Wellcare | New for 2023 AEP – Update to the VBE / HRA Process!

Wellcare | New for 2023 AEP – Update to the VBE / HRA Process!
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Attention Valued Partner,

We want to make you aware of some updates happening with the Value-Based Enrollment (VBE) process for Health Risk Assessment (HRA) completions.

New for 2023 AEP, you can earn a $75 administrative payment for completing an HRA for each completed MA/MAPD enrollment!

You can also earn a $125 administrative payment for completing an HRA for each eligible Dual-Eligible Special Needs Plan (DSNP) and Chronic Conditions Special Needs Plan (CSNP) enrollment, which remains the same as the current payment structure.

Also new for 2023, the HRA process will be integrated within Sunfire, as it currently is within Ascend. 

Summary of Changes

Administrative payments can be earned for successfully completing HRAs on all enrollment types:

  • $75 administrative payment for eligible MA/MAPD enrollments.*
  • $125 administrative payment for eligible DSNP/CSNP enrollments.
  • VBEs are limited to enrollments for Legacy Centene, Fidelis and Wellcare plans. Ascension Complete enrollments are not eligible.
  • All payment and process changes go into effect for 2023 effective enrollments, with the first administrative payment occurring in mid-November 2022.

*Please note: Call Center agents are not eligible to receive the $75 administrative payment for MA/MAPD HRAs.

Reminder

In order to receive payment credit, you must:

  • Fully complete the HRA.
  • Select the Submit button to complete the VBE process, if completing within Ascend.

We hope you find the updates helpful as you prepare for the 2023 AEP selling season.

As always, we thank you for your continued partnership!

For more information, contact a Pinnacle Financial Services representative today

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

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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
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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

Vice President | Marketing

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Annuities and Income in Retirement

Annuities and Income in Retirement

Annuities and Income in Retirement
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What is the best way to produce income in retirement? Do you rely on a company-sponsored retirement plan, your own Individual Retirement Account, a Pension, Social Security, Brokerage account, or rental income? How about an annuity and income in retirement? This consideration has many nuances to consider and is something that is different for each individual’s own circumstances. But the only solution that provides guaranteed income for life, like Social Security, is the annuity, as more and more pensions are being phased out or are non-existent.

Retirement Income

So, what does that mean by income in retirement? Well, in its basic form it is the transition from relying on a salary, or earnings to pay for the necessities of life, and now relying on income in retirement from savings, investments, possible rental income, or a new career or part-time work.

The considerations must be this. Do you need to strive for the highest accumulation now that you are approaching, or are already in retirement, or do you look for more guarantees? It is recommended that no matter what your personal circumstances are that a portion of your savings should provide a level of guarantees, and that would incorporate the annuity for income in retirement.

Retirement Replacement Income

A simple way to help determine your need is this. First register on www.sss.gov/myaccount. Once there you will be able to see your estimated benefit based on your FRA(Full retirement age). Once you have obtained this number determine how much of your pre-retirement salary you want to replace. Quick example: If you are making $100,00 a year, one example would be replacing 60%, or $60,000, or $5,000 a Month. You can now calculate how much you would need to put into the annuity to produce this amount for life. Now assess your fixed expenses and determine how much will come from Social Security, and how much additional you will need to feel comfortable from a living standpoint. If Social Security is exclusively being spent to take care of your fixed expenses, then you need the additional buffer that an annuity will provide for lifetime retirement income.

Retirement Costs

Whatever your circumstances are costs are going up not just to live. Healthcare, travel, and housing are just a few things that continue to increase. Having an annuity as a part of your retirement plan can give you the peace of mind necessary to outlive what you have saved.

If you need an expert to explain and suggest options with annuities that can provide the guaranteed income for life in retirement that a client or yourself would benefit from, contact the experts at Pinnacle Financial Services, to provide important insight and solutions.

For more information, contact a Pinnacle Financial Services representative today

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

Senior Sales Director | Life, Annuity, & LTC

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CMS.gov | 2023 Medicare Parts A & B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts

CMS.gov | 2023 Medicare Parts A & B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts

CMS.gov | 2023 Medicare Parts A & B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts
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On September 27, 2022, the Centers for Medicare & Medicaid Services (CMS) released the 2023 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2023 Medicare Part D income-related monthly adjustment amounts.

Medicare Part B Premium and Deductible

Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A. 

Each year the Medicare Part B premium, deductible, and coinsurance rates are determined according to the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $164.90 for 2023, a decrease of $5.20 from $170.10 in 2022. The annual deductible for all Medicare Part B beneficiaries is $226 in 2023, a decrease of $7 from the annual deductible of $233 in 2022.

The 2022 premium included a contingency margin to cover projected Part B spending for a new drug, Aduhelm. Lower-than-projected spending on both Aduhelm and other Part B items and services resulted in much larger reserves in the Part B account of the Supplementary Medical Insurance (SMI) Trust Fund, which can be used to limit future Part B premium increases. The decrease in the 2023 Part B premium aligns with the CMS recommendation in a May 2022 report that excess SMI reserves be passed along to people with Medicare Part B coverage.

Beginning in 2023, certain Medicare enrollees who are 36 months post kidney transplant, and therefore are no longer eligible for full Medicare coverage, can elect to continue Part B coverage of immunosuppressive drugs by paying a premium. For 2023, the immunosuppressive drug premium is $97.10.

Medicare Open Enrollment and Medicare Savings Programs

Medicare Open Enrollment for 2023 will begin on October 15, 2022, and ends on December 7, 2022. During this time, people eligible for Medicare can compare 2023 coverage options between Original Medicare, Medicare Advantage, and Part D prescription drug plans. In addition to the soon-to-be-released premiums and cost-sharing information for 2023 Medicare Advantage and Part D plans, the Fee-for-Service Medicare premiums and cost-sharing information released today will enable people with Medicare to understand their Medicare coverage options for the year ahead. Medicare health and drug plan costs and covered benefits can change from year to year, so people with Medicare should look at their coverage choices annually and decide on the options that best meet their health needs.

To help with their Medicare costs, low-income seniors and adults with disabilities may qualify to receive financial assistance from the Medicare Savings Programs (MSPs). The MSPs help millions of Americans access high-quality health care at a reduced cost, yet only about half of eligible people are enrolled. The MSPs help pay Medicare premiums and may also pay Medicare deductibles, coinsurance, and copayments for those who meet the conditions of eligibility. Enrolling in an MSP offers relief from these Medicare costs, allowing people to spend that money on other vital needs, including food, housing, or transportation. People with Medicare interested in learning more can visit https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/medicare-savings-programs.

Medicare Part B Income-Related Monthly Adjustment Amounts

Since 2007, a beneficiary’s Part B monthly premium is based on his or her income. These income-related monthly adjustment amounts affect roughly 7 percent of people with Medicare Part B. The 2023 Part B total premiums for high-income beneficiaries with full Part B coverage are shown in the following table:

For more information, contact a Pinnacle Financial Services representative today

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

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Aetna |  CMS final rule requirements | New D-SNP HRA amount | Video podcasts and more

Aetna | CMS final rule requirements | New D-SNP HRA amount | Video podcasts and more

Aetna | CMS final rule requirements | New D-SNP HRA amount | Video podcasts and more
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brokernews

Your source for Aetna Medicare broker news and information

September 22, 2022

New and noteworthy

Earn a $110 administrative fee if your new D-SNP member completes the HRA 

New for 2023 AEP, you can earn a $110 administration fee for completing a health risk assessment (HRA) with eligible D-SNP enrollments through the Think Agent tool. Available for field sales agents only.

You can also earn a $70 administration fee for completing the HRA with MA/MAPD enrollments, which is the same as last year. Please note that HRAs will be paid on issued sales only. 

Remember, starting October 1, you must record calls with beneficiaries and incorporate a new disclaimer statement

As outlined in the 2023 CMS Final Rule released earlier this year, starting October 1, agents are required to record calls with beneficiaries related to Medicare Advantage (MA, MAPD, D-SNP) and Prescription Drug Plans, and incorporate a new disclaimer.

Sales info

Are you ready to sell for 2023?

Think Agent is your electronic enrollment tool and so much more for 2023 AEP

Think Agent is Aetna’s new electronic enrollment app that offers an optimized enrollment experience for you and your clients. There’s a website version and an app version that you can use on any mobile device, even your cell phone

Order and use the correct formularies with 2023 enrollment kits

When ordering 2023 enrollment kits, please order all formularies recommended with the selected enrollment kits at checkout.

Why is this important? In some cases, because of how the formularies are titled, it may seem like you’re ordering duplicates. For example, you may see two B2 formularies or two B4 formularies. In these cases, one of the formulary versions is for plans participating in the Insulin Savings Program and one is for those that aren’t. All formularies shown with your selected enrollment kits should be ordered.

How can you tell which formulary corresponds to plans participating in the Insulin Savings Program?

Marketing

Guidelines for assisting your clients prior to October 1

As you know, AEP runs from October 15 to December 7. The first day you can begin marketing 2023 plans is October 1. Before October 1, you’re prohibited from discussing 2023 plans or plan changes with your existing clients or with prospects. Additionally, you may not accept, collect or take possession of a completed AEP enrollment application prior to October 15.

Access 2023 sales presentations

This year, you have several options for presenting Aetna’s consumer-facing sales presentation at sales events and beneficiary meetings starting October 1. You can use a traditional PowerPoint presentation format or share the video version. There is also a PDF version with speaker notes.

NOTE: All of these versions are CMS-approved and cover all required topics. To remain compliant, it is very important you do not add to, remove, or alter anything in the presentations.

2023 MA/MAPD sales PowerPoint presentation (English version)

2023 MA/MAPD sales presentation VIDEO (13 mins)

Start marketing your business with social media

Want to use social media to grow your business, but not sure where to start? Get tips from the pros! Below, watch new episodes focused on social media from our video podcast series Successful Sales Solutions.

Compliance reminders

Sales and marketing tips to stay compliant with this AEP

Tip #1: Explain to prospects about the Part D formulary and drug coverage rules. Pharmacy terms are very confusing to consumers. 

To help them:

Tip #2: If you use a sign-in sheet for in-person meetings, be sure to use the one on Producer World. It is optional if a prospect or member provides their contact information. It is against CMS rules to verbally request any type of personal contact information and ask beneficiaries to sign in. CMS considers this pressuring for personal information.

For more information, contact a Pinnacle Financial Services representative today

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

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
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Wellcare | Important CMS Regulatory Update: New Call Recording and TPMO Disclaimer Requirement

Wellcare | Important CMS Regulatory Update: New Call Recording and TPMO Disclaimer Requirement
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Attention Valued Partner,

We would like to inform you of new requirements for Third-Party Marketing Organizations (TPMO)resulting from a recent ruling made by the Centers for Medicare and Medicaid Services (CMS). All of the following new requirements go into effect on October 1, 2022.

Please review the following sections to learn more about each new CMS requirement.

Telephonic Recordings

Beginning October 1, 2022, for all 2023 activities, all TPMOs, including all third-party marketing/lead generation vendors, agencies, 1099 agents, and brokers (captive, independent street brokers, TeleDigital agents, etc.), will be required to record all beneficiary calls (sales, enrollment, administrative, etc.) – inbound and outbound – in their entirety, with no exception. Other important requirements:

  •  Applies to all telephonic activities, even if it does not result in enrollment.
  • The requirement applies to all beneficiaries and members. There is no distinction made between new and existing clients.
  • Consent to the record must be obtained for all calls.
  • Recordings are not required for in-person activities.
  • Medicare requires all records be maintained for 10 years.

Remote Agent Telephonic Enrollment (RATE) through Ascend will be updated to include outbound call recording functionality. Recordings may be captured outside of Ascend but must comply with all relevant regulations and laws (consent, retention, producibility, etc.).   

TPMO Disclaimer Language

Beginning October 1, 2022, the TPMO Disclaimer must be used by any TPMO that sells plans on behalf of more than one MA plan provider unless the TPMO sells all commercially available MA plans in a given service area. The disclaimer must be:

  • Verbally conveyed within the first minute of a sales call.
  • Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication (regardless of content).
  • Prominently displayed on TPMO websites (regardless of content).
  • Included in any marketing materials, including print materials and television advertisements, developed, used, or distributed by the TPMO.

Lead Generation Activities

Beginning October 1, 2022, lead-generating activities (either directly or indirectly) facilitated by a TPMO will need to include a notice to the beneficiary that their information may be shared with a licensed agent for future contact. The disclosure must be provided:

  • Verbally when communicating with a beneficiary through telephone.
  • In writing when communicating with a beneficiary through mail or other paper.
  • Electronically when communicating with a beneficiary through email, online chat, or another electronic messaging platform.
  • When beneficiary information is requested or collected (e.g., web forms, consent to contact, etc.), a call transfer will take place.

The disclosure must also be made to the beneficiary that he or she is being transferred to a licensed agent who can enroll them into a new plan.

Oversight & Reporting

To fully comply with the new CMS requirements, TPMOs must:

  • Report to the plans monthly any staff disciplinary actions associated with beneficiary interaction.
  • Report all violations made by TPMOs of those rules that apply to the plans.
  • Make available all enrollment lead sources to the Plan upon request.
  • Disclose any subcontracted relationships used for marketing, lead generation, and enrollment.

New 2023 TPME Contracts

As required by CMS, the 2023 Centene Third-Party Marketing Entity (TPME) contracts include the new TPMO contract requirements. No future action is needed if you have already signed the 2023 contract. In order to be considered Ready To Sell (RTS) with Centene/Wellcare, the 2023 Centene TPME contract must be signed.

The new contract updates relating to TPMO requirements include:

  • Disclosure of any subcontracted relationships used for marketing, lead generation, and enrollment.
  • The requirement to record all beneficiary calls in their entirety.
  • Report to the plans monthly any staff disciplinary actions associated with beneficiary interaction.
  • Report all violations made by TPMOs of those rules that apply to the plans.
  • Applicable TPMO marketing disclaimer/disclosure. 
For more information, contact a Pinnacle Financial Services representative today

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

Contact a Pinnacle Representative if you have any questions.

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

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