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Medicare Blog | Medicare News | Medicare Information

Medicare Advantage Maintains Upward Trend

Posted by www.psmbrokerage.com Admin on Tue, Jan 23, 2024 @ 02:46 PM

mark farrahThe Medicare Open Enrollment Period, also known as the “Medicare Advantage (MA) and Prescription Drug Plan (PDP) annual election period” or “AEP,” occurs annually from October 15th to December 7th. As of early 2024, there's a consistent increase in MA enrollments from January 2020, reaching nearly 33.5 million, while PDP enrollments have started to recover after a downward trend, now at 23 million.



Tags: Medicare Advantage, Medicare Part D

CMS Prior Authorization Rule and the Impact on Insurers

Posted by www.psmbrokerage.com Admin on Tue, Jan 23, 2024 @ 09:30 AM

CMS Prior Authorization Rule and the Impact on Insurers

The CMS prior authorization rule significantly impacts insurers by mandating more efficient and transparent prior authorization processes, particularly for Medicare and Medicaid plans. This rule compels insurers to adopt standardized electronic communication methods, enhancing administrative efficiency and patient care coordination.

While it may initially increase compliance costs due to necessary IT upgrades and procedural changes, it aims to reduce inappropriate denials and appeals, thereby potentially lowering long-term operational costs. Insurers will need to adjust their prior authorization criteria and reporting practices, ensuring better patient outcomes and higher satisfaction, which could ultimately lead to cost savings and improved service quality.

Here's how this rule generally affects insurers:

Increased Administrative Efficiency: The rule aims to standardize and streamline the prior authorization process. Insurers are expected to adopt more efficient electronic communication methods, which can reduce administrative burden and costs over time.

Enhanced Transparency: Insurers are required to be more transparent about their prior authorization requirements and policies. This can involve publicly disclosing the rationales for denials and providing specific information about the services that require prior authorization.

Improved Patient Care Coordination: By requiring insurers to expedite the prior authorization process, the rule intends to minimize delays in patient care. This may lead to better coordination and continuity of care.

Potential for Increased Compliance Costs: Implementing standardized electronic processes and adhering to new transparency requirements may initially increase operational costs for insurers. This includes costs related to upgrading IT systems, training staff, and modifying existing procedures.

Impact on Clinical Decision-Making: Insurers may need to adjust their criteria for prior authorization to align with the new rules. This could affect how they manage approvals for certain treatments or medications.

Data Reporting Requirements: Insurers might be required to report on their prior authorization activities, including denial rates and the average time taken to respond to requests. This adds an additional layer of data management and reporting.

Potential Reduction in Denials and Appeals: The standardization and transparency required by the rule could lead to a decrease in inappropriate denials, thereby reducing the volume of appeals insurers need to process.

Quality of Care and Patient Satisfaction: Improved and quicker prior authorization processes can lead to better patient outcomes and higher patient satisfaction, which is beneficial for insurers in terms of reputation and patient trust.

Adaptation to Technology Standards: Insurers will need to ensure that their electronic communications meet the technical standards set by CMS, which may require significant IT infrastructure adjustments.

Long-Term Cost Savings: While there might be initial costs associated with complying with the new rule, in the long run, the efficiencies gained could lead to cost savings for insurers.

Insurers must stay informed and adapt to these changes to remain compliant with CMS regulations while continuing to provide effective services to their beneficiaries.

You can view the details here.

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Tags: Medicare Advantage, Medicare Part D, CMS

An Inflation Reduction Act (IRA) provision is improving prescription drug affordability for many people with Medicare Part D

Posted by www.psmbrokerage.com Admin on Thu, Jan 04, 2024 @ 03:48 PM

IRA-1The Inflation Reduction Act (IRA) includes provisions aimed at improving prescription drug affordability. These provisions focus on addressing rising drug costs, a significant concern for many Americans. While the specific details of the IRA's prescription drug provisions may vary, the overarching goal is to make essential medications more affordable and accessible to the public. This can involve measures such as price controls, negotiations with pharmaceutical companies, and incentives for generic drug development. By tackling the issue of prescription drug affordability, the IRA seeks to alleviate the financial burden on individuals and ensure that necessary medications are within reach for all Americans.

The Inflation Reduction Act (IRA) introduces several key provisions aimed at addressing the affordability of prescription drugs, and these have notable implications for senior citizens:

Lower Prescription Drug Costs: The IRA includes measures to reduce the overall cost of prescription medications, which is particularly important for seniors on fixed incomes. By implementing strategies to control drug prices and enhance competition, the act aims to make essential medications more affordable.

Medicare Drug Price Negotiations: One significant provision allows Medicare to negotiate drug prices directly with pharmaceutical companies. This can lead to lower drug prices for seniors enrolled in Medicare Part D, potentially resulting in substantial savings.

Out-of-Pocket Cost Caps: The IRA may establish limits on out-of-pocket expenses for prescription drugs for Medicare beneficiaries. This means that seniors will have a maximum amount they need to spend on medications before insurance coverage kicks in, providing financial relief.

Incentives for Generic Drugs: The act encourages the development and availability of generic drugs, which are typically more cost-effective than brand-name equivalents. Seniors can benefit from increased access to affordable generic medications.

Coverage Gap (Donut Hole) Closure: The IRA may continue efforts to close the Medicare Part D coverage gap, often referred to as the "donut hole." Closing this gap helps seniors access prescription drugs more affordably, as they pay reduced out-of-pocket costs for medications.

Inflation Reduction Act (IRA)

Improved Access to Preventive Drugs: The act may promote seniors' access to preventive drugs, such as those used to manage chronic conditions. This can lead to better health outcomes and reduced overall healthcare costs for seniors.

Enhanced Transparency: The IRA emphasizes transparency in drug pricing and ensures that seniors have access to information about the cost of their medications. This transparency enables seniors to make informed choices about their prescriptions.

In summary, the Inflation Reduction Act (IRA) aims to alleviate the financial burden of prescription drugs on senior citizens by lowering costs, negotiating prices, capping out-of-pocket expenses, promoting generics, and enhancing access to essential medications. These provisions collectively work to improve the affordability and accessibility of prescription drugs for seniors, contributing to better healthcare outcomes and financial security in retirement.

Helpful resources:



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Tags: Medicare Part D

Your Guide to Marketing Medicare Plans in Your Community

Posted by www.psmbrokerage.com Admin on Thu, Nov 02, 2023 @ 01:32 PM

Medicare Marketing - LocalIn this guide we will explore some creative and effective marketing ideas to engage with your local community to build a formidable Medicare business. All while staying local and budget-friendly. Added bonus - Learn about a simple idea that is inexpensive and generates fantastic results. Download the guide today.

Building relationships and trust within your community is paramount. By demonstrating a genuine commitment to helping seniors find the right Medicare plans for their needs, you can establish yourself as a valuable resource and trusted partner in healthcare decisions.

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Tags: Medicare Advantage, Medicare Supplement, Medicare Part D, Professional Networking, direct mail, Seminar, Marketing, Local

Agent Compliance Guide: Staying Compliant Before the Sale

Posted by www.psmbrokerage.com Admin on Thu, Nov 02, 2023 @ 11:18 AM

Tags: Medicare Advantage, Medicare Part D, Compliance

Benefits of Using a Client Needs Assessment Form

Posted by www.psmbrokerage.com Admin on Wed, Oct 04, 2023 @ 12:24 PM

CNA Form The assessment form allows insurance agents to gather comprehensive information about the client. This information is crucial for guiding clients towards the most suitable plans. With a clear understanding of the client's needs, agents can recommend plans that align with the client's health requirements and preferences. This ensures that clients enroll in plans that cover their specific healthcare services and medications.

Want a custom version with your info and logo? Inquire with your Marketing Representative today and we would be happy to accommodate!

Step 1 - Collecting information through a CNA for all your clients is the optimal method to guarantee your ability to offer coverage options and plan selections that align with their present circumstances.

Step 2 - Engage in the CNA process to gain insights (or refresh your understanding) into your client's Medicare eligibility, existing coverage, and their primary concerns regarding their healthcare coverage.

Step 3 - Utilize the details gathered from the CNA, along with your discussion, to introduce potential plan choices that align with their particular requirements.


By analyzing the assessment form, insurance agents can identify potential coverage gaps in a client's current or desired plan. This allows agents to suggest supplemental plans to fill those gaps. By involving clients in the assessment process, insurance agents educate them about different coverage options, and potential out-of-pocket costs. This empowers clients to make informed decisions about their healthcare.


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Tags: Medicare Advantage, Medicare Supplement, Medicare Part D, Professional Networking, Marketing

Inflation Reduction Act: Update on CMS Implementation

Posted by www.psmbrokerage.com Admin on Mon, Aug 28, 2023 @ 10:40 AM

CMS The Inflation Reduction Act of 2022 was signed into law on August 16, 2022. The new law provides meaningful financial relief for millions of people with Medicare by improving access to affordable treatments and strengthening the Medicare Program both now and in the long run. The law makes improvements to Medicare by expanding benefits, lowering drug costs, keeping prescription drug premiums stable, and improving the strength of the Medicare program. The law also extends enhanced financial help to purchase HealthCare.gov and state-based Marketplace plans and expands access to Advisory Committee on Immunization Practices (ACIP) recommended vaccines for adults with Medicaid coverage.

 Specifically, the Inflation Reduction Act:

  • Ensures that people with Medicare pay no more than $35 for a month’s supply for each covered insulin product under Medicare prescription drug coverage, Traditional Medicare, or Medicare Advantage.
  • Lowers Medicare Part D prescription drug costs and redesigns the prescription drug program (e.g., people enrolled in Medicare prescription drug coverage who have very high drug costs will no longer have to pay cost-sharing for their prescription drugs in the catastrophic phase of the program starting in 2024, and caps annual out-of-pocket prescription drug costs at $2,000 for 2025).
  • Makes adult vaccines, recommended by the ACIP, available at no cost for people with Medicare prescription drug coverage starting January 1, 2023, and later in 2023 for people with Medicaid coverage.
  • Allows Medicare to negotiate directly with participating drug companies to improve access to innovative treatments for people with Medicare and lower costs for the Medicare program.
  • Requires drug companies that raise their drug prices faster than the rate of inflation to pay Medicare a rebate and reduces coinsurance for these drugs for people with Medicare under certain circumstances.
  • Provides more assistance in affording Medicare prescription drug coverage premiums and out-of-pocket drug costs by expanding the low-income subsidy program (LIS or “Extra Help”) under Medicare Part D to 150% of the federal poverty level starting in 2024.
  • Extends increased financial help to purchase affordable, comprehensive health insurance plans through HealthCare.gov and the state-based Marketplaces.

This law means millions of Americans across all 50 states, U.S. territories, and the District of Columbia will save money from meaningful benefits. The Inflation Reduction Act is accomplishing the following just one year after being enacted:

  • Saving Affordable Care Act Marketplace consumers an average of more than $800 per year from continued expansion of financial assistance, based on national estimates.
  • Driving the nation’s uninsured rate to historic lows.
  • Lowering insulin costs for 4 million seniors and other Medicare beneficiaries with diabetes by capping a month’s supply of each covered insulin at $35.
  • Providing ACIP-recommended adult vaccines at no cost to millions of people with Medicare.
  • Lowering out-of-pocket costs for some people with Medicare for certain Part B drugs and biologicals with prices that have increased faster than the rate of inflation.
  • Projecting savings for nearly 19 million seniors of an average of $400 per year when the $2,000 cap on out-of-pocket prescription drug costs goes into effect in 2025.



Tags: Medicare Advantage, Medicare Supplement, Medicare Part D, CMS

Important Cigna PDP Update: Commissionable PDP in AEP 2024

Posted by www.psmbrokerage.com Admin on Thu, Jul 06, 2023 @ 04:16 PM

Tags: Cigna, Medicare Part D

2024 FMV Medicare Advantage & PDP Commissions Announced

Posted by www.psmbrokerage.com Admin on Thu, Jun 22, 2023 @ 09:32 AM

2024 MA Commissions

2024 Commissions for MA, PDP and referrals have been announced.

We have highlighted the 2024 document changes below. You can review the official CMS notice here. Over the last decade the National rate for MA first year and renewal commissions have increased by 50%.

MA and Section 1876 Cost Plans
Compensation Type National Connecticut, Pennsylvania,
District of Columbia
New Jersey
Puerto Rico, U.S. Virgin Islands
Initial Year $611 $689 $762 $418
Renewal Years $306 $345 $381 $209
Initial Year $100
Renewal Years $50
Referral Fees
Initial Year $100
Renewal Years $25

NOTE: CMS rounded the FMV amounts for CY 2024 up to the nearest dollar. The Initial Year amount is the maximum allowable amount that organizations may pay for enrollments during compensation cycle-year 1. The renewal amount is the maximum allowable amount that organizations may pay for enrollments during compensation cycle-years 2 and beyond, for a like plan type. 


The AEP is right around the corner and there are some exciting opportunities on the horizon for 2024. Get prepared early to ensure a successful Annual Enrollment Period. We are here to help!


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Tags: Medicare Advantage, Referrals, Medicare Part D, CMS, commissions

Important Cigna PDP Commissions Update

Posted by www.psmbrokerage.com Admin on Thu, May 04, 2023 @ 02:47 PM

Tags: Cigna, Medicare Part D

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