week period to really make your mark in AEP and attract those beneficiaries from other players. And also, you know, attract agents as well any agents that are in their initial coverage during that time period, because you're doing so much marketing already, you really can kind of grab up some of those pennies as well.
Betsy Seals 03:39
So there's still a lot of movement that's happening both in terms of switchers and of course people aging into to the system as well.
Beth Bierbower 03:48
Right? And I think, you know, you explained it, well, there's this really short window, right, sort of like Black Friday for retail, right? This is a really short window for you to really get the attention of your consumers. Now let's even think about plan design. I think about it in two components, I think about coverage. And then I think about costs and want to think about costs, I think about the impact of the premiums and how much premium is it? What are the cost shares? The office visit copays, the hospital co pays? So let's talk about the cost part first. What is it in that equation? Do you think? Or do you have any insights on that would cause somebody to really say, hey, I need to shop? Is it a? Is it a significant increase or an increase of a certain amount on a premium? Or is it hey, it's my primary care copay. That's Really important. What are your thoughts around that?
Betsy Seals 04:37
You know, I think that there are a number of different things that play into kind of the switcher activity and AEP. Some of those are certainly cost related. You're always going to have your, you know, $0 shoppers, and it may be that their plan went from $0 premium to a $10 premium, but that to them is still reason to go see if there's another carrier that has that $0 and $0 PCP and $0, you know, tier one copay for prescriptions. So a perk, a certain segment of the population and Medicare Advantage is always going to be your shopper population. And that has to do with maybe premiums or co pays were raised. Or maybe there are new supplemental benefits, which I'm sure we'll talk about a bit later, that are available in another plan that aren't available on theirs. And the other you know, things that we see really drive beneficiaries to look elsewhere are providers provider in network is one of the main reasons that we'll see switchers during AEP and Medicare Advantage Plans know this very well, if they were contracted with a big provider network in a certain County and they lose that contract, that whole county is shifting to, you know, the competition. So that is certainly one of the kind of top plan choice drivers that we see. And then, you know, member experience as well. And that plays into beneficiary saying, yeah, my co pays are my premium is low within this plan. But I call and I'm not getting answers, you know, I filed a number of grievances I'm keep filing appeals, whatever it is, that beneficiary experience is not good. And that will often as well cause someone to look around at other options.
Beth Bierbower 06:13
Sure, that's great information, I want to pull on a few threads that you that you had there. I think it is important that what I hear you saying is premium stability, and cost share stability is really important, because these people are on fixed incomes in general, right? And so they need a 10% increase, it may be off of a $25 a month premium, but why your Social Security is only going up 2% That matters, right?
Betsy Seals 06:38
Absolutely, it does matter. And I think, you know, I started my career in Medicare Advantage and customer service. I was in college. And it was a great job, right, because it paid me 12 bucks an hour and I didn't have to be on my feet like in my waitressing jobs. And I think through that experience, I really got to understand the the struggles of your typical Medicare beneficiary and especially to low income beneficiary, when you're talking about folks who are on a fixed income $2 is a big deal, $2 on a prescription where they didn't have to pay $2 before may mean the difference between eating breakfast. So it's it's difficult sometimes I think for us when we're just looking at plan design. And you know, putting all the pieces and parts together to make a successful plan financially, sometimes lose sight of the fact that to Medicare beneficiaries, and especially duals, or low income beneficiaries, a couple dollars is a huge deal, a huge deal, and that can absolutely drive them somewhere else.
Beth Bierbower 07:33
Good information. So let's talk about coverage a little bit and the benefit plan designs, we know that CMS has really changed your view a little bit, broaden their view, if you will. And there are now special supplemental benefits available for people that are chronically ill. And I think those became effective, effective back in January of 2020. So the health plans have had some experience with them. And they do include items that were not traditionally covered under Medicare, but are tied to a specific chronic condition could be maybe a ramp for example or something like that. How do you see health plans? Do you see them taking advantage of these new this new chronic conditions supplement? And what types of benefits? Are you seeing emerging that typically wouldn't have been covered before under Medicare?
Betsy Seals 08:25
Yeah, so this has been a really interesting thing to watch. Because if we think about the timeline, right, these SSB CI special supplemental benefits for the chronically ill subset became available starting plan year, 1/1/2020. So the regulations were there, and we you know, all put these benefits into the bid or didn't. And then they were available, and then COVID hits, right. So Well, for me, for example, I love to watch these things. I think he okay, I'm really interested to see what happens, how they're utilized, well, then everything changed, the landscape completely changed, where you have, you know, folks getting their care through TelaDoc. And, and different needs, certainly from a social perspective. So I would say that, you know, what we are watching and what we're expecting, really, everything that happened in the world threw a wrench into it. So I have seen a very slow adoption to the SSB CI benefits. Where you have some players really kind of thinking it's too complicated, right? To get all these people in the room, it's already hard to come up with a PBP or benefit design. To begin, but to get the players in the room on the clinical side, to really say which of these non health related benefits are going to have a meaningful impact on this chronic condition. It makes that even more difficult.
Betsy Seals 09:42
So from a big picture perspective, I think that a lot of this is underutilized. And especially you know, with certain Medicare Advantage plans, you see some organizations like I know Anthem came out and I was I was really, you know, interested and excited to see them offering Things like a pet food benefit for people who had a service animal, there we go. And then Humana did some really interesting things as well, you know, and especially during COVID really took advantage of some of these, these options. But from a big picture perspective, I think that there is a lot that can be done a lot that can be done to really impact, you know, social determinants of health, impact, those things that are not primarily health related, but we know have a huge impact on health outcomes, like social isolation, right, and especially during this time, so there's a lot of room and I do see some companies kind of coming up with really innovative ideas, you know, different apps for mental health, as an example, innovative ideas to really get to the core issues, that just the basic healthcare that we've been used to over the past, you know, 20 years that I've been, and Medicare Advantage really doesn't even scratch the surface of those other factors that impact health outcomes.
Beth Bierbower 11:02
Well, it sounds like we still have a lot of opportunity for health plans to continue to grow and become more savvy around these chronic condition benefit designs, if you will. So let's go outside that and go to what I would refer to as traditional supplemental benefits, right dental vision, over the counter, I think we're seeing transportation services, as you mentioned, was SDoH, and, and food cards to the grocery store, things like that. What are you seeing this out there? And do you have a feel for what you think is most popular, and maybe most popular right now means from a health plan perspective, as opposed to a consumer perspective? Because these are new to some of them?
Betsy Seals 11:39
Yeah. So over the past, I want to say, kind of think what year we're in here. Over the past five years, I would say we've kind of seen a huge increase in your standard supplemental benefits, like dental vision, transportation, OTC, certainly over the past several years have been has become almost a table stakes benefit. And then now we're seeing newer items like the food cards, or the Part B premium buy down, right, that are entering the market, Medicare Advantage is becoming more and more and more competitive. And so we're seeing organizations get really creative in what they're providing, and the services and benefits that they're providing. So I would say that, you know, yes, these benefits are popular with Medicare Advantage beneficiaries, and especially shoppers, if you know, we're talking about Mrs. Smith, who's on a fixed income, and you're going to bring a bag of groceries, you're going to give her a food card that she can use each month. And she has an OTC benefit, where she can get her you know, over the counter items at CVS, those things that make a pretty big difference to her in her life and her day to day, transportation as well. So definitely these supplemental benefits, we'll call them the standard supplemental benefits are things that Medicare Advantage beneficiaries are looking for, and are shopping for. And it's interesting, because we don't actually always see, you know, full utilization, but of these items, but what you'll find in going to sales meetings and talking to Medicare beneficiaries, is they kind of have their checklist, right? Somebody told them, these are the things you want to look for. And they're going to ask the question of do you have OTC and do you have transportation? And will you bring my groceries? So really important for organizations to kind of strategize around those benefits and in terms of their local market?
Beth Bierbower 13:25
Well, you answer my own question around the utilization as to whether or not these are getting utilized. But that's a really neat perspective to understand that the senior has their checklist. And I can envision that right that they have a checklist, their friends have told them what to what to expect, and whether they use it or not. They want to see that it's that it's there. So I can see how it can get extremely competitive for the health plan. And then just when you mentioned Part B subsidization of Part B, I'm must say this a duality eligible, and her Part B cost is $167 a month. And that's, that's a lot of money. And that's a lot of money that people you know, the people could use. So I could see that being very popular to go into a plan is going to subsidize my, my part B payment for sure. So let's talk a little bit about health outcomes. Now. We talked about that, from the chronic conditions, they're new. So we don't really know whether we're seeing outcomes, but what about some of these other things have been around about dental and vision? You know, we know they contribute to health. Are we seeing outcomes with those or is it just more that they have to be there from a competitive checklist standpoint?
Betsy Seals 14:34
I definitely know that there is data to support as well, from a clinical perspective, certainly the dental the comprehensive dental, transportation, right, just from getting a beneficiary from their home to their doctor's office. Not only is that you know, increasing routine care, but also from the financial side for the Medicare Advantage, health plan, you know, risk adjustment as well as stars all of those things play into getting that many in front of the doctor for their routine care. You know, certainly food when we're looking at providing, you know, food instability, right, and we're looking at providing food to a beneficiary who's not sure where their next meal is gonna come from those things have market, you know, outcomes and difference from a clinical perspective as well and a health outcomes perspective as well. So, so definitely, I think there's a lot of evidence to really support that these are important benefits, as well as being you know, good from a competitive perspective,
Beth Bierbower 15:27
Based upon your experience Betsy, are there benefits, so you think we're missing that we're not seeing out there yet that you think gotta be out there or things that you think might be coming?
Betsy Seals 15:37
I think I could probably talk about that for an hour. And I would definitely want, you know, bring my clinicians and as well to the conversation, and, and my pharmacist, I think, really looking in at if I'm running a health plan, looking at the chronic conditions that are prevalent within my population within my beneficiaries and saying, Okay, if we have a high percentage of diabetics, what can we really do? Is it health education? Is it you know, food delivery, what can we really do to have an impact on that chronic condition or other chronic conditions. And I think putting in place those SSB CI benefits, whether it's, you know, a social club, or its modifications to the home for somebody who's in a wheelchair, those things really can and will have a meaningful impact if we can take advantage of the opportunity that CMS has given us within regulation. So that's really what I'm waiting to see. And like I said, some health plans have done a really good job of being innovative and being at the forefront, and some are not quite there yet.
Beth Bierbower 16:39
Now, you mentioned the social club, are you seeing benefits that health plans are offering due to social isolation, which I can only imagine has been exacerbated because of the pandemic?
Betsy Seals 16:50
Yes, we have seen that. And, and yeah, it is, it is exacerbated because of the pandemic. And it's also more difficult because of the pandemic, we have seen some interesting ideas that have to do with, you know, social clubs at coffee hours through the computer, although I think for Medicare Advantage, beneficiaries, that can be tricky when it comes to technology perspective. But adult daycare, you know, for beneficiaries, who have a caregiver at home, the caregiver needs that break, the beneficiary needs that, that social outlet. So we see a lot of different items in play in the industry, some of them that are being covered by the health plan, and some of them that are more community based. So we see that really coming into play as well, you know, as we learn and understand more, and especially this last year, right, we understand it very clearly what social isolation does to a person's mental health, no matter what age, and it's really, you know, critically important in the Medicare Advantage population, which tends to be more socially isolated anyway. And also, during this time has, you know, had a reason more to stay within their house and not go out. So, so we see it very clearly at this time. And I think there's a lot of different companies doing, you know, innovative products and designs and, and programs to help with that.
Beth Bierbower 18:09
And Betsy, I want to talk about one other thing that you just briefly touched upon in response to an earlier question, and that's customer experience. We know that product designs can be replicated, you know, year over year, one plan does this and other ones, it's up, we're going to replicate that. But most experts would say that the customer experience is the most important. And we know the CMS is starting to focus on that right because they've increased their weightings on customer satisfaction in the cap survey. What do you see as a trend happening in customer experience, whether it's in traditional Medicare Advantage, whether it's tied to stars, and, and doesn't really influence member acquisition and retention?
Betsy Seals 18:51
So member experience and customer experience is a difficult thing to manage, you know, having been on the health plan side and, and starting in customer service I and then you know, moving over to consulting and working in all different areas of the business that really can have an impact on customer service or beneficiary experience, we'll say it's a very difficult thing to master. There are some companies that have really done a very good job of it and others that we see struggling, right. And what we've seen with CMS is they have increasingly put more weight on customer experience. And what we really are hearing as a message from CMS is if you can, as an industry start to get this right, right, we've given you enough time. If you can't get it right, you are not going to be successful. Because when you have I think it's over 50% of the weighted measures in 2020. By if I remember correctly, are around customer experience, you know in one aspect or another. If you don't get that right, you're not going to get your bonus payments. And if you don't get your bonus payments, you're not going to be able to have as competitive of a benefit design. So the way that we see stars and customer experience really flowing into benefits in the competitive landscape. It's not necessarily that beneficiaries are shopping based on stars, but that they're shopping based on the best benefits, right. And usually what we see is because of that bonus, then that bonus payment impacts your benefit structure. And so kind of in a way, it does lead out, you know, one way or the other the low performing plans. And so that's really the trend that we see, by and large, I'd say that, that Medicare beneficiaries are not real aware of how the star ratings program works.
Beth Bierbower 20:32
So they're not really using it. But to your point, when you have those extra dollars to play with, you could make your benefits more attractive, I have to share a story with you and are with our audience very quickly, because last week, I had to go to the Department of Motor Vehicles in Florida.
Betsy Seals 20:45
Beth Bierbower 20:46
Right. Right, You get this picture. But um, my husband, I was so excited because you made we made an appointment online. And when we got in there, we could see we were moving through very quickly, we said, oh, this is great, until we were standing there, while the gentleman was processing our paper. And we could see people walking up to this window that hadn't made an appointment. And literally, they were just turning them away. And these were elderly people, and they were telling them, well, you don't have an appointment. We only make appointments online, you have to go to the library you have to do and, and I'm thinking, why are they doing that to these people? Why are not they just making an appointment for them? What are they doing? They have to go to the library to have somebody over there help them make an appointment? There, he they're here? And wouldn't that be a better customer experience? You may, you may still tell the elderly person I can help you with your problem today, but I can't schedule you for an appointment. And they wouldn't they wouldn't even do that. So it was it was part improvement, because we didn't have a long wait. But it was really very disillusioning, saying all these people out here still obviously need help. They don't have computers, they're not savvy on computer, and they couldn't even get an appointment. So lesson learned, I think for anybody in, in business thing. Online is not going to be the way for everybody. Right? And help people are at the point of service, when they reach out to you. Guess what may not be in your protocol, may not be in the line of thinking that you're thinking about when people need help just do the right thing, override the script and help them. I wish I would have seen that at the DMV in Florida last week.
Betsy Seals 22:23
Yeah, and I have seen that many times, you know, I've had I'll say the pleasure of listening and on to customer service and sales calls and, and a lot of different aspects of the business, you know, whether it's looking at grievances and appeals. And what we see is, you know, the lack of member experience, really the lack of lack of customer service, because if a Medicare beneficiary calls Member Services and needs help with something, and you transfer them here and transfer them there, you know, a lot of ways what we're really creating as a barrier to care. And that's what we see in this population, they're not going to go to library, right? To get on your download your whatever and do this or that, and they're just not going to get the care. And so it's really important, you know, that customer service and that training of your frontline that's interacting, to help them understand how this really does have an impact. And, you know, whatever it is to make sure that we provide that service to the beneficiary.
Beth Bierbower 23:18
I think what you said is really important, Betsy, excuse me for you for interrupting that those people won't get care. Because the one thing that I witnessed last week, in my experience, when the woman working for the Department kept saying, No, you have to go to the library, don't give me your papers, I can't help you, the woman who had very visible physical ailments, just threw up her hands, and turned and walked away. And you thought that woman is probably not going to be able to drive? No, not much. She's not she's not giving the help. And what happens when you're an older person, and you stop driving your road gets really small really, really, really fast, simply because somebody was unwilling to move off script and help you.
Betsy Seals 24:00
Yes, absolutely. I actually experienced this myself with a family member of mine in Medicare, who was diagnosed with a certain condition, and really just could not get answers could not get help. Luckily, right. I worked in Medicare Medicare Advantage for 20 years, so I know where to go. But my, you know, understanding of the program after those 20 years of working it, there's no possible way we can expect the Medicare beneficiary to have a similar same understanding. So making you know, providing that service and making sure they get the help they need is really important. And I've seen examples like that a million times No, mam, we can't help you call such and such number. Well, you know, they're not answering they can't help either. And at a certain point don't give up for very sad it really is.
Beth Bierbower 24:48
Now, Betsy, we know there have been a lot of new market entrants into medicare advantage over the last 1010 plus years. You know Plover, Devoted, Clever, Zing. What is it? What's the value? proposition of these new plans?
Betsy Seals 25:01
So I actually put these into a couple of different categories. And I think it's really interesting, you know when we look back at market entry around the timeframe that companies like Clover came in, right, big tech backing. And we've seen that in the industry, a lot of kind of innovation in the space. And that technology background has impacted the way that they do business. In Medicare Advantage, I would say, from an innovation standpoint, we're really behind the times we have been, I think we're catching up now. And we see companies like Clover with, you know, tech background and funding coming into the industry, we see that increases, right, or innovation and different ideas, right. And I think that's really a healthy thing that we've seen in the industry, with companies like Clover. And then you look at your companies like Zing health, Clever Health, Medicare Advantage plan that just opened up Leon Health and Miami Area, right? These companies are really focusing on the different kinds of underserved populations. And I see that as a trend that's happening right now, one that, you know, is very interesting, but also very clearly needed. Right, we know that there are underserved populations in different parts of the country. So developing plans that really understand the needs of those populations. And, and really, you know, supporting those populations is a trend that we're seeing now, which I think is really, really interesting and important. Now, not to say that anybody is excluded from those plans, everybody can join any plan, but really understanding the needs in the market that they're serving. So that's a trend that I've seen more recently. And I'm really excited to kind of see what impact that can help have as well.
Beth Bierbower 26:42
Yeah, I agree with you. And I think it's interesting to see plants such as clever as, as an example that are really, really tightly integrated with the community and focus on certain aspects. I know you work with a lot of managed care plans. So I'm not asking you to pick one. But I am asking for 2022. Do you think it's going to be a good year for Medicare Advantage? In general, do you think we're gonna see record or record in enrollments? What do you what do you see?
Betsy Seals 27:11
That's a great question. And I wish I had a crystal ball. I would say that what my perspective is that we have seen a low, right, certainly last year, there's a lot of nervousness. And all of a sudden, we saw what was typically a face-to-face sale go completely virtual. Nobody was really leaving and 2020 AEP. So we saw a reduction in a lot of pretty much across the board of switchers. I do think that this, this AEP, and a lot of ways will kind of makeup for that. I also think that because of that law that we've seen a lot of companies really went out with competitive benefit designs are really also trying to take, you know market share back in those big five. So I'm really interested to see how the benefits trends and enrollment trends change this year, or in fact, this year, I do think we'll see a lot of activity, I think we'll see a continuation of those, you know, Part B premium by downs. I'm interested to see that data, which I should have shortly. And then how is that impacting market shares? And what are we going to see in January? So, you know, verdicts still out? I would say but My prediction is that we'll see some good shifts in the industry.
Beth Bierbower 28:26
Okay, well, we will, we will know, in probably another what, six, eight weeks as numbers start to get released. And as um, as we start to see earnings, earnings calls in the first quarter from the major, major players. Betsy, we are learners on this podcast. And we like to ask our guests, if they have any books that have inspired them or podcasts that they listen to anything you'd like to share with our audience.
Betsy Seals 28:50
Yeah. So I actually, just a few years ago, started listening to podcasts. And I mostly listened to industry podcasts. And I think, like a lot of us, right, we really like to keep a keen eye on what's going on and what other leaders in the industry are thinking and perspective, that's really important. So I mostly listen to podcasts that I hear, you know, a connection on Facebook, and it's posted. In fact, that's how I found out about yours, a friend of mine was on your podcast as well. And so that's where I get a lot of my information and kind of keep pulse on where different segments of the industry are seeing and where we think things are going. And then when it comes to books, I'll be honest, I have two young children. I want a business so don't have a lot of time to read books these days. Last book I actually read was a novel called where the crawdads sing. I think this one
Beth Bierbower 29:44
It's very good. Yes.
Betsy Seals 29:45
Good. Very good. And it's going to be a movie I hear too. So I'm excited for that.
Beth Bierbower 29:49
Good. Well, you know what we do have about just a few more minutes. So let me just ask you to take a couple of minutes because we have a lot of healthcare leaders listening and why don't you explain who the Rebellis group is? What'd you do?
Betsy Seals 30:01
Sure. So we Rebellis Group are a managed care consulting firm, and we are focused specifically on Medicare Advantage. We are an expert model. So all of our consultants have 50 to 30 plus years in the industry, in their, you know, area of expertise. So we are structured very much like a health plan where we have kind of the counterpart for each area, you know, we have compliance experts, we have a Part D team, we have clinical team, we have operations teams. So, you know, I always kind of joke when somebody for Medicare Advantage plan calls me and says, Do you do A, B or C? My answer is we do everything in Medicare Advantage, everything you can think of. So that's really, you know, our kind of niche area, as well as other managed care programs. But the majority of our work and our focus is on Medicare Advantage, and not just kind of the day to day operations and compliance but really being innovative in the space, helping our clients look at what we can do you know, when we talk about those SSB CI benefits, joining all those different parts together and how we can really be at the forefront of innovation.
Beth Bierbower 31:08
Well, I took a look at some of your co-workers and they are very, very impressive. Where can people reach you? Is there an email or website?
Betsy Seals 31:17
We are rebellisgroup.com, and I can be reached at email@example.com We like to keep it simple.
Beth Bierbower 31:23
Alright, great. Bessie, thank you so much for being with us today and for sharing your insights on Medicare Advantage and I will be anxious to see what happens after the after or during the first quarter after the first of the year with enrollment for sure. Appreciate you being here.
Betsy Seals 31:39
Thank you for having me.
Beth Bierbower 31:40
All right. And with that, that's another episode of B-Time and as a reminder, we will be back after the first of the year, and Happy Holidays everybody. Thank you