11 tips to stay compliant in selling Medicare Advantage

11 tips to stay compliant in selling Medicare Advantage
By  from Insurance NewsNet

Calendar year 2023 Medicare Advantage and Part D Final Rule (CMS-4192-F) was recently released, after public input. The result might be challenging for the industry.

Agents and brokers are now considered third-party marketing organizations, or TPMOs, which means they now are required to record all marketing calls with both clients and prospects where Medicare Advantage and Medicare Part D plans are discussed.

CMS also now requires a standardized disclaimer where appropriate:

“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.”

Moreover, this CMS-required disclaimer must be prominently displayed on any landing page, website or email sent by a TPMO or their first-tier, downstream or related entity.

Additionally, when applicable, TPMOs must disclose to the Medicare beneficiary that their information will be provided to a licensed agent for future contact.

Many are asking, and rightly so, what exactly do we need to do differently?

Here are 11 tips to ensure your system keeps you in compliance with these new CMS marketing rules.

  1. Make sure your system uses artificial intelligence-generated conversation guides for each prospect automatically. If the prospect needs to be informed of anything for compliance, that talking point should automatically be included in the conversation guide. Your system should track everything sent or said by either party. The same compliance statement should not be suggested if the prospect has already been informed.
  2. The talking point for the required disclosure should stand out from the other conversation talking points by any or all of these approaches:
  • All capital letters.
  • Stand-out colors like red or yellow.
  • Bold text.
  • Italic text.
  1. The system could show a green flag that lets the agent know that the wording of the disclosure has been changed in the last 10 days (to stay current with any future CMS changes) so the agent will know they need to read the new wording rather than rely on their memory of the required disclosure message.
  2. When the sales representative begins discussing the next point, the system should automatically reload the AI-generated conversation guide so that the required compliance statement is then listed as “compliance statement given” in normal text (maybe with a check mark to indicate that the required compliance has been given). The agent sees a positive affirmation that the compliance statement has been delivered. This positive affirmation could appear in the conversation guide for subsequent calls so that agents will know that the compliance requirement has been met.
  3. At the beginning of a call, there might not be enough information on the prospect to know if (or which) the compliance statement must be read to the prospect. For example: If the prospect’s age is discovered during the conversation, just entering their birthdate (or age) should trigger any required compliance statement to pop up in the screen and automatically be added to the regenerated conversation guide to make it “click simple” to know what to say and to document when it was said for compliance tracking.
  4. At the end of each call, the system should generate an email to summarize the points discussed and include links to appropriate reference material. These AI-generated emails also should include the appropriate reference to (or complete compliance statement) to document that the prospect was informed appropriately.
  5. A detailed record showing the date, exact time, and actual duration of the discussion of the compliance statement should be added automatically to a “story-so-far”-type record for that prospect.
  6. This story-so-far-type record should be a call map showing the details of every call. If the agent is recording the call, their manager or anyone who wants to confirm the discussion of the required disclosure statement should be able to click on the entry in this story-so-far-type record to play the recording of the discussion (maybe even giving a 3D view of the discussion if the agent was recording the meeting with visual (like recorded Zoom calls) meeting recording tools.
  7. It also should be easy for the system to generate reports with links to both the recorded calls and to the documented discussion of the compliance statement in this story-so-far-type record.
  8. Reports also should highlight prospect meetings where the agent failed to make required compliance statements as a management/compliance tool and to guide the agent to make another contact so they can give the required disclosure.
  9. The system reports also should validate that the compliance statement was made in all the applicable calls (with the exception of the agent mistakes that should have been documented and corrected in Point 10 above.)

Lloyd Lofton is the founder of Power Behind the Sales. He is the author of The Saleshero’s Guide To Handling Objections, voted 1 of the 11 Best New Presentation Books To Read in 2020 by BookAuthority. Lloyd may be contacted at lloyd.lofton@innfeedback.com.

Why join Medicare?

Why join Medicare?

With information from the official website of https://www.usa.gov/medicare/ we can define Medicare as follows; it is the basic health insurance program in the United States for people over 65 and people with disabilities. The program has four parts:

 

  • Hospital Insurance (Part A) – Helps pay for inpatient or skilled nursing facility stay services and some hospice or home health care services.

 

  • Medical Insurance (Part B) – Helps pay for doctor services, hospital outpatient services, and other medical services not covered by hospital insurance.

 

  • Medicare Advantage Plans (Part C) – Includes health care provider organizations and allows people with Medicare Parts A and B to choose to receive all health care through one of these organizations.

 

  • Medicare Prescription Drug Coverage (Part D) – Helps pay for the drugs your doctors prescribe as part of your treatment.

 

Why sell Medicare?

 

One of the great advantages of selling #Medicare is the residual income that you can receive in a sustainable way in the long term.

 

Currently, Medicare sales are at a very high point due to its great benefits, which leads to great monetary benefits for the insurance agent, since today many companies are paying commissions for 7 years, and some even pay commissions forever.

 

According to a study conducted by MedicareGuide.com, by 2040 in the USA there will be more than 82.3 million seniors, which indicates that Medicare enrollments will be much more frequent each year.

 

Medicare for Insurance Agents

 

If you are a new insurance agent, we invite you to take a training to sell Medicare Advantage and start cultivating your profits. Since these are grants directly from the United States government, they offer a lot of educational materials through their official accounts, or you can go to any local Social Security office for more information yourself.

 

If, on the other hand, you are an already certified agent, we recommend that you keep updated with any news that may arise. It is always good to have a specialized agency with experience in the health insurance market to guide you in the sales process.

 

A good marketing plan will always help you reach potential customers or strengthen relationships with existing ones. Keep in mind that clients will always prefer an agent who is 100% trained to guide them in the process of acquiring their health plan and you on the other hand will earn very good commissions. If you have any questions about marketing plans, please reach out to our Director of Strategic Communications, Megan Whitehead, at meg@newhealthpartner.com

 

The OEP is almost here and for everything that has happened in recent times, this will be a good season where potential clients will need insurance coverage with the best quality. Prepare yourself, educate yourself, and join one of the best companies with which you can grow and obtain the best income in the market.

AEP for Health Insurance Agents

AEP for Health Insurance Agents

Now that health care Annual Enrollment Period, (AEP) is here, you’ve got probably reviewed the bulk your client’s coverage choices to work out if their coverage continues to fulfill their medical and money needs. Around 10% of Medicare Advantage (MAPD) enrollees switch arranges every year. If you’re a brand-new Medicare agent, a standard prevalence you’ll face within the AEP varies with beneficiaries, and their current plan may now not match their life style or budget. as a result of Agent Pipeline is devoted to serving to insurance agents grow and develop their skilled skillsets – we’ve worked with a number of the highest manufacturing Medicare agents to help you get a stronger understanding of why beneficiaries amendment coverage throughout the AEP.

Price of Coverage:

In line with several of our expertise health care insurance brokers, a standard reason for beneficiaries to modify coverage is their current Medicare health arrange doesn’t slot in their budget. Beneficiaries can be missing out on equal coverage at a lower monthly premium. One in every of the first roles of a Medicare insurance agent is to assist beneficiaries compare plans to confirm they need the coverage that creates the foremost sense. If you’re a brand-new Medicare agent, strive asking your health care beneficiaries queries like:

  • Will your current Medicare health arrange charge a monthly premium additionally to your half B premium?
  • What quantity does one pay in copays?
  • Will your current Medicare health plan have an annual deductible?
  • What’s your most due cost?
  • Is your network restricted?
  • Are your most well-liked doctors in your current network?
  • Does one have a prescription medicine plan? If so, are your current prescriptions covered?
  • Are there any extra advantages on your current Medicare health plan that you just must-have if you switch?

We all know too typically amendment is inevitable. Typically, your beneficiary’s aid wants may change, requiring completely different coverage. Reckoning on their specific situation, they will make changes outside of AEP throughout the Special Enrollment Period (SEP). However, during the AEP, conjointly called the Annual Enrollment Period, your beneficiaries have the liberty to create the subsequent changes to their health care Health arrange:

  • Amendment to a Medicare Advantage plan (Medicare half C) from Original Medicare (Parts A and B)
  • Amendment from a Medicare Advantage plan (Medicare half C) to Original Medicare (Parts A and B)
  • Enroll in an exceedingly Medicare Supplement (also called a Medigap policy) to try with original health care half A & half B
  • Amendment Medicare Advantage arranges (Medicare half C)
  • Inscribe in an exceedingly new complete half D plan
  • Amendment to a distinct stand-alone half D arrange

Opt-out of a prescription medicine plan (PDP), if they need listing in a new Medicare Advantage (MAPD) plan which incorporates prescription drug coverage.

How to Sell Obamacare? For new agents.

How to Sell Obamacare? For new agents.

insurance

Before starting with some ideas of How To Sell Obamacare, it is important to know that Obamacare (Affordable Care Act) is not an insurance carrier or plan, it is an option established in health care law that subsidizes the health plan that the client wishes to buy.

The Affordable Care Act comes from the same insurance providers that you already know.

STEP 1: Become a Certified Insurance Agent: To become an insurance agent, you must first pass a pre-license course at an insurance school certified by your state. In this case, we have our approved insurance school in the state of Florida. This step is not optional, it is mandatory.

STEP 2: Get the approval of the insurance companies; Yes, it is true that you made a great effort and managed to obtain your license as an insurance agent, but you are not yet ready. you must become certified for the insurance companies that you are going to offer.

For example, Bright Health Care can help all the new agents to get them “Appointed”. In states like: California, Florida, North Carolina and Texas.

STEP 3: Obtain your National Producer Number: In this case, you already have your insurance license, you are a certified agent, you are already admitted to the different insurance companies, but there are two important steps to get to sell Obamacare insurance.

One of them is to obtain your National Producer Number or NPN, which is unique and important to identify you when selling health insurance. It is not difficult, it is only a procedure and the fact of being within an insurance agency allows you to be helped in that process.

STEP 4: Take the exam and Get Certified To Be Able To Sell; You are already a certified insurance agent, you have the admission of medical insurers, you have your national producer number, but the federal government needs to know if you really know the health care laws and if you can be prepared to sell Obamacare insurance.

This Is another advantage of being represented by an agency. since the agency can help you in that process and work with you to open your account on the official CMS website and take the exam.

Everything is on the internet, you don’t have to go anywhere and from the comfort of your computer you can achieve the goal of being not only a licensed insurance agent; but certified to sell the federally subsidized health plans, better known as Obamacare.

House Democrats propose making permanent expanded ObamaCare subsidies

House Democrats propose making permanent expanded ObamaCare subsidies

House Democrats late Friday night proposed making permanent enhanced ObamaCare subsidies that give people greater help in affording their premiums.

The American Rescue Plan signed by President Biden earlier this year provided larger financial assistance to help with health insurance premiums for Affordable Care Act enrollees but only until 2022.

The House Ways and Means Committee’s proposal released late Friday would make that larger financial assistance permanent as part of Democrats’ $3.5 trillion social spending package.

The enhanced subsidies lower the percentage of income that any ObamaCare enrollee has to pay for health insurance from around 10 percent to 8.5 percent. Notably, the proposal also allows people who make more than 400 percent of the federal poverty limit (about $100,000 for a family of four) to access the financial assistance for their premiums.

Extending this enhanced financial assistance has been a priority of Speaker Nancy Pelosi (D-Calif.), though there has been some debate with progressives like Sen. Bernie Sanders (I-Vt.) who have prioritized adding dental, hearing and vision benefits to Medicare.

The House bill does not begin Medicare dental benefits until 2028, in part because there is limited money for both the Medicare expansion and making the ACA enhancements permanent.

Previously released sections of the House package would also create a new federal program to expand Medicaid in the 12 GOP-led states that have refused the expansion under the ACA.

A study from the Urban Institute released earlier this week found that the Medicaid expansion provision and making the enhanced ACA subsidies permanent would together reduce the number of uninsured people by 7 million, or about one quarter.

 

 

www.thehill.com

BY PETER SULLIVAN

What are health insurance benefits and coverage?

What are health insurance benefits and coverage?

Take a look at this easy-to-read summary that lets you compare the costs and coverage offered by different health plans side-by-side. You can compare your options based on prices, benefits, and other features that may be important to you. You received the “Summary of Benefits and Coverage” (SBC) when you purchased coverage yourself or through your job, when you renewed or changed coverage, or requested an SBC from your health insurance company.

 

You can use the SBC to compare prices, benefits, and other health plan options and features that may be important to you.

 

Although it is intended to make the information easier to understand, it may seem like a lot at first. It will be helpful to put together something to help your audience navigate through an SBC, so they can understand what to expect, especially if they are in need of specific treatment or in the event of an emergency.

 

The 10 Essential Benefits of Obamacare

 

Whether you purchase health insurance from the Health Insurance Marketplace, from a private company, or through your insurance agents, you can receive the “10 essential benefits” for health care:

 

• Preventive care, general check-ups, chronic disease treatments

• Prescription drugs

• Medical emergencies

• Hospitalization

• Laboratories

• Pediatrics

• Pregnancy, childbirth, and postpartum

• Psychiatry, addiction treatments

• Rehabilitation Therapies

• Outpatient care

 

To apply for Obamacare benefits, you are required to meet two requirements: have legal status in the United States and a minimum income. The minimum income varies each year, call us for the most up-to-date information.

 

The process is very simple, and you will be able to access some of the best medical insurance plans in the United States.

 

If you need to review Obamacare plans, benefits, prices, and coverage options, you can contact us. Our agents will help you simplify the process.

When Can I Buy Health Insurance?

When Can I Buy Health Insurance?
Enrollment

 

We often miss the opportunity to purchase affordable health insurance because we are not within the enrollment period for health insurance plans.

 

The good news is that you have a chance to get or change health coverage all year long if you qualify for certain life events such as losing health coverage, moving, getting married, having a baby, or adopting a child. These events may qualify you to enroll or change your Marketplace plan outside of the annual Open Enrollment Period, which begins November 1.

 

  Some of these events are specifically the following:

  1. You tried to enroll during the open enrollment period but were unable to

  2. You have lost your employer health benefits

  3. You are no longer eligible for coverage through other types of insurance

  4. You signed up during the open enrollment period, but something happened and the enrollment was not processed correctly

  5. You moved to the United States, you returned to the United States after living abroad, or you are released from prison

  6. Exceptional circumstances prevented you from enrolling

  7. You already have health insurance through the marketplace, but your family circumstances have changed

  8. You already have health insurance through the marketplace, but your income has changed

  9. You already have health insurance through the market, but you have changed your address

  10. You are a member of an Indian tribe (recognized by the governments of the United States)

 

It is important to note that if you qualify for Medicaid or the Children’s Health Insurance Program (CHIP), you can apply at any time.

 

There is always an opportunity to treat your health or get your annual checkup, do not miss this opportunity and make sure it is with the best for you and your family. Your health is a priority and the health insurance marketplace has many options so that you and your family are always healthy.

Oscar Health, Inc. Announces 2022 Market Expansion Plans, Culturally Competent Care Focus

Oscar Health, Inc. Announces 2022 Market Expansion Plans, Culturally Competent Care Focus

Oscar Health, Inc. (“Oscar”) (NYSE: OSCR), the first health insurance company built on a full stack technology platform, announced its Individual & Family market expansion plans for 2022. During the upcoming Open Enrollment period, the company plans to offer health insurance to individuals and families in 3 new states and 146 new counties.1 With this expansion, Oscar will have a footprint in a total of 22 states and 607 counties across its Individual & Family, Medicare Advantage, and Small Group (including Cigna+Oscar) plans.

2022 will mark the fifth consecutive year Oscar expands its footprint. As a part of the 2022 expansion, Oscar will offer Individual and Family Plans for the first time in Arkansas, Illinois, and Nebraska. Oscar also will expand its existing state footprints in Colorado, Florida, Georgia, Iowa, Missouri, Oklahoma, Pennsylvania, and Texas.2

“Our focus at Oscar has always been to expand access to high quality, low cost health care that meets the individual needs of our members,” said Oscar Co-Founder and CEO Mario Schlosser. “In light of the COVID-19 pandemic, this has never been more important. With this latest market expansion, we’re doubling down on our efforts to bring our members the most innovative and personalized care possible.”

The expansion will also include the launch of new programs and plan designs built on Oscar’s full-stack, consumer-focused technology, which allows for rapid response and adaptation to members’ needs. Oscar will be expanding its Virtual Primary Care program offering to members on select plans in San Antonio and El Paso. Oscar’s Virtual Primary Care program is powered by Oscar’s technology platform, which is designed to help drive improved efficiency and superior engagement with members.

Oscar will leverage its insights and platform to build upon its Culturally Competent Care program, which was designed to provide tailored care access for members with diverse values, beliefs, and behaviors. This includes connecting members with culturally competent providers who can deliver care that meets their social, cultural, and linguistic needs.

Oscar also plans to launch an innovative new plan to better serve diabetic members. The plan will be available to members on Individual and Family Plans in most Oscar states3. For members who enroll in the diabetes plan, they will enjoy cost-saving benefits, including:

  • $0 diabetic eye and foot exams
  • $0 labs to manage diabetes
  • Out of pocket costs for insulin are capped at $100/month
  • $0 PCP visits


“Our clinical philosophy centers around a belief that people will live a happier and healthier life if they have access to quality high-value care at an affordable price,” said Sameer Amin, Oscar’s Chief Medical Officer. “By empowering patients with diabetes and helping them engage with the health care system early and often, we hope to create a differentiated experience for our members.”

The specifics of Oscar’s 2022 insurance plan portfolio are still being reviewed by regulators. Details regarding pricing, network partners, and added benefits will be available closer to the Open Enrollment Period this fall. More information can be found at www.hioscar.com.

About Oscar Health
Oscar Health, Inc. (“Oscar”) is the first health insurance company built around a full-stack technology platform and a relentless focus on serving its members. At Oscar, our mission is to make a healthier life accessible and affordable for all. Headquartered in New York City, Oscar has been challenging the health care system’s status quo since our founding in 2012. The company’s member-first philosophy and innovative approach to care has earned us the trust of approximately 560,000 members as of June 30, 2021. We offer Individual & Family, Small Group and Medicare Advantage plans, and +Oscar, our full-stack technology platform to others within the provider and payor space. Our vision is to refactor health care to make good care cost less. Refactor is a term used in software engineering that means to improve the design, structure, and implementation of the software while preserving its functionality. At Oscar, we take this definition a step further. We improve our members’ experience by building trust through deep engagement, personalized guidance, and rapid iteration.

1 Pending regulatory approvals.
2 Pending regulatory approval.
3 The Oscar diabetes plan will be available to Individual & Family plan members in all states where Oscar offers health plans, except California, Colorado, New York, New Jersey, Tennessee, Virginia, and Michigan.

MEDIA CONTACT:
Jackie Kahn, Oscar
202.538.0128
JKahn@hioscar.com

Source: Oscar Health, Inc.

New Health Partner Contact Information 

info@newhealthpartner.com

305-962-0942

www.newhealthpartner.com

Choosing Health Insurance

Choosing Health Insurance

Considering choosing an insurance plan can be complicated, as many questions arise along the way. The Internet can give us a broad vision of what the health market offers, but how do you choose the right one?

Here are some tips to make the process faster and more reliable.

If you do not have a chronic disease or a major condition, it is best to start with a basic plan that helps you cover your needs, but which company do you choose and how do you know what your deductibles are? 

The first thing we need to know is what benefits do insurance companies provide? In this case, you can always have the help of a (certified) insurance agent who will give you the necessary guidance to find the plan that best suits you.

There is no universal health coverage in the United States. In this country, medical assistance is completely private and citizens are obliged to take out medical insurance if they want to receive such medical assistance.

One of the best options is the ACA; formally known as the Patient Protection and Affordable Care Act, and often just called Obamacare, the law includes a list of healthcare policies intended to extend health insurance coverage to millions of uninsured Americans.

Lower-income families qualify for subsidies for coverage purchased through the Marketplace. It was designed to extend health coverage to millions of uninsured Americans.

Health insurance helps people protect themselves against high medical costs in the event of any health need.

What are the factors that influence when selecting a health insurance plan?

1) Age: it is perhaps the most determining factor if we talk about calculating risks. In this case, two people with a large age difference will have disparate needs.

2) Health Status: The vast majority of health insurance plans established as a requirement for contracting the need to respond to a medical questionnaire or even medical tests to determine the level of treatment or health plan that the person will need in the future.

3) Place of residence: This is to define that there are specific products or health centers that vary in price depending on the region or locality.

4) The number of insured: In general, when it comes to a family group, insurers usually offer a percentage discount for their members.

All these variants will depend on various factors that will be broken down according to the conditions of each person. What is important to bear in mind is that being insured can offer you many advantages and the most specific are:

  • Security for family members and assets
  • Financial guarantee
  • Trust and freedom

The health plans offered by the government may be a good option if you are looking to save money and fulfill your well-being.

So if you are not insured, now you know what to expect when choosing your health plan.

HHS Announces Over Two Million Sign-Ups For Health Coverage During the 2021 Special Enrollment Period

HHS Announces Over Two Million Sign-Ups For Health Coverage During the 2021 Special Enrollment Period

Today, the Centers for Medicare & Medicaid Services (CMS) released new enrollment reports showing more than two million people have signed up for health coverage during the Biden-Harris Administration’s 2021 Special Enrollment Period (SEP), which opened on February 15, 2021, as the country grappled with the pandemic, and will conclude on the extended deadline August 15, 2021. In addition, today’s reports show access to health care continues to expand with 81 million people receiving coverage through Medicaid and the Children’s Health Insurance Program (CHIP) as of February 2021. The historic and rising enrollments demonstrate how the Affordable Care Act, Medicaid, and other vital health care programs deliver high-quality, affordable health care to millions of Americans, families, and children.

The June Marketplace SEP report shows that since February 15, 1.5 million Americans have signed up on HealthCare.gov with an additional 600,000 enrolling in coverage through the 15 State-based Marketplaces. The report also shows that of the new and returning consumers who have selected a plan since April 1, 1.2 million consumers (34%) have selected a plan that costs $10 or less per month after the American Rescue Plan’s (ARP) premium reductions. The ARP’s expanded premium tax credits have reduced premiums, increased savings, and given consumers access to quality, affordable health care coverage through the Marketplace, and President Biden has proposed to make these lower premiums permanent as laid out in his Build Back Better Agenda.

The February 2021 Medicaid and CHIP Enrollment Trends Snapshot also shows record-high enrollment with more than 81 million people covered through Medicaid and CHIP. An additional 500,000 children and adults enrolled in Medicaid and CHIP from January to February 2021. Nearly 10.4 million individuals, a 14.7% increase, enrolled in coverage between February 2020, the month before the COVID-19 public health emergency was declared, to February 2021.

“Let’s be clear – the monthly Marketplace numbers show that across the country, there’s a demand for high-quality, low-cost health coverage. And month after month, we are reminded that the Biden-Harris Administration is fulfilling its promise to deliver access to quality, affordable health coverage by strengthening the Affordable Care Act and pushing its Build Back Better Agenda,” said HHS Secretary Xavier Becerra. “Whether through expanded Medicaid or the Health Insurance Marketplace, the ACA is working for millions of Americans – and we’re committed to building on this historic progress.”

“The American Rescue Plan has made health coverage more affordable and accessible than ever – and people are signing up. Health coverage provides the peace of mind that every American deserves,” said CMS Administrator Chiquita Brooks-LaSure. “Through August 15, the American people have an opportunity to select a quality health care plan that works for them, with costs that are at an all-time low. CMS is dedicated to ensuring people in our communities have the coverage they need.”

For the full press release, visit:
https://www.cms.gov/newsroom/press-releases/health-care-sign-ups-surpass-2-million-during-2021-special-enrollment-period-ahead-aug-15-deadline

For more information on the June Marketplace SEP report, visit: https://www.cms.gov/newsroom/fact-sheets/2021-marketplace-special-enrollment-period-report-3

For the February 2021 Medicaid and CHIP Enrollment Trends Snapshot visit: https://www.medicaid.gov/medicaid/program-information/medicaid-chip-enrollment-data/medicaid-and-chip-enrollment-trend-snapshot/index.html

For more information about the Health Insurance Marketplace®1, visit: https://www.healthcare.gov/quick-guide/getting-marketplace-health-insurance/

For more information about the American Rescue Plan and the Health Insurance Marketplace®1, visit: https://www.cms.gov/newsroom/fact-sheets/american-rescue-plan-and-marketplace