Agents will have visibility into their production since January 1, 2023. To access this new function, click the graph icon on the left side of your screen and select the “Performance” tab at the top.
This report will showcase:
Medicare Blog | Medicare News | Medicare Information
Another Year, Another New Rule from CMS…
Yes, we feel your pain.
It seems like every year there’s a new set of compliance rules that agents must follow when selling Medicare Advantage and Part D plans. Some are a minor nuisance; others require scrambling to find and put new systems in place before the deadline (call recording, anybody?).
Remember why CMS does this: They are trying to protect Medicare beneficiaries against misleading and confusing sales and marketing tactics, and make sure these consumers get the right help to end up with the appropriate plan for their needs. This is the same goal that most independent agents have when selling Medicare plans.
While most independent agents focus on providing the best service possible, there are some bad actors. According to CMS, the number of consumer complaints rose from 15,497 in 2020 to 39,617 in 2021.
Medicare Marketing Changes in 2024: New TPMO Disclaimer
There are many resources you can turn to that dive into the changes for 2024. We won’t go over all of them here. But there is one specific rule that directly affects AgentMethods’ customers and the service we provide: the TPMO (Third Party Marketing Organization) Disclaimer.
To make sure it’s clear to customers what companies and plans an agent can offer them, CMS has provided an updated TPMO disclaimer that agents must use in communication and marketing materials such as email, online chat, advertisements, and websites. The new disclaimer is:
“We do not offer every plan available in your area. Currently, we represent [insert number of organizations] organizations which offer [insert number of plans] plans in your area. Please contact Medicare.gov, 1–800–MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.” (source: https://www.ecfr.gov/current/title-42/part-422/subpart-V#p-422.2267(e)(41))
But there’s one tiny problem with the new disclaimer…
The New Disclaimer Doesn’t Work on Websites
While this new disclaimer is helpful for direct mail campaigns and one-on-one communications, it creates a problem when communicating with anonymous website visitors who don’t know their local area. In that case, you aren’t able to provide a correct number for organizations you work with and plans you offer within their area.
We are seeing creative solutions, such as:
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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."
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.