Medicare Advantage Commissions Increased for 2018 Enrollments
This memorandum provides contract year (CY) 2018 compensation limits for agents and brokers, directions for submitting amounts into the Health Plan Management System (HPMS), as well as training and testing requirements.
Compensation Rate Adjustment for CY 2018
As provided in 42 C.F.R. §§422.2274(b)(1) and 423.2274(b), the compensation amount paid to an independent agent or broker for an enrollment must be at or below the fair market value (FMV) cutoff amounts published yearly by CMS.
The CY 2018 FMV cut-off amounts for all organizations are as follows:
(2.7% increase ($12 / $6) to the writing agent for 2018 Medicare Advantage enrollments.)
NOTE: The FMV amounts for CY 2018 are rounded to the nearest dollar. The Initial Year amount is the maximum allowable to be paid for enrollments during compensation cycle-year 1. The renewal amount is the maximum allowable to be paid for enrollments during compensation cycle-years 2 and beyond.
Compensation Rate Submission for CY 2018
As in past years, all organizations must inform CMS via HPMS whether they are using employed, captive, or independent agents. Organizations that use independent agents must provide the initial 2 and renewal compensation amount or range of amounts paid to these agents. Additionally, if an organization pays referral fees, the organization must disclose the referral fee amount. CMS has provided instructions for data entry in the HPMS Marketing Module User Guide.
Organizations may submit their agent/broker information in the HPMS Marketing Module from
CMS expects organizations to keep full records documenting that they are updating compensation schedules and paying agents and brokers according to CMS requirements.
Please note that the CY 2018 compensation information submitted will be made available for the public to view on www.cms.gov prior to the annual election period for CY 2018.
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Long-Term Care in America:
The AP-NORC Center’s fifth annual Long-Term Care Poll explores how older Americans feel about the services and support in their community, the country’s preparedness to meet the care needs of an aging population, and other attitudinal trends.
Results from the 2017 Long-Term Care trends poll find that two-thirds of Americans age 40 and older feel the country is not prepared for the rapid growth of the older adult population. The Associated Press-NORC Center for Public Affairs Research survey also finds that at the local level, less than half of older Americans say their community is doing a good job of meeting older adults’ needs for nursing homes, assisted living facilities, and home health care aides to provide long-term care. Additionally, a majority of older adults say they would like the federal government to devote a lot or a great deal of effort this year to helping people with the costs of ongoing living assistance.
The population of Americans age 65 and older is growing at an unprecedented rate. In 2014, there were 46.2 million adults age 65 and older, and this number is expected to more than double to comprise about 98 million older adults by the year 2060. The majority of these older adults will require at least some support with activities of daily living as they age—things like cooking, bathing, or remembering to take medicine.
Five Things You Should Know From The AP-NORC Center’s 2017 Long-Term Care Poll:
Tags: long term care
Profits are booming at health insurance companies
The largest health insurance companies in the United States reaped historically large profits in the first quarter of this year, despite all the noise surrounding the Affordable Care Act's individual marketplaces.
Aetna, Anthem, Cigna, Humana and UnitedHealth Group — the big five for-profit insurers — cumulatively collected $4.5 billion in net earnings in the first three months of 2017. That was by far the biggest first-quarter haul for the group since the ACA exchanges went live in 2014.
Aetna lost money because it had to pay Humana a $1 billion break-up fee after their merger failed; otherwise it would have been in the black. Some other things to keep in mind:
Tags: Health Insurance
5 New Facts About Retirees' Real Health Care Bills
Analysts who want to protect low-income Medicare enrollees against increased out-of-pocket costs have published interesting new data on the high-income enrollees’ out-of-pocket spending.
Cathy Schoen and two other colleagues affiliated with the Commonwealth Fund put the spending estimates, which are based on government survey data, in a review of Medicare enrollees' cost burden, broken down by income and health status.
Younger people and health care policymakers tend to talk as if Medicare is a magic wand that makes patients' health care costs disappear.
Insurance agents and financial advisors know that the opposite is true, and the Commonwealth Fund analysts show how untrue that fantasy was in 2016.
The 56 million enrollees in the data sample spent an average of $3,024 per year on all kinds of acute and long-term care out of pocket in 2016.
Of course, the typical Medicare enrollee who is using the services of a financial professional is likely to have a higher-than-average income. For a financial professional, the most interesting bits in the new paper may be the out-of-pocket spending estimates for Medicare enrollees in the authors' top income category, for people in households that earn more than 400% of the federal poverty level.
Here's a look at what the authors are reporting about those relatively high-income households.
Even the authors' top-income category may not be of much use for professionals working mainly with families with very high post-retirement income.
About 12.5 million of the Medicare retirees in the data sample, or 22% of all Medicare enrollees, had household income over 400% of the federal poverty level in 2016.
In 2016, in most of the United States, 400% of FPL was just $48,240 for a single individual, and $64,960 for a couple.
The people in the analysts' highest-income category spend an average of $3,486 per year each on out-of-pocket health care expenses.
If a husband and wife who together have $64,960 in annual income each spend $3,486 per year on health care bills, that means out-of-pocket spending will eat up about 11% of their income.
The authors of the new paper don't break catastrophic risk down by income level, but they note that Medicare enrollees in the top 5% in terms of out-of-pocket spending probably spent an average of $19,009 out of pocket in 2016.
(Related: Majority of Medicare Advantage Enrollees Switching From Traditional Medicare)
If one spouse in a couple spent $19,009 in 2016, and the other spouse spent $3,486, the couple's total spending would amount to about 35% of the $64,960 in annual income for a couple right at the 400% of the federal poverty level income cutoff.
Because basic Medicare is generous about covering inpatient hospital expenses, inpatient hospital bills make up less than 10% of the out-of-pocket spending burden even for the Medicare enrollees who rank in the top 5% in terms of spending.
About 60% of high-income Medicare enrollees have employer-sponsored retiree health benefits, and those plans often offer especially generous inpatient and outpatient hospital care benefits.
That means the biggest components of out-of-pocket spending for high-income Medicare enrollees tend to be bills for the expensive drugs used to treat conditions such as high blood cholesterol levels, and for hearing care, vision care and dental care.
In 2016, high-income Medicare enrollees spent an average of $564 on dental care, $820 on audiologists and other providers not paid by Medicare, and $913 on prescription drug co-payments and coinsurance bills.
Professionals who help clients with stand-alone long-term care insurance, long-term care hybrids based on annuity or life insurance frameworks, or other long-term care planning strategies know that long-term care costs can dwarf other health care spending drivers.
The new out-of-pocket spending analysis shows that, for the 2016 Medicare enrollees in the top 5% in terms of out-of-pocketing spending, long-term care spending of all kinds accounted for more than $13,400 of the $19,009 in average out-of-pocket spending.
Psychology of Sales: Use Your Personality Type to Your Advantage
Many years ago, Carl Jung researched and proposed the existence of 16 personality types. Using a test called the Myers-Briggs Type Indicator, or the MBTI, which has a minimum of 93 questions, people can find out which type they are.
Each type is comprised of four pairs of personality factors: introversion (I) and extroversion (E), intuition (N) and sensing (S), thinking (T) and feeling (F), and judging (J) and perceiving (P). These factors are represented by a letter, and the combination of the four letters is your type.
Once you’ve taken the test, you can find out how much each personality factor affects your disposition.
In the sales profession, some people may think only certain personalities can be successful; for example, it’s a common belief that only extroverts can close deals and relate to customers.
According to research, however, introversion is slightly more common than extroversion overall, and it takes both extroverts and introverts to build a successful sales team.
Use your personality profile to your advantage. No matter if you’re an INTJ or an ESFP, you can reach and convert customers. Learn more about your personality type, and how to use it to your advantage, in the infographic below.