Today’s edition has information on the following topics:

• OEP Best Practices – Navigate MA OEP with strategies for success
• Formulary Search – Find formularies with fast and accurate searches
• DST-SEP Review – Brush up on Disaster Special Enrollment Periods
• Broker Resources – Bookmark these links for ongoing sales success

MA OEP Best Practices

Navigating the do’s and don’ts for activities during the Medicare Advantage Open Enrollment Period (OEP) can make all the difference between surviving or thriving year-round. Understanding the rules and leveraging your knowledge throughout the period can help set you up for your most successful year yet.

Start by reviewing some of the do’s and don’ts for marketing and sales activities:

Learn more about allowed and disallowed MA OEP marketing activities by reviewing the Medicare Advantage Open Enrollment Period Marketing Guidelines.

Key Features

• Low-Income Subsidy (LIS) plans are specifically designed to complement the government’s LIS program.
• More meaningful medical and supplemental benefits focus on members’ overall health, as prescription needs are addressed by the subsidy.
• Ideal for beneficiaries who receive Extra Help for Part D from the government, but do not qualify for a zero cost-share D-SNP, and are seeking richer benefits than those offered by a $0 premium plan.
• Additional competitive benefits are available in full dual eligibility plans as well.
• NEW for 2024 – Beneficiaries with incomes up to 150% of Federal Poverty Guidelines, and resources at or below the limits for partial LIS benefits, are now eligible for full LIS benefits.

Please note that it is important to fully understand LIS status at the point of enrollment in order to properly articulate premium, deductible and copays, and select the best plan match for your member.

More information about Wellcare LIS plans is available in the resources below:

LIS Fact Sheet

LIS Product Overview Video

As always, thank you for your continued partnership!

Take a few moments to review highlights for some of the key selling features of our 2024 Push Plans and how they complement unique beneficiary needs:

• $0 or low-premium plans – Value-conscious shoppers will appreciate the monthly cost savings these plans offer while still supplying a variety of extra benefits.
• D-SNP plans – Medicare and Medicaid dually eligible participants may choose these plans which all include the Wellcare Spendables™ benefit card and $0 prescription drugs.
• LIS plans – Beneficiaries receiving the Low-Income Subsidy and those with certain chronic medical conditions qualify for these plans featuring a Medicare Part B premium giveback option.
• Patriot plans – Premium giveback or no premium options make these plans a good fit for veterans or others who may have their prescription drugs covered by another source.
• HMO, HMO-POS and PPO plans – Members can choose the type of network that best fits their needs, with options that offer in-network or out-of-network cost share flexibility when choosing between these plans.
• PDP plans – Beneficiaries wishing to stay with original Medicare but still obtain lower drug out-of-pocket costs may need a stand-alone prescription drug plan.

Note: Not all plans are available in every state. Please visit WellcareFirstLook.com to view the plan details and individual key selling features, found at the top of each sub-region page, for the plans available within a specific market.

With AEP upon us, we are delivering the Wellcare Insider: AEP Edition to you each week. This weekly update will continue to be your source for important updates and reminders, with AEP news you can use to provide excellent service and grow your business.

Today’s edition has information on the following topics:

• Star Rating Action Needed – Update materials and review new CMS ratings
• RFI Resolution – Know the process for quickly resolving information requests
• LinkedIn Group for Agents – Join the Wellcare Brokers Forum on LinkedIn
• HRA Member Benefits – Help your members achieve their health goals
• Important Links – Bookmark the tools you need for a great sales season

Important Correction – Pharmacy Updates Communication

Our Nov. 6 communication featuring pharmacy updates and reminders included a list of covered insulin products but did not denote those with restrictions such as covered on MAPD plans only, or non-formulary for Classic PDP plan only. 

Our comprehensive 2024 List of Covered Insulin Products, with all guidelines and restrictions, is included in this Part D Coverage of Insulin for MAPD & PDP resource.

CMS Star Ratings Action Needed

As recently communicated, the 2024 CMS Star Ratings for all Wellcare plans are now available. The updated ratings are required to be included in all plan materials distributed on or after Nov. 1, 2023.

Review the 2024 CMS Star Ratings

Take a moment to review the 2024 CMS Star Ratings for the plans you serve. Achieving positive quality ratings is vital. These ratings are crucial to our members, brokers, and partners, and to our overall growth at Wellcare. With increased CMS focus on patient experience and access to care, we must continue to put our members first and empower them to partner with their providers to make good healthcare decisions. Your role as the member’s trusted advisor is more important than ever as you guide and support them in their best plan match.

Verify sales materials are current:

• Ensure that you have now replaced the 2023 CMS Star Rating documents within your existing inventory of sales enrollment kits with the new 2024 CMS Star Ratings documents.
• Be sure to dispose of any outdated 2023 CMS Star Rating documents. However, you can still utilize Enrollment Guides if accompanied with the updated ratings.

Resolving Requests for Information (RFI)

Request for Information (RFI) status occurs when a submitted application is either incomplete or contains incorrect information. To avoid processing delays or application denial, please ensure you provide accurate and complete information.

You will be informed through email and text message if you have applications in RFI status. Please be on the lookout for these notifications and act promptly to resolve them. There are two ways to resolve outstanding RFIs:

1. Create a Centene Workbench Support ticket on Centene Workbench, using the Enrollment ticket type and RFI sub-type.
2. Contact Broker Support at 866-822-1339 and select prompt 3. Note: Prior to calling Broker Support, please have all required information to resolve the RFI (e.g., NPN, Beneficiary Information – MBI, First Name, Last Name, DOB). Important: RFIs must be resolved within 21 days of application receipt from the member, or the application will be denied.

The RFI Resource Page contains further instructions on how to resolve RFIs.

Wellcare Brokers Forum on LinkedIn

Have you joined the Wellcare Brokers Forum, our LinkedIn Group just for Wellcare agents? This group was designed as a place where our brokers can connect and engage with one another, and to share your challenges, successes, best practices and solutions.

How to Join

Joining the group is easy – just follow this link and click the Join button on the page. Our group admins will be notified of your request to join, and then admit you into the group. Tip: Be logged in to LinkedIn on your device before clicking to join.

Get Involved

• Post a pic – Photos of events or gatherings are a terrific way to engage others.
• Ask a question – Curious how other brokers go about building their business? Seek insights from your peers. Tip: Be specific about the topic, then ask for thoughts in the comments.
• Say hello – Introducing yourself is a quick and easy way to get a conversation started.
• Comment on a post – Chime in with replies or questions on other group members’ posts, keeping the dialogue flowing and the connections growing.

HRAs Improve Health Outcomes for Members

Health Risk Assessments (HRA) are a valuable tool for improving the overall health of our members. In addition to identifying health needs to ensure beneficiaries are receiving the right care at the right time, HRAs also play an important role in understanding the overall patient population with the goal of improving personalized and targeted care for all.

Help your members to understand some of the valuable benefits for them in completing an HRA at the time of enrollment:

Personalized Care – Completing an HRA provides a tailored assessment of your member’s health and risk factors. This information can be used to create a personalized care plan that will address each of the member’s needs.

Health Education – HRAs provide an opportunity for members to learn more about behaviors that influence improved health, such as preventative care, healthy lifestyle choices, and how best to manage chronic conditions.

Increased Satisfaction – Completing an HRA with your member allows them the opportunity to share more about their health and lifestyle with you, reinforcing your relationship as a trusted advisor to your member.

Completing an HRA is quick and easy, and can be captured directly within the Ascend Enrollment Platform or Sunfire after the enrollment is submitted using the integrated tool.  

Learn more about completing an HRA after enrollment by reviewing the Ascend 2024 Integrated and Standalone Value Based Enrollment Training.

Resources Available

• Over-the-Counter Catalogs
• Sales Presentation Videos
• Pre-Enrollment Guides
• Benefit Highlights
• Comprehensive Formularies
• Formulary Search Tools
• NEW! Scope of Appointments
• NEW! Paper Enrollment Applications
• Coming Soon! CMS Star Ratings

Added for 2024, highly requested member materials for agent use:

• NEW! Evidence of Coverage
• NEW! Summary of Benefits

We hope that you find these resources beneficial for all of your sales efforts throughout this AEP season and beyond.

As always, thank you for your continued partnership!