Have you seem this in the Bill that passed both the House and Senate by Veto proof margins.
Its not going to be pretty for a lot of agents, Thoughs?
[COLOR=red]SEC. 103. PROHIBITIONS AND LIMITATIONS ON CERTAIN SALES AND MARKETING ACTIVITIES UNDER MEDICARE ADVANTAGE PLANS AND PRESCRIPTION DRUG PLANS.[/COLOR]
(a) Prohibitions-
(1) MEDICARE ADVANTAGE PROGRAM-
(A) IN GENERAL- Section 1851 of the Social Security Act (42 U.S.C. 1395w-21) is amended--
(i) in subsection (h)(4)--
(I) in subparagraph (A)--
(aa) by striking cash or other monetary rebates and inserting , subject to subsection (j)(2)(C), cash, gifts, prizes, or other monetary rebates; and
(bb) by striking , and at the end and inserting a semicolon;
(II) in subparagraph (B), by striking the period at the end and inserting a semicolon; and
(III) by adding at the end the following new subparagraph:
(C) shall not permit a Medicare Advantage organization (or the agents, brokers, and other third parties representing such organization) to conduct the prohibited activities described in subsection (j)(1); and; and
(ii) by adding at the end the following new subsection:
(j) Prohibited Activities Described and Limitations on the Conduct of Certain Other Activities-
[COLOR=red](1) PROHIBITED ACTIVITIES DESCRIBED- The following prohibited activities are described in this paragraph:[/COLOR]
[COLOR=red](A) UNSOLICITED MEANS OF DIRECT CONTACT- Any unsolicited means of direct contact of prospective enrollees, including soliciting door-to-door or any outbound telemarketing without the prospective enrollee initiating contact.[/COLOR]
[COLOR=red](B) CROSS-SELLING- The sale of other non-health related products (such as annuities and life insurance) during any sales or marketing activity or presentation conducted with respect to a Medicare Advantage plan.[/COLOR]
[COLOR=red](C) MEALS- The provision of meals of any sort, regardless of value, to prospective enrollees at promotional and sales activities.[/COLOR]
[COLOR=red](D) SALES AND MARKETING IN HEALTH CARE SETTINGS AND AT EDUCATIONAL EVENTS- Sales and marketing activities for the enrollment of individuals in Medicare Advantage plans that are conducted--[/COLOR]
[COLOR=red](i) in health care settings in areas where health care is delivered to individuals (such as physician offices and pharmacies), except in the case where such activities are conducted in common areas in health care settings; and[/COLOR]
[COLOR=red](ii) at educational events..[/COLOR]
(2) MEDICARE PRESCRIPTION DRUG PROGRAM- Section 1860D-4 of the Social Security Act (42 U.S.C. 1395w-104) is amended by adding at the end the following new subsection:
(l) Requirements With Respect to Sales and Marketing Activities- The following provisions shall apply to a PDP sponsor (and the agents, brokers, and other third parties representing such sponsor) in the same manner as such provisions apply to a Medicare Advantage organization (and the agents, brokers, and other third parties representing such organization):
(1) The prohibition under section 1851(h)(4)(C) on conducting activities described in section 1851(j)(1)..
(3) EFFECTIVE DATE- The amendments made by this subsection shall apply to plan years beginning on or after January 1, 2009.
(b) Limitations-
(1) MEDICARE ADVANTAGE PROGRAM- Section 1851 of the Social Security Act (42 U.S.C. 1395w-21), as amended by subsection (a)(1), is amended--
(A) in subsection (h)(4), by adding at the end the following new subparagraph:
(D) shall only permit a Medicare Advantage organization (and the agents, brokers, and other third parties representing such organization) to conduct the activities described in subsection (j)(2) in accordance with the limitations established under such subsection.; and
(B) in subsection (j), by adding at the end the following new paragraph:
(2) LIMITATIONS- The Secretary shall establish limitations with respect to at least the following:
(A) SCOPE OF MARKETING APPOINTMENTS- The scope of any appointment with respect to the marketing of a Medicare Advantage plan. Such limitation shall require advance agreement with a prospective enrollee on the scope of the marketing appointment and documentation of such agreement by the Medicare Advantage organization. In the case where the marketing appointment is in person, such documentation shall be in writing.
(B) CO-BRANDING- The use of the name or logo of a co-branded network provider on Medicare Advantage plan membership and marketing materials.
(C) LIMITATION OF GIFTS TO NOMINAL DOLLAR VALUE- The offering of gifts and other promotional items other than those that are of nominal value (as determined by the Secretary) to prospective enrollees at promotional activities.
(D) COMPENSATION- The use of compensation other than as provided under guidelines established by the Secretary. Such guidelines shall ensure that the use of compensation creates incentives for agents and brokers to enroll individuals in the Medicare Advantage plan that is intended to best meet their health care needs.
(E) REQUIRED TRAINING, ANNUAL RETRAINING, AND TESTING OF AGENTS, BROKERS, AND OTHER THIRD PARTIES- The use by a Medicare Advantage organization of any individual as an agent, broker, or other third party representing the organization that has not completed an initial training and testing program and does not complete an annual retraining and testing program..
(2) MEDICARE PRESCRIPTION DRUG PROGRAM- Section 1860D-4(l) of the Social Security Act, as added by subsection (a)(2), is amended by adding at the end the following new paragraph:
(2) The requirement under section 1851(h)(4)(D) to conduct activities described in section 1851(j)(2) in accordance with the limitations established under such subsection..
(3) EFFECTIVE DATE- The amendments made by this subsection shall take effect on a date specified by the Secretary (but in no case later than November 15, 2008).
(c) Required Inclusion of Plan Type in Plan Name-
(1) MEDICARE ADVANTAGE PROGRAM- Section 1851(h) of the Social Security Act (42 U.S.C. 1395w-21(h)) is amended by adding at the end following new paragraph:
(6) REQUIRED INCLUSION OF PLAN TYPE IN PLAN NAME- For plan years beginning on or after January 1, 2010, a Medicare Advantage organization must ensure that the name of each Medicare Advantage plan offered by the Medicare Advantage organization includes the plan type of the plan (using standard terminology developed by the Secretary)..
So in english you can't feed them can't cold call them and can't knock on thier doors. So how do you contact them?
The carriers will love all of this because it puts everyone on an equal playing field and drives everyone in through their telemarketing and bypasses the agents which they also love to do. Some zamboni of the phone slams them into an MA and an hour later they dont know what the hell they have or who to call about it. I suppose it is also a windfall for captive agents who get some feed off the tv ads and mailings and not have to compete with the independents at the local buffet. However, after next enrollment season, the entire field looks grim for them too.
This bill only address how to market. Other legislation will address whether they will be offered at all. The PFFS piece has already taken a fatal hit.
As with the PFFS plans, congress will probably not kill MA's but cut their subsidies and then tell the carriers to do what they want. Then when the carriers raise their rates to cover costs or failure to realize savings then the public will just say "what the hell, I can get a full med supp without the smoke and mirrors of an MA for another fifty bucks a month beyond what the MA would cost me."
Winter
------------------------------------ Spending Our Way to Prosperity
No more paying for 15 meals for people that go to a meeting everyday.
I'm saddened!! -sarcasm-
On a side note: The funny thing is we do have a lot of people who complain they don't get enough information. it would be nice if you could at least call people and invite them to a seminar!
[COLOR=Black](C) MEALS- The provision of meals of any sort, regardless of value, to prospective enrollees at promotional and sales activities.[/COLOR]
Shoney's, Perkins, Picadilly Cafeteria et. al. are in for some hard times.
I don't see MA PPO & HMO plans going away nor their subsidies cut substantially. They are slightly over subsidized and I can see some adjustments, but Medicare itself has cut reimbursement rates and the trend is going to be to shave a little off of everything.
Hospitals negotiate rates with the MA's and don't accept just medicare assignment like Drs. do, and that is creating problems with networks in some areas.
I don't see MA PPO & HMO plans going away nor their subsidies cut substantially. They are slightly over subsidized and I can see some adjustments, but Medicare itself has cut reimbursement rates and the trend is going to be to shave a little off of everything.
Hospitals negotiate rates with the MA's and don't accept just medicare assignment like Drs. do, and that is creating problems with networks in some areas.
I heard that PFFS plan would not have the deeming anymore and would have docs on a provider list instead... like a PPO or HMO.
You can thank all the greedy bad apples in this market, now all of us suffer. It was bound to happen considering the feedback I've gotten from seniors.
You can thank all the greedy bad apples in this market, now all of us suffer. It was bound to happen considering the feedback I've gotten from seniors.
I went to Bravo last year to find out about MA plans. First, they gave everyone the answers to the CMS test - 1st clue.
Second, their manager told everyone that the basic pitch was "these are benefits in addition to your Medicaid and nothing changes."
He harped on "not confusing the seniors."
Yes...we don't want to confuse seniors with the truth. So if you want to blame someone, blame outfits like this with a room packed with 40 agents teaching people to lie.
I went to Bravo last year to find out about MA plans. First, they gave everyone the answers to the CMS test - 1st clue.
Second, their manager told everyone that the basic pitch was "these are benefits in addition to your Medicaid and nothing changes."
He harped on "not confusing the seniors."
Yes...we don't want to confuse seniors with the truth. So if you want to blame someone, blame outfits like this with a room packed with 40 agents teaching people to lie.
Yea, I had a guy that wanted me to get appointed with him and he sent me the MA test and answers.
Needless to say that I never worked with him or talked to him again.
Same thing happened at UnitedHealthCare training. The company instructor allowed agents to share answers during their test. And wasn't the ear plug -- stupid glasses -- AARP desensitization training another example of a need for one standardized Federal test. We don't even get CE credits for the hours upon hours of certification.
I went to Bravo last year to find out about MA plans. First, they gave everyone the answers to the CMS test - 1st clue.
Second, their manager told everyone that the basic pitch was "these are benefits in addition to your Medicaid and nothing changes."
He harped on "not confusing the seniors."
Yes...we don't want to confuse seniors with the truth. So if you want to blame someone, blame outfits like this with a room packed with 40 agents teaching people to lie.
Totally agree there are alot of those types out there. The outfit I'm with is small and has a very good compliance lady who cracks the whip on those issues. I can say they are very diligent about doing the right thing but had turned blind eyes on some top agents because of sales at times. They finally weeded out some unscrupulous agents only to see them move clients away. My wife heads up the department that deals everyday with compliance and customer retention issues on the customer service side, so I get an inside view almost daily.
No more Medicare Advantage leads
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