fbpx
2024 Scope of Appointment

2024 Scope of Appointment

2024 Scope of Appointment
Comments

The 2024 Scope of Appointment rules have changed, yet again, for this year. Due to the 2024 Medicare Final Rule, there have been added regulations put into place regarding the collection of SOAs.

2024 Final Rule SOA Updates

The Centers for Medicare and Medicaid Services (CMS) implements sweeping changes to the Medicare system every year. Changes can impact the agents, carriers and clients alike. Over the past few years, rules and regulations have been aimed at stopping unfair marketing practices with large-scale call centers. Unfortunately, these updates have had a negative impact on individual sales agents as well. Here are the changes to this year’s scope of appointment rules:

  1. 48-Hour waiting period reimplemented. SOAs are required before meeting with a beneficiary to have any discussions that may lead to a sale. Agents must now wait a full 48 hours to conduct a personal marketing appointment. Exceptions to this include the last 4 days of a valid election period and if a beneficiary initiates an unscheduled in-person meeting (walk-in into an office).
  2. SOAs are limited to 12 months from the beneficiary’s signature date or the beneficiary’s request for information.
  3. SOAs are no longer allowed to be collected at educational events. This prohibits agents from setting up future sales appointments while at educational events. However, BRCs (Business Reply Cards) can be made available to collect beneficiary information.

Where does Pinnacle Financial Services come in?

Pinnacle Financial Services is a full service “FMO” that offers the best technology in the business, top-notch back-office support, and on-demand training to ensure you stay 100% compliant. It’s never too late to start. Call us today and ask about our exclusive IE-SNP product!

AEP is here! Check out our AEP Toolkit

For more information, contact a Pinnacle Financial Services representative today

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

Rob Valincius

Rob Valincius

National Director of Training

x7701 | rvalincius@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.

CallEmail

5-Star Medicare Advantage plans

5-Star Medicare Advantage plans

5-Star Medicare Advantage plans
Comments

5-Star Medicare Advantage plans are a year-round opportunity for both clients and sales agents. Although the 5-star plan designation is scarce throughout the country, there are still various opportunities depending on what state you and your client are in!

What are Star Ratings, and How do They Impact Plans

Medicare star ratings are basically a plan’s overall performance and quality based on data that is provided from the prior year. The scale is numbers 5 to 1, with 5 being excellent and 1 being poor. The 5 categories that the Centers for Medicare and Medicaid Services (CMS) uses to review plan performances are:

  1. Customer Service
  2. Plan Responsiveness
  3. Management of Member Complaints
  4. Preventative Service (Health outcomes of members)
  5. Chronic Condition Management

These ratings impact both the plan sponsor offering them and the clients choosing/staying with them. Plan sponsors benefit from having highly-rated plans by receiving higher rebates and quality bonus payments. This allows them to offer additional supplemental benefits (extras like dental, vision, and hearing), lower to no premiums, and help with future improvements to plan quality. Plans with low stars run the risk of having the contract terminated altogether.

For clients, having a 5-star plan gives them two things. The first is peace of mind. The higher the star rating for a plan, the more confidence they have when choosing that plan. The second is potential special enrollment opportunities. A 5-star Medicare Advantage plan receives a special enrollment period that lasts from December 8th to November 30th every year. This allows the client to make a one-time switch to that plan if it’s available in their service area.

Where does Pinnacle Financial Services come in?

Pinnacle Financial Services is the only “FMO” in the country that has access to a special Institutional-equivalent, 5-star plan available in 30 states across the country. This is an exciting opportunity to market a product that the external distribution channel has never sold. Not to mention, we offer the best technology in the business, back-office support, and training. Don’t hesitate to call us today about how to get set up for this unique opportunity!

AEP is around the corner! Check out our AEP Toolkit

For more information, contact a Pinnacle Financial Services representative today

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

Rob Valincius

Rob Valincius

Author Position

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.

CallEmail

2024 Medicare Final Rule

2024 Medicare Final Rule

2024 Medicare Final Rule
Comments

The 2024 Medicare Final Rule was preliminarily released on April 5th ,2023, and has left insurance agents seeking clarity on its implications for their roles and their clients. As professionals dedicated to helping beneficiaries make informed decisions about their Medicare coverage, it’s crucial for insurance agents to stay up-to-date on the latest changes and understand how these new regulations will affect their day-to-day operations.

2024 Medicare Final Rule Updates

The Medicare Final Rule 2024 introduces a series of significant changes that will directly affect insurance agents, their marketing strategies, and their interactions with beneficiaries. To help insurance agents adapt to these new regulations, we’ve compiled a detailed overview of some of the major changes:

  1. Requiring 48 hours between a Scope of Appointment and an agent meeting with a beneficiary, with exceptions for beneficiary-initiated walk-ins and the end of a valid enrollment period.
  2. Modifying the TPMO disclaimer to add SHIPs as an option for beneficiaries to obtain additional help; modifying the TPMO disclaimer to state the number of organizations represented by the TPMO as well as the number of plans.
  3. Prohibiting marketing of benefits in a service area where those benefits are not available, unless unavoidable because of use of local or regional media that covers the service area(s).
  4. Requiring agents to explain the effect of an enrollee’s enrollment choice on their current coverage whenever the enrollee makes an enrollment decision.
  5. Limiting the time that a sales agent can call a potential enrollee to no more than 12 months following the date that the enrollee first asked for information. New permission to contact will be required to call the beneficiary after the 12-month window has ended.
  6. Limiting the requirement to record calls between third-party marketing organizations (TPMOs) and beneficiaries to marketing (sales) and enrollment calls.
  7. Prohibiting a marketing event from occurring within 12 hours of an educational event at the same location.
  8. Prohibiting the collection of Scope of Appointment cards at educational events.
  9. Placing discrete limits around the use of the Medicare name, logo, and Medicare card; this includes specifically prohibiting the misleading use of the Medicare name, CMS logo, and products or information issued by the Federal Government, as well as prohibiting the use of the Medicare card unless previously approved by CMS.
  10. Clarifying the requirement to record calls between TPMOs and beneficiaries, such that it is clear that the requirement includes virtual connections such as video conferencing and other virtual telepresence methods.

Where does Pinnacle Financial Services come in?

While the Medicare Final Rule 2024 was implemented to protect beneficiaries and promote transparency, it is undeniable that these new regulations impose additional burdens on Medicare agents. The heightened requirements and restrictions may result in more extensive administrative work, increased oversight, and the need for constant vigilance to ensure compliance with ever-evolving CMS guidelines. Pinnacle Financial Services is a full-service “FMO” that is dedicated to helping agents navigate through the ever-changing rules and regulations imposed by CMS. Give us a call today for more information on key regulatory changes that could affect your business!

For more information, contact a Pinnacle Financial Services representative today

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

Rob Valincius

Rob Valincius

National director of Agent Training

x7701 | rvalincius@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.

CallEmail

2024 Medicare Certifications

2024 Medicare Certifications

2024 Medicare Certifications
Comments

2024 Medicare certifications are right around the corner with the launch of AHIP (America’s Health Insurance Plans) and NABIP’s (National Association of Business Insurance Professionals) certifications in a few weeks.

Typically, agents won’t begin the process until the major carriers begin to launch their own specific training for the 2024 season. This is mainly because the agents typically get a discount on the training from these companies when done through their won portals.

What is AHIP and NABIP?

AHIP stands for American Health Insurance Plans and was established in 2003 through a merger of the Health Insurance Association of America and the American Association of Health Plans. AHIP offers Medicare training that is accepted by CMS (Centers for Medicare and Medicaid Services) and nationally by all Medicare insurance carriers.

NABIP stands for National Association of Business Insurance Professionals and is a non-profit professional association that was established in 1930. NAHU has chapters all over the country that are organized to promote common business interests to those who are engaged in the sale of health insurance products and services. 2 years ago, NABIP launched its own version of AHIP’s Medicare training to compete with the other organization. You can find all the details on that Here.

2024 Medicare Certifications: Current Dates to Remember

In planning for 2024 AEP, it is important to plan out and take all required certifications in a timely fashion. So far, AHIP and a handful of national carriers have announced the dates of when the new training will be available for agents. Here is a list with corresponding dates:

  • AHIP: June 21st

  • NAHU: TBD

  • Devoted: June 26th   

  • United Healthcare: June 1st- 2024 study guide available. Certifications will open shortly after 

  • Humana: End of June

  • Anthem: June 28th

  • Aetna: June 28th

  • Cigna: July 1st

  • Independence Blue Cross: July 18th

  • Clover: July 18th

  • Wellcare: July 19th

Where does Pinnacle Financial Services come in?

Pinnacle Financial Services is a full-service “FMO” that is dedicated to helping agents across the country grow their book of business. It is essential to be prepared for the upcoming 2024 Medicare AEP season, and we have the tools here for your success! We offer the best back-office support in the industry, top-notch technology, and a national agent trainer to help guide you through the certification process. Give us a call today to set up a 2024 pre-certification call to ensure you are prepared and ready to go!

Need more guidance? Check out our AEP Toolkit

For more information, contact a Pinnacle Financial Services representative today

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

Rob Valincius

Rob Valincius

Director of agent training

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.

CallEmail

Value Based Care

Value Based Care

Value Based Care
Comments

Fee-Based vs. Value-Based Care: Navigating the Future of Healthcare

As healthcare systems strive to improve patient outcomes and reduce costs, the shift from fee-based to value-based care is gaining momentum. Both models have distinct approaches to healthcare delivery, and understanding their differences is essential for patients, providers, and policymakers alike.

Fee-Based Care

Fee-based care, which is also known as the fee-for-service model, is the traditional approach to healthcare where providers are reimbursed for each service rendered. This payment structure incentivizes a high volume of services, but may not necessarily promote quality care. While the fee-for-service model offers patients flexibility in choosing providers and services, it can also lead to fragmented care, overutilization of services, and increased healthcare costs.

The impact of fee-based care on patient outcomes can be mixed. On one hand, providers are motivated to offer a wide range of services to generate revenue. On the other hand, this model may not prioritize preventive care or long-term patient health, resulting in less-than-optimal outcomes. Financially, fee-based care can burden both patients and healthcare providers, with patients facing high out-of-pocket expenses and providers facing financial pressures to increase service volume.

Value-Based Care

Value-based care is an alternative healthcare model that focuses on improving patient outcomes while reducing costs. In this model, providers are rewarded based on the quality and efficiency of care they deliver, rather than the quantity of services provided. The primary goal of value-based care is to promote a more patient-centered approach, emphasizing prevention, care coordination, and long-term health management.

In terms of patient care and outcomes, value-based care incentivizes providers to focus on delivering high-quality care that leads to better health results. By tying reimbursements to performance metrics such as reduced hospital readmissions and improved patient satisfaction, value-based care encourages providers to prioritize preventive care and effective treatment plans. Financially, this model has the potential to lower healthcare costs for patients and providers by emphasizing cost-effective care delivery and reducing the need for unnecessary or redundant services.

Comparing Fee-Based and Value-Based Care

The differences in care delivery and patient experience between fee-based and value-based care are significant. While fee-for-service models may offer more flexibility in provider choice, they often lack continuity of care and fail to prioritize patient engagement. In contrast, value-based care models foster stronger patient-provider relationships and emphasize patient satisfaction, leading to better overall health outcomes.

The impact on healthcare costs is another key distinction between the two models. Although transitioning to value-based care may require initial investments in infrastructure and care coordination, the long-term cost savings and improved patient outcomes can outweigh these expenses. By promoting cost-effective healthcare delivery, value-based care has the potential to benefit both patients and providers financially.

Where does Pinnacle Financial Services come in?

The key differences between fee-based and value-based care lie in their approach to healthcare delivery, their impact on patient care and outcomes, and their financial implications for patients and providers. As the healthcare landscape continues to evolve, the shift toward value-based care models will play a critical role in achieving improved patient outcomes and cost efficiency. Pinnacle Financial Services is a full-service “FMO” that is dedicated to helping agents across the country navigate through the future of healthcare. Give us a call today for more information on key regulatory changes that could affect your business!

For more information, contact a Pinnacle Financial Services representative today

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

Rob Valincius

Rob Valincius

DIRECTOR OF AGENT TRAINING

x7701 | rvalincius@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.

CallEmail