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State of Medicare Advantage 2024

Better Medicare Alliance | Report Download

The Medicare Advantage program is expanding and becoming increasingly diverse, serving as an affordable healthcare option for many Medicare-eligible seniors in America. This growth is driven by the program's ability to offer comprehensive coverage, including additional benefits such as vision, dental, and wellness programs, which are not typically covered under traditional Medicare.

Currently, a record 33.8 million seniors and individuals with disabilities have chosen Medicare Advantage, making up nearly 55% of the Medicare population. This significant enrollment reflects the program's appeal and effectiveness in meeting the diverse healthcare needs of its beneficiaries. Additionally, 30% of Medicare Advantage beneficiaries identify as Black, Latino, or Asian, compared to only 18% in Fee-For-Service Medicare.

This demographic shift highlights the program's success in reaching and serving a more diverse population, ensuring that a broader spectrum of individuals can access quality healthcare tailored to their specific needs.

Source: Better Medicare Alliance

Important Update:
CMS’s New One-to-One Consent Regulations for 2025

Effective October 1, 2024, CMS will enforce a new one-to-one consent rule for Third-Party Marketing Organizations (TPMOs), including independent agents and brokers. This rule requires TPMOs to obtain prior express written consent from consumers before sharing their personal beneficiary data with another TPMO for marketing or enrollment purposes. The goal is to protect consumer privacy and prevent aggressive marketing tactics, such as reselling leads or cold-calling.

Under this new regulation, agents must ensure that all leads have a valid, CMS-compliant one-to-one consent in place. The consent must be clear, prominent, and specific to the TPMO using the data, with consumers explicitly agreeing to share their information with each listed TPMO. Verbal consent will be allowed for real-time transfers, but only when the transfer is conducted on a recorded line and the consumer agrees to speak with the next TPMO by name.

It’s important to note that leads obtained prior to October 1, 2024, without compliant consent cannot be used for outreach after the effective date, and failure to comply may result in penalties or contract termination. This rule does not apply to direct inbound calls, but all outbound calls must meet these new requirements.

We are here to support you in understanding and navigating these changes. If you have any questions or need guidance on how to ensure compliance with these new regulations, please reach out to our team.

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AgencyBloc and SunFire To Forge New Integration that Empowers Insurance Agencies

AgencyBloc and SunFire are set to integrate their platforms, connecting AgencyBloc’s agency management system with SunFire’s Medicare quoting and proposal tool. This integration aims to streamline the Medicare quoting process, enhancing efficiency for insurance agencies in the senior market. Users will be able to securely transfer client data to SunFire with a single click, reducing manual data-sharing efforts.

Tim Robinson, CEO of AgencyBloc, emphasized that this partnership supports their mission to equip insurance agencies with essential tools for success. Similarly, SunFire's CEO, David Graf, expressed excitement about the collaboration, noting it will improve operational efficiency for their shared clients.

For more updates on AgencyBloc and their integrations, visit www.agencybloc.com/news.

4 Ways to Keep Medicare Client Data Safe During AEP

With the increased activity and sensitive client information exchanged during AEP (Annual Enrollment Period), it’s crucial for agents to take the necessary steps to protect Medicare client data. Breaches not only harm clients but can also lead to hefty fines and damage to your reputation.

Here are four essential ways to ensure client data is secure during this busy period:

1. Use Secure Communication Channels

During AEP, you’ll be exchanging a lot of personal information with clients, including Social Security numbers and health records. Ensure you’re using secure communication methods, such as encrypted email or client portals, to share sensitive data. Avoid using standard email or texting, as these can be easily intercepted.

• Tip: Consider using a CRM system that provides secure messaging features to keep communication confidential.

2. Follow CMS Regulations on Data Sharing

The Centers for Medicare & Medicaid Services (CMS) have implemented strict regulations on how client data can be shared, especially with the introduction of new rules surrounding Third-Party Marketing Organizations (TPMOs). Agents must obtain prior express written consent before sharing any personal beneficiary information with another entity.

• Tip: Educate your team on the latest CMS rules to avoid accidental violations and ensure proper data handling protocols are in place.

3. Implement Strong Passwords and Multi-Factor Authentication

Ensure that all systems, client portals, and software that contain sensitive Medicare client data are protected with strong passwords and multi-factor authentication (MFA). This adds an extra layer of security, making it harder for unauthorized users to access client information.

• Tip: Regularly update passwords and encourage the use of password management tools to prevent weak password usage.

4. Secure Physical Documents

Even in the digital age, many agents handle physical paperwork that contains sensitive client information. Ensure that any physical documents are stored securely, such as in locked cabinets or shredding them when no longer needed. Be cautious of leaving documents in shared or unsecure areas.

• Tip: Establish a "clean desk" policy to minimize the risk of exposing client data unintentionally.

Protecting Medicare client data is more than just a compliance requirement; it’s a critical part of building trust with your clients. By implementing secure communication methods, adhering to CMS regulations, using strong digital security measures, and safeguarding physical documents, you can ensure a safe AEP for both your clients and your business.

10 common Medicare misconceptions every agent should clarify for their clients:

1. Medicare is Free
   Many people think Medicare is free, but most parts require premiums, deductibles, and co-payments, particularly for Part B and Part D.

2. Medicare Covers All Health Care Costs
   Medicare doesn’t cover everything. There are gaps in coverage, such as dental, vision, hearing, and long-term care, that clients need to plan for.

3. Medicare and Medicaid Are the Same
   Medicare and Medicaid serve different purposes. Medicare is primarily for people 65+ and some younger individuals with disabilities, while Medicaid is a state and federal program for low-income individuals.

4. Medicare Automatically Includes Prescription Drug Coverage
   Medicare Part A and Part B do not cover prescription drugs. Clients need to enroll in a standalone Part D plan or choose a Medicare Advantage plan that includes drug coverage.

5. You Can Sign Up for Medicare Anytime After 65
   There’s a limited enrollment window. Missing it can result in late penalties, particularly for Part B and Part D.

6. Medicare Advantage Plans Are Always the Best Option
   Medicare Advantage plans can be great, but they aren’t for everyone. Some clients may prefer the flexibility of Original Medicare with a Medigap plan for broader provider access.

7. Medigap Covers Everything Medicare Doesn’t
   While Medigap fills in some gaps, it doesn’t cover all additional costs, such as prescription drugs, dental, or vision care.

8. You Don’t Need Medicare if You Have Employer Coverage
   Some assume they can skip Medicare if they’re working past 65. However, enrolling in Medicare when eligible is often the best move, depending on the size of the employer and coverage offered.

9. Medicare Covers Long-Term Care
   Medicare only covers short-term stays in skilled nursing facilities after a hospital stay. It doesn’t cover custodial care or long-term care.

10. You Can’t Change Medicare Plans After Signing Up
    Medicare has specific enrollment periods, such as the Annual Enrollment Period (AEP), that allow clients to switch or modify their plans if their needs change.

These clarifications help clients make informed decisions and avoid costly mistakes.