No More Wellcare or Coventry PFFS After 12/31/09Go to Top
I just got the emails that makes it official.
I'm out of the PFFS Business. I think I will stay completely away from anything to do with CMS.
And nope.... I'm not even going to do Med Sups either.
I think I'll move to Florida and work for the mouse.
From Wellcare:
2010 Private Fee For Service Announcement Dear Valued Producer:
WellCare has notified the Centers for Medicare & Medicaid Services (CMS) that it does not intend to renew its contracts to offer Medicare private fee-for-service (PFFS) plans in 2010. Our intention to withdraw from Medicare Advantage PFFS was a difficult decision, and we regret that in 2010 we will no longer be able to offer these plans.
WellCare Medicare Advantage plan members whose identification cards include the letters "PFFS" and WellCare identification numbers that start with the letter "F" will be affected by this action. WellCare does not offer Medicare Advantage PFFS plans in Connecticut, Florida and Texas, so WellCare Medicare Advantage members enrolled in these states will not be affected. Also, members enrolled in a WellCare HMO (coordinated care) plan or a prescription drug plan (PDP), or a WellCare Medicaid plan, will not be affected. As of March 31, 2009, about 110,000 of the approximately 2.5 million members served by WellCare were Medicare Advantage PFFS members.
Members currently enrolled in one of WellCare's PFFS plans will continue to have access to WellCare benefits until January 1, 2010. These members will have an opportunity to choose a new Medicare Advantage plan or return to original Medicare coverage during the regular annual election period from November 15 to December 31, 2009. Members do not need to make a change to their WellCare Medicare Advantage PFFS coverage until then. Written notification will be provided to WellCare Medicare Advantage PFFS members before the annual election period in accordance with CMS requirements, and CMS will send all Medicare beneficiaries a Medicare & You booklet that includes information about the various health care options available to Medicare beneficiaries in 2010.
For 2010, WellCare will remain focused on WellCare's core HMO and PDP business, and help members with a smooth transition to other WellCare plan coverage, coverage from another Medicare Advantage plan or coverage from original Medicare.
WellCare appreciates the vital role of the producer in WellCare's success and intends to re-engage producers upon our return to marketing our Medicare Advantage and PDP programs. As such, WellCare will continue to keep producers informed of important industry news, upcoming legislative activity and WellCare's progress in our efforts to re-launch sales and marketing activities.
Please note that you will be notified when more information becomes available. In the meantime, please refer to the attached FAQ's for additional clarification.
Sincerely,
Kevin A. LeBlanc
Vice President, National Distribution
Breaking News Regarding Your PFFS Coventry Business
Coventry will not offer Medicare Advantage PFFS Plans in 2010
Coventry Health Care has announced that they will not be offering Medicare Advantage Private Fee for Service (PFFS) plans for the 2010 plan year, and no new commissions will be paid on individual or group PFFS plans sold with a plan effective date of July 1, 2009 or later, citing the Medicare Advantage rate cuts announced in April and the rising cost of medical care as contributing to their decision.
The Implications for Coventry Agents:
No new commissions will be paid on individual or group PFFS plans sold with a plan effective date of July 1, 2009 or later.
Renewal commissions for PFFS plans will continue to be paid through December 31, 2009. Renewals will continue beyond December 31, 2009 if the client converts to a Coventry Coordinated Care Plan.
Part D plans are still available.
Ultimately, this means that if you sold Coventry PFFS plans to clients in the past, these plans cannot be changed until the November 15, 2009 Annual Election Period. In the meantime, for your clients who are aging-in to Medicare, contact your marketing organization for alternative product solutions.
Re: No More Wellcare or Coventry PFFS After 12/31/09Go to Top
Originally Posted by coachd
Now I want to find a list of people on these near me. That will be some good money in 2010 Jan.
If you have such a list, you had better believe it would be very valuable. I'm thinking there may be others before it's over with. Either that or increased premiums and/or decreased benefits. But in the latter case the member is not eligible for a GI supp.
Re: No More Wellcare or Coventry PFFS After 12/31/09Go to Top
With the new budget cuts I think there is a good chance most or all the MA companies will drop out. I think we will see both increased premium and decreased benefits. Could be big opportunities for 2010.
Re: No More Wellcare or Coventry PFFS After 12/31/09Go to Top
Originally Posted by Insuranceman
With the new budget cuts I think there is a good chance most or all the MA companies will drop out. I think we will see both increased premium and decreased benefits. Could be big opportunities for 2010.
I think a number of the PFFS companies who dipped their toe in the water in the middle part of the decade and got into the market after the Medicare Modernization Act passed will probably drop out sooner or later.
I wouldn't bet on the big HMO companies like Humana, United Healthcare and maybe a few others dropping out, although decreased benefits and increased premium are likely, and maybe pulling out of some markets depending on how deep the cuts go.
Also, this announcement states that Wellcare announced they are getting out of the PFFS market, not HMO. I don't know whether the problems they had with CMS were related to PFFS, HMO or both.
Last edited by Cenla Agent : 05-05-2009 at 04:20 PM.
Re: No More Wellcare or Coventry PFFS After 12/31/09Go to Top
All those poor souls that have health issues are going to be totally screwed when they have to be underwritten back into a Med Supp.....They will be forever stuck in a PFFS/PPO/HMO....
Re: No More Wellcare or Coventry PFFS After 12/31/09Go to Top
We all figured on this happening, didn't we?
Well the ones whos plan will not be available next year will at least have a guaranteed issue opportunity and won't have to be underwritten, med supp companies won't like that and I can see the med supp rates taking a big hike adding all of these uninsurable people to their plans.
Re: No More Wellcare or Coventry PFFS After 12/31/09Go to Top
Originally Posted by brkrsrevolution
We all figured on this happening, didn't we?
Well the ones whos plan will not be available next year will at least have a guaranteed issue opportunity and won't have to be underwritten, med supp companies won't like that and I can see the med supp rates taking a big hike adding all of these uninsurable people to their plans.
Spot on!
Yep, we sure did, at least I did. That is the reason I never did get started selling PFFS plans. I didn't like them when they first came out and like them even less now.
I think your assessment of what is going to happen to Med Supps may be very accurate. We have guaranteed issue in Missouri and I wish they would do away with it. It may be good for agents in the short run but agents who are in the business for the long haul end up with a lot of unhappy clients when they get huge rate increases because of it.
I am so pleased to hear that PFFS plans are going away.
In the next couple of years we are going to see a huge increase in Med Supp sales. Now it the time for agents to begin positioning themselves to be there when it happens.
I have gotten a lot of calls recently from agents who want to be trained to prospect for and sell Med Supps.
------------------------------------ Professional Medicare Supplement Sales Training, Coaching and Support.
"The Perfect Contact Management Program (CMP) for the Insurance Professional" www.YourInsuranceOffice.com
877.633.0808
Re: No More Wellcare or Coventry PFFS After 12/31/09Go to Top
Frank..... I don't know you but I respect you completely for your knowledge and your willingness to help other agents freely. But I don't agree with this statement.
Originally Posted by Frank Stastny
I am so pleased to hear that PFFS plans are going away.
In the next couple of years we are going to see a huge increase in Med Supp sales. Now it the time for agents to begin positioning themselves to be there when it happens.
Here in Upstate/Western, New York State, the senior population will have to chose between eating and buying a Med Sup.
Most of my clients are not poor enough to qualify for Medicaid, but poor enough that they can not afford to buy a Med Sup or a Part D.
Medicare Advantage PFFS was the ONLY thing they could afford to have and still be able to take prescribed meds, pay their heating bill and eat.
What do you suggest a senior making $1,000 a month on SS do to survive ? Just curious ?
Re: No More Wellcare or Coventry PFFS After 12/31/09Go to Top
Originally Posted by Hank
What do you suggest a senior making $1,000 a month on SS do to survive ? Just curious ?
Wait for a government bailout like GM is getting.
The reality is that seniors don't have to buy a med supplement. Unless they are in the hospital or have chemo, they will likely not save enough in services by paying a premium.
I feel bad for people that don't have a lot of money, but are we to pay for their insurance? That's socialism. We already provide 80% of the cost and many doctors and clinics will waive the other 20%.
If the f*cking government hadn't put all the fraternal societies out of business in beginning of the 20th century with their great idea of welfare, we wouldn't have this problem - nor would we have needed Medicare.
Rick
------------------------------------ ILIAA
Training, Community, Support, and Success Independent Life Insurance Agents Assn rick@iliaa.org
Re: No More Wellcare or Coventry PFFS After 12/31/09Go to Top
Originally Posted by GreenSky
Wait for a government bailout like GM is getting.
The reality is that seniors don't have to buy a med supplement. Unless they are in the hospital or have chemo, they will likely not save enough in services by paying a premium.
I feel bad for people that don't have a lot of money, but are we to pay for their insurance? That's socialism. We already provide 80% of the cost and many doctors and clinics will waive the other 20%.
If the f*cking government hadn't put all the fraternal societies out of business in beginning of the 20th century with their great idea of welfare, we wouldn't have this problem - nor would we have needed Medicare.
Rick
I take it you don't write a great deal of med-supps?
I'm sure you have seen that three of our major competitors (Coventry, WellCare and Health Net) in the individual Private Fee-for-Service (PFFS) market have officially announced they are withdrawing from thismarket as of December 31, 2009 - this year end. Under current CMS rules and regulations, their existing individual PFFS members will be terminated and thus be forced to seek other coverage.
Our Chairman, Richard Barasch, in a recent investor call stated, "For 2010, we expect to bid in all of our current MA markets, including PFFS counties. We go into this bidding season with a favorable trend in our benefit ratios and an improving G&A structure."
From Mr. Barasch's statement, you are assured that we will continue to be in the individual PFFS market and thus continue to support You - a member of our valued field force. We continue to welcome Your Business in the remainder of 2009 as well as in 2010.
We have received numerous phone calls asking whether or not we are withdrawing from the individual PFFS market. Hopefully this clarifies that we are not withdrawing and we are here to support you and your clients.
Very truly yours,
Gary W. Bryant
Executive Vice President &
Chief Operating Officer
Re: No More Wellcare or Coventry PFFS After 12/31/09Go to Top
Originally Posted by thereaper
I believe I read that all PFFS will become regional PPO's in their prespective areas beginning 2010, but can't find where I read it.
Since I've basically gotten out of this market I can't remember where I read it either and I haven't kept up on all of the latest developments. I had read that PFFS will start looking more like a PPO (or at least it was proposed) in the sense that providers will be contracted, etc. But it wasn't exactly going to work like a PPO either.
It may be different in other parts of the country, but in the states I'm familiar with, Humana is the only Regional PPO that I'm aware of.
No More Wellcare or Coventry PFFS After 12/31/09
I'm not even going to do Med Sups either.
But I don't agree with this statement. 
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