Medicare Sales Allegation

[policywunk]

This is were difference in carriers come in . Supposedly United doesn’t provide termination of enrollment data because they don’t want the agent contacting . But on humana vantage you can see future terms into month end . In reality Humana’s agreeing these are your clients until it goes inactive the 1st of the following month . I save many of those as a ton of clients don’t realize they were switched .at the very least i alert them and if they say they went with better plan . I explain the difference and if they say i want my new plan. I say that fine take care . But I wasn’t them to know the truth in the benefits of both so they understand

Don I think this is a little different because OP said" This person was a client I had written earlier this year and when I called her, discovered she had been switched a couple months after I wrote her." so he would have seen a chargeback and there would be no doubt she had terminated plan - well there would be no doubt to me anyway if I see a chargeback.BTW there is a roundabout way to see most disenrollments with UHC if you check your most recent renewal statement each pay out day wednesday and fridays it updates plan terms in most recent renewal statement.To check for AEP applications that may have switched to other plans look at production summary for 1/1/23 effective in jarvis.If it says PAID they have switched MA plan.

 

[DonP]

Don I think this is a little different because OP said" This person was a client I had written earlier this year and when I called her, discovered she had been switched a couple months after I wrote her." so he would have seen a chargeback and there would be no doubt she had terminated plan - well there would be no doubt to me anyway if I see a chargeback.BTW there is a roundabout way to see most disenrollments with UHC if you check your most recent renewal statement each pay out day wednesday and fridays it updates plan terms in most recent renewal statement.To check for AEP applications that may have switched to other plans look at production summary for 1/1/23 effective in jarvis.If it says PAID they have switched MA plan.

Correct on Uhc . You must down load the commission statement to excel . That’s worked but me and another agent have noticed it’s showing nothing for December to show terms . I’m wondering if they changed it. It’s showing terms on renewals but not any terms on business less than 12 months old . I had a 2022 termed policy and it’s not showing up . Also another way to see your aep payout is to look at held transactions under your commissions at the bottom of the page. Also another way to track terms is if your active count drops it means something fell off the books . United removes all future terms from your active count immediately. Humana leaves them on the active until they actually term Jan 1 .

 

[Newby]

I beg to differ. One of my recorded MAPD enrollments was audited by the carrier and I was reprimanded for not offering the member an option of how they wished to pay their premium (direct bill, SS, bank draft, etc.). "IT IS A ZERO PREMIUM PLAN, Sir Ma'am!!!"
In so many words, the carrier was advising me to confuse the member by asking them how they preferred to make monthly payments on something that costs $0.00 monthly. Was I supposed to ask the member if they wanted $0.00 coming out of their SS, or ask for their bank account number for the carrier to draft $0.00, so the member doesn't lose their plan for nonpayment?
Help me, please! What did I miss?

I remember from training years ago you had to give them the options because you have to explain the the premium is only guaranteed to be zero for the first 12-months. But if they continue on the plan past the first year there will likely be a premium at some point in the future.

 

[policywunk]

I remember from training years ago you had to give them the options because you have to explain the the premium is only guaranteed to be zero for the first 12-months. But if they continue on the plan past the first year there will likely be a premium at some point in the future.

That and because you are also supposed to read the LEP disclosure to them and this gives them a choice of how to pay.This helps prevents getting a call from someone you enroll and was already paying a LEP and didn't know it and now they blame you for having the LEP or someone who was aware of penalty and they do not like the payment method you chose for them.

 

[titeye]

I remember from training years ago you had to give them the options because you have to explain the the premium is only guaranteed to be zero for the first 12-months. But if they continue on the plan past the first year there will likely be a premium at some point in the future.

Let's assume that's still true today, for a moment. Let's also assume that, unbeknownst to anyone, the premium does change 13-months from now. Is the member giving the carrier a blind check to deduct an amount in the future that is currently unknown by anyone, including the carrier, regardless of how large the premium may be at the time? I am trying to wrap my mind around the logic of CMS or the carrier. I would think that would end up being the #1 complaint to CMS, if I understand correctly what you are saying.

 

[Newby]

Let's assume that's still true today, for a moment. Let's also assume that, unbeknownst to anyone, the premium does change 13-months from now. Is the member giving the carrier a blind check to deduct an amount in the future that is currently unknown by anyone, including the carrier, regardless of how large the premium may be at the time? I am trying to wrap my mind around the logic of CMS or the carrier. I would think that would end up being the #1 complaint to CMS, if I understand correctly what you are saying.

What do you not understand? All MA and MAPD plans are 12-month contracts that run from Jan 1st to Dec 31st each year. The zero premium is guaranteed for 12-months. Each October the members HAVE to review what their plan is doing for the next year. Many zero premium plans do add a premium in later years. That’s why when they sign up you have to explain all that to them. So they don’t sleep through the annual enrollment and not pay attention. They do have selective payment option because at some point they will likely have a payment unless they change plans. It will never happen to them without their knowledge unless they completely don’t understand how it all works.

 

[titeye]

What do you not understand? All MA and MAPD plans are 12-month contracts that run from Jan 1st to Dec 31st each year. The zero premium is guaranteed for 12-months. Each October the members HAVE to review what their plan is doing for the next year. Many zero premium plans do add a premium in later years. That’s why when they sign up you have to explain all that to them. So they don’t sleep through the annual enrollment and not pay attention. They do have selective payment option because at some point they will likely have a payment unless they change plans. It will never happen to them without their knowledge unless they completely don’t understand how it all works.

I understood everything you said before and everything you're saying now. But you didn't answer the question.
If the plan they choose today is a zero premium plan, 1) why would you ask them if they prefer to pay for this plan out of their SS or bank account? 2) Why would you ask them for their bank account information for something that may or may not happen next year? Not only that, it is impossible to elaborate on next year's plan or premium because neither exists at this point. Would you give anyone your bank information when neither you nor the agent knows whether or not the plan will even be offered next year or what the premium amount could possibly be, if it were offered? Therefore, what I don't understand is your logic offering them various payment options at the point of sale, when there are no payments required? As you stated, 12-months from now, or prior to AEP deadline, you will conduct a review. If the plan they then choose is not a zero premium plan, including the plan they currently have, then you explain their payment options for the next 12months.

 

[Newby]

I understood everything you said before and everything you're saying now. But you didn't answer the question.
If the plan they choose today is a zero premium plan, 1) why would you ask them if they prefer to pay for this plan out of their SS or bank account? 2) Why would you ask them for their bank account information for something that may or may not happen next year? Not only that, it is impossible to elaborate on next year's plan or premium because neither exists at this point. Would you give anyone your bank information when neither you nor the agent knows whether or not the plan will even be offered next year or what the premium amount could possibly be, if it were offered? Therefore, what I don't understand is your logic offering them various payment options at the point of sale, this year, when there are no payments required this year? As you stated, 12-months from now, or prior to AEP deadline, you will conduct a review.

Every one I ever sold I told them we have to select a payment option even though for the first 12-months there is no payment needed. I recommend that they choose social security withdrawal and they all do.
It’s not even an issue unless you make it an issue.

 

[DonP]

You have to do that because cms requires it. Also some people have leps that come out . Even With duals you have to do that will never pay a penny

 

[titeye]

Every one I ever sold I told them we have to select a payment option even though for the first 12-months there is no payment needed. I recommend that they choose social security withdrawal and they all do.
It’s not even an issue unless you make it an issue.

It has never been an issue with the beneficiary. The carrier made it an issue, until they realized the situation did not call for what they were challenging. Every zero premium plan I've ever sold, I advised them to select direct bill, and they all understand why that option makes the most sense. When I have sold non-zero premium plans, I've advised they select one of the options other than direct bill. They understand why direct bill is not in their best interest.
Consumer confusion is one of the biggest complaints received by CMS. If I offer SS withdrawal as an option for payment on a zero premium plan, I must offer Auto Bank Draft and every other payment option. The point to my original post was simply this: Requiring the agent to offer a beneficiary the option of automatic bank draft for a zero premium plan contributes to confusion, not reduces it. Personally, I think the agent is doing himself and his client a disservice even when he advises SS withdrawal on zero-premium plans. If, for example, the plan does change and has a price increase, yet your attempts to contact your client for review fail, you have authorized the carrier to deduct from their SS next year an amount they possibly do not have or cannot afford. What if the financial consequence from this doesn't sit well with your client and they complain to CMS about you? Direct bill on a zero premium plan makes them responsible for choosing to pay any increase, or not, the following year regardless of whether you were successful in your attempt to review. Just my thoughts.