Monday, May 9, 2022, was just an ordinary day for most individuals across the land. Now for those of us in the business of health insurance, we were presented with news that will change the dynamic of the entire industry.
On that day, the Centers for Medicare and Medicaid Services (CMS) released its 2023 Final Rule, and in this extensive document, there are two important guidelines we’d like to highlight in a more simplified manner.
New Required Disclaimer
“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”
This disclaimer must be:
Verbally conveyed within the first minute of a sales call.
Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication.
Prominently displayed on Third Party Marketing Organization (TPMO) websites.
Included in any marketing materials, including print materials and television advertisements, developed, used or distributed by the TPMO.
Aside from that, this disclaimer needs to be added to any previously approved materials and resubmitted to CMS for approval.
Calls With Beneficiaries Must Be Recorded
Agents making calls to beneficiaries must record ALL calls in their entirety. In addition, TPMOs must retain and make the recordings available upon request for a minimum of 10 years. You may ask, at which stage of the sales process or enrollment will a recording need to be started? Here is your answer.
This includes calls that are part of the chain of enrollment into a Medicare Advantage or Part D Plan (the steps a beneficiary takes from becoming aware of a Medicare plan or plans to conducting enrollments over the phone), as well as post-enrollment telephonic discussions.
This rule applies to telephonic conversations only, not face-to-face meetings. The YourMedicare team was well aware of this change and immediately took action in implementing the resources needed to comply with these new requirements.
Introducing the YourMedicareSunFire Integrated Telephony System. This addition to our state-of-the-art online enrollment tool will not only assist agents during the sales process but also help to keep them completely compliant with Medicare Advantage and Prescription Drug Plan enrollments.
INBOUND & OUTBOUND DIALING
The YourMedicareSunFire Integrated Telephony System provides a virtual phone number that can be used directly in the YourMedicareSunFire platform or with an agent’s personal cell phone.
RECORDING & STORAGE
The platform saves recorded conversations in a safe and HIPPA-compliant manner for the minimum of 10 years. Agents will have various available storage options, based on the outcome of the call. Record, save and store all in one spot!
The YourMedicareSunFire Integrated Telephony System displays integrated prompts within the platform to ensure agents have everything needed to adhere to these requirements.
This is just the beginning of what is to come. As new information becomes available, we’ll keep you updated on all new enhancements, news and more specific details relating to the 2023 CMS Final Rule and the YourMedicareSunFire recording functions.
As you are well aware, agents will juggle vast amounts of activity during this time. Unintended actions may be a pathway to making compliance mistakes, which may derail the AEP application process. Before we lift off into a new AEP season, let's consider a few significant points related to compliance in order to remain on the right trajectory for a successful launch.
SCOPE OF APPOINTMENTS
Scope of Appointments detail the exact topics beneficiaries would like to discuss with an agent. CMS requires agents to have beneficiaries sign an SOA prior to discussing Medicare Advantage or Part D Prescription drug plans. Every appointment with a beneficiary requires an SOA and these forms must be kept on file for 10 years, even if the appointment doesn't result in a sale. Also, starting this year, a new CMS ruling requires agents to read a disclaimer to all potential clients at the beginning of a sales call. Reading this during the SOA process is an optimal time for this disclosure. These calls must be recorded and stored for 10 years.
HEALTH CARE PROVIDERS
Before agents can help a client with a Medicare plan, they must know the physicians and the specialists a client sees for their healthcare services. Many beneficiaries are happy with their healthcare providers and don't want to change. Compare their current providers with the providers in the plan's network to ensure there isn't a disruption in services.
PRESCRIPTION DRUG FORMULARY
It's important to review a client's prescriptions in order to help them clearly understand the cost of drugs for a particular plan. An unexpected increase in drug prices can quickly turn an exceptional client experience into an unsatisfactory one. Make sure to review enrollment data with your clients, this way, if there is an error, you can fix it on the spot rather than having the application returned. Reviewing a client's prescriptions will ensure they are given options for the most comprehensive coverage for their individual needs.
SUMMARY OF BENEFITS
A Summary of Benefits must be provided to beneficiaries at the time of enrollment to provide clarity regarding coverage. Although beneficiaries will receive a hard copy of this document after enrollment, agents must summarize key features such as covered benefits and cost sharing. The Summary of Benefits needs to be thoroughly discussed prior to signature-collection and verification of intent-to enroll.
TIMELY APPLICATION SUBMISSIONS
Agents are certainly busy during AEP and sometimes put off submitting an application to a carrier. This can result in the application not being submitted in the required 24-48 hour time frame. An agent's primary responsibility is to ensure a clients' insurance needs are met. It's important to take the extra time and double check to make sure your clients' applications have been taken care of within this time frame.
So there you have it - you should be all set for a successful launch! Thanks for tuning in and good luck this season! As always, we thank you for your continued support and cooperation. Please do not hesitate to reach out with any questions or comments.
The annual enrollment period is just around the corner, so in this month's compliance bulletin we thought it would be beneficial to take a bird's eye approach in reviewing AEP in general and then dive into some compliance tips regarding what to avoid saying in order to stay CMS compliant.
As you'll recall, the annual enrollment period is a time when your clients can essentially make any change they are eligible for. Among other things, these changes may include enrolling in Medicare Advantage for the first time, switching from one Medicare Advantage plan to another, or joining a Medicare prescription drug plan.
As you may know, AEP only lasts from October 15 through December 7th. This only gives you roughly seven and a half weeks to close on sales. With such a small window of time to enroll potential clients, it's important to take care of all your contracting, certifications, and training as soon as possible. Here are a few important points to consider before you can jump into AEP.
The sooner you can answer yes to all of these questions the better off you'll be - as AEP is fast approaching.
Now that we've gotten the general information out of the way, let's look into a few tips regarding what to avoid saying to current and potential clients in order to stay CMS compliant.
"Free premiums!" This is never 100% accurate. Zero dollar premiums and copays usually only pertain to specific areas and plans - and they are not free. Do not generalize a plan or use misleading language such as, "this is the best plan out there".
"Is your spouse eligible for Medicare?" - "How about your friends?" - "Can I have their number so I can call them?" While it's okay to ask for referrals, you may only ask for their names and mailing addresses. Instead, you should give out your business card.
"If you're liking this Medicare plan, you should check out this life insurance plan." During an appointment, an agent cannot cross-sell insurance products or provide non-health-related products to their Medicare clients.
"Let me get your contact information so that you are able to come to my event." You cannot require potential clients to provide any contact information in order to attend an event. While on the topic of events, signing-in is never required. If you have a sign-in sheet, it should explicitly state that sign-ins are optional.
"While you're waiting for your doctor, let me tell you about your Medicare options." Agents can never conduct sales and marketing activities where beneficiaries receive their health care services. This includes waiting rooms, exam rooms, treatment centers and pharmacies.
As you are well aware, there are many other requirements to consider in order to remain CMS compliant. Our aim today was to help you gear up as October 15th quickly approaches. Remember to complete your contracting and certifications, order your supplies, read up on any compliance changes, and set your goals. Thanks for tuning in, and we'll see you next month with some more compliance tips.
A new analysis from the AARP Public Policy Institute finds drug companies have increased prices for many brand name Part D drugs in 2022, contributing to affordability challenges for people with Medicare.
According to the report, 75 of the 100 brand name drugs with the highest Medicare Part D spending in 2020 saw their list prices increase in January 2022; none experienced a decrease. The average increase was 5%, with some drug prices (12 of 75) growing by nearly 8%. In 2020, these 75 drugs were used by more than 19 million Part D enrollees and accounted for nearly half of all Medicare Part D prescription drug spending ($93.2 billion out of $198.7 billion).
These price hikes will have a cumulative impact, as they are building on those in prior years. For example, the typical cost of a brand name medication in 2020 was $6,600–$3,700 more than it would have been, had drug prices not grown faster than inflation every year since 2006. For Medicare beneficiaries, who take an average of four to five prescription drugs per month and have a median annual income of just under $30,000, this can be a significant burden.
Prescription drug price hikes also affect Medicare’s financing. The Medicare Payment Advisory Commission (MedPAC) has consistently cited high prices as a key reason for growth in Medicare Part D spending. From 2013 to 2018 alone, Part D spending on prescription drugs increased by 26%. The commissioners attributed “nearly all of the growth . . . to higher prices rather than an increase in the number of prescriptions filled by beneficiaries.”
And the consequences don’t stop there. As AARP notes, “High and growing prescription drug prices will eventually affect all Americans in some way . . . those with private health insurance will pay higher cost sharing and premiums. Increased government spending driven by drug price increases will lead to higher taxes and/or less spending for other priorities. Equally important, high drug prices and related costs will prompt more older Americans to stop taking necessary medications.”
Immediate action is needed to reform the nation’s drug pricing system in ways that will strengthen Medicare and improve beneficiary well-being. Absent such interventions, prices and unaffordability will continue to rise, as will risks to the program. An ever-growing number of Americans could be priced out of needed medications and coverage, leading to worse health outcomes and higher costs in the future. At the same time, policymakers could seek to control government spending through Medicare changes that threaten beneficiary health and financial security.
Medicare Rights supports comprehensive efforts to lower prescription drug prices, including as outlined in the House-passed budget reconciliation bill. Though its changes are less comprehensive than originally envisioned in H.R. 3, it retains that bill’s core elements by capping beneficiary out-of-pocket (OOP) drug costs; realigning Part D financial obligations; penalizing drug manufacturers for price hikes that outpace inflation; and allowing Medicare to negotiate drug prices. Together, these policies would achieve historic coverage and affordability gains, better ensuring that all people with Medicare have meaningful access to care.