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As an insurance agent, when it comes to selling Medicare plans, one of the most critical aspects of your compliance toolkit is the Permission to Contact (PTC) form. This form is not just a regulatory requirement—it’s a vital step in building trust with your clients and ensuring that your interactions with potential enrollees are transparent and respectful. In this blog, we’ll break down the key requirements for the Permission to Contact form, why it’s important, and how to use it correctly to stay compliant while maximizing your success.

What is the Permission to Contact Form?

The Permission to Contact form is a document that grants you, the agent, the legal right to reach out to a potential client regarding Medicare plans. Whether it’s for a Medicare Advantage (MA) plan, a Part D prescription drug plan, or other related Medicare products, the PTC form must be completed and signed by the individual before you initiate any form of contact, including phone calls, emails, or home visits.

Why is the PTC Form Important?

The Centers for Medicare & Medicaid Services (CMS) has stringent rules in place to protect Medicare beneficiaries from unsolicited and potentially confusing or misleading marketing practices. The PTC form is a safeguard that ensures beneficiaries are only contacted when they have explicitly agreed to receive information about Medicare products. For agents, adhering to this requirement is essential not only to remain compliant but also to maintain the trust and confidence of your clients.

Key Requirements for the Permission to Contact Form

To ensure you’re using the PTC form correctly, it’s important to understand the specific requirements set by CMS:

1. Voluntary Consent: The form must be filled out voluntarily by the potential client. There should be no pressure, coercion, or misleading information provided during the process of obtaining consent.
2. Specific Contact Information: The PTC form should clearly indicate the type of contact the beneficiary is agreeing to—whether it’s a phone call, email, home visit, or another form of communication. It’s crucial that the client understands what they are consenting to.
3. Valid Time Frame: The PTC form is not an indefinite consent. Typically, it’s valid for a specific period, often up to 12 months. After this period, if the client wishes to continue communication, a new PTC form must be obtained.
4. Scope of Permission: The PTC form should specify what products or services the client is interested in discussing. This means that if a client consents to being contacted about a Medicare Advantage plan, you cannot use that consent to discuss unrelated products, such as life insurance or annuities, unless separately agreed upon.
5. Documentation and Record-Keeping: Once the PTC form is signed, it’s important to maintain accurate records of the consent. This documentation must be kept on file and available for review if required by CMS or other regulatory bodies. Keeping these records organized and accessible is essential for demonstrating compliance.

How to Use the Permission to Contact Form Effectively

To make the most of the PTC form while ensuring compliance, follow these best practices:

• Educate Your Clients: Take the time to explain the purpose of the PTC form to your clients. Ensure they understand that it protects their rights and gives them control over who contacts them about Medicare products.
• Ensure Clarity and Transparency: When presenting the PTC form, be clear about what the client is agreeing to. Avoid industry jargon or confusing terms that might lead to misunderstandings.
• Follow the Scope of Permission: Stick strictly to the topics that the client has consented to discuss. If during the conversation the client expresses interest in other products, you can ask for permission to discuss those areas and update the PTC form accordingly.
• Respect the Client’s Decision: If a client chooses not to sign the PTC form or later decides they no longer wish to be contacted, respect their decision without pressuring them. Their autonomy is paramount.
• Stay Organized: Keep all signed PTC forms organized and easily accessible. Regularly review your records to ensure that all your communications are within the allowed time frame and scope of permission.

Conclusion

The Permission to Contact form is a vital component of the compliance framework for Medicare plan marketing. By understanding and adhering to the CMS requirements for this form, you not only protect yourself and your business but also foster a relationship of trust with your clients. Remember, the PTC form is more than just a piece of paperwork—it’s a commitment to ethical and transparent business practices. By using it correctly, you can confidently guide your clients through their Medicare choices while ensuring you stay on the right side of the regulations.

Contact us for custom outreach pieces at (800) 998-7715.

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As an insurance agent, it's essential to guide your clients when they receive their Annual Notice of Coverage (ANOC) from their Medicare Advantage or Part D plan. The ANOC, typically sent out around September, details any changes to their coverage for the upcoming year.

Understanding these changes is crucial for your clients as they consider whether to adjust their coverage during Medicare’s Fall Annual Enrollment period, which runs from October 15th to December 7th.

Encourage your clients to pay close attention to three key areas in their ANOC:

• Plan Costs: Highlight any changes to premiums, deductibles, and copayments.
• Network Changes: Ensure clients understand how any modifications to their plan’s network could impact their current providers and pharmacies.
• Formulary Adjustments: Review changes to the plan’s formulary that might affect the coverage or cost of their current medications.

Once your clients are informed about these updates, help them assess whether their current plan will continue to meet their needs in the new year or if switching plans during Fall Open Enrollment would be more beneficial. Your expertise can make a significant difference in ensuring they have the best coverage possible.

Helpful Resources:
https://www.psmbrokerage.com/inflation-reduction-act-medicare-reforms

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As of July 19, 2024, CMS is blocking agents and brokers from making changes to a consumer’s FFM enrollment unless the agent is already associated with the consumer’s enrollment. This applies to all agent-assisted enrollment applications across all enrollment platforms.

For more information on the changes CMS has implemented, access the full statement from CMS here.

The team at HealthSherpa understands that these CMS changes cause a major disruption to agents who are trying to help consumers update policies. We are working with CMS to understand the intent of this change and to clarify details. As we learn more, we will update agents who use HealthSherpa.

• Error message from CMS
• How to submit policy changes when encountering this error
• Identifying consumers with current plan year enrollments
• Frequently asked questions
• Additional resources

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On July 25, 2024, the U.S. District Court for the Eastern District of Texas halted the effective date of the Department of Labor’s (DOL) 2024 Fiduciary Rule and its amendment to Prohibited Transaction Exemption (PTE) 84-24. The following day, the U.S. District Court for the Northern District of Texas issued its own stay on the 2024 Fiduciary Rule and all related exemptions.

As a result, the 2024 Fiduciary Rule will not take effect as scheduled in September, providing temporary relief for retirement advisers. The rule, aimed at redefining "investment advice fiduciary," had significant changes that would impact compliance costs and market dynamics. 

Both courts found issues with the rule's consistency with ERISA and the Administrative Procedure Act. The DOL may appeal these decisions, and further legal and legislative developments are expected. In the meantime, advisers should stay informed and consider potential impacts on their practices.

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Washington, D.C. – Senate Finance Committee Chair Ron Wyden, D-Ore., and five senators introduced a bill to apply criminal penalties to rogue insurance brokers who are changing Americans’ Affordable Care Act (ACA) marketplace plans without their knowledge or consent, and take other steps to strengthen consumer health insurance protections.

“Predatory health insurance brokers are stealing money out of families’ pockets by leaving them with uncovered medical expenses, unexpected tax liabilities and more by fraudulently changing or enrolling Americans in health insurance plans in the federal marketplace,” Wyden said. 

“It is critical for these bad actors to be held criminally responsible and implement common sense consumer protections so working families can confidently purchase quality, affordable health insurance that works for them through honest brokers. My bill will crack down on fraudulent tactics that cheat hard working Americans out of getting the health care they need. The solution to fraud is to go after fraudsters, not to take away middle class tax credits for health care.”

The one-pager is available here.

A summary of the bill is available here.

The bill text is available here.

Source: https://www.finance.senate.gov

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The Centers for Medicare & Medicaid Services (CMS) recently released preliminary technical Medicare Part D bid information for the 2025 contract year to assist Part D plan sponsors in finalizing their Part D and Medicare Advantage (MA) offerings. This preparation is crucial for the upcoming Medicare Open Enrollment period. Additionally, CMS has announced a voluntary demonstration to support the implementation of the redesigned Part D benefit, aiming to improve stability for Medicare beneficiaries in 2025. Preliminary average Part D premiums will be released later this summer, with the finalized 2025 landscape available in mid-to-late September.

The Inflation Reduction Act (IRA), also known as the prescription drug law, introduces several significant improvements to the Part D drug benefit, projected to save Medicare beneficiaries an average of 30% in annual out-of-pocket prescription drug costs by 2025. This will result in a reduction of approximately $7.4 billion in out-of-pocket prescription drug spending for people with Medicare Part D. Key changes include a $2,000 cap on out-of-pocket spending, the elimination of the coverage gap phase ("donut hole"), and the introduction of the Manufacturer Discount Program, which replaces the Coverage Gap Discount Program. The reinsurance payment amount will decrease, with more upfront costs and subsidies shifted to plans.

The base beneficiary premium for 2025 will be $36.78, an increase of $2.08 from 2024. CMS is also conducting a voluntary demonstration to test premium stabilization and revised risk corridors for stand-alone prescription drug plans (PDPs). This demonstration includes a uniform reduction of $15 to the base beneficiary premium, a $35 limit on year-over-year premium increases, and changes to the risk corridors for greater government risk sharing. The demonstration aims to ensure stability and predictability in the Part D market as the IRA changes are implemented.

Overall, these changes shift the government subsidy to Part D plans from reinsurance payments to upfront payments, encouraging better cost management. The national average monthly bid amount for 2025 will be $179.45, reflecting these shifts. CMS aims to provide stability across the Part D market through this demonstration, which is voluntary and open to all stand-alone PDP sponsors.

Source: https://www.cms.gov

View all CMS Inflation Protection Act Press Releases here.

  Inflation Reduction Act  Agent Resource Page

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ACA Resources:

•  ACA Sales Opportunities 
•  Agent Guide on How to Sell ACA Insurance
•  How to get FFM Certified to sell Health Insurance
•  ACA Open Enrollment: Key Dates and Tips

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Upcoming Changes and Strategic Planning for AEP

As we approach the Annual Enrollment Period (AEP), it’s crucial to stay informed about significant changes in the Medicare landscape. These changes, influenced by various market dynamics and regulatory adjustments, could impact your clients' plans and coverage. Here’s a comprehensive overview of what to expect and how to strategically navigate the AEP.

Key Changes to Expect

Insurance carriers are strategically reassessing their plans to mitigate potential financial risks. This involves making tough decisions such as pulling out of specific markets, reducing certain benefits, and even designating some Prescription Drug Plans (PDPs) as non-commissionable. These adjustments reflect a proactive approach to ensuring the long-term sustainability and viability of the plans offered to Medicare beneficiaries.

Strategic Plan for AEP:

In August, kick off your AEP preparations by sending out personalized AEP letters to your clients. Tailor these letters to two specific groups:

For your Medicare Supplement members, reassure them that their trusted Medicare Supplement plan will remain unchanged, but remind them that adjustments to their Part D plan may be on the horizon. Let them know that you are available to assist them through this process and encourage them to use tools like SunFire to ensure their Rx drug lists are up to date.

When addressing your MAPD members, be transparent about the potential of negative changes in most plans. Set clear expectations that these changes will come into effect on January 1, 2025, and promise to keep them informed through email as more details become available.

To further support your clients' understanding, create engaging and informative content where you walk through the Annual Notice of Change (ANOC) step by step. Share these resources to ensure that only your clients have access to this important information.

As October approaches, schedule emails to be sent out on the 1st of the month. These emails should outline the upcoming plan changes and offer a preliminary diagnosis of how these adjustments may impact each client. Ensure that carrier representatives provide you with the ANOC by September so that you can accurately communicate these changes to your clients in a timely manner.

Client Engagement

To enhance client engagement and ensure a smooth AEP process, consider hosting informative and interactive events such as in-person group meetings and Q&A sessions. These sessions can provide a platform for clients to ask questions, voice concerns, and gain a deeper understanding of their plan options. Additionally, personally reaching out to each member in the early days of October to guide them through the re-enrollment process can offer a personalized touch and instill confidence in their plan decisions.

Sending out Scope of Appointment (SOA) forms to all current clients is a proactive step to prepare for upcoming appointments starting on October 15. By reaching out to clients in September to gather their Rx drug lists and then following up in October to review their plans, you can streamline the enrollment process and ensure that their coverage aligns with their healthcare needs.

These personalized touchpoints and strategic planning efforts can help build trust with clients, demonstrate your commitment to their well-being, and ultimately lead to a successful AEP season for both you and your clients.

Efficiency Tips

When it comes to efficiently managing your client base during AEP, it's essential to make the most of your time and resources. Utilizing bulk meetings and phone calls allows you to reach as many clients as possible in a streamlined manner. By identifying clients who have decided to stay on their current plan, you can easily cross them off your list and focus your attention on those who may need assistance with plan changes.

Instead of time-consuming home visits, consider inviting clients to visit you at a designated location for personalized consultations. This not only saves you time but also provides a professional setting for productive discussions about their plan options.

In today's digital age, leveraging social media can be a powerful tool for client updates and support. Consider creating a private Facebook group where clients can access important information, ask questions, and engage with each other. This interactive platform can enhance communication and foster a sense of community among your clients.

Handling Non-commissionable PDPs

When handling non-commissionable Prescription Drug Plans (PDPs), it is essential to prioritize your clients' best interests above all else. Regardless of commissions, your primary focus should be advising clients on the plan that suits their healthcare needs and budget most effectively. Position PDPs as a complementary service for your Medicare Supplement clients, emphasizing the importance of comprehensive coverage. By guiding clients towards the most beneficial plans without being influenced by commissions, you can build trust, loyalty, and satisfaction among your client base.

ANOC Highlights

When focusing on deductible and copay/tier changes, it's important to delve into the specifics of how these adjustments could impact your clients' out-of-pocket costs and overall healthcare expenses. By highlighting the potential changes in deductibles, copayments, and tier structures, you can help clients understand the financial implications of their plan choices and make informed decisions. Additionally, as each Annual Notice of Change (ANOC) will provide updates on Rx drug changes, it's crucial to thoroughly review these updates with your clients and explain any modifications to their prescription drug coverage. 

Summary

By following this strategic plan, you can efficiently manage the AEP period, keep clients informed, and ensure they are enrolled in the best possible plans for their needs. By staying ahead of the curve and proactively addressing any potential changes or challenges, you demonstrate your dedication to ensuring that your clients have access to the most beneficial and cost-effective healthcare coverage options available.

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As of the first quarter of 2024, the U.S. individual health insurance market has reached unprecedented heights, with enrollment totaling approximately 24.3 million. This marks a significant increase of 4.9 million enrollees from the previous year, driven by several factors including regulatory changes and the aftermath of the COVID-19 pandemic.

Source: https://www.markfarrah.com

The passage and implementation of the Affordable Care Act (ACA) initially spurred enrollment, though it faced declines due to legal challenges and policy changes. Since the end of the COVID-19 Public Health Emergency in May 2023, enrollment has surged, partly due to individuals transitioning from Medicaid to subsidized individual plans and the rising popularity of Individual Coverage Health Reimbursement Arrangements (ICHRAs).

Despite these gains, insurers face financial challenges with premium growth struggling to keep pace with rising medical expenses, leading to shifts in market participation. The average premiums per member per month (PMPM) increased to $542 in 1Q24, while claims rose to $427 PMPM, reflecting a market attempting to balance growth with cost management.

ACA Resources:

•  ACA Sales Opportunities 
•  Agent Guide on How to Sell ACA Insurance
•  How to get FFM Certified to sell Health Insurance
•  ACA Open Enrollment: Key Dates and Tips

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