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Annuities 101 Guide

Posted by www.psmbrokerage.com Admin on Thu, Dec 28, 2023 @ 10:27 AM

annuities 101

Annuities are financial instruments that offer a unique way to plan for one's financial future. Essentially, they are contracts between an individual and an insurance company, designed to provide a steady stream of income over a specified period or for life. Annuities come in various forms, each with its own features and benefits. Some provide guaranteed income, while others offer the potential for growth based on market performance.

Download the Guide


Annuities can be a valuable tool for retirement planning, helping individuals secure a stable income source during their post-working years. Understanding the different types of annuities and how they align with your financial goals is essential to making informed decisions about your financial future.

image-png-Dec-28-2023-04-00-10-6280-PMWhen integrated into a diversified retirement strategy, annuities provide an additional layer of financial protection and offer opportunities for long-term care benefits, making them a comprehensive solution for securing your retirement.

Annuities offer a host of advantages that make them a compelling choice for individuals planning for retirement. First and foremost, they provide a dependable source of income, ensuring regular payments that can cover living expenses throughout retirement. Additionally, many annuities come with tax advantages, allowing your earnings to grow tax-deferred until you start receiving payments. This can be a significant benefit, as it maximizes your savings over time. Furthermore, certain types of annuities, like fixed and indexed annuities, guarantee the return of your principal investment, safeguarding your money from market volatility. This principal protection can provide peace of mind, knowing that your savings are secure.

Annuities can offer a sense of financial security, especially during retirement, by providing a predictable source of income. However, it's essential to carefully consider the terms, fees, and options associated with annuities to choose the right one for individual financial goals and circumstances.

Are you a Medicare Advisor looking to offer your clients Annuity options?

We have drafted up an effective cross-marketing letter you can use to market annuities to your Medicare clients. If you would like it personalized, please reach out to us today.

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   For Agent Use Only. Not for the general public.


Tags: Fixed Annuity, Annuity Information, cross marketing

Happy New Year 2024

Posted by www.psmbrokerage.com Admin on Wed, Dec 27, 2023 @ 03:26 PM

new year 2024

Happy New Year from Precision Senior Marketing! As we step into another year, we want to take a moment to express our heartfelt gratitude for your continued support and partnership. Together, we've navigated the challenges and celebrated the successes of the past year, and we're excited to embark on a new journey with you in the year ahead.

Here's to a year filled with health, happiness, and prosperity for you and your loved ones. Let's make 2024 a remarkable year! 🥂


As we usher in the New Year, it presents a fresh canvas filled with possibilities and opportunities. Making this year a great one starts with setting intentions – not just lofty resolutions, but achievable goals rooted in our deepest values and aspirations. It's about embracing each day with a renewed sense of purpose and positivity, whether it's through small daily habits or significant life changes. This year could be the one where we cultivate healthier relationships, focus on personal well-being, or pursue new learning and career milestones.

Remember, greatness in the year ahead isn't just about monumental achievements; it's found in the joys of everyday moments and in our resilience to overcome challenges. Let's approach this New Year with an open heart, a mindful attitude, and a commitment to make each day count, turning hopes into actions and dreams into realities. Here's to a year brimming with fulfillment, growth, and happiness!

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   For Agent Use Only. Not for the general public.


Understanding the Proposed CMS Rules

Posted by www.psmbrokerage.com Admin on Wed, Dec 27, 2023 @ 11:59 AM

Understanding the Proposed CMS Rules

As you’re aware, CMS recently issued proposed amendments to its regulations governing the 2025 Medicare Advantage Program (MA) and Medicare Prescription Drug Benefit Program (PDP). Click here to read the proposed rules.

As conversations about these proposed rules have continued with our partners and throughout our industry, there remains much confusion surrounding the impact these proposed rules may have on our industry. As such, we’ve prepared a FAQ page designed to clarify our interpretation of the rules and how you should view them.

This matter impacts everyone. In collaboration with our partners at Amerilife and our Carrier Partners, we are actively engaged in discussions with CMS to convey our concerns about the proposed rule and its negative implications for Medicare.

The deadline for submitting comments on the proposed rule to CMS is approaching quickly. We encourage you to take the opportunity to write and send your own letters to CMS and your elected officials to make your voice heard.


thnak you for your support


We appreciate your dedication to serving your clients, and in turn, we are devoted to supporting you. United, we can strive to prevent CMS from implementing this proposed policy. Thanks for your assistance.

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   For Agent Use Only. Not for the general public.


Tags: Medicare Advantage, Medicare Supplement

The Rewarding Path of Selling Medicare Plans as an Independent Insurance Agent

Posted by www.psmbrokerage.com Admin on Thu, Dec 21, 2023 @ 02:48 PM

The insurance industry, especially in the realm of Medicare plans, presents a landscape brimming with opportunities for those seeking a blend of autonomy, financial stability, and the satisfaction of providing a valuable service. As an independent insurance agent specializing in Medicare plans, you stand at the forefront of a rapidly growing market, offering vital services to a demographic that is expanding each year: seniors.

The Expanding Senior Market

The demographic landscape of the United States is undergoing a significant shift. With the Baby Boomer generation reaching retirement age, there is an unprecedented increase in the population of seniors. Statistics indicate that by 2030, all Baby Boomers will be over the age of 65, thereby expanding the senior market substantially. This growth translates into a growing need for Medicare plans, tailored to meet the diverse health care needs of the aging population.

Unlike many other professions, where income is directly tied to the hours worked, Medicare plans offer the potential for earning a recurring income on policies sold. This means that each policy sold can continue to provide income for years, compounding over time as you build your client base. This structure offers not only a steady income stream but also the peace of mind that comes with financial stability.

Autonomy and Flexibility

Being an independent agent means being your own boss. This autonomy allows you to set your own schedule, choose your clients, and create a work-life balance that suits your lifestyle. Whether you prefer to work from home, set up an office, or be on the move, the flexibility inherent in this career path supports a variety of working styles and preferences. This level of independence is particularly appealing to those who thrive in an environment where they can take charge of their business growth and direction.

The satisfaction of providing a service that helps people understand and access the healthcare they need cannot be overstated. It’s a role that not only benefits your clients but also brings a deep sense of personal fulfillment.

The opportunity is here!

The role of an independent insurance agent selling Medicare plans offers more than just a career; it presents a pathway to a fulfilling, flexible, and financially rewarding profession. In the face of the growing senior market, the ability to generate residual income, and the autonomy of being your own boss, this career path stands out as an excellent choice for those looking to make a positive impact while building a sustainable business. As the population ages, the need for knowledgeable, compassionate, and dedicated Medicare plan agents will only grow, making now an ideal time to step into this rewarding field.


With approximately 10,000 individuals in the United States becoming eligible for Medicare each day, finding the right Field Marketing Organization (FMO) to partner with is crucial for achieving success. PSM goes above and beyond to empower independent agents, agencies, and brokers by offering unparalleled insurance products, exceptional back-office support, and a wealth of valuable tools and resources.

We take pride in providing our agents with high quality senior insurance products that bring a sense of security and peace of mind to the nation's exploding senior population. Our experienced insurance marketing team provides our agents with a robust product portfolio, game-changing technology and unrivaled support. We look forward to showing you how we can personalize our services to help grow your business.

Precision Senior Marketing was founded in 2006, in Austin, Texas. In the intervening time with almost two decades of experience, PSM has grown to a nationwide footprint, with a mission to empower agents to honestly and ethically help people live longer, healthier and more financially secure lives.


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   For Agent Use Only. Not for the general public.


Tags: Medicare Advantage, Medicare Supplement, New Business Opportunities

15 Strategies to increase customer retention

Posted by www.psmbrokerage.com Admin on Thu, Dec 21, 2023 @ 11:33 AM

Strategies to increase customer retention

"Loyal customers, they don't just come back, they don't simply recommend you, they insist that their friends do business with you." – Chip Bell

Retaining clients is of paramount importance for any business, as it signifies not only the satisfaction and trust of existing customers but also offers a multitude of benefits. It is significantly more cost-effective to retain clients than acquire new ones, saving resources and marketing expenses.

Additionally, loyal clients tend to spend more, refer others, and become brand advocates, thereby boosting revenue and brand reputation. Retaining clients also allows for deeper relationships, better understanding of their needs, and the opportunity to tailor products or services accordingly, leading to increased customer satisfaction and long-term success.

Here are some go-to retention ideas tailored for agents serving the senior market:

•  Regular Check-Ins: Schedule periodic check-ins with your senior clients. These can be in-person meetings, phone calls, or even video calls. Show that you care about their well-being and are available to address their insurance needs.

•  Educational Workshops: Host workshops specifically designed for seniors to educate them about insurance options, changes in policies, and relevant healthcare updates. This positions you as an informative resource.

•  Personalized Policies: Customize insurance policies to meet the unique needs of your senior clients. Understand their health conditions, financial situations, and preferences to offer tailored coverage.

•  Annual Policy Reviews: Conduct annual policy reviews to ensure that the insurance coverage still aligns with your client's changing needs. Discuss any necessary adjustments or new offerings.

•  Health and Wellness Information: Provide resources on health and wellness topics relevant to seniors, such as exercise programs, nutrition guides, or local healthcare services. This demonstrates a holistic approach to their well-being.

•  Easy Access to Information: Create user-friendly materials that simplify insurance-related jargon and processes. Seniors often appreciate clear and concise communication.

•  Digital Literacy Support: Offer assistance with using online portals and digital tools for managing policies, claims, and payments. Many seniors may need guidance in this area.

•  Long-Term Care Planning: Assist seniors in planning for long-term care needs, including options for nursing homes, assisted living facilities, and home healthcare. Help them understand how insurance can play a role in covering these expenses.

•  Family Involvement: Encourage seniors to involve their adult children or trusted family members in discussions about insurance and financial planning. This can lead to more informed decisions.

•  Emergency Support: Provide emergency contact information and support for clients and their families in case of unexpected events. This adds a layer of security and trust.

•  Social Engagement: Organize social events or gatherings for your senior clients. These can be opportunities for them to connect with peers and build a sense of community.

•  Loyalty Rewards: Consider loyalty programs or discounts for long-term clients to show appreciation for their continued business.

•  Referral Program: Encourage your senior clients to refer friends and family to your insurance services. Reward them for successful referrals.

•  Stress-Free Claims Process: Ensure that the claims process is straightforward and easy to navigate. Assist clients with filing claims and provide guidance throughout the process.

•  Feedback and Improvement: Request feedback from your senior clients on their experiences and use their input to make improvements to your services.


"The key is to set realistic customer expectations and then not to just meet them, but to exceed them — preferably in unexpected and helpful ways."

– Richard Branson


Remember that building trust and maintaining open lines of communication are essential when working with the senior market. By demonstrating your commitment to their well-being and being a reliable source of support, you can foster long-lasting client relationships.

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Mutual Sales Leaders 2025 - Dublin

Posted by www.psmbrokerage.com Admin on Thu, Dec 21, 2023 @ 10:07 AM

Mutual Sales Leaders 2025 - Dublin

Mutual Sales Leaders 2025 - Dublin

Dublin is considered the friendliest city in Europe, if not in the entire world. Kindness and politeness are baked into the city’s honest, down-to-earth culture, which is evident on the cobblestone streets as locals look each other in the eye and salute each other with a jolly “dia dhuit” — or hello.

So, channel the Irish spirit of hard work and become an honorary Dubliner by qualifying for Mutual Sales Leaders 2025, where we’ll raise a glass to your success and recognize you for your outstanding achievements.

You belong in Dublin in 2025!

Visit the Places That Shaped Dublin

The people of Dublin are fiercely proud of their city’s rich history. Dublin was established more than 1,000 years ago on the east coast of Ireland, and many of the places that helped define the traditions, customs and identity of Ireland’s capital still stand today. View Flyer


Mutual Sales Leaders is a well-deserved trip for the best of the best, and we know you have what it takes to be one of the year’s distinguished sales leaders.

Set a goal to join us Dublin, a city where grit, hard work and determination reign supreme. One of Europe’s oldest cities is definitely a “suiomh foirfe” — perfect setting — to recognize our sales stars for their truly historic achievements.

By qualifying for Mutual Sales Leaders 2025, you’ll feel the sense of satisfaction and honor that will make Dubliners proud to call you one of their own.

View Qualifications

Mutual Sales Leaders 2025 - Dublin

Med Supp Broker Bonus Program

Every day, your clients are rewarded with great Medicare supplement and dental coverage. And we think you should be rewarded too! When you place your business with Mutual of Omaha, you’ll be rewarded with credits to grow your business.

Click on the flyers below to view more details.


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Tags: Medicare Supplement, mutual of omaha

F&G: How can you jump start your clients' retirement?

Posted by www.psmbrokerage.com Admin on Tue, Dec 19, 2023 @ 09:32 AM

fg updates

How can you jump start your clients' retirement?

With a New Year rapidly approaching, learn how F&G’s Performance Pro®, a fixed indexed annuity, can reignite your clients’ retirement with a 15%1 jump start.

In summary, Performance Pro offers:

Check out our latest flyer to learn how Performance Pro’s premium bonus can jump start your clients’ retirement goals today.

Questions? Request details here or call 800.998.7715

For financial professional use only. Not for use with the general public.

1For issue age 75 and under in most states. Subject to change. The premium bonus is automatically included with Performance Pro for an annual rider fee of .10%. See the Statement of Understanding for complete details.

2For a fee.

3If specific qualifications for impairment are met (see rider for details) and the Account Value is greater than zero, withdrawal payments increase by 2X (1.5X if joint contract).

“F&G” is the marketing name for Fidelity & Guaranty Life Insurance Company issuing insurance in the United States outside of New York. Life insurance and annuities issued by Fidelity & Guaranty Life Insurance Company, Des Moines, IA.

Guarantees are based on the claims paying ability of the issuing insurer, Fidelity & Guaranty Life Insurance Company, Des Moines, IA.

The premium bonus is calculated based on the first year premium and vests according to a vesting schedule over the duration of the surrender period.

This is a fixed deferred indexed annuity providing minimum guaranteed surrender values. You should understand how the minimum guaranteed surrender values are determined and the product features used to determine the values. Even though contract values may be affected by external indexes, the contract annuity is not an investment in the stock market and does not participate in any stock, bond or equity investments.

Interest rates subject to change at insurer’s discretion and are effective annual rates.

Annuities that offer a vesting bonus may have higher fees, longer surrender charge periods, lower interest crediting rates, lower participation rates, lower cap rates and higher spreads than annuities without vesting bonuses.

The provisions, riders and optional additional features of this product have limitations and restrictions, may have additional charges, and are subject to change.


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Tags: Annuities, F&G

Higher lifetime withdrawal rates for Nationwide Peak® 10

Posted by www.psmbrokerage.com Admin on Mon, Dec 11, 2023 @ 04:23 PM

nationwide logo
nationwide header

Provide your clients with even more guaranteed retirement income!

Effective December 11, 2023, Nationwide is boosting withdrawal percentages on the Bonus Income+ rider for the Nationwide Peak 10® fixed indexed annuity.

The rider gives your clients:

  •  20% initial bonusÂą
  •  8% simple interest roll-up²
  • Competitive guaranteed lifetime incomeÂł

Take a look at our increased withdrawal rates:

Request Details

Important Transition Date Information

  • Contracts issued on or after December 11, 2023 will receive the increased lifetime withdrawal percentages.
  • FOR PENDING BUSINESS: Any contracts signed prior to the December 11 effective date, and in pending status on or after December 11, 2023, will receive the increased lifetime withdrawal percentages upon issuance.

FOR NEWLY ISSUED BUSINESS IN THE FREE-LOOK WINDOW: To receive the increased lifetime withdrawal percentages, issued contracts still within the free-look window will need to exercise the free-look provision. At a minimum, this process will require a new application, free-look letter of instruction and updated Certificate of Disclosure, all of which should reflect a signature date of December 11, 2023 or later. Please also check with your IMO on its free-look requirements.

natiowide logo white



(1) Credited at contract issue and based on the purchase payment; added to the Income Benefit Base.
(2) For the first 10 years or until lifetime withdrawal begins, whichever occurs first.
(3) All guarantees and protections are backed by the claims-paying ability of Nationwide Life and Annuity Insurance Company.


This material is not a recommendation to buy or sell a financial product or to adopt an investment strategy. Investors should discuss their specific situation with their financial professional.

Nationwide Peak 10 is an individual, single-purchase-payment, deferred fixed indexed annuity issued by Nationwide Life and Annuity Insurance Company, Columbus, Ohio. Please note: The contract does not directly participate in the stock market or any index. Withdrawals are subject to income tax, and withdrawals before age 59 1/2 may be subject to a 10% federal tax penalty.

Annuities have limitations. They are long-term vehicles designed for retirement purposes. They are not intended to replace emergency funds, to be used as income for day-to-day expenses or to fund short-term savings goals. Please read the contract for complete details.

Nationwide, the Nationwide N and Eagle, Nationwide is on your side, and other marks displayed in this message are service marks of Nationwide Mutual Insurance Company and/or its affiliates, unless otherwise disclosed. © 2023 Nationwide.


FAM-1581M1-AL (12/23)

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Tags: Annuities, Nationwide

2024 Medicare OEP Details

Posted by www.psmbrokerage.com Admin on Thu, Dec 07, 2023 @ 12:20 PM

Medicare OEP

The Medicare Open Enrollment Period (OEP), which runs from January 1st to March 31st each year, is an important time for Medicare beneficiaries. It allows individuals enrolled in Medicare Advantage plans to make certain changes to their coverage.

Here are key rules and guidelines for the Medicare OEP:

Medicare Advantage Plan Changes:
Beneficiaries enrolled in a Medicare Advantage plan as of January 1 can switch to another Medicare Advantage plan or return to Original Medicare (Part A and B). This can be done only once during the OEP.

Prescription Drug Plan Changes:
If a beneficiary switches to Original Medicare during this period, they can also join a Medicare Prescription Drug Plan (Part D) to add drug coverage.

No Changes for Standalone Part D Plans:
Beneficiaries who have Original Medicare with a standalone Part D plan cannot use this period to switch their Part D plan.

No Effect on Medigap Policies:
The OEP does not provide an opportunity to purchase or switch Medigap (Medicare Supplement) policies. Medigap enrollment rules are separate and not tied to the OEP.

One-Time Change:
Each beneficiary is allowed one plan change during the OEP. Once a change is made, the beneficiary cannot make another change until the next Annual Enrollment Period, unless they qualify for a Special Enrollment Period.

Coverage Effective Dates:
Changes made during the OEP take effect on the first day of the month after the plan receives the enrollment request. For example, a change made in February will take effect on March 1st.

No New Enrollments for Medicare:
The OEP is not for individuals who are newly eligible for Medicare to enroll in Medicare Advantage or Part D. New enrollees have separate initial enrollment periods.

Marketing Restrictions:
There are specific rules restricting insurance providers from actively marketing to beneficiaries during OEP. This includes no unsolicited marketing materials specifically about the OEP.

Royal Neighbors AnnuitiesUnderstanding these rules is crucial for anyone working with Medicare beneficiaries, especially insurance agents and healthcare advisors, to ensure compliance and provide accurate guidance.

After the Annual Enrollment Period (AEP), there are several effective sales strategies you can employ to maintain momentum and continue growing your business.

Check out a summary of ideas here.

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Tags: Medicare Advantage plans, OEP, Compliance

Get More with Physicians Mutual®

Posted by www.psmbrokerage.com Admin on Thu, Dec 07, 2023 @ 12:20 PM


Get More with Physicians Mutual

You can now add Physicians Mutual to your product portfolio. This is a game-changing opportunity for agents like you who want to increase their sales while helping clients save more money. Find out why so many agents are excited!

Great reasons to add Physicians Mutual to your portfolio:

More Innovation

Cutting-Edge Products | Access to patented Medicare Supplement plans exclusive to Physicians Mutual.

Comprehensive Coverage | Products for all ages, including dental, cancer, life, and pet insurance.

Extras | Policyholders receive access to Rx discounts, discounted fitness club memberships, vision & hearing discounted and more.

More Support

Personalized Service | No toll-free numbers needed.

Easy Selling | Online sales presentation and enrollment tools.

Ongoing Support | Live, online, and pre-recorded sales trainings.

Marketing | Free and customized marketing materials (for select products) to help promote your brand.

Extras | Hassle free compliant seminars. No CMS-requirement. No Scope of appointment. No sales recording or storage requirements.

More Rewards

Earn More | Competitive compensation packages and monthly bonuses with no cap.

World-Class Incentive Trips | Yearly trips for our top performing agents. Recent trips include Mexico and Ireland.

Ask us for details on what sets Physicians Mutual apart from the competition — and why you won’t want to sell others' products. You won’t regret it!

To request details, Please call us at 800-998-7715 or click on the link below.

learn-more-button - Cryer Pools & Spas, Inc.

For recruiting purposes only. Products/features vary by state.

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Tags: medicare supplement insurance, dental plans, Physicans Mutual

2025 CMS Proposed Final Rule

Posted by www.psmbrokerage.com Admin on Thu, Dec 07, 2023 @ 12:19 PM

final rule

Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Plan Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly, and Health Information Technology Standards


On November 6, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would revise the Medicare Advantage Program (MA), Medicare Prescription Drug Benefit Program (Part D), Medicare Cost Plan Program, Programs of All-Inclusive Care for the Elderly (PACE), and Health Information Technology Standards and Implementation Specifications. The proposed policies build on existing Biden-Harris policies to strengthen beneficiary protections and guardrails to promote healthy competition and ensure Medicare Advantage plans best meet the needs of beneficiaries. In addition, these proposed policies would promote access to behavioral health care providers, promote equity in coverage, and improve supplemental benefits. 

On December 14, 2022, CMS issued CMS-4201-P, which proposed revisions to regulations governing MA, Part D, Medicare cost plans, PACE, and Health Information Technology Standards and Implementation Specifications. All the provisions included in the proposed rule CMS-4201-P were open for public comment from December 14, 2022, to February 13, 2023. On April 5, 2023, CMS issued final rule CMS-4201-F, which finalized several provisions proposed in CMS-4201-P. CMS intends to address a number of the remaining provisions from the proposed rule, CMS-4201-P, in future rulemaking, including in the final version of this rule.

This fact sheet discusses the major provisions of the 2025 proposed rule. The proposed rule can be downloaded here: https://www.federalregister.gov/public-inspection/current. 

Enhancements to Medicare Advantage and Medicare Part D 

New Guardrails for Plan Compensation to Agents and Brokers to Stop Anti-competitive Steering.

Many beneficiaries rely on agents and brokers to help navigate complex Medicare choices as they comparison shop for coverage options. The Medicare statute requires that CMS’s marketing standards ensure that CMS develops guidelines to ensure that the use of compensation creates incentives for agents and brokers to enroll individuals in the Medicare Advantage plan that is intended to best meet their health care needs. However, financial incentives to agents and brokers, more readily paid by large plans, can result in beneficiaries being steered to some Medicare Advantage plans over others based on excessive broker and agent compensation and other bonus arrangements—rather than recommending plans based on the prospective enrollee’s best interests. 

Specifically, CMS is proposing to redefine “compensation” to set a clear, fixed amount that agents and brokers can be paid regardless of the plan the beneficiary enrolls in, addressing loopholes that result in commissions above this amount that create anti-competitive and anti-consumer steering incentives. The proposal ensures the payment of agent and broker compensation reflects only the legitimate activities required of agents and brokers by broadening the scope of the regulatory definition of “compensation” so that it is inclusive of all activities associated with the sales to/enrollment of a beneficiary into a Medicare Advantage plan or Part D plan. The proposed national agent/broker fixed compensation amount for Medicare Advantage is $642. This proposed fixed amount for Medicare Advantage compensation, compared to the existing national compensation cap of no more than $611, would eliminate the current variability in payments and improve the predictability of compensation for agents and brokers. 

Additionally, the proposed rule would generally prohibit contract terms between Medicare Advantage plan organizations and marketing middlemen, such as field marketing organizations, that result in things such as volume-based bonuses for enrollment into certain plans, which may interfere with the ability of agents or brokers to assist the enrollee in finding the plan that is best suited to their needs.

These proposed policies advance the goals of President Biden’s historic Competition Council and Executive Order signed in July 2021 by helping to ensure a robust and competitive Medicare Advantage marketplace

Improving Access to Behavioral Health Care Providers

CMS is taking steps to improve access to behavioral health care services for Medicare Advantage plan enrollees by proposing updates to network adequacy standards. The Consolidated Appropriations Act, 2023 established a new statutory Medicare benefit category for services furnished by marriage and family therapists (MFTs) and mental health counselors (MHCs). Through separate rulemaking in the Calendar Year 2024 Physician Fee Schedule final rule, Through separate rulemaking in the Calendar Year 2024 Physician Fee Schedule final rule, CMS has also finalized that addiction or drug and alcohol counselors, who otherwise meet the statutory requirements of MHCs, are able to enroll in Medicare. An estimated 400,000 MFTs and MHCs will be eligible to enroll in Medicare, and enrolled MFTs and MHCs can bill Medicare for services starting January 1, 2024. Most of these providers practice within outpatient behavioral health facilities, such as mental health centers, substance use treatment centers, and hospitals. To help ensure that people with a Medicare Advantage plan have access to behavioral health providers, including these newly enrolled providers, CMS is proposing to add a range of behavioral health providers under one category called “Outpatient Behavioral Health” as a facility-specialty for which CMS sets Medicare Advantage plan network adequacy standards. Specialists under this category will include MFTs and MHCs, Opioid Treatment Program providers, Community Mental Health Centers, addiction medicine physicians, and other providers who furnish addiction medicine and behavioral health counseling or therapy services in Medicare today. 

In addition, CMS is proposing to add this Outpatient Behavioral Health facility specialty to the list of the specialty types that will receive a 10% credit if the Medicare Advantage plan organization’s contracted network of providers includes one or more telehealth providers of that specialty type who provide additional telehealth benefits for covered services.

Mid-Year Enrollee Notification of Available Supplemental Benefits

An increasing share of Medicare dollars is going toward Medicare Advantage plan rebates that Medicare Advantage plans are using to advertise a wide array of supplemental benefits, including special supplemental benefits for chronically ill enrollees. In 2022, over 99% of Medicare Advantage plans offered at least one supplemental benefit, the median was 23 supplemental benefits, and the most frequently offered benefits were vision, hearing, fitness, and dental. Some of these benefits address unmet social determinants of health needs, such as food insecurity or inadequate access to transportation. However, at the same time, plans have reported that enrollee utilization of many of these benefits is low. To ensure the large federal investment of taxpayer dollars in these benefits is actually making its way to beneficiaries and are not primarily used as a marketing ploy, the proposed rule requires Medicare Advantage plans to engage in minimum outreach efforts so that enrollees are aware of the supplemental benefits available to them. CMS is proposing that a “Mid-Year Enrollee Notification of Unused Supplemental Benefits” be issued annually, personalized to each enrollee, that includes a list of any supplemental benefits not accessed during the first six months of the year. In addition, the notification would include the scope of the benefit, cost-sharing, instructions on how to access the benefit, any network application information for each available benefit, and a customer service number to call if additional help is needed. These policies advance the goals of President Biden’s historic Competition Council and Executive Order signed in July 2021 by helping make consumers aware of their plan benefits, facilitating better decision-making and consumer choice in the Medicare Advantage marketplace.

New Standards for Supplemental Benefits for the Chronically Ill

The Bipartisan Budget Act of 2018 introduced special supplemental benefits for the chronically ill (SSBCI), which are benefits provided to eligible chronically ill enrollees who have a reasonable expectation of improving or maintaining health or overall function. CMS proposes new requirements for Medicare Advantage plans to demonstrate, by the time they submit bids, that SSBCI items and services meet the legal threshold of having a reasonable expectation of improving the health or overall function of chronically ill enrollees and are supported by research. CMS is proposing that Medicare Advantage plans establish and maintain bibliographies of relevant research studies or other data to demonstrate that an SSBCI meets these requirements. Additionally, CMS proposes to update SSBCI marketing requirements to prevent misleading marketing related to these benefits that makes it appear that the benefits are available to everyone. These policies advance the goals of President Biden’s historic Competition Council and Executive Order signed in July 2021 by helping to ensure a robust and competitive Medicare Advantage marketplace made up of plan options with meaningful benefits.

Annual Health Equity Analysis of Utilization Management Policies and Procedures

Prior authorization policies and procedures may have a disproportionate impact on underserved populations and may delay or deny access to certain services. The proposed rule ensures that Medicare Advantage plan organizations analyze their utilization management (UM) policies and procedures from a health equity perspective. CMS is proposing updates to the composition of, and responsibilities for, the Utilization Management (UM) committee to require: 1) a member of the UM committee to have expertise in health equity, 2) the UM committee conduct an annual health equity analysis of prior authorization policies and procedures used by the Medicare Advantage plan organization, and 3) Medicare Advantage plan organizations to make the results of the analysis publicly available on their website. The goal of the health equity analysis is to create additional transparency and identify disproportionate impacts of UM policies and procedures on enrollees who receive the Part D low-income subsidy, are dually eligible, or have a disability.

Enhance Enrollees’ Rights to Appeal a Medicare Advantage Plan’s Decision to Terminate Coverage for Non-Hospital Provider Services

Currently, Medicare beneficiaries enrolled in a Medicare Advantage Plan under current regulations do not have the same access to Quality Improvement Organization (QIO) review of a fast-track appeal as Traditional Medicare beneficiaries. CMS is proposing to (1) require the QIO, instead of the Medicare Advantage Plan, to review untimely fast-track appeals of a Medicare Advantage Plan’s decision to terminate services in a skilled nursing facility, comprehensive outpatient rehabilitation facility, or by a home health agency; and (2) fully eliminate the provision requiring forfeiture of an enrollee’s right to appeal a termination of services decision when they leave the facility. These proposals would bring Medicare Advantage Plan regulations in line with the parallel reviews available to beneficiaries in Traditional Medicare and expand the rights of Medicare Advantage Plan beneficiaries to access the fast-track appeals process.

Increase the Percentage of Dually Eligible Managed Care Enrollees Who Receive Integrated Medicare and Medicaid Services 

Dually eligible individuals face a complex assortment of enrollment options. To improve the experiences and outcomes for dually eligible individuals, the proposed rule would increase the percentage of dually eligible Medicare Advantage Plan enrollees who are in plans that also cover Medicaid by offering more opportunities for enrollment in plans that integrate Medicare and Medicaid and more opportunities to switch to Traditional Medicare, as opposed to Medicare Advantage Plans that differ from the enrollee’s Medicaid plan. To achieve this, the proposed rule would revise the current quarterly special enrollment period (SEP) for dually eligible and other Part D low-income subsidy (LIS) enrolled individuals to a once-per-month SEP to enroll in a standalone prescription drug plan and create a new integrated care SEP, to allow dually eligible individuals to elect an integrated dual eligible special needs plan (D-SNP) on a monthly basis.

Increasing the percentage of dually eligible Medicare Advantage Plan enrollees who are in plans that also cover Medicaid would expand access to integrated materials, unified appeal processes across Medicare and Medicaid, and continued Medicare services during an appeal for those individuals. By reducing the number of plans that can enroll dually eligible individuals outside of the annual election period, the proposed rule would also reduce aggressive, confusing marketing tactics toward dually eligible individuals throughout the year. These policies advance the goals of President Biden’s historic Competition Council and Executive Order signed in July 2021 by promoting beneficiary choice and facilitating improved access to an array of Medicare coverage options for low-income beneficiaries.

For D-SNP PPOs, Limit Out-of-Network Cost Sharing

The proposed rule would limit out-of-network cost sharing for D-SNP preferred provider organizations (PPOs) for specific services, beginning in 2026. The proposed rule would reduce cost shifting to Medicaid, increase payments to safety net providers, expand dually eligible enrollees’ access to providers, and protect dually eligible enrollees from unaffordable costs.

Standardize the Medicare Advantage Plan Risk Adjustment Data Validation (RADV) Appeals Process

The proposed rule addresses operational constraints included in existing Risk Adjustment Data Validation (RADV) appeal regulations. CMS is proposing that Medicare Advantage Plan organizations may request only a medical record review determination appeal or payment error calculation appeal for purposes of reconsideration, and not both at the same time. CMS is proposing that Medicare Advantage Plan organizations that request a medical record review determination appeal may only request a payment error calculation appeal after the completion of the medical record review determination administrative RADV appeal process. Additionally, the proposed rule clarifies that a revised audit report containing a recalculated payment error calculation will not be issued by the Secretary at each level of appeal but instead will be issued when a medical record review determination appeal or a payment error calculation appeal is final, as applicable. Finally, the proposed rule includes a requirement that if the CMS Administrator does not decline to review or does not elect to review within 90 days of receipt of either the Medicare Advantage Plan organization’s or CMS’s timely request for review (whichever is later), the hearing officer’s decision becomes final.

Threshold for Identifying D-SNP Look-Alikes

The proposed rule would change contracting standards for D-SNP look-alikes. We adopted these contracting limitations to ensure full implementation of requirements for D-SNPs, including minimum integration standards as required under Section 1859(f)(8)(D)(i) of the Act, as added by the Bipartisan Budget Act of 2018. We are proposing to lower the D-SNP look-alike threshold from 80% to 70% in 2025 and to 60% in 2026. This proposal would help to address the continued proliferation of Medicare Advantage Plans that are serving high percentages of dually eligible individuals without meeting the requirements to be a D-SNP.

More Flexibility to More Quickly Substitute Lower Cost Biosimilar Biological Products for Their Reference Products 

We are proposing to permit Part D sponsors to treat formulary substitutions of biosimilar biological products other than interchangeable biological products for their reference products as “maintenance changes” that would not require prior approval by CMS. Under our current guidance, plans must obtain explicit approval prior to substituting with biosimilar biological products other than interchangeable biological products, and these substitutions apply only to enrollees who begin therapy after the effective date of the change—delaying enrollees’ access to cheaper options. Treating these substitutions as maintenance changes would also mean that any substitutions would apply to all enrollees (including those already taking the reference product prior to the effective date of the change) following a 30-day notice, so that enrollee access to equally effective, but potentially more affordable, options would be available sooner. Consistent with the work of the President’s Competition Council, this proposal continues the Biden-Harris Administration's commitment to promoting enhanced access to affordable biosimilar and generic products.

Source: https://www.cms.gov/newsroom/fact-sheets/contract-year-2025-policy-and-technical-changes-medicare-advantage-plan-program-medicare 

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Essential MA OEP Reminders

Posted by www.psmbrokerage.com Admin on Thu, Dec 07, 2023 @ 12:18 PM


In January, some clients who recently enrolled in new Medicare Advantage plans may contact you, expressing uncertainty about their decision. Moving from a familiar plan to an unfamiliar one can be daunting. Fortunately for your client, they're not locked into their new coverage. Shortly after the Annual Enrollment Period (AEP), beneficiaries in Medicare Advantage plans have the option to reconsider their plan choice.

Today we'll look into what options beneficiaries have, as well as a few points to consider as it relates to restrictions on marketing during this time.

As you might be aware, the Medicare Advantage Open Enrollment Period (MA OEP) is designed for two specific groups:

  • Clients who are new to Medicare and have chosen to enroll in a Medicare Advantage (MA) plan during their Initial Coverage Election Period (ICEP). These beneficiaries are granted a three-month OEP, which initiates in the same month they become eligible for both Part A and B of Medicare.
  • Clients who have already enrolled in MA plans starting on January ,. For these clients, an OEP is available from January 1 to March 31.

This means that clients who contact you in January, expressing dissatisfaction with their new plan, have the opportunity to make a one-time switch in their coverage. So, what alternatives do they have?

Keep in mind that Part D changes during the MA 0EP are tied to MA plan changes. Clients can modify their drug coverage by switching to a different MAPD plan, transitioning from MA to MAPD, or returning to Original Medicare with a standalone Part D plan. However, if someone has Original Medicare with a Part D plan, they cannot switch to a different drug plan during the MA 0EP; they must wait for a Special Enrollment Period (SEP) or the next Annual Enrollment Period (AEP).

Restrictions on Marketing

One major point to consider is the restriction on marketing during the MA OEP window. 

Agents cannot knowingly target or send unsolicited marketing materials to MA or Part D enrollees during the MA OEP 0anuary 1 to March 31). It's important to note that "knowingly" takes into account the intended recipient as well as the content of the message.

SureBridge Dental PlansUnderstanding these rules is crucial for anyone working with Medicare beneficiaries, especially insurance agents and healthcare advisors, to ensure compliance and provide accurate guidance.

After the Annual Enrollment Period (AEP), there are several effective sales strategies you can employ to maintain momentum and continue growing your business.

Check out a summary of ideas here.

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Tags: Medicare Advantage plans, OEP, Compliance

Maintain Momentum and Continue Growing After AEP

Posted by www.psmbrokerage.com Admin on Thu, Dec 07, 2023 @ 10:18 AM

After AEP

After the Annual Enrollment Period (AEP), there are several effective sales strategies you can employ to maintain momentum and continue growing your business:

Follow-Up with Prospects and Clients: Reach out to those who didn't make a decision during AEP. They might be more receptive now that the rush has subsided.

Review and Cross-Sell: Analyze your current client base for cross-selling opportunities. Offer complementary products like life insurance, dental, vision & hearing plans, or discuss long-term care insurance.

Educational Workshops and Seminars: Host events focused on educating seniors about health and wellness, financial planning, or other relevant topics. This can position you as a trusted advisor.

Referral Programs: Encourage satisfied clients to refer friends or family members. Offer incentives for referrals that lead to new business.

image-png-Sep-28-2023-09-51-59-7509-PMCommunity Involvement: Get involved in local senior communities or centers. Sponsor events or volunteer, which can help build recognition and trust.

Digital Marketing: Utilize email campaigns, social media, and a robust website to keep your audience engaged and informed about their options outside of AEP.

Personalized Communications: Send out personalized birthday cards, holiday greetings, or newsletters to stay in touch with clients and prospects.

Client Reviews and Feedback: Schedule reviews with existing clients to discuss their current plans and any changes in their needs or circumstances.

Networking: Attend industry events, join local business groups, or collaborate with other professionals (like financial planners or healthcare providers) to expand your network.

Health and Wellness Programs: Partner with local gyms, nutritionists, or health coaches to offer wellness programs, adding value to your clients’ lives beyond insurance products.

Voya AnNUITIESBy focusing on these strategies, you can effectively engage with your clients and prospects, ensuring a steady business flow even outside of the high-intensity AEP window.

Additional Resources:

Guide to Understanding Medicare Advantage & Medicare Drug Plan Enrollment Periods.

You can download the guide here.

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