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Agent Compliance Guide - Checklist

Posted by www.psmbrokerage.com Admin on Mon, Oct 19, 2020 @ 12:52 PM

checklist

Agent Compliance Guide - Checklist

 

We all need help remembering tasks that need to be completed throughout the week.

Especially when it comes to the amount of documentation and compliance issues an insurance agent needs to deal with.

So we’ve put together a detailed 10 page checklist with interactive check boxes to help remind you of all the things that are required to remain compliant before, during, and after a sale.

Use the PDF digitally or print it out as a reminder of all the things you need to be aware of.

The check list includes reminders for things such as :

Completing a Scope of Appointment

Licensing

Meeting with a client

Making a compliant presentation

Communicating with a client after the sale

Avoiding and dealing with canceled applications

Avoiding and dealing with Rapid Disenrollment’s

Dealing with complaints

And much, much more..

 

Below you can see an example of the 10 page checklist.

 

agent compliance 1

 

 

Download the complete 10 page interactive PDF checklist

 

Part D Overview for AEP 2021

Posted by www.psmbrokerage.com Admin on Fri, Oct 16, 2020 @ 03:41 PM

Medicare Advantage, Part D members shifting to higher-rated plans

Part D Overview for AEP 2021

In 2021, 996 Prescription Drug Plans will be offered across the 34 PDP regions nationwide (excluding the territories).

This represents an increase of 48 PDPs from 2020 (a 5% increase) and an increase of 250 plans (a 34% increase) since 2017.
This fact sheet provides an overview of the Medicare Part D program, plan availability, enrollment, spending and financing.


Part D Benefit Parameters Increasing in 2021
Part d parameters 2021

The Part D standard benefit has several phases, including a deductible, an initial coverage phase, a coverage gap phase and catastrophic coverage.

Between 2020 and 2021, the parameters of the standard benefit are rising, which means Part D beneficiaries will face higher out-of-pocket costs for the deductible and in the initial coverage phase, as they have in prior years, and will have to pay more out-of-pocket before qualifying for catastrophic coverage (see graph above).

  • The standard deductible increases from $435 in 2020 to $445 in 2021;
  • The initial coverage limit increases from $4,020 to $4,130, and;
  • The out-of-pocket spending threshold increases from $6,350 to $6,550 (equivalent to $10,048 in total drug spending in 2021, up from $9,719 in 2020).

Part D Standalone Enrollment has Declined, But Increased in Medicare Advantage Plans

Part D Enrollment


In 2020, 46.5 million Medicare beneficiaries are enrolled in Medicare Part D plans, including employer-only group plans; of the total, just over half (53%) are enrolled in stand-alone PDPs and nearly half (47%) are enrolled in Medicare Advantage drug plans.

Full article with many interactive graphs

Trump Admin Drives Telehealth Services in Medicare and Medicaid

Posted by www.psmbrokerage.com Admin on Fri, Oct 16, 2020 @ 10:00 AM

White House

Trump Admin Drives Telehealth Services in Medicare and Medicaid

Today, the Centers for Medicare & Medicaid Services (CMS) expanded the list of telehealth services that Medicare Fee-For-Service will pay for during the coronavirus disease 2019 (COVID-19) Public Health Emergency (PHE).

CMS is also providing additional support to state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their efforts to expand access to telehealth.

The actions reinforce President Trump’s Executive Order on Improving Rural Health and Telehealth Access to improve the health of all Americans by increasing access to better care.

 

Expanding Medicare Telehealth Services

For the first time using a new expedited process, CMS is adding 11 new services to the Medicare telehealth services list since the publication of the May 1, 2020, COVID-19 Interim Final Rule with comment period (IFC).

Medicare will begin paying eligible practitioners who furnish these newly added telehealth services effective immediately, and for the duration of the PHE.

These new telehealth services include certain neurostimulator analysis and programming services, and cardiac and pulmonary rehabilitation services.

The list of these newly added services is available at: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.

 

Preliminary Medicaid and CHIP Data Snapshot on Telehealth Utilization and Medicaid & CHIP Telehealth Toolkit Supplement

In an effort to provide greater transparency on telehealth access in Medicaid and CHIP, CMS is releasing, for the first time, a preliminary Medicaid and CHIP data snapshot on telehealth utilization during the PHE.

This snapshot shows, among other things, that there have been more than 34.5 million services delivered via telehealth to Medicaid and CHIP beneficiaries between March and June of this year.

Full Article

To further drive telehealth, CMS is releasing a new supplement to its State Medicaid & CHIP Telehealth Toolkit: Policy Considerations for States Expanding Use of Telehealth, COVID-19 Version that provides numerous new examples and insights into lessons learned from states that have implemented telehealth changes.

To view the Medicaid and CHIP data snapshot on telehealth utilization during the PHE, please visit: https://www.medicaid.gov/resources-for-states/downloads/medicaid-chip-beneficiaries-COVID-19-snapshot-data-through-20200630.pdf.

5 Tips To Make Your AEP Successful

Posted by www.psmbrokerage.com Admin on Tue, Oct 13, 2020 @ 09:32 AM

succcess-go-get-itPhoto by Gerd Altmann from Pexels

5 Tips To Make Your AEP Successful

About 23 million of the 62 million people eligible for Medicare have Medicare Advantage coverage, and about 14 million have Medigap coverage.

Some of the other Medicare enrollees have other types of Medicare plans. Companies in the Medicare market are so enthusiastic that, last spring, as the first C-19 wave was peaking, distributors put out press releases announcing they were hiring a total of thousands of call center agents.

Here are five things to know about the Medicare plan market heading toward Thursday:

 ► The market looks competitive: UnitedHealthcare has put out rate sheets showing that, in states like Alabama and Maine, its typical standard rates will be going up about 6% to 7% in 2021.

CMS has spreadsheets showing what’s happening to Medicare Advantage and Part D prices. There, the average monthly premium is on track to decrease 11% in 2021, to $21;

► 31% of people aging into Medicare plan to get enrollment help from live humans: GoHealth, a broker, came up with that statistic in an online survey of 2,106 people 62 and older and not enrolled in Medicare; or 65 and older and enrolled in Medicare;

► Agents and marketers in the field are feeling the effects of the increased level of competition: Jesse Slome of the American Association for Medicare Supplement Insurance (AAMSI) said the “pace of change has been greatly accelerated compared to a year ago.

There is accelerated consolidation and acquisition of companies
that will give larger national distributors significant competitive advantages.”;

► COVID-19 itself might not have that much effect on experienced retail agents: Lindsay Engle, a Medicare market tracker who works for

MedicareFAQ.com, said the image of local agents meeting with clients at a kitchen table is off the mark. “Social distancing won’t have much of an impact, since most sell over the phone.”;

► At least some in the private Medicare plan sector are excited about the idea of the possibility of a change in Medicare age eligibility: Looking ahead, the growth potential for the industry is enormous if the eligibility age is dropped to 60.

If the federal government cuts the regular Medicare eligibility to age 60, “That will result in an immediate growth of the market by 20.5 million,” said Jesse Slome of the AAMSI.

Read The Full Article

Star Ratings Released for Medicare Advantage, Part D

Posted by www.psmbrokerage.com Admin on Fri, Oct 09, 2020 @ 01:41 PM

Star ratings

Star Ratings Released for Med Adv, Part D

The CMS released Star Ratings for Medicare Advantage and Part D plans Thursday, and the quality ratings of M/A and prescription drug plans remain strong.

Most Medicare beneficiaries – about 77% – who enroll in M/A plans with drug coverage will be in plans with 4-or-more stars in 2021, compared to 69% of beneficiaries enrolled in such plans in 2017.

The 21 health plans earning 5 stars include:

KelseyCare Advantage, 
Kaiser Permanente,
UnitedHealthcare,
CarePlus by Humana,
Tufts Health Plan,
Health Partners,
Capital District Physicians' Health Plan,
Quartz Medicare Advantage of Wisconsin,
Cigna,
Health Sun - Anthem,
BCBS - Health Now New York and Martins Point.


MA star ratings 2020


Almost half – about 49% – of M/A plans offering prescription drug coverage will have an overall rating of four stars or higher, up from about 45% in 2017.

The average Star Rating for all M/A plans with prescription drug coverage improved to 4.06 out of 5 stars in 2021, up from 4.02 in 2017.

2021 Star Rating Fact Sheet
Full Article

Enrollment 2020: A Different Challenge

Posted by www.psmbrokerage.com Admin on Thu, Oct 08, 2020 @ 12:04 PM

uncertainty in health coveragephoto created by creativeart

Enrollment 2020: A Different Challenge

The unpredictable impacts of the coronavirus pandemic on Medicare open enrollment will require both broker and member engagement to be technology-enabled, transparent, and streamlined.

Britta Orr, chief Medicare officer at Allina Health l Aetna, told HealthPayerIntelligence that she could see the pandemic having two disparate effects on member decision-making during this open enrollment season.

“There's been sort of a shift in the market and the mindset around insurance,” said Orr. “We see a lot of employers in small and large group plans really choosing to stay put right now with what they're offering their employees.”

These employers and members may be more hesitant to switch out of their current plan given the unpredictable economy and uncertain healthcare environment.

Instead of shifting to an untested plan, those in this category prefer to stay in a plan where they already have an idea of what their costs will be. This could improve retention in the health payer industry, Orr noted.

Meanwhile, other employers and members may be more eager to switch plans and may be more interested in educating themselves about their options than in previous years, given the possibility that they may catch COVID-19.

BE CLEAR ABOUT COVID-19 BENEFITS

Whereas last year the changes to Medigap Plan F stirred up a lot of confusion among members, brokers, and navigators alike, this year there have been no major regulatory shifts to trigger uncertainty.

Medicare covers COVID-19 lab testing, antibody tests, medically necessary hospitalizations and hospital quarantines—though some copays may apply—, and the potential COVID-19 vaccine.

Medicare Advantage plans cover many of these same services and may provide coverage for additional benefits, such as telehealth and meal delivery.

However, some of these benefits are not permanent. For example, according to a Peterson-Kaiser Family Foundation brief published in August, coronavirus waivers for a little over 31 percent of payers on the individual and fully-insured markets will end in December 2020.

This extends to some Medicare Advantage plans as well.


ELIMINATE THE EXTRA NOISE IN MESSAGING

This is a time for payers to streamline and focus their messaging, Orr emphasized.

The coronavirus pandemic creates a lot of noise for members. In order to support careful, informed decision-making during open enrollment, payers need to pare down their messaging for both members and brokers to the most relevant content.

For the first half of the year as the country struggled to manage the pandemic, preventive and direct, clinical care fell lower on the priority list for payers and members alike. Humana recently reported a sharp decline in preventive care when COVID-19 struck.

Now, however, preventive care and primary care services are more important than ever.

The payer has resumed its emphasis on these services by participating in Aetna’s Time for Care campaign.

The campaign informs members about how to get wellness checks and safely meet with their providers.

Agents Need to be on top of all the information coming out about plans and Medicare COVID-19 related coverage, as there are a lot of questions around the subject.

The better you are able to explain the situation and put your clients at ease, the better chance you have of finding the right plan for the right person.

Full Article

Centene Expands Medicare Advantage Offerings for 2021

Posted by www.psmbrokerage.com Admin on Wed, Oct 07, 2020 @ 02:42 PM

centene corp building

Centene Corporation Expands Medicare Advantage Offerings for 2021

Centene Corporation announced today it plans to expand its Medicare Advantage offerings for 2021.

The company's Medicare plans – branded WellCare, Allwell, Fidelis, and Health Net – will operate in 1,249 counties across 33 states in 2021 – a 30% increase since 2020.

"At a time when many seniors are grappling with the effects of COVID-19, we are committed to expanding choice and access to high-quality, affordable Medicare plans that support our members' health and well-being during the pandemic and beyond," said Michael F. Neidorff, Chairman, President and CEO for Centene.

Today, Centene serves nearly 1 million Medicare members across the country, and in 2021, the company will continue to expand its presence. Among the highlights, Centene is offering:

  • 122 new plan designs across 30 states;
  • Medicare Advantage plans in Vermont (10 counties) and Rhode Island (statewide); and,
  • Preferred Provider Organization (PPO) plans in 10 additional states including Alabama, Arizona, Illinois, Kansas, Kentucky, Louisiana, Mississippi, New Jersey, Rhode Island, and Vermont.

"Selecting a Medicare plan is one of the most critical decisions seniors and their families make each year," said Michael Polen, Centene's Senior Vice President and Chief Executive Officer, Medicare Solutions.

"As we approach the Annual Enrollment Period, we want our members to know we are expanding our presence and continue to offer a number of new benefits and solutions to help our members live better, healthier lives."

Official News Release

 

 

Cigna Expands Medicare Advantage Offerings to 23 States

Posted by www.psmbrokerage.com Admin on Wed, Oct 07, 2020 @ 09:27 AM

CIGNA-HQ-2

Cigna Expands Medicare Advantage With Offerings Now Across 23 States

Cigna Corporation is rapidly expanding its Medicare Advantage (MA) plans to make it easier for more customers to access affordable, predictable and simple health care.

During the 2021 Medicare Annual Election Period (AEP), beginning October 15, customers will be offered comprehensive, highly-rated, affordable MA plans – including a $0 premium plan in every market.

Telehealth services offered to all customers, including behavioral health and physical therapy

To help seniors access care from the safety and comfort of their homes, Cigna is offering telehealth services to all MA customers, including no-cost access to behavioral health providers via audio and video.

For the first time, Cigna also is adding virtual physical therapy services to its MA plans. This new feature is an addition to 2021 plans to help customers gain strength and/or recover from less complex procedures at home.

"Since the COVID-19 pandemic, we've seen a significant change in how people want to receive care and these patterns vary based on regions of the country and individual preferences.

We're offering our customers more options than ever before, so they can seek affordable, high-quality care in a way that meets their lifestyle – whether that's in-person, over the phone or virtually," said Brian Evanko, president of Cigna's government business. 

"No matter the setting, our Medicare Advantage plans ensure our valued customers get the proper preventive care, chronic condition management and emotional support they need during these challenging times."

Medicare Advantage provides additional benefits beyond what Medicare traditionally offers. In most of its MA plans for 2021, Cigna includes vision, dental, fitness, and discharge meal benefits along with an allowance on common over-the-counter products, like aspirin, adhesive bandages, and dental care products.

Cigna is also offering benefits associated with social determinants of our customers' health, addressing key factors like transportation and nutrition.

In select markets in 2021, the company is adding Healthy Benefits Plus, a new program making it easier for customers to purchase fresh fruits and vegetables through a produce card with a monthly allowance of up to $30.

Reaching more communities

In 2021, Cigna will offer plans in 369 counties spanning 23 states, representing a 22 percent increase in our county footprint.

Cigna is expanding to 67 new counties for 2021, including a broad portfolio of HMO and/or PPO plans. In addition to the new county expansion, Cigna is expanding PPO offerings in 154 counties in our existing footprint.

PPOs typically offer an out-of-network benefit, while HMO plans generally do not.

Cigna will enter markets in five new states in 2021 with MA plans:

  • Ohio (Cleveland area)
  • Virginia (Tri-Cities area in the southwest part of the state)
  • Oklahoma (Oklahoma City area)
  • Utah (Salt Lake City area)
  • New Mexico (Albuquerque area)

This expansion builds upon Cigna's 2020 footprint, which currently serves more than 500,000 MA customers across 18 states and the District of Columbia.

The 2020 footprint includes: Alabama, Arkansas, Arizona, Colorado, Delaware, Florida, Georgia, Illinois, Kansas, Missouri, Maryland, Mississippi, New Jersey, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas and the District of Columbia.

Driving better health care outcomes

To accommodate the expansion, Cigna has significantly increased its network, adding more than 25,000 physicians throughout its service territory.

Physician collaboration is an important part of the Cigna MA model, with more than 85 percent of its customers cared for by doctors who are in a value-based arrangement.

Value-based care increases coordination, emphasizes preventive care and generally results in better health outcomes and greater patient satisfaction.

Additionally, Cigna continues to offer a Dual Special Needs Plan in many geographies that coordinates care for people who qualify for both Medicare and Medicaid.

Increased consumer choice

The company offers six standalone Prescription Drug Plans (PDPs) for 2021 in all states, including three branded Cigna and three branded Express Scripts, providing cost savings and benefit options for all customer needs.

The Cigna Secure Rx and Express Scripts Medicare – Value plans are collectively qualified for CMS low-income subsidy auto-enrollment in 33 regions in 2021.

The Secure and Value plans offer $0 copays (Tier 6) and $1 copays (Tier 1) for medications purchased at preferred pharmacies, and will offer $0 copays (Tier 6) for select insulins at preferred pharmacies.

All six plans have $0 copay options for select medications purchased through preferred mail order.

Additionally, the Cigna Secure-Extra Rx plan and Express Scripts Medicare – Saver and Express Scripts Medicare – Choice plans will participate in the CMS Part D Senior Savings Model, helping Medicare customers manage diabetes with affordable and predictable insulin copays of $35 or less.

Cigna also offers Medicare Supplement plans in 48 states and the District of Columbia. Medicare Supplement insurance helps pay for what Original Medicare doesn't cover, including copayments, coinsurance and deductibles.

Medicare's AEP begins October 15 and continues through December 7. Plans selected during AEP are effective January 1, 2021.

News Release

 

 

Life Insurance Sales: August 2020

Posted by www.psmbrokerage.com Admin on Tue, Oct 06, 2020 @ 11:05 AM

analysis

Life Insurance Sales: August 2020

LIMRA tracks monthly sales in order to provide continuing insight into the COVID-19 pandemic’s impact on individual life sales and applications.

Sales in August (the most recent month for which information has been compiled) continued the positive trend from July with a 4% increase in premium and 8% increase in policy sales.

Policy growth was driven primarily by large, direct-to-consumer carriers.


Monthly Sales Growth

monthly life sales growth

 

Sales Growth by Product

life sales growth by product

 

Premium growth was driven by indexed universal life, which lead on both a growth rate and overall dollar increase basis.

IUL premiums were driven by a one-time occurrence for one carrier and a new product introduction.

Two participants dropped their IUL product this year. Overall, just under half of IUL companies had a premium increase in August.

IUL policy gains were more widespread. VUL and whole life premiums also increased in August.

On a policy basis, term and whole life also increased.

August Premium Growth Range by Product

august life premium growth by product

 

August Policy Growth Range by Product

life policy growth rate by product

 

August applications were up 6%, however less than half of participants reported an increase over August 2019.

Applications increased for all products except fixed universal life and variable universal life.

For companies able to respond, face-to-face application submissions dropped off in August after increasing in July while online/mobile applications continue to do better.

Face-to-face channels fared slightly better than in previous months, with a slightly higher percentage experiencing an increase.

Download the Full Report

 

Mid-Year Health Care Trends & Performance

Posted by www.psmbrokerage.com Admin on Mon, Oct 05, 2020 @ 01:43 PM

Analysis

 

Mid-Year Health Care Trends & Performance

 

About 274 million people received medical coverage from U.S. health insurers as of June 30, 2020, up from 268.2 million – about 5.8 million – from a year ago.

Mid-year enrollment trends indicated membership gains for Individual,
Medicare Advantage and Employer-Group ASO (administrative services only for self-funded plans) business, while the Employer-Group risk segment experienced a year-over-year decline.

This brief is an assessment of the latest year-over-year enrollment trends, comparing Q2 2019 with Q2 2020 segment membership.


Enrollment by Segment: Q2 2020

Enrollment-1

 

The individual market has weathered the storm during the early years of ACA and stabilized into a health segment for insurers.

COVID-19 hasn’t presented major challenges for the segment so far. In June 2020, insurers reported total individual, non-group coverage for over 15.3 million people, a 2.8% increase, or 420,000 members, from 14.9 million in June 2019 and the first year-over-year increase since 2015.

Medicare Advantage continues to experience enrollment gains as M/A plans, with extra benefits and services remain appealing to seniors. 

Although M/A market penetration is strong, there is still ample opportunity for growth with just 36% of the nearly 70 million people eligible for Medicare enrolled in M/A plans.

 

Enrollment by Segment: Q2 2020

Segment Percent 

Health Enrollment Shifts Segment

Segment Shifts

Read the Full Brief

 

Relaxed Medicare Repayment Terms Ease the Burden on Healthcare Providers

Posted by www.psmbrokerage.com Admin on Thu, Oct 01, 2020 @ 02:32 PM

us capitol

Relaxed Medicare Repayment Terms Ease the Burden on Healthcare Providers

President Donald Trump on Sept. 30 signed a short-term spending bill that funds the government through Dec. 11 and relaxes the repayment terms for Medicare loans hospitals received earlier this year. 

Below are the details on six key healthcare provisions in the CR for providers:

Revises the Medicare Accelerated and Advance Payment (AAP) Program.
The CR allows providers (a) to extend repayment for a full year before recoupment of the AAP payment begins, and (b) to limit claim offsets to 25 percent of the full Medicare payment for 11 months followed by six months with claim offsets limited to 50 percent of the full amount.

This change effectively provides a full 29 months to repay the AAP amount in full.

Delays Medicaid Disproportionate Share Hospital (DSH) Reductions.
The CR delays until Dec. 11, 2020, scheduled Medicaid payment reductions for DSH hospitals.

Extends Health Center and Workforce Funding.
The CR extends funding for Community Health Centers, National Health Service Corps and the Teaching Health Center Graduate Medical Education Program through Dec. 11, 2020.

Clarifies Medicaid Drug Rebate Program for Medication-Assisted Treatment.
The CR clarifies that any drugs and biologicals used for medication-assisted treatment will continue to be eligible for rebates under the Medicaid program.

Maintains Medicare Reimbursement for Rural Providers.
Medicare reimbursement for physicians and other providers includes three geographic adjustments. The CR extends a “floor” for such adjustment at 1.0 until Dec. 12, 2020.

Provides for Additional Medicaid Extensions.
he CR also extends three CARES Act provisions changing the Medicaid program.

Specifically the CR further extends two Medicaid demonstration programs — the Medicaid Money Follows the Person demonstration project and the Medicaid Community Mental Health Services demonstration — as well as the Medicaid spousal impoverishment protections program.

 
Summary

The CR gives healthcare providers participating in federal programs some flexibility in repayment timelines for amounts received from CMS as part of the AAP program, including both a delayed start for repayments and a longer period to repay the full sum.

This reflects the ongoing and long-term nature of the COVID-19 pandemic, which may impact future funding bills.

Similarly, the CR extends certain Medicare and Medicaid provisions until December.

Congress will return after the election to determine how lawmakers will address funding the government beyond Dec. 11, 2020.

Full Article

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