Medicare Advantage 48 Hour Rule

[sshafran]

My experience is that people don't generally bring up MA/MAPD. So, since I normally need to in certain situations, I'll go back.

Here is what I do when they can't afford a supp (i.e. when you walk in and they are shocked and dismayed that they'll need to pay $115 to Uncle Sam).

1. Find out about their income level, if appropriate (usually is) call with them for the LIS application. i.e. create trust, I just helped them get help on their costs - and I didn't not earn a dime for it.
-Also call about MPAP if appropriate.

2. Bring out the scope - schedule an appointment for a later date. Try to do it by the time you'll know about the LIS. When I know what assistance they qualify for, I'll be able to know what Supp or MAPD to help them with.

It's a process, but I'm not in this for the short-term.

Profitable? I just helped a guy get signed up with an MAPD using a special election period as a result of helping him get his LIS. Sometimes it is worth two visits, and I'm not worried about whether or not I was sorta compliant.

 

[RFNAPLES]

Chapter 3 – Medicare Marketing Guidelines
For Medicare Advantage Plans, Medicare Advantage Prescription Drug Plans, Prescription Drug Plans, and Section 1876 Cost Plans
(Rev.96, Issued: 5-17-11)

Final 2012 Medicare Marketing Guidelines [zip, 1.1Mb]

 

[LadyYaYa]

If you are in a med supp appointment and the prospect asks you about MA, you are supposed to have them sign the SOA appointment sheet and then come back at least 48 hours later.

Here is a part of the Medicare Marketing Guidelines. Starts on page 95: ( or click her to see the full document of Overview Managed Care Marketing )

Plan sponsors must secure scope of appointment documentation prior to the appointment. A beneficiary cannot agree to the scope over the phone (unless it is recorded) and then sign the documentation form at the beginning of the sales appointment. Any scope of appointment form must be completed by the beneficiary and returned prior to the appointment. If it is not feasible for the scope of appointment form to be executed prior to the appointment, an agent may have the beneficiary sign the form at the beginning of the marketing appointment. However, CMS expects plans to record and maintain documentation on why it was not feasible to obtain the scope of appointment prior to the appointment.

• The documentation must be in writing, in the form of a signed agreement by the beneficiary, or a recorded oral agreement. A plan sponsor (or agent)
[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]cannot agree to the scope of appointment on behalf of the beneficiary but can confirm the appointment. See § 70.5.1-Specific Guidance on Third Party Telephonic Contact. [/FONT][/FONT]


[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]•[/FONT][/FONT]Plan sponsors are allowed and encouraged to use a variety of technological means to fulfill the scope of appointment requirement, including conference calls, fax machines, designated recording line, pre-paid envelopes[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman], [/FONT][/FONT]and e-mail, etc.
• A beneficiary may sign a scope of appointment form at a marketing
[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]/sales event [/FONT][/FONT]for a [FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]future [/FONT][/FONT]appointment. In these instances, the forty-eight (48) hour waiting period does not apply. For example, if a beneficiary attends a marketing presentation, and, after the presentation, requests an individual appointment, the sales person can arrange for that appointment to take place immediately following the sales presentation provided the beneficiary has completed the scope of appointment form.

 

[Guest]

Keep in mind, there is no place on the scope for a date of appt. to be filled in.

 

[jdeasy]

If you are in a med supp appointment and the prospect asks you about MA, you are supposed to have them sign the SOA appointment sheet and then come back at least 48 hours later.

Here is a part of the Medicare Marketing Guidelines. Starts on page 95: ( or click her to see the full document of Overview Managed Care Marketing )

Plan sponsors must secure scope of appointment documentation prior to the appointment. A beneficiary cannot agree to the scope over the phone (unless it is recorded) and then sign the documentation form at the beginning of the sales appointment. Any scope of appointment form must be completed by the beneficiary and returned prior to the appointment. If it is not feasible for the scope of appointment form to be executed prior to the appointment, an agent may have the beneficiary sign the form at the beginning of the marketing appointment. However, CMS expects plans to record and maintain documentation on why it was not feasible to obtain the scope of appointment prior to the appointment.

• The documentation must be in writing, in the form of a signed agreement by the beneficiary, or a recorded oral agreement. A plan sponsor (or agent)
[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]cannot agree to the scope of appointment on behalf of the beneficiary but can confirm the appointment. See § 70.5.1-Specific Guidance on Third Party Telephonic Contact. [/FONT][/FONT]


[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]•[/FONT][/FONT]Plan sponsors are allowed and encouraged to use a variety of technological means to fulfill the scope of appointment requirement, including conference calls, fax machines, designated recording line, pre-paid envelopes[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman], [/FONT][/FONT]and e-mail, etc.
• A beneficiary may sign a scope of appointment form at a marketing
[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]/sales event [/FONT][/FONT]for a [FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]future [/FONT][/FONT]appointment. In these instances, the forty-eight (48) hour waiting period does not apply. For example, if a beneficiary attends a marketing presentation, and, after the presentation, requests an individual appointment, the sales person can arrange for that appointment to take place immediately following the sales presentation provided the beneficiary has completed the scope of appointment form.

If I'm already there and they bring it up, it is not feasable for me to wait 48 hours and come back since I am already an hour from the office.

I would not a problem in the world with saying that it wasn't feasable and I can't imagine that it would ever cause a problem.

No reason to look for the bogeyman in every situation.

 

[AllGold]

Keep in mind, there is no place on the scope for a date of appt. to be filled in.

There is for some carriers.

 

[supersupps]

What would be some acceptable reasons for folks to not want to wait the 48 hours and sign the scope then and continue the appt?:

" I need to do this today. I'm going out of town."

" I want to do this now. I donnot know when I will have time to do this again."

I do not want to wait the 48 hours. I am here and want to do it now and cannot wait 48 hours. "

anyone else have some good cms acceptable replies

 

[Josh]

There are none. Those are all specifically listed by carriers as *NOT* being acceptable reasons to not wait the 48 hours. It doesn't matter if it's the last day of the month and they won't be able to enroll because that is the end of an enrollment period, at that point, the ship has sailed. If they are truly dying to sign up you can have them contact the plan directly or go to medicare.gov, but an agent can't make the presentation unless the 48 hours have passed.

If you don't wait 48 hours, expect to get trouble.

Let's not forget that there was a group in NY doing it by the book and the agency ended up getting a six figure fine over doing things the way the rules said they could.

 

[maniacagent]

What would be some acceptable reasons for folks to not want to wait the 48 hours and sign the scope then and continue the appt?:

" I need to do this today. I'm going out of town."

" I want to do this now. I donnot know when I will have time to do this again."

I do not want to wait the 48 hours. I am here and want to do it now and cannot wait 48 hours. "

anyone else have some good cms acceptable replies

Gas is cheaper today than it will be tomorrow.
Will you send me a gas check before the next appointment so I have enough gas to drive back a second time?