A More Logical Time-frame for MAs and PDPs?

[Joe Moore]

If we MUST stay with the current AEP, OEP system, could it not be improved without the mad rush from December 31 to January 1? The next day!

Technically an application could be taken at 11:59pm December 31, and be effective 12:00am January 1 (the next minute).

Would it not be a better idea for Plans and agents to have at least a time to get their act together for the start of the next year?

My suggestions:

Start the AEP on November 1.
Cut it off December 15th.
Start the new Plan as normal, January 1.
OEP could be as it is now, January 1-March 31.

This would completely eliminate the Christmas Holiday from the 45 day AEP. This would give agents and Plans a 15-day opportunity to catch any mistakes. This may not be perfect but should be much better than what we have to work with now.

I realize some on the board completely disagree with the 45 day AEP, but seems this suggestion would be at least a small compromise in the right direction.

Comments or improvements to my suggestions?

 

[GreenSky]

It's a better solution than we have now if we must keep this stupid situation going.

The better solution is to get rid of lock-in so that seniors actually have choices. But that's too logical.

Rick

 

[stormtracker]

Your suggestion makes good sense... Unfortunately, "good sense" is not the criteria by which CMS makes such decisions...

 

[Joe Moore]

It's a better solution than we have now if we must keep this stupid situation going.

The better solution is to get rid of lock-in so that seniors actually have choices. But that's too logical.

Rick

Rick,

I agree, but that is tooooo logical. I am just trying to look at one step at a time.
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Your suggestion makes good sense... Unfortunately, "good sense" is not the criteria by which CMS makes such decisions...

I understand what you are saying. Regrettably, I must agree.

 

[retread]

There is no need for the AEP as it stands. Eliminate it. Make one enrollment period other than the IEP like group insurance is done, except move it to January thru March, which is the redundant OEP.... OR just make enrollment available all year round... what's wrong with that? I know, the insurance companies want to enslave their clients....

 

[Josh]

It's a better solution than we have now if we must keep this stupid situation going.

The better solution is to get rid of lock-in so that seniors actually have choices. But that's too logical.

Rick

I don't like the way things are now and I think it should just be one AEP/OEP period, but here's a few other things to consider.

When we had continuous enrollment just a few years ago it did have a bunch of problems:
1. Seniors switching plans never had up to date ID cards and that really confused the providers billing offices. When doctors offices get sick of dealing with insurance companies, whether it's the insurance companies fault or not, they stop wanting to participate with the company. I had many provider offices complain to me about patients changing insurance without telling them and it taking in excess of 4 months to get it straightened out. What would happen is they would bill Medicare, Medicare would pay it, two months later Medicare would say "just kidding" and take the money back, then the provider would say "Why'd you take the money back" and they'd say "the member was enrolled in a Med Advantage plan so you need to bill them" and then the provider bills and in a perfect world gets paid. When seniors can change plans every month if they feel like it, some of them do, and this problem just compounds.
2. It's rough on your renewals, if Mrs. Jones can switch plans next month when the next agent comes in the door to show her a plan she thinks looks better even though you already discussed it with her and she didn't like at the time, you get a chargeback. What agent likes getting chargebacks, especially when it's because a senior forgot a conversation you had with them about the other plan already and they chose the plan you enrolled them in.
3. From a health plan perspective, it's a lot of administrative work. Processing applications, reconciling payments from Medicare, reconciling commission payments, processing chargebacks, sending out ID cards, verification calls and other activities are all done by people the health plan has to pay. When you pay extra money to shuffle papers you don't get paid on it means you have to either lower benefits, cut back benefits, or lower agent commissions.

Again, I don't like the system now, but there is at least some method to the madness.

 

[GreenSky]

I don't like the way things are now and I think it should just be one AEP/OEP period, but here's a few other things to consider.

When we had continuous enrollment just a few years ago it did have a bunch of problems:
1. Seniors switching plans never had up to date ID cards and that really confused the providers billing offices.

Not a big problem if CMS requires enrollment by the 15th for a 1st of the next month effective.

2. It's rough on your renewals, if Mrs. Jones can switch plans next month when the next agent comes in the door to show her a plan she thinks looks better even though you already discussed it with her and she didn't like at the time, you get a chargeback. What agent likes getting chargebacks, especially when it's because a senior forgot a conversation you had with them about the other plan already and they chose the plan you enrolled them in.

Then sell your plan better. Or pay as earned. Problem solved.

3. From a health plan perspective, it's a lot of administrative work.

Cost of doing business. I suspect the carriers would rather write a piece of business even with the admin costs than pass up on an enrollment that earns them $850 a month.

Rick

 

[Josh]

Not a big problem if CMS requires enrollment by the 15th for a 1st of the next month effective.



Then sell your plan better. Or pay as earned. Problem solved.



Cost of doing business. I suspect the carriers would rather write a piece of business even with the admin costs than pass up on an enrollment that earns them $850 a month.

Rick

I'd rather not get into a back and forth about this but you really are missing a few key points. Many agents don't work with carriers enough to understand that some of the restrictions on plans is actually a good thing. I'll be the first to admit that many of them are bogus/random/pointless, but sometimes there is a method to the madness.

1. CMS updating their systems FROM THEIR end takes time to process. Have you either had or heard of Medicare beneficiaries having a problem with SS still withdrawing their premium from the check even though they disenrolled from that MA plan months ago? The same thing will happen with providers and billing. If a doctors office has to pay someone even $10/hour to spend three hours trying to get paid on a $45 claim then the provider is going to end up not wanting to par. Why would doctors decide to lose money for working? None of us would do that intentionally. Even if the app was in by the 15th and the member had their ID card by the end of the month you'd still see an increase in billing issues and overall Medicare Advantage dissatisfaction by doing it that way.

2. We all know that when you're working with the senior population, no matter how well you present the plan they decide to enroll in, some of them will completely forget why they made the decision. That is only further confused when another agent comes in and talks up another plan so they can get the commission. It would be in everyones best interest if the seniors worked with an agent every year to evaluate what plan would best suit their needs and then just stay in it until next year when the plans change again.

3. It's not just the administrative cost, please take the time to read the rest of that paragraph. Of course they don't mind paying to process an application if it means getting $10,000-$15,000+/year (of which the usually only profit around 5%), but it does increase their cost of doing business, especially if it's for members they don't even get or for members that stay in the plan for less than a few months. When the plan has to pay for something it usually takes money out things like plan benefits, provider reimbursement and agent compensation. It's a lose for the plan, a lose for the broker, and a lose for the members and potential members.

Again, I'll be the first to admit some of these policies and procedures are pointless, but occasionally they do have good reason behind them.

 

[jdeasy]

I'd rather not get into a back and forth about this but you really are missing a few key points. Many agents don't work with carriers enough to understand that some of the restrictions on plans is actually a good thing. I'll be the first to admit that many of them are bogus/random/pointless, but sometimes there is a method to the madness.

1. CMS updating their systems FROM THEIR end takes time to process. Have you either had or heard of Medicare beneficiaries having a problem with SS still withdrawing their premium from the check even though they disenrolled from that MA plan months ago? The same thing will happen with providers and billing. If a doctors office has to pay someone even $10/hour to spend three hours trying to get paid on a $45 claim then the provider is going to end up not wanting to par. Why would doctors decide to lose money for working? None of us would do that intentionally. Even if the app was in by the 15th and the member had their ID card by the end of the month you'd still see an increase in billing issues and overall Medicare Advantage dissatisfaction by doing it that way.

2. We all know that when you're working with the senior population, no matter how well you present the plan they decide to enroll in, some of them will completely forget why they made the decision. That is only further confused when another agent comes in and talks up another plan so they can get the commission. It would be in everyones best interest if the seniors worked with an agent every year to evaluate what plan would best suit their needs and then just stay in it until next year when the plans change again.

3. It's not just the administrative cost, please take the time to read the rest of that paragraph. Of course they don't mind paying to process an application if it means getting $10,000-$15,000+/year (of which the usually only profit around 5%), but it does increase their cost of doing business, especially if it's for members they don't even get or for members that stay in the plan for less than a few months. When the plan has to pay for something it usually takes money out things like plan benefits, provider reimbursement and agent compensation. It's a lose for the plan, a lose for the broker, and a lose for the members and potential members.

Again, I'll be the first to admit some of these policies and procedures are pointless, but occasionally they do have good reason behind them.

I work the carriers plenty and I do a lot of dual eligibles whom do have a year round election period. The carriers can take care of those people in a timely manner when they want to do so.

I see no good reason to have AEP or OEP. In fact, most every problem, if not every, comes from the AEP and OEP periods. Eliminate the AEP and OEP and allow medicare folks to enroll all year long and it would be much better system. The cream of the crop agents and carriers would rise to the top. I can't see how that's a bad thing.

We had a situation here last week where an agent didn't change some people's PDP plan because he didn't know he could. Converely, if an agent enrolls someone in a bad plan, they should be able to get out of it.

Yes, working with duals has taught me that you must do a better job of explaining the plan and servicing the plan or they will opt out. If forcing the agent to do a better job is the outcome from not having AEP, then, again, I'm all for eliminating it.

If chargebacks are an issue, pay the agent as earned. I have worked the MA/PDP business quite extensively since 2006. I have enrolled over 700 members into MA plans during that time. I cannot think of one instance where the client benefitted from AEP/OEP. I have seen many damaged by the restrictions.

 

[GreenSky]

I have worked the MA/PDP business quite extensively since 2006. I have enrolled over 700 members into MA plans during that time. I cannot think of one instance where the client benefitted from AEP/OEP. I have seen many damaged by the restrictions.

Damn. You're getting smarter and smarter!

Rick