|
Marketing for 2021 Annual Enrollment Period - Reminder
Rule of thumb: If the purpose of the marketing activity is to eventually solicit an appointment for AEP, per CMS, it is NOT acceptable before October 1st 2020. If an agent is found to be marketing for AEP before October 1st, the agent could be penalized from the insurance carrier being marketed, or from CMS. It is a good idea for agents to take this time before October 1st to work on certifications and becoming Ready to Sell for the 2021 AEP season. Save all marketing efforts for after October 1st. 2021 AEP Resources:
 |
Thousands of seniors with Highmark’s Medicare Advantage plans will lose in-network access to UPMC hospitals a year earlier under a Wednesday state Supreme Court decision than they would have under a lower court’s ruling.
“We are disappointed in today’s Pennsylvania Supreme Court ruling,” Highmark spokesman Aaron Billger said in an emailed statement. “While this is not how we interpreted the consent decrees intended to guide the Highmark and UPMC relationship, we will work in full compliance with the ruling and trust UPMC will do the same.”
“UPMC is grateful the Supreme Court expeditiously reached this decision, allowing seniors ample time to make the best choices for their health care,” UPMC spokesman Paul Wood said in an emailed statement.
Medicare Advantage and Medicare supplemental insurance (Medigap) are each intended to enhance the value of traditional Medicare coverage. Understanding how Medicare Advantage and Medicare Supplements operate can help agents determine how to structure, market and support these plans. What are the differences between Medicare Advantage and Medigap insurance, and what does each offer its beneficiaries?
CMS will no longer provide “Medigap C and F” plans by 2020, which are plans that cover extra Part B costs
The Better Medicare Alliance, a Washington-based coalition for companies and groups with an interest in the Medicare Advantage has posted a copy of a memo that shows CMS is reinterpreting the phrase “primarily health related” when deciding whether a Medicare Advantage plan can cover a specific benefit.
The Medicare Advantage programs lets insurers offer consumers comprehensive plans that serve as an alternative to traditional Medicare coverage. CMS tries to control current costs, avoid any incentives for patients to get more care, and help patients shop for plans on an apples-to-apples basis by putting tight limits on the benefits the plan issuers can offer.
But the 
The CMS is also moving forward with plans to increase the use of encounter data to determine risk scores for plans. As a result of the finalized rule, 75% of Medicare Advantage risk scores will be based on traditional fee-for-service data, and 25% based on encounter data. That differs from 2018, when the agency used a risk score blend of 85% fee-for-service data and 15% encounter data.
Stakeholders such as the American Hospital Association have pushed back at using encounter data after a January 2017 Government Accountability Office report found such information often isn't accurate.
"Since the quality of the encounter data has improved, CMS believes it is appropriate to move forward with the proposed increased percentage of encounter data in the blend," the agency said in a release Monday.
The CMS also finalized a policy to prevent Medicare beneficiaries who are deemed at risk for opioid misuse or abuse from obtaining prescription drugs from multiple doctors or pharmacies. Instead, they'll be locked into one pharmacy or prescriber for Medicare Part D benefits.
This lock-in will limit an at-risk beneficiary's access to coverage for frequently abused drugs to those that are prescribed by a specified pharmacy or provider.
Medicare Advantage enrollment is projected to grow by 9% to 20.4 million in 2018. The CMS estimated that more than one-third of all Medicare enrollees, or 34%, will be in a Medicare Advantage plan in 2018.
Stakeholders such as the American Hospital Association have pushed back at using encounter data after a January 2017 Government Accountability Office report found such information often isn't accurate.
"Since the quality of the encounter data has improved, CMS believes it is appropriate to move forward with the proposed increased percentage of encounter data in the blend," the agency said in a release Monday.
The CMS also finalized a policy to prevent Medicare beneficiaries who are deemed at risk for opioid misuse or abuse from obtaining prescription drugs from multiple doctors or pharmacies. Instead, they'll be locked into one pharmacy or prescriber for Medicare Part D benefits.
This lock-in will limit an at-risk beneficiary's access to coverage for frequently abused drugs to those that are prescribed by a specified pharmacy or provider.
Medicare Advantage enrollment is projected to grow by 9% to 20.4 million in 2018. The CMS estimated that more than one-third of all Medicare enrollees, or 34%, will be in a Medicare Advantage plan in 2018.
