Scroll down for a discussion on PFFS Plans - STOP SELLING! within the Senior Insurance Forum.
CMS has ordered all companies to cease writing PFFS plans until they comply with new regulations.
I received this:
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CMS has ordered all companies to cease writing PFFS plans until they comply with new regulations.
I received this:
<SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: Arial"><FONT face=Verdana><FONT size=2>Pyramid Life: Today’s Options has just informed us that CMS has ordered a temporary suspension of Medicare Advantage sales effective Friday, June 22. CMS is recertifying all companies to bring them all into compliance.
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Training, Community, Support, and Success Independent Life Insurance Agents Assn rick@iliaa.org
The following companies have agreed to halt marketing PFFS plans for now:
Unitedhealthcare
Humana
Coventry
Sterling
Universal American Financial
Wellcare
According to Humana, all HMO and PPO plans will still be offered.
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"Government's view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it." Ronald Reagan
[COLOR=#003366]NRHA Testifies on Medicare Advantage PFFS Plans Brock Slabach details concerns for rural seniors to powerful [/COLOR][COLOR=#003366]Ways and Means Subcommittee[/COLOR]
(Washington, D.C.) On May 22, NRHA board member, Brock Slabach, told the U.S. House Ways and Means Subcommittee on Health that certain rapidly growing Medicare plans impede access to health care in rural America. Mr. Slabach outlined the NRHA’s concerns for rural patients and providers alike over the growth of Medicare Advantage Private Fee-for-Service plans (PFFS) in rural America in his testimony before the committee.
"Rural Medicare beneficiaries deserve a Medicare plan that is sensitive to their needs and provides security to the fragile rural health care safety net," testified Mr. Slabach. He further stated that as these plans gain more and more market share in rural communities, "the consequences to rural health are potentially quite negative."
Mr. Slabach then outlined several of the NRHA’s concerns that Medicare Advantage PFFS plans harm rural seniors’ access to care, including concern that such plans often reimburse providers at rates far lower than under traditional Medicare. For example, numerous PFFS plans do not comply with the cost-based reimbursement requirements for Critical Access Hospitals established in the Balanced Budget Act of 1997. "These plans have the potential of completely undoing the reimbursement structure that Congress created," said Mr. Slabach.
Mr. Slabach also testified that PFFS plans are often confusing to seniors, contain gaps in coverage and are sold with questionable marketing tactics. "We can and must do better for our rural seniors," Slabach told the committee.
Private Fee-For-Service has experienced enormous growth following Medicare Advantage payment increases made by the Medicare Modernization Act of 2003. In 2003, less than 26,000 beneficiaries were enrolled in PFFS plans, but by April 2007 that number had exploded to nearly 1.5 million – a growth of more than 5600 percent. Though only a small percentage of rural Medicare beneficiaries are enrolled in Medicare Advantage Plans, the NRHA is concerned because enrollment has doubled in the last year, making rural enrollment one of the fastest growing demographics of MA plans.
Private Fee-For-Service plans are different from other MA plans. They are exempt from many of the rules and reporting requirements that apply to other MA plans. Additionally, MA Plans are paid on average 112 percent of fee-for-service Medicare. However, PFFS plans are located in geographic areas where payments are on average 119 percent of what it would cost to care for the same beneficiaries in traditional Medicare.
Subcommittee Chairman, Fortney "Pete" Stark (D-CA) said, "the alarming growth in these overpaid plans … results in increased premiums for all Medicare beneficiaries and shortened solvency of the Hospital Insurance Trust Fund."
Mr. Slabach also outlined the NRHA’s recommendations and told the Committee that, as it works to modify the Medicare Advantage PFFS program, it must:
Ensure that rural providers receive equitable reimbursements in amounts no less than they would be paid by traditional Medicare;
Require CMS to engage with rural health experts regarding how to determine and enforce rural community access standards and mandate MedPAC, which advises Congress on Medicare, to have proportional rural representation; and
Provide the Federal Office of Rural Health Policy expanded authority to provide technical assistance and outreach on ways rural providers can collaborate in the review of MA contracts.
The NRHA is a national nonprofit organization, with nearly 15,000 members that provides leadership on rural health issues. The Association’s mission is to improve the health and wellbeing of rural Americans and to provide leadership on rural health issues through advocacy, communications, education, and research. The NRHA membership is made up of a diverse collection of individuals and organizations, all of whom share the common bond of an interest in rural health. Mr. Slabach also serves as hospital administrator of a critical access hospital and three Rural Health Clinics, all in Mississippi.
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I couldn't edit the original post to be more clear on who did what so thanks to everyone for filling in the blanks.
By the way, CMS designed the PFFS plans and approved them. Now they decided they don't like the way they are being sold.
Am I the only one who is fed up with the government providing healthcare? Medicare was and is a bad idea from the start. MA plans were even worse. When you combine Medicare with MA (effectively free visits to doctors), costs skyrocket.
Now folks will have to buy a medicare supplement, during the interim.
Sales will shoot up again, maybe co's will even give us better incentives, like bonuses or higher %.
Maybe we should telemkt existing MA's and convert them back to original Medicare. Oh what a mess that would be.....all those agents living on all those advances.
Wonder if there is a backlash from the medical community on MA's, and they are refusing the co-pays. That would cramp the PFFS big time.
Oh well...just found out that the ANY ANY pLAN IS paying commissions on apps in force Jan-Mar. Checks to post by Wed.
It looks like 7 companies will be halting the sales of their MA plans....I know there are more than 7 different MA companies.....do you think all of them will have to pull out until this gets straightened out?
It looks like 7 companies will be halting the sales of their MA plans....I know there are more than 7 different MA companies.....do you think all of them will have to pull out until this gets straightened out?
Definitely. Pyramid said ok to sell until 7/22 so I suspect the others are going to announce something similar on Monday.
This affects ALL companies writing PFFS plans.
And I just got a commission bump with Pyramid on Monday, just in time to NOT write any business.
I would not be surprised if the market stays shut until 2008 season.
I just was appointed today to sell their PFFS plan and about to "give-notice" to my dubious, fixed-indexed annuity peddler that I work for now. Welcome the biz, I guess.
I am so excited. I hope these plans go south so I can write TONS of med supp biz. O gosh, I cant wait, I knew this day would come.
Well, I hope they put a hault forever. I guess I shouldn't get my hopes up yet. I honestly doubt it was a voluntary hault. It is probably more like, "you either stop selling or we will make you stop selling. How do you want it to look in the press?"
1. Agents promising the world, or mis-informing the clients
2. Providers unaware of PFFS plans and not taking them
In regards to the second, this will only hurt the process, unless they start communicating with doctor offices. Some still do not know what a PFFS plan is. Others have only looked at one, decided they did not like the plan, and said no to them all.
Now, in the consumer eye, this all depends on the press. If they run with it, that could hurt the PFFS sales. If they do not, most people will have no idea what is going on.
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"Government's view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it." Ronald Reagan
It's a damn good thing we can sell that zero premium life insurance policy. That will more than make up the loss of income from the PFFS plan moratorium.
Actually, I have ran into clients who had captive agents from senior solutions sign them up without knowing...... I think its funny that they won't have any products to sell now. Atleast here in IN.
The problem with using captive agents is that they cannot survive in the rural markets.
In metro areas, I know that Humana only has captive agents sell the HMO and PPO plans. Coventry does the same here in Kansas City.
Both, however, use brokers in the rural markets.
It seems that this is more of a provider contracting issue, since the sale of HMO and PPO polices are not effected.
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"Government's view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it." Ronald Reagan
Personally I have never liked them from the beginning. I have not moved any of my existing clients into them and strongly recommend to prospects that they take a Med Supp instead. I work the rural areas and occasionally in St. Louis.
I got a call yesterday from a woman in St. Louis, a referral, who is turning 65 and she asked about them. She thought that is what she wanted. Wrong! I ended up selling her a Med Supp. Yep, I did it over the phone but not in my underwear, a ratty pair of Levis and a "Testicle Festival" t-shirt. LOL
Maybe when my clients, and the prospects who have asked me about them, see the news it will add a little more credibility to what I told them. I only have three clients who have PFFS, the rest are on Med Supps. The three who do have them couldn't get a Med Supp.
Like Senior, I will be contacting those prospects who I know took a PFFS plan and again suggesting they may want to consider a Med Supp.
Senior, we are going to get rich. Thank you for screwing things up CMS.
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Medicare Supplement Sales Training and Coaching.
"The Perfect Contact Management Program (CMP) for the Insurance Professional" www.YourInsuranceOffice.com
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[COLOR=blue]While dismayed and extremely disappointed, I am not completely shocked. Thank you everyone for posting. It's actually a week from today we can no longer do any more bz. on the PFFS side.I received emails from Humana, Coventry, and Pyramid today. Funny though, I learned the news from you good people here and not my FMOs. Thank you.[/COLOR]
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[COLOR=blue] Nothing yet from United or Wellcare but I'm sure that's just a matter of time. These plans are NOT for everybody and far toooooooooooo many agents have abused this. I truly feel they have a place for some; but not for all. You get what you pay for; so if one can afford the med sup, do it. that's my personal stance. Midwest called it right on with the providers not being fully informed. That's also a huge part of this mess too but I know all of you are aware of that. [/COLOR]
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[COLOR=#0000ff]I have posted what Pyramid says below and their last day to do business.[/COLOR]
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[COLOR=#0000ff]From this post, it says - no more bz. till fall for 08 effective date.[/COLOR]
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[COLOR=#0000ff]My question is do you guys and gals think they will change their minds to allow us to sell this year 07 for 07 or it's a full hecky no?[/COLOR]
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[COLOR=#0000ff][/COLOR] http://image.exct.net/members/22799/...sion.FINAL.pdf
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On Friday, June 15th, Universal American, along with six other PFFS plan sponsors, coordinated with the Centers for Medicare and Medicaid (CMS) to temporarily suspend the marketing of PFFS in the individual, non-group market until we demonstrate our compliance with CMS's new 2008 marketing requirements. The temporary suspension is effective on Friday, June 22, 2007.
Nothing is more important to us than the relationship we have with our members. We are, therefore, in full support of the effort by CMS to help the industry improve the way in which it markets this valuable coverage to Medicare beneficiaries. We are proud of the rigorous marketing and sales approach we’ve employed to date, yet we stand ready to review and change our marketing practices in whatever way necessary to meet the new standards.
This suspension of marketing activities of Today's Options is temporary, and will be lifted after CMS reviews and approves our marketing material, agent training materials and tests, systems and controls that will enable us to satisfy their new 2008 marketing requirements. Because we already perform many of these 2008 requirements today, we believe we are in a position to satisfy CMS in a relatively short time. Therefore, we are confident that we will be able to have you resume your marketing of Today's Options within a brief period of time after the CMS review process concludes.
READ CAREFULLY – IMPACT TO AGENTS AND BROKERS
If you are a current certified agent or broker of Today's Options, you may continue selling Today's Options in accordance with CMS's marketing guidelines and our corporate policies until close of business on Friday, June 22, 2007. After that date, YOU MAY NOT engage in any marketing activities regarding Today's Options whatsoever. Any application submitted by an agent or broker and received after the close of business on this date WILL BE REJECTED.
For the avoidance of doubt, you may not advertise Today's Options, send out lead cards, set appointments (even if requested to do so by a beneficiary), contact prospective customers, conduct seminars, or do any other kind of marketing or sales activities.
Continued
After CMS has completed its review of our enhanced marketing and sales procedures, systems and controls, all agents or brokers must also complete a training course and pass a written test that demonstrates their thorough familiarity with both the Medicare program and our Today’s Options
plans. Upon passing the test, an agent will be "re-certified" to sell the product. The training program and additional communications will provide instruction on all new procedures and practices that affect agents and brokers and are derived from the new CMS requirements.
OUR GOALS REMAIN THE SAME
While our policies and procedures will change slightly as a result of this announcement, our overall goal remains the same: to ensure that we set a leadership standard not only for CMS compliance but, more significantly, to meet the expectations of our customers and to deliver high-quality benefits and service to Medicare beneficiaries.
Please take a moment to review the attached press release issued late this afternoon by American’s Health Insurance Plans (AHIP). AHIP played a central role in helping to align CMS and the insurance industry on this initiative, and we are proud to have provided added leadership and support as a member of the association. The press release issued by Universal American is also attached for your review.
We apologize for the interruption of your business activities, but we believe that this important initiative will, in the end, serve the best interests of your clients. We are working diligently to enhance our systems and controls to ensure that we get through this process as quickly as possible, and we will continue to update you as we know more. In the meantime, we ask for your patience as we fight the battle to end the improper sales tactics that have caused this suspension. We thank you in advance for your support of this important initiative.
Very truly yours,
Gary W. Bryant
President, Pyramid Life Insurance Company
Executive Vice President, American Progressive Life & Health Insurance Company
And I think the real problems here are the medical providers/billing depts.
They are KEY to making this transistion from Orig Medicare to an Advantage company. If that claim is not processed properly by them, then you have unhappy customers all the way around....Dr.,patient, biller,CMS...carriers.
Factor in that providers can drop participation anytime because there is no "formal" contract, and this becomes too fluid and unstable. When this took off in 2006, I think a PPO/HMO model should have been used to start with initially. It would have given everyone time to assimilate a new alternative to healthcare for seniors. Carriers would have had time to solicit the medical community to participate.
Instead, these MA's came out like a "IN YOUR FACE" blitzkrieg. "Dr, if you don't take these co-pays, you better not treat the patient or you will be forced to do so".
I and others have posted some articles that were negative press about the MA's. Well let's see how this plays out..but stay in touch with your Advantage clients. You may have to become an "Oral Roberts" and "convert" them to the other side. LOLOL
PFFS Plans - STOP SELLING!
LOLOL
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