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Aetna’s Value Based Enrollment Program

Aetna’s Value Based Enrollment Program

Aetna’s Value Based Enrollment Program

As the Medicare industry continues to grow, so will the way companies try to interpret healthcare needs. As an FMO, it is our job to help pass along all the exciting new programs that companies roll out to both the agents and clients. Available in select markets, Aetna is introducing a program called Value Based Enrollment or VBE for short.

So, you may be asking yourself what a value-based enrollment is and what it entails for you and your clients. VBE is a new option that is available through the Ascend Virtual Sales Office app that Aetna offers for online enrollment of Medicare Advantage plans. After the online enrollment of your client is complete (through Ascend Virtual Sales Office only), you can help them schedule a voluntary health-related survey phone call. This phone call consists of a wellness advocate of Aetna speaking with your clients about what their health goals may be and help them schedule a wellness visit with their PCP (Primary Care Physician). Please be aware that agents are not allowed to be present with their clients while this call is being done.

There are 3 options to complete the VBE with your client. Once the Ascend application is completed, you will have the option to:

  1. Connect Me Now: This is when your client wishes to do the call at that time.
  2. Schedule a Callback: This is if your client wants to schedule a future date and time to complete the call.
  3. Decline: This is if they do not wish to do the VBE call at all.

In order to participate, please keep in mind that you need to be ready-to-sell for Aetna and have access to the Ascend application. In order to get access, you must request it through Aetna’s Producer’s World. Keep in mind, agents who complete the VBE call either now or set-up for a future date, will earn a service fee for doing so.

Why should agents do this? It benefits all parties in the process. The client will get to share their health goals, as well as, set up a wellness check with their doctor. The agent will strengthen their relationships with their clients by helping coordinate their care and make a couple extra dollars doing so. For Aetna, it will help improve their quality of care of members and help gain insights into how to help your clients avoid potential health risks.

Pinnacle Financial Services is always in the loop on all these added programs to help build, and retain, your clients. We have plenty of lead and co-op opportunities available as the Medicare annual election period (or AEP) approaches.

Contact Pinnacle Financial Services today to learn more about Aetna’s VBE program and Medicare required training.

Rob Valincius

Rob Valincius

Director of Sales - Health

x7701 | rvalincius@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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AHIP

AHIP

AHIP

Agents who are looking to sell, or who already sell, Medicare Advantage and PDPs are required to do yearly training. The government governs Medicare by utilizing CMS which stands for Centers for Medicare & Medicaid Services. AHIP is the preferred training for most of the major carriers. AHIP stands for America’s Health Insurance Plans and has been around since 2013.

In order to market and sell Medicare Advantage plans for the upcoming year, most companies have a requirement to complete AHIP as part of their yearly certifications. Currently, AHIP for the 2019 selling season is available through the AHIP website or through a partner link via the carriers you are contracting with. 2019 certifications will be shut down as of June 14th and reopen on June 17th for the 2020 selling season. If you wait to take the 2020 AHIP test, it will cover you for the rest of the 2019 as well.

The AHIP certification has 2 major modules which is Medicare and Fraud, Waste and Abuse. The Medicare module has 5 modules to cover which range from Medicare plans to Medicare marketing regulations and ends with 1 major exam. This exam has 50 multiple choice questions on all the material covered within the other 5 modules. Unlike the FFM (Federally Facilitated Marketplace) for individual healthcare insurance, the final AHIP exam does not have unlimited tries. Agents get 3 attempts to finish the exam with a 90 percent or better (at least 45 correct answers).

AHIP is also not free for agents unless you qualify for a reimbursement through a carrier (like Aetna’s Front Runner program). The cost to do this every year is $175, however; if you do AHIP through a carrier’s portion to their website, you will get a $50 discount. As an FMO, it is our job to help you sell throughout the year so that you qualify for these programs. As a special thanks for newly contracted agents, Pinnacle will reimburse this cost to newly contracted agents who contract for select carriers.

Pinnacle has many tools for new agents that can make their first open enrollment a major success, like our Connect4Medicare online enrollment software. I am sure some of you are familiar with Medicare.gov and enrolling clients through their software. Connect4Medicare was created by the same company and, unlike Medicare.gov, enrolling clients through our software allows you to make commissions on the sale! Please contact us for more details on how to qualify for AHIP 2020 and get access to this amazing software!

Contact Pinnacle Financial Services today to learn more about AHIP and Medicare required training.

Rob Valincius

Rob Valincius

Director of Sales - Health

x7701 | rvalincius@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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Pace & Pacenet

Pace & Pacenet

Pace & Pacenet

PACE and PACENET are a Pennsylvania funded and run program that helps Medicare eligible beneficiaries save money on their prescription drug costs. PACE stands for Pharmaceutical Assistance Contract for the Elderly while PACENET stands for PACE Needs Enhancement Tier. These programs are run by Pennsylvania’s Department of Aging.

In order to qualify for PACE, you need to meet the following eligibility requirements:

  • You must be 65 years of age or older.
  • A Pennsylvania resident for at least 90 days prior to the date of application.
  • You cannot be enrolled in the Department of Human Service’s Medicaid prescription benefit.
  • For a single person, total income must be $14,500 or less.
  • For a married couple, combined total income must be $17,700 or less.

In order to qualify for PACENET, you need to meet the following eligibility requirements:

  • You must be 65 years of age or older.
  • A Pennsylvania resident for at least 90 days prior to the date of application.
  • You cannot be enrolled in the Department of Human Service’s Medicaid prescription benefit.
  • PACENET income limits are slightly higher than those for PACE
  • For a single person, total income can be between $14,500 and $27,500
  • For a married couple, combined total income can be between $17,700 and $35,500

HOW PACE/PACENET WORKS WITH MEDICARE

PACE/PACENET is designed to help people that are 65 or older to qualify for pharmaceutical assistance. Unlike most state pharmaceutical programs, PA does not require the person to be enrolled into a Medicare Part D plan. PACENET members are encouraged to sign-up for a Part D plan as they will incur a $37.03 premium at the pharmacy each month if they do not have one. The generic copayments for PACE beneficiaries are $6 and $9 for brand name drugs. The beneficiaries for PACENET will have a $8 copayment for generic and $15 for brand name drugs.

Beneficiaries that are enrolled into the PACE/PACENET program are granted a one-time special election period (SEP) outside of the annual election period (AEP) or open enrollment period (OEP)during that year. This gives agents another opportunity to help get these beneficiaries into another plan that may best suit their needs. Pinnacle Financial Services has plenty of lead opportunities for this market which makes them an excellent lead source throughout the year.

How to Enroll in PACE/PACENET

You can do the following (via the state website):

  • CALL them- 1-800-225-7223
    (Make sure they have their income and insurance information available.)
  • Apply online via the state website
  • Fill out an application
  • Mail to
    • PACE/PACENET
      PO BOX 8806
      HARRISBURG PA
      17105-8806
  • Fax to 1-888-656-0372
  • E-mail the application to papace@magellanhealth.com

Contact Pinnacle Financial Services today to learn more about the Pennsylvania PACE/PACENET program.

Rob Valincius

Rob Valincius

Director of Sales - Health

x7701 | rvalincius@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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