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CMS proposes Medicare Advantage and Part D payment and policy updates to maximize competition and coverage

Today, the Centers for Medicare & Medicaid Services (CMS) released proposed changes that will take significant steps in continuing the agency’s efforts to maximize competition among Medicare Advantage and Part D plans. These proposals will increase plan choices and benefits and include important actions to address the opioid crisis.

“CMS is committed to modernizing Medicare and our top priority is to ensure that seniors have more choices and affordable options in receiving their Medicare benefits,” said CMS Administrator Seema Verma. “Medicare Advantage enrollment is at an all-time high as more and more seniors are choosing to enroll in private Medicare health and drug plans, and we need to maximize competition by providing plans the flexibility to meet patients’ needs.”

The proposed changes will expand opportunities for seniors to choose Medicare Advantage plans that for the first time are providing new supplemental benefits in 2019. Beginning with the 2019 plan year, Medicare Advantage plans can provide certain enrollees with access to different benefits and services. For the 2020 plan year and beyond, under statutory changes and the proposed guidance on which we are soliciting comment in today’s release, Medicare Advantage plans will have greater flexibility to offer chronically ill patients a broader range of supplemental benefits that are tailored to their specific needs, such as providing home-delivered meals or transportation for non-medical needs.

The agency is also proposing new action to combat the nation’s opioid crisis. CMS is encouraging Medicare Advantage plans to take advantage of new flexibilities to offer targeted benefits and cost sharing reductions for patients with chronic pain or undergoing addiction treatment, and encouraging Part D plans to provide lower cost sharing for opioid-reversal agents. CMS’ overutilization policies have resulted in a 14 percent decrease in the share of Part D beneficiaries using opioids between 2010 and 2017 (36.3 percent to 31.3 percent), with the largest decrease from 2016 to 2017 (5 percent).

Medicare Advantage remains a popular choice among beneficiaries and has high satisfaction ratings. Average Medicare Advantage and Part D premiums are at their lowest in three years and plan choices have increased. Today’s proposals build in additional flexibilities to continue to increase choice and competition among Medicare health and drug plans.

For a fact sheet on the 2020 Advance Notices (Part I and Part II) and the Draft Call Letter, please visit: https://www.cms.gov/newsroom/fact-sheets/2020-medicare-advantage-and-part-d-advance-notice-part-ii-and-draft-call-letter. CMS released Part I of the Advance Notice on December 20, 2018.

The 2020 Advance Notices (Part I and Part II) and Draft Call Letter may be viewed by going to: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Advance2020Part2.pdf and selecting “2020 Advance Notices.”

All comments on the Advance Notices – including Part I – and Draft Call Letter must be submitted by March 1, 2019. The final 2020 Rate Announcement will be published by Monday, April 1, 2019.

The Out-of-Pocket Cost Burden for Specialty Drugs in Medicare Part D in 2019

By the Kaiser Family Foundation – January 30, 2019

Part D made prescription drugs more affordable for Medicare beneficiaries, yet many beneficiaries continue to face high out-of-pocket costs for their medications. Part D enrollees not receiving low-income subsidies can expect to pay thousands of dollars OoP for a specialty tier drug in 2019: median annual OoP costs in 2019 for 28 of the 30 studied specialty tier drugs range from $2,622 for Zepatier (hepatitis C) to $16,551 for Idhifa (leukemia). Not all specialty tier drugs are covered by all Part D plans, unless they are in one of the six protected classes (such as cancer drugs). 

 In 2019, annual out-of-pocket costs are 12% higher than in 2016, on average.

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Medicare’s New “What’s Covered” App

The CMS released a new app yesterday that describes what Medicare will cover, part of CMS’s plan to help beneficiaries decide between coverage options. The What's Covered app will let users see whether Medicare covers a specific item or service.

The app delivers general cost, coverage and eligibility details for items and services covered by Part A and Part B. Search or browse to learn what’s covered and not covered; how and when to get covered benefits; and basic cost information. You can also get a list of covered preventive services and Medicare Advantage options.

Article

• The out-of-pocket burden for specialty drugs on Part D - View
• MA plans face "Land Grab" year, focus on benefits in 2019 - View
• CMS completes rollout of new Medicare cards - View
• Increase your sales with our complimentary tools and tech - View
• Express: Mutual of Omaha weekly updates - View
• VALUES Quote of the Week - View
• Current agent incentive trips and contests - View
• The DSNP Market is hot. Are you missing out? - View

MA Plans Face ‘Land Grab’ Year, Focus on ‘Sizzle’ Benefits in 2019

By Judy Packer-Tursman – AIS Health – January 28, 2019

Opportunities for managed care plans abound in Medicare Advantage (MA), the popular, competitive program that seems to enjoy bipartisan support, experts tell AIS Health.

The bottom line is, “The [MA] payment rate seems OK, and there will be a lot of innovation, heavy advertising, more vertical integration,” says Stephen Wood, managing partner at Clear View Solutions, LLC. “It’s still a very robust market…and the Medicare population is growing by leaps and bounds.”

Wood, along with his partner, Kirk Twiss, describes the MA environment as “market consolidation at the top — with some states virtually dominated by two or three carriers, a few ‘ankle biters,’ and that’s it — and fragmentation, growth and specialization at the bottom.”

The latter includes local provider-sponsored startups trying to launch specialized MA products, he says. But he notes that such startups face fundamental challenges: gaining sufficient enrollment and having enough revenue to cover administrative expenses. Moreover, Twiss points out, it’s “hard to compete against national plans with so many resources.”

On the Medicare Part D side, much remains in play, Twiss notes. Due to industry consolidation and vertical integration, there won’t be independent PBMs, he says, and issues surrounding prescription drug rebates, Part D benefit design and drug pricing are all unresolved.

With MA bids for next year due in early June, Brad Piper, principal and consulting actuary for Milliman, Inc., says “In my mind, flexibility was probably one of the key drivers [of MA] in 2019, and I think we’re going to see that still in 2020.”

The Medicare Advantage program, by including more flexibility on supplemental benefits, is allowing what Piper calls “enticement” benefits. In addition to fitness, dental, hearing and vision benefits, plans increasingly are offering a benefit to help members purchase over-the-counter health-related items, he says, and transportation to the doctor’s office is becoming more popular.

Wood describes them as “sizzle” benefits that are “more marketing oriented than clinically oriented.” He says companies continue to assess how to deliver such benefits and develop solid 2020 bids containing them by the June deadline.

What does the future hold for MA? “At least for the next year, it’s all good news,” Twiss says. “Beyond that, things change very quickly in the health care business.”

Source: https://aishealth.com/medicare-and-medicaid/ma-plans-face-land-grab-year-focus-on-sizzle-benefits-in-2019/

Image: Freepik

Medicare Announces New Model to Test Changes to Part D Payments

This week, the Centers for Medicare & Medicaid Services (CMS) announced a new model to test changes to prescription drug payments and incentives. The CMS Center for Medicare and Medicaid Innovation (CMMI) will create a voluntary, five-year model in which Part D Plans (PDPs) and Medicare Advantage Prescription Drug Plans (MAPDs) may apply to participate.

According to CMS, the model is intended to test “new incentives for plans, patients, and providers to choose drugs with lower list prices in order to address rising federal reinsurance subsidy costs.”

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CMS Completes Rollout of New Medicare Cards Ahead of Schedule

Last week, the Centers for Medicare & Medicaid Services (CMS)—the agency that oversees the Medicare program—announced that they finished the rollout of new Medicare cards to 61 million people with Medicare ahead of the original deadline of April, 2019. This means that all people with Medicare should now have Medicare cards that include a random Medicare Beneficiary Identifier (MBI) instead of a number based on their Social Security number.

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86% of Payers Fail to Deliver Readable Medicare Communications

Most documents intended for Medicare and Medicare Advantage members do not meet accessibility standards for the average reader, according to a new report from VisibleThread, a text analysis company. 

More than 86 percent of payers offering Medicare products share information with beneficiaries that does not meet federal guidelines for clear, accessible communication as mandated by the Plain Writing Act of 2010. 

The law, which started to apply to health insurance providers in 2013, is intended to ensure that entities use plain language, defined as being at or below a 6th grade reading level, to share information with consumers.  

According to national statistics from 2003, more than half of Medicare-aged adults (aged 65 or older) are at a “basic” or “below basic” reading level, rendering them unable to understand the typical instructions for taking a prescription medication, for example.  

And more than one-third of the United States’ illiterate population is aged 65 or older, equating to 10.6 million elderly adults.  

Only 6 out of the 30 payers met recommended standards for plain language communications.  Amerigroup, Kaiser Permanente, AARP, Emblem Health, Health Markets, and Aetna all managed to keep their readability scores at or below the optimal threshold.  

“Trust in the health insurance industry in the US is declining, according to the Edelman Trust Barometer,” says Fergal McGovern, CEO of VisibleThread.

 “This is alarming as trust isn't a 'nice to have'. Lack of trust means less customer loyalty. And that means customers take their business elsewhere. Acquiring new customers becomes more difficult and expensive for organizations.” 

The bottom five companies – American National Insurance, State Farm Accolade, the US Government, High Mark, and Liberty Mutual – used twice as many run-on sentences as recommended.

 Improving communication with Medicare and Medicare Advantage beneficiaries has become a top priority for payers as more potential members age into the highly lucrative market. 

Most beneficiaries are not at all satisfied with the way their health plans share information, provide reminders, or engage them in chronic disease management tasks. 

 “Leadership needs to define what quality means,” the report stressed. “Teams should be outfitted with the tools to efficiently enforce the standards.”

SOURCE: https://healthpayerintelligence.com/news/86-of-payers-fail-to-deliver-readable-medicare-communications

Ten Mistakes That Kill Sales Opportunities

Words of wisdom from Anthony Iannarino

Here are ten mistakes you can make that will cost your deal.

1. Taking Shortcuts: Anything that you believe leads to a faster deal leads to a no deal. You can’t rush your buyer through the process because you are in a hurry or because you are behind on your number.
   
   
2. Asking for Unearned Commitments: You can’t ask for commitments that you haven’t earned. If you haven’t created the value to deserve the next commitment, pressing for that commitment will shut your deal down.
   
   
3. Poor Follow Up: Failing to follow up on the little commitments you make only proves you don’t care, that you aren’t detail-oriented, and you can’t be counted on. Deal-breaker.
   
   
4. Selling Without Dissatisfaction: If you can’t find or create a compelling reason for your prospective client to change, you aren’t going to make a sale. No deal.
   
   
5. Not Doing Discovery: If you don’t do the discovery work necessary to know exactly how to help your prospective client, you aren’t going to create or win an opportunity. It’s over.
   
   
6. Not Building Consensus: You have to believe me here. You aren’t going to win with a single stakeholder. You will lose if you can’t help your client build consensus. No votes.
   
   
7. Failing to Make the Ask: If you don’t ask for access to the people and information you need to win a deal, you will lose that deal. You cannot fear “the ask.” Not asking is the same as no.
   
   
8. An Inability to Articulate Value: You must be able to articulate the value that you and your solution creates. If can’t tell your client how they will be made better, you have no deal.
   
   
9. Failure to Provide Proof: Your prospect is going to want some proof that you are who you say you are, that you will execute. Maybe you need a fancy ROI calculator. Or maybe you need a reference. Zilch.
   
   
10. Being Transactional: Treating your prospective client as a means to an end is the fastest way to alienate them. And it’s a surefire way to lose. Brick.

 Source

Important News on Americo Medicare Supplement: Introducing Great Southern Life Insurance Company

2018 was a very successful year for Americo Medicare Supplement sales and 2019 is going to be even better! Med Supp sales doubled in 2018 thanks to:

• One of the best processes in the industry - instant decision with no prescription or doctor information required.
• Competitive rates with availability in 38 states
• Security of an ‘A’ rated company
• UFirst Rewards, our unique cash bonus incentive program for agents

To continue building on this success, we are excited to announce:

• Great new Medicare Supplement premium rates through our subsidiary company, Great Southern Life Insurance Company (GSL).
• Increased UFirst Rewards bonus payout of 5 and 10%! UFirst Rewards Qualifications

Beginning March 4, 2019 GSL Medicare Supplement will be available in these states: CO, FL, GA, IL, IN, IA, KS, MD, NC, PA, SC, SD, and TX. There will be additional state releases in June and August. Stay tuned for more information on upcoming releases.

Looking to sell GSL Med Supp plans? Request details here

We look forward to sharing more information on the new Med Supp through Great Southern Life Insurance company as more details become available. stay tuned!

Americo Medicare Supplement:
Start 2019 with a Bonus

Meet the UFirst Rewards requirements and receive your bonus check that month. Keep producing and get a monthly bonus check on any new qualifying business. Make even more money by hitting $30,000 and get paid retroactively! Bonus payment based on the following:
 

$15,000 to $29,999 = 4% Bonus payout

$30,000 and above = 8% Bonus payout

Must have at least 65% underwritten business. Disability and Guaranteed Issue policies are excluded. Medicare Supplement production will be counted at 100% of paid annualized first-year premium. Monthly bonus payments will be made at the end of each month during the qualification period.

UFirst Rewards Details

Not appointed to sell Americo's Medicare Supplement plans? Request details here

CMS Announces New Model to Lower Drug Prices in Medicare Part D and Transformative Updates to Existing Model for Medicare Advantage

Today, CMS’s Center for Medicare and Medicaid Innovation (“Innovation Center”), which tests innovative payment and service delivery models to lower costs and improve the quality of care, announced a new payment model and transformative updates to an existing model.  The models are designed to enable Medicare Advantage and Part D plans, which are private plans that provide Medicare beneficiaries with medical and prescription drug coverage, to better serve patients and help them achieve good health.

“Expanding choices for patients, aligning incentives, and providing new flexibility for insurers in Medicare Advantage and Medicare Part D will deliver better value from these programs,” said HHS Secretary Alex Azar.  “The models being announced today create new incentives for plans, patients, and providers to choose drugs with lower list prices, and new ways to meet the unique healthcare needs of specific populations, prevent disease, and expand the use of telehealth.  Today’s announcement draws on successes we have already seen in Medicare and advances our priority of using HHS programs to build a value-driven healthcare system.”

The model for Medicare Advantage plans is an update to the Medicare Advantage Value-Based Insurance Design or “VBID” model that CMS first launched in 2017.  The model for Part D plans is called the Part D Payment Modernization model.  These are both voluntary models to advance innovation – meaning certain Medicare Advantage and Part D plans can choose to participate, and patients can choose to enroll in participating plans.  The models will be closely monitored, and if they clear certain thresholds for impact on quality, costs, and access to benefits, the models can be expanded in scope.

“The American healthcare system is very different today than it was thirteen years ago when the Medicare Advantage and Part D programs were launched in their current forms, but due to the slow pace of change in government, these programs have not been fully updated to reflect today’s realities,” said CMS Administrator Seema Verma.  “Today’s announcements are prime examples of how CMMI can test policies to modernize CMS programs and ensure that our seniors can access the latest benefits.  These two models ignite greater competition among plans, creating pressure to improve quality and lower costs in order to attract beneficiaries.”

The President’s Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs called on HHS to increase competition, improve negotiation, create incentives for lower list prices, and reduce out-of-pocket costs.  Through the Part D Payment Modernization model announced today, CMS is executing on the Blueprint.  This model advances President Trump’s commitment to lower prescription drug prices, with Medicare beneficiaries, Part D plans, and CMS all benefiting from a more aligned system.

The Part D Payment Modernization model announced today advances President Trump’s commitment to lower prescription drug prices.  Currently in Part D, once a patient’s prescription drug spending is high enough for the patient to enter the final phase of the benefit, known as the “catastrophic phase,” Medicare is responsible for 80 percent of drug costs.  This introduces perverse incentives and leaves plans with little reason to negotiate lower costs for the highest-spending patients.

In fact, over the past 10 years (2008-2017), federal spending in the Part D catastrophic phase has nearly quadrupled from $9.4 billion to $37.4 billion, reflecting an average increase of 17 percent per year.  In 2016, 3.2 million beneficiaries reached the Part D catastrophic phase, and the beneficiaries in catastrophic who did not qualify for the low-income subsidy faced average annual out-of-pocket drug costs of over $3,000.

This issue of plans having limited responsibility in the catastrophic phase, and the related lack of incentives plans have to focus on high list prices, was raised in the President’s FY 2019 budget, and it has been highlighted by MedPAC and by multiple other stakeholders in response to CMS RFIs.  Under the new model, which takes effect for the 2020 plan year, participating plans will take on greater risk for spending in the catastrophic phase of Part D, creating new incentives for plans, patients, and providers to choose drugs with lower list prices.  Based on plan year performance, CMS will calculate a spending target for what governmental spending would have been without plans taking on this additional risk.  Participating Part D plans will share in savings if they stay below the target but will be accountable for losses if they exceed the target.  For the first time, the model also introduces a Part D rewards and incentives program to align this model with the changes to VBID, and to provide Part D plans with additional tools to control drug costs and help enrollees in choosing drugs with lower list prices. 

The wide-ranging enhancements to the VBID model announced today will test a new series of service delivery approaches for Medicare Advantage plan beneficiaries for the 2020 plan year, including:

• Allowing plans to provide reduced cost sharing and additional benefits to enrollees in amore targeted fashion than has previously been allowed, including customization based on chronic condition, socioeconomic status, or both, and even for benefits not primarily related to health care, such as transportation;
  
  
• Bolstering the rewards and incentives programs that plans can offer beneficiaries to take steps to improve their health, permitting plans to offer higher value individual rewards than were previously allowed; and
  
  
• Increasing access to telehealth services by allowing plans to use access to telehealth services instead of in-person visits, as long as an in-person option remains, to meet a range of network requirements, including certain requirements that could not previously be fulfilled through telehealth.

Beginning in the 2021 plan year, the VBID model will also test allowing Medicare Advantage plans to offer Medicare’s hospice benefit.  This change is designed to increase access to hospice services and facilitate better coordination between patients’ hospice providers and their other clinicians.

Plans participating in the VBID program will be offered along with traditional Medicare Advantage plans.  CMS will monitor whether plans that take up these more tailored coverage options are able to reduce costs and increase quality.

Medicare Advantage plans in all 50 states and territories may apply for the VBID model for 2020, thanks to a provision signed into law by President Trump in the Bipartisan Budget Act of 2018.  Additionally, the model is now available to more Medicare Advantage plan types, including all Special Needs Plans and Regional PPOs in all states and territories.  The Part D Payment Modernization and VBID models will run through 2024.  Requests for Applications for participating in the VBID model for 2020 and the Part D Payment Modernization model for 2020 will be made available by CMS the week of January 21, 2019.  Medicare beneficiaries will be able to select plans participating in these models for the 2020 plan year.

Today, CMS is also issuing an evaluation report for the first year of the VBID model.  Plans in only 7 states could participate in the model for the first year (2017).  The report shows that participating plans began to leverage the new tools that were introduced right away, with 45 plans participating and offering more benefits to enrollees.  Most 2017 Medicare Advantage data are not yet complete for a full impact analysis, but the agency is continuing to assess the model.  Today’s update of VBID was informed by experience during the early years of the model.

For fact sheets on today’s announcements, please visit https://cms.gov/newsroom/fact-sheets/value-based-insurance-design-model-vbid-fact-sheet-cy-2020 and https://cms.gov/newsroom/fact-sheets/part-d-payment-modernization-model-fact-sheet.

Welltok Report - 65 Years Young:
Health for The New Senior Generation

Medicare Advantage is Growing, Again...

Aetna: "Don't worry, Walmart is still an in-network pharmacy for 2019 MAPD and PDP products"

Government Shutdown Spares Medicare

Insurers Boast of Great Med Adv Growth

Medicaid Changes Likely in 2019

Proposed Marketplace Changes Could Harm People with Medicare

Cigna Plans Broader Medicare Advantage Offerings

2019 Change for Dual Eligible Enrollments

Special Enrollment Period for Low Income Subsidy or Dual Eligible Beneficiaries (LIS/Dual SEP)

Is Plan F going Away in 2020? Not Exactly

• 2019 Change in Dual Eligible Enrollments - View
• Medicare at 55 could gain momentum in 2019 - View
• LTC premiums skyrocketing as insurers dropping out - View
• Cigna 2020 Sales Convention - Monaco - View
• Mutual of Omaha Sales Leaders 2020 - London - View
• Increase your sales with our complimentary tools and tech - View
• Express: Mutual of Omaha weekly updates - View
• VALUES Quote of the Week - View
• Current agent incentive trips and contests - View
• The DSNP Market continues to grow. Are you missing out? - View

Medicare At 55 Could Gain Momentum In 2019

 
After two years of defending the Affordable Care Act from Republican appeal attempts, Democrats could go on the offensive with popular ideas they’ve had to keep on the shelf while out of power like lowering the eligibility age for Medicare.

LTC Premiums Skyrocketing, Carriers Dropping Out

By Philly.Com – January 8, 2019

In its Q3 report to shareholders, Genworth Life Insurance Co. – recording a loss of $34 million from long-term insurance – said it has approval from state agencies for average rate increases of 53%. About 100 companies across America sold stand-alone LTC insurance in 2002, according to the National Association of Insurance Commissioners: today there are 17.

The problems hit from many sides, including years of low interest rates that cratered insurance companies’ investment earnings and overly optimistic assumptions factored into calculations about the cost of long-term care.

ARTICLE

Announcing Cigna's
2020 Sales Convention! Monaco

Your other life awaits in Monaco.

Your other life, in another world, in Monaco, June 7–11, 2020.

You’ll live just steps from the famed Monte Carlo Casino. From there you can stroll west to explore the Musee oceanagraphique. Or feel the cool breeze off the Mediterranean in Port Hercule. The world’s elite salespeople like yourself will be catered to at Cigna Supplemental Benefits (CSB) 2020 Incentive Trip. Your other life is waiting – in Monaco.

How to qualify

• March 1, 2019–February 29, 2020
• Earn 300% of IAP* for supplemental health, accident and whole life
• Earn 100% of IAP* for Medicare Supplement
• No cap on qualifiers

Not appointed with Cigna Supplemental?
Request details here or call us at 800-998-7715 to ask for an online contracting link.

Mutual of Omaha Sales Leaders:
Electric London - March 19-24, 2020

How can you experience the electricity of London? Place qualifying business with Mutual of Omaha during 2019 and become a Mutual Sales Leader — and join us for a brilliant time in England.

2019 QUALIFICATION HIGHLIGHTS
MEDICARE SUPPLEMENT AND DENTAL/VISION PRODUCTS

Qualification Period | January 1 through December 31, 2019
• Business must be net issued between January 1 and December 31, 2019
• All issued policies must be placed and premium collected and received by Mutual of Omaha by January 15, 2020
• Qualifiers will be determined after January 20, 2020

Eligible Business | Medicare Supplement and Dental/Vision products

Production Requirement | 275,000 production credits (Based on net-issued business and measured in annualized new business premium)

For Complete Details | Download a copy of the official qualification requirements at mutualsalesleaders.com

Not appointed with Mutual of Omaha?
Request details here or call us at 800-998-7715 to ask for an online contracting link.

MedPAC: Medicare Advantage Payments Remain Equal to Medicare Fee-for-Service