Nearly half of Medicare beneficiaries, or 48%, are enrolled in Medicare Advantage plans. This is highly concentrated across UnitedHealthcare and Humana, which account for almost half of all MA enrollees.
Nearly half of Medicare beneficiaries, or 48%, are enrolled in Medicare Advantage plans. As soon as next year, this number could cross the 50% threshold, a report published Thursday predicts.
The Kaiser Family Foundation analysis also found that in 2022, MA enrollment accounted for $427 billion, or 55%, of all federal Medicare spending. The report used data from the Centers for Medicare & Medicaid Services for its study.
⚡ Take your MA sales to the next level with us.Learn More!
MA enrollment has more than doubled since 2007, when it was just 19% of the Medicare population, the report said. Between 2021 and 2022, MA enrollment rose by 8%, or by 2.2 million beneficiaries. This is slightly lower than the prior year, when enrollment grew by 10%. The Congressional Budget Office predicts that by 2032, MA enrollees will make up 61% of the Medicare population.
UnitedHealthcare and Humana account for almost half of all MA enrollees this year. UnitedHealthcare has 28% of total MA enrollment and Humana has 18%. In about a third of all counties in the U.S., the payers account for at least 75% of MA enrollment.
Meanwhile, Blue Cross Blue Shield has 14% of MA enrollment, CVS Health has 11%, Kaiser Permanente has 6%, Centene has 5%, Cigna has 2% and the remaining 16% is made up of other insurers.
UnitedHealthcare and Humana historically have had the highest share of MA enrollment. In 2010, UnitedHealthcare had 20% of MA beneficiaries and Humana had 16%. UnitedHealthcare has also seen the largest growth since 2010.
KFF also found:
About two-thirds of MA enrollees, or 66%, are in individual plans. Meanwhile, 18% are in employer/union-sponsored group plans and 16% are in special needs plans.
The share of Medicare beneficiaries enrolled in MA plans varies by state. This year, Alaska has the lowest with 1% enrolled in MA, while Hawaii has the highest with 59% enrolled in MA.
In 2022, almost seven out of 10 MA enrollees are in plans with prescription drug coverage that don’t require premiums other than the Medicare Part B premium. This was reported in a separate analysis by KFF, also published Thursday.
Most enrollees in individual MA plans have access to benefits that aren’t covered by traditional Medicare. This includes eye exams, hearing exams and fitness.
Nearly all MA enrollees, or 99%, are in plans that require prior authorization for some services. This refers to a process utilized by insurers that determines if they will cover a certain procedure or medication. It is mostly used for expensive services, such as prescription drugs administered by a physician, skilled nursing facility stays and inpatient hospital stays, KFF found. However, it is rarely needed for preventive services.
The Medicare Annual Enrollment Period (AEP) will be here before we know it, so now is the time to refresh your product knowledge.
We have a variety of on-demand training videos about our product features and benefits to help you create a plan of protection to meet your clients' needs.
Just click the images below to view each video.
Your AEP resources
The countdown is on to AEP! We've put helpful guides and links to frequently used tools all in one place, so you can quickly access the information you need during AEP. Whether you're a new agent or have been around for a few years, it's easy to get caught up in all of the noise about AEP.
Make sure you're ready to sell, learn about about the online tools available to you, and more.
Aetna members who have Medicare Supplement (includes Accendo Medicare Supplement) and complementary product insurance plans can get discounts through LifeMart, which offers discounts on wellness programs (such as GlobalFit), as well as travel, events, electronics, and more. Members can sign up for LifeMart discounts by going to the secure member side of AetnaSeniorProducts.com.
IMPORTANT: Member discounts, including LifeMart, can not be shared with potential members or used to sell a policy. This information only becomes available to members after a policy is issued.
* Aetna Senior Supplemental Insurance includes products underwritten by: Accendo Insurance Company (ACC), part of the CVS Health® family of companies and Aetna affiliate; Aetna Health and Life Insurance Company (AHLIC); Aetna Health Insurance Company (AHIC), American Continental Insurance Company (ACI); Continental Life Insurance Company of Brentwood, Tennessee (CLI).
For agent use only. Not for public use or distribution.
With the bundled solution fromAmerican Home Life(AHL), producers and customers alike can enjoy a product with more benefits and less complexity to holistically address the needs of clients — the way insurance was meant to be.
Finding The Best Plan For Your Client
Whether your client needs Final Expense or Medicare Supplement, American Home Life has exactly what they need. Our Patriot Series Final Expense product is available to provide flexible coverage to meet your client's unique needs and our Medicare Supplement product offers Plans A, F, G, and N with varying amounts of coverage.
Patriot Series Final Expense
The Patriot Series Final Expense offers 4 plans to best meet your clients needs. Three level plans and one modified plan are all available with flexible coverage options.
The American Home Life Insurance Company also offers Medicare Supplement plans. Plan A provides basic benefits, while Plan F offers more comprehensive coverage.
It's a great time to offer more value-driven options to your Med Supp customers. Through PSM, you'll now have access to National General's new Med Supp product that includes MultiDiscount1 so your customers can save more.
The annual enrollment period is just around the corner, so in this month's compliance bulletin we thought it would be beneficial to take a bird's eye approach in reviewing AEP in general and then dive into some compliance tips regarding what to avoid saying in order to stay CMS compliant.
As you'll recall, the annual enrollment period is a time when your clients can essentially make any change they are eligible for. Among other things, these changes may include enrolling in Medicare Advantage for the first time, switching from one Medicare Advantage plan to another, or joining a Medicare prescription drug plan.
As you may know, AEP only lasts from October 15 through December 7th. This only gives you roughly seven and a half weeks to close on sales. With such a small window of time to enroll potential clients, it's important to take care of all your contracting, certifications, and training as soon as possible. Here are a few important points to consider before you can jump into AEP.
The sooner you can answer yes to all of these questions the better off you'll be - as AEP is fast approaching.
Now that we've gotten the general information out of the way, let's look into a few tips regarding what to avoid saying to current and potential clients in order to stay CMS compliant.
"Free premiums!" This is never 100% accurate. Zero dollar premiums and copays usually only pertain to specific areas and plans - and they are not free. Do not generalize a plan or use misleading language such as, "this is the best plan out there".
"Is your spouse eligible for Medicare?" - "How about your friends?" - "Can I have their number so I can call them?" While it's okay to ask for referrals, you may only ask for their names and mailing addresses. Instead, you should give out your business card.
"If you're liking this Medicare plan, you should check out this life insurance plan." During an appointment, an agent cannot cross-sell insurance products or provide non-health-related products to their Medicare clients.
"Let me get your contact information so that you are able to come to my event." You cannot require potential clients to provide any contact information in order to attend an event. While on the topic of events, signing-in is never required. If you have a sign-in sheet, it should explicitly state that sign-ins are optional.
"While you're waiting for your doctor, let me tell you about your Medicare options." Agents can never conduct sales and marketing activities where beneficiaries receive their health care services. This includes waiting rooms, exam rooms, treatment centers and pharmacies.
As you are well aware, there are many other requirements to consider in order to remain CMS compliant. Our aim today was to help you gear up as October 15th quickly approaches. Remember to complete your contracting and certifications, order your supplies, read up on any compliance changes, and set your goals. Thanks for tuning in, and we'll see you next month with some more compliance tips.
While attending an insurance conference recently I was asked to participate in a Q&A panel called Ask the Experts where I was pinpointed as being very effective at networking and building relationships. I was then asked to provide some actionable steps someone can take to be better at relationship building in business. After giving a short, but effective response I wanted to expand on it more, and therefore in this article you'll find some excellent information on some simple steps you can take to truly build a vast network full of deep relationships that will allow you to elevate your business as well as the business of others.
"No One Cares How Much You Know, Until They Know How Much You Care."
We've all heard this old adage before, and as cliché as it may sound it is absolutely and unequivocally spot on. The first step in building effective relationships in your business is that you must genuinely and authentically care about people. This is one of those things that you cannot "fake it until you make it." If you do not sincerely care about the well-being and success of others you should cease reading this article immediately and go gaze in the mirror at your own reflection.
By definition caring is someone or something that shows kindness and concern for others. A person who is concerned about others and who does kind things for them is an example of someone who would be described as caring. Insert care emoji. But how do we effectively show someone that we care? Maya Angelou wrote, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel”. In other words, if we want to build a positive relationship with someone, we need to invoke positive emotions. Feelings of love, happiness, admiration and appreciation. We'll know we've accomplished this when we see someone smile as a direct effect of our actions.
A Long History with Med Supp Insurance Nassau Life Insurance Company of Kansas, the company that issues Nassau Medicare Supplement plans, was previously known as The Pyramid Life Insurance Company. Pyramid was formed in 1913 and has a long history of providing Medicare Supplement coverage – back to the introduction of Medicare.
170+ Years of Innovation in Underwriting Phoenix Life was the first insurance carrier to offer reduced life insurance premium rates for women. As the hazards of smoking gain public awareness, Phoenix was the first to offer discounted premiums on all policies to non-smokers.
Instant Decision Utilizing a fully automated eApplication process, your agents can expect that most of your sales will be completed and a decision given in about 30 minutes, saving you valuable time and reducing unnecessary follow up.
Rapid Underwriting and Policy Issuance With only 15 yes/no underwriting questions for most states, your agents can feel confident in our modern underwriting approach. Client medical histories are obtained electronically, which is a big time saver, and they will receive their decision in minutes, not days, even if a tele-interview is needed.
At some point in your career you will start to question what you want to do with your business when you no longer want to remain active in it. The choices can be difficult planning your exit from your business.
I get it, it's your life’s work and likely represents decades of blood sweat and tears.
All the more reason you should be carefully creating a succession plan before you need one.
You don’t want to leave this to chance or make a half-hearted decision at the last moment. There are big risks for not having a succession plan. Let’s look at some of those real quick, before we go any further.
Some risks of not having a succession plan:
Loss of mission critical knowledge that may never be recovered.
Naming a successor who lacks personal drive, commitment, knowledge, training or skills needed to perform the job successfully.
Significant loss of time spent getting a new successor up to speed.
Potential disruptions to workplace processes, workflows, and protocols.
The risks go on, but that’s enough to make you realize the importance of creating a succession plan long before you actually need one.
What is succession planning and why is it important?
Succession planning is the process of identifying very important positions in the organization and creating a talent pipeline, by preparing employees to fill vacancies in their organization as others retire or move on.
A successor is an employee with the knowledge, skills, and abilities to fill a vacant position until a permanent replacement can be identified.
Succession planning helps ensure business continuity and performance, particularly during times of shifting leadership and change. Even when there is no identifiable successor within an organization, succession planning can help identify the knowledge, skills and training needed in a future external candidate.
What options are there when creating a succession plan?
For the most part, there are 3 options you have as an independent agent.
In no particular order:
Let your current book of business run off.
This is probably the least ideal option available to you. By not servicing your business you are not taking care of your customers.
Sure, at first it might seem like the easiest option. You stop servicing your clients, continue to get paid, and you may not even notice a drop off right away.
I assure you this will be short lived. As soon as your clients need help and you’re not there for them, they will look for help elsewhere, and other agents will be more than happy to explain how you intended to just lay back and make money off of them, without lifting a finger.
Your book of business will slowly, or even quickly begin to fade away. All those years of hard work slipping away. What a waste, right?
Let a family member or business partner take over the business.
If you have someone in a position to take over your business this is a great option. Of course, it takes time to get someone up to speed with your business model and all the things that go into running your business.
If you have someone working directly with you, then this makes things easier. If not, well, that’s the point of the succession plan. To plan out how to get that individual up to speed, so they will be able to step in when you are ready to step out.
You will need to decide how the financing will be handled. There are endless ways to structure this, but at the end of the day, you will be getting paid as your business continues to thrive.
With this option you have the piece of mind that the business you put so much effort into will continue to help, not just your clients, but the new owners of the company for years to come.
Sell your book of business.
You will likely have the option to sell your book of business to another agency. Agencies are always looking for a good book of business to expand their own.
Keep in mind, having a CRM in place will be a big deal when it comes time to sell. Most companies are going to want to import all the info from your business into their own CRM. This makes servicing the business far more feasible than if all of the information was on paper.
You are likely working with an FMO that may be happy to take care of your business, and also offer a fair price for it. That price will vary based on what’s in your book.
Generally, the average valuation we see in the industry is around 1.5 - 2 times the commissions, for example. This can obviously vary based on what’s in your book, the age of the contracts, etc.
Of course, you want to be sure that whoever you sell your business to will be able to service your clients. You want to know that the clients you worked so hard for, for so long, will be taken care of.
We talk to far too many agents with 10 years into their business, who think they will live for ever and have plenty of time to worry about succession planning in the future.
That may be a mistake. The best time to start planning is yesterday. You never know what the future will bring and you don’t want to risk the business you put so much effort into.
Succession planning is serious business that must be considered carefully. If you have any questions or would like some guidance, our experienced marketers are here to help.
Effective October 1, 2022 Field Agents will be required to record all sales and marketing calls in their entirety. The recordings must be retained in a HIPAA compliant manner for 10 years. View details on the new CMS rule here.
This pertains to calling leads, scheduling appointments, collecting drug and provider lists and conducting phone enrollments.
Only in person, face to face appointments are excluded, however any follow up calls related to sales and completing the enrollment process must be recorded.
Additionally, a new disclaimer must be verbally conveyed within the first minute of a sales phone call.
National General Accident & Health’s individual healthcare business is becoming Allstate Health Solutions, putting the power of the Allstate brand behind important individual coverage offerings typically sold to consumers outside of the workplace. Allstate Health Solutions’ portfolio includes products that minimize a customer’s medical out-of-pocket costs, such as short-term medical, dental, and Medicare supplement insurance.
This new branding is for the National General individual healthcare products and does not impact Allstate Benefits-branded worksite products. This is another step in the integration of National General Holdings Corp., which was acquired by The Allstate Corporation in January 2021.
There is no impact to insureds, and insurance brokers and agents will continue offering these products using the current processes. Sales partners with questions can reach out to their Allstate Health Solutions contact at NatGenAHAgentServ@ngic.com.
Allstate Health Solutions FAQ
The Allstate Health Solutions name will be used for National General’s portfolio of individual healthcare products, including Short-Term Medical, Hospital Indemnity, Critical Illness, Accident, Dental, and Medicare Supplement insurance.
When will the Allstate Health Solutions brand begin appearing in the marketplace?
The goal is to have the new brand in place by the important Open Enrollment period this fall.
Do agents need to take any action to continue doing business with Allstate Health Solutions?
No, agents do not need to take any action to continue doing business with us.
How will current National General policyholders be informed of the change?
We will inform customers of the new brand, and let them know that nothing changes with their policies and they do not need to take any action.
2023 CMS Final Rule – Third-Party Marketing Organization (TPMO) Guidelines
Medicare Advantage organizations are responsible for ensuring that Third-Party Marketing Organizations (TPMOs) adhere to all applicable laws, regulations and CMS guidelines, including the requirements for conducting lead generation, marketing, selling, and enrollment activities with Medicare beneficiaries as outlined within the 2023 CMS Final Rule released May 9, 2022.
Please review and implement the new requirements outlined below.
New TPMO disclaimer
The following new disclaimer needs to be on all third-party CY2023 materials, effective for marketing beginning October 1, 2022:
“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”
TPMOs must add this disclaimer to any previously approved material.
This disclaimer must be:
Verbally conveyed within the first minute of a sales call.
Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication.
Prominently displayed on TPMO websites.
Included in any marketing materials, including print materials and television advertisements, developed, used or distributed by the TPMO.
Compliance oversight of all lead sources
TPMOs are responsible for compliance oversight including ensuring all lead sources used to solicit Medicare product enrollments are compliant with CMS guidelines, and all other state or federal laws, rules and regulations.
This includes but is not limited to ensuring that the TPMO, when conducting lead generating activities, either directly or indirectly, for an MA organization, must:
Disclose to the beneficiary that his or her information will be provided to a licensed agent for future contact. This must be done:
Verbally when communicating with a beneficiary by phone.
In writing when communicating with a beneficiary through mail or other paper.
Electronically when communicating with a beneficiary through email, online chat, or other electronic messaging platform.
Disclose to the beneficiary that he or she is being transferred to a licensed agent who can enroll him or her into a new plan.
Recording calls with beneficiaries
TPMOs, including lead generation vendors and downstream related entities, must record all calls with beneficiaries in their entirety. In addition, TPMOs must retain and make the recordings available upon request for a minimum of 10 years. This includes calls that are part of the chain of enrollment into a Medicare Advantage or Part D Plan (the steps taken by a beneficiary from becoming aware of a Medicare plan or plans to making an enrollment decision), as well as post-enrollment telephonic discussions
This rule applies to telephonic conversations only, not face-to-face meetings.
Thank you for your cooperation in ensuring compliance with these requirements. If you have any questions, please contact us here or call 800-998-7715.
In preparation for the new CMS Rule, PSM is proud to announce a Telephonic Enrollment solution for field agents. Effective immediately, licensed Medicare agents can enroll beneficiaries telephonically into MA, MAPD, and PDP plans.
"The platform's call recording and analytics capabilities are available now to help field agents prepare to comply and excel under the new CMS Final Rule."