Mutual of Omaha 2020 Medicare Advantage
Mutual of Omaha Medicare Advantage and Part D Market Overview Released
They’re here!! Mutual of Omaha Medicare Advantage Company (MOMAC), Omaha Health Insurance Company (OHIC) and Medicare Advantage Insurance Company of Omaha (MAICO) market overview information has been posted on Forms & Materials on Sales Professional Access (SPA) www.mutualofomaha.com/broker. This is your opportunity for a sneak peek at the service areas, provider networks and benefits that are anticipated for Plan Year 2020. You won’t want to miss out on this!
Because plan information is pending CMS bid approval, these documents are available as download only. Also, keep in mind, plan design and service areas are pending government approval and are subject to change. The posted material is for producer use only and cannot be shared with the general public.
AHIP and Product Training
America’s Health Insurance Plans (AHIP) Certification, Medicare Advantage product training and Part D Prescription Drug Plans (PDP) product training is now available on SPA: www.mutualofomaha.com/broker
Even better, your AHIP Certification results can now be submitted electronically to Mutual of Omaha. No need to fax or mail your certificate. If you have completed the assessment using another carrier, you can still have the results conveniently sent to us. Just navigate to the AHIP site using the link on SPA. You will find instructions on how to transmit your results electronically. You will not have to pay or take the assessment again.
Not appointed to sell Mutual of Omaha Medicare Advantage plans?
It’s time to get Ready to Sell for 2020 Medicare Products
Get Ready to Sell our Medicare Advantage and PDP products in just 3 easy steps!! Start the process today.
That’s all there is to it!
Re-contracting for Mutual of Omaha’s MA market expansion
If you are currently contracted for Medicare Advantage through Mutual of Omaha Medicare Advantage Company (MOMAC), a Medicare Advantage Insurance Company of Omaha (MAICO) Amendment will be required if you are planning to sell outside the current MOMAC markets. This new company is for Medicare Advantage plans rolling out this year in the following markets: Denver, Dallas/Fort Worth and El Paso.
And remember, to earn renewal compensation you will need to be Ready-to-Sell for the plan year compensation is to be paid.
Not appointed to sell Mutual of Omaha Medicare Advantage plans?
Medicare Blog | Medicare News | Medicare Information
FROM: Kathryn A. Coleman / Director
SUBJECT: Contract Year 2020 Agent and Broker Compensation Rate, Referral/Finder’s Fees, Submissions, and Training and Testing Requirements
This memorandum provides contract year (CY) 2020 compensation and referral/finder’s fee limits for agents and brokers, directions for submitting amounts into the Health Plan Management System (HPMS), as well as training and testing requirements.
Compensation Rates and Referral/Finder’s Fees for CY 2020
As provided in 42 C.F.R. §§422.2274(b)(1) and 423.2274(b), the compensation amount an organization pays to an independent agent or broker for an enrollment must be at or below the fair market value (FMV) cut-off amounts published yearly by the Center for Medicare and Medicaid Services (CMS). 42 C.F.R. §§422.2274(h) and 423.2274(h) states that referral/finder’s fees paid to independent, captive, or employed agents may not exceed a CMS specified amount. Additionally, referral/finder’s fees paid to independent agents/brokers must be included in FMV for that CY.
The CY 2020 FMV cut-off amounts for all organizations and referral/finder’s fees are as follows:
Compensation Rate Submission for CY 2020
As in past years, all organizations must inform CMS via HPMS whether they are using employed, captive, or independent agents. Organizations that use independent agents must provide the initial and renewal compensation amount or range of amounts paid to these agents. Additionally, if an organization pays referral/finder’s fees, the organization must disclose the amount. CMS has provided instructions for data entry in the HPMS Marketing Module User Guide.
Organizations must submit their agent/broker information in the HPMS Marketing Module between June 1, 2019 and July 26, 2019, 11:59 pm EST. Please note that CMS does not consider the submission process complete until the organization’s CEO, COO, or CFO has completed the attestation in HPMS. Organizations that fail to submit and attest to their agent and broker compensation data by July 26, 2019 will be out of compliance with CMS requirements.
Organizations will not be able to make changes to those submissions after the July 26, 2019 deadline.
CMS expects organizations to keep full records documenting that they are updating compensation schedules and paying agents and brokers according to CMS requirements.
Please note that CMS will make the CY 2020 organization-submitted compensation information available for the public to view on www.cms.gov prior to the annual election period for CY 2020.
Curricula for Training and Testing Agents and Brokers for CY 2020
Regulations at 42 C.F.R. §§422.2274 and 423.2274 require that organizations train and test all agents and brokers selling Medicare products, including employees, subcontractors, downstream entities, and/or delegated entities annually on Medicare Parts A, B, C, D, and plan specific information. CMS further requires that all agents and brokers obtain an 85% passing rate on the test.
In order to ensure the quality of agent and broker training and testing programs, CMS annually provides minimum training and testing requirements to organizations. Organizations should review these requirements before developing their own agent and broker training and testing programs to ensure compliance with CMS requirements. CMS permits and encourages organizations and third-party training and testing vendors to include other relevant topics, in addition to the minimum required elements.
Pharmaceutical Spending Will Reach $370B in 2019
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.
We want to notify you about an issue affecting all Medicare members who elected to pay plan premiums from their Social Security Administration (SSA) or Railroad Retirement Board (RRB) check.
Normally, when members select this premium payment option, the SSA/RRB withholds funds from members’ SSA/RRB checks to cover their plan premiums.
Unfortunately, due to a system issue, this did not occur for two or more months starting February 1, 2019. This issue affected all carriers, not just Aetna. Although the system issue is now fixed, the SSA/RRB cannot retroactively deduct premium payments from members’ checks.
What do members need to do?
Because these members now have past-due accounts, their premium payment method has changed to direct billing, effective February 1, 2019. This means they now need to pay any past-due premium amounts to Aetna directly.
Members will receive a letter explaining what happened and what they need to do later this month. Letters are being mailed in waves, between May 10-24, so members will receive them over several weeks. View the member letter.
What happens next?
Encourage members to call us with any questions
Although this issue was out of our control, we realize it will be an inconvenience for our members. If they have any questions, please encourage them to call Member Services by dialing the number on their member ID card. The Member Services team is available 7 days a week, from 8 a.m. to 8 p.m.
As always, thank you for your dedication to our members and for your help educating them on this matter. If you have any questions, please contact the Aetna Medicare Broker Services Department at 1-866-714-9301 or firstname.lastname@example.org.
How Large is Medicare Part D?
In less than two decades, Part D has become an industry behemoth
Medicare is second only to private insurance as a major payer for retail prescription drugs. The program’s share of the nation’s retail prescription drug spending increased from 18% in 2006 to 30% in 2018.
Percent of Retail Drug Spending, By Payer
Drugs Covered by Part D and Part B Accounted for 19% of all Medicare Spending in 2016
Part D Spending is Poised to Escalate
Mutual of Omaha: Submitting and Tracking Your PDP Enrollments
Scope of Appointment
All paper enrollment forms MUST be received by Mutual of Omaha Rx’s enrollment processor within 48 hours after the signed enrollment date.
Mutual of Omaha Rx (PDP) is a prescription drug plan with a Medicare contract. Enrollment in the Mutual of Omaha RX plan depends on the contract renewal.
Mutual of Omaha: Submitting and Tracking Your Medicare Advantage Enrollments
Humana Adds "Grandkids-on-Demand" as Benefit
Papa is a peer-to-peer service platform — like ride-hailing or short-term-rental services — that connects seniors to vetted college-aged young adults to help them with anything outside of medical or assisted-living needs. Think of things that young adult grandchildren might do for their grandparents, such as light housework, going on walks, running errands or just socializing.
Papa vets and hires young adults through interviews; criminal, background and driving-history checks; and a personality test to ensure the contractors, called Papa Pals, are engaging and sensitive to seniors' needs.
The deal, announced Tuesday, the is another example of Humana's holistic, value-based approach to caring for the seniors it insures. Specifically, the deal is intended to help seniors reduce loneliness and social isolation.
Humana executives said the company's better-than-projected earnings for the third quarter and the year so far were a result of its success in addressing clinical and non-clinical needs of its insurance plans.
“At Humana, we know if we truly want to impact the health of our Medicare Advantage members, we need to look at the whole person, and that includes the social determinants of health, like loneliness and social isolation,” Deb Galloway, president of Humana's Medicare program for Central and North Florida, said in a news release.
Reducing loneliness and social isolation in its members is a big deal for Humana. The Louisville-based health care and health insurance company said in a recently published report that socially isolated seniors are at a much greater risk of developing dementia and Alzheimer's disease; are four times more likely to be hospitalized with in a year of discharge; and are two to five times more likely to die prematurely than seniors with strong social ties.
Papa is headquartered in Miami, Fla., and its services to Humana Medicare Advantage members are currently limited to Tampa region, according to the release. The service is offered for free or at a nominal fee to qualifying Humana members.
In late October, Papa closed a $2.4 million seed funding round that included a lead investment from San Francisco-based Initialized Capital and an investment from Los Angeles-based Sound Ventures, a venture capital firm co-founded by actor and activist Ashton Kutcher, as the South Florida Business Journal reports.
Papa launched its services in late 2017. Seniors can access Papa's services and over 600 contractors by phone, Papa's mobile app or on the company's website.
HHS Proposes to Link Medicare Part B Payment for Prescription Drugs to International Price
Commonwealth Fund research shows that such bold payment models are needed to tackle high prescription drug prices in the U.S., and that paying international prices might move Medicare and beneficiaries’ drug spending in the right direction. If the proposal moves forward, a number of questions about how it will work need to be resolved, and it’s important to note that Part B spending accounts for just a small slice — 5 percent — of the total national drug bill.
Spending in Medicare Part B
Under Medicare Part B, physicians administer drugs in their offices, often to treat patients with cancer, immunological disorders such as rheumatoid arthritis, and age-related eye conditions like macular degeneration. Medicare’s current payment to physicians, which is based on the average U.S. sales price for these drugs and biologics, is 47 percent higher on average than prices paid by 16 industrialized countries for the same products, according to the administration’s analysis.
Beneficiaries’ cost-sharing is also high for Part B drugs; they pay 20 percent of the Medicare price for each dose. Commonwealth Fund research finds drug costs exacerbate struggles of Americans with serious illnesses, who can face financial ruin even if they have health coverage.
The outline of HHS’s proposed Part B rule, which would be released next spring, reflects an innovative attempt to lower drug spending:
Several unaddressed details of the Part B model will determine whether it will save Medicare money and lower what beneficiaries pay for their prescription drugs.
Certain features of Medicare and the pharmaceutical market may present stumbling blocks to achieving the model’s goals. For example, how will a target price enable vendors to negotiate with sole-source manufacturers who retain monopoly pricing power? What levers will vendors have in these circumstances? Could global pricing dynamics spur manufacturers to raise prices in other countries in order to raise the Medicare reference price? Answers to these and other questions raised by HHS could reveal limits of the model design.
Total U.S. Spending
Of course, Part B spending is a small portion of total Medicare drug spending, and the bulk of national drug spending falls outside of Medicare. Medicare Part D, for example, which covers drugs dispensed by retail pharmacies, accounts for a much larger share of total U.S. drug spending (27%). Medicare spending for the highest-cost drugs paid under Part D’s catastrophic benefit has grown at an average annual rate of 18 percent since 2007. That is faster than the 9.8 percent drug spending growth under Part B. Leaving Part D out of the proposal therefore leaves a lot of potential savings on the table.
Moreover, prescription drug costs paid by U.S. workers and employers would not be captured under the Part B model. These costs account for a large share of U.S. drug spending. Insurers estimate that prescription drugs now account for 33 percent of employer-paid health insurance premiums, mainly because of high and increasing prices for the same drugs covered by Part B. The Food and Drug Administration (FDA) has announced a series of steps to encourage more price competition from lower-priced products, such as generics and biosimilars. However, FDA actions will need to be coupled with bolder reforms to patent and exclusivity protections that impede U.S. payers from negotiating prices that approximate those achieved by peer countries.
A Broader Strategy
Rather than linking to prices abroad for a slice of U.S. consumers, HHS could pursue a broader strategy that adapts core elements of the international approach to drug pricing. Other developed countries aggregate purchasing power to gain leverage with drug companies, systematically assess the value of individual drugs to inform their purchasing decisions, and enter into a negotiation process with manufacturers that they can stand behind. Adapting these elements to the U.S. would take bold action, but if we did so we could create our own system — one that could achieve the lower drug costs that other countries are able to provide for their residents.
Scope of Appointment Documentation
What is the Purpose of a Scope of Appointment?
The scope of appointment form is a CMS requirement used to document an in person appointment witch a beneficiary to ensure that no other types of products are discussed outside of what the beneficiary originally requested.
Below is some information regarding Scope of Appointments ("SOAs") to help keep you compliant during this AEP season.
Also, sales presentations are required to be by appointment only and should not be made by marketing through unsolicited direct contact.
Steps to completing an SOA:
Returning a minimum of 48 hours later allows the consumer to have a "fresh mind" and gives way to a better understanding of the new product you are discussing.
If you have any questions our marketers are here to help.
Good luck, and happy selling.