2025 Part D Changes

2025 Part D Changes

2025 Part D Changes
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For the plan year 2025, CMS has announced some massive changes to the Part D program. These changes are in an effort to both streamline and simplify the Part D program for seniors.

Key Changes for 2025

Some of the key changes for 2025 for the part D program include:

  1. Removal of the Donut Hole (Gap Phase) and Initial Coverage Phase- These 2 are being merged together and will be now referred to as the “Standard Coverage Phase.” This condenses the Part D program from 4 phases to 3 (Deductible, Standard, Catastrophic).
  2. The Annual Out of Pocket (OOP) threshold is now $2,000 (changing from the current $8,000) TrOOP.
  3. The sunsetting of the Coverage Gap Discount Program (CGDP) and the establishment of the Manufacturer Discount Program. This will impact what drugs receive discounts, how they are counted towards the $2,000 OOP, and who is responsible for the cost beyond the set amount.

Where does Pinnacle Financial Services come in?

Pinnacle Financial Services is a full-service “FMO” that will always keep you in the know on industry changes. Medicare is always changing yearly and it’s best to understand new rules and regulations. Outside of the industry knowledge, Pinnacle has full-service back office support, top-notch training, and the best technology in the business. Don’t hesitate and call us today about an exclusive opportunity to market an IE-SNP product!

Check out the 2025 CMS Final Rule regulations proposed Here.

For more information, contact a Pinnacle Financial Services representative today

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

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Devoted | Boost your sales with our marketing storefront

Devoted | Boost your sales with our marketing storefront

Devoted | Boost your sales with our marketing storefront
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Tools to help you win big

Don’t miss out on our marketing storefront. It has easy-to-use tools for your agency and agents to drive sales year-round – including co-branded assets that can be customized with your logo.

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Wellcare | Sales Compensation

Wellcare | Sales Compensation

Wellcare | Sales Compensation
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Wellcare Realigns Health Risk Assessment Program Effective

April 1, 2024

To support quality improvement, retention, and effectuation initiatives, Wellcare will change its payment of all D-SNP and C-SNP Health Risk Assessments (HRAs) to effectuation versus submission effective April 1, 2024.

This change applies to D-SNP and C-SNP HRAs completed in both Ascend and Sunfire on or after April 1 and for members with an effective date of May 1 and forward. Additionally, Wellcare will update its administrative payment amounts effective on the same date.

Key Change Highlights 

WellCare’s new plan will change the current administrative payment amounts to:

  • $150 for Special Needs Plans (D-SNPs and C-SNPs) HRA completion payments on effectuated members for 1099 partners.
  • Removal of payment for non-SNP HRA completion.

HRAs can be completed up to 90 days after the application submission date. 

Learn More

For HRA program questions, please take a few moments to view our helpful HRA Announcement Video and Transcript and review the HRA Program Realignment FAQ.

If you have additional questions about this change, please contact your local Sales Leader.

For more information, contact a Pinnacle Financial Services representative today

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

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Wellcare | Sales Compensation

Wellcare | Realignment of Health Risk Assessment Program Effective April 1, 2024

Wellcare | Realignment of Health Risk Assessment Program Effective April 1, 2024
Comments

To support quality improvement, retention, and effectuation initiatives, Wellcare will change its payment of all D-SNP and C-SNP Health Risk Assessments (HRAs) to effectuation versus submission effective April 1, 2024.

This change applies to D-SNP and C-SNP HRAs completed in both Ascend and Sunfire on or after April 1, and for members with an effective date of May 1 and forward. Additionally, Wellcare will update its administrative payment amounts effective on the same date.

Key Change Highlights 

Wellcare’s new plan will change the current administrative payment amounts to:

  • $150 for Special Needs Plans (D-SNPs and C-SNP) HRA completion payments on effectuated members for 1099 partners.
  • Removal of payment for non-SNP HRA completion.

HRAs can be completed up to 90 days after the application submission date. 

For helpful HRA program questions, please review the HRA Program Realignment FAQ. If you have additional questions about this change, please contact your local Sales Leader.

As always, thank you for your valued partnership!

For more information, contact a Pinnacle Financial Services representative today

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

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Understanding Dental Benefits in Medicare: A Simple Guide

Understanding Dental Benefits in Medicare: A Simple Guide

Understanding Dental Benefits in Medicare: A Simple Guide
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Medicare is health insurance for people 65 or older. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). 

Some people get Medicare automatically, others have to actively sign up — it depends if you start getting retirement or disability benefits from Social Security before you turn 65. 

It comprises various components, each of which addresses a distinct health requirement, much like puzzle pieces. We’re delving into Medicare’s treatment of dental benefits today, with a particular emphasis on Parts A and B and Medicare Advantage.

What are Parts A and B of Medicare?

On a high-level view, most of Part A is devoted to hospital insurance, skilled nursing care, and hospice care. Part B is dedicated to services from doctors and outpatient care.

Do Medicare Parts A & B Cover Dental?

This is where dental care can get a little complicated. Medicare Parts A and B typically do not cover routine dental care, including dental exams, cleanings, fillings, dentures, and the majority of tooth extractions.

There are a few exceptions, though. For instance, Part A might pay for dental care if you require it while in the hospital as part of a more extensive treatment plan. Consider that you are undergoing jaw surgery and that the procedure includes dental work. Since it’s seen as a component of your overall medical care in this instance, Medicare may be able to assist with the costs.

What About Medicare Advantage?

Things start to look up from here. Medicare Advantage Plans, sometimes referred to as Part C, are essentially an enhanced version of the original Medicare program. Medicare-approved private insurance providers provide these plans. One of its features is that many Medicare Advantage plans provide dental insurance. Keep in mind that Medicare Advantage Plans are not required to cover more than original Medicare Parts A and B, so not every MA plan will have dental.

Dental treatment for more involved procedures like crowns, bridges, and dentures as well as more basic procedures like cleanings, exams, X-rays, and fillings can be included in a Medicare Advantage Plan. It’s crucial to remember, though, that dental coverage varies greatly among Medicare Advantage plans. While some provide basic dental care, others might offer more extensive coverage.

Stand-alone Dental Coverage

Because they recognize how important dental health is, many Medicare beneficiaries inquire about dental coverage.  This is the point at which you can begin the dental coverage discussion through a stand-alone supplemental (stand-alone) dental plan.  There are numerous options, as well as dental insurance providers. Each plan offers a variety of coverage options, such as exams, cleanings, fillings, and other dental operations. It is important for beneficiaries to understand that dental plans work well only when they receive dental treatment from in-network providers. As an agent, you must confirm that the dentist they are thinking about is covered under that particular dental plan.

 

Delta Dental

Pinnacle Financial offers several options for stand-alone dental insurance. One such option, Delta Dental, is well-known for its strong network and benefits. Delta is also available in all 50 states and covers a wide variety of preventative and major services.  This can be a great option for individuals who have a Medicare Supplement plan as they do not cover any dental insurance.

To learn more about the different plan options available to your clients, contact a Pinnacle Financial Services team member today. They can be reached at 800-772-6881 x-7731 or by email at healthsales@pfsinsurance.com.

For more information, contact a Pinnacle Financial Services representative today

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

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