Marketing for 2021 Annual Enrollment Period - Reminder

Posted by www.psmbrokerage.com Admin on Mon, Sep 14, 2020 @ 03:01 PM

0 Comments Click here to read/write comments

Tags: Medicare Advantage plans, Medicare, Medicare Supplement, Medicare Part D, CMS, 2021 aep

2021 Medicare Part D Cost-Sharing Chart

Posted by www.psmbrokerage.com Admin on Mon, Sep 14, 2020 @ 02:49 PM

1 Comment Click here to read/write comments

Tags: Medicare, Medicare Part D, CMS

CMS Unveils New Comparison Tool

Posted by www.psmbrokerage.com Admin on Mon, Sep 14, 2020 @ 02:43 PM

0 Comments Click here to read/write comments

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

Senior Market Clients Need Their Agents

Posted by www.psmbrokerage.com Admin on Mon, Sep 14, 2020 @ 02:27 PM

0 Comments Click here to read/write comments

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

We are pleased to launch Anthem’s Medicare products to our Agents

Posted by www.psmbrokerage.com Admin on Wed, Sep 09, 2020 @ 11:35 AM

0 Comments Click here to read/write comments

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

Medicare Enrollment Periods Explained

Posted by www.psmbrokerage.com Admin on Wed, Aug 26, 2020 @ 01:41 PM

0 Comments Click here to read/write comments

Tags: Medicare Advantage, Medicare, Medicare Part D

Enrollment Guidance Policy Changes and Updates and Model Medicare Advantage and Prescription Drug Plan Individual Enrollment Request Form for Contract Year 2021

Posted by www.psmbrokerage.com Admin on Tue, Aug 25, 2020 @ 09:49 AM

Compliance

SUBJECT: Enrollment Guidance Policy Changes and Updates and Model Medicare Advantage and Prescription Drug Plan Individual Enrollment Request Form for Contract Year 2021

The Centers for Medicare & Medicaid Services (CMS) is issuing Medicare Advantage (MA), Prescription Drug Plan (PDP), and §1876 Cost Plan Enrollment and Disenrollment Guidance revisions for contract year 2021. These updates primarily reflect revisions resulting from final regulations published on June 2, 2020, in CMS-4190-F (Contract Year 2021 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program). To implement these changes, we updated guidance to Chapter 2 and 17D of the Medicare Managed Care Manual and Chapter 3 of the Medicare Prescription Drug Benefit Manual.

CMS is also announcing the release of the new Model Individual Enrollment Request Form to enroll in an MA or Part D plan, OMB No. 0938-1378. CMS revised and improved the standard (“long”) model form used for MA and PDP enrollment to the new “shortened” form to simplify the enrollment process.

All enrollments with an effective date on or after January 1, 2021, must be processed in accordance with the revised guidance requirements, including the new model MA and PDP enrollment form. MA and Part D plans are expected to use the new model form for the 2021 plan year Annual Enrollment Period (AEP) which begins on October 15, 2020.

Significant changes to the guidance include:

1.Medicare Advantage (MA) Plan Options for End-Stage Renal Disease (ESRD) Beneficiaries.

Effective for the plan year beginning January 1, 2021, CMS removed the prohibition on beneficiaries with ESRD enrolling in an MA plan. Plans can accept and process elections made by ESRD beneficiaries that choose to join an MA plan during a valid election period.

2. Special Election Periods (SEPs) for Exceptional Conditions

CMS codified a number of SEPs previously adopted and implemented through subregulatory guidance as exceptional circumstances SEPs. We also established two new SEPs for exceptional circumstances:

SEP for Individuals Enrolled in a Plan Placed in Receivership CMS established new SEPs, at §§ 422.62(b)(24) and 423.38(c)(31), for individuals enrolled in plans that are experiencing financial difficulties to such an extent that a state or territorial regulatory authority has placed the organization in receivership.

SEP for Individuals Enrolled in a Plan that has been identified by CMS as a Consistent Poor Performer CMS established new SEPs, at §§ 422.62(b)(25) and 423.38(c)(32), for individuals who are enrolled in plans identified with the low performing icon (LPI) in accordance with §§ 422.166(h)(1)(ii) and §423.186(h)(1)(ii), respectively.

3. Medicare Advantage and Prescription Drug Plan Model Enrollment forms

CMS revised and improved the standard (“long”) model form used for MA and PDP enrollment to a new streamlined form. The new model enrollment form requires the minimal amount of information to process the enrollment, and other limited information that the sponsor is required or chooses to provide to the beneficiary1. The new model form consists of the following parts outlined below:

1.Cover Page
The cover page includes information for the beneficiary on Medicare enrollment and instructionsto complete the enrollment form.

2. Model Enrollment Request Form
Section 1 includes data elements required to process the beneficiary’s enrollment.
Section 2 includes mandatory data elements that the plan is required to include on the application and optional data elements which the plan is not required to include. All data elements in Section 2 are optional for the beneficiary to complete. Plan enrollment will not be affected if the beneficiary does not complete this additional information.

Mandatory Data Elements: Beneficiary language or accessible format preference2.

1 Requests for enrollment must comply with all requirements outlined in 42 CFR 422.2262 and 423.2262 and be approved by CMS.
2 Organizations are required to provide information to individuals in accessible/alternate formats (e.g., Large Print, Braille), upon request and thereafter, as outlined in Section 504 of the Rehabilitation Act of 1973. CMS will allow plans3

Optional Data Elements: Information that a plan may determine to be useful in processing an enrollment request, including options for beneficiary premium payment, choice of primary care physician (where applicable), or other information determined useful by the sponsor.

Electronic Delivery of Plan Specific Materials Section 2 also allows plan sponsors to list those categories of materials available for electronic delivery.

The OMB-approved enrollment form is considered a “model” for purposes of CMS review and approval of plan marketing materials; and plans can choose to customize the form as needed.

4. Additional Updates

Model Notice update

We removed information from Chapter 2 Exhibit 22 regarding the option to use an SEP to disenroll from the plan due to the loss of optional supplemental benefits due to nonpayment of optional supplemental premiums. An individual would be able to disenroll only if s/he is eligible for one of the existing SEPs.

Electronic Signatures

As part of the Electronic Enrollment process, plan sponsors are afforded the flexibility to accept electronic signatures from a beneficiary that affirms his/her intent to complete the enrollment. We added language that allows plan sponsors to obtain an electronic signature as an alternative to the “Enroll Now” or “I Agree” button or tool used in completing an Electronic Enrollment request. This change only applies to the Electronic Enrollment mechanism. The affirmation requirements for the Telephonic and Paper Enrollment mechanisms remain the same.

An electronic signature is considered to have the same legal effect and validity as a pen-and-ink signature. An organization utilizing electronic signatures must, at a minimum, comply with the CMS security policies. The requirements for legally binding electronic signatures can be found in the Electronic Signatures in Global and National Commerce Act, 15 U.S.C. § 7001.

Updates are incorporated into the contract year 2021 enrollment guidance. The revised guidance chapters, in their entirety, will be posted at the links below within 5 business days of this memorandum.

0 Comments Click here to read/write comments

Tags: Medicare Advantage, Medicare Part D

AHIP Warns of Part D Rebate Rule Impact

Posted by www.psmbrokerage.com Admin on Mon, Aug 03, 2020 @ 03:55 PM

AHIP Warns of Part D Rebate Rule Impact

The average basic premium for Medicare Part D prescription plans will be the second lowest average Part D premium since 2013, CMS announced. But industry leaders are not expressing as much optimism about the lower premiums as CMS.

AHIP acknowledged the current Part D average basic premium is one of the lowest since 2013, but the payer organization pointed out the effects the rebate rule could have in continuing savings on out-of-pocket health care costs.

The week before the Administration announced the average basic premium for 2021, the Trump administration signed three executive orders that placed restrictions on pharmacy benefit managers and sought to heighten drug importations. Through these measures, the executive orders aimed to lower drug prices.

AHIP, using CMS statistics, argued the executive orders would instead cause Medicare premiums to rise by 25%, up drug spending in Medicare programs by over $195 billion, and contribute $100 billion toward bailing out drug makers.

AHIP argues, "the Problem Is Still the Price. But nothing in the proposed rule would require Big Pharma to lower their prices."

"We’re winning great savings for seniors. But with the rebate rule, seniors will lose. Let’s focus on real, bipartisan solutions to out-of-control drug costs. In the midst of the COVID-19 crisis – seniors deserve those savings more than ever."

SOURCE

0 Comments Click here to read/write comments

Tags: Medicare Part D, Part D, AHIP

Part D Premiums to Increase Slightly in 2021

Posted by www.psmbrokerage.com Admin on Mon, Aug 03, 2020 @ 11:29 AM

Part D Premiums to Increase Slightly

Part D premiums are set to take a slight uptick in 2021, according to CMS, which estimates the average premium in Part D will be $30.50 next year, a slight increase from $30 in 2020, but still the second-lowest premium rate ever.

Part D premiums have been on a steady decline over the past several years, decreasing by 12% since 2017. Part D enrollment increased alongside declining premiums, with enrollment increasing by 16.7% since 2017.

Part D enrollment has increased alongside declining premiums, CMS said, with enrollment increasing by 16.7% since 2017.

CMS also touted Trump administration efforts to curb costs for Part D beneficiaries, such as launching the Part D Senior Savings Model earlier this year, in which participating Part D plans will offer insulin with a cap at $35 for a monthly supply.

CMS also eliminated the so-called pharmacy "gag clause," which prevented pharmacists from providing beneficiaries with information on alternative, less expensive ways to purchase drugs than through their Part D plan.

President Donald Trump also signed four executive orders targeting drug pricing late last week, including one that aims to revive the scuttled rule that would nix anti-kickback safe harbors for drug rebates in Part D.

More information on the Part D Senior Savings Model can be viewed at: https://innovation.cms.gov/initiatives/part-d-savings-model.

0 Comments Click here to read/write comments

Tags: Medicare Part D, Part D