- Thread starter
- #11
CMS now says:
[FONT=Arial,Helvetica,sans-serif][FONT=Arial,Helvetica,sans-serif]On July 31, 2009 CMS did release revised guidance on the qualifying criteria for 2009 initial year commission payments. Effective immediately, according to CMS, an enrollment of a beneficiary into an Medicare Advantage (MA) or Part D prescription drug plan (PDP) or Cost plan must meet one of the following criteria to be eligible for initial year commission payment:
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From an E&O risk managment point of view, selling MA plans is asking for trouble. If the Feds pull the reins in on MA, you will have some very PO'd seniors. Was it not back in the early 1990's that the Feds talked insurance companies into offering managed care medicare supps and then the money ended. Left a lot of PO'd people and PO'd people file suits. Due diligence and a prudent man law could find you in a pickle if you aren't informing your clients about potential financial changes in the MA funding.
Even if you don't want to tie your client to an HMO/PPO the PFFS is presenting fiscal problems.
[/FONT]"The average PFFS plan feeds, pig-like, at the Medicare trough. It receives $114 more per member per month than traditional Medicare would spend on the same senior. Meanwhile, it delivers "extra" benefits worth $35 a month. And who is paying the $114 tip? Medicare Advantage is financed by traditional Medicare.
Thus, the 78 percent of Medicare beneficiaries who have stuck with traditional Medicare are funding the bonus for PFFs. (They pay higher deductibles and co-pays to keep Medicare going while it dispenses such largesse to MA insurers.) Not only that, seniors in regular Medicare are spending $3 for $1 of extra benefits going to someone else. This hardly seems fair.
Why are PFFS so expensive? They are not designed to rein in spending. Quite the opposite, "fee for service" encourages over treatment: the more a provider does, the more he is paid. There are so many gray areas in medicine, and this is where fee-for-service creates incentives to "do more."
When the MA plans first came out I thought it was a good things but I am changing my mind. And I am changing my mind rather quickly.
Although I will miss that large $12 renewal commission that is paid on each member. NOT!
Working with CMS near by is such a treat. Like last year when it was April when I got paid for November business. Why you may ask?
"You will initially receive a renewal payment and then once CMS determines who is new to an Advantage program, then we will give you the remaining new business commissions. We do not have a timeframe for that yet. Please send me the list as to who you are waiting to be paid on. Thanks!"
What a wonderful business model to work with - under? CMS had determined that a lot of the cases with a certain carrier were not new business but they were new business. The carrier had to fight with CMS. How wonderful.
$500?
Man the carrier I chose last year ripped me off by about $250.
Is the $500 for PFFS?
[FONT=Arial,Helvetica,sans-serif][FONT=Arial,Helvetica,sans-serif]On July 31, 2009 CMS did release revised guidance on the qualifying criteria for 2009 initial year commission payments. Effective immediately, according to CMS, an enrollment of a beneficiary into an Medicare Advantage (MA) or Part D prescription drug plan (PDP) or Cost plan must meet one of the following criteria to be eligible for initial year commission payment:
[/FONT]
- [FONT=Arial,Helvetica,sans-serif] Enrollment of a beneficiary into an MA, Cost plan or PDP who is completely new to Medicare;
[/FONT] - [FONT=Arial,Helvetica,sans-serif] Enrollment of a beneficiary into an MA, Cost plan or PDP who is currently in Original Medicare only;
[/FONT] - [FONT=Arial,Helvetica,sans-serif] Enrollment of a beneficiary into an MA plan who is currently in Original Medicare with a PDP;
[/FONT] - [FONT=Arial,Helvetica,sans-serif] Enrollment of a beneficiary into a PDP who is currently enrolled in an MA-only plan, or
[/FONT] - [FONT=Arial,Helvetica,sans-serif] Enrollment of a beneficiary into a PDP who is currently in an MA plan.
[/FONT]
From an E&O risk managment point of view, selling MA plans is asking for trouble. If the Feds pull the reins in on MA, you will have some very PO'd seniors. Was it not back in the early 1990's that the Feds talked insurance companies into offering managed care medicare supps and then the money ended. Left a lot of PO'd people and PO'd people file suits. Due diligence and a prudent man law could find you in a pickle if you aren't informing your clients about potential financial changes in the MA funding.
Even if you don't want to tie your client to an HMO/PPO the PFFS is presenting fiscal problems.
[/FONT]"The average PFFS plan feeds, pig-like, at the Medicare trough. It receives $114 more per member per month than traditional Medicare would spend on the same senior. Meanwhile, it delivers "extra" benefits worth $35 a month. And who is paying the $114 tip? Medicare Advantage is financed by traditional Medicare.
Thus, the 78 percent of Medicare beneficiaries who have stuck with traditional Medicare are funding the bonus for PFFs. (They pay higher deductibles and co-pays to keep Medicare going while it dispenses such largesse to MA insurers.) Not only that, seniors in regular Medicare are spending $3 for $1 of extra benefits going to someone else. This hardly seems fair.
Why are PFFS so expensive? They are not designed to rein in spending. Quite the opposite, "fee for service" encourages over treatment: the more a provider does, the more he is paid. There are so many gray areas in medicine, and this is where fee-for-service creates incentives to "do more."
When the MA plans first came out I thought it was a good things but I am changing my mind. And I am changing my mind rather quickly.
Although I will miss that large $12 renewal commission that is paid on each member. NOT!
Working with CMS near by is such a treat. Like last year when it was April when I got paid for November business. Why you may ask?
"You will initially receive a renewal payment and then once CMS determines who is new to an Advantage program, then we will give you the remaining new business commissions. We do not have a timeframe for that yet. Please send me the list as to who you are waiting to be paid on. Thanks!"
What a wonderful business model to work with - under? CMS had determined that a lot of the cases with a certain carrier were not new business but they were new business. The carrier had to fight with CMS. How wonderful.
- - - - - - - - - - - - - - - - - -
$500?
Man the carrier I chose last year ripped me off by about $250.
Is the $500 for PFFS?
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