Insurance Agent Forum

[midwestbroker]

I have heard through the grapevine that the Government has passed a bill allowing PFFS plans to be offered for the next 2 years, with no lock-in.

Stips are that they are MA only plans (no PDP), since the lock-in still applies to the Part D side of Medicare.

Anyone heard of this? One of my brokers told me about this. I looked on Google and did not find anything (but I did not dig very deep).

[Insuranceman]

I heard the same thing too from my broker. He said he heard it from a couple different reliable sources.

[Frank Stastny]

That would make a lot more sense.

I was told the same thing yesterday but cautioned not to start making plans yet until more information is available. Hopefully that won't take too long.

I went to the CMS site but didn't see anything.

[midwestbroker]

I asked the powers that be here at Humana and they said that they have heard something about it. And that is all I got out of them. Prob because in the Kansas City market we only have PFFS plans with Part D tied into it.

But this is only a trouble for the Supplement companies, for the simple fact that if they have a MAPD plan, they are locked in unless they want to drop their Part D coverage.

[sman]

Originally Posted by midwestbroker

I asked the powers that be here at Humana and they said that they have heard something about it. And that is all I got out of them. Prob because in the Kansas City market we only have PFFS plans with Part D tied into it.

But this is only a trouble for the Supplement companies, for the simple fact that if they have a MAPD plan, they are locked in unless they want to drop their Part D coverage.

Midwest,

Why do you think this is trouble for supplement companies? I'm finding more and more people who would prefer to have the supplement (assuming they can afford it) due to the problems they've incurred on the MA plans. In addition, MANY doctors here Georgia are starting to refuse to accept Humana's PFFS plan. They are citing slow to reimburse, low reimbursements and poor customer service as their reasons.

While I welcome a "year-round" open enrollment for MA plans, I don't see this as a problem for supplement carriers. However, I do see it as an administrative nightmare for CMS. Can you imagin those that have the premiums taken from their social security check and how that would work if they switched from month to month on MA plans?

[James]

If the bill hasn't gone through Congress yet I doubt it will for the next two years. MA plans will not be a staple till they lift the lock out, which makes no sense to me at all but it is what it is. Plus according to Sterling, Humana hasn't petition for the lock out to be done away with in the last few years in DC meetings, according to Sterling CEO. Now that is coming from Sterling, Humana might have another take on the story. Yet though, I hear more cuts are coming with Humana this year? More talk about Humana being in trouble, but what is new. You know Humana owned Hospitals in KY are no longer excepting the Humana Plans, that has been out for a while now.

[Frank Stastny]

I tried to call CMS this morning and that was totally a waste of time.

I then called Senator Kit Bond's office and they said they didn't know of anything recently. They gave me a number for Congressional Search Services and I got the recording saying that it was not a working number.

I called Pyramid and all they said is they too had heard the rumor but couldn't direct me to any specific information.

It is kind of strange that a rumor like that would surface yesterday, the day I first heard about it, considering that Congress has been adjourned for the last two weeks.

The bill has been proposed but has NOT passed yet. That is why you will not get a definitive answer from anywhere.

If it does pass they will NOT be able to switch every month, but instead it allows people to get into a PFFS plan any time of the year--but with limitations such as switching one time in a calender year.

This is a good idea--most people are still clueless about MA plans and their availability. CMS needs to get the word out more before imposing a lock-in.

CMS is already a nightmare--I recommend doing automatic bank drafts as opposed to Social Security deductions.

[midwestbroker]

I see this as a problem for supp companies because of their premium increases. When you have plan F that is $165 a month (about the average I see here in KC) vs. a PFFS plan that is $30 a month, people really start to think about how much they need their supps.

Humana has been in Kansas City since about 1991, so we have a very established network of Docs and Hospitals. So, the network here is typically not an issue. Sure on a supp, you can see any doc you want, but if they are all in a HMO or PPO network, why pay more? That is where it becomes a co-pay vs. supp premium.

For CMS it very well could be a nightmare, but I am willing to bet too that there will be a limit on the number of changes you can make. Social Security has been a nightmare when it comes to doing the whole premium thing. I too rec. bank draft, as that is how most supp companies do it as well.

[Zydo]

Just received notification of the limited continuous open enrollment period april 1 thru Dec 31, 2007. MA's may be sold thru 12/31/07 based on certain criteria.

Commissions may be cut 50 to 75% in designated counties.

For those of you marketing the MA's, what do you think of this?

From whom did you receive this notice?

[midwestbroker]

Who did you get the notice from and what are the limitations?

[Zydo]

Here is a copy of the email I received from Pyramid.

Contact your FMO, IMO or company about your specific product.

__________________________________________________ _________

DATE: December 29, 2006

TO: All Agents

FROM: Gary W. Bryant

RE: Important Changes - Medicare Advantage Products



Great News!! Today's Options (Medicare Advantage Only) Open Enrollment Selling Season Extended!!



We are writing to inform you of several important changes that will affect sales of Today's Options Private-Fee-For-Service plans beginning February 1, 2007.



As you may know, Congress recently adapted existing legislation, which President Bush signed into law, to create a Limited Continuous Open Enrollment Period for Today's Options, MA-only plans. The Limited Open Enrollment Period, which begins, at the end of the current 2007 Open Enrollment Period, gives us a very exciting opportunity to continue selling MA plans beyond March 31, 2007.



What does this mean for agents?



This provision allows continuous open enrollment of original Medicare beneficiaries, during 2007 and 2008, into Medicare Advantage plans - with the stipulation that beneficiaries may exercise this right only one time per year. This means that:

Medicare beneficiaries who have not elected Part D may choose to enroll in any MA plan that does not offer Part D coverage (i.e., an MA-only HMO or PPO plan; a PFFS plan that does not include Part D benefits, or an MSA plan (which is not permitted to include Part D benefits)).
Medicare beneficiaries who have elected Part D may choose to enroll in an MA PFFS plan that does not offer Part D coverage or in an MSA plan. CMS is currently considering whether these beneficiaries could also enroll in an MA only HMO or PPO plan.
Specifically, for this current selling season, from January 1 - March 31, 2007 while a Medicare beneficiary can change their Medicare Prescription Drug Plan (PDP) carrier they may not change their Medicare Part D status. Beginning April 1, 2007, the Limited Continuous Open Enrollment Period only applies to beneficiaries enrolled in original Medicare (Parts A & B).


Please review the included chart - Exhibit A.



Scenarios:

If a Medicare Beneficiary is enrolled in a Medicare Advantage plan as of April 1, 2007, the Medicare beneficiary may not make any changes to their existing coverage. As a result, the beneficiary will be locked in to his/her plan from April 1, 2007 until December 31, 2007 (Subject to the "first time" in a Medicare Advantage disenrollment election and the changes that a beneficiary can make if they have a "special election period").
If a Medicare Beneficiary enrolls in an MA plan prior to December 31, 2006 and the beneficiary elects to use the one time change option to change his/her MA coverage between January 1 and March 31, 2007, to another MA plan, then the beneficiary is locked into the MA plan for the rest of the year.
If a Medicare Beneficiary is enrolled in original Medicare as of April 1, 2007 (they are not enrolled currently in a MA, MAPD plan) he/she can make one election to enroll in an MA only plan between April 1 and December 31.
Regardless of the scenario, original Medicare beneficiaries may only make one election to enroll in an MA plan from January 1 - December 31, 2007.



Other Implications:



Product/Plan Highlights - All four of our Today's Options plans allow members the freedom of seeing any provider in the U.S. who accepts Medicare and the plans' terms and conditions of payment; however only two of our plans do not include drug coverage and are, therefore, considered MA-Only products. Every member of Today's Options will have access to additional services including 24-hour, toll-free Eldercare Services counseling and a voluntary CareContact program designed to help individuals with chronic conditions such as diabetes or congestive heart failure take better care of their health. Our plans without drug coverage are:

Today's Options Value Plan is the most affordable plan. It offers low doctor and hospital co-pays, annual preventative screenings for $0 co-pay, and an out-of-pocket limit of $3,000 on healthcare services.
Today's Options Premier Plan offers members the same range of health benefits as the Value Plan but with lower co-pays on healthcare services and a lower out-of-pocket limit of $2,500.


Reduced Commission Counties - As a result of the extended selling season, for MA-Only products, we are also making reductions to the commission schedule for a limited number of counties. The attached Addendum A is effective for all Enrollments we receive on or after February 1, 2007. Please attach the Addendum A to your Agent Application and Agreement for Medicare - Approved Private Fee-for-Service document for easy reference. We recognize that these changes will affect the opportunity for agents in these specific markets, however, the overall market opportunity remains extremely strong for our products with more than 84% of all Pyramid Life's Today's Options counties we service at full commission.



Certification - Agents who are not certified to sell Today's Options are not allowed to submit any new business until such time as they complete either on-line or paper certification and testing.



Verification Calls - As was communicated last month, agents who do not have their applicants complete telephone verification calls will not be paid or advanced commissions until such time as the telephone verification is completed.



In summary, this represents great news for all of us! As you can see, it looks like we'll be able to sell our exceptional Today's Options products well beyond March 31, 2007 and bring more value to the seniors and other Medicare beneficiaries we serve. We are very pleased with the results to date for our 2007 Today's Options products, and believe that, on balance, these changes represent additional opportunity for you. If you have any questions, please contact your Marketing department with any questions.



As always, we appreciate your ongoing support of our business and look forward to helping you and your clients during the remainder of the year

[midwestbroker]

So, if I understand this, we can sell MA only plans through Dec 31st. The client has one plan option change for the year. So once they enroll that is what they have for the rest of the year (unless it is a SEP situation).

That sounds great to me!!!

It appears that HR Bill 6111 did pass on 12/20/2006

Originally Posted by midwestbroker

So, if I understand this, we can sell MA only plans through Dec 31st.

Actually, you can enroll them through Dec 31 2008

SEC. 206. LIMITED CONTINUOUS OPEN ENROLLMENT OF
ORIGINAL MEDICARE FEE-FOR-SERVICE EN-
ROLLEES INTO MEDICARE ADVANTAGE NON-
PRESCRIPTION DRUG PLANS.
(a) IN GENERAL.—Section 1851(e)(2) of the Social
Security Act (42 U.S.C. 1395w–21(e)(2)) is amended by
Adding at the end the following new subparagraph:
‘‘(E) LIMITED CONTINUOUS OPEN ENROLLMENT OF ORIGINAL FEE-FOR-SERVICE ENROLLEES IN MEDICARE ADVANTAGE NON-PRE-
SCRIPTION DRUG PLANS.—
‘‘(i) IN GENERAL.—On any date dur-
Ing 2007 or 2008 on which a Medicare Ad-
Vantage eligible individual is an unenrolled
Fee-for-service individual (as defined in
Clause (ii)), the individual may elect under
VerDate 0ct 09 2002 21:12 Dec 07, 2006 Jkt 000000 PO 00000 Frm 00160 Fmt 6652 Sfmt 6201 C:\TEMP\HWC_419.XML HOLCPC
subsection (a)(1) to enroll in a Medicare
Advantage plan that is not an MA–PD
Plan.
‘‘(ii) UNENROLLED FEE-FOR-SERVICE
INDIVIDUAL DEFINED.—In this subpara-
Graph, the term ‘unenrolled fee-for-service
Individual’ means, with respect to a date,
A Medicare Advantage eligible individual
Who—
‘‘(I) is receiving benefits under
This title through enrollment in the
Original medicare fee-for-service pro-
Gram under parts A and B;
‘‘(II) is not enrolled in an MA
Plan on such date; and
‘‘(III) as of such date is not oth-
Erwise eligible to elect to enroll in an
MA plan.
‘‘(iii) LIMITATION OF ONE CHANGE
DURING YEAR.—An individual may exer-
Cise the right under clause (i) only once
During the year.
‘‘(iv) NO EFFECT ON COVERAGE
UNDER A PRESCRIPTION DRUG PLAN.—
Nothing in this subparagraph shall be con-
Strued as permitting an individual exer-
Cising the right under clause (i)—
‘‘(I) who is enrolled in a prescrip-
Tion drug plan under part D, to
Disenroll from such plan or to enroll in a different prescription drug plan;or
‘‘(II) who is not enrolled in a
Prescription drug plan, to enroll in
Such a plan.’’.
(b) CONFORMING AMENDMENT.—Section 1860D–
1(b)(1)(B)(iii) of the Social Security Act (42 U.S.C.
1395w–101(b)(1)(B)(iii)) is amended by striking ‘‘sub-
Paragraphs (B) and (C)’’ and inserting ‘‘subparagraphs
(B), (C), and (E)’’.

[midwestbroker]

Straight Supp replacement is what this boils down to. So, if you have a good book of supplement business sounds like a good deal.

Originally Posted by midwestbroker

Straight Supp replacement is what this boils down to. So, if you have a good book of supplement business sounds like a good deal.

Why focus on replacing supps? I have no intention of replacing my supp business with MA plans unless my client is struggling financially to pay the supp premiums. Focus on people who are turning 65, or those who can not afford a supp.

I really have a low opinion of captive agents in the field who make their living by switching people from one supp to theirs--especially when there is little benefit to the switch.
I know that's not what you are referring to, but I see it all the time and it really ticks me off.

[Steve]

I really have a low opinion of captive agents in the field who make their living by switching people from one supp to theirs--especially when there is little benefit to the switch.

Unless I'm missing something, you must be referring to a specific individual. Why would the above situation apply to a captive agent and not an independent?

This is a question, not a challenge...

I am the only independent broker in my town that I know of, so everytime I have seen it, it has been captive agents. It is never the same agent either, but usually the same insurance company. The reason it is never the same agent is because they can not keep agents and they always send newbies out with old leads--"go get'em tiger"!.
These agents are so hungry for a sale that they will do whatever it takes. I just had a client switch from a plan D supp because they were told they were getting a plan F for the same price--a lie. They are getting a plan B. I see this sort of thing all the time.

It certainly is not above the independent agent to do this but most indies have the best companies in their portfolio anyways so if they're switching someone it's for good reason. At least that's the case with me.

[Steve]

Thanks