Medicare Agent Broker Compensation Rate Adjustment - Medicare Advantage Contract Year 2019 

This memorandum provides contract year (CY) 2019 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 2019
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) cut-off amounts published yearly by the Center for Medicare and Medicaid Services (CMS).

The CY 2019 FMV cut-off amounts for all organizations are as follows:

5.9% increase ($27) on first year Medicare Advantage and 5.7% increase ($13) on renewal for 2019*.
PDP also increased the writing agent commission by 2.7%.

(*National rates referenced above. For Agent Use Only.)

NOTE: The FMV amounts for CY 2019 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 2019
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 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 June 4, 2018 through July 27, 2018, 11:59 pm EST. Please note that CMS does not consider the submission process complete until the organization’s CEO, COO, or CFO has completed the attestation in HPMS. Organizations that fail to submit and attest to their agent and broker compensation data by July 27, 2018 will be out of compliance with CMS requirements. Organizations will not be able to make changes to those submissions after the July 27, 2018 deadline.

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 2019 compensation information submitted will be made available for the public to view on www.cms.gov prior to the annual election period for CY 2019.

Curricula for Training and Testing Agents and Brokers for CY 2019
Regulations at 42 C.F.R. §§422.2274 and 423.2274 require that agents and brokers selling Medicare products, including employees, subcontractors, downstream entities, and/or delegated entities, be trained and tested annually on Medicare Parts A, B, C, D, and plan specific information. CMS further requires that agents and brokers obtain an 85% passing rate on the test.

In order to ensure the quality of all agent and broker training and testing programs, CMS annually provides minimum training and testing requirements to organizations. Organizations should review these requirements before developing their own agent and broker training and testing program to ensure compliance with CMS requirements. CMS permits and encourages organizations and third-party training and testing vendors to include other relevant topics, in addition to the minimum required elements.

The CY 2019 CMS training and testing requirements for CY 2019 may be found here.

Source

• Medicare Agent Broker Compensation Rate Adjustment - 2019 - View

• Medicare Part D in 2018: Latest on enrollment, premiums and cost sharing - View

• Continued Growth for Medicare Supplement Plans - View

• Express: Mutual of Omaha Weekly Updates - View
  

We have some exciting news to share. Aetna is expanding their Medicare plan offerings to new counties for 2019!

We are excited to tell you more about this opportunity! Give our Marketing Team a call at 800-998-7715 for more information!

Now is a great time to review carrier expansions and incorporate them into you 2019 AEP marketing plans.

• Medicare Part D in 2018: Latest on enrollment, premiums and cost sharing - View

• Continued Growth for Medicare Supplement Plans - View

• Trump Administration unveils drug pricing strategy - View

• Express: Mutual of Omaha Weekly Updates - View

• VALUES Quote of the Week - View

• Current Agent Incentive Trips and Contests - View

Medicare Open Enrollment Period (OEP)
is Back for 2019

There are several changes for 2019 Medicare Advantage (MA) enrollments. 

Please review the important information below regarding new CMS Guidance for Section 30.5, Chapter 2 of the Medicare Managed Care Manual.

30.5 - Medicare Advantage Open Enrollment Period (MA OEP)

42 CFR 422.62(a)(3) (Rev. 1, Issued: July 31, 2018; Effective/Implementation: 01-01-2019)

During the MA OEP, MA plan enrollees may enroll in another MA plan or disenroll from their MA plan and return to Original Medicare. Individuals may make only one election during the MA OEP.

This chart outlines who can use the MA OEP and when:

Individuals may add or drop Part D coverage during the MA OEP. Individuals enrolled in either MA-PD or MA-only plans can switch to:

• MA-PD
• MA-only
• Original Medicare (with or without a stand-alone Part D plan)

The effective date for an MA OEP election is the first of the month following receipt of the enrollment request.

NOTE: The MA OEP does not provide an opportunity for an individual enrolled in Original Medicare to join a MA plan. It also does not allow for Part D changes for individuals enrolled in Original Medicare, including those enrolled in stand-alone Part D plans. The MA OEP is not available for those enrolled in Medicare Savings Accounts or other Medicare health plan types (such as cost plans or PACE).

Some may see it as an opportunity and others as a bother. Nevertheless, prepare yourself and your clients and you should be able to navigate the new OEP with ease.

If you have any questions or need assistance in getting appointed with our leading Medicare Advantage and Part D companies, call us today and one of our knowledgeable marketers would be happy to assist.

Review the full legislation here.

• Medicare Agent Broker Compensation Rate Adjustment - 2019 - View

• Medicare Part D in 2018: Latest on enrollment, premiums and cost sharing - View

• Continued Growth for Medicare Supplement Plans - View

• Express: Mutual of Omaha Weekly Updates - View
  

Medicare Supplement 1st Quarter 2018 Results

Last month CSG Actuarial reported the 1st quarter 2018 Medicare Supplement enrollment results for UnitedHealthcare.  We now have updates from other market leaders Aetna, Humana, CNO Financial, and Torchmark, summarized below.

Aetna Reports Medicare Supplement Results for 1st Quarter 2018

For 1st quarter 2018, Aetna reported Medicare Supplement member in-force counts of 748,000, up 8,000 from 4th quarter 2017 and 37,000 over the past 12 months.  The 8,000 increase in membership during 1st quarter 2018 is 69% lower than the membership growth in 1st quarter 2017.  Aetna’s Medicare Supplement membership growth rate slowed considerably since 2016 due to an overall weakening of competitive positioning and increased competition from other market leaders on Plan G.  The table below shows Aetna’s Medicare Supplement enrollment counts by quarter since 4th quarter 2011 and annual increase in Medicare Supplement enrollment counts by quarter since 4th quarter 2012.  CSG Actuarial projects Aetna’s overall Medicare Supplement sales at 4th in the overall market over the past 12 months.

Humana Reports Medicare Supplement Results for 1st Quarter 2018

Humana reported 1st quarter 2018 Medicare Supplement lives of 238,700, a 1.2% increase over 4th quarter 2017 and a 3% increase over 1st quarter 2017.  The 2,800 increase in membership during 1st quarter 2018 is 78% lower than the membership growth in 1st quarter 2017.  The table below shows Humana’s Medicare Supplement enrollment counts by quarter since 1st quarter 2011.  Humana also reported 1st quarter 2018 Medicare Supplement premiums of $125 million, up 6% from 1st quarter 2017.  Based on estimates from CSG Actuarial, Humana’s sales ranked 7th in the market over the past 12 months.

CNO Financial Group Reports Medicare Supplement Sales in 1st Quarter 2018

CNO Financial Group (parent company of Bankers Life & Casualty, Washington National, and Colonial Penn) reported 1st quarter 2018 Medicare Supplement sales of $12.9 million, down 20% from 1st quarter 2017.  For the past 12 months CNO Financial Group reported Medicare Supplement sales of $62.7 million, ranking in the top 10 in the Medicare Supplement market.  CNO Financial Group also reported 1st quarter 2018 Medicare Supplement earned premiums of $206 million, down $4 million from 1st quarter 2017.

Torchmark Reports Medicare Supplement Sales in 1st Quarter 2018

Torchmark reported 1st quarter 2018 Medicare Supplement annualized new sales of $15.7 million, up 22% from 1st quarter 2017.  For the past 12 months, Torchmark reported Medicare Supplement annualized new sales of $69.1 million, ranking in the top 10 in the market.

Source

• Great article on how to get started in Medicare Sales - View

• UnitedHealthcare Voice signature now available in new states - View

• UnitedHealthcare Med Supp Bonus in FL and GA - View

• A meditation to recharge your mind - View

• Express: Mutual of Omaha Weekly Updates - View

• VALUES Quote of the Week - View

• Current Agent Incentive Trips and Contests - View

Medicare Advantage Plans Can Pay for Many
LTC Services in 2019

The Centers for Medicare and Medicaid Services is getting ready to let Medicare Advantage plan issuers add major new long-term care benefits to their supplemental benefits menus.

The Better Medicare Alliance, a Washington-based coalition for companies and groups with an interest in the Medicare Advantage  has posted a copy of a memo that shows CMS is reinterpreting the phrase “primarily health related” when deciding whether a Medicare Advantage plan can cover a specific benefit.

Kathryn Coleman, director of the CMS Medicare Drug & Health Plan Contract Administration Group, writes in the memo, which was sent to Medicare Advantage organizations April 27, that CMS will let a plan cover adult day care services for adults who need help with either the basic “activities of daily living,” such as walking or going to the bathroom, or with “instrumental activities of daily living,” such as the ability to cook, clean or shop.

A Medicare Advantage plan could not, apparently, cover skilled nursing home care, or assisted living facility fees. But, in addition to adult day care, a Medicare Advantage plan could pay for:

• In-home support services to help people with disabilities or medical conditions perform activities of daily living and instrumental activities of daily living within the home, “to compensate for physical impairments, ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and health care utilization.”
  
  
• Short-term “respite care” or other support services for family caregivers.
  
  
• Making non-Medicare-covered safety changes, such as installing grab bars, that might help people stay in their homes.
  
  
• Non-emergency transportation to health care services. (Plans can already pay for ambulance services for enrollees experiencing medical emergencies.)

The Better Market Alliance says the memo is a form of subregulatory guidance. It’s possible that CMS could revise the guidance, and there’s no indication whether any Medicare Advantage issuers will be in a position to add major LTC benefits to their benefits packages for 2019.

CMS said it would be changing the 2019 Medicare Advantage program benefits uniformity requirements in the preamble to a collection of 2019 Medicare program regulations posted in April.

The Medicare Advantage programs lets insurers offer consumers comprehensive plans that serve as an alternative to traditional Medicare coverage. CMS tries to control current costs, avoid any incentives for patients to get more care, and help patients shop for plans on an apples-to-apples basis by putting tight limits on the benefits the plan issuers can offer.

The Better Medicare Alliance serves many health care providers and provider groups. It also includes many insurance- and benefits-related players, including the National Association of Health Underwriters, the American Benefits Council, and Aetna Inc., Humana Inc., Scan Health Plan and UnitedHealth Group Inc.

Issuers of private long-term care insurance once treated Medicaid and Medicare benefits that “crowded out” private insurance benefits as a serious problem.

In recent years, however, as low interest rates, strict rate increase rules, and actuarial projection problems have reduced private insurers’ participation in the private LTCI market, the private issuers themselves have talked about the need for public-private partnerships.

Source

• Humana may lead Aetna, Cigna in Medicare Advantage LTC race - View

• Express: Mutual of Omaha Weekly Updates - View

• VALUES Quote of the Week - View

• Current Agent Incentive Trips and Contests - View

An Informative Guide on Breaking Into the
Senior Market

Below is an excerpt from a new article just published by PSM. In the article we address the questions we get asked the most about getting started in selling Medicare products. Whether you’re a seasoned agent looking to add Medicare to your portfolio, or a Greenhorn looking to get started, there should be something in the article for everyone.

You can read the full article here: How To Get Started In Medicare Sales

Selling Medicare can be a very rewarding and lucrative career that offers the opportunity to own your own business and enjoy passive income for years into the future.

By 2030, 18% of the US population will be at least age 65 according to Pew Research. This avalanche of seniors into Medicare has created a groundswell opportunity, and many agents are capitalizing on it.

If you have any questions, as always, feel free to give us a call and continue the conversation with an experienced marketer.

Check out the full article here: How To Get Started In Medicare Sales

Happy Selling…

• New Medicare Advantage and Part D Referral Program - View

• Looking for prospects? Check out our lead program for producing agents - View

• If you run an office, here is what may be missing from your job description - View

• Infographic: Successful People Vs. Unsuccessful People - View

• Express: Mutual of Omaha Weekly Updates - View

• VALUES Quote of the Week - View

• Current Agent Incentive Trips and Contests - View