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ACA Marketplace: New CMS Consent Rules Effective 6/18/23

Posted by www.psmbrokerage.com Admin on Mon, Jun 19, 2023 @ 10:50 AM

New CMS Consent Rule

Source: HealthSherpa

CMS covered their new rules around Consent and Review for all marketplace enrollments at their CMS Summit for Agents and Brokers on 5/24/2023. These rules build upon the existing rules that were outlined in the 2022 Understanding Marketplace Compliance Rules & Regulations slides, as well as the various FAQs that address Consent and PII rules and regulations.

When comparing the 2023 Understanding Key CMS Rules and Regulations to Maintain Marketplace Compliance slides to the Rules and Regulations from previous plan years, the following are some of the key additional requirements that will need to be met in addition to past guidance. This is not an exhaustive list, so be sure to review the 2023 Rules and Regulations yourself when developing your consent documenting systems for PY 2024.

Consent Documentation Requirements:

  • The consumer or their authorized representative must take an action to produce the documentation;

  • Provide consumers a process with which they can rescind consent;

  • A description of the scope, purpose, and duration of the consent provided by the consumer or their authorized representative.

  • In addition to the previously required fields.


Review Documentation Requirements:

  • Maintain documentation stating a consumer or their authorized representative has reviewed and confirmed their application information is accurate (45 C.F.R § 155.220(j)(2)(ii)(A)(1)-(2)). (Referred to as “Review Documentation Requirements”);

  • The consumer or their authorized representative takes an action to produce the documentation;

  • The documentation must contain, at a minimum, the following information:

    • The date the information was reviewed;

    • The name of the consumer or their authorized representative;

    • An explanation of the attestations at the end of the eligibility application; and

    • The name of the assisting agent, broker, or web-broker.

  • The agent, broker, or web-broker must maintain the documentation for a minimum of 10 years.


Protecting Consumer PII:

  • You must provide consumers the opportunity to opt-in and allow you (and your agency, if applicable) to use their PII (e.g., through the record of consent). You should also provide a mechanism through which the consumer, or their authorized representative, can limit the use of their PII.

  • PII may only be used for the authorized functions discussed earlier, in the context of completing an application for QHP, APTC, or CSRs eligibility, if applicable, or enrolling in a QHP, or any data transmitted from or through the Marketplace, if applicable.

  • PII may not be used for any other purposes not outlined in these agreements without the explicit consent of the consumer or their authorized representative.


Third Party Relationships:

  • Agents and brokers and any third party with which they have entered into a business relationship must adhere to requirements for the use and disclosure of all consumer PII or protected health information (PHI), including all PII/PHI collected by the third party.

  • Agents and brokers are required to obtain consent from the consumer or their authorized representative. Third party means, such as lead-generators, do not constitute consent in a manner that complies with 45 C.F.R. § 155.220.

    • For example, consumers merely checking a box to indicate that they attest to being enrolled in Marketplace coverage does not constitute consumer consent for purposes of complying with CMS Marketplace requirements.


System Usage:

  • CMS systems that agents and brokers access when assisting consumers, include, but are not limited to, the CMS Enterprise Portal, HealthCare.gov, and HealthSherpa EDE and DE Pathways.

    • Only maintain one CMS Enterprise Portal account, accessible by the registered agent or broker.

    • Only conduct one log-in session at a time.

    • No scripting or automation without written CMS permission.


The documentation requirements go into effect beginning June 18th, 2023.
They are not retroactive; agents do not have to go back and gather documentation for applications completed before this date, but should implement these practices moving forward. We do expect further guidance in the form of Clarifying FAQs to come from CMS by or shortly after this date.

Remember, all of the rules and regulations around consent and client review are to help you protect your client and your relationship with your client.

 Download the CMS Model Agent Broker Consent Form.

Source: HealthSherpa

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Tags: CMS, ACA

Your Questions About CMS’s New Rules, Answered

Posted by www.psmbrokerage.com Admin on Mon, May 22, 2023 @ 02:47 PM

New CMS Rules QandA

On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) issued long-awaited rules pertaining to, among other matters, the marketing of Medicare Advantage (MA) plans. YourMedicare and its partners had been anticipating these changes and have activated a task force to study the newly published rules in detail and clarify their implications for our affiliated agents’ businesses.

The FAQ is the culmination of that effort. Here you will find answers to a number of questions we have received since April 5, as well as clarification on the new rules our team is proactively providing.

CMS New Rules FAQs
Please bookmark this page
for future reference. As new information and interpretations become available, we will add those to this page.

Newest Blog Posts  |  All Blog Posts

Tags: Medicare Advantage, CMS, medicare changes, medicare marketing guidelines

CMS Memo: Definition of Marketing

Posted by www.psmbrokerage.com Admin on Mon, May 15, 2023 @ 11:24 AM

CMS Memo- Definition of Marketing

Date: May 10, 2023

To: Medicare Advantage Organizations, Medicare Advantage-Prescription Drug Plans, Prescription Drug Plan Sponsors, and Section 1876 Cost Plans

From: Kathryn A. Coleman, Director

Subject: Definition of Marketing

📑 Download the official announcement

In order to ensure Medicare beneficiaries are making enrollment decisions based on up-to-date and accurate information, the Centers for Medicare & Medicaid Services (CMS) is issuing this memo to clarify the definition of marketing for Medicare Advantage-Prescription Drug Plans, stand-alone Prescription Drug Plans, 1876 Cost Plans, and Third-Party Marketing Organizations (TPMOs).

Regulations at 42 CFR §§ 422.2260 and 423.2260 define marketing as communication materials and activities which meet specific intent and content standards.

  • The intent component of the definition of “marketing” is met when any material or activity is intended to draw a beneficiary's attention to plan or plans, influence a beneficiary's decision-making process when selecting a plan, or influence a beneficiary's decision to stay enrolled in a plan (that is, retention-based marketing).

  • The content component of the definition of “marketing” is met when any material or activity includes or addresses plan benefits, benefits structure, premiums, or cost sharing; measuring or ranking standards; or rewards and incentives.

To date, CMS has permitted the mentioning of widely available benefits (i.e., vision, dental, premium reduction, and hearing) in materials or activities without those materials or activities being considered marketing subject to the marketing regulations. We did not believe the general descriptions were made with sufficient intent to draw attention to a particular plan or subset of plans. This interpretation was predicated on the assumption that a beneficiary would be unlikely to make an enrollment decision based on widely offered benefits advertised without information on the associated costs for enrollees. CMS monitors both organization and TPMO marketing by reviewing marketing and communication materials and activities, reviewing complaints received through 1-800-Medicare, and listening to marketing and enrollment calls.

Due primarily to the recent proliferation of TPMO advertising, we have found, however, through our surveillance, reviews, and discussions with interested parties that many beneficiaries do inquire and some enroll based on the original advertisement of these types of benefits. Beneficiaries have contacted agents, made calls to 1-800 numbers, and responded to flyers asking about the dental, vision, hearing, and cost-savings being marketed. Therefore, we are expanding our interpretation of the regulatory definition of “marketing” to include content that mentions any type of benefit covered by the plan and is intended to draw a beneficiary's attention to plan or plans, influence a beneficiary's decision-making process when selecting a plan, or influence a beneficiary's decision to stay enrolled in a plan (that is, retention-based marketing) and thus subject to review.

As stated above, marketing requires both intent and content. Content that beneficiaries can receive benefits such as dental, vision, cost-savings, and/or hearing services is sufficient information about plan benefits, benefits structure or cost sharing to meet the content standard in the definition of marketing in §§ 422.2260 and 423.2260. Further, the use of these statements in advertisements and activities directed to Medicare beneficiaries clearly meets the intent standard. Therefore, beginning July 10, 2023, any material or activity that is distributed via any means (e.g., mailing, television, social media, etc.) that mentions any benefit will be considered marketing and must be submitted into HPMS. This clarification, along with the new marketing safeguards codified in the Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly final rule (CMS-4201-F), will help ensure that beneficiaries have accurate information when shopping for Medicare coverage and are protected from potentially misleading marketing activities.

Questions may be sent to marketing@cms.hhs.gov. Please copy your Marketing Reviewer.

Tags: CMS, Compliance, Marketing

New CMS Rules To Impact Medicare Advantage Marketing

Posted by www.psmbrokerage.com Admin on Thu, May 11, 2023 @ 09:02 AM

New CMS Rules To Impact

On Wednesday, April 5, the Centers for Medicare & Medicaid Services (CMS) issued long-awaited rules pertaining to, among other matters, the marketing of Medicare Advantage (MA) plans. These rules were developed with the intention of protecting Medicare beneficiaries from misleading or deceptive advertising practices. Our leadership quickly activated a task force to study the newly published rules in detail and clarify their implications for our agents' businesses.

The new rules go into effect on June 5 and will be applicable on Sept. 30 for coverage beginning January 1, 2024. This means that they will impact activities that will take place during this year’s Medicare Annual Enrollment Period (AEP), which begins on Oct. 15.

What can you do now?

While the new CMS rules are applicable on Sept. 30, there are steps agents and agencies can start right now.

  • Audit lead generation and marketing materials and evaluate against the newly issued CMS regulations. Lead generation and marketing materials include:
    • Internet ads
    • Direct mail pieces
    • Call scripts
    • Web pages
    • Emails
  • Identify marketing materials, including materials that mention plan benefits, premiums, and cost-savings; and evaluate.
  • Be cautious where the Medicare logo is used on any advertising or in a misleading manner when used for MA or PDP marketing.

PSM anticipates rolling out insight and guidance over the coming weeks. While these efforts are underway, please continue to adhere to current compliance guidelines and submit any marketing materials developed over the normal course of business through your usual approval processes.

Should you have questions related to the CMS announcement, please email them to info@psmbrokerage.com

 

 

Tags: Medicare Advantage, CMS, Marketing

Half of All Eligible Medicare Beneficiaries Are Now Enrolled in Private Medicare Advantage Plans

Posted by www.psmbrokerage.com Admin on Wed, May 03, 2023 @ 10:35 AM

Half of All Eligible Medicare Beneficiaries Are Now Enrolled in Private Medicare Advantage Plans

According to recently released data from the Centers for Medicare & Medicaid Services (CMS), Medicare Advantage now provides Medicare coverage for just over half of eligible beneficiaries. In January 2023, 30.19 million of the 59.82 million people with both Medicare Part A and Part B were enrolled in a private plan.

Medicare Advantage, the private plan alternative to traditional Medicare, covers Medicare Part A and B benefits (and typically Part D benefits), often for no additional premium (other than the Part B premium). Insurance companies contract with the Medicare program and receive payments for providing these services.

Enrollment in Medicare Advantage has increased dramatically in recent years. In 2007, less than one in five (19%) eligible Medicare beneficiaries were enrolled in a private plan. The growth in enrollment is due to a number of factors, including the attraction of extra benefits offered by most plans, such as vision, hearing, and dental services, and the potential for lower out-of-pocket spending, particularly compared to traditional Medicare without supplemental coverage.

Read the full article here.

Source: https://www.kff.org/policy-watch/half-of-all-eligible-medicare-beneficiaries-are-now-enrolled-in-private-medicare-advantage-plans/ 

 

 

Tags: Medicare Advantage, Medicare Part D, CMS, star ratings

2024 Medicare Advantage and Part D Final Rule (CMS-4201-F)

Posted by www.psmbrokerage.com Admin on Mon, May 01, 2023 @ 11:56 AM

1-Apr-13-2023-03-27-46-9666-PM

Background

On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revises the Medicare Advantage (MA or Part C), Medicare Prescription Drug Benefit (Part D), Medicare Cost Plan, and Programs of All-Inclusive Care for the Elderly (PACE) regulations to implement changes related to Star Ratings, marketing and communications, health equity, provider directories, coverage criteria, prior authorization, network adequacy, and other programmatic areas. This final rule also codifies regulations implementing section 118 of Division CC of the Consolidated Appropriations Act, 2021, and section 11404 of the Inflation Reduction Act, and includes provisions to codify existing sub-regulatory guidance in the Part C, Part D, and PACE programs. 

In this final rule, CMS is not addressing comments received on the provisions of the proposed rule that we are not finalizing at this time. Rather, the agency will address them at a later time, such as in possible future rulemaking, as appropriate.

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

Enhancements to Medicare Advantage and Medicare Part D

4-4

Ensuring Timely Access to Care: Utilization Management Requirements

CMS has received numerous inquiries regarding the use of prior authorization by Medicare Advantage plans and the effect on beneficiary access to care. In the rule, CMS finalizes impactful changes to address these concerns and to advance timely access to medically necessary care for enrollees.

The final rule clarifies clinical criteria guidelines to ensure people with MA receive access to the same medically necessary care they would receive in Traditional Medicare. This aligns with recent Office of Inspector General (OIG) recommendations. Specifically, CMS clarifies rules related to acceptable coverage criteria for basic benefits by requiring that MA plans must comply with national coverage determinations (NCD), local coverage determinations (LCD), and general coverage and benefit conditions included in Traditional Medicare regulations. CMS is also finalizing that when coverage criteria are not fully established, MA organizations may create internal coverage criteria based on current evidence in widely used treatment guidelines or clinical literature made publicly available to CMS, enrollees, and providers. In the final rule, CMS more clearly defines when applicable Medicare coverage criteria are not fully established by explicitly stating the circumstances under which MA plans may apply internal coverage criteria when making medical necessity decisions. CMS believes that permitting the use of publicly accessible internal coverage criteria in limited circumstances is necessary to promote transparent, and evidence-based clinical decisions by MA plans that are consistent with Traditional Medicare.

The final rule also streamlines prior authorization requirements, including adding continuity of care requirements and reducing disruptions for beneficiaries. CMS’ final rule requires that coordinated care plan prior authorization policies may only be used to confirm the presence of diagnoses or other medical criteria and/or ensure that an item or service is medically necessary. Second, this final rule requires coordinated care plans to provide a minimum 90-day transition period when an enrollee currently undergoing treatment switches to a new MA plan, during which the new MA plan may not require prior authorization for the active course of treatment. Third, to ensure prior authorization is being used appropriately, CMS is requiring all MA plans establish a Utilization Management Committee to review policies annually and ensure consistency with Traditional Medicare’s national and local coverage decisions and guidelines. Finally, to address concerns that the proposed rule did not sufficiently define the expected duration of “course of treatment,” the final rule requires that approval of a prior authorization request for a course of treatment must be valid for as long as medically reasonable and necessary to avoid disruptions in care in accordance with applicable coverage criteria, the patient’s medical history, and the treating provider’s recommendation.

Together, these changes will help ensure enrollees have consistent access to medically- necessary care while also maintaining medical management tools that emphasize the important role MA plans play in coordinating medically-necessary care.

2-Apr-13-2023-03-29-48-0508-PM

Protecting Beneficiaries: Marketing Requirements

The final rule also takes critical steps to protect people with Medicare from confusing and potentially misleading marketing while also ensuring they have accurate and necessary information to make coverage choices that best meet their needs. The proliferation of certain television advertisements generically promoting enrollment in MA plans has been a specific topic of concern. To address these concerns, CMS is prohibiting ads that do not mention a specific plan name as well as ads that use words and imagery that may confuse beneficiaries or use language or Medicare logos in a way that is misleading, confusing, or misrepresents the plan. In the rule, CMS also reinstates important protections that prevent predatory behavior and finalized changes that strengthen the role of plans in monitoring agent and broker activity. CMS is also finalizing requirements to further protect Medicare beneficiaries by ensuring they receive accurate information about Medicare coverage and are aware of how to access accurate information from other available sources.

CMS is finalizing 21 of the 22 provisions we proposed, with 17 of the 21 provisions being finalized as proposed. The four provisions CMS is finalizing but modifying include: permitting agents to make Business Reply Cards available at educational events; requiring an agent to tell prospective enrollees how many plans are available from the  organization for whom the agent sells; extending the length of time agents are able to re-contact beneficiaries to discuss plan options to twelve months; and allowing an agent to meet with a beneficiary without waiting the full 48-hour cooling off period when the timeframe runs up against the end of an election period, or a beneficiary faces transportation or access challenges, or the beneficiary voluntarily walks into an agent’s office. CMS will continue to explore including the provision that is not being finalized in this rule in possible future rulemaking.

3-Apr-13-2023-03-30-01-6709-PM

Strengthening Quality: Star Ratings Program

CMS continues improvements to the Star Ratings program by finalizing new methodological enhancements to further drive quality improvement for all enrollees. In this rule, CMS finalizes a health equity index (HEI) reward, beginning with the 2027 Star Ratings, to further encourage MA and Part D plans to improve care for enrollees with certain social risk factors. CMS also reduces the weight of patient experience/complaints and access measures to further align with other CMS quality programs and the current CMS Quality Strategy. In addition, CMS includes an additional rule for the removal of Star Ratings measures and removes the 60 percent rule that is part of the adjustment for extreme and uncontrollable circumstances. The changes will further drive quality improvement and health equity in MA and Part D.

Advancing Health Equity

CMS is committed to advancing health equity for all, including those who have been historically underserved, marginalized, and adversely affected by persistent poverty and inequality.[1] CMS is clarifying current rules, expanding the example list of populations that MA organizations must provide services in a culturally competent manner. These include people: (1) with limited English proficiency or reading skills; (2) of ethnic, cultural, racial, or religious minorities; (3) with disabilities; (4) who identify as lesbian, gay, bisexual, or other diverse sexual orientations; (5) who identify as transgender, nonbinary, and other diverse gender identities, or people who were born intersex; (6) who live in rural areas and other areas with high levels of deprivation; and (7) otherwise adversely affected by persistent poverty or inequality.

Studies demonstrate low digital health literacy, especially among populations experiencing health disparities, continues to impede telehealth access and worsen care gaps particularly among older adults. CMS is finalizing requirements for MA organizations to develop and maintain procedures to offer digital health education to enrollees to improve access to medically necessary covered telehealth benefits. In addition, CMS is enhancing current best practices by requiring MA organizations to include providers’ cultural and linguistic capabilities in provider directories. This change will improve the quality and usability of provider directories, particularly for non-English speakers, limited English proficient individuals, and enrollees who use American Sign Language. Finally, CMS is requiring that MA organizations’ quality improvement programs include efforts to reduce disparities.  

Improving Access to Behavioral Health

CMS recognizes the importance of building strong MA behavioral health networks that improve timely access to services. CMS is finalizing policies strengthening network adequacy requirements and reaffirming MA organizations’ responsibilities to provide behavioral health services. Specifically, CMS will: (1) add Clinical Psychologists and Licensed Clinical Social Workers as specialty types for which we set network standards, and make these types eligible for the 10-percentage point telehealth credit; (2) amend general access to services standards to include explicitly behavioral health services; (3) codify standards for appointment wait times for primary care and behavioral health services; (4) clarify that emergency behavioral health services must not be subject to prior authorization; (5) require that MA organizations notify enrollees when the enrollee’s behavioral health or primary care provider(s) are dropped midyear from networks; and (6) require MA organizations to establish care coordination programs, including coordination of community, social, and behavioral health services to help move towards parity between behavioral health and physical health services and advance whole-person care.

Implementation of Certain Provisions of the Consolidated Appropriations Act, 2021 and the Inflation Reduction Act of 2022

The final rule also makes changes to the Part C and D programs stemming from the Inflation Reduction Act (IRA) of 2022 and the Consolidated Appropriations Act (CAA), 2021.

Making Permanent: Limited Income Newly Eligible Transition (LI NET) Program

LI NET currently operates as a demonstration program that provides immediate and retroactive Part D coverage for eligible low-income beneficiaries who do not yet have prescription drug coverage. In this final rule, CMS is making the LI NET program a permanent part of Medicare Part D, as required by section 118 of the CAA.

Enhancing Financial Stability: Expanding Low-Income Subsidies Under Part D

CMS is finalizing regulations to expand eligibility for the full low-income subsidy (LIS) benefit (also known as “Extra Help”) to individuals with incomes up to 150% of the federal poverty level who meet eligibility criteria. Beginning January 1, 2024, this change will provide the full low-income subsidy to those who currently qualify for the partial subsidy. This implements section 11404 of the IRA and will improve access to affordable prescription drug coverage for approximately 300,000 low-income individuals with Medicare. 

Implementation of Certain Provisions of the Bipartisan Budget Act of 2018 and the Consolidated Appropriations Act, 2021

Finally, the rule finalizes several changes stemming from federal laws related to the Part C and D programs—including the Inflation Reduction Act (IRA) of 2022, the Consolidated Appropriations Act (CAA) of 2021, and the Bipartisan Budget Act (BBA) of 2018.

Source: https://www.cms.gov/newsroom/fact-sheets/2024-medicare-advantage-and-part-d-final-rule-cms-4201-f 

 

 

Tags: Medicare Advantage, Medicare Part D, CMS, star ratings, Marketing

Come see PSM at the 2023 Medicarians Conference

Posted by www.psmbrokerage.com Admin on Thu, Apr 20, 2023 @ 11:13 AM

medicarians-1

WHAT IS MEDICARIANS

THE FUTURE OF SENIOR HEALTH, WEALTH, AND AGETECH
__________________________

image-png-Apr-20-2023-03-36-26-3518-PMMedicarians is the home of the product creators, distributors, provider networks, plan administrators, venture investors, and innovators helping the people live longer, better lives both physically, financially, and mentally. https://medicarians.com/ 

WHO SHOULD ATTEND

Brokers, Agencies & Distribution Partners

•  Network with product owners and administrators in health, wealth, and aging
•  Develop partnerships with leading participants in the industry
•  See what tools and technology can accelerate your business

 Startups, AgeTech Innovators, and Technology Providers

•  Gain visibility into what the leading players in senior care and aging seek
•  Meet thought leaders and leave with deep insight into the forces shaping the industry
•  Understand the competitive landscape to position yourself for success
VENUE
MEDICARIANS 2023 WILL TAKE PLACE AT THE MGM GRAND HOTEL IN LAS VEGAS, NEVADA.

The Medicarians hotel room block at the MGM Grand is now full. But, rooms are still available at the MGM Grand as well as The Signature at the current public rate.

 

Tags: Medicare Advantage, Medicare Part D, Professional Networking, CMS, star ratings, Marketing

Nearly 80 Percent of Medicare Advantage Enrollees Covered by 10 Insurers

Posted by www.psmbrokerage.com Admin on Wed, Apr 19, 2023 @ 04:01 PM

80 percent

As the 2023 Medicare Open Enrollment season winds to a close, and beneficiaries and enrollees finalize their decisions, nearly half, 48.7%, of people eligible for Medicare have decided on Medicare Advantage plans, up from 46.1% in March of 2022. Based on the Centers for Medicare & Medicaid Services (CMS) enrollment data for March 1, 2023, total Medicare Advantage (MA), including Medicare Advantage with Prescription Drug Plan (MA-PD) membership, stood at 31,753,301 with a net gain of 2,276,490 members from March 1, 2022. Medicare stand-alone prescription drug plans (PDPs) covered 22,533,411 members as of March 1, 2023, a net decrease of 910,978 from the previous year. Surprisingly, nearly 80 percent of MA enrollees selected one of 10 insurers, out of the 294 offering plans in 2023. This brief assesses Medicare Advantage and PDP performance, market share and market penetration by state as of March 1, 2023.

Medicare Advantage (MA) Membership

Medicare Advantage (MA) market penetration remains strong; however, there is still abundant opportunity for growth with 48.7% of the nearly 65.2 million people eligible for Medicare enrolled in a MA plan. According to CMS Medicare Advantage enrollment reports aggregated by Mark Farrah Associates (MFA) in Medicare Business Online™, total Medicare Advantage plan enrollment, as of March 1, 2023, increased 9.8% from March 2022. The top ten companies, each with more than 300,000 members in this segment, collectively provided coverage for nearly 80% of the market. Most leading MA companies realized year-over-year growth with an overall net gain of 8.2%.

MA Leading Plan Performance

There are 294 insurers covering the MA marketplace in the United States, however nearly 80 percent of MA enrollees selected one of only 10 insurers.  As of March 2023, UnitedHealth continues to dominate in this highly competitive segment. With over 9 million enrolled, UnitedHealth commands 28.5% of the MA market. Humana ranks second with nearly 18% market share and over 5.6 million lives. CVS maintains the third position, enrolling approximately 3.37 million, and Elevance Health (formerly Anthem) follows, with over 2 million lives. Together the top three insurers cover 56.9% of the MA market.

Source: https://www.markfarrah.com/mfa-briefs/nearly-80-percent-of-medicare-advantage-enrollees-covered-by-10-insurers/ 

 

 

 

Tags: Medicare Advantage, Medicare Part D, CMS, star ratings, Marketing

2023 MedicareCon Recap

Posted by www.psmbrokerage.com Admin on Tue, Apr 18, 2023 @ 11:22 AM

MedicareCon, April 11-12, 2023 at the MGM Grand in Las Vegas


Big thanks to Justin Brock and his BBI team for putting on an amazing MedicareCon event! 3rd time was definitely a charm without a doubt.. 
 
Precision Senior Marketing was a proud sponsor and it was great talking shop and networking with a group of such strong-minded, intelligent, and driven individuals who are so passionate about their businesses and our industry.
 
AGENTS are the lifeblood of our industry and make an event like this so worthwhile. We look forward to what’s in store for next year!
 
MedicareCon #1
 
If you’re dedicated to making headway in the Medicare market, there’s no better event to attend than MedicareCon. The conference is designed specifically for Medicare agents who are forward thinkers, trailblazers, and entrepreneurs.

   

Speakers shared exactly what it takes to scale an agency, with tips and advice that can be applied whether you’re just getting started, or you’re looking to take your business to the next level. With a focus on practicality and real-world results, MedicareCon was a great event and one you can’t afford to miss in 2024.

     


Networking:

We’ve all heard the term, “It’s not what you know, it’s who you know?”

One of the greatest things about the MedicareCon is the attendees themselves. Friendships, partnerships, and mentorships have all happened from agents just like yourself who happened to bump into the right person in the audience.

By connecting with the person to your left or your right (or both) at the conference, you can hold each other accountable to your new goals, challenge yourselves to do more every day, and help each other to keep a growth mindset.

It’s important to keep successful people around you if you want to achieve your goals and the people who attend MedicareCon are the ones who are committed to doing something big with their lives.

https://medicarecon.com/ 

MedicareCon #2  MedicareCon #4

 

 

 

Tags: Medicare Advantage, Medicare Part D, Professional Networking, CMS, MedicareCon, Marketing

Expectation of Agents During Telephonic Enrollments

Posted by www.psmbrokerage.com Admin on Thu, Apr 13, 2023 @ 04:18 PM

telephonic enrollments

Today, we'll be discussing the expectation of agents during telephonic enrollments. Although what we'll discuss mainly pertains to agents working in call centers, this information is certainly beneficial for all agents if you have a few minutes to spare. Recently, a carrier conducted an audit and found that most agents missed five key elements during telephonic enrollments. It's crucial for agents to be aware of CMS and Carrier expectations when conducting these enrollments, not only to protect the client, but also to safeguard themselves from corrective action.

Summary of Benefits 

First, it's critical that agents review the Summary of Benefits before completing the enrollment process. This document contains important information about the plan and must be completed by agents in accordance with the approved script requirement. Agents must also ensure they accurately answer any additional questions asked by the applicant or their legal representative, and provide accurate information on plan details described in the SOB. This includes details such as benefits, costs, and coverage limitations. By doing so, agents can provide the applicant with a clear and comprehensive understanding of the plan, which ultimately leads to a successful enrollment process.

Required Disclosures

During telephonic enrollments, agents must read all required and relevant disclosures. as outlined in CMS approved scripts, for the specific plan that the applicant is interested in. Agents should collect agreement and understanding from the applicant regarding these disclosures to confirm that everyone is on the same page and that the applicant fully comprehends what they are signing up for. These disclosures may be presented in various formats such as pop-up boxes or required statements and must be presented to the applicant clearly and concisely to ensure transparency and compliance with CMS and Carrier expectations. 

Complete the Application

When completing the caller's application, the agent must ensure they accurately enter the applicant's contact information, payment options, language preference, and alternate format election.

Additionally, the agent must:

•    Provide the name of the plan that the applicant is enrolling in. 
•    Advise the applicant of the plan's effective date. 
•    Confirm with the applicant that they are ready to complete the enrollment process. 

Call Closing

It's important to provide a compliant call closing to wrap up the call. To do so, you must provide the caller with the carrier name and customer service phone number so they know who to contact for support in the future. Additionally, it's important to provide the TTY number for the benefit of those with hearing impairments. Finally, make sure to provide an application confirmation number for the caller's records, so they have a way to reference their enrollment in the future. 

Accessing MARx 

Before accessing MARX, the agent must obtain and document the beneficiary's permission. The agent should explain that they may collect information related to the beneficiary's current enrollment status, dates of Medicare Part A and B entitlement, eligibility information, and incarceration, if applicable. The beneficiary must be informed about the purpose of accessing this system and be given an opportunity to decline or approve the request. Lastly, the agent must document the beneficiary's response for future reference.

video

Tags: Medicare Advantage, Medicare Part D, CMS, star ratings, Marketing

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