|
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.
|
|||
-jpeg.jpeg?width=303&height=404&name=Image%20(019)-jpeg.jpeg)
-jpeg.jpeg?width=303&height=404&name=Image%20(002)-jpeg.jpeg)
-jpeg.jpeg?width=200&height=267&name=Image%20(006)-jpeg.jpeg)
-jpeg.jpeg?width=200&height=267&name=Image%20(00A)-jpeg.jpeg)
-jpeg.jpeg?width=200&height=267&name=Image%20(00C)-jpeg.jpeg)
.png?width=625&height=350&name=Copy%20of%20PROSPECTING%20(3).png)
What are the New CMS Requirements?
The CMS Final Rule 2023 was announced in May 2022 and requires all Medicare and Medicaid marketing calls to be recorded and stored for at least 10 years.
Call Recording Requirements
The language is important here as CMS has confirmed it interprets “enrollment” as “marketing.” The call recording requirement applies to all healthcare agents who enroll beneficiaries in new plans. Healthcare agents and brokers will be required to record all “marketing” calls with beneficiaries in their entirety, including the enrollment process. This rule applies to both new and existing clients. The call recordings must then be stored in a HIPAA compliant manner for at least 10 years.
CMS considers a “marketing” call anything that falls under the “Chain of Enrollment,” which is defined as any events from the point when a beneficiary is made aware of an MA/PDP plan to the end of the enrollment process.
Some examples of what the new recording rules cover include:
- Contacting potential clients
- Scheduling appointments for new and current clients
- Collecting drug and provider lists
- Hosting informational meetings
- Enrolling clients by phone
Disclaimer
All agents will also be required to include the following disclaimer:
“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 your options.”
The disclaimer must be included in the following places:
- Verbally expressed within the first minute of a sales phone call
- Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means
- Prominently displayed on the agent’s or broker’s website
- Included in all marketing materials, including print collateral (12-point font)
and television advertisements
Additionally, the following requirements must be included in all call recordings and appointment forms:
- Date of appointment
- Beneficiary and agent contact information
- Product types to be discussed
CMS has stated that there is no obligation to re-enroll current Medicare participants and their enrollment status will not be affected. Automatic enrollment will also not occur. That said, a new Scope of Appointment (SOA) is required if the beneficiary requests information about a plan not previously discussed.
NOTE: CMS has not laid out a compliance verification or auditing plan for the Final Rule 2023 changes.
How to Achieve Compliance
Ensuring agents can meet these new CMS requirements by October 1, 2022, comes down to two primary factors: technology and training.
PSM and YourMedicare have launched the Telephony system to agents nationwide. This new system gives agents the ability to make and receive calls through the YourMedicare SunFire platform. The system assigns agents a virtual phone number with a customizable area code, making the number more familiar for their clients.
Let’s address the new disclaimer CMS requires agents to state during the first minute of each call. With the YourMedicare SunFire platform, each call starts with a recording of the disclaimer, so there’s absolutely no need to worry about it.
Now is a great time to make sure you have access to SunFire's enrollment platform and have a solution in place to remain compliant.
|
Guide: > Download the PDF Guide here |
