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

Posted by www.psmbrokerage.com Admin on Thu, Jan 31, 2019 @ 11:20 AM

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.

 
Additional Updates:
 

Tags: Medicare Advantage, Medicare

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

Posted by www.psmbrokerage.com Admin on Thu, Jan 31, 2019 @ 10:57 AM

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). 

untitled grid blog

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

ARTICLE

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Tags: Medicare, Medicare Part D

Medicare’s New “What’s Covered” App

Posted by www.psmbrokerage.com Admin on Thu, Jan 31, 2019 @ 10:27 AM

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

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  • MA plans face "Land Grab" year, focus on benefits in 2019 - View
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Tags: Medicare Advantage, Medicare, Medicare Part D

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

Posted by www.psmbrokerage.com Admin on Tue, Jan 29, 2019 @ 11:29 AM

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.”

With MA bids for next year due in early June-1On 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

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Tags: Medicare Advantage, Medicare, Medicare Part D

Medicare Announces New Model to Test Changes to Part D Payments

Posted by www.psmbrokerage.com Admin on Tue, Jan 29, 2019 @ 10:34 AM

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.”

Read More

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Tags: Medicare, Medicare Part D

CMS Completes Rollout of New Medicare Cards Ahead of Schedule

Posted by www.psmbrokerage.com Admin on Tue, Jan 29, 2019 @ 10:28 AM

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.

Read More

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Tags: Medicare, CMS, New Medicare Cards

Payers Fail To Deliver Readable Medicare Communications

Posted by www.psmbrokerage.com Admin on Thu, Jan 24, 2019 @ 10:15 AM

86% of Payers Fail to Deliver Readable Medicare Communications

Confused Senior

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.

readability

 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

 
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Tags: Medicare Advantage, Medicare

Ten Mistakes That Kill Sales Opportunities

Posted by www.psmbrokerage.com Admin on Wed, Jan 23, 2019 @ 09:52 AM

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

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Tags: sales advice

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

Posted by www.psmbrokerage.com Admin on Mon, Jan 21, 2019 @ 03:18 PM

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

Great Southern Life Medicare Supplement Plans

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!

 
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Tags: americo medicare supplement

Americo Medicare Supplement: Start 2019 with a Bonus

Posted by www.psmbrokerage.com Admin on Mon, Jan 21, 2019 @ 02:15 PM

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

 
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Tags: americo medicare supplement

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

Posted by www.psmbrokerage.com Admin on Mon, Jan 21, 2019 @ 11:24 AM

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

CMS Generic Header - Canva

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.

 
Additional Updates:
 

Tags: Medicare Advantage, Medicare

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

Posted by www.psmbrokerage.com Admin on Fri, Jan 18, 2019 @ 02:50 PM

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

Welltok's New Research Shows Seniors Want More Health and Wellbeing Support from Medicare Plans


A new survey by Welltok, the leading consumer health SaaS company, validated that today's seniors are increasingly tech savvy, expect more from Medicare plans and are striving for total wellbeing. With over 60 million Americans projected to be covered by Medicare by 20201, it is critical for plans to understand and meet members' individual needs in a meaningful way to attract, retain and better manage this growing market. 

65 Years and Young

You can download the PDF here

Welltok, which works with national and regional health plans, conducted a nationwide survey of 1,000 seniors age 65 and older to gather primary data on what seniors are looking for from their plans, how they want to be communicated with and their health priorities. Key findings of the newly released survey include:

  • Why Seniors Would Switch Plans: Nearly six in 10 seniors said they would consider switching their current Medicare Advantage plan in the near future. Low out-of-pocket costs, prescription drug coverage and in-network access to providers were cited as primary factors that could influence a plan change. Seniors also say it is important for their insurance provider to offer programs and resources that address their total health and wellbeing. Yet, roughly half feel that their current plan is not offering relevant or personalized support.

  • 65 is the new 45Seniors want to stay healthy and active as they age – 88 percent say they feel healthier than their parents' generation and approximately four in five feel younger than their actual age.

  • Seniors' New Definition of Health:To improve quality of life, seniors are adopting a new definition of health, which includes all aspects of health (physical, social, emotional and financial). They are most likely to say financial stability (94 percent), adequate sleep (91 percent), and positive relationships (90 percent) are most important for them to achieve and maintain. Managing stress, good nutrition and then maintaining an appropriate level of physical activity followed in importance.

  • How to Reach Seniors: The way seniors communicate is changing and plans need to track and honor preferences to be successful. Email emerged as the top way that seniors want to communicate with their health plan, especially among Medicare Advantage members (52 percent), followed by phone (automated voice or live agent) and regular mail. There is also growing interest in connecting digitally, including text messaging. 

"Seniors are the fastest growing population, and health plans will lose if they treat them as a homogenous population," said April Gill, vice president health plan market solutions for Welltok. "We analyze all types of data to understand and target seniors to drive health actions, including gathering insights and preferences directly from consumers themselves. Our Medicare acquisition and retentions solutions are designed to deliver the personalized experience that seniors not only want but expect from their plans." 

About Welltok 
Welltok is a data-driven, enterprise SaaS company that delivers the healthcare industry's leading consumer activation platform. Welltok's solutions empower leading health plans, employers, providers and public entities to connect consumers with personalized health improvement resources, making it easy and rewarding for consumers to complete actions that optimize their health and wellbeing. Only Welltok leverages a machine-learning, multi-channel approach proven to help innovative organizations power growth and retention initiatives, improve healthcare value, and streamline the consumer experience, while upholding the highest security and compliance standards.

About the Study
These are the findings from an Ipsos poll conducted October 31 – November 1, 2018 on behalf of Welltok. For the survey, a sample of 1,004 adults ages 65 and over from the continental U.S., Alaska and Hawaii was interviewed online, in English. In order to qualify for the survey, seniors had to be covered by Medicare. This includes 503 adults who currently have an original Medicare plan (Parts A/B through government) and 501 adults who have a Medicare Advantage Plan. The precision of Ipsos online polls is measured using a credibility interval. In this case, the poll has a credibility interval of ±3.5 percentage points for all respondents.

https://www.prnewswire.com/news-releases/new-national-survey-reveals-greater-risk-of-seniors-switching-medicare-advantage-plans-in-2019-300779338.html

Additional Updates:
 

Tags: Medicare Advantage, Medicare

Apple is in talks with private Medicare plans about bringing its watch to at-risk seniors

Posted by www.psmbrokerage.com Admin on Wed, Jan 16, 2019 @ 04:42 PM

Apple is in Talks with Private Medicare Plans About Bringing its Watch to At-Risk Seniors

By Christina Farr – CNBC – January 16, 2019 

  • Apple is in talks with private Medicare plans about getting Apple Watches into the hands — or on the wrists — of millions of people over the age of 65.
  • It makes a lot of sense for Apple to do that, health experts tell CNBC, since it could prevent pricey doctor or hospital visits.
  • Apple has previously signed a deal with insurance giants Aetna and United Healthcare about subsidizing the cost of the watch. 

Apple has been in talks with at least three private Medicare plans about subsidizing the Apple Watch for people over 65 to use as a health tracker, according to people familiar with the discussions. 

The insurers are exploring ways to subsidize the cost of the device for those who can't afford the $279 price tag, which is the starting cost of an older model. The latest version of the device, which includes the most extensive health features including fall detection and an electrocardiogram to measure the heart's rhythm, retails for a minimum of $399, which many seniors could benefit from but can't afford. 

The talks have not resulted in any official deals just yet, the people said. Apple has paid a visit to several of the largest insurers in the market, as well as some smaller, venture-backed Medicare Advantage plans. The people declined to be named as the discussions are still private. Apple declined to comment. 

Health experts say that seniors are an ideal market for the Apple Watch, which has introduced features that can be used by anyone, but are most beneficial to seniors, including fall detection and cardiac arrhythmia monitoring. It also makes sense as a business model for insurers, as seniors are a particularly lucrative market. 

"It's the segment of health insurance with the highest dollar revenue and margin per member," explains Augustin Ruta, a health insurance consultant at A2 Strategy Group. Ruta also noted that Medicare members enrolled in these private plans tend to have lower churn rates, which gives insurers more of an incentive to invest in members' long-term health outcomes. 

A win for Apple, insurers and patients

About 19 million seniors, and growing, are enrolled in a Medicare Advantage plan, which are private health plans that receive government payouts for providing services to seniors — about $10,000 per member, on average. Consulting firm PwC, the brand name for PricewaterhouseCoopers, expects the Medicare Advantage market to generate more than $350 billion in annual revenue by 2020, although the market is regulated to limit insurers' profits.

Read more

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Tags: Medicare Advantage, Medicare

UnitedHealth grows Medicare business by 400,000

Posted by www.psmbrokerage.com Admin on Wed, Jan 16, 2019 @ 04:10 PM

UnitedHealth grows Medicare business by 400,000

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By Christopher Snowbeck - Minneapolis Star Tribune – January 16, 2019

Following a Medicare open-enrollment period that included the company’s debut in Minnesota, UnitedHealthcare officials said Tuesday that the health insurer expects in 2019 to add more than 400,000 Medicare Advantage enrollees across the country.

UnitedHealthcare was already the nation’s largest provider of Medicare Advantage plans, a newer form of coverage where enrollees opt to receive their government benefits through a private health insurance company.

At the end of last year, 4.9 million people were enrolled in the company’s MA health plans. Government data show that UnitedHealthcare enrolled about 2,300 Minnesotans in Medicare Advantage plans this month.

“We completed a strong Medicare Advantage enrollment season last month and are on track to achieve 2019 growth within the 400,000 to 450,000 range of expectations,” said Steve Nelson, an executive vice president at parent company UnitedHealth Group, during a conference call.

Shares of UnitedHealth Group closed up more than 3 percent in trading Tuesday after the Minnetonka-based health care giant beat analyst expectations for fourth-quarter profit on continued growth at its Optum division for health care services.

For the first time, annual sales at Optum hit the $100 billion mark, company officials said Tuesday, as the division’s operating earnings for the year grew more than $1.5 billion, or 23 percent, to $8.2 billion.

Read more

Additional Updates:
 

Tags: Medicare Advantage, Medicare, UnitedHealthcare

Medicare Advantage is Growing, Again...

Posted by www.psmbrokerage.com Admin on Wed, Jan 16, 2019 @ 10:58 AM

Medicare Advantage is Growing, Again...

Almost 22.4 million seniors and people with disabilities are enrolled in Medicare Advantage plans for 2019 — up 6.8% from the same point last year, according to preliminary federal data.

Why it matters: The growing enrollment total is in line with what the Trump administration expected and continues a decade-long trend of moving more of the traditional Medicare program into a privatized version run by health insurers.

Winners: Most insurers are winners to some degree, considering MA is "a friendly environment" right now for the industry. And the biggest companies are getting even bigger.

By the numbers: Together, three companies control more than half of the MA market.

The big picture: The federal government is expected to pay MA insurers $250 billion this year. With profit margins hovering around 4% or higher for many companies, that equals billions of dollars of profit.

Yes, but: Federal prosecutors and auditors are scrutinizing the coding practices of MA insurers and may be willing to claw back overpayments soon.

What's next: February's enrollment data will provide an even clearer picture of how much the Medicare Advantage program grew for this year.

ARTICLE

Additional Updates:
 

Tags: Medicare Advantage, Medicare

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

Posted by www.psmbrokerage.com Admin on Wed, Jan 16, 2019 @ 10:46 AM

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

CVS Health recently announced that Walmart has opted to leave its pharmacy network for Commercial and Medicaid plans. As stated in the press release, this has no impact on Medicare plans. Please let your clients know:

  1. There’s no impact to our Medicare pharmacy network.
  2. Walmart continues to participate in the pharmacy network for our Medicare Advantage plans (MAPD), Prescription Drug Plans (PDP), Dual-eligible Special Needs Plans (DSNP) and Employer Group plans.
    • Walmart continues to be a preferred pharmacy for any Medicare Advantage plans that offer a preferred pharmacy network, as well as for Aetna Medicare Rx Saver (PDP) and Aetna Medicare Value Plus (PDP) plans.
    • Walmart will remain an in-network, non-preferred pharmacy for the Aetna Medicare Rx Select (PDP) plan.
  3. Aetna Medicare members can continue to receive their medicines at Walmart or at any of our 65,000+ network pharmacies nationwide.

If members have any questions, they can call Member Services using the number on their member ID card.

Additional Updates:
 

Tags: aetna, CVS, Walmart

Walmart to Leave CVS Network, Roiling Drugstores

Posted by www.psmbrokerage.com Admin on Wed, Jan 16, 2019 @ 10:30 AM

Walmart to Leave CVS Network, Roiling Drugstores

 Robert Langreth and Matthew Boyle / Bloomberg News / Employee Benefit Adviser

Walmart will leave CVS Health’s network that administers drug benefits for millions of Americans, in a dispute over costs that could roil the business of filling prescriptions.

Walmart, the world’s largest retail chain, was demanding higher reimbursements for its in-store pharmacies where customers who have CVS pharmacy-benefit management plans could pick up their prescriptions, CVS said in a statement announcing the split.

Walmart said that it was resisting efforts by CVS to steer consumers to certain pharmacies to have their prescriptions filled. The Bentonville, Arkansas, company said in an emailed statement that it was committed to giving customers access to affordable healthcare, “but we don’t want to give that value to the middle man.”

90(Image: Bloomberg)

“This issue underscores the problems that can arise when a PBM can exert their unregulated power to direct members on where to fill their scripts, disrupting patients’ healthcare,” the statement said. “Walmart is standing up to CVS’s behaviors that are putting pressure on pharmacies and disrupting patient care.” 

“Walmart’s requested rates would ultimately result in higher costs for our clients and consumers,” CVS Caremark President Derica Rice said in the statement. “We simply could not agree to their recent demands for an increase in reimbursement.” 

CVS isn’t only one of the U.S.’s biggest pharmacy chains, with almost 10,000 locations. It also oversees drug benefits for about 93 million people, including setting up networks of drugstores where they can pick up their prescriptions. 

Walmart is a major pharmacy operator as well, and dispenses drugs in most of its almost 5,000 locations. It has also flirted with getting more involved in the healthcare industry, looking at offering wellness services and other offerings that will become a key part of CVS’s business with its takeover of health insurer Aetna last year.

The split won’t affect Medicare beneficiaries in CVS’s Part D drug plans. It also won’t apply to Walmart’s Sam’s Club stores, CVS said in the statement.

CVS said the move won’t materially impact its 2019 results. News of the split was reported earlier by the Wall Street Journal.

ARTICLE

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Tags: CVS, Walmart

Government Shutdown Spares Medicare

Posted by www.psmbrokerage.com Admin on Wed, Jan 16, 2019 @ 10:10 AM

Government Shutdown Spares Medicare

(Image: Pexels)

The partial government shutdown (day 24) is not affecting Medicare, but other health-related services are feeling the pinch.

By Jennifer Bresnick – HealthPayerIntelligence – January 14, 2019

 - The partial government shutdown will have no impact on Medicare and Medicaid at the federal level, CMS has stressed to industry observers.

The nation’s public payers will continue to operate as normal, since funding for CMS is assured until at least September 30, 2019.

“CMS and its programs (including, but not limited to, @Medicaregov, @Medicaidgov and @Healthcaregov) are NOT affected by the partial gov't shutdown,” CMS stated on Twitter after the partial shutdown began in late December.

Federal workers in departments without funding are also assured of health insurance coverage during for the duration of the shutdown, the Office of Personnel Management (OPM) stated in an FAQ.

“The employee’s Federal Employee Health Benefits (FEHB) coverage will continue even if an agency does not make the premium payments on time,” the agency said. “Since the employee will be in a non-pay status, the enrollee share of the FEHB premium will accumulate and be withheld from pay upon return to pay status.” 

Beneficiaries will not have the option to terminate or cancel their coverage, OPM added.  New enrollments or changes in enrollment status will not take effect until the employee has reentered paid status.

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ARTICLE

Additional Updates:
 

Tags: Medicare Advantage, Medicare

Understanding Aetna’s 2019 dental plans

Posted by www.psmbrokerage.com Admin on Wed, Jan 16, 2019 @ 09:59 AM

Understanding Aetna’s 2019 dental plans

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When working with your clients, it’s important you educate them about the dental benefit on any plans they’re considering. There are several different types of dental benefits you may encounter on our plans.

Different types of dental coverage – Know how each one works

The chart below outlines the three main types of dental coverage offered with our 2019 Medicare Advantage plans (MA/MAPD). While not all plans have a dental benefit (view a list of plans that don’t offer dental), when they do, the dental benefit fits into one of the buckets below.


Embedded Coverage (Network Structure)

  • Included in the plan; members don’t have to enroll separately to get dental coverage.
  • With HMO plans, members must use a dental network.
  • With PPO plans, members can use out-of-network dentists at higher costs.
  • You can find a network dentist online.


Embedded Allowance (Direct Member Reimbursement Structure)

  • Included in the plan; members don’t have to enroll separately to get dental coverage.
  • Requires members to pay upfront and submit a receipt for reimbursement.
  • Can be used for preventive and comprehensive services (i.e., all ADA codes, including dentures & implants).
  • Members can see any licensed dental provider (no network).
  • In certain states (CT, MA, ME, NH and RI), some allowances may have a co-insurance amount. For example, if the co-insurance is 50%, the member is reimbursed for 50% of their costs, up to their benefit maximum.
  • Allowance amounts do not rollover each year.
  • To request reimbursement:
    • Get a receipt or proof of payment from the doctor along with a description of the dental services provided.
    • Include the members’ printed name and member ID # on the receipt.
    • Submit the receipt to us at the claims address on the ID card (a claim form can be found online at the website on the ID card).
    • We’ll reimburse up to the benefit amount.


Optional supplemental benefit (OSB)

  • Must be purchased separately for an additional premium.
  • Members must enroll in an OSB when they enroll in their plan, or within 30 days of plan start date (or during another valid election period).
  • Requires member to use a dental network.
  • Those with the DMO network need to choose and visit a primary care dentist for us to cover their care.
  • PPO members can use out-of-network dentists at higher costs.
  • You can find a network dentist online.


Not appointed to sell Aetna Supplemental Plans? Request details here

Additional Updates:
 

Tags: aetna, dental plans

Insurers Boast of Great Medicare Advantage Growth

Posted by www.psmbrokerage.com Admin on Wed, Jan 16, 2019 @ 09:50 AM

Insurers Boast of Great Med Adv Growth

(Image: Freepik)

By Tina Reed – FierceHealthcare – January 11, 2019

A common theme among insurers speaking at the J.P. Morgan Health Care Conference this week: the boost from Medicare Advantage. Executives from several companies pointed to the program as they discussed their upcoming year at the conference. 

Humana officials said they’ve been beating Wall Street expectations over the past several quarters in part because of their M/A business. “2019 is shaping up to be a very, very strong year,” said CFO Brian Kane. “We’ve revised upward our M/A enrollment and expect individual M/A growth this year to be 375,000 to 400,000 members. That’s a 12-13% growth rate.”

Nationally, M/A enrollment and spending are expected to surge over the next decade, until more than 4 in 10 beneficiaries are in the program by 2028, according to a recent report in the New England Journal of Medicine. The M/A enrollment rate is set to grow from 34% in 2018 to 42% over the next 10 years. There are now more than 22 million Americans enrolled in privately-administered M/A plans for 2019 with the number expected to continue to rise. M/A enrollment will rise to 38 million by 2025, according to a report from L.E.K. Consulting.

ARTICLE

Additional Updates:
 

Tags: Humana, Medicare Advantage, Medicare, UnitedHealthcare, aetna

Medicaid Changes Likely in 2019

Posted by www.psmbrokerage.com Admin on Wed, Jan 16, 2019 @ 09:40 AM

Medicaid Changes Likely in 2019

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Julie Carter / Medicare Watch

As 2019 gets underway, the Medicaid program continues to be in the spotlight. This week, the Kaiser Family Foundation (KFF) released an issue brief that highlights some of the major program changes that states, the Administration, and Congress may pursue in 2019.
 
Over 66 million people receive their health coverage through Medicaid, including older adults, people with disabilities, children, low-income parents, and other adults. Any changes to the program, therefore, have the potential to affect millions of families.

Read More

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Tags: Medicare, Medicaid

Proposed Marketplace Changes Could Harm People with Medicare

Posted by www.psmbrokerage.com Admin on Wed, Jan 16, 2019 @ 09:37 AM

Proposed Marketplace Changes Could Harm People with Medicare

Lindsey Copeland / January 10, 2019

In November, the Centers for Medicare & Medicaid Services proposed regulatory changes to the Affordable Care Act’s Health Insurance Marketplaces. We submitted comments this week, in which we raise concerns with several aspects of the proposed rule that could have negative implications for people with Medicare. 
 
CMS indicates it is proposing this rule in part to ensure that people are in the "most appropriate type of coverage.” While Medicare Rights supports this goal, we disagree with the agency’s proposal to achieve it by automatically terminating Marketplace coverage for people who are eligible for or enrolled in Medicare Part A.

Read More

Additional Updates:
 

Tags: Medicare

Cigna Plans Broader Medicare Advantage Offerings

Posted by www.psmbrokerage.com Admin on Wed, Jan 16, 2019 @ 09:31 AM

Cigna Plans Broader Medicare Advantage Offerings

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By Bruce Jepson – Forbes – January 10, 2019

Fresh from the completion of the Express Scripts acquisition, Cigna CEO David Cordani plans to broaden the insurer’s offerings to more seniors choosing Medicare Advantage plans as part of a major business expansion in coming years.

Cigna’s disclosure this week at the JPMorgan Healthcare Conference comes as the insurer and its rivals including Aetna, Anthem, Humana and UnitedHealth Group are expanding into new geographic regions to sell more Medicare Advantage products. All of these insurers are taking advantage of a market of more than 10,000 baby boomers aging into the Medicare population every day.

“We are well positioned today and going forward for existing and new markets,” Cordani said of future MA offerings. “Today, Cigna focuses on the individual, not the group M.A. marketplace. The group M.A. marketplace presents a future growth opportunity for us.”

Cigna has more than 435,000 Medicare Advantage enrollees, which is far fewer than UnitedHealth, Aetna and Humana. But Cigna and an increasing number of other insurers see a bigger opportunity as the Centers for Medicare & Medicaid Services changes rules allowing health plans to provide richer benefit packages to attract more seniors to Medicare Advantage plans.

Cigna is also looking to offer new less restrictive health plans that allow seniors more choices outside of health plan networks by introducing preferred provider organization (PPO) plans for Medicare Advantage enrollees. Unlike PPOs, HMOs restrict doctor choices to their networks. Cordani didn’t disclose a timetable for the PPO offerings.

“Today, Cigna participates largely in the individual HMO portion of the marketplace, not the individual PPO part of the marketplace,” Cordani said. “That presents additional growth opportunity for us as we go forward, but that growth is built off of the success of the individual HMO market.”

Medicare Advantage plans contract with the federal government to provide extra benefits and services to seniors, such as disease management and nurse help hotlines with some even providing vision and dental care and wellness programs.

There are now more than 22 million Americans enrolled in privately-administered Medicare Advantage plans for 2019 with the number expected to continue to rise. Medicare Advantage enrollment will rise to 38 million, or 50% market penetration by the end of 2025, according to a report from L.E.K. Consulting.

Cigna also sees an opportunity as Medicare moves to value-based payment models and away from traditional fee-for-service reimbursement that has been shown to lead to unnecessary tests and procedures due to its emphasis on volume of care delivered.

Cordani said 85% of Cigna's Medicare Advantage “customers are in aligned value-based relationships.” “Those are very important in terms of how our model works: hand in glove with high-performing physician organizations and integrated hospital systems for the benefit of our M.A. customers,” Cordani said.

https://www.forbes.com/sites/brucejapsen/2019/01/10/cigna-plans-broader-medicare-advantage-offerings/#74cdd59a44f5

Additional Updates:
 

Tags: Cigna

2019 Aetna Senior Supplemental Incentives

Posted by www.psmbrokerage.com Admin on Wed, Jan 16, 2019 @ 09:01 AM

2019 Aetna Senior Supplemental Incentives

Medicare Supplement Bonus Program - Click on Image to open flyer

Aetna Med Supp Bonus


New Agent Bonus Program 
- Click on Image to open flyer

Aetna New Agent Bonus

New Agent Bonus Program - Click on Image to open flyer

Aetna Mult-Product Bonus


Not appointed to sell Aetna Supplemental Plans? 
Request details here

Additional Updates:
 

Tags: Aetna Medicare Supplement, aetna

Mutual of Omaha: MA and PDP Compensation Payments

Posted by www.psmbrokerage.com Admin on Wed, Jan 16, 2019 @ 08:40 AM


The following is information regarding the payment of compensation for Mutual CareAdvantage (HMO) (MA) and Mutual of Omaha Rx (PDP) sales.

 
Medicare Advantage Compensation

  • Payment will be made beginning January 2019
  • Compensation Schedules – can be found on Sales Professional Access (SPA), click on the Profile icon in the upper righthand corner.  Choose Communications and filter on company – Mutual of Omaha Medicare Advantage Company and access your contract packet which includes your compensation schedule. 
  • Compensation Statements -  can be found on the Medicare Advantage producer portal by clicking on the ‘Commission’ icon. A link to the portal is found on the Medicare Advantage product page on Sales Professional Access (SPA) mutualofomaha.com/broker.  
  • For questions:
  • Click for details regarding MA compensation.

 Prescription Drug Plans Compensation

  • Payment will begin April 2019
  • Compensation Schedules – Can be found on Sales Professional Access (SPA), click on the Profile icon in the upper right hand corner. Choose Communications and filter on company – Omaha Health Insurance Company and access your contract packet which includes your compensation schedule. 
  • Compensation Statements - can be found on Sales Professional Access (SPA) under Reports beginning in April.
  • For questions:
  • Click for details on PDP Compensation

Not appointed to sell Mutual of Omaha PDP plans? Request details here

Additional Updates:
 

Tags: Medicare Advantage, Medicare Part D, mutual of omaha

Introducing Gerber Life’s Whole Life Insurance Plan

Posted by www.psmbrokerage.com Admin on Wed, Jan 16, 2019 @ 08:31 AM

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Introducing Gerber Life’s Whole Life Insurance Plan. Our new policy makes it easier for adults to protect their families by enabling them to put affordable coverage in place that lasts a lifetime.

WHAT BENEFITS DOES A GERBER LIFE WHOLE LIFE INSURANCE PLAN OFFER TO YOUR CLIENTS?

The Plan provides:

  • A death benefit, premiums and cash value that are guaranteed so your clients can take comfort in knowing they’ve got a plan in place to protect themselves and their families1
  • Up to $1,000,000 in life insurance coverage to individuals from 18 to 70 years old
  • Lifetime insurance protection (as long as premiums are paid) for your clients and their families so they can be prepared should the unexpected happen
  • An array of Rider options for enhanced protection
  • Quick underwriting decisions2
  • No required illustrations 

WHY SHOULD YOU AND YOUR CLIENTS CONSIDER GERBER LIFE’S WHOLE LIFE INSURANCE PLAN?

  • You’ll like it because it’s easy for you to sell and easy for clients to buy. Plus, you will receive renewal commissions in years 2–5. Contact your General Agent for more information about compensation.
  • Your clients will like it because the application process is quick and easy, and the Plan is fully guaranteed1 and easy for them to understand.


GERBER LIFE WHOLE LIFE MARKETING MATERIALS

Our new marketing materials are accessible through Gerber Life’s Agent Portal, including a new Whole Life consumer brochure, a handy agent reference guide and a sales tip flyer for agents.

You can also download the materials below.
Whole Life Consumer Brochure, click here.
Whole Life Agent Reference Guide, click here.
Whole Life Agent Sales Tip Flyer, click here.

Questions? Contact us today at 800-998-7715. Request details here

Additional Updates:
 

Tags: Whole Life, gerber life

2019 Change for Dual Eligible Enrollments

Posted by www.psmbrokerage.com Admin on Tue, Jan 08, 2019 @ 04:59 PM

2019 Change for Dual Eligible Enrollments

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

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The Center for Medicare and Medicaid Services ("CMS") implemented a significant change to the LIS/Dual Special Enrollment Period.  Beginning January 1, 2019, beneficiaries eligible for the LIS/Dual SEP will be permitted to make a coverage change one time per quarter during the first nine months of the year: 

  • January - March
  • April - June
  • July - September 

The LIS/Dual SEP may not be used during the fourth quarter of the year (October - December). 

The effective date of the enrollment into the new plan will be the first of the month following the receipt of an enrollment request.  Per CMS guidelines, the SEP is considered "used" based on the month in which the election was made.  Using their example, if an election is made in March with an April effective, the first quarter use of the SEP would be considered "used" not the second quarter.  

An SEP for Individuals who gain, lose or have a change in their Dual or LIS eligibility, have a one time opportunity to make an election within three months of the change or notification of the change, whichever is later.

Additional Updates:


Tags: Medicare Advantage, Medicare, Dual Eligibles

MACRA and the future of Medicare Supplements

Posted by www.psmbrokerage.com Admin on Tue, Jan 08, 2019 @ 04:42 PM

Is Plan F going Away in 2020? Not Exactly


Recently passed legislation referred to as MACRA (Medicare Access and CHIP Reauthorization Act of 2015 ) will, among other things, affect the Medicare Supplement industry in calendar year 2020. Specifically, the Part B deductible can’t be covered. Therefore, Plan F will no longer be an option for individuals newly eligible for Medicare starting January 1, 2020. However, in-force policyholders will be able to keep their current versions of Plan F and individuals eligible for Medicare prior to January 1, 2020 (i.e., not “newly eligible”), can purchase the current version of Plan F on or after January 1, 2020.

For the Medicare Supplement market, the news is mixed. Overall loss ratio experience (and resulting premium rate pressure) could be more favorable for several years following the implementation of MACRA. However, retention dollars (premium less claims) will most likely be reduced due to MACRA. 

Individual carriers are in a position now to plan a course to proactively mitigate risks or exploit opportunities. We recommend analyzing the financial impact of MACRA implementation on your Medicare Supplement product portfolio to provide insight into appropriate next steps. Using a model built from our knowledge of the market, we have simulated the future policy issues of Medicare Supplement Plans F and G and observed some interesting insights. 

Medicare Supplement market will split into two distinct markets

What we now consider one market for Medicare Supplement will effectively become two markets starting in 2020. We will call them Newly Eligible (NE) and Non Newly Eligible (NNE). This is terminology from the regulatory language that specifies eligibility to purchase Plan F (or Plan C). The NE market will consist of individuals who reach the age of 65 on January 1, 2020, and later. Over time, this market will have an increasing maximum age and a minimum age of 65. The NNE market will consist of individuals who reach the age of 65 before January 1, 2020, and an increasing minimum age but no maximum age.

Overall loss ratio experience should be better for a few years following MACRA implementation

Based on modeling various reasonable scenarios of the Medicare Supplement market, experience on policies issued in 2020 and later should initially exhibit a loss ratio as much as 1.0% - 2.5% lower than would otherwise be the case. The reason is that exposure to the non-medically underwritten higher loss ratio open enrollees will shift from Plan F to Plan G, a lower benefit plan. Therefore, the higher loss ratio business has lower exposure and the overall loss ratio is lower all else being equal. This loss ratio improvement will likely last for a few years and then reverse with portfolio loss ratios realizing a steady increase in future years as Plan G exposure overtakes Plan F. Appendix A illustrates this pattern based on our overall projection of the market with and without the implications of MACRA.

Plan F sales, which will only be available to the NNE market, will consist of a greater portion of healthier underwritten business than under the current environment. Plan F will still be available to NNE individuals under guarantee issue provisions.

On the other hand, Plan G will likely comprise a greater portion of higher cost/utilization open enrollment and guarantee issue business from the NE market. As the NE market grows and the NNE market shrinks over time, the relative mix of Plan F and Plan G will shift and the market will be more reflective of Plan G experience.

Initially, the favorable underwritten Plan F experience issued at higher rate levels could offset the negative Plan G experience. As time goes by and Plan G becomes an even greater portion of the market, this relatively unfavorable experience will overcome the positive Plan F experience unless corrective action is taken. The aggregate impact may remain positive for numerous years.

Download the PDF / Read the full article

Questions / comments? We would love to hear your thoughts and how these changes might impact your current business.

Additional Updates:
  • 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

Tags: Medicare, Medicare Supplement, MACRA

Medicare At 55 Could Gain Momentum In 2019

Posted by www.psmbrokerage.com Admin on Tue, Jan 08, 2019 @ 04:08 PM

Medicare At 55 Could Gain Momentum In 2019

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(Image: Freepik)

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.

One of those ideas is the so-called ”Medicare at 55 Act,” which gives Americans between the ages of 55 and 64 an option to buy into Medicare, the federal health insurance program for the elderly. It’s one of the healthcare issues Democrats have talked about in recent years, but it hasn’t gotten nearly the attention as their recent 2018 mid-term election campaign to save the ACA and its protections for patients with pre-existing medical conditions.

But “Medicare at 55" could get a serious airing in the U.S. House of Representatives where Democrats will be in control effective this week and in the Senate where key supporters just won re-election to new terms.

Continue reading

Additional Updates:


Tags: Medicare

LTC Premiums Skyrocketing, Carriers Dropping Out

Posted by www.psmbrokerage.com Admin on Tue, Jan 08, 2019 @ 08:27 AM

LTC Premiums Skyrocketing, Carriers Dropping Out


(Image: Freepik)

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

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Tags: long term care

Announcing Cigna's 2020 Sales Convention! Monaco

Posted by www.psmbrokerage.com Admin on Mon, Jan 07, 2019 @ 02:12 PM

Announcing Cigna's
2020 Sales Convention! Monaco

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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


iconPeek into Monaco

Monaco is just two square miles in size with so much to do and so little effort to experience it all.

Experience the Formula One racecourse
Explore the famed Musee oceanagraphique
Wander through Princess Grace’s Rose Garden


iconFlyer

Take all of the Monaco 2020 information with you in a simple format to read when it’s most convenient. Download the Monaco flyer [PDF]

 

Who will qualify
 
Recruiting Agency

All recruiting agencies with a minimum of $2,000,000 in production credits will be able to bring one qualifier and a guest.

Agents

All agents with a minimum of $250,000 in production credits will be able to bring one qualifier and a guest.

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


All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including American Retirement Life Insurance Company, Cigna Health and Life Insurance Company and Loyal American Life Insurance Company. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All pictures are used for illustrative purposes only.

Additional Updates:
 

Tags: Cigna

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

Posted by www.psmbrokerage.com Admin on Fri, Jan 04, 2019 @ 02:58 PM

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

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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)

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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.

Additional Updates:


Tags: mutual of omaha

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

Posted by www.psmbrokerage.com Admin on Wed, Jan 02, 2019 @ 03:47 PM

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


By Tom Kornfield – AHIP – December 28, 2018
 

Medicare Advantage (MA) is improving quality for seniors. And while quality goes up, costs continue to go down for taxpayers. This was further demonstrated last week, when the Medicare Payment Advisory Commission (MedPAC) announced average payments to MA plans remain equivalent to fee-for-service (also called “traditional”) Medicare costs.

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Since the passage of the Affordable Care Act, MA plans have consistently covered the basic Medicare benefit for less than what those benefits cost traditional Medicare. MA plan costs have fallen nearly every year, and in 2019 the average MA plan bid is 11 percent below local costs for traditional Medicare. This is good news, because it means MA plans continue to drive down costs while delivering high-quality care. 

While the Medicare program now spends the same amount on average for MA as it does for traditional Medicare, MA plans offer much more than traditional Medicare, such as additional benefits, out-of-pocket spending caps, and prescription drug coverage for no additional premiums. 

Seniors see – and like – the difference. MA enrollment has increased by nearly 80 percent since 2010, as plans have consistently demonstrated their ability to deliver value. In 2019, 90 percent of Medicare beneficiaries will have access to an MA plan with drug benefits offered at no additional premium. Enrollee satisfaction is very high, with 90 percent of MA members reporting satisfaction with their health care coverage and their preventive services, and 84 percent satisfied with their prescription drug coverage. 

Recent research has found that MA beneficiaries spend less time in rehabilitation after leaving the hospital, return home faster and are less likely to be readmitted. 

In addition, previous research shows MA brings cost-effective improvements to the rest of the health care system and has a diminishing effect on traditional Medicare spending. 

The goal of payment parity between MA and traditional Medicare sought by MedPAC has now been sustained for several years. And evidence is growing that due to the spillover effect, the more people who enroll in MA in certain areas, the slower costs grow in traditional Medicare overall.

https://www.ahip.org/medpac-announces-2017-medicare-advantage-payments-equal-traditional-medicare-costs/

Additional Updates:


Tags: Medicare Advantage, Medicare

Overview of the 2019 Medicare Advantage Open Enrollment Period

Posted by www.psmbrokerage.com Admin on Wed, Jan 02, 2019 @ 01:08 PM

Overview of the 2019 Medicare Advantage Open Enrollment Period (OEP)

Along with a helpful Guide on the dos and don'ts

(Image: Freepik)

Starting in 2019, CMS restores the Medicare Advantage (MA) Open Enrollment Period (OEP). The MA OEP will take place from January 1 through March 31 each year. The OEP allows individuals enrolled in an MA plan, including newly MA-eligible individuals, to make a one-time election to switch to another MA plan (with or without Part D coverage) or to return to Original Medicare (with or without Part D coverage).

Here’s what you need to know

When is the OEP?

January 1 through March 31 each year.

For newly MA-eligible individuals, the OEP occurs the first 3 months in which they have both Part A and Part B.

When do MA OEP plan elections take effect?
The effective date for an MA OEP election is the first of the month following receipt of the enrollment request.

Who can use the MA OEP?
Individuals enrolled in an MAPD plan or an MA-only plan.

What changes can be made during the MA OEP?

Individuals enrolled in an MAPD plan can use the OEP to get a different MAPD plan, an MA-only plan, or Original Medicare (with or without a PDP).

Individuals enrolled in an MA-only plan can use the OEP to switch to a different MA-only plan, an MAPD plan, or Original Medicare (with or without a PDP).

What types of changes are not allowed during the OEP?
Individuals enrolled in Original Medicare cannot use the OEP to join an MA or MAPD plan, add a PDP, or change their PDP. In addition, the OEP is not available to those enrolled in Medicare Savings Accounts or other Medicare health plan types (such as cost plans or PACE).

How many plan elections can be made during OEP? Only one.


Rules and requirements

CMS guidance states that plan sponsors and producers can’t knowingly target or send unsolicited marketing materials to any MA or MAPD enrollee during the continuous OEP. “Knowingly” takes into account the intended recipient as well as the content of the message. For details, be sure to review section 40.7 of CMS’ 2019 Medicare Communications and Marketing Guidelines.


Important dos and don’ts for producers

During the OEP, you may not: During the OEP, you may:

• Send unsolicited materials advertising the ability/ opportunity to make an additional enrollment change or referencing the OEP

• Specifically target beneficiaries who are in the OEP because they made a choice during AEP, by purchase of mailing lists or other means of identification

• Engage in or promote agent/broker activities that intend to target the OEP as an opportunity to make further sales

• Call or otherwise contact former enrollees who have selected a new plan during the AEP

• Market to age-ins (who have not yet made an enrollment decision)

• Market to dual-eligible and low-income subsidy (LIS) beneficiaries who, in general, may make changes once per calendar quarter during the first nine months of the year

• At a beneficiary’s proactive request, send marketing materials, have one-on-one meetings, and provide information on the OEP


Please note that the lists above are not an exhaustive listing of prohibited and compliant OEP marketing activities. For more OEP information, please reference “Chapter 2 — Medicare Advantage Enrollment and Disenrollment” in the Medicare Managed Care Manual.

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.

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Tags: Medicare Advantage, Medicare

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