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Medicare Blog | Medicare News | Medicare Information
CMS proposes new prior authorization requirements for payers, including MA plans
Posted by www.psmbrokerage.com Admin on Wed, Dec 14, 2022 @ 02:27 PM
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Tags: Medicare Advantage
Dually Eligible Individuals - Categories
Posted by www.psmbrokerage.com Admin on Tue, Oct 18, 2022 @ 10:54 AM
Check out this resource that summarizes the eligibility categories for dually eligible individuals, including the degree to which individuals in each category receive assistance with Medicare Parts A and B premiums and cost sharing. Each eligibility category is mutually exclusive.
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Tags: Medicare Advantage, Dual Eligibles
Humana Announces Major Expansion of Florida Dental Network, Benefits
Posted by www.psmbrokerage.com Admin on Tue, Oct 18, 2022 @ 10:33 AM
In addition, the health and well-being company’s 2023 Medicare Advantage plans for Floridians eligible for both Medicare and Medicaid will feature new benefits including extra financial assistance to help pay for living expenses. New for 2023 Beginning Jan. 1, Floridians enrolled in a 2023 Humana HMO or PPO Medicare Advantage plan will have access to the Florida GoldPlus Dental Network, which includes 8,100 dentists across the state, as well as a nationwide network, meaning they can seek in-network care in and outside of Florida. Coats said the company is also expanding coverage for dental procedures and offering more flexible ways to pay for them, including:
More Help for Floridians Eligible for Both Medicare and Medicaid
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Tags: Humana, Medicare Advantage
Bright Health to exit ACA exchanges, slash MA footprint to 2 states
Posted by www.psmbrokerage.com Admin on Wed, Oct 12, 2022 @ 03:41 PM
Earlier this year, Bright Health Group announced it will exit six insurance markets as its financial struggles mount. Now, the insurtech has announced that it is axing its full lineup of plans on the Affordable Care Act's exchanges and cutting its Medicare Advantage (MA) offerings to two states for the 2023 plan year. The company said it plans to focus on its multipayer care model in markets where that is thriving and will have MA plans available in California and Florida for next year. The move, Bright Health Group said, will enable the company to build a stable growth trajectory with less risk, putting it on a quicker path to profitability. "This is not a decision we made lightly, but one we believe is in the best interest of progressing our mission and the next chapter of our continued story of transforming healthcare in America," Bright Health CEO Mike Mikan told investors on a call Tuesday morning. Cutting back its insurance product, Bright said, significantly reduces the amount of regulated capital the company needs, and it expects the change to release $250 million in excess regulated capital if state regulators give their approval. The company said it will continue to provide services to members through the end of the year and that it will support members in the upcoming open enrollment windows to ensure they don't face breaks in coverage. Mikan added on the investor call that value-based care models like Bright's have shown they can "deliver on the promise of better, more affordable healthcare." Putting a greater focus on the company's model allows it to expand the types of products and financing that can find success in a value-based approach. In addition to the news that it would exit certain markets, Bright Health Group also said it has raised $175 million in funding that it can use to drive toward greater profitability. The insurtech went public in June of last year, raising nearly $1 billion and setting a new high for insurance initial public offerings. The company reported a $1.2 billion loss for 2021 in its full-year earnings. And while Bright is pivoting its focus, rivals in the insurtech space aren't giving up on the exchanges. Oscar Health CEO Mario Schlosser told Fierce Healthcare that the company is bullish on the individual market and that Bright's exit opens the door for "more opportunity to assert ourselves" in the space. He did acknowledge that the ACA market can be difficult to navigate, as risk adjustment is complicated and membership fluctuates. "I think the market is in the most stable position it's been since the founding, and this should not distract from that," he said. ![]() |
Tags: Medicare Advantage, CMS, Bright Health
CMS Releases 2023 Medicare Advantage and Part D Star Ratings
Posted by www.psmbrokerage.com Admin on Wed, Oct 12, 2022 @ 03:00 PM
The Centers for Medicare & Medicaid Services (CMS) released the 2023 Star Ratings for Medicare Advantage (Medicare Part C) and Medicare Part D prescription drug plans to help people with Medicare compare plans ahead of Medicare Open Enrollment, which kicks off on October 15. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Star Ratings are released annually and reflect the experiences of people enrolled in Medicare Advantage and Part D prescription drug plans. The Star Ratings system supports CMS’ efforts to empower people to make health care decisions that are best for them. People with Medicare can use the Medicare Plan Finder tool, available on Medicare.gov, to compare plan quality through the Star Ratings, along with other information, such as cost and coverage. Approximately 72% of people currently in Medicare Advantage plans that offer prescription drug coverage are enrolled in a plan that earned four or more stars in 2023. Approximately 51% of Medicare Advantage plans that offer prescription drug coverage will have an overall rating of four stars or higher in 2023. Medicare Open Enrollment begins October 15, 2022, and ends December 7, 2022. During this time, Medicare beneficiaries can compare coverage options, including Original Medicare and Medicare Advantage, and choose high quality health and drug plans for 2023. Medicare Advantage and Part D plan costs and covered benefits can change from year to year, so Medicare beneficiaries should look at their coverage choices and decide on the options that best meet their health needs. They can visit Medicare.gov (https://www.medicare.gov), call 1-800-MEDICARE, or contact their State Health Insurance Assistance Program. 1-800-MEDICARE is available 24 hours a day, seven days a week, to provide help in English and Spanish, as well as support in over 200 languages. People who want to keep their current Medicare coverage do not need to re-enroll. CMS released the 2023 premium and coverage information for 2023 Medicare Advantage and Part D plans on September 29, 2022. Projections for 2023 indicate lower premiums for both Medicare Advantage and basic Part D coverage compared to 2022. Additionally, starting in 2023 under the Inflation Reduction Act, people with Medicare prescription drug coverage will have improved and more affordable benefits, including a $35 cost-sharing limit on a month’s supply of each covered insulin product, as well as adult vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP) at no additional cost. For more information on the 2023 Medicare Advantage and Part D Star Ratings, including a fact sheet, please visit: http://go.cms.gov/partcanddstarratings. ![]() |
Tags: Medicare Advantage, Medicare Part D, CMS, star ratings
Tags: Medicare Advantage, Medicare Supplement, Medicare Part D, Bonus Program, Incentives
Biden-Harris Administration Announces Lower Premiums for Medicare Advantage and Prescription Drug Plans in 2023
Posted by www.psmbrokerage.com Admin on Fri, Sep 30, 2022 @ 08:53 AM
Ahead of the upcoming Medicare Open Enrollment beginning October 15, the Centers for Medicare & Medicaid Services (CMS) is releasing key information, including 2023 premiums and deductibles for Medicare Advantage and Medicare Part D prescription drug plans, to help Medicare enrollees determine the best coverage for their needs. “Today we’re delivering on our commitment to reduce health care costs for Americans, including 64 million people with Medicare,” said HHS Secretary Xavier Becerra. “Thanks to President Biden’s Inflation Reduction Act, millions of Medicare enrollees will have lower prescription drug costs and improved benefits when they sign up this year. We will continue working to strengthen Medicare to ensure everyone gets the high-quality, affordable care they deserve.” “The Inflation Reduction Act will provide much needed financial relief and increase access to affordable drugs,” said CMS Administrator Chiquita Brooks-LaSure. “It is more important than ever for people to review their health care coverage and explore their Medicare options during Open Enrollment this year.” Enrollment in Medicare Advantage — private health plans that cover all Medicare Parts A and B benefits and may provide additional benefits — continues to increase. Projections indicate enrollment will reach 31.8 million people in 2023. The projected average premium for 2023 Medicare Advantage plans is $18 per month, a decline of nearly 8% from the 2022 average premium of $19.52. Medicare Advantage plans will continue to offer a wide range of supplemental benefits in 2023, including eyewear, hearing aids, preventive and comprehensive dental benefits, access to meals (for a limited duration), over-the-counter items, and fitness benefits. In addition, more than 1,200 Medicare Advantage plans will participate in the CMS Innovation Center’s Medicare Advantage Value-Based Insurance Design (VBID) Model in 2023, which tests the effect of customized benefits that are designed to better manage diseases and meet a wide range of health-related social needs, from food insecurity to social isolation. The benefits under this model are projected to be offered to 6 million people. The VBID Model’s Hospice Benefit Component, now in its third year, will also be offered by 119 Medicare Advantage plans in portions of 24 states and U.S. territories, providing enrollees increased access to palliative and integrated hospice care. Medicare Advantage plans participating in the Hospice Benefit Component will implement strategies to advance health equity across all aspects of their participation. CMS continues to improve options for enrollees who are dually eligible for Medicare and Medicaid. For example, in 2023, CMS will begin to require all Medicare Advantage dual eligible special needs plans (D-SNPs) to establish enrollee advisory committees and consult with those committees on various issues, including improving health equity for underserved populations. Additionally, new policies related to cost sharing are estimated to increase payment from MA plans to providers serving dually eligible individuals who incur high costs. As previously announced, the average basic monthly premium for standard Part D coverage is projected to be $31.50, compared to $32.08 in 2022. The Medicare Part D program helps people with Medicare pay for both brand-name and generic prescription drugs. Medicare Open Enrollment — Important Dates & Resources Medicare Open Enrollment runs from October 15 to December 7, 2022. During this time, people eligible for Medicare can compare 2023 coverage options on Medicare.gov. Medicare.gov provides clear, easy-to-use information, as well as an updated Medicare Plan Finder, to allow people to compare options for health and drug coverage, which may change from year to year. Medicare Plan Finder will be updated with the 2023 Medicare health and prescription drug plan information on October 1, 2022. 1-800-MEDICARE is also available 24 hours a day, seven days a week to provide help in English and Spanish as well as language support in over 200 languages. People who want to keep their current Medicare coverage do not need to re-enroll. During Open Enrollment, people with Medicare who take insulin are encouraged to call 1-800-MEDICARE or contact their State Health Insurance Assistance Programs (https://www.shiphelp.org/) for help comparing plans and costs this year. To help with their Medicare costs, low-income seniors and adults with disabilities may qualify to receive financial assistance from the Medicare Savings Programs (MSPs). The MSPs are essential to help millions of Americans access high-quality health care at a reduced cost, yet only about half of eligible people are enrolled. The MSPs help pay Medicare premiums and may also pay Medicare deductibles, coinsurance and copayments if people meet the conditions of eligibility. Enrolling in an MSP offers relief from these Medicare costs, allowing people to spend that money on other necessities like food, housing or transportation. Individuals interested in learning more can visit: https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/medicare-savings-programs. ![]() |
Tags: Medicare Advantage, Medicare Part D, CMS
Cigna Brokers can earn an additional $50 per enrollment
Posted by www.psmbrokerage.com Admin on Thu, Sep 29, 2022 @ 02:36 PM
Brokers can now earn up to $50 for submitting digital applications and collecting the customer’s email address We are so excited to share Cigna's new value based enrollment (VBE) program for new to Cigna customers starting with January 1, 2023 effective dates and forward! With Cigna's new program, you will receive additional payments when you submit digital applications and capture important customer information at the point of sale. It’s easy to make additional money with Cigna Medicare! Follow the steps below to earn up to $50 on every enrollment!*
This new program will be available starting with January 1, 2023 effective dates. Be on the lookout for more details coming soon! *The VBE payment will be made for new Medicare Advantage customers and voluntary plan changes that result in Cigna customers. *The agent must be qualified as Ready to Sell in order to receive payout. *The VBE payment is an agent level payment only. If an AOC is in place, the VBE payout will be made to the agent's upline.
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Tags: Cigna, Medicare Advantage
YourMedicare SunFire Daily Webinars
Posted by www.psmbrokerage.com Admin on Wed, Sep 28, 2022 @ 10:24 AM
YourMedicare SunFire Daily Webinars Starting this Wednesday, YourMedicare will be hosting daily webinars specifically going over the new call recording technology in YourMedicare SunFire. They will all be at 2:00 EST. YourMedicare will cover the setup process, how to use the new feature and answer all of your questions! This is a reoccurring event so there is no registration required. Join us every Wednesday at 2:00 EST. You can also learn more by attending one of our weekly webinars. View schedule
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Tags: Medicare Advantage, AEP, SunFireMatrix, Compliance, MyMedicareBot, call recording
Sunfire: Telephony System is LIVE!
Posted by www.psmbrokerage.com Admin on Fri, Sep 23, 2022 @ 09:56 AM
YourMedicare SunFire users, Today is the day! Be sure to log in and establish your new virtual phone number. Here is a step-by-step guide:
To register for a webinar go to https://yourmedicareresources.com/webinars/ To register for the SunFire Platform, request details here.
New CMS Requirement
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.
Now is a great time to make sure you have access to Sunfire's enrollment platform and have a solution in place for the upcoming 2023 AEP.
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Tags: Medicare Advantage, CMS, AEP, SunFireMatrix, Compliance, 2023