Subject: Suspension of implementation of June 5, 2009 HPMS memo on agent/broker compensation;
Impending guidance on criteria for paying initial compensation fees in 2009
Suspension of Implementation of June 5, 2009 HPMS Memo on Agent/Broker Compensation: CMS has received feedback concerning the agent and broker compensation requirements in our June 5, 2009 HPMS memorandum titled "2009 Medicare Advantage and Prescription Drug Program Agent and Broker Compensation Refinements and Compensation Rate Adjustment for 2010." While we evaluate the issues and concerns being raised, we are suspending the implementation of these requirements. We expect to issue clarifying guidance shortly.
Impending Guidance on Criteria for Paying Initial Compensation Fees in 2009: CMS has received feedback about confusion on whether agents and brokers should be paid an initial compensation fee for 2009 enrollments from a PDP to an MA plan. We believe our regulatory guidance is clear that for 2010 agents and brokers should be paid an initial fee for enrollments from a PDP to an MA plan. CMS is examining its guidance pertaining to 2009 enrollments and expects to release additional guidance shortly. Plans should contact their agents and brokers to inform them that CMS is reconsidering its guidance for 2009 and expects to release additional guidance shortly.
Monday, June 29, 2009
Friday, June 26, 2009
How do US Healthcare Proposals Compare?
FACTBOX: How Do U.S. Healthcare Proposals Compare?
Wed Jun 24, 2009 10:53am EDT
(Reuters) - U.S. President Barack Obama said in an interview aired on Wednesday that he "absolutely" will get healthcare reform completed in 2009 but declined to say what the final package would eventually look like.
Lawmakers in Congress are working on at least three draft versions of proposals to overhaul the U.S. healthcare system.
In the House of Representatives, three committees have joined together to produce one draft House bill.
In the Senate, the Health, Education, Labor and Pensions (HELP) Committee has started work on a second Democratic proposal, while the Senate Finance Committee is in closed-door negotiations over a possible third healthcare bill that would win bipartisan support.
Here is a summary comparing the various bills.
INSURANCE MARKET REFORMS
* Both the House and Senate bills call for sweeping insurance market reforms.
*The House bill would set up a new government plan to compete with private companies. The Senate HELP panel bill leaves this open for later consideration.
* The Senate Finance Committee, chiefly to address Republican concerns, is instead looking at creating non-profit medical co-operatives to compete with insurers.
* All individuals would be required to obtain insurance under all of the bills.
*The Senate HELP bill leaves open the issue of employer responsibility. The House bill would require employers to pay an 8 percent of payroll "fee" if they choose not to provide health benefits to workers. The Senate Finance Committee is looking at requiring employers to pay a fee if their workers are insured by Medicaid or obtain federally subsidized coverage in the proposed insurance exchange.
* All the bills bar insurance companies from refusing to cover people or charging them more because of health history or gender. All the bills place some limits on insurance premiums.
* Insurers in all bills would be required to cover some preventive services.
* All the bills include caps on out-of-pocket expenses. The Finance Committee bill is expected to do the same.
INSURANCE GATEWAY OR EXCHANGE
* The House and Senate Finance bills would both create state insurance exchanges to act as clearing houses for individuals and small businesses to buy insurance.
* The Senate HELP committee bill proposes similar exchanges called "gateways."
*The HELP bill includes temporary reinsurance funding to help employers make medical coverage available for retirees between the ages of 55 and 64 until their state establishes a gateway.
* A proposed new public plan, or co-op, would be offered as an option available in the gateway.
OTHER COVERAGE PROVISIONS
* The HELP bill includes a sliding scale of subsidies for the purchase of insurance for people with incomes up to 500 percent of the poverty level. The Senate Finance bill would scale that back to 300 percent of the poverty level, about $66,150 for a family of four.
* Millions more people would become eligible for state Medicaid health plans for the poor. People with incomes up to 150 percent of the poverty level would be able to get Medicaid under Senate HELP bill. The Senate Finance and House bills put the level at 133 percent of poverty.
* A new support service for disabled, homebound and institutionalized people would be set up in the Senate HELP bill.
* All bills include incentives for employers to automatically enroll workers into offered health plans.
* All bills include prevention and wellness incentives.
* All bills include provisions to improve quality of healthcare in the Medicare program for the elderly. Payments to be designed to encourage quality, not quantity of services.
(Compiled by Donna Smith; Editing by Eric Walsh)
Wed Jun 24, 2009 10:53am EDT
(Reuters) - U.S. President Barack Obama said in an interview aired on Wednesday that he "absolutely" will get healthcare reform completed in 2009 but declined to say what the final package would eventually look like.
Lawmakers in Congress are working on at least three draft versions of proposals to overhaul the U.S. healthcare system.
In the House of Representatives, three committees have joined together to produce one draft House bill.
In the Senate, the Health, Education, Labor and Pensions (HELP) Committee has started work on a second Democratic proposal, while the Senate Finance Committee is in closed-door negotiations over a possible third healthcare bill that would win bipartisan support.
Here is a summary comparing the various bills.
INSURANCE MARKET REFORMS
* Both the House and Senate bills call for sweeping insurance market reforms.
*The House bill would set up a new government plan to compete with private companies. The Senate HELP panel bill leaves this open for later consideration.
* The Senate Finance Committee, chiefly to address Republican concerns, is instead looking at creating non-profit medical co-operatives to compete with insurers.
* All individuals would be required to obtain insurance under all of the bills.
*The Senate HELP bill leaves open the issue of employer responsibility. The House bill would require employers to pay an 8 percent of payroll "fee" if they choose not to provide health benefits to workers. The Senate Finance Committee is looking at requiring employers to pay a fee if their workers are insured by Medicaid or obtain federally subsidized coverage in the proposed insurance exchange.
* All the bills bar insurance companies from refusing to cover people or charging them more because of health history or gender. All the bills place some limits on insurance premiums.
* Insurers in all bills would be required to cover some preventive services.
* All the bills include caps on out-of-pocket expenses. The Finance Committee bill is expected to do the same.
INSURANCE GATEWAY OR EXCHANGE
* The House and Senate Finance bills would both create state insurance exchanges to act as clearing houses for individuals and small businesses to buy insurance.
* The Senate HELP committee bill proposes similar exchanges called "gateways."
*The HELP bill includes temporary reinsurance funding to help employers make medical coverage available for retirees between the ages of 55 and 64 until their state establishes a gateway.
* A proposed new public plan, or co-op, would be offered as an option available in the gateway.
OTHER COVERAGE PROVISIONS
* The HELP bill includes a sliding scale of subsidies for the purchase of insurance for people with incomes up to 500 percent of the poverty level. The Senate Finance bill would scale that back to 300 percent of the poverty level, about $66,150 for a family of four.
* Millions more people would become eligible for state Medicaid health plans for the poor. People with incomes up to 150 percent of the poverty level would be able to get Medicaid under Senate HELP bill. The Senate Finance and House bills put the level at 133 percent of poverty.
* A new support service for disabled, homebound and institutionalized people would be set up in the Senate HELP bill.
* All bills include incentives for employers to automatically enroll workers into offered health plans.
* All bills include prevention and wellness incentives.
* All bills include provisions to improve quality of healthcare in the Medicare program for the elderly. Payments to be designed to encourage quality, not quantity of services.
(Compiled by Donna Smith; Editing by Eric Walsh)
Wednesday, June 24, 2009
Weekly Industry Update
As promised, below you will find our weekly industry/company updates in the MA, Med Supp, and insurance industry as a whole. Please let one of our marketers know if you have any questions at all. Thanks!
WEEKLY UPDATE…
Our #1 goal at SMS is to keep you, the agents, informed and up-to-date with what is going on in our industry and within our company.
As new updates and information becomes available regarding the MA industry and the upcoming sales season, we will forward them to you promptly. Here is what we know right now:
1. 2010 MA Plan Previews are coming soon… if you would like to see the plans as they become available, please make sure we have a the most current email and phone number on file for you. Also check our website daily for any pertinent information.
2. Coventry has announced much of their PPO/HMO county expansions. Call us for details specific to your county.
3. CMS has announced their interpretation of the “true-up” commission guidelines. See the attached document for the companies announcements. As an industry we are out-raged with this new announcement and all of us should be very vocal about this newest decision.
4. With the recent announcements by several carriers to withdraw from the PFFS market, this leaves Hundreds of Thousands of clients losing their coverage January 1st. We have several options and plans to help those people. We are putting together an options guide for our agents. This will allow you quick and easy access to the 4 pathways your clients can choose from.
a. Switch to a PPO/HMO in their county
b. Switch to another carriers PFFS
c. Switch back to Original Medicare and take out a Medicare Supplement Plan (A, B, C, F, K, L are all guaranteed issued if you client is losing their PFFS coverage due to a pulled product)
d. Switch back to Original Medicare and take out a separate Hospital Plan.
Let’s not forget about the two great products Equitable Life has to offer, EquiCash Hospital Plan and CancerCare+. SMS has just completed client presentation templates for each product. If you would like us to send them your way please email charli@smsteam.net.
Last, but not least, we are very proud to introduce our newest sales associate to you, Dan Mangus. Here at SMS we have known Dan for many years. We have worked with him and his SE Missouri agency on many many projects over the years. Dan will be our sales leader for the Sterling Life, Living Legacy product. As we continue to kick this product off across the country, the enthusiasm for this product is overwhelming and we recognized the need for someone with a strong background in sales and agent support to take the lead with this product.
Again, please let us know if you have any questions, need any supplies, or have any projects you need help on.
WEEKLY UPDATE…
Our #1 goal at SMS is to keep you, the agents, informed and up-to-date with what is going on in our industry and within our company.
As new updates and information becomes available regarding the MA industry and the upcoming sales season, we will forward them to you promptly. Here is what we know right now:
1. 2010 MA Plan Previews are coming soon… if you would like to see the plans as they become available, please make sure we have a the most current email and phone number on file for you. Also check our website daily for any pertinent information.
2. Coventry has announced much of their PPO/HMO county expansions. Call us for details specific to your county.
3. CMS has announced their interpretation of the “true-up” commission guidelines. See the attached document for the companies announcements. As an industry we are out-raged with this new announcement and all of us should be very vocal about this newest decision.
4. With the recent announcements by several carriers to withdraw from the PFFS market, this leaves Hundreds of Thousands of clients losing their coverage January 1st. We have several options and plans to help those people. We are putting together an options guide for our agents. This will allow you quick and easy access to the 4 pathways your clients can choose from.
a. Switch to a PPO/HMO in their county
b. Switch to another carriers PFFS
c. Switch back to Original Medicare and take out a Medicare Supplement Plan (A, B, C, F, K, L are all guaranteed issued if you client is losing their PFFS coverage due to a pulled product)
d. Switch back to Original Medicare and take out a separate Hospital Plan.
Let’s not forget about the two great products Equitable Life has to offer, EquiCash Hospital Plan and CancerCare+. SMS has just completed client presentation templates for each product. If you would like us to send them your way please email charli@smsteam.net.
Last, but not least, we are very proud to introduce our newest sales associate to you, Dan Mangus. Here at SMS we have known Dan for many years. We have worked with him and his SE Missouri agency on many many projects over the years. Dan will be our sales leader for the Sterling Life, Living Legacy product. As we continue to kick this product off across the country, the enthusiasm for this product is overwhelming and we recognized the need for someone with a strong background in sales and agent support to take the lead with this product.
Again, please let us know if you have any questions, need any supplies, or have any projects you need help on.
Medicare Advantage SEP
I've come across many agents lately that are confused about when they can and can't sell Medicare Advantage. Some think they can only sell it during Annual Enrollment Period and some think you can sell it any time of the year.
For the most part, Medicare Advantage plans are sold during either Annual Enrollment Period or Open Enrollment Period, which runs from November 15 of each year to March 31. However, there are many cirucumstatnces that allow a client to have a Special Election Period during the rest of the year.
If you're not sure of what would constitute an Special Election Period, please contact us. You can call us at 800-689-2800, email us at charli@smsteam.net or visit our website at www.smsteam.net.
For the most part, Medicare Advantage plans are sold during either Annual Enrollment Period or Open Enrollment Period, which runs from November 15 of each year to March 31. However, there are many cirucumstatnces that allow a client to have a Special Election Period during the rest of the year.
If you're not sure of what would constitute an Special Election Period, please contact us. You can call us at 800-689-2800, email us at charli@smsteam.net or visit our website at www.smsteam.net.
Tuesday, June 23, 2009
Sterling Life Offers Your Clients a Way to Leave a Lasting Legacy
Remember when you were young and checked the mail on your birthday? You were looking for that special card from your grandparents or favorite aunt and uncle. The one that always had a check made out to you in it. You felt a little extra loved when you received that check.I know many people who would love to be able to leave that "extra loved" feeling for their loved ones after they pass.
Sterling Life now allows you to do that with a revolutionary new product.Your clients can choose a loved one, a favored charity, their church, or any organization to receive a check each year on the date of their choice. The check will come in the mail, along with a card, chosen by your client. They can choose to have the gift sent for 10 years or for 20 years after they pass.
What better way to leave a lasting legacy? To be remembered years after you're gone? To keep the memory of you alive in a loved one's heart?The best thing is how affordable this is.
Here's an example:
Mary Sullivan would like to provide a loving legacy for each of her three grandchildren, Bobby, Christy and Chad. She choose to leave each one a gift each year of $200 for ten years after her passing. Mary's monthly premium would only be $25.59 per month!
If you'd like to get more information on this product, please visit our website at www.smsteam.net, give us a call at 800-689-2800 or email us at charli@smsteam.net.
Sterling Life now allows you to do that with a revolutionary new product.Your clients can choose a loved one, a favored charity, their church, or any organization to receive a check each year on the date of their choice. The check will come in the mail, along with a card, chosen by your client. They can choose to have the gift sent for 10 years or for 20 years after they pass.
What better way to leave a lasting legacy? To be remembered years after you're gone? To keep the memory of you alive in a loved one's heart?The best thing is how affordable this is.
Here's an example:
Mary Sullivan would like to provide a loving legacy for each of her three grandchildren, Bobby, Christy and Chad. She choose to leave each one a gift each year of $200 for ten years after her passing. Mary's monthly premium would only be $25.59 per month!
If you'd like to get more information on this product, please visit our website at www.smsteam.net, give us a call at 800-689-2800 or email us at charli@smsteam.net.
Monday, June 22, 2009
CMS Releases News on Medicare Advantage "True Up" Commissions
Like you, we have been eagerly awaiting the report from CMS regarding the "true-up" of the 2nd half of your Medicare Advantage commissions.
We have just been informed that CMS is now saying that someone who had a stand alone PDP adn enrolled in a MA or MAPD in 2009 would only be considered a "renewal" and not "new business". This means that the agent will not receive the 2nd half of their commission on these clients.
We are working with the carriers to fight this and will keep you posted!
If you have any questions on any of this, please give us a call at 800-689-2800 or email us at charli@smsteam.net.
We have just been informed that CMS is now saying that someone who had a stand alone PDP adn enrolled in a MA or MAPD in 2009 would only be considered a "renewal" and not "new business". This means that the agent will not receive the 2nd half of their commission on these clients.
We are working with the carriers to fight this and will keep you posted!
If you have any questions on any of this, please give us a call at 800-689-2800 or email us at charli@smsteam.net.
Pharmaceutical Industry Pledges $80 Billion To Reduce Cost of Drugs
Barack Obama on Monday welcomed the pharmaceutical industry's agreement to help close a gap in Medicare's drug coverage, calling the pact a step forward in the push for overhaul of the nation's health care system.
Drug companies have pledged to spend $80 billion over the next decade to help reduce the cost of drugs for seniors and pay for a portion of Obama's health care legislation. The agreement with the pharmaceutical industry would help close a gap in prescription drug coverage under Medicare.
Obama stated the move on Medicare will help correct an anomaly in the program that provides a prescription drug benefit through the government health care program for the elderly and disabled. Under the deal, drug companies will pay part of the cost of brand name drugs for lower and middle-income older people in the "donut hole".
Part of the $80 billion would be used to halve the cost of brand name drugs for Medicare recipients when they are in a coverage gap of the program. AARP, which represents 40 million older Americans, has lobbied to eliminate the "donut hole" completely.
This deal would affect about 26 million low and middle income recipients and apply to brand name and biologic drugs, but not generic. This would likely take effect in July 2010.
Drug companies have pledged to spend $80 billion over the next decade to help reduce the cost of drugs for seniors and pay for a portion of Obama's health care legislation. The agreement with the pharmaceutical industry would help close a gap in prescription drug coverage under Medicare.
Obama stated the move on Medicare will help correct an anomaly in the program that provides a prescription drug benefit through the government health care program for the elderly and disabled. Under the deal, drug companies will pay part of the cost of brand name drugs for lower and middle-income older people in the "donut hole".
Part of the $80 billion would be used to halve the cost of brand name drugs for Medicare recipients when they are in a coverage gap of the program. AARP, which represents 40 million older Americans, has lobbied to eliminate the "donut hole" completely.
This deal would affect about 26 million low and middle income recipients and apply to brand name and biologic drugs, but not generic. This would likely take effect in July 2010.
Heartland National Medicare Supplement is officially released in MO June 16, 2009. Rates start at just $121.78 for a 65 year old female. For contracting information, contact us!
Call us at 800-689-2800
Email us at charli@smsteam.net
Visit our website at www.smsteam.net
We look forward to helping you with all your senior market needs!
Call us at 800-689-2800
Email us at charli@smsteam.net
Visit our website at www.smsteam.net
We look forward to helping you with all your senior market needs!
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