4 Racing Tips to Help You Win This AEP
TIP #1: STUDY THE COURSE
Keep your book of business organized from day one. Know the plans and products available to you so that you’ll have time to map out a strategy. The more you can prepare now, ahead of Oct. 15, the less you’ll be scrambling at go-time. It’s also important to lighten your load at home. Knowing your work will become much busier in October can be helpful when planning your work-life balance for the next few months. Consider any potential personal commitments or important family holidays — like Thanksgiving — now. Plan ahead and minimize your stress during AEP. TIP #2: START YOUR ENGINES
Friendly, pre-AEP reminders to Medicare beneficiaries are a great way to get ahead. Just remember: Communications can’t include anything specific regarding plans, like pricing or benefit details. AEP lasts 54 days. It’s a race to Dec. 7, where your focus could be the difference between achieving your goals and not. How are you planning to fuel your growth this year with a goal of 25% YoY growth in your submitted app count? TIP #3 STAY EFFICIENT
Leverage available technology for important services like scheduling and comparing plans. You have access to the YourMedicare Enrollment Center — a multicarrier platform where agents can compare plans, get quotes and enroll their clients. Agents have turned to the YourMedicare Enrollment Center as their “goto” platform for enrolling beneficiaries into Medicare Advantage and Part D prescription drug plans. And with AEP coming up, using the YourMedicare Enrollment Center is a double win: For every submitted application mad through the platform, YourMedicare donates at least 10 meals to Feeding America. With more than 550,000 meals donated already, YourMedicare is well on its way to reaching its goal of donating 1 million meals in 2022. Agents also have access to YourFMO.com, a one-stop shop for growth with Medicare TIP #4 ALWAYS LOOK AHEAD
Remember: Your contacts are also someone else’s prospects. If you’re not planning ahead, chances are, someone else is. Year-round communication can help you stay top of mind. Try things like birthday cards, newsletters or quarterly mailers. The simple act of following up can help create lifelong customers and relationships. And remember to keep preparing for AEP all year long. When one AEP ends (or even during this AEP), start thinking about the next. Mastering the art of the AEP sale comes with practice. As you find what serves the client’s best interest, you’ll build on your success and your business will thrive. Have a great 2023 AEP! ![]() |
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4 Racing Tips to Help You Win This AEP
Posted by www.psmbrokerage.com Admin on Fri, Sep 09, 2022 @ 11:13 AM
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Tags: Medicare Advantage plans, Medicare Advantage News, CMS, Compliance, call recording
Celebrity Medicare Sales Pitches Are Toned Down After Scrutiny
Posted by www.psmbrokerage.com Admin on Wed, Sep 07, 2022 @ 04:25 PM
Soaring complaints and aggressive sales efforts result in tighter rules from regulatorsIf it’s football season, you can count on seeing Joe Namath on television, along with William Shatner and Jimmie “J J” Walker. They are the most prominent pitchmen for what has become an annual fall selling frenzy for Medicare Advantage policies. After a surge in consumer complaints, and stiffer government rules, the sales pitches will likely be tamer this year. If there is confusion, “we’ll change things so it satisfies everybody and eliminates the confusion,” said Mr. Shatner, best known for his role as Captain Kirk in the “Star Trek” franchise The federal Centers for Medicare and Medicaid Services toughened its oversight after consumer marketing complaints surged 165% last year to 41,136 compared with 2020. Brokerages, agents and other marketing businesses tried to convince Medicare recipients to switch plans, with promises of perks in their new plans such as home-delivered meals, rides to doctors’ appointments and cash. In some cases, beneficiaries would effectively pay for the perks with more-limited provider networks, forcing them to find new doctors, regulators say. The celebrity pitchmen haven’t been accused of violating any rules. The aggressive sales efforts by marketers are the result of billions invested by private-equity firms, financial-services companies and stock-market investors into virtual call centers, internet-based lead-origination firms and other marketing businesses over the past several years. The investors all focused on the annual sign-up period for Medicare Advantage plans, which are an alternative to the traditional fee-for-service Medicare plans. Enrollment in the plans, which are offered by private insurers and paid for by the government, grew 8% last year to 28.4 million in 2022, according to the Kaiser Family Foundation. Consumers can sign up for new plans every year, making them a prime opportunity to generate sales commissions for brokers. “Seniors are being bombarded,” said Ron Henderson, a deputy insurance commissioner in Louisiana. The sign-up period runs from Oct. 15 to Dec. 7. The stiffer rules are targeted at marketers that sell policies on behalf of health insurers. They will need to disclose more to their customers while CMS clarified that insurers will be responsible for what their marketers say. ![]() |
Tags: Medicare Advantage plans, Medicare Advantage News, CMS, Compliance, call recording
Medicare 2023: What Agents and Clients Need to Know
Posted by www.psmbrokerage.com Admin on Wed, Sep 07, 2022 @ 04:07 PM
Many of the general rules governing Medicare remain the same, said Harriett, though some plans and benefits will change. Some rules are specific to agents while others may be helpful to their clients. However, Harriett said, there are always a few general rules agents need to know when dealing with clients. Here is an overview of what agents need to know for 2023, according to Harriett: General enrollment period dates have changedThere are a number of reasons someone did not enroll in Medicare when he or she was first eligible. In that case, most reasons qualify them to enroll during a Special Election Period, Harriett said. But some people who did not enroll when they were first eligible and had no special election period were restricted to enroll only between Jan. 1-March 31 of each year, with their effective enrollment date beginning July 1. This year, things have changed. For those paying for Medicare Part A, and for those enrolling in Part B, Harriett said, their effective date will be the first day of the month after they enroll. Applicable penalties will still apply. Coverage gap continues to get smallerThe Medicare Part D Prescription Drug program has always had a phase, known as the coverage gap (previously known as the “doughnut hole”). This is a period in prescription-drug coverage when a client’s coverage is reduced if costs escalate to a certain point, and the client pays more for a period of time. Since its inception, Harriett said, the coverage gap has been a point of political contention, with several attempts over the years to fix the burdens this gap created for those who need expensive drugs. In the last few years, Medicare has broadened the definition of “True out of Pocket Costs,” including how the gap is calculated. Now, once in the coverage gap, drug manufacturers pay 70% of the cost of a drug, the insurer pays 5%, and the client covers 25%. But 100% of those costs count toward the beneficiary’s total spending, which gets them out of the gap more quickly and into catastrophic coverage. For example, Harriett explained, a drug with a true cost of $100 in the coverage gap would be paid as follows: The manufacturer covers $70, and the insurance company pays $5. The beneficiary is responsible for $25. But the Explanation of Benefits will show that the beneficiary has paid $100 in out-of-pocket costs. Disclosures must increaseThe huge number of marketing calls from call centers in recent years has led to a striking increase in the number of complaints to the Centers for Medicare and Medicaid Services (CMS) regarding AEP enrollments. Because of this, there have been a few alterations to the rules, Harriett said. This year, marketing organizations must disclose when and if their information is being transferred to a licensed agent (if they were not talking with one originally). Also, there is a new general disclaimer, which must be read to all beneficiaries within the first minute of their telephone call to agents. A full copy of this disclaimer can be found in the insurance company’s Medicare Advantage/PDP compliance bulletins, Harriet said. Marketing, enrollment calls must be recordedAs the rules stand today, all calls that market and enroll beneficiaries in Centers for Medicare and Medicaid Services (CMS)-regulated Medicare products must be recorded from beginning to end and stored safely and securely for at least 10 years. “How this will look in the future is anyone’s guess as it is being challenged by a number of organizations,” Harriett pointed out, “but it appears that for now, the rule is here and will be in place. So, if you are going to be marketing products during AEP, be sure to set up a recording system. If you won’t be marketing, be sure to tell your clients they will be recorded when they talk with someone about it.” The call recording is a big change, Harriett said. But apart from the general change in Medicare costs or numbers (the bulk of which will most likely not be published until at least the end of October), many things in Medicare carry over from this year, Harriett said. “But that does not mean you or your clients should relax,” she said, adding “Always check over benefits with your clients. Prescription drug plans and Medicare Advantage plans change each year. And next year’s plan may not meet your client’s health or financial needs for 2023.” Always use this opportunity to talk to everyone about it.”
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Tags: Medicare Advantage plans, Medicare Advantage News, CMS, Compliance, call recording
3 ways to navigate the new CMS call recording rules
Posted by www.psmbrokerage.com Admin on Thu, Sep 01, 2022 @ 04:51 PM
It’s 2008, and the Centers for Medicare & Medicaid Services just published what quickly would be deemed as “industry-shaking” new Medicare communication and marketing guidelines. From rules regarding scopes of appointment and other requirements intended to clean up poor business practices, many marketers and agents were beside themselves. A palpable panic began to emerge as we scrambled to understand the implications of these new rules to our businesses, our client engagements and our future prospects. Let’s face it – we were living perfectly fine before these rules were published and our industry was riding high. But these new rules weren’t just some one-off requirement. They were a watershed moment for our industry, and they started a cascade of new guidelines from CMS designed to protect consumers and help agents maintain credibility, transparency and trust with those very consumers. Fast forward to today and we find ourselves in a similar position with CMS’s recently published requirements regarding call recordings. As in 2008, I’ve received many of the same questions: “How will this impact me and my business?” “What tools or resources are available to help me do this?” and “What does this mean for engagements with existing clients versus prospective clients?” These are perfectly understandable questions for agents to ask. Compounding the confusion and hard feelings is the notion that CMS likely implemented these new rules in reaction to one particular bad actor and now we all have to deal with the repercussions (not to mention the vagueness of the rules themselves and their release so close to the all-important annual enrollment period selling season). Many of us remember a time when door-knocking dominated our industry, and face-to-face interaction played a vital role in developing client trust. But as we’ve shifted to telephone and e-selling approaches, you can’t help but feel as though today’s agents are being punished for the natural evolution of our industry and consumer engagement. However, rather than continue to bemoan yet another layer of compliance, it’s important to see the opportunity in front of us. Simply put, we always can do better. The biggest threat to our business always has been the commoditization of the agent-consumer relationship, and these rules help ensure that we continue to be perceived and operate as the trusted advisors we need to be.
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Tags: Medicare Advantage plans, Medicare Advantage News, CMS, Compliance, call recording
MA to become predominant form of coverage for Medicare beneficiaries, report finds
Posted by www.psmbrokerage.com Admin on Wed, Aug 31, 2022 @ 02:31 PM
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MA enrollment has more than doubled since 2007, when it was just 19% of the Medicare population, the report said. Between 2021 and 2022, MA enrollment rose by 8%, or by 2.2 million beneficiaries. This is slightly lower than the prior year, when enrollment grew by 10%. The Congressional Budget Office predicts that by 2032, MA enrollees will make up 61% of the Medicare population.
UnitedHealthcare and Humana account for almost half of all MA enrollees this year. UnitedHealthcare has 28% of total MA enrollment and Humana has 18%. In about a third of all counties in the U.S., the payers account for at least 75% of MA enrollment.
Meanwhile, Blue Cross Blue Shield has 14% of MA enrollment, CVS Health has 11%, Kaiser Permanente has 6%, Centene has 5%, Cigna has 2% and the remaining 16% is made up of other insurers.
UnitedHealthcare and Humana historically have had the highest share of MA enrollment. In 2010, UnitedHealthcare had 20% of MA beneficiaries and Humana had 16%. UnitedHealthcare has also seen the largest growth since 2010.
KFF also found:
- About two-thirds of MA enrollees, or 66%, are in individual plans. Meanwhile, 18% are in employer/union-sponsored group plans and 16% are in special needs plans.
- The share of Medicare beneficiaries enrolled in MA plans varies by state. This year, Alaska has the lowest with 1% enrolled in MA, while Hawaii has the highest with 59% enrolled in MA.
- In 2022, almost seven out of 10 MA enrollees are in plans with prescription drug coverage that don’t require premiums other than the Medicare Part B premium. This was reported in a separate analysis by KFF, also published Thursday.
- Most enrollees in individual MA plans have access to benefits that aren’t covered by traditional Medicare. This includes eye exams, hearing exams and fitness.
- Nearly all MA enrollees, or 99%, are in plans that require prior authorization for some services. This refers to a process utilized by insurers that determines if they will cover a certain procedure or medication. It is mostly used for expensive services, such as prescription drugs administered by a physician, skilled nursing facility stays and inpatient hospital stays, KFF found. However, it is rarely needed for preventive services.

2023 Medicare Advantage / PDP Agent Commissions (FMV)
Posted by www.psmbrokerage.com Admin on Tue, Jun 14, 2022 @ 09:45 AM
2023 Medicare Advantage / PDP Agent Commissions have increased! And it's another increase from the year prior. That makes 8 years in a row.
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Tags: Medicare Advantage News, PDP, commissions, 2023
CMS finalizes 8.5% rate hike for Medicare Advantage, Part D plans in 2023
Posted by www.psmbrokerage.com Admin on Thu, Apr 07, 2022 @ 02:26 PM
The Biden administration finalized an 8.5% increase in rates to Medicare Part D and Medicare Advantage plans, slightly above the 7.98% proposed earlier this year. The Centers for Medicare & Medicaid Services (CMS) released the final 2023 MA and Part D rate announcement on Monday and with it a 4.88% effective growth rate, slightly above the 4.75% rate released in the advance notice. The change from 7.98% to 8.5% is due in part to the application of the rebasing/re-pricing impact, which was not available when the advance notice was released back in February. CMS did not change the planned coding pattern adjustment of 5.9% to reflect any differences in diagnosis coding between MA plans and fee-for-service providers, with that being the statutory minimum. The agency acknowledged it had received several comments asking for a higher adjustment than the minimum and that CMS must consider differences in coding patterns across MA plans. The comments come as critics have charged some MA plans engage in risk adjustment tactics such as up-coding to increase unnecessary diagnoses and glean overpayments from Medicare. CMS decided, however, to not make any changes to the coding pattern adjustment at this time. “CMS continually reviews MA coding patterns and continues to assess how we calculate the MA coding pattern adjustment, how best to apply it and what the appropriate level of the adjustment should be,” the agency said in a fact sheet. The agency also solicited feedback on what measurements it should pursue to improve health equity in MA and Part D star ratings. This includes comments on how to develop a health equity index to determine how MA and Part D plans performed in combating social risk factors, and how it will affect star ratings. Another measure would assess whether plans are screening enrollees for social needs such as transportation or food insecurity, according to a release from CMS. The agency did not release any specific reforms, but said it will take the “feedback received into consideration as we continue to explore ways to further drive health equity and high quality care.” Improving health equity is a major priority for the Biden administration and CMS has hinted how equity will be a factor in agency regulations. The Center for Medicare and Medicaid Innovation recently outlined new equity requirements, including the development of an equity plan, as part of the newly unveiled ACO REACH payment model. ![]() |
Tags: Medicare Advantage News
Best companies for Medicare Advantage in 2022
Posted by www.psmbrokerage.com Admin on Mon, Oct 18, 2021 @ 03:28 PM
The highest-ranked (US News) Insurance Company for Medicare Advantage Plans is defined as a company whose plans were all rated as at least three out of five stars by CMS and whose plans have an average rating of 4.5 or more stars within the state.
U.S. News analyzed insurance companies’ offerings in each state based on their 2022 CMS star ratings, and below provides a list of the top-rated insurance companies for Medicare Advantage plans in each state.
Click the links to view the individual plans and their rating details.
Tags: Medicare Advantage News
MA Beneficiaries Spend Less than Fee-for-Service Medicare Beneficiaries
Posted by www.psmbrokerage.com Admin on Tue, Jul 06, 2021 @ 03:35 PM
When it comes to premiums, those who are enrolled in traditional Medicare with a drug plan pay an average of $2,186 per year on premiums (the other $3,174 was spent on out-of-pocket costs). Beneficiaries who opt for additional Medigap coverage pay an average of $4,392 per year on premiums with an additional $1,599 in out-of-pocket costs. MA beneficiaries, however, spend less in premiums and out-of-pocket costs in comparison ($2,013 and $1,545, respectively).
The report also included state-specific savings. For example, in the state of Florida, MA beneficiaries experience an average savings of 57% compared to Medicare FFS beneficiaries. MA beneficiaries in Florida have an average $2,880 savings over Medicare FFS and a prescription drug plan and an average $3,865 savings over Medigap Part G option. In the state of Maryland, MA beneficiaries experience an average savings of 32% compared to Medicare FFS beneficiaries, totaling a $1,574 average savings over Medicare FFS and prescription drug plan (an average $1,916 savings over Medigap Part G). In Texas, MA beneficiaries save an average of 43% compared to Medicare FFS beneficiaries, resulting in a $2,180 average savings over Medicare FFS and prescription drug plan ($2,449 average savings when compared to Medigap Part G option). California also sees a significant cost savings for MA beneficiaries, averaging to a 45% savings when compared to Medicare FFS beneficiaries ($2,029 average savings over Medicare FFS and prescription drug plan and $2,704 average savings over Medigap Part G). New York’s average savings for MA beneficiaries is 44%, resulting in a $1,317 savings over Medicare FFS with a prescription drug plan and $3,151 savings over Medigap Part G option. Enhanced Services The report also notes that MA plans typically offer additional services and financial protections that are not offered by Medicare fee-for-service plans, such as: dental, vision, and hearing services; meals, non-emergency transportation and care coordination; and in-home health assessments. The researchers who conducted the study acknowledged that estimated health care spending is often a “key factor in the choice between MA and [fee-for-service] coverage.” Source:
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Tags: Medicare Advantage News
Enrollment Trends in Medicare Options
Posted by www.psmbrokerage.com Admin on Tue, Jul 06, 2021 @ 03:06 PM
To limit their annual spending on care, retirees usually buy some type of insurance policy to help pay the bills Medicare does not cover. But a big shift is under way: the Medigap and employer plans that once dominated are now in decline. Only about a third of retirees have one of these two supplementary arrangements, down from two-thirds in 2002.
Helen Levy at the University of Michigan digs into what the market changes mean for retirees’ bottom line in recent research funded by the U.S. Social Security Administration. With fewer employers offering retiree health insurance, new Medicare beneficiaries focus on the tradeoffs between Medigap and Advantage policies. A big reason the Advantage plans have taken off is lower premiums, which are, on average, substantially below the premiums on Medigap plans. Advantage plans’ other appeal is that they frequently cover extra services like dentists and eyeglasses. Both Advantage and Medigap plans can still leave beneficiaries with high out-of-pocket spending. The federal limit on Advantage plans’ deductibles and copays increased this year to $7,550 per year, though insurers are permitted to reduce this cap. Many Medigap plans do not have out-of-pocket maximums at all. However, these plans tend to give more protection from large medical bills overall. Just as important to retirees as paying the bills is the risk of being socked with inordinately high spending on hospital and physician care in a bad year. Levy defines this unpredictability as retirees having to shell out more than 10 percent of income out of their pockets, excluding all premiums. Under this standard, about 23 percent of the retirees in the study with Advantage plans spent more than 10 percent of their income for care – versus 17 percent of Medigap buyers. About 28 percent of those without any coverage outside of Medicare exceeded the 10-percent threshold. More certainty in the Medigap plans is only part of their appeal – at least, for the people who can afford the premiums. The other benefit to retirees is the ability to choose their own doctors, who are required to take Medigap if the practice accepts Medicare patients. Retirees have to decide on the tradeoffs they’re willing to make. “That is, after all, how insurance works,” she said. To read this study, authored by Helen Levy, see “The Risk of High Out-of-Pocket Health Spending Among Older Americans.” Source: https://squaredawayblog.bc.edu/squared-away/enrollment-trends-in-medicare-options/ ![]() |
Tags: Medicare Advantage News