2021 Medicare Updates
Every year, CMS (Center for Medicare and Medicaid Services) makes updates and changes to their rules, regulations, and commissions. Over the past few years, there have been some major changes that have changed how Medicare agents solicit to potential clients. One of the more notable changes was back in 2018 when CMS removed the 48-hour requirement for Scopes of Appointment. For those new into the industry, Scopes of Appointment (SOA) would be required 2 days before you were able to meet with a client about any Medicare Advantage Prescription Drug Plans (MAPD) or stand-alone Prescription Drug Plans (PDP).
This year, we’ve identified some of the changes that will benefit all Medicare agents. Here are a few:
1. Commission Increase: The trend since 2009 has been a steady increase in commissions for all agents. For those of you who sell in PA, CT, DE, CA, and NJ, you will be able to make more than anyone else in the country. For Medicare Advantage, for the whole country, the increase is over 5% for both new and renewal rates. Prescription Drug Plans had close to a 4% increase for the whole country. Here is a breakdown of what this year looks like:
| Medicare Advantage | PDP | |||||||
| Plan Year | National Rate | PA, CT, & DC | CA & NJ | National Rate | ||||
| 2021 | $539 | $270 | $607 | $304 | $672 | $336 | $81 | $41 |
2. Referrals: CMS removed the regulations that limited when a marketing representative could solicit referrals and what types of gifts could be provided in exchange for those referrals. This is an incredible change and allows for more flexibility when trying to get more future business from your current book. Keep in mind that nominal value (usually $15) and FWA (Fraud, Waste, and Abuse) laws still apply.
3. Notable changes to marketing events: Advertisements and invitations, in any form of media, that would be utilized to invite a potential client to a marketing (informal/formal) or educational event must include a specific statement. The statement is: “For accommodation of persons with special needs at meetings call <Phone Number and TTY number>.”
4. Educational events: Meals can now be provided to potential clients. In the past, you could only offer light snacks and refreshments. Keep in mind, nominal value still applies ($15) so you would need to factor that into the event planning.
It is extremely important for us here at Pinnacle Financial Services to make sure all our agents are aware of changes that may affect them. Much like the technology industry, Medicare is an ever-evolving mechanism that changes all the time. We would like to be your partner along this journey and help navigate you through any of the challenges you may encounter. We offer top-notch technology (like our proprietary Connect4Medicare platform), personalized sales and marketing training, and back-office support that is the best in the business. Pinnacle Financial Services is not just a typical FMO and will help you have the best AEP (Annual Election Period) possible!
1 (800) 772-6881 x7731 | sales@pfsinsurance.com
Rob Valincius
National Director of Agent Training
Contact a Pinnacle Representative if you have any questions.
1 (800) 772-6881
support@pfsinsurance.com
