Opinions on what is expected with the final rule for Medicare

[goillini52]

Beginning September 1, 2024, short-term products are restricted to a term of no more than 3 months with an option one month renewal or extension, for a maximum duration of no more than 4 months.

Ok, so I enroll Joe Blow into a Short Term plan on 01/01/24. He has answered NO to all health questions and thinks that he's healthy. Then he goes to the doctor for a pain a month later and finds out that he has cancer, needs heart surgery etc. Surgery scheduled for 04/01.

His ST policy has ended and he can't qualify for a new ST and he's passed the ACA open enrollment. So he is Sh*t out of luck until the next ACA open enrollment.

Is he just supposed to suck it up and die?

I don't sell Short Term, but with a 1 month extension , wouldn't he be covered to 5/1/24?

 

[Yagents]

Beginning September 1, 2024, short-term products are restricted to a term of no more than 3 months with an option one month renewal or extension, for a maximum duration of no more than 4 months.

Ok, so I enroll Joe Blow into a Short Term plan on 01/01/24. He has answered NO to all health questions and thinks that he's healthy. Then he goes to the doctor for a pain a month later and finds out that he has cancer, needs heart surgery etc. Surgery scheduled for 04/01.

His ST policy has ended and he can't qualify for a new ST and he's passed the ACA open enrollment. So he is Sh*t out of luck until the next ACA open enrollment.

Is he just supposed to suck it up and die?

Yup, it's why I won't write 3 month policies. Too much risk vs reward. Another scenario: loses job, can't afford cobra, new job group starts in 3 months, car accident, can't work, no group, stm expires. He's fukd

 

[Chazm]

STM plans will go back to being used to fill in the few months gap when starting Medicare. Otherwise it’ll be worthless again

 

[hockeyday]

This has been discussed at length in other threads . The answer to you question is nobody knows what this will look like in the end . We have no idea what cms’s response is to questions for clarification carriers are asking . We have no idea how carriers determine what they want to do once clarification is made . They might want to keep most of the overrides and sink it into internal call centers .On your pt #1 compensation has always been up to the carrier what to pay up to fmv comp . They could take that and allocate to fmo’s . Your #9 for duals they’ll only be able to move monthly if their dual is integrated . Very few states have full integration as far as i know . I’ve read non integrated dual plans/lis will have the same enrollment periods as regular plans next yr like oep.aep etc

Funny Christian brindle just dropped a youtube that he says his sources and quoted from pages 513 and 514 or something like that, that overrides are still in place,marketing money still in place, only thing being cut is HRA's, but agents are getting 100 bucks extra to make up for that, he says no changes are Coming and went as far to say that individual agent may be no longer viewed as a tpmo going forward

 

[DonP]

Funny Christian brindle just dropped a youtube that he says his sources and quoted from pages 513 and 514 or something like that, that overrides are still in place,marketing money still in place, only thing being cut is HRA's, but agents are getting 100 bucks extra to make up for that, he says no changes are Coming and went as far to say that individual agent may be no longer viewed as a tpmo going forward

Lol. I’m pretty damm sure cms didn’t do all this just so shitty hra’s could be done away with and give the agent an extra $100. Let everything stay as is . Lol

 

[hockeyday]

Lol. I’m pretty damm sure cms didn’t do all this just so shitty hra’s could be done away with and give the agent an extra $100. Let everything stay as is . Lol

Ya I'm not sure where that guy gets his info,

 

[Midlevel]

HRA’s literally take 2-3 minutes but if I don’t have to do them and get the extra $100.00 I will take it.

 

[sshafran]

Ya I'm not sure where that guy gets his info,

Always trust influencers!

 

[DonP]

Always trust influencers!

Were assuming a lot of things . At this pt I’d say the carriers give the agent the $100/$50 as cms specifically ear marked it for agents . But the $250 overrides top of hierarchy fmos were getting and up to $250 an ap marketing money per app ( this includes carrier marketing money direct to fmo’s AND direct to agents . Top agents got both but fmo’s pocketed a ton of that as profit . So carriers could easily say cms says no marketing money ( even though there will different ways to give ) and continue giving the $250 overrides to fmo’s in a different format of payment . The question then becomes since there marketing money a big profit center is gone will they squeeze the ga,mga etc ? Carriers will find a way to pay the fmo’s . Will it be less ? We don’t know . Also an fmo can set a top Medicare agent up with fe or life contracts and funnel the marketing money ( part of there medicare ) overrides that way . I really started thinking . Did all the new rules from 48 hr soa’s , call recordings and crackdown on ads stop the call centers ? Hell no there worse than ever . The only way to stop any of this is restrict the flow of profit . I have to think with increased agent pay there will be less money for overrides if there allowed in some form .

 

[TwoCents]

Correct . People with no lose ,gain , change in lis or Medicaid can only move during regular enrollment periods unless they move to an integrated plan . Most states don’t have integration so those people can’t move quarterly . If you do have an integrated plan you can move monthly . As far as confusion on the new rules . There’s mass confusion surround cam carriers pay fmos a try or of fee ? We know it can’t be an override for enrollments

No!!!

It's 3 different SEPs --

1. Brand New -- The integrated DSNP monthly SEP.

2. Updated -- The quarterly SEP becomes monthly and changes to allow only PDP enrollment.

3. Status Quo -- Gain/Loss/Change SEP stays the same.