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. ![]() |
Medicare Blog | Medicare News | Medicare Information
CMS Releases 2023 Medicare Advantage and Part D Star Ratings
Posted by www.psmbrokerage.com Admin on Wed, Oct 12, 2022 @ 03:00 PM
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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
Coming Soon for AEP! YourMedicareSunFire Recording Capabilities
Posted by www.psmbrokerage.com Admin on Fri, Sep 09, 2022 @ 10:29 AM
On that day, the Centers for Medicare and Medicaid Services (CMS) released its 2023 Final Rule, and in this extensive document, there are two important guidelines we’d like to highlight in a more simplified manner. New Required Disclaimer
Aside from that, this disclaimer needs to be added to any previously approved materials and resubmitted to CMS for approval. Calls With Beneficiaries Must Be Recorded Agents making calls to beneficiaries must record ALL calls in their entirety. In addition, This includes calls that are part of the chain of enrollment into a Medicare Advantage or This rule applies to telephonic conversations only, not face-to-face meetings. The YourMedicare team was well aware of this change and immediately took action in
This is just the beginning of what is to come. As new information becomes available, we’ll keep you updated on all new enhancements, news and more specific details ![]() |
Tags: Medicare Advantage, Medicare Part D, Prescription Drugs, AEP, SunFireMatrix, Compliance, 2023, call recording
Set for Launch - Compliance Tips for AEP
Posted by www.psmbrokerage.com Admin on Thu, Sep 08, 2022 @ 12:39 PM
As you are well aware, agents will juggle vast amounts of activity during this time. Unintended actions may be a pathway to making compliance mistakes, which may derail the AEP application process. Before we lift off into a new AEP season, let's consider a few significant points related to compliance in order to remain on the right trajectory for a successful launch. Scope of Appointments detail the exact topics beneficiaries would like to discuss with an agent. CMS requires agents to have beneficiaries sign an SOA prior to discussing Medicare Advantage or Part D Prescription drug plans. Every appointment with a beneficiary requires an SOA and these forms must be kept on file for 10 years, even if the appointment doesn't result in a sale. Also, starting this year, a new CMS ruling requires agents to read a disclaimer to all potential clients at the beginning of a sales call. Reading this during the SOA process is an optimal time for this disclosure. These calls must be recorded and stored for 10 years.
Before agents can help a client with a Medicare plan, they must know the physicians and the specialists a client sees for their healthcare services. Many beneficiaries are happy with their healthcare providers and don't want to change. Compare their current providers with the providers in the plan's network to ensure there isn't a disruption in services. It's important to review a client's prescriptions in order to help them clearly understand the cost of drugs for a particular plan. An unexpected increase in drug prices can quickly turn an exceptional client experience into an unsatisfactory one. Make sure to review enrollment data with your clients, this way, if there is an error, you can fix it on the spot rather than having the application returned. Reviewing a client's prescriptions will ensure they are given options for the most comprehensive coverage for their individual needs. A Summary of Benefits must be provided to beneficiaries at the time of enrollment to provide clarity regarding coverage. Although beneficiaries will receive a hard copy of this document after enrollment, agents must summarize key features such as covered benefits and cost sharing. The Summary of Benefits needs to be thoroughly discussed prior to signature-collection and verification of intent-to enroll. Agents are certainly busy during AEP and sometimes put off submitting an application to a carrier. This can result in the application not being submitted in the required 24-48 hour time frame. An agent's primary responsibility is to ensure a clients' insurance needs are met. It's important to take the extra time and double check to make sure your clients' applications have been taken care of within this time frame. ![]() |
Tags: Medicare Advantage, Medicare Part D, Prescription Drugs, AEP, Compliance, 2023
Gearing Up for AEP - Compliance Bulletin
Posted by www.psmbrokerage.com Admin on Tue, Aug 23, 2022 @ 01:36 PM
As you'll recall, the annual enrollment period is a time when your clients can essentially make any change they are eligible for. Among other things, these changes may include enrolling in Medicare Advantage for the first time, switching from one Medicare Advantage plan to another, or joining a Medicare prescription drug plan. As you may know, AEP only lasts from October 15 through December 7th. This only gives you roughly seven and a half weeks to close on sales. With such a small window of time to enroll potential clients, it's important to take care of all your contracting, certifications, and training as soon as possible. Here are a few important points to consider before you can jump into AEP.
Now that we've gotten the general information out of the way, let's look into a few tips regarding what to avoid saying to current and potential clients in order to stay CMS compliant. "Free premiums!" "Is your spouse eligible for Medicare?" - "How about your friends?" - "Can I have their number so I can call them?" "If you're liking this Medicare plan, you should check out this life insurance plan." "Let me get your contact information so that you are able to come to my event." "While you're waiting for your doctor, let me tell you about your Medicare options." As you are well aware, there are many other requirements to consider in order to remain CMS compliant. Our aim today was to help you gear up as October 15th quickly approaches. Remember to complete your contracting and certifications, order your supplies, read up on any compliance changes, and set your goals. Thanks for tuning in, and we'll see you next month with some more compliance tips. We hope you find this information informative and we are always happy to assist with any questions. You can review a video summary of this information here. ![]() |
Tags: Medicare Advantage, Medicare Part D, Prescription Drugs, AEP, Compliance, 2023
Learn How to Become Certified and Sell Medicare Advantage Plans
Posted by www.psmbrokerage.com Admin on Tue, Aug 23, 2022 @ 10:42 AM
From just 13% of new enrollees in 2004, MA’s market share has grown to more than 34% today and is projected to reach 42% by 2028. As more senior clients vote with their checkbooks – in favor of MA plans – many of the top senior-focused agents are taking steps to add MA plans to the product portfolio. All the trends - the regulatory changes being advocated by HHS and CMS leadership, the demographics, the positive health outcomes for beneficiaries – point toward continued growth and popularity for Medicare Advantage plans. Increasingly, clients and prospects are going to want to work with agents who provide complete Medicare solutions, and that means being equipped to offer access to MA plans. Top agents are finding that it is well worth the extra effort to jump into this large and rapidly growing market. ![]() |
Tags: Medicare Advantage, Medicare Part D, Prescription Drugs
2023 CMS Final Rule – Third-Party Marketing Organization guidelines
Posted by www.psmbrokerage.com Admin on Wed, Aug 10, 2022 @ 08:38 AM
2023 CMS Final Rule – Third-Party Marketing Organization (TPMO) Guidelines Medicare Advantage organizations are responsible for ensuring that Third-Party Marketing Organizations (TPMOs) adhere to all applicable laws, regulations and CMS guidelines, including the requirements for conducting lead generation, marketing, selling, and enrollment activities with Medicare beneficiaries as outlined within the 2023 CMS Final Rule released May 9, 2022. Please review and implement the new requirements outlined below. New TPMO disclaimer The following new disclaimer needs to be on all third-party CY2023 materials, effective for marketing beginning October 1, 2022: “We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.” TPMOs must add this disclaimer to any previously approved material. This disclaimer must be:
Compliance oversight of all lead sources TPMOs are responsible for compliance oversight including ensuring all lead sources used to solicit Medicare product enrollments are compliant with CMS guidelines, and all other state or federal laws, rules and regulations. This includes but is not limited to ensuring that the TPMO, when conducting lead generating activities, either directly or indirectly, for an MA organization, must:
Recording calls with beneficiaries TPMOs, including lead generation vendors and downstream related entities, must record all calls with beneficiaries in their entirety. In addition, TPMOs must retain and make the recordings available upon request for a minimum of 10 years. This includes calls that are part of the chain of enrollment into a Medicare Advantage or Part D Plan (the steps taken by a beneficiary from becoming aware of a Medicare plan or plans to making an enrollment decision), as well as post-enrollment telephonic discussions This rule applies to telephonic conversations only, not face-to-face meetings. Questions? Thank you for your cooperation in ensuring compliance with these requirements. If you have any questions, please contact us here or call 800-998-7715.
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Health agents seek reversal of CMS rule on recording Medicare Advantage calls
Posted by www.psmbrokerage.com Admin on Wed, Jul 27, 2022 @ 09:35 AM
Or the phone rings, and the person on the other end of the line says they represent a Medicare Advantage plan that will give them “additional benefits.” They may even recommend a plan that is not available in the call recipient’s area. The Centers for Medicare & Medicaid Services is taking notice of these sales tactics. But the agency’s regulations aimed at fighting misleading Medicare Advantage claims are not sitting well with a health insurance agents’ association, whose members are urged to sign a petition against these rules. Members of Health Agents for America are being asked to sign a petition on Change.org, asking CMS to reverse its requirements that licensed and certified independent agents record phone calls that result in enrolling a client into a Medicare Advantage or Medicare Part D prescription drug plan. The new call recording regulations would take effect October 1st.
According to the Federal Registry, in 2022, CMS reported 39,617 "complaints to Medicare" out of 29 million enrollments. This represents only 0.0013661% of the total enrollments made during the most recent open enrollment period. Most of these complaints originated from misleading TV commercials, encouraging Medicare beneficiaries to call a 1-800 number, according to the Agents and Brokers group. Third-party marketing organizations created many these misleading TV commercials, according to the group. The ads encouraged Medicare beneficiaries to call a toll-free number answered by a call center employee whose primary job was to encourage the beneficiary to change their existing Medicare health or drug plan to a plan that offered "additional benefits," when in fact the new plan may not cover their prescriptions or have their primary care provider in the plan's provider network. In some cases, the plans recommended were not available in the beneficiary's county or area. CMS addressed the complaints received from these ads by creating new regulations to protect Medicare beneficiaries. These new regulations require third-party marketing organizations, agents and brokers to record calls that may result in a new enrollment of a Medicare Advantage or prescription drug plan. Rules may discourage brokers, agentsThe new CMS call regulations will discourage many licensed and certified agents and brokers from representing Medicare Advantage and prescription drug plans, the Agents and Brokers group said. There are more than 100,000 licensed independent agents and brokers who certify each year to offer Medicare Part C and D plans. With fewer certified agents and brokers, the complaints to Medicare and workload may increase, not decrease, the group said. Fewer certified agents and brokers will also increase the workload of the estimated 15,000 State Health Insurance and Assistance Counselors nationwide, leaving beneficiaries with fewer options when considering Medicare health and drug plans. Additional concerns include HIPAA requirements to store data compliantly. The petition also recommends the CMS remove the licensed and certified independent agents and brokers from the definition of a third-party marketing organization and exempt the agents and brokers from the new call recording requirements. The call recording requirements raise some questions for HAFA members, said its president and CEO Ronnell Nolan. Those questions include:
“The whole idea behind this regulation is to make sure that folks who are on Medicare get the correct information and are being treated with the utmost respect,” she said. “The CMS rules were originally intended to go after these bad eggs that are calling these seniors and talking them into making changes that they shouldn't make, or that they don't even know that they're making. But Medicare agents go through extensive training to sell plans. This just seems like a slap in the face to the agent community.” ![]() |
How to Calculate the Part D Late Enrollment Penalty
Posted by www.psmbrokerage.com Admin on Wed, Jul 20, 2022 @ 09:59 AM
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Example |
Mrs. Martinez has Medicare, and her first chance to get Medicare drug coverage (during her Initial Enrollment Period) ended on July 31, 2018. She doesn’t have prescription drug coverage from any other source. She didn’t join a Medicare drug plan by July 31, 2018, and instead joined during the Open Enrollment Period that ended December 7, 2020. Her Medicare drug coverage started January 1, 2021. Since Mrs. Martinez was without creditable prescription drug coverage from August 2018–December 2020, her penalty in 2021 is 29% (1% for each of the 29 months) of $33.37 (the national base beneficiary premium) or $9.68 each month. Since the monthly penalty is always rounded to the nearest $0.10, she will pay $9.70 each month in addition to her plan’s monthly premium. Here's the math: .29 (29% penalty) × $33.37 (base beneficiary premium) = $9.68 $9.68 rounded to the nearest $0.10 = $9.70 $9.70 = Mrs. Martinez's monthly late enrollment penalty for 2021 |
How do I know if I owe a penalty?
What if I don't agree with the late enrollment penalty?
You may be able to ask for a "reconsideration." Your drug plan will send information about how to request a reconsideration.
Complete the form, and return it to the address or fax number listed on the form. You must do this within 60 days from the date on the letter telling you that you owe a late enrollment penalty. Also send any proof that supports your case, like a copy of your notice of creditable prescription drug coverage from an employer or union plan.
Do I have to pay the penalty even if I don't agree with it?
Related Resources

Tags: Medicare Part D, Penalty