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Medicare Advantage & Part D Poised to See Significant Compliance Changes in 2024

Medicare Advantage & Part D Poised to See Significant Compliance Changes in 2024

Medicare Advantage & Part D Poised to See Significant Compliance Changes in 2024
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The 2024 Proposed Rule from the Centers for Medicare & Medicaid Services suggests a return to more controlled Medicare communications and marketing standards.

Medicare sales call recording regulations and new third-party marketing organization criteria became required for agents selling Medicare Advantage and prescription drug plans in 2023. In an ongoing effort to tighten down on misleading sales tactics, CMS has proposed clarifying a few points connected to these requirements, bringing back a few outdated rules, and adding a few new ones for 2024.

NABIP, formerly NAHU, submitted a comment letter to CMS this week in response to a new Medicare marketing proposed rule. It’s the ultimate hope that the proposed rule will not go into effect as currently laid out.

The impending Medicare Advantage and Part D rule modifications that will likely be completed prior to this year’s Annual Enrollment Period are summarized below.

Remember TPMO from 2023.  The Centers for Medicare and Medicaid Services (CMS) published its 2023 Final Rule this past spring. The Final Rule announces changes that have been made to existing marketing and communication requirements for both Medicare Advantage and Part D plans.

These changes sought to strengthen the oversight of third-party marketing organizations (TPMO) and include new consumer protections.

TPMO Sharing of Beneficiary Information

TPMOs are defined by CMS as organizations and individuals who are compensated to perform lead generation, marketing, sales, and enrollment-related functions as part of the chain of enrollment. (The steps taken by a beneficiary from becoming aware of a Medicare plan or plans to make an enrollment decision). TPMO also includes independent agents/brokers.

The sharing of personal beneficiary information with other TPMOs would now become prohibited, and the TPMO disclaimer has been updated.

State Health Insurance Programs (SHIPs) will need to be listed in the updated disclaimer as a way for beneficiaries to get further assistance, in addition to an MA organization and Part D sponsor with which the TPMO has a contract in the beneficiary’s service region.

“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 which are [insert list of MA organizations or Part D sponsors]. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.”

Updates to the 2023 Final Rule on Call Recording

Only sales, marketing, and enrollment calls between TPMOs and beneficiaries must be recorded according to CMS. This should do away with the requirement to record calls for scheduling appointments and check-ins following sales. Calls with current clients, however, must be recorded for client retention reasons.

Additionally, CMS is requiring that all virtual calls for enrollment, marketing, and sales that are conducted by video conferencing or other forms of virtual telepresence be recorded.

Scope of Appointment Rule Change

In order to prevent personal marketing appointments from happening before 48 hours have passed since a potential enrollee has finished a Scope of Appointment, SOA, CMS plans to reestablish the 48-hour SOA time restriction. If you are familiar with the prior 48-hour SOA requirement you should know that the phrase “when practicable” will not be included in the new rule. It will be necessary to obtain SOAs at least 48 hours beforehand.

An SOA is only valid for six months after the beneficiary signs it, according to CMS.

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Holding an Education Event

Agents will not be permitted to make future selling appointments at educational events or gather SOAs or beneficiary contact information. Additionally, agents will not be allowed to have a sales event there within 12 hours of the educational event. (The entire building or nearby buildings are considered to be in the same place.)

How Pinnacle Can Help

We recognize that these changes will present significant challenges for you when assisting clients with their Medicare coverage. Please keep in mind that we are here to assist you as you work through them to conduct your business compliantly, continue growing your sales, and provide the best service to your clients.

Please reach out to the team at Pinnacle Financial Services for additional information on these or any other questions you have, by contacting our Compliance team by email at compliance@pfsinsurance.com.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Bob Brzyski

Bob Brzyski

Vice President - Marketing

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

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Contact a Pinnacle Financial Service representative today for assistance.

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Best Medicare Advantage Leads

Best Medicare Advantage Leads

Best Medicare Advantage Leads
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The Best Medicare Advantage lead programs can vary by how an agent wants to do business. Lead generation is more and more the lifeblood of insurance agents in the Senior Market. Here at Pinnacle Financial Services, we take the time to test all lead programs before we make them available. Price, return percentages, appointment ratios, and of course, closing rates are all factored into the final decision of whether a program is promoted.

Proven Medicare Advantage Leads

The best Medicare Advantage lead programs right now are available to all agents working with Pinnacle. As an FMO for all the top Medicare Advantage carriers, we know it’s crucial to have a proven Medicare lead program for our agent distribution.

ARE YOU PLANNING ON YOUR BEST Medicare YEAR?

HAVE YOU PUT TO PAPER YOUR GOALS?

DOES IT INCLUDE A PROVEN LEAD GENERATION PROGRAM?

Types of Medicare Advantage Leads

Here at Pinnacle Financial Services, we know that the Medicare Advantage marketing and lead generation programs must work and be compliant.  As an established Medicare FMO Pinnacle has the infrastructure and proven knowledge to guide agents through the CMS maze of regulations to make sure the lead programs agents use give results.

Consider the different types of lead sources:

If you are not sure you are working with proven programs that are CMS compliant then you need to call us now.

Here at Pinnacle Financial Services, our success is measured by our agent’s success.

Don’t delay, contact the Medicare experts at Pinnacle Financial Services today at     1-800-772-6881 x7731 or email healthsales@pfsinsurance.com.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Bob Brzyski

Bob Brzyski

Vice President | Marketing

x7742 | bbrzyski@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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Tips for Selling Life Insurance

Tips for Selling Life Insurance

Tips for Selling Life Insurance
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There are many types of life insurance that are available for individuals to purchase. As a life insurance agent, how do you know what type of product, amount of coverage, and how to best structure an illustration? You want to be competitive so you do not lose the business to an internet quoting tool, but you also do not want to give them an unrealistic quote that will cause you to be unable to place the case down the road. 

The ultimate goal as a life insurance professional is to conduct good field fact-finding and field underwriting so that you are able to give the best options to your prospect. The reason your clients have an interest in life insurance can vary to include protecting their family, retirement income, burial expenses, college planning, and more. So how do you go about this part of the process? First, have a good fact-finding process you follow. There are plenty of fact-finding documents that can help you have this conversation. Learning about a client’s family, their assets, current insurance policies, and household income are just some of the important facts you will uncover. 

Once the goal of the prospect is discovered you are able to offer the best product option from the wide variety of life insurance types, and sub-types, from term insurance to universal life, and whole life insurance. If they are looking to protect their family in case something was to happen to them then a term life could fit the bill as an income replacement option. Maybe you uncover your prospects have maxed out their 401k contributions and are looking for other ways to supplement their retirement income. Now an Index Universal life might be the way to go. A permanent cash-growing plan that your prospect can contribute that will give the opportunity for cash-free income in retirement, permanent death benefit coverage, and in some cases long-term care-type benefits. 

The next part of the process now that you have an idea of the goal and type of policy that will fit the situation is looking at can your client medically qualify for a policy. Field underwriting is incredibly important so that you can give a quote that is accurate for a particular client’s situation. 

 Some field underwriting considerations: 

Age: Obviously it is less expensive the younger you are. Usually, you are healthier when you are in your 20’s and 30’s than you are in your 50’s and 60’s. 

Male vs Female: A women’s life expectancy is longer than a man’s. Therefore, premiums are less for women than for men. 

Health History: This category has several factors. 

First: are they going to the doctor and if so, what for? 

Second: are they on any medications? 

Third: what are their height and weight? 

Fourth: do they smoke cigarettes or cigars or use chewing tobacco? If they quit, how long has it been?

Lastly: what does their family history look like? Has a parent died at an early age due to a heart attack or cancer or are they still alive in their 90s? 

Extracurricular Activities: What does this have to do with pricing? Everything! If your customer is a race car driver on the weekends or a scuba diver in shark-infested waters or likes to jump out of a perfectly good airplane once a month, they are at higher risk for death. Underwriters are not big fans of these activities. On the other hand, does your customer participate in 5K’s, or are they an avid gardener or belong to a gym? If this is the case, they could qualify for a better-rate class. 

MVR: Does your client have a clean driving record or do they have speeding tickets and DUI’s? If they are reckless with driving, they might be reckless with their health. 

Career: This is similar to activities, especially if your customer is an electrician or works at a nuclear power plant. Any high-risk occupation could classify them as a risk. 

With the answers to these important questions, you can now give the most accurate rate quote possible. 

Also, keep in mind that individual insurance carriers can look at a particular client differently. Just because one company might give your client a standard rate does not mean they cannot get a preferred rate with another. 

At the end of the day when you prepare, and give accurate quotes based on the goals of the prospect, you are more likely to place more business, have happier clients, make more income and garner more referrals. 

Contact the team at Pinnacle Financial Services to assist with your next life case. From easy issue final expense to cash value Index Universal life we can make sure you have the best options for your client. 

 

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x6003 | lifesales@pfsinsurance.com

Bob Brzyski

Bob Brzyski

Vice President, Marketing

x7742 | bbrzyski@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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Prescription Drug Savings

Prescription Drug Savings

Prescription Drug Savings
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The high cost of inflation has all Americans looking for ways to save money. Prescription drug saving options are increasingly important as costs continue to rise.  Advances in technology have made it possible to extend life for millions of people and improve the quality of life for millions more. But the high costs are making it increasingly more difficult for average individuals to make ends meet. There are options that insurance agents can use to help their clients save money.

GLIC RX

The GlicRx prescription discount card helps provide relief from the high costs of prescription medication to everyone, whether they are insured, are on Medicare or do not have insurance.

GLICRX FOR AGENTS

Great news!  Pinnacle Financial Services is a preferred organization making GlicRx available for agents and agencies to give to everyone.  Easy and quick to get set up.  GlicRx will give a personalized landing page and code for agents to give the GlicRx prescription drug discount card free to everyone and GET PAID!

GLIC Pharmacy Options

GlicRx has a national network of drugstores and retail outlets, including Walgreens, CVS, Walmart, Costco, Kroger, Publix, and many others. That’s almost 35,000 pharmacy locations in the US that have partnered with GlicRx to offer lower prescription prices. You can find participating pharmacies near you by searching for your zip code on GlicRx.com.

GETTING STARTED WITH GLICRX

To get set up for GlicRx today reach out to the team at Pinnacle Financial Services.  We can be reached at 800-772-6881 x-7731 or by email Healthsales@pfsinsurance.com.

The GlicRx Prescription Savings Program is NOT insurance. To learn more about the GlicRx Prescription Savings Program, including eligible pharmacies, included prescriptions and related pricing, and other important terms and conditions and contact information, please visit www.GlicRx.com.

*Prescription savings vary by prescription and by pharmacy.  There is no cost to sign up. For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Bob Brzyski

Bob Brzyski

Vice President | Marketing

x7742 | bbrzyski@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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Agent Call Recording Solutions for Medicare Sales

Agent Call Recording Solutions for Medicare Sales

Agent Call Recording Solutions for Medicare Sales
Comments

The Centers for Medicare and Medicaid Services (CMS) Final Rule goes into effect for Contract Year 2023.  In essence, AEP businesses with a 1/1/2023 effective date for Medicare Advantage and Medicare Part D will be required to follow the new guidelines.

CMS FINAL RULE 2023- SUMMARY OF MARKETING CHANGES

The following is a summary of the changes published.

All field agents must begin recording all marketing phone calls that are part of the chain of enrollment with beneficiaries

The 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. “must be conveyed as follows:

  • Verbally conveyed within the first minute of a sales phone 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 websites
  • Included in any third-party marketing organization marketing materials, including print materials and television advertisements.

TPMOs are defined by CMS as organizations and individuals who are compensated to perform lead generation, marketing, sales, and enrollment-related functions as part of the chain of enrollment. (The steps taken by a beneficiary from becoming aware of a Medicare plan or plans to make an enrollment decision). TPMO also includes independent agents/brokers.

Pinnacle Financial Services is providing several all-in-one solutions free of charge to our agent partners through Connecture, SunFire and MyMedicareBot.

These voice Recording Enrollment Systems are now available to agents of Pinnacle Financial Services through our proprietary Connect4Medicare platform.

Seamlessly record your calls and stay compliant with the new CMS regulation.  The call recording systems through Connect4Medicare are FREE for all agents with Pinnacle Financial Services. Stores recordings automatically for the 10-year required period.

Pinnacle Financial Services is your one-stop for all the technology you need to quote, compare and enroll your Medicare clients. Use any of the approved compliant platforms depending solely on your preference. 

To receive access, please make sure you are contracted and certified for all of your Medicare carriers through Pinnacle Financial Services.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Bob Brzyski

Bob Brzyski

Vice President | Marketing

x7742 | bbrzyski@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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