Medicare Enrollment Periods Explained

Posted by www.psmbrokerage.com Admin on Wed, Aug 26, 2020 @ 01:41 PM

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Tags: Medicare Advantage, Medicare, Medicare Part D

Enrollment Guidance Policy Changes and Updates and Model Medicare Advantage and Prescription Drug Plan Individual Enrollment Request Form for Contract Year 2021

Posted by www.psmbrokerage.com Admin on Tue, Aug 25, 2020 @ 09:49 AM

Compliance

SUBJECT: Enrollment Guidance Policy Changes and Updates and Model Medicare Advantage and Prescription Drug Plan Individual Enrollment Request Form for Contract Year 2021

The Centers for Medicare & Medicaid Services (CMS) is issuing Medicare Advantage (MA), Prescription Drug Plan (PDP), and §1876 Cost Plan Enrollment and Disenrollment Guidance revisions for contract year 2021. These updates primarily reflect revisions resulting from final regulations published on June 2, 2020, in CMS-4190-F (Contract Year 2021 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program). To implement these changes, we updated guidance to Chapter 2 and 17D of the Medicare Managed Care Manual and Chapter 3 of the Medicare Prescription Drug Benefit Manual.

CMS is also announcing the release of the new Model Individual Enrollment Request Form to enroll in an MA or Part D plan, OMB No. 0938-1378. CMS revised and improved the standard (“long”) model form used for MA and PDP enrollment to the new “shortened” form to simplify the enrollment process.

All enrollments with an effective date on or after January 1, 2021, must be processed in accordance with the revised guidance requirements, including the new model MA and PDP enrollment form. MA and Part D plans are expected to use the new model form for the 2021 plan year Annual Enrollment Period (AEP) which begins on October 15, 2020.

Significant changes to the guidance include:

1.Medicare Advantage (MA) Plan Options for End-Stage Renal Disease (ESRD) Beneficiaries.

Effective for the plan year beginning January 1, 2021, CMS removed the prohibition on beneficiaries with ESRD enrolling in an MA plan. Plans can accept and process elections made by ESRD beneficiaries that choose to join an MA plan during a valid election period.

2. Special Election Periods (SEPs) for Exceptional Conditions

CMS codified a number of SEPs previously adopted and implemented through subregulatory guidance as exceptional circumstances SEPs. We also established two new SEPs for exceptional circumstances:

SEP for Individuals Enrolled in a Plan Placed in Receivership CMS established new SEPs, at §§ 422.62(b)(24) and 423.38(c)(31), for individuals enrolled in plans that are experiencing financial difficulties to such an extent that a state or territorial regulatory authority has placed the organization in receivership.

SEP for Individuals Enrolled in a Plan that has been identified by CMS as a Consistent Poor Performer CMS established new SEPs, at §§ 422.62(b)(25) and 423.38(c)(32), for individuals who are enrolled in plans identified with the low performing icon (LPI) in accordance with §§ 422.166(h)(1)(ii) and §423.186(h)(1)(ii), respectively.

3. Medicare Advantage and Prescription Drug Plan Model Enrollment forms

CMS revised and improved the standard (“long”) model form used for MA and PDP enrollment to a new streamlined form. The new model enrollment form requires the minimal amount of information to process the enrollment, and other limited information that the sponsor is required or chooses to provide to the beneficiary1. The new model form consists of the following parts outlined below:

1.Cover Page
The cover page includes information for the beneficiary on Medicare enrollment and instructionsto complete the enrollment form.

2. Model Enrollment Request Form
Section 1 includes data elements required to process the beneficiary’s enrollment.
Section 2 includes mandatory data elements that the plan is required to include on the application and optional data elements which the plan is not required to include. All data elements in Section 2 are optional for the beneficiary to complete. Plan enrollment will not be affected if the beneficiary does not complete this additional information.

Mandatory Data Elements: Beneficiary language or accessible format preference2.

1 Requests for enrollment must comply with all requirements outlined in 42 CFR 422.2262 and 423.2262 and be approved by CMS.
2 Organizations are required to provide information to individuals in accessible/alternate formats (e.g., Large Print, Braille), upon request and thereafter, as outlined in Section 504 of the Rehabilitation Act of 1973. CMS will allow plans3

Optional Data Elements: Information that a plan may determine to be useful in processing an enrollment request, including options for beneficiary premium payment, choice of primary care physician (where applicable), or other information determined useful by the sponsor.

Electronic Delivery of Plan Specific Materials Section 2 also allows plan sponsors to list those categories of materials available for electronic delivery.

The OMB-approved enrollment form is considered a “model” for purposes of CMS review and approval of plan marketing materials; and plans can choose to customize the form as needed.

4. Additional Updates

Model Notice update

We removed information from Chapter 2 Exhibit 22 regarding the option to use an SEP to disenroll from the plan due to the loss of optional supplemental benefits due to nonpayment of optional supplemental premiums. An individual would be able to disenroll only if s/he is eligible for one of the existing SEPs.

Electronic Signatures

As part of the Electronic Enrollment process, plan sponsors are afforded the flexibility to accept electronic signatures from a beneficiary that affirms his/her intent to complete the enrollment. We added language that allows plan sponsors to obtain an electronic signature as an alternative to the “Enroll Now” or “I Agree” button or tool used in completing an Electronic Enrollment request. This change only applies to the Electronic Enrollment mechanism. The affirmation requirements for the Telephonic and Paper Enrollment mechanisms remain the same.

An electronic signature is considered to have the same legal effect and validity as a pen-and-ink signature. An organization utilizing electronic signatures must, at a minimum, comply with the CMS security policies. The requirements for legally binding electronic signatures can be found in the Electronic Signatures in Global and National Commerce Act, 15 U.S.C. § 7001.

Updates are incorporated into the contract year 2021 enrollment guidance. The revised guidance chapters, in their entirety, will be posted at the links below within 5 business days of this memorandum.

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Tags: Medicare Advantage, Medicare Part D

It’s a Great Time to be in Medicare Market

Posted by www.psmbrokerage.com Admin on Tue, Aug 25, 2020 @ 09:25 AM

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Tags: Medicare Supplement, CSG Actuarial

Should You Start Selling Insurance Part Time?

Posted by www.psmbrokerage.com Admin on Fri, Aug 21, 2020 @ 04:55 PM

Should You Start Selling Insurance Part Time?

Starting a new career as an independent agent is a daunting task.

Some may be starting out young while others may be a bit older and looking for a new profession.

Many ask; "How do I start something new when quitting my current profession is just not feasible?"

It takes time to learn new skills and processes and that could mean less money in your pocket if you quit your full time job.

If that's your situation, then starting a new career on the side may be a good option for you.

If you can keep your regular job and get started without the pay cut, that may give you enough time to build up momentum before going in full time.

So, should you start selling insurance part time?

We're going to help you decide if it might be for you, and it will only take a few minutes. We'll look at some pros and cons and talk about the steps to take to be successful.

Section Links

⍟ Start Part Time and Earn an Extra Paycheck
⍟ Start Out With a Plan
⍟ Get Familiar With the Industry
⍟ Deciding What to Sell
⍟ Managing Clients Expectations
⍟ Conclusion

Start Part Time and Earn an Extra Paycheck

Not everyone has the option of simply starting over.

If you’ve been in an industry for years and want to make a change, you are likely going to see a sizable pay cut if you start over.

Unless, of course, you can keep your current job and start your new venture selling insurance part time.

This can be a great way to get your feet wet and test out the industry.

You can test the waters and see if it might be a good fit before making any risky decisions.

Down the road when you feel more confident and the money is starting to flow, it’s even possible to reverse your situation.

You could always go full time as an independent and keep a part time job just to make up the money.

This isn’t ideal, but there is no real shortcut.

You will have to put the work in one way or the other.

This strategy will however, allow you to transition to a new profession rather than jumping in cold turkey.

Like we said, it can take some time in the beginning to start making money selling insurance.

This slow ramp up in your new venture can begin while you’re still collecting another paycheck and not cramp your lifestyle too much.

Start Out with a Plan

Because you are starting part time it will be important to have a carefully thought out plan. If you aren’t devoting your entire day to learning the craft you could easily be thrown off course.

Because you will be spending most of your day on a different job it will be easy to forget where you left off and miss details you had fresh in your mind when you were last working on it.

You want to have a system of keeping detailed information that you can refer to daily. This can be almost like a journal to record thoughts, details, important tasks, etc.

This is where having contacts in the industry will pay off dividends.

Getting advice as to when to zig and when to zag is priceless when you are just getting started. These are things that will need to be addressed as they come up and will vary depending on your situation.

You may not know exactly what you will encounter but you can prepare ahead of time by having resources at your fingertips when you need them.

Get Familiar with the Industry

Starting part time will allow you to test the waters and feel what it would be like to be in the industry without the risk of quitting a job and losing that income.

You are starting a business, but the risk is lessened when you have another job.

This way you can decide if you like the work, what type of products might be best for you to sell, what populations you like to work with, etc.

If you’re jumping into a new industry it will be necessary to have friends that are already in the business.

If you don’t have any, make some and try to learn from them. Having a mentor would also be very beneficial.

Everyone who is in the industry went through a similar process so they will understand. Don’t be afraid of asking others if you can buy them lunch and ask them for some advice.

Talk to an FMO about what's required to sell the different plans and get a better understanding of what's required.

Deciding What to Sell

This is more of a personal choice. What suits your personality? What area are you most interested in? Do you know anyone successfully selling insurance who could mentor you?

There are a number of things to consider, but you will have to navigate that to find something that fits you.

There are pros and cons to selling different types of insurance, it really comes down to simply choosing one that you can see yourself talking about and helping people with regularly.

With over 10,000 people a day turning 65, we have identified the senior market as a great opportunity now, and for years to come.

At PSM, we have established a strong portfolio of companies and have introduced quoting and sales technology to help our agents get a jump-start to success. If you're having trouble deciding, our marketers are here to answer any questions you may have.

Managing Clients Expectations

Whether you are jumping in full time or starting slow as a part time agent, your clients shouldn’t be able to tell the difference.

To be successful you will need to be there for your clients when they need you. Having said that, there is a lot you can do to manage their expectations.

Don't ever let your clients feel like you are giving them part time attention. Every interaction you have has to make your clients feel like they have your full attention and efforts.

Setting expectation up front can really help with this. Let your clients know the best time(s) to contact you and when they do you will return their call quickly.

Most people are reasonable enough to not expect you to answer the call immediately each time you call, as long as you set their expectation up front.

Nevertheless, just because your not able to work full time as an insurance agent does't mean you can put off communicating effectively with your clients.

Make every effort to take calls at every opportunity. Whether that's your lunch time, break time, and any time throughout the day you can pull away.

Conclusion

Being an independent insurance agent can be a very rewarding career. If you stick with it and develop a sizable client base you will also be building a book of business that will serve as your nest egg when, or if, you decide to sell it.

If you are entrepreneurial minded and like the idea of being your own boss, or owning your own company then there is plenty of opportunity as an independent insurance agent.

Just because you can't quit your full time job doesn't mean you can't still get started on a new rewarding career.

With the right approach and help from a good FMO you can start on a part time basis and begin building a business you can develop into a full time career.

Good luck in your efforts and remember, we're just a phone call away.

Additional Updates:

Selling Medicare Insurance Over the Phone - View
A Young Insurance Agents Guide to Success - View
Selling Insurance From Home - View
Learn How to Sell Medicare Advantage Plans - View
7 Ways to Grow Your Insurance Business - View

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10 Reasons to Use E- Applications

Posted by www.psmbrokerage.com Admin on Thu, Aug 13, 2020 @ 12:59 PM

10 Reasons to Use E-Applications

Since the Coronavirus lock down, the ability to use e-applications has become a hot topic. The lockdown really highlighted the importance of being able to sell from home and complete applications online.

In an industry based on relationships, it is still possible to conduct business, successfully, and build trust with clients without meeting face-to-face.

There are still ways to connect with customers, such as: over the phone or via video call.

E-Apps give you the flexibility to not be right there with your customer but still be able to get a completed application from them.

Agents are starting to realize the many benefits of filling out applications online. This isn’t relegated to times of mandatory social distancing. There are good reasons agents should be using e-applications all the time, whether we have a quarantine situation or not.

E-apps are a great way to submit business. They are quick and easy for agents and clients alike, and can be signed electronically. An application that may take you 30-40 minutes by paper may take you just 10 minutes online.

10 Reasons to Use E-Applications

1. E-Apps Are Quicker

E-apps are a much quicker way to do business. They aren’t just quicker to fill out, the time to process the applications is also sped up. In some cases, turnaround time for approvals can be decreased by up to 2 weeks.

2. Fewer Mistakes With E-Apps

There are far less mistakes with an online application, since the application can alert you if something is missed or input incorrectly.

3. Pre-Qualify your clients

You can pre-qualify your clients by answering required health questions. No waiting days just to find out if they qualify. Find out instantly with most carriers.

4. E-Apps Save Time

In addition to application and approval time savings there are more efficiencies agents gain by using this process. An agent will also benefit from the time not having to drive out to client’s homes as they would with paper applications, not to mention the associated costs of travel.

5. Serve More Clients With the Time You Save

The time gained by using online e-applications can now be put into dealing with more clients, increasing the number of applications that can be submitted compared to the old manual process.

6. Covid Has Made a Virtual Meeting a Friendly Option

People can be hesitant when it comes inviting a stranger into their home. This can make a virtual meeting and e-app option much easier to sell to clients.

7. Get Paid to Submit E-Apps

You heard that right. Most insurance companies are offering bonuses to agents when they use e-apps. Why are they doing this? Because they benefit from the efficiency of online applications just like everyone else does. As agents turn more and more to online applications it allows insurance companies to streamline their business around that process.

8. Quicker Underwriting Approval

Some carriers offer immediate underwriting approval. With these carriers you know on the spot if your client is declined. No more waiting for days just to find out the app was approved or not.

9. Complete Multiple Apps at Once

Some carriers such as Mutual of Omaha and Cigna (as of the date of this article) allow you to submit applications for different plans. Ex. A client that is looking for a Med Supp. and a cancer policy can be done in one pass without the redundant paperwork.

10. Get Paid More Quickly

Since the entire process of completing, submitting and approval of applications is quicker with e-apps, then you will obviously get paid quicker. Getting paid quickly means more money in your pocket in less time. Its hard to argue with those types of benefits.

Don’t think of handling applications online as a novel method to be used in just a few circumstances.

There is no reason not to be using e-apps as often as possible. Using e-applications is simply the best method available right now. It will benefit you, your clients and the carrier if you do.

As always , if you have any questions about the tools we have available to help you become more productive, our experienced marketers are here to help.

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Tags: Online Enrollment

ACA Enrollment Rose in Early 2020

Posted by www.psmbrokerage.com Admin on Tue, Aug 11, 2020 @ 10:55 AM

ACA Enrollment Rose a Bit in Early 2020

As of March 15, 202010.7 million consumers had effectuated coverage through the Exchanges for February 2020, meaning that they selected a plan, paid their first month’s premium, if applicable, and had coverage in February 2020.

This number represents approximately 94 percent of consumers who made plan selections during the 2020 Open Enrollment Period (11.4 million).

Although the number of plan selections through the Exchanges were approximately equal in the 2019 and 2020 Open Enrollment Periods (OEPs), a greater number of consumers had effectuated coverage in February 2020 compared to February 2019, as of March 15 of both
years.

Total effectuated enrollment for February 2020 increased by approximately one percent from total effectuated enrollment for February 2019.

The average total monthly premium for Exchange enrollees in February 2020 was $576.16, a decrease of three percent from the February 2019 average premium of $594.17.

Approximately 9.2 million, or 86 percent, of Exchange enrollees in February 2020 received APTC, which represents a decrease of approximately 1 percentage
point from the share of Exchange enrollees who received APTC in February 2019.

The average monthly amount of APTC per enrollee receiving APTC fell by approximately four percent from February 2019, to $491.53.

The numbers reported today may be revised in future months as additional data on new effectuations, terminations, and cancellations become available. Later this year, CMS plans to publish effectuated enrollment data for the first six months of 2020, which will include updated February 2020 enrollment data.

Effectuated Map

Source : https://go.cms.gov/39EBfmu, https://go.cms.gov/3g6dSEK.
Infographic: https://aishealth.com/health-plans/effectuated-aca-exchange-enrollment-rises-slightly-in-early-2020-2/

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Retirees Growing More Confident With Technology

Posted by www.psmbrokerage.com Admin on Thu, Aug 06, 2020 @ 11:24 AM

Retirees Growing More Confident With Technology

For years seniors have been getting more and more comfortable with technology. The recent C-19 pandemic has only accelerated this trend.

Seniors have been using technology for a number of tasks where they previously may not have, from booking virtual visits with doctors to ordering prescriptions online.

Telemedicine use has jumped 340% among Medicare-eligible seniors since the start of the pandemic, according to a new survey.

Nearly one-third of consumers 64+ say they monitor their health using a wearable; 4 in 10 want a wearable that helps them maintain social distance, according to healthinsurance.com.

Data from insurance giant UnitedHealth also shows that the telehealth sector is making inroads with specific hard-to-reach demographics; telehealth adoption has rapidly increased among seniors.

Of America’s Seniors:

97% say their doctor accepts Medicare
89% have a smartphone
83% use Facebook the most
73% use social media
69% with a Medicare Advantage plan are happy with it
68% have an iPad or other type of tablet
30% use social media to staying in touch with friends

Don't be afraid to engage senior clients online and know that, now more than ever, seniors can be found online and through social media.

They may also welcome the option of meeting virtually to talk about their needs and how you can help them, as they get more accustomed to the process.

Don't miss the opportunity to gain the efficiencies of using new technologies to do business with your senior clients and benefit from the efficiencies you will gain by using them.

Seniors and tech

Based on SURVEY

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Is Telemedicine Here to Stay?

Posted by www.psmbrokerage.com Admin on Wed, Aug 05, 2020 @ 08:48 AM

Is Telemedicine Here to Stay?

The answer largely depends on whether Medicare and private health insurers will adequately cover virtual doctor visits once coronavirus outbreaks subside

Telemedicine is having its moment. Over the last few months, millions of people have relied on video or telephone calls to talk to their doctors. But as the pandemic moves across the United States, and eventually recedes in some places, how long will the moment last?

While patients used virtual visits to avoid overcrowded and potentially infectious doctor’s offices or emergency rooms, many are returning to face-to-face appointments in cities where the threat has subsided.

And insurance payments for telehealth services, especially at full cost, may only be temporary.

Medicare’s coverage of a broad range of services is slated to end when the coronavirus no longer poses a public health emergency. Private insurers, which followed the federal government’s lead, could revert to paying doctors for virtual visits at a fraction of the cost for traditional visits, if anything at all.

Some of the nation’s biggest insurers, like UnitedHealthcare and Anthem, say they haven’t decided beyond September or October on whether to extend the policies they adopted that allowed for coverage in lieu of doctors’ visits during the coronavirus crisis.

“The concern everyone in the industry has is that reimbursement is in jeopardy,” said Dr. Mia Levy, the director of the cancer center at Rush University Medical Center in Chicago, which treated patients virtually during the height of the pandemic. “Because of telehealth, we were able to stay actively engaged with our patients,” she said.

While there is broad bipartisan support for telehealth coverage, Congress would have to pass specific legislation to make some of Medicare’s changes permanent.

“Reversing course would be a mistake,” said Seema Verma, the administrator for the federal program, which reimbursed doctors the same for virtual visits, including those over the telephone, as for in-person ones and relaxed rules about who can use telemedicine.

About nine million people under traditional Medicare used telemedicine services during the early months of the crisis. Early data does not show wide variations in use by race or ethnicity.

“It was really a no-brainer for us,” Ms. Verma said.

Source: View the full article.

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Tags: Telemedicine

AHIP Warns of Part D Rebate Rule Impact

Posted by www.psmbrokerage.com Admin on Mon, Aug 03, 2020 @ 03:55 PM

AHIP Warns of Part D Rebate Rule Impact

The average basic premium for Medicare Part D prescription plans will be the second lowest average Part D premium since 2013, CMS announced. But industry leaders are not expressing as much optimism about the lower premiums as CMS.

AHIP acknowledged the current Part D average basic premium is one of the lowest since 2013, but the payer organization pointed out the effects the rebate rule could have in continuing savings on out-of-pocket health care costs.

The week before the Administration announced the average basic premium for 2021, the Trump administration signed three executive orders that placed restrictions on pharmacy benefit managers and sought to heighten drug importations. Through these measures, the executive orders aimed to lower drug prices.

AHIP, using CMS statistics, argued the executive orders would instead cause Medicare premiums to rise by 25%, up drug spending in Medicare programs by over $195 billion, and contribute $100 billion toward bailing out drug makers.

AHIP argues, "the Problem Is Still the Price. But nothing in the proposed rule would require Big Pharma to lower their prices."

"We’re winning great savings for seniors. But with the rebate rule, seniors will lose. Let’s focus on real, bipartisan solutions to out-of-control drug costs. In the midst of the COVID-19 crisis – seniors deserve those savings more than ever."

SOURCE

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Tags: Medicare Part D, Part D, AHIP

Part D Premiums to Increase Slightly in 2021

Posted by www.psmbrokerage.com Admin on Mon, Aug 03, 2020 @ 11:29 AM

Part D Premiums to Increase Slightly

Part D premiums are set to take a slight uptick in 2021, according to CMS, which estimates the average premium in Part D will be $30.50 next year, a slight increase from $30 in 2020, but still the second-lowest premium rate ever.

Part D premiums have been on a steady decline over the past several years, decreasing by 12% since 2017. Part D enrollment increased alongside declining premiums, with enrollment increasing by 16.7% since 2017.

Part D enrollment has increased alongside declining premiums, CMS said, with enrollment increasing by 16.7% since 2017.

CMS also touted Trump administration efforts to curb costs for Part D beneficiaries, such as launching the Part D Senior Savings Model earlier this year, in which participating Part D plans will offer insulin with a cap at $35 for a monthly supply.

CMS also eliminated the so-called pharmacy "gag clause," which prevented pharmacists from providing beneficiaries with information on alternative, less expensive ways to purchase drugs than through their Part D plan.

President Donald Trump also signed four executive orders targeting drug pricing late last week, including one that aims to revive the scuttled rule that would nix anti-kickback safe harbors for drug rebates in Part D.

More information on the Part D Senior Savings Model can be viewed at: https://innovation.cms.gov/initiatives/part-d-savings-model.

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Tags: Medicare Part D, Part D

Medicare Blog | Medicare News | Medicare Information

Medicare Enrollment Periods Explained

Enrollment Guidance Policy Changes and Updates and Model Medicare Advantage and Prescription Drug Plan Individual Enrollment Request Form for Contract Year 2021

It’s a Great Time to be in Medicare Market

Should You Start Selling Insurance Part Time?

Should You Start Selling Insurance Part Time?

10 Reasons to Use E- Applications

ACA Enrollment Rose in Early 2020

ACA Enrollment Rose a Bit in Early 2020

Retirees Growing More Confident With Technology

Retirees Growing More Confident With Technology

Is Telemedicine Here to Stay?

Is Telemedicine Here to Stay?

The answer largely depends on whether Medicare and private health insurers will adequately cover virtual doctor visits once coronavirus outbreaks subside

AHIP Warns of Part D Rebate Rule Impact

AHIP Warns of Part D Rebate Rule Impact

Part D Premiums to Increase Slightly in 2021

Part D Premiums to Increase Slightly

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