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The Medicare Open Enrollment Period, also known as the “Medicare Advantage (MA) and Prescription Drug Plan (PDP) annual election period” or “AEP,” occurs annually from October 15th to December 7th. As of early 2024, there's a consistent increase in MA enrollments from January 2020, reaching nearly 33.5 million, while PDP enrollments have started to recover after a downward trend, now at 23 million.

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The CMS prior authorization rule significantly impacts insurers by mandating more efficient and transparent prior authorization processes, particularly for Medicare and Medicaid plans. This rule compels insurers to adopt standardized electronic communication methods, enhancing administrative efficiency and patient care coordination.

While it may initially increase compliance costs due to necessary IT upgrades and procedural changes, it aims to reduce inappropriate denials and appeals, thereby potentially lowering long-term operational costs. Insurers will need to adjust their prior authorization criteria and reporting practices, ensuring better patient outcomes and higher satisfaction, which could ultimately lead to cost savings and improved service quality.

Here's how this rule generally affects insurers:

Increased Administrative Efficiency: The rule aims to standardize and streamline the prior authorization process. Insurers are expected to adopt more efficient electronic communication methods, which can reduce administrative burden and costs over time.

Enhanced Transparency: Insurers are required to be more transparent about their prior authorization requirements and policies. This can involve publicly disclosing the rationales for denials and providing specific information about the services that require prior authorization.

Improved Patient Care Coordination: By requiring insurers to expedite the prior authorization process, the rule intends to minimize delays in patient care. This may lead to better coordination and continuity of care.

Potential for Increased Compliance Costs: Implementing standardized electronic processes and adhering to new transparency requirements may initially increase operational costs for insurers. This includes costs related to upgrading IT systems, training staff, and modifying existing procedures.

Impact on Clinical Decision-Making: Insurers may need to adjust their criteria for prior authorization to align with the new rules. This could affect how they manage approvals for certain treatments or medications.

Data Reporting Requirements: Insurers might be required to report on their prior authorization activities, including denial rates and the average time taken to respond to requests. This adds an additional layer of data management and reporting.

Potential Reduction in Denials and Appeals: The standardization and transparency required by the rule could lead to a decrease in inappropriate denials, thereby reducing the volume of appeals insurers need to process.

Quality of Care and Patient Satisfaction: Improved and quicker prior authorization processes can lead to better patient outcomes and higher patient satisfaction, which is beneficial for insurers in terms of reputation and patient trust.

Adaptation to Technology Standards: Insurers will need to ensure that their electronic communications meet the technical standards set by CMS, which may require significant IT infrastructure adjustments.

Long-Term Cost Savings: While there might be initial costs associated with complying with the new rule, in the long run, the efficiencies gained could lead to cost savings for insurers.

Insurers must stay informed and adapt to these changes to remain compliant with CMS regulations while continuing to provide effective services to their beneficiaries.

You can view the details here.

CMS has proposed new regulations that will impact agent and broker compensation – as well as potentially disrupt the FMO support model. Time is running out for your voice to be heard and influence the final rule!

Precision Senior Marketing is actively engaging with CMS, and subsequently lawmakers in DC, to influence the final language of the proposed rule. The first and primary method to influence the final rule is through the comment letter process. Comment letters on this proposed rule are due to CMS no later than January 5^th at 5PM ET.

As a critical stakeholder, we encourage you to write your own letter to CMS explaining the significant value that Agents and FMOs provide to American seniors in MA distribution and post-enrollment support. Your efforts here can play a vital role in shaping the final rule that CMS will enact. To help you draft an effective 1-page comment letter, we have provided detailed guidance on yourFMO.com.

NOTE: CMS discounts form / templatized letters – so to ensure the greatest impact of your submission, we have provided bullets for you to consider to include or summarize, in your words, for your own unique letter. This should allow you to craft an impactful letter in as little as 10 minutes.

Will you join us in the effort to protect agents, brokers, and FMOs – and educate Washington on the vital role we play in ensuring consumers are placed in the right plan for their healthcare needs?

For Agent Use Only. Not for the general public.

As you’re aware, CMS recently issued proposed amendments to its regulations governing the 2025 Medicare Advantage Program (MA) and Medicare Prescription Drug Benefit Program (PDP). Click here to read the proposed rules.

As conversations about these proposed rules have continued with our partners and throughout our industry, there remains much confusion surrounding the impact these proposed rules may have on our industry. As such, we’ve prepared a FAQ page designed to clarify our interpretation of the rules and how you should view them.

This matter impacts everyone. In collaboration with our partners at Amerilife and our Carrier Partners, we are actively engaged in discussions with CMS to convey our concerns about the proposed rule and its negative implications for Medicare.

The deadline for submitting comments on the proposed rule to CMS is approaching quickly. We encourage you to take the opportunity to write and send your own letters to CMS and your elected officials to make your voice heard.

    DEADLINE TO COMMENT IS JANUARY 5, 2024    

SUBMIT COMMENTS TO CMS

We appreciate your dedication to serving your clients, and in turn, we are devoted to supporting you. United, we can strive to prevent CMS from implementing this proposed policy. Thanks for your assistance.

The insurance industry, especially in the realm of Medicare plans, presents a landscape brimming with opportunities for those seeking a blend of autonomy, financial stability, and the satisfaction of providing a valuable service. As an independent insurance agent specializing in Medicare plans, you stand at the forefront of a rapidly growing market, offering vital services to a demographic that is expanding each year: seniors.

The Expanding Senior Market

The demographic landscape of the United States is undergoing a significant shift. With the Baby Boomer generation reaching retirement age, there is an unprecedented increase in the population of seniors. Statistics indicate that by 2030, all Baby Boomers will be over the age of 65, thereby expanding the senior market substantially. This growth translates into a growing need for Medicare plans, tailored to meet the diverse health care needs of the aging population.

Unlike many other professions, where income is directly tied to the hours worked, Medicare plans offer the potential for earning a recurring income on policies sold. This means that each policy sold can continue to provide income for years, compounding over time as you build your client base. This structure offers not only a steady income stream but also the peace of mind that comes with financial stability.

Autonomy and Flexibility

Being an independent agent means being your own boss. This autonomy allows you to set your own schedule, choose your clients, and create a work-life balance that suits your lifestyle. Whether you prefer to work from home, set up an office, or be on the move, the flexibility inherent in this career path supports a variety of working styles and preferences. This level of independence is particularly appealing to those who thrive in an environment where they can take charge of their business growth and direction.

The satisfaction of providing a service that helps people understand and access the healthcare they need cannot be overstated. It’s a role that not only benefits your clients but also brings a deep sense of personal fulfillment.

The opportunity is here!

The role of an independent insurance agent selling Medicare plans offers more than just a career; it presents a pathway to a fulfilling, flexible, and financially rewarding profession. In the face of the growing senior market, the ability to generate residual income, and the autonomy of being your own boss, this career path stands out as an excellent choice for those looking to make a positive impact while building a sustainable business. As the population ages, the need for knowledgeable, compassionate, and dedicated Medicare plan agents will only grow, making now an ideal time to step into this rewarding field.

With approximately 10,000 individuals in the United States becoming eligible for Medicare each day, finding the right Field Marketing Organization (FMO) to partner with is crucial for achieving success. PSM goes above and beyond to empower independent agents, agencies, and brokers by offering unparalleled insurance products, exceptional back-office support, and a wealth of valuable tools and resources.

We take pride in providing our agents with high quality senior insurance products that bring a sense of security and peace of mind to the nation's exploding senior population. Our experienced insurance marketing team provides our agents with a robust product portfolio, game-changing technology and unrivaled support. We look forward to showing you how we can personalize our services to help grow your business.

Precision Senior Marketing was founded in 2006, in Austin, Texas. In the intervening time with almost two decades of experience, PSM has grown to a nationwide footprint, with a mission to empower agents to honestly and ethically help people live longer, healthier and more financially secure lives.

In this guide we will explore some creative and effective marketing ideas to engage with your local community to build a formidable Medicare business. All while staying local and budget-friendly. Added bonus - Learn about a simple idea that is inexpensive and generates fantastic results. Download the guide today.

Building relationships and trust within your community is paramount. By demonstrating a genuine commitment to helping seniors find the right Medicare plans for their needs, you can establish yourself as a valuable resource and trusted partner in healthcare decisions.

Know other independent agents who would thrive in our dynamic environment? Refer them to PSM and earn fantastic incentives! Your success is our success, and together, we'll build a thriving community of agents making a real impact.

Download the flyer here.

We hope you enjoyed last week’s edition of Marketing Masterminds. In this session, Bobby and Brian further reinforced their sales process and answered live questions from our attendees.

If you couldn’t make it, we recorded the session for you to watch by clicking this link.

A copy of Bobby and Brian’s sales process is also available here.

Want to join us for another Q&A session? We’re hosting 2 more during AEP that you can register for by clicking either of the links below!

Thursday, November 9 at 1:00pm ET

Wednesday, December 6 at 1:00pm ET

As a PSM producing agent you have the opportunity to tap into our Top Flight Lead Incentive awarding you with $430 per 10 Medicare Supplement or Medicare Advantage sales to use for leads or other Medicare Marketing initiatives.*

This $430 credit per 10 sales can be used for initiatives including:

• 1,000 piece direct mail campaign
• Facebook Advertising / Marketing Campaign for Medicare
• Internet leads or another vendor specifically for Medicare (Buy the leads, send us the invoice, and we will reimburse you back up to $430)
• Medicare Advantage Sales Seminars and Educational Events
• E&O Reimbursement
• Annual membership to ReferMe IQ Referral Platform

* Street level contract direct to PSM  /  * Med Supp GI Business not included

In addition to our Top Flight Lead Incentive, we also provide the following value-added benefits:

• 50/50 co-op for Medicare Advantage Marketing* - we will reimburse half of what an agent spends on their Medicare marketing initiatives. For example if an agent spends $2,000 on their Medicare Marketing, we will reimburse $1,000 as long as we have receipts / invoices to show $2,000 was spent on Medicare Marketing.
  * Requires prior approval
• Access to Retail Programs at Wal-Mart during AEP for lead generation activities & sales events.  
• Connections to local market managers for certain carriers to provide local trainings and hands on events for Medicare Advantage, Special Needs Plans, and Dual Eligible Plans.
• Access to a remote enrollment system allowing agents to compliantly write Medicare Advantage and Prescription Drug applications electronically and by phone.
• Comprehensive quoting software from CSG that quotes ALL carriers in the US for Medicare Supplements, Medicare Advantage, Prescription Drugs, Hospital Indemnity, Dental, and Final Expense plans.
• Comprehensive training videos with assessment tests at the end to test knowledge and move toward becoming an expert.
• Open Release Policy – we will not hold you captive.

At PSM we offer the industry's leading carriers, with the highest attainable contracts, along with the tools, resources and incentives necessary to grow your business and succeed in a booming market. We look forward to working with you!

Related Article: “The Benefits of Working with an Insurance FMO”

Are you looking for Pre-Approved Medicare Marketing materials?

Great news! We are here to assist.

We are pleased to provide you with a library of pre-approved marketing materials to help you retain and grow your book of business. 

These pieces have been created to engage consumers and motivate them to consider working with you to meet their Medicare needs.

In today's competitive market, it is helpful to have marketing materials that help you stand out with potential clients.

We also understand the challenge of coming up with something creative and engaging, in addition to adhering to CMS guidelines.

Lucky for you, we have worked with our carrier partners to make sure our agents have access to not only carrier approved marketing materials, but also a library of generic pre-approved Medicare marketing materials. Get your free marketing materials here.

Direct mail is an effective means of driving response among Medicare eligibles. It allows you to target your message to specific people at specific times. 

Even though direct mail is considered more effective than other mass media options, it is important to do everything you can to help maximize your success.

Here are some tips to follow:

• Use a targeted and proven mailing list - Data has shown that consumers 65-75 are more likely to switch Medicare plans than their elder peers. So be sure that segment is included in your mailings.
  
• Segment your list - For Medicare prospects, low-income targets will likely respond better to low-price messages while higher-income prospects might be more attracted to value-added benefits or expansive network messages.
• Test your messages / creative executions - For Medicare marketing, it may be wise to execute A/B mail splits - dropping different messages to segments of the same audience at the same time. This will allow you to determine which messages are getting the best responses.
• Commit to a mailing plan based on your overall marketing activities - Mailboxes will be full especially during AEP, but you can't afford to be absent. If you sprinkle your marketing plan with other media exposure and events, your piece will like be more recognized in the mailbox and read.
• Think about consumer's behavior when planning your marketing - First they will research plans, then they'll shop, then they'll decide. You want to be present and available at each of these steps!
  

Marketing Pieces Include:

Age-In, CSNP, DSNP, Educational, Generic and more

To request access and speak with a marketing Representative about what pieces are available and how to have the customized, Get your free marketing materials here.

You can also call us at 800-998-7715 and speak with one of our friendly marketing representatives.

Carrier specific resources available through of our partners: Humana, Aetna, UnitedHealthcare, Cigna