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Medicare Blog | Medicare News | Medicare Information

Countdown to the 2020 AEP: AHIP, Company Certifications, Expansions and First Looks

Posted by www.psmbrokerage.com Admin on Mon, Jun 17, 2019 @ 12:19 PM

With the 2020 AEP upon us, now is a great time to make sure you are preparing and staying ahead of the curve. AHIP Medicare Training has been released and we are also starting to get details on carrier specific certifications as well as 2020 plan benefits and roll out dates. Take a look at what is available now and keep a look out for future updates as we get closer to AEP.

✪ 2020 AHIP Training

Precision Senior Marketing is proud to be able to help support our agents that sell Medicare Advantage and Prescription Drug Plans. That's why our agents will be able to access AHIP's 2020 Medicare certification for only $125. That's a $50 savings to you just for being part of our team.


As an added "Thank You" to our writing agents we would like to pay for 100% of your AHIP costs after you have five issued 2020 Medicare Advantage enrollments. Ask your Marketer for details. *This is only available to street level agents contracted directly with Precision Senior Marketing.

✪ 2020 Carrier Specific Certifications

To keep things simple, we have all the carrier specific certification instructions available on our certification page. Most will require you complete AHIP in advance, but not all. Please take the time to review the requirements for the different carriers you represent.

Carrier Specific Certification Instructions

✪ 2020 Medicare Advantage and PDP First Looks

As we receive first looks and product information from the carriers we represent, we will be sharing those details with our agents. You can sign up to receive this information by visiting the following web page and completing the form. You can also call one of our marketing representatives at 800-998-7715 and ask for more details.

✪ Online Quoting Tools and Submission Platforms

PSM Has made significant investments to make sure our agents have access to the best in class quoting tools and online submission platforms. Even better, these tools are provided at  no cost to our contracted agents. Please visit the following web page for more details and to request access.

✪ Lead Incentives and Opportunities

PSM is proud to be able to help support our directly contracted Medicare agents.For every ten (10) Medicare Supplement* or Medicare Advantage enrollments placed and issued, you will qualify for a complimentary 1,000 piece lead mailer*. This offer includes the postage, printing, mailing data and return postage on all submitted business return cards ~ ZERO cost to you!

View more details by visiting our Lead Incentives web page

For agent use only. Not for use with consumers. Certain exclusions and limitations may apply. Not affiliated with the United States government or the federal Medicare program. Enrollments for this promotion must be with carriers the agent is appointed with through Precision Senior Marketing. Eligibility for this program will be determined by PSM. Only directly contracted writing agents may participate. Lead vendor and mailers for this program will be determined by PSM, and cash equivalents and reimbursements will not be offered. Agent must be trained and certified and must abide by PSM’s compliance program.

✪ Service and Support

As a reminder, We pride ourselves on a "Do the Right Thing" approach and will go above and beyond to service the needs of our agents. We look forward to having a successful AEP and supporting you with products, technology and the personalized service you have come to expect from PSM. We appreciate the opportunity to earn your business and wish you the best!

thank you

Additional Updates:

Tags: Medicare Advantage, Medicare Part D, AEP, certification, AHIP

Mutual of Omaha: Medicare Solutions Product Portfolio

Posted by www.psmbrokerage.com Admin on Wed, Jun 12, 2019 @ 01:04 PM


As people approach age 65, they’re bombarded with insurance offers. While some companies continue to add to the clutter and confusion, Mutual of Omaha is focused on helping you guide your clients through the complexity of selecting Medicare coverage. So, when they turn to you for help, turn to Mutual of Omaha’s Medicare Solutions portfolio.

Medicare-age clients are looking to stay physically and financially healthy. Considering they need to make their savings last, they want to know what’s covered and how much things will cost. They want to feel confident that the coverages they choose will help protect their health and budget.

Mutual of Omaha’s Medicare Solutions can do just that.

Take a look at their products that help solve your clients’ needs during their retirement years:

  • Medicare Supplement Insurance. Competitive pricing, premium savers and fast policy issue
  • Dental Insurance. Guaranteed issue, two plans available (both with optional vision rider), backed by a network of about 375,000 provider locations
  • Mutual of Omaha Rx. Two national prescription drug plans with affordable premiums, Value plan has $0 deductible for Tiers 1 & 2 prescriptions
  • Cancer, Heart Attack/Stroke Insurance. Limited underwriting, direct payment upon diagnosis, policies up to $100,000

Mutual of Omaha’s great senior product offerings and unparalleled service are the perfect complement to your clients’ needs.

If you have questions or would like to get contracted, please call us at (800) 998-7715 or complete our online request form.

Mutual of Omaha Rx (PDP) is a prescription drug plan with a Medicare contract. Enrollment in the Mutual of Omaha Rx plan depends on contract renewal.

Additional Updates:

Tags: Medicare Supplement, Medicare Part D, Mutual of Omaha Medicare Supplement, dental plans, MACRA

Payment Glitch Interrupts Automatic Medicare Advantage and Part D Premium Withdrawals

Posted by www.psmbrokerage.com Admin on Mon, Jun 10, 2019 @ 04:35 PM

Payment Glitch Interrupts Automatic Medicare Advantage and Part D Premium Withdrawals

Earlier this year, a federal government systems issue prevented Medicare Advantage and Part D premiums from being automatically deducted from the Social Security payments of some people with Medicare. Normally, if a beneficiary elects, Social Security deducts the premiums and sends them directly to the plan. In this instance, the payments were not sent to the plans, and beneficiaries did not know that their plans were not receiving them.

While the issue has since been resolved and premium payments should be processed correctly moving forward, Medicare Rights remains concerned about the scope of the processing error and the potential impacts on beneficiaries—including confusion, financial hardship, and coverage losses.

According to the Centers for Medicare & Medicaid Services (CMS), affected individuals include those who were “enrolled either in a Medicare Advantage Plan or in a Medicare Prescription Drug Plan for coverage starting January 1, 2019” and chose to have their premiums automatically deducted from their monthly Social Security benefit, rather than pay the plan directly.

However, it’s not yet clear how many of these enrollees were affected, if those who were have been made aware, or how much they might owe. The Social Security Administration (SSA) notes that “Plans will be sending premium bills to those affected. If you are affected and haven’t already received a bill in the mail, you will soon. The first bill will likely be for a larger amount than usual to make up for the unpaid premiums.”

Importantly, plans must offer enrollees a “grace period” to repay the missed premium payments, which must last at least as long as the delay in billing. Plans also have the option not to pursue these outstanding payments.

CMS advises beneficiaries to call their plan directly with any questions or concerns. Medicare Rights’ Helpline counselors are also available at 800-333-4114, and enrollees may want to contact their local SHIP or 1-800-Medicare for assistance.

Medicare Rights appreciates federal agency and plan efforts to educate affected enrollees and we encourage them to continue to work together to hold beneficiaries harmless.

Read the CMS notice.

Image: www.Canva.com

Additional Updates:

Tags: Medicare Advantage, Medicare, Medicare Part D

Spending on Pharmaceuticals to Soar past $370B in 2019

Posted by www.psmbrokerage.com Admin on Wed, May 29, 2019 @ 10:44 AM

Pharmaceutical Spending Will Reach $370B in 2019

Pharmaceutical cost-1


U.S. pharmaceutical spending is expected to grow by 2.5% in 2019, topping $370 billion, while overall healthcare spending is projected to grow by 4% and reach $3.6 trillion, according to a Fitch Solutions report released Monday.

By 2023, Fitch Solutions estimates pharmaceutical sales will top $420 billion, account for nearly 1.7% of the national GDP, and 9.7% of overall health expenditures.

Overall healthcare spending is expected to reach $4.3 trillion during the same period of time.

Source: https://www.healthleadersmedia.com/finance/pharmaceutical-spending-top-370b-2019

Additional Updates:

Tags: Medicare Part D, Part D, Prescription Drugs

Recent Trends in Drug Pricing Show Stark Differences in Brand-Name and Generic Drug Affordability

Posted by www.psmbrokerage.com Admin on Mon, Apr 22, 2019 @ 01:41 PM

A new report from the AARP Public Policy Institute (PPI) examines trends in prices for 390 generic prescription drugs widely used by older adults. The report found that retail prices for these drugs fell by an average of 9.3% between 2016 and 2017; the general inflation rate rose by 2.1% during the same period. This follows two consecutive years of substantial generic drug price decreases; the previous two years saw prices increase.
These price changes have meaningful financial consequences for people with Medicare and others who rely on generic drugs to stay healthy. According to the report, the average annual cost for one generic medication used on a chronic basis was $365 in 2017. This represents a dramatic drop since 2013, when the average annual cost of therapy was more than two times higher ($751).
These findings are in stark contrast with trends in the brand-name drug market, where price increases continue to significantly outpace inflation. In 2017 alone, brand-name drugs widely used by older Americans increased by an average of 8.4%.

Source: https://blog.medicarerights.org/recent-trends-in-drug-pricing-show-stark-differences-in-brand-name-and-generic-drug-affordability

Image: www.Canva.com

Additional Updates:

Tags: Medicare, Medicare Part D, Prescription Drugs

CMS rule gives Medicare Advantage plans an edge over traditional Medicare

Posted by www.psmbrokerage.com Admin on Thu, Apr 04, 2019 @ 09:52 AM

man on mountain


The Centers for Medicare and Medicaid Services today finalized payment updates to Medicare Advantage and Part D plans for 2020.

MA rates increase 2.53 percent. This includes the phasing-in of a risk adjustment model that takes into account the number of chronic conditions a person has, according to CMS Administrator Seema Verma.

CMS originally had released a rate increase of 1.59 percent.

The effective growth rate increased from 4.59 percent in the advance notice, to 5.62 percent today. Verma said the reason for the change is that CMS is continually updating information.

However, the biggest changes for Medicare Advantage insurers is in their ability to offer additional, non-health benefits to members who have a chronic condition, if there is a reasonable expectation of improving or maintaining the health or overall function of the enrollee. Plans can address the social benefits of health in these tailored benefits.

For example, beneficiaries could now receive transportation for non-medical needs like grocery shopping and home environment services to cover home air cleaners and carpet shampooing for asthma sufferers.


Today's supplemental benefit flexibility gives Medicare Advantage plans an edge in competition over traditional Medicare fee-for-service.

The flexibility in today's rule is due to legislation in the Bipartisan Budget Act, Verma said.

Asked why Congress would allow MA plans to have an edge in offering benefits over traditional Medicare fee-for-service, Verma said fee-for-service is an open-ended benefit program while MA is capped and is a value-based payment systems. CMS supports allowing the flexibility for plans to address the social determinants of health in a value-based arrangement, she said.

The varying benefits are also expected to spur competition between MA plan offerings.

Medicare Advantage is a growing program both for seniors and for insurers, with CMS not-so-subtly promoting the private health insurance option.

Average Medicare Advantage premiums are at their lowest in six years, Part D premiums are at their lowest in three years, and plan choices have increased, CMS said today.


CMS calculates risk scores using diagnoses submitted by Medicare fee-for-service providers and by MA organizations.

CMS is including encounter data in  calculating the risk scores despite objections by some stakeholders. For 2020, CMS will blend 50 percent of the risk score calculated using diagnoses from encounter data, the RAPS Risk Adjustment Processing System inpatient diagnoses and FFS diagnoses, with 50 percent of the risk score calculated with diagnoses from RAPS and FFS.

For 2020 CMS expects the underlying coding trend to increase risk scores, on average by 3.3 percent.


The payment and policy updates include actions to address the opioid crisis,  encouraging Part D plans to provide at least one opioid-reversal agent on a lower cost-sharing tier.

CMS said its overutilization policies have resulted in a 14 percent decrease in the share of Part D beneficiaries using opioids between 2010 and 2017 (36.3 percent to 31.3 percent), with the largest decrease from 2016 to 2017 (5 percent).


Starting this year, Medicare Advantage plans could offer supplemental benefits that are not covered under Medicare Parts A or B, such as adult day health services, and/or in-home support services under an expanded definition of supplemental benefits.

The updates released today continue the Trump administration's efforts to increase competition among Medicare Advantage and Part D plans. CMS said.


"Today's changes give plans the ability to be innovative and offering benefits and services that address social determinants of health for people with chronic disease," Verma said. "With Medicare Advantage enrollment at an all-time high, plans need greater flexibility in offering benefits that they focus on preventing disease and keeping people healthy." 

Source: https://www.healthcarefinancenews.com/news/cms-rule-gives-medicare-advantage-plans-edge-over-traditional-medicare

Photo by eberhard grossgasteiger from Pexels

Additional Updates:

Tags: Medicare Advantage, Medicare Part D

No Donut Hole, But Drug Costs Still Bite

Posted by www.psmbrokerage.com Admin on Tue, Apr 02, 2019 @ 03:54 PM

No Donut Hole, But Drug Costs Still Bite

donut hole.jpg

By the Kaiser Family Foundation – March 29, 2019

The 2006 introduction of the Medicare prescription drug benefit was a boon for seniors, but the coverage had weak spots. One was the so-called donut hole – the gap beneficiaries fell into after they accumulated a few thousand dollars in drug expenses and were on the hook for the full cost of their medications. Another was the lack of an annual cap on drug spending. Legislative changes have gradually closed the donut hole so that, this year, beneficiaries no longer face a coverage gap. But there’s no limit for prescription medications in Part D. With the cost of specialty drugs increasing, some Medicare beneficiaries could owe thousands of dollars in out-of-pocket drug costs every year for a single drug. Recent proposals by the administration would address the long-standing problem by imposing a spending cap. But it’s unclear whether any of these proposals will gain a foothold.

Read more.

Source: https://khn.org/news/doughnut-hole-is-gone-but-medicares-uncapped-drug-costs-still-bite-into-budgets/

Image: Freepik

Additional Updates:

Tags: Medicare Part D

Continued Year-Over-Year Medicare Advantage and PDP Membership Increases

Posted by www.psmbrokerage.com Admin on Tue, Apr 02, 2019 @ 02:42 PM

Continued Year-Over-Year Medicare Advantage and PDP Membership Increases

growth arrow.jpg

The Annual Election Period (AEP) for Medicare Advantage (MA) and prescription drug plans (PDPs) runs each year from October 15th through December 7th.  Health companies compete by offering new pricing and product options to beneficiaries during the AEP.  Plans then begin to analyze final enrollment results in February and March to evaluate their standing and assess which competitors gained and lost members during the last AEP. 

Many companies conduct their post-AEP competitive assessments by using tools such as Mark Farrah Associates’ (MFA) Medicare Business Online™ and Health Coverage Portal™.  As of March 1, 2019, total Medicare Advantage, including Medicare Advantage with Prescription Drug Plan (MA-PD) membership stood at 22,654,276 with a net gain of 1,554,366 members, year-over-year.  Medicare stand-alone prescription drug plans (PDPs) covered 25,559,801 members as of March 1, 2019, a gain of 38,835 from the previous year.  This brief assesses Medicare Advantage and PDP performance, market share and market penetration by state as of March 1, 2019.

MA Enrollment Growth by State


Click here to read more. 

Source: https://www.markfarrah.com/mfa-briefs/continued-year-over-year-medicare-advantage-and-pdp-membership-increases/

Image: Freepik

Additional Updates:

Tags: Medicare Advantage, Medicare Part D

What Beneficiaries Want in a Medicare Plan

Posted by www.psmbrokerage.com Admin on Wed, Feb 20, 2019 @ 02:18 PM

What Beneficiaries Want in a Medicare Plan

By eHealth – February 20, 2019

Medicare beneficiaries love their coverage and think more Americans should have access. Only 6% express dissatisfaction with their Medicare coverage; 41% say that all Americans should have Medicare-like coverage (an increase from 34% since last August); an additional 11% say that at least people age 55 and older should be eligible for Medicare. A new report from eHealth defines what beneficiaries find most important in their Medicare Plans.

blog chart 2-20-2019
Source: https://www.prnewswire.com/news-releases/ehealth-survey-reducing-prescription-drug-costs-seen-as-key-to-ensuring-medicares-future-300797020.html

To read the full report, click here.

Additional Updates:

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

Humana expects more than 700K will drop out of Part D plans as market competition heats up

Posted by www.psmbrokerage.com Admin on Wed, Feb 06, 2019 @ 03:15 PM

Humana expects more than 700K will drop out of their Part D plans

By Paige Minemyer – FierceHealthCare – February 6, 2019

Humana is expected to bleed a significant number of members from its Part D plans, as greater competition has chipped away at the company’s market share. 

Brian Kane, Humana’s chief financial officer, said on the company’s earnings call Wednesday morning that the insurer expects to lose between 700,000 and 750,000 members in its stand-alone Medicare prescription drug plans in 2019. That is a decrease in projections from November, when Humana estimated that as many as 800,000 people could drop from its Part D rolls. 

As more competitors have entered the Part D market, Humana’s plans are no longer consistently the lowest cost, which is leading some members to switch to other insurers, Kane said. Humana is now working to “innovate” the value proposition in their plans. 

“While it will take time, we intend to stay competitive,” CEO Bruce Broussard said. 

Though Humana expects a downturn in enrollment in its Part D plans, it is still projecting about 4.5 million enrollees in those plans, according to its earnings documents. 

Policy changes in Part D add another wrinkle to this discussion, Kane said, but Humana is rethinking its approach in that market irrespective of how proposals play out. 

That said, should the Department of Health and Human Services finalize its plan to end drug rebate protections in Part D for the 2020 plan year, that change would be “material” and would have significant implications for how these plans function, he said. 

The biggest risk, he said, is a potential adverse selection in pricing if the approach to negotiation is fundamentally changed. In addition, Humana is also concerned that the policy change is likely to drive up premiums in Part D plans. 

Though Humana reported a downturn for enrollment in its Part D plans, its Medicare Advantage business was a bright light in 2018 and is a key source of the company’s momentum heading into the 2019 fiscal year. 

Medicare Advantage a bright spot

Humana reported a 6% increase in revenue for 2018, reaching $56.91 billion compared to $53.77 billion in 2017. Fourth quarter revenues were also on the rise, totalling $14.07 billion, a 7% uptick from $13.10 billion in Q4 2017.

As the health insurance fee was pushed off to 2020, Humana was able to invest significantly in improved service for its MA plans, Broussard said. The Centers for Medicare & Medicaid Services set strong rates for MA in the 2019 plan year, as well, he said, so that growth is expected to continue this year.

Humana expects to add 370,000 to 400,000 seniors to its MA plans in 2019, increasing its membership by 12% to 13%. Kane said the company also expects to add about 30,000 people to its group Medicare Advantage plans. 

“We are pleased with the consistency of ongoing improvement in our performance,” Broussard said.

Source: https://www.fiercehealthcare.com/payer/humana-expects-more-than-700k-will-drop-out-part-d-plans-as-market-competition-heats-up

Additional Updates:

Tags: Humana, Medicare Advantage, Medicare, Medicare Part D

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