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This guide was developed to aid compliance throughout all stages of the sales process and includes critical information and useful tips to keep in mind at all times. Making a Compliant MA/PDP Presentation Featuring a handy check list, presentation phases are covered in three sections: Prior – Key points
During – Necessary steps
After – Important follow-up actions
Things to Know
In addition to the preceding information, the compliance guide addresses the following topics:
Download the Compliance Guide here!  |
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It’s no secret that Medicare Advantage (MA) plans are the fastest growing segment of the Medicare market. MA enrollment increased by 10% since last year – continuing a 14-year growth trend – to reach an estimated 22 million people.
From just 13% of new enrollees in 2004, MA’s market share has grown to more than 34% today and is projected to reach 42% by 2028. As more senior clients vote with their checkbooks – in favor of MA plans – many of the top senior-focused agents are taking steps to add Medicare Advantage plans to the product portfolio.
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⍟ What are MA Plans?
⍟ Why are MA Plans Becoming so Popular?
⍟ Why Do Some Agents Hesitate to Sell MA?
⍟ The Path to Becoming an MA Agent
What are Medicare Advantage plans?
The Center for Medicare and Medicaid Services (CMS) describes MA as an “all-in-one alternative to Original Medicare,” bundling Medicare Part A, Part B, and usually Part D in a single plan.
“Some plans may have lower out-of-pocket costs than Original Medicare,” CMS says, and “some plans offer extra benefits that Original Medicare doesn’t cover - like vision, hearing, or dental.”
Both Medicare Supplement and MA plans:
- For those who are Medicare-eligible
- Have monthly premiums (except those MA plans that provide $0 premium coverage)
- May leave the enrollee with deductibles or co-pays
- Require the enrollee to pay Medicare’s Part B premium (some MA plans offer a monthly Part B giveback)
Only MA Plans:
- Provide an alternative to coverage by Original Medicare
- Are not standardized but must offer the same benefits as Medicare Parts A and Part B
- May include prescription drug coverage
- Allow enrollment only during four designated enrollment periods
- Initial Enrollment Period: the 7 month period that begins three months before the
month the individual turns 65 - Annual Enrollment Period: Oct. 15 through Dec. 7
- Open Enrollment Period: Jan. 1 through Mar. 31 – certain limitations may apply
- Special Enrollment Period: allows a beneficiary to enroll outside of a designated
enrollment period if certain eligibility criteria is met.
Why are MA plans becoming so popular?
- MA premium rates have been steadily declining. Medicare Advantage premium rates went down by an average of 6% from 2018-2019. That continued a multi-year trend; MA premium rates have dropped each year since 2015.**
- For many Medicare beneficiaries, MA plans offer high perceived value. At an industry meeting in July, CMS Administrator Seema Verma went out of her way to praise MA plans, declaring them the most successful element of Medicare. “What works in the Medicare program is Medicare Advantage – because plans are competing on the basis of cost and quality, driving towards value and increasing choices for beneficiaries,” Verma said.
- Seniors are already comfortable with MA-type products and services. People
approaching or at age 65 have long experience with the HMO and PPO plans hosted by their employers. Furthermore, they are internet savvy. And many have been primed by the financial crisis to prefer lower premiums. - More providers are now offering MA plans. Medicare Advantage has added 600 new plans in recent years, a trend which shows no signs of abating.
- More MA plans are adding non-traditional benefits. In an April rule, CMS expanded the supplemental benefits that may be provided in MA plans. Now, plans can offer a host of non-traditional benefits, such as at-home grocery delivery, non-emergency medical transportation to doctor appointments, or home modifications like the installation of air conditioning for beneficiaries with asthma, and home renovations for the fall-prone elderly.
- Health and Human Services and CMS officials are reducing once onerous regulations. Administration officials in April unveiled a plan to shift fee-for-service into a global pay structure where physicians, hospitals, clinics or Medicare Advantage plans would assume more risk. Such a move would create even more opportunities for competition in the MA business.
All the signs are positive for the MA market:
- Beneficiaries are enjoying better care and seeing better results (MA truly is managed
care). - By adding MA products to their portfolio, agents can become true “solutions experts,”
further cement client relationships, and significantly grow their businesses as they
address client needs on a more holistic basis.
Why is it that some retiree-focused agents hesitate to sell MA Plans?
Some brokers and agents have perceived issues with MA plan features. Even more have resisted due to the perceived hassle of obtaining the certification they need to sell MA plans. Let’s analyze each of these concerns.
Perceived issues with MA plans, in many cases, turn out to be “non-issues”
- Network size and coverage: In the past, some HMO networks were limited in size and geographic area; some clients were concerned that their doctors and specialists would be excluded from the plan’s network.
Today, this is a “non-issue.” In the past five years, plans have greatly expanded their networks and service areas (and they continue to grow rapidly). Today’s networks will likely include your client’s doctor and specialists.
Plans have also expanded the geographic reach of their doctor networks and many now allow their PPO members to use any doctor in their PPO networks across the nation. - Referrals: In the past, some clients were concerned that they would need a referral from their PCP to see a specialist. This is another “non-issue.” PPO plans have never had this requirement, and many of today’s HMO plans are going to “open access” and dropping their referral requirements altogether.
The path to becoming an MA agent is straightforward.
Here are the simple steps for you, the agent, to follow:
Here are the simple steps for you, the agent, to follow:
- Start your certification process now. Realistically, agents need to have their contracting and certification for MA plans locked down several weeks in advance of AEP – ideally by mid-September. As always, AEP runs from Oct. 15 through Dec. 7. Visit our carrier certification page here.
- Reach out to a marketing director at an organization, such as your contact at Precision Senior Marketing, who will help you identify which carriers are competitive in your market.
Your marketing director will work with you to determine what your portfolio of carriers and products should look like. Not every carrier is active in every
market; in your market, there may be only one or two major carriers active - or there
may be many more. - Next, have your marketing director send you the information that you will need to obtain a contract. They then send an email to each agent’s inbox that contains a link to AgentXcelerator where agents can register. Once registered, the agent goes to the producer-contracting section to begin the contracting process.
The first contract is slightly more time-intensive than subsequent ones, but even the first one will take only 10-15 minutes to complete.
The first contract process requests several pieces of information (such as addresses, banking information, voided checks, etc.) that, once entered, become part of the agent’s profile and can be used in all subsequent carrier contracts.
The agent completes each of the contracts electronically, digitally signs them and submits. - Allow seven-10 business days to process your contract. (The timeframe may vary, depending on the carrier.) During this time, the carrier conducts background checks and makes sure all their criteria are satisfied before accepting your submissions.
Assuming all looks good, the carrier then assigns you an agent number and provides instructions on how you can log into the carrier’s site. - After you are set up with an individual carrier, shift your focus to the preparation and training you’ll need to become certified. Most major carriers require you to take tests administered by America’s Health Insurance Plans (AHIP).
But before you begin the AHIP testing, spend time re-familiarizing yourself with Medicare overall, as well as with the specifics of MA plans. You can find this training at AgentXcelerator.com, and is offered free to PSM agents.
This site will take you through the ABCD’s of Medicare, the differences between Med Supp and MA, PDP features, and processes for appeals, grievances, and penalties; it has all the information you need to obtain a basic understanding of Medicare. - Sign up for the AHIP test. (You can access the test here. When you use our link, you’ll receive a $50 discount on the AHIP test.) The test has five modules on topics including ethics, compliance, fraud and abuse.
Each module ends with a quiz. After completing the five modules, agents take a 50-question test. All totaled, it approximately 5-6 hours to complete the modules and the test. You’ll need a 90% score to pass, and you’ll need to pass in no more than three attempts. - Once you’ve completed and passed the AHIP tests, go to the site of your individual carrier to take its specific training. You’ll need to complete both AHIP and individual carrier-specific certification before you’ll be ready to sell MA plans.
Each major carrier requires agents to take certification tests on their sites – these involve carrier-specific content such as plan information, carrier marketing rules, and instructions on how to submit business and how to market (such as the use of company logos).
- Now, it’s time to compare rates and submit business. Once you’ve contracted with a carrier and passed your tests to become certified, it all becomes real - and it’s time to get out there and sell.
You could go the old “pen and paper” route, but more likely you’ll want an all-in-one platform where you can run quotes, compare plans and actually enroll clients without having to go to all the major carriers’ sites.
This includes tools such as those available on the YourMedicare enrollment center on AgentXcelerator.com, including:- Quoting – allows you to compare all MA plans available in the area.
- Enrollment – provides the ability to electronically enroll clients in MA plans using a digital signature either in-person or via email. In addition, the YourMedicare
enrollment center provides agents with another option: send clients a link through
personal URL (PURL). With the PURL feature, clients can review plan options and
pricing, select the best fit and then electronically apply at their convenience. The link is tied back to the agent’s NPN so the enrollment will automatically be credited to the agent. - Even with all the technology at your disposal, be sure to make back-up hard copies of all your key documents, including applications, Summary of Benefits and Scope of Appointments. In fact, CMS requires you to retain SoA’s for at least 10 years.
All the trends - the regulatory changes being advocated by HHS and CMS leadership,
the demographics, the positive health outcomes for beneficiaries – point toward continued growth and popularity for Medicare Advantage plans.
Increasingly, clients and prospects are going to want to work with agents who provide complete Medicare solutions, and that means being equipped to offer access to MA plans. Top agents are finding that it is well worth the extra effort to jump into this large and rapidly growing market.
If you are interesting in pursuing the Medicare Advantage market, please reach out to one of our Marketing Directors and they will gladly assist with everything you need. We appreciate your time and the opportunity to assist in growing your Medicare business.
Email: info@psmbrokerage.com
