When CMS makes stupid decisions, it is for ALL plans.
Rick
That was my undersanding but I just spoke with an FMO that does just Humana plans and they insisted that it only applies to PFFS. Doesnt make sense to me but I dont really know so that is why I asked.
Does that CMS rule prohibiting MA seminar marketing apply to all MA plans or just PFFS?
Winter
don't know for sure about PFFS but i know that we have booked seminars for SecureHorizons PPO for November, The rub is that we can only offer a beverage and cookies and such at a nominal cost.
To me this is a good thing because it will get rid of most of the free lunch for seniors groupies i had following me around last year.
I'm in management in the MA industry, here's the scoop:
1. CMS regulations on MA plans cover PFFS, HMO and PPO across the board. At least right now.
2. New CMS regulations that take effect on October 1, 2008 stipulate that no meals are to be served at MA seminars. That rule is being interpreted generally that refreshments like water, juice, coffee and cookies are okay. At least right now. And that's not a problem, since we're all having to play by the same rules.
3. PFFS plans are on the way out, and will be gone by 2011, per Congress mandate. You'll see managed care plans (PPO and HMO) only after that, which is fine. Managed care plans are less costly to administer than PFFS, plus they're somewhat easier to explain and understand than PFFS.
As a result, the companies that are now just getting into the industry by offering PFFS plans are badly behind the curve. They'll have to be able to create strong networks between now and then, which won't be easy given the existence of the big boys, such as Kaiser, United and Humana.
One other - important - thing. CMS is not fooling around, and I don't blame them, given the amount of fraud and deceit aimed at seniors. If you're going to sell MA plans, get with a big carrier and follow the rules. No cold calling. No advertising without approval from the carrier. Nothing approaching high-pressure selling. Follow the rules, don't try to push the envelope.
A great industry, though. If you love working with seniors (and I do), there's no better place to be right now, in my humble opinion.
...
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"Hey waitress! Bring us a bottle of tequila and call the cops!"
I'm in management in the MA industry, here's the scoop:
1. CMS regulations on MA plans cover PFFS, HMO and PPO across the board. At least right now.
2. New CMS regulations that take effect on October 1, 2008 stipulate that no meals are to be served at MA seminars. That rule is being interpreted generally that refreshments like water, juice, coffee and cookies are okay. At least right now. And that's not a problem, since we're all having to play by the same rules.
3. PFFS plans are on the way out, and will be gone by 2011, per Congress mandate. You'll see managed care plans (PPO and HMO) only after that, which is fine. Managed care plans are less costly to administer than PFFS, plus they're somewhat easier to explain and understand than PFFS.
As a result, the companies that are now just getting into the industry by offering PFFS plans are badly behind the curve. They'll have to be able to create strong networks between now and then, which won't be easy given the existence of the big boys, such as Kaiser, United and Humana.
One other - important - thing. CMS is not fooling around, and I don't blame them, given the amount of fraud and deceit aimed at seniors. If you're going to sell MA plans, get with a big carrier and follow the rules. No cold calling. No advertising without approval from the carrier. Nothing approaching high-pressure selling. Follow the rules, don't try to push the envelope.
A great industry, though. If you love working with seniors (and I do), there's no better place to be right now, in my humble opinion.
...
You may be in management, but, you are not giving the proper story here. You seem to be pushing for agents to get with a captive company.
The CMS rules are not rules yet. They are guidelines at this point. They will most likely be rules that closely resemble the guidelines, but, many companies, obviously not your's, are feverishly negotiating with CMS over the implementation of many of the proposals and their effect on the industry and, more importantly, the seniors themselves.
Nor has Congress mandated tha PFFS services be gone. That is just blatantly false. If your mangement is telling you that, it's time for new management. Now, the requirement for PFFS plans to have a network in counties where there are two or more companies will be the death knell of the PFFS. Unless, of course, there are changes made to the recomendations, which I fully expect to happen once the public gets an understanding of what's happened. A PFFS with a network is a PPO. Naturally in ruarl areas, there won't be a network and people will lose their PFFS in 3 years barring an intervention. That is not the same as a "Congress mandate".
I have not seen it in print, however I have been told that even though meals cannot be served, and a "snack" can, the limit is still $15 that can be spent on an attendee.
Must be expecting inflation to get real strong fast.
Has anyone else heard anything on this? Or have I heard wrong?
------------------------------------
Joe Moore
National Senior Benefits
Asurco Insurance Marketing www.finalexpenseagents.comwww.shenagents.com
PO Box 1954, Morristown, TN 37816
1-800-226-1004, 1-423-581-1004
Yep, the $15 rule remains in effect, and that includes food & beverages and the full (not discounted) cash value of all giveaways and prizes.
There was a lot of complaining initially about no longer being able to buy meals, until everyone realized that we're all in the same boat and no one will have an advantage.
Well, I would point out where you are wrong as well, and you are, but I'm afraid I just don't care enough to do so.
Additionally, I prefer to communicate with people who can be a bit more civil and mature in their responses.
For the rest of you -- be careful, be sure to stay on top of the rules, don't break 'em, and you'll do great!
..
No, I'm not wrong and the reason you don't show where you think I am is because you can't.
The captive companies are loving this stuff because they feel they will be able to control the business now because they will be sending out mailers and then only making leads available to their captive agents.
The ball is currently in their court. But, the independents can and will have seminars. Plus, those that have been in the business for a while have plenty of referrals.
If you got your feelings hurt because of my other reply, you are too thin shinned to post here, I can assure you of that.
This is becoming more clear. You're angry at the "mean" MA companies. This is about you. I get it.
I realize you don't know this, but my compensation is tied to all MA enrollments both nationally and within a certain region. So whether a captive agent does the enrollment, or an independent agent does the enrollment, or if the enrollment is done directly online, it's all the same to me. So, do your seminars. I hope you do well.
Believe it or not, there are some people in this industry who want to help others in the industry, and want to help others stay out of trouble. CMS rules are tough and they're enforced, but for very good reason given the way seniors are treated. And I've seen a number of agents lose their ability to sell MA plans because they either didn't know the rules well enough or didn't follow them closely enough. One case was an entire agency.
Further, a vast majority of CMS violations have been made by non-captive agents (but you wouldn't know that either). This situation is understandable, of course, since these agents sell many other products and don't have the time to focus on these plans, their regulations, or the new rules coming down the road.
I can't help you with your anger at those mean insurance companies. But I can offer advice to agents from an inside perspective, and they can choose to use it or not. They don't know me from Adam, but I can at least try to help.
I feel a certain obligation to reply to your angry and uncivil responses out of common courtesy, but I'd much rather focus on the positive, which is my nature. Buy a punching bag or a stress ball. Life is too short for such cynicism.
This is becoming more clear. You're angry at the "mean" MA companies. This is about you. I get it.
Actually, it has become about you. Who ARE you?
But I can offer advice to agents from an inside perspective, and they can choose to use it or not. They don't know me from Adam, but I can at least try to help.
Why should anyone here believe you? Who ARE you? What or whom do you "manage" (as you bragged in an earlier post.)
I don't know if you are the CEO of Coventry or if you are some guy in a trailer park just outside of Bupkiss, Alabama, but for now I'm going with the latter.
If you want respect here you need to give it and you can start up by showing us your credentials BEFORE telling us how much you know, how important you are, and why we should take what you post seriously.
We have enough "cloaked" experts on this board who claim legitimacy without credentials... we hardly need any others.
Bottom Line: "The CMS rules are not rules yet." And the new rules will apply to both captives and independents. Until we see the final rules published, we can only speculate. Some are planning with limited knowledge and will have to change after October 1st. Today, we are ALL under old rules.
It doesn't matter if you like tequila, wine or beer! When the final rules are published all of us will have something to talk about.
This is becoming more clear. You're angry at the "mean" MA companies. This is about you. I get it.
I realize you don't know this, but my compensation is tied to all MA enrollments both nationally and within a certain region. So whether a captive agent does the enrollment, or an independent agent does the enrollment, or if the enrollment is done directly online, it's all the same to me. So, do your seminars. I hope you do well.
Believe it or not, there are some people in this industry who want to help others in the industry, and want to help others stay out of trouble. CMS rules are tough and they're enforced, but for very good reason given the way seniors are treated. And I've seen a number of agents lose their ability to sell MA plans because they either didn't know the rules well enough or didn't follow them closely enough. One case was an entire agency.
Further, a vast majority of CMS violations have been made by non-captive agents (but you wouldn't know that either). This situation is understandable, of course, since these agents sell many other products and don't have the time to focus on these plans, their regulations, or the new rules coming down the road.
I can't help you with your anger at those mean insurance companies. But I can offer advice to agents from an inside perspective, and they can choose to use it or not. They don't know me from Adam, but I can at least try to help.
I feel a certain obligation to reply to your angry and uncivil responses out of common courtesy, but I'd much rather focus on the positive, which is my nature. Buy a punching bag or a stress ball. Life is too short for such cynicism.
Best wishes.
...
You sure exposed yourself with that one. What a loser. What's with the "boy" stuff? You were shown to be wrong then you make personal attacks.
My comments are neiter angry nor uncivil. Also, I know the rules quite well and have been certified by CMS to train others. That's how I know your "scoop" is not a scoop at all.
But, just for fun, can you provide the statute, rule, law, proposal, statement or anything to back up your claim that there is a "Congres mandate" to get rid of the PFFS plans?
Just providing that little nugget will go a long way towards establishing some creditability for you. You being this all knowing big wig manager and all that hoopla should make it easy for you to provide the proof of your claims.
Bottom Line: "The CMS rules are not rules yet." And the new rules will apply to both captives and independents. Until we see the final rules published, we can only speculate. Some are planning with limited knowledge and will have to change after October 1st. Today, we are ALL under old rules.
It doesn't matter if you like tequila, wine or beer! When the final rules are published all of us will have something to talk about.
You sure exposed yourself with that one. What a loser. What's with the "boy" stuff? You were shown to be wrong then you make personal attacks.
You've never heard the expression "ho boy" before? Seriously? Holy cow. Wait, I'm not calling you a "cow", "holy cow" is an expression too. Calm down.
You said, "But, just for fun, can you provide the statute, rule, law, proposal, statement or anything to back up your claim that there is a "Congres mandate" to get rid of the PFFS plans?"
OK, more work than I care to put into this, but for the benefit of all:
From the story:
"H.R. 6331 not only starts to phase out the subsidies, it requires that any PFFS player establish networks byJanuary 1, 2011 - converting PFFS members to mainstream Medicare Advantage. “With PFFS gone in 2011, the Congressional Budget Office (CBO) estimated that $14 billion in savings could be transferred to physician payments.” http://healthaffairs.org/blog/"
"Converting PFFS members to mainstream Medicare Advantage." As I said. I've known this since before it was passed, because I'm right in the middle of it.
In other words, MA companies will be establishing more HMO/PPO networks in the next two years to convert their existing PFFS books to managed care plans. My original point before all of this silliness.
It's also quite likely that most outlying areas will get these plans too. Not all, but most. I know that my company is planning to do so, and I know the competition is, as well.
I have no doubt that all this evidence will not be good enough for you, as clear as it is, since you're now so heavily invested in discrediting me, for some reason.
I must also say that it's disturbing that someone who "knows the rules quite well and has been certified by CMS to train others" didn't even know about H.R. 6331. Disturbing, but not surprising. Quality control is always a concern of ours, and a battle we have to fight constantly.
Now, if you want to think that I'm a fry cook at Burger King, by all means, run with it (I must say, being a fry cook is problematic considering I don't eat red meat, but a job is a job). I truly don't care.
This is becoming very tedious. But go ahead, spin away.
...
Last edited by Mac1958 : 08-31-2008 at 02:48 PM.
Reason: Addition
You've never heard the expression "ho boy" before? Seriously? Holy cow. Wait, I'm not calling you a "cow", "holy cow" is an expression too. Calm down.
You said, "But, just for fun, can you provide the statute, rule, law, proposal, statement or anything to back up your claim that there is a "Congres mandate" to get rid of the PFFS plans?"
OK, more work than I care to put into this, but for the benefit of all:
From the story:
"H.R. 6331 not only starts to phase out the subsidies, it requires that any PFFS player establish networks byJanuary 1, 2011 - converting PFFS members to mainstream Medicare Advantage. “With PFFS gone in 2011, the Congressional Budget Office (CBO) estimated that $14 billion in savings could be transferred to physician payments.” http://healthaffairs.org/blog/"
"Converting PFFS members to mainstream Medicare Advantage." As I said. I've known this since before it was passed, because I'm right in the middle of it.
In other words, MA companies will be establishing more HMO/PPO networks in the next two years to convert their existing PFFS books to managed care plans. My original point before all of this silliness.
It's also quite likely that most outlying areas will get these plans too. Not all, but most. I know that my company is planning to do so, and I know the competition is, as well.
I have no doubt that all this evidence will not be good enough for you, as clear as it is, since you're now so heavily invested in discrediting me, for some reason.
I must also say that it's disturbing that someone who "knows the rules quite well and has been certified by CMS to train others" didn't even know about H.R. 6331. Disturbing, but not surprising. Quality control is always a concern of ours, and a battle we have to fight constantly.
Now, if you want to think that I'm a fry cook at Burger King, by all means, run with it (I must say, being a fry cook is problematic considering I don't eat red meat, but a job is a job). I truly don't care.
This is becoming very tedious. But go ahead, spin away.
...
No spin required mr. manager. You stated that there was a "mandate" from Congress to get rid of PFFS. I said that was false. I did say that the way the proposed rules are drawn up now, barring changes, would be the death knell for PFFS plans. You replied that that I didn't know what I was talking about because I wasn't a ballyhoo'ed manager with a captive company. Then you bring in a racial insult.
I asked you to provide some proof for your charge about the Congress "mandate". In your infintestament managerial knowledge, you post proposed CMS regulations that support exactly what I said all along. And, to top it off, you think it was supporting your contentions.
I sure am glad that I'm not a big wheeled manager. I would be clueless, too.
I backed up precisely what I said. With specific proof. Just as you asked.
"You replied that that I didn't know what I was talking about because I wasn't a ballyhoo'ed manager with a captive company."
Please point out where I said that. Or do you feel a need to engage in hyperbole in an effort to prove a point? Not a good sign. Please point that post out for us.
"Then you bring in a racial insult."
Huh? What? When? Where? And precisely how am I supposed to know your race, as if it matters, by letters typed on a screen? Is this a joke?
Jdeasy, with respect, why don't we just end this dialogue. Again, I much prefer mature, civil discourse, and again, I don't know why you're so desperate to discredit me. You've dug yourself into a hole and you're still flailing. This is silly.
I've been enjoying this forum very much until this bizarre conversation.
MA seminars or lack thereof
Re: MA seminars or lack thereof
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