The 10th National Forum was held in St. Louis from June 12-14, and was attended by agents, carriers, marketing organizations, actuarial and administrative firms, and consultants from across the Medigap industry.
The CSG team presented in two sessions, discussing the status of the Medigap market, and trends we anticipate will impact the industry. Details for each session are listed below, as well as a copy of the presentation for you to download.
2018 Medicare Supplement Industry Overivew: Latest Data, Trends & Outlook
Jared Strock, Consulting Actuary at CSG Actuarial, presented with Ryan Wolfe from Mark Farah Associates on the current state of the Medigap market, including trends in new sales premium, enrollment, and rate increases.
Market Overview: The Latest Data for Medicare Supplement and Medicare Advantage Sales
Doug Feekin, Principal and Consulting Actuary at CSG Actuarial, presented a review of the Medicare Supplement and Medicare Advantage environment today and helpful insights into where the market is trending
Medicare Blog | Medicare News | Medicare Information
Medicare Supplement Costs Ranked By State
HealthView Services provided Business Insider with the average annual cost projections for Medicare Supplement Plan F, the most popular level of Medigap coverage, across every state.
Most to Least Expensive Med Supp: (Sample)
#1: Massachusetts - Average annual Medigap plan cost; $1,947;
#9: Florida - Average annual Medigap plan cost: $1,831;
#51: Hawaii - Average annual Medigap plan cost: $1,310;
Check the full article to see how much Medigap Plan F costs in every state, plus Washington, DC.
CMS Expands Benefit Flexibility In
Beginning in 2019, MA plans can leverage the new flexibility to partner with community-based organizations to create services aimed at addressing barriers to access to care or avoiding costly care.
The major new flexibilities for 2019 and beyond include:
Benefit Uniformity Flexibility:
In 2019, MA plans can design disease-specific benefits for individuals with certain chronic conditions or other high-risk health conditions if 1) they are available to all enrollees, 2) MA plans use objective and measurable medical criteria, and 3) beneficiaries’ diagnoses have been certified by a provider...
The previous “primarily health-related” definition has been expanded for supplemental benefits to permit coverage of services to diagnose, prevent, or improve the effects of injuries or health conditions, or reduce avoidable emergency healthcare utilization...
Social Security Cost of Living Adjustment
May top 3% in 2019
The annual Social Security (SS) cost-of-living adjustment for 2019 could top 3%. That would be the largest increase in seven years, according to The Senior Citizens League, a nonpartisan advocacy group.
A 3% cost of living adjustment (COLA) in 2019 would be the biggest annual hike since 2012, when SS benefits grew by 3.6%. This year the COLA was 2%. If Social Security benefits increase next year, Medicare premiums for the typical retiree may also rise.
A "hold harmless" provision – enjoyed by about 70% of beneficiaries who have Medicare premiums deducted from their SS – prohibits annual increases in Part B premiums from exceeding the dollar amount of the COLA increase in annual SS benefits. Part B premiums are normally deducted directly from Social Security benefits.
Medicare Extends Late Enrollment Amnesty
Call it the Obamacare-Medicare penalty: you sign up for the ACA sometime before you turn 65 and then mistakenly stay there past age 65, when you must switch to Medicare.
That results in costly lifetime late-enrollment penalties on your Medicare premiums. Confusion about the transition from ACA to Medicare has been so widespread that the CMS opened up a window for a limited time last year allowing people caught in the switches to apply for relief from the penalties.
CMS decided to allow people who should have signed up at 65 to apply for “time-limited equitable relief,” allowing them to enroll in Part B without penalties.
Now CMS is expanding that opportunity, but the deadline for straightening out the problem is Sept. 30.
Aetna / Coventry Medicare Advantage and PDP
2019 Aetna Individual Medicare producer certification begins July 11
Starting July 11, you can complete the 2019 annual certification process for Aetna and Coventry Individual Medicare products (MA/MAPD, PDP). It's one of the annual requirements you must complete to sell our 2019 plans this Annual Election Period. Watch for more details about certification later this month.
AHIP launches 2019 AHIP training on June 18... So why wait until July 11?
Simply put, because you can save money. When you complete 2019 Aetna Individual Medicare producer certification, it includes AHIP and costs $125 – That’s a savings of $50 off the retail price! Mark your calendars and plan to certify with us starting July 11.
Coming soon: Enhancements to the Ascend Virtual Sales Office app
We’ve wrapping up some cool new enhancements to our online enrollment app, the Ascend Virtual Sales Office app. Later this month, the home screen will feature a new look that makes it easier and faster for you to get where you need to go, and reach the most frequently used tools. Once the enhancements are live, after logging in, with one click you’ll be able to:
Watch for more details coming soon! Not yet using the Ascend app? Once you’re “ready to sell,” just request access on Producer World here.
Your prospects are online – Why not enroll them online too?
When you enroll your clients using the Ascend Virtual Sales Office app, our electronic enrollment tool, you can:
To start using the Ascend app, login to Producer World, go to the Ascend Virtual Sales Office app section and then click on "request access" to get started. If you have questions about the Ascend app, just contact your local Aetna Medicare Broker Manager.
Compliance Connection: Complete an event verification form before sales events
Don’t forget to fill out an event verification form when you hold a sales meeting or event about our Individual Medicare plans. The form helps protect you and Aetna if CMS decides to audit your event. It’s easy to complete. Just download the form and print it out before your next event. Then, have the form signed by your event venue contact before your event starts. Lastly, keep the form on file. You can learn more on Producer World.
Questions? We're here to help!
If you have any questions, just contact the Aetna Medicare Broker Services Department at 1-866-714-9301 or firstname.lastname@example.org.
Humana Medicare Advantage / PDP
AEP for Plan Year 2019 will be here soon and Humana is looking forward to a great sales year! Get certified or recertified with Humana! We are pleased to announce the details for Plan Year (PY) 2019 Certification and Recertification.
NEW FOR PLAN YEAR 2019:
Making it easier to complete initial MAPD certification online
Humana is making it easier for you to locate and complete certification training by making certification a single course. After successful completion of the online-only course, you will be certified for all Medicare products.
Time Saving Improvements for Certification and Recertification
We hear from agents and partners like you that certification and recertification takes too long to complete. For PY19, we have managed to make significant improvements to course content and overall course outlines while preserving the high quality training that is expected with Humana. In short, you will notice shorter course outlines and will be able to more easily take away content that you need.
TRAINING DETAILS FOR PLAN YEAR 2019:
Certification and Recertification Launch Dates
AHIP Remains a Requirement for Certification and Recertification
2019 AHIP is required for both Certification and Recertification. Agents typically take AHIP through Humana after they have logged into training from our Humana site. If an agent goes directly to AHIP to register, the fee is $175.00 and must have their AHIP results transferred to Humana before they can continue completing their certification or recertification.
IMPORTANT: We are not recommending or suggesting that agents should take AHIP as soon as it is available by going directly to the AHIP site. Agents going directly to AHIP will be shown the AHIP e-commerce site where they are required to pay AHIP for their AHIP training, and that rate will not be the Humana discounted rate. For agents who typically have the AHIP fee waived (career and certain non-career agents) they must go through the Humana site to have the AHIP fee covered upfront.
For those agents required to pay the AHIP registration fee, the 2018 charge is $125.00, if the training is accessed via the Humana MarketPoint University.
Closing of PY18 Certification - What Agents Need to Know!
Each year, we must take down the current plan year Certification courses in preparation for the next plan year.
This year, Humana’s Plan Year 2018 Certification course closes at 5:00 PM EST on June 15, 2018. AHIP also closes their PY18 training on June 15, 2018.
Recertification Deadlines and Specific Information
All recertification courses will launch July 17, 2018 at Noon EST.
Please note these important details about agent recertication:
Accessing Certification and Recertification
New Medicare Advantage Rules Hold
Improving health outcomes using population health strategies could get a major boost with a new Medicare Advantage rule taking effect this week.
The rule could see an array of new benefits aimed at improving health outcomes by addressing issues such as housing and food insecurity, transportation, social isolation and home health aides.
Potential benefits include ride-hailing services, home visits, nutritional support, air conditioners for people with asthma, home renovations such as grab bars and other accommodations to prevent falls.
Medicare Part A to Dry Up Earlier Than Predicted
Trustees for Medicare reported Tuesday that Medicare Part A, which covers hospital bills, will become insolvent in 2026, 3 years earlier than the projection last year.
In its annual report, the trustees cited lower payroll taxes attributable to lowered wages in 2017, lower levels of projected gross domestic product (GDP), and lower income from the taxation of Social Security benefits as a result of the tax-reform package President Trump signed into law in December 2017.
Part A spending is projected to be slightly higher than last year’s estimates, because of legislation that increased hospital spending, and higher Medicare Advantage payments.
In 2017, income into Medicare Part A, formally known as the Hospital Insurance Trust Fund (HI), exceeded expenditures by $2.8 billion. The report projects deficits in all future years until the trust fund becomes depleted in 2026.
The assets were $202 billion at the beginning of 2018, representing about 65% of expenditures during the year, which is below the trustees’ minimum recommended level of 100%.
Growth in HI expenditures has averaged 2.1% annually over the last 5 years, compared with non-interest income growth of 4.9%.
Over the next 5 years, projected annual growth rates for expenditures and non-interest income are 6.2% and 5.3%, respectively.
In response to the report, there were calls for both reforms and blame.
“We should keep our attention focused on reforming these programs so that they can truly benefit future generations,” Senate Finance Committee Chairman Orrin Hatch, R-Utah, said in a statement.
In a statement sent to reporters after the report was released, Senator Ron Wyden, D-Oregon, ranking member of the Senate Finance Committee, said the “report should eliminate any doubt that Trump’s tax law yanked Medicare closer to insolvency.”
The report said that Medicare costs will grow from about 3.7% of GDP in 2017, to 5.8% of GDP by 2038, and will increase gradually thereafter to about 6.2% of GDP by 2092.
The annual report also included Social Security projections. Those costs equaled 4.9% of GDP in 2017 and are expected to rise to 6.1% of GDP by 2038, decline to 5.9% of GDP by 2052. By 2092, it will rise to 6.1% of GDP.
Tags: medicare updates
CMS Updates for Medicare Advantage and Part D
On April 2, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule, updating Medicare Advantage (MA) and the prescription drug benefit program (Part D). The Final Rule includes, among other provisions:
Preclusion List Requirements for Prescribers in Part D and Individuals and Entities in Medicare Advantage, Cost Plans, and PACE: The Final Rule eliminates the MA and Part D prescriber and provider enrollment requirement. Instead, CMS is compiling a “Preclusion List” of prescribers, individuals, and entities that: (1) are currently revoked from Medicare, under an active reenrollment bar, or have engaged in behavior for which CMS could have revoked enrollment in Medicare and (2) in addition, CMS determines that the underlying conduct is detrimental to the best interests of the Medicare program. The Preclusion List will be made available to MA plans and Part D prescription drug plans, which must deny payment for claims submitted by, or associated with prescriptions written by prescribers and providers on the list.
Eliminating “Meaningful Difference” Requirements: Beginning with CY 2019 bid submissions, CMS has eliminated the requirement that MA plans offered by the same organization in the same county comply with the “meaningful difference” requirements, which limit the variety of plans an MA organization can offer in the same county.
The Final Rule also eliminates the “meaningful difference” requirement for PDP Enhanced Alternative (EA) benefit designs offered by the same organization in the same region, but does not change this requirement as between PDP Basic and EA prescription drug plan offerings.
Medicare Advantage Uniformity Requirements Flexibility: As an option for all MA plans, the Final Rule allows the plans to reduce cost sharing for certain covered benefits, offer specific tailored supplemental benefits, and offer different deductibles for beneficiaries that meet specific medical criteria.
Definition of Marketing: The Final Rule changes the definition of “marketing” to include only materials that are most likely to lead to a beneficiary to make an enrollment decision. CMS is adopting requirements for a new category called “communications,” comprised of materials and activities that fall outside the new definition of marketing.
Comprehensive Addiction and Recovery Act of 2016 (CARA) Implementation: In accordance with CARA, CMS established a framework allowing Part D sponsors to implement drug management programs that limit access to coverage for frequently abused drugs for at-risk beneficiaries, beginning with the 2019 plan year. Beneficiaries being treated for active cancer-related pain, are receiving palliative or end-of-life care, or are in hospice or long-term care from drug management programs will be exempt from the programs. CMS will designate opioids and benzodiazepines as frequently abused drugs. The framework includes, among other provisions:
Integration of the drug management programs with the existing Overutilization Monitoring System (OMS). The clinical guidelines for determining whether a beneficiary is potentially at-risk (based on using opioids from multiple prescribers and/or multiple pharmacies) will be expanded. Sponsors will be allowed to “lock in” an at-risk beneficiary’s access to frequently abused drugs to selected prescribers and/or pharmacies. In order to implement these limitations, Part D sponsors must have engaged in case management with the prescribers, and allow beneficiaries to submit prescriber and pharmacy preferences.
CMS is limiting the availability of the special enrollment period (SEP) for dually or other low income subsidy (LIS) eligible beneficiaries who are identified as at-risk or potentially at-risk for prescription drug abuse.
At-risk determinations, including prescriber and pharmacy lock-in, will be subject to the existing beneficiary appeals process.
Any Willing Pharmacy Provisions and Revised Definition of Retail Pharmacy: The regulations clarify statutorily-required “any willing pharmacy provisions”, and revise the definition of “retail pharmacy.” The Final rule also sets deadlines for Part D sponsors to respond to requests for pharmacy contracting standard terms and conditions.
Decreased Transition Supply Days for Long Term Care: The Final Rule reduces the transition supply in the long term care setting from 90 days to 30 days (currently provided in the outpatient setting ) so that the transition supply in both settings is for the same period.
Part D Tiering Exceptions: The Final Rule provides that Part D plans are no longer allowed to exclude a dedicated generic tier from the tiering exceptions process.
Expedited Substitutions of Certain Generics and Midyear Formulary Changes: The Final Rule allows Part D sponsors to immediately substitute generics for brand name drugs on the same or lower cost-sharing tier if they meet certain requirements.
Part A and Part B Premium Adjustments as “Initial Determinations:” The Final Rule codifies existing policy of treating FFS premium adjustments as initial determinations that can be appealed.
Lengthening Part D Adjudication Timeframes: The Final Rule lengthens the maximum timeframes for adjudicating enrollee payment appeal requests at the redetermination and independent review entity (IRE) reconsideration levels from 7 to 14 calendar days.
Eliminating MA Plan Notice of Forwarded Appeals: CMS has removed the redundant requirement that MA plans notify an appellant when his/her appeal case file is forwarded to Medicare’s Part C IRE, and the Part C IRE will continue to notify MA enrollees of forwarded cases.
Default Enrollment: The Final Rule changes the current enrollment mechanism that to allow MA organizations to provide continuation of coverage for beneficiaries once they become Medicare eligible.
Passive Enrollment for Dually Eligible Beneficiaries: The Final Rule provides passive enrollment for full-benefit dually eligible beneficiaries from a non-renewing integrated D-SNP to another comparable plan, after consulting with a state Medicaid agency, and where other conditions are met relating to continuity and quality of care.
Limitation to the Part D Special Enrollment Period for Dual and Other LIS-Eligible Beneficiaries: The Final Rule converts the Special Election Period (SEP) for dual-eligible and LIS beneficiaries from an open-ended monthly SEP to one that may be used only once per calendar quarter during the first nine months of the year. The Final Rule also includes separate SEPs that can be used: (1) within a prescribed time after a CMS or state-initiated enrollment; and (2) within a prescribed time after a change to an individual’s LIS or Medicaid status.
Similar Treatment of Biosimilar and Interchangeable Biological Products and Generic Drugs for Purposes of Low Income Subsidy (LIS) Cost Sharing.: CMS is applying generic cost-sharing to biosimilar and interchangeable biological products for LIS enrollees in all phases of the Part D benefit.
Maximum Out-of-Pocket (MOOP) and Cost Sharing Limits: CMS is revising the regulations controlling maximum out-of-pocket (MOOP) limits, to enable future changes to CMS’s existing methodology.
Restoration of the Medicare Advantage Open Enrollment Period: Effective for 2019, the Final Rule implements a new Medicare Advantage open enrollment period (OEP) that will take place from January 1st through March 31st annually, and that will allow individuals to make a one-time election to go to another MA plan or Original Medicare.
Removing the Quality Improvement Project (QIP) from Quality Improvement Requirements: The Final Rule removes theQIP from quality improvement requirements. According to CMS, the QIP was duplicative of activities MA plans were already doing to meet other plan needs and requirements, and its elimination allows MA plans to focus on one project that supports improving the management of chronic conditions.
Reduction in Required Medical Loss Ratio (MLR) Data: The Final Rule is reducing the amount of MLR data that MA organizations and Part D sponsors must provide on an annual basis.
Electronic Delivery of Beneficiary Documents: CMS is separating the delivery dates so that beneficiaries receive the Annual Notice of Change (ANOC) first, followed by the Evidence of Coverage (EOC). MA and Part D sponsors can now provide certain materials electronically, such as the EOC (or via hard copy if the beneficiary prefers).
Star Ratings Methodology: In the Final Rule, CMS provided increased transparency for the MA and Part D Star Ratings methodology, codifying principles for adding, updating, and removing measures, and the methodology for calculating and weighting measures used in the ratings process. The Final Rule also established new rules related to how Star Ratings are assigned when contracts consolidate and new methods for applying scaled reductions when CMS determines that the data for the appeals measures are not complete.
Tags: medicare updates
Guide: How to Market to Seniors
Check out this article full of great information, best practices and overall solid advice on how to market and engage the baby boomer generation.
Section Links Include:
Hope you enjoy and learn some new techniques to benefit your business.
Medicare Part D Coverage Gap Closing Quickly
The gap for brand-name prescription drugs for Medicare beneficiaries is likely to slip down to 25% of drug costs from the scheduled 30% next year, thanks to the Bipartisan Budget Act of 2018. Agents may want to explain to their clients to compare Part D options during the Annual enrollment Period late this year, enabling them to take advantage of the gap and save on prescription costs.
The coverage gap had been gradually shrinking for several years since the Affordable Care Act set a path to close it by 2020. “The gap was never scheduled to close 100%,” says Dr. Katy Votava, president of GoodCare.com. Once it closes, “beneficiaries will still pay 25% out of their pockets.”
Although the brand-name coverage gap closes in 2019 instead of 2020, the coverage gap doesn’t end a year early for generic drugs. That stays on the closure schedule as prescribed by the ACA—cost-sharing will fall to 25% for generics in 2020, after dropping to 37% for 2019. Even though generic cost-sharing isn’t falling as fast, “37% of the price of generic drugs is likely to be less than 25% of brand-name drugs,” says Juliette Cubanski, associate director of the program on Medicare policy at the Kaiser Family Foundation.
The government sped up the closure of the gap for brand names by shifting costs to manufacturers. The budget law increases the discount that brand-name drug manufacturers provide from 50% to 70% in 2019; Part D plans will pick up the remaining 5% of costs in the coverage gap. “There’s no similar provision for generics—so plans would have to pick up costs” if the gap closed faster for generics, says Cubanski.
How the Coverage Gap (doughnut hole) Works
The law doesn’t change the doughnut hole’s beginning and end points, notes Casey Schwarz, senior counsel for education and federal policy at the Medicare Rights Center. Under the standard rules, a beneficiary pays 25% of drug costs after the Part D deductible, while the plan picks up 75% of the costs, until the total amount the beneficiary and the plan pay hits the initial coverage limit of $3,750 in total drug costs this year.
Then the beneficiary enters the doughnut hole. In 2018, the beneficiary pays 35% for brand-name drugs, while the plan pays 15% and the manufacturer offers a 50% discount. For generic drugs in 2018, the beneficiary pays 44% of drug costs and the plan pays 56%.
The beneficiary exits the doughnut hole after he exceeds $5,000 in out-of-pocket spending for covered drugs. Once out of the gap, catastrophic coverage kicks in and the beneficiary pays 5% of drug costs, while the plan pays 15% and Medicare pays 80%.
The budget law change effective in 2019 means beneficiaries will pay 25% for brand-name drugs until reaching catastrophic coverage. And come 2020, cost-sharing for all drugs—brand name and generic—will be 25% for beneficiaries before catastrophic coverage.
While all Part D plans have to match these rules in actuarial terms, what consumers actually pay varies among Part D plans. Many plans have tiers, for instance, where preferred drugs have low cost-sharing and nonpreferred have higher cost-sharing, and some plans offer additional coverage in the doughnut hole.
Because the drugs you take and the different plan structures can affect your actual costs, it’s important to shop Part D plans every year at open enrollment, which runs October 15 through December 7, to see if you can score a better deal. At the least, landing in the coverage gap for brand-name drugs next year will cost a little less.