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Center for Medicare Advocacy Releases Analysis of Various Medicare Advantage Changes

Posted by www.psmbrokerage.com Admin on Thu, Sep 20, 2018 @ 04:00 PM

Center for Medicare Advocacy Releases Analysis of Various Medicare Advantage Changes


This week, the Center for Medicare Advocacy (CMA) released an issue brief that examines the details and legal underpinnings of several proposed and upcoming changes to the Medicare Advantage (MA) program. Designed to be a resource for advocates and attorneys, CMA’s analysis combines several disparate sources of MA changes, including recently signed legislation, regulatory rulemaking, and sub-regulatory guidance. It also predicts some of the consequences of these changes on, among other things, beneficiary decision-making and informed choice.

The brief outlines the changes to MA made in the Balanced Budget Act of 2018 (BBA), in the Part C and D final rule issued earlier this year, and in the Final Call Letter for 2019. These changes increase flexibility for MA plans in several ways, including:

  • expanding what supplemental benefits plans may choose to offer (effective in 2019 for changes from the C & D final rule and effective in 2020 for changes from the BBA ),
  • allowing plans to treat beneficiaries differently based on health status, allowing companies to offer more plan choices,
  • streamlining the process for a sponsor to enroll a newly-eligible Medicare beneficiary who was previously enrolled in that company’s non-MA plan, and
  • creating expanded enrollment opportunities.

With so many significantly overlapping changes, this report provides a comprehensive and thorough analysis – listing together the various flexibilities and freedoms MA plans will have in the coming years. Medicare Rights continues to monitor and analyze how these regulatory trends and practical changes will affect people with Medicare and those who help them navigate coverage decisions. As part of this process, we will be releasing consumer-friendly education tools and policy analysis in the coming weeks on the anticipated changes to MA plans, beneficiary tools and resources, Medicare and the opioid crisis, and Medicare enrollment periods.

We also remain actively engaged in the implementation of these regulatory developments, to ensure the beneficiary perspective is considered and embedded in any changes to the program. We recognize that some of the new policies may not ultimately benefit people with Medicare, and we will continue to monitor the use and potential abuse of these new rules.

Read the CMA issue brief.

Additional Updates:

Tags: Annual Enrollment Period, medicare advantage updates

CMS Expands Benefit Flexibility In Medicare Advantage

Posted by www.psmbrokerage.com Admin on Tue, Jun 19, 2018 @ 11:13 AM


CMS Expands Benefit Flexibility In
Medicare Advantage

Beginning in 2019, MA plans can leverage the new flexibility to partner with community-based organizations to create services aimed at addressing barriers to access to care or avoiding costly care.

The major new flexibilities for 2019 and beyond include:

Benefit Uniformity Flexibility:

In 2019, MA plans can design disease-specific benefits for individuals with certain chronic conditions or other high-risk health conditions if 1) they are available to all enrollees, 2) MA plans use objective and measurable medical criteria, and 3) beneficiaries’ diagnoses have been certified by a provider...

Supplemental Benefits:

The previous “primarily health-related” definition has been expanded for supplemental benefits to permit coverage of services to diagnose, prevent, or improve the effects of injuries or health conditions, or reduce avoidable emergency healthcare utilization...


Additional Updates:
  • UnitedHealthcare acquires Peoples Health, an HMO in Louisiana - View
  • New Federal Law could spur Medicare Advantage plans to avoid enrolling sick beneficiaries - View
  • Stand-alone PDP premiums rise modestly - View
  • 1 in 4 major health systems preparing to launch Medicare Advantage plans - View
  • Differentiate yourself early and close more sales - View
  • Express: Mutual of Omaha Weekly Updates - View
  • VALUES Quote of the Week - View
  • Current Agent Incentive Trips and Contests - View

Tags: medicare advantage updates, New Med Advantage Rules, medicare updates

Medicare Advantage Contract Year 2019 Agent and Broker Compensation Rate Adjustments

Posted by www.psmbrokerage.com Admin on Tue, May 29, 2018 @ 04:23 PM

Medicare Agent Broker Compensation Rate Adjustment - Medicare Advantage Contract Year 2019 

This memorandum provides contract year (CY) 2019 compensation limits for agents and brokers, directions for submitting amounts into the Health Plan Management System (HPMS), as well as training and testing requirements.

Compensation Rate Adjustment for CY 2019
As provided in 42 C.F.R. §§422.2274(b)(1) and 423.2274(b), the compensation amount paid to an independent agent or broker for an enrollment must be at or below the fair market value (FMV) cut-off amounts published yearly by the Center for Medicare and Medicaid Services (CMS).

The CY 2019 FMV cut-off amounts for all organizations are as follows:

Compensation Grid

5.9% increase ($27) on first year Medicare Advantage and 5.7% increase ($13) on renewal for 2019*.
PDP also increased the writing agent commission by 2.7%.

(*National rates referenced above. For Agent Use Only.)

NOTE: The FMV amounts for CY 2019 are rounded to the nearest dollar. The Initial Year amount is the maximum allowable to be paid for enrollments during compensation cycle-year 1. The renewal amount is the maximum allowable to be paid for enrollments during compensation cycle-years 2 and beyond.

Compensation Rate Submission for CY 2019
As in past years, all organizations must inform CMS via HPMS whether they are using employed, captive, or independent agents. Organizations that use independent agents must provide the initial and renewal compensation amount or range of amounts paid to these agents. Additionally, if an organization pays referral fees, the organization must disclose the referral fee amount. 
CMS has provided instructions for data entry in the HPMS Marketing Module User Guide.

Organizations may submit their agent/broker information in the HPMS Marketing Module June 4, 2018 through July 27, 2018, 11:59 pm EST. Please note that CMS does not consider the submission process complete until the organization’s CEO, COO, or CFO has completed the attestation in HPMS. Organizations that fail to submit and attest to their agent and broker compensation data by July 27, 2018 will be out of compliance with CMS requirements. Organizations will not be able to make changes to those submissions after the July 27, 2018 deadline.

CMS expects organizations to keep full records documenting that they are updating compensation schedules and paying agents and brokers according to CMS requirements.

Please note that the CY 2019 compensation information submitted will be made available for the public to view on www.cms.gov prior to the annual election period for CY 2019.

Curricula for Training and Testing Agents and Brokers for CY 2019
Regulations at 42 C.F.R. §§422.2274 and 423.2274 require that agents and brokers selling Medicare products, including employees, subcontractors, downstream entities, and/or delegated entities, be trained and tested annually on Medicare Parts A, B, C, D, and plan specific information. CMS further requires that agents and brokers obtain an 85% passing rate on the test.

In order to ensure the quality of all agent and broker training and testing programs, CMS annually provides minimum training and testing requirements to organizations. Organizations should review these requirements before developing their own agent and broker training and testing program to ensure compliance with CMS requirements. CMS permits and encourages organizations and third-party training and testing vendors to include other relevant topics, in addition to the minimum required elements.

The CY 2019 CMS training and testing requirements for CY 2019 may be found here.


Additional Updates:
  • Medicare Agent Broker Compensation Rate Adjustment - 2019 - View
  • Medicare Part D in 2018: Latest on enrollment, premiums and cost sharing - View
  • Continued Growth for Medicare Supplement Plans - View
  • Express: Mutual of Omaha Weekly Updates - View

Tags: medicare advantage updates, medicare updates, Medicare Open Enrollment Period, OEP

2019 Aetna Medicare Advantage Expansion Details

Posted by www.psmbrokerage.com Admin on Tue, May 29, 2018 @ 01:38 PM

We have some exciting news to share. Aetna is expanding their Medicare plan offerings to new counties for 2019!


We are excited to tell you more about this opportunity! Give our Marketing Team a call at 800-998-7715 for more information!

Now is a great time to review carrier expansions and incorporate them into you 2019 AEP marketing plans.

Additional Updates:
  • Medicare Part D in 2018: Latest on enrollment, premiums and cost sharing - View
  • Continued Growth for Medicare Supplement Plans - View
  • Trump Administration unveils drug pricing strategy - View
  • Express: Mutual of Omaha Weekly Updates - View
  • VALUES Quote of the Week - View
  • Current Agent Incentive Trips and Contests - View

Tags: medicare advantage updates, aetna, medicare updates, Medicare Open Enrollment Period, OEP

Medicare Open Enrollment Period (OEP) is Back for 2019

Posted by www.psmbrokerage.com Admin on Tue, May 22, 2018 @ 10:14 AM

Medicare Open Enrollment Period (OEP)
is Back for 2019

Medicare Open Enrollment Period (OEP) is Back for 2019-1

There are several changes for 2019 Medicare Advantage (MA) enrollments. 

Please review the important information below regarding new CMS Guidance for Section 30.5, Chapter 2 of the Medicare Managed Care Manual.

30.5 - Medicare Advantage Open Enrollment Period (MA OEP)

42 CFR 422.62(a)(3) (Rev. 1, Issued: July 31, 2018; Effective/Implementation: 01-01-2019)

During the MA OEP, MA plan enrollees may enroll in another MA plan or disenroll from their MA plan and return to Original Medicare. Individuals may make only one election during the MA OEP.

This chart outlines who can use the MA OEP and when:

OEP Chart

Individuals may add or drop Part D coverage during the MA OEP. Individuals enrolled in either MA-PD or MA-only plans can switch to:

  • MA-PD
  • MA-only
  • Original Medicare (with or without a stand-alone Part D plan)

The effective date for an MA OEP election is the first of the month following receipt of the enrollment request.

NOTE: The MA OEP does not provide an opportunity for an individual enrolled in Original Medicare to join a MA plan. It also does not allow for Part D changes for individuals enrolled in Original Medicare, including those enrolled in stand-alone Part D plans. The MA OEP is not available for those enrolled in Medicare Savings Accounts or other Medicare health plan types (such as cost plans or PACE).

Some may see it as an opportunity and others as a bother. Nevertheless, prepare yourself and your clients and you should be able to navigate the new OEP with ease.

If you have any questions or need assistance in getting appointed with our leading Medicare Advantage and Part D companies, call us today and one of our knowledgeable marketers would be happy to assist.

Review the full legislation here.

Additional Updates:
  • Medicare Agent Broker Compensation Rate Adjustment - 2019 - View
  • Medicare Part D in 2018: Latest on enrollment, premiums and cost sharing - View
  • Continued Growth for Medicare Supplement Plans - View
  • Express: Mutual of Omaha Weekly Updates - View

Tags: medicare advantage updates, medicare updates, Medicare Open Enrollment Period, OEP

Medicare Advantage Tops 17 Million Members

Posted by www.psmbrokerage.com Admin on Thu, Apr 02, 2015 @ 11:49 AM

blog pic More than 17.3 million people were enrolled in Medicare Advantage plans as of March 2015. Year over year, total Medicare Advantage enrollment increased by more than 1.3 million as managed Medicare continues to be an attractive growth market for health insurance companies. The latest CMS (Centers for Medicare and Medicaid Services) reports indicate 54.3 million are eligible for Medicare in the United States and U.S. territories. Medicare Advantage (MA), with an unpenetrated market of 37 million and growing, is big business for many health plans. UnitedHealth and Humana lead the segment and each leader enrolls more than 3 million MA members. Kaiser Permanente and Aetna also command significant market share with more than 1.2 million MA enrolled.

This brief provides insights about competitive positioning in the Medicare Advantage market. We also assess market share for individually purchased versus employer-sponsored benefits and look at changes in Medicare Advantage plan type preferences.

Competitive Dynamics

Medicare Advantage (MA) enrollment stands at 17.3 million, which represents an 8% increase year-over-year. Ten companies, each with more than 250,000 members, have a sizeable stake in this segment and collectively they provide coverage for 67% of the market. Per the reference table below, all leading MA companies realized growth from March 2014 to March 2015 except for Anthem and Highmark. The aggregate net gain for the leading companies, year-over-year, was 8.2% and segment growth for all other MA companies was on par.

UnitedHealth retains its position as the top Medicare Advantage organization in the country; with 3.4 million enrolled, UnitedHealth owns 20% of the market. Humana ranks a strong second with 18% share and 3.1 million lives. Kaiser Permanente is positioned as third on the leader board, enrolling 7.5% of the total market or 1.3 million. Aetna trails closely behind Kaiser Permanente owning 7.2% of the market and more than 1.2 million lives.

Each year, Medicare Advantage plans rely on February and March enrollment reports to not only evaluate their standing but also assess which competitors gained and lost members during the last AEP (Annual Election Period). The AEP occurs between October 15 and December 7 each year and is also referred to as the Open Enrollment Period for Medicare Advantage and prescription drug plans.

This year, Humana experienced the largest gain in terms of membership, adding 369,747 members for a net gain of 13.2%. UnitedHealth's MA enrollment grew by 271,245 for a net gain of 8.5%. Aetna saw a net gain of 13.9%, adding 152,780 members to its MA book in the last year. Per the reference table below, membership gains were fairly substantial for other growth leaders in this segment, ranging from 83,365 for Kaiser Permanente to 32,729 for Blue Cross Blue Shield of Minnesota.

The majority of people with Medicare Advantage purchased a plan directly from the company and this is referred to as individual or direct purchase enrollment. As of March 2015, about 82% (approximately 14 million) of MA membership was individual. This speaks to why plans invest considerable time to devise market and selling strategies in preparation for the AEP every year.

Only 18% of total MA membership (slightly more than 3 million) originated through an employer group health plan or retirement health benefit. Nonetheless, group membership grew by 6% year-over-year primarily driven by UnitedHealth plan gains. Some companies strategically target group MA business because employers are interested in the cost savings MA plans can offer. Note that 57% of Aetna's MA membership is through group plans. Though many employers are shifting away from providing retirement benefits, larger volumes of people retiring may continue to sustain group Medicare Advantage opportunities over the next few years.

It is important to note that individual and group enrollment counts are slightly lower than total segment enrollment due to different reporting requirements.




Source: markfarrah.com

Additional Updates:

Tags: medicare advantage updates, Medicare Advantage, Medicare Advantage News, medicare advantage enrollment,, ma enrollment,

2015 Medicare Advantage Sneak Peek

Posted by Jeremy Davis on Fri, Jul 18, 2014 @ 03:56 PM

Medicare Supplements

PSM has received the 2015 proposed benefits for two of our top MA-PD carriers. Aetna / Coventry and UnitedHealthcare®. Both companies are offering strong offerings for 2015 with many zero premium areas. Contact us today to make sure you have these companies in your portfolio for the upcoming Enrollment window.

Request Details

Source: psmbrokerage.com

Additional Updates:
  • 2015 Proposed Medicare Advantage Plan Benefits and Certification Details Now Available. Contact a Marketing Representative today at 800-998-7715.

Tags: medicare advantage updates, medicare advantage 2015 updates, medicare advantage rates 2015

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