CMS Has Made It Official...But We Already Knew

[Bob_The_Insurance_Guy]

CMS Email

From: Health Plan Management System (HPMS)
Date: October 30, 2015
Subject: Agent/Broker Compensation

This purpose of this email is to update and clarify payment guidance in Section 120.4.2 of the Medicare Marketing Guidelines. There are three scenarios affecting how an organization may pay full or pro-rated initial compensation.

1) For a beneficiary's first year of enrollment in a plan, in which the MARx report lists the prior plan type as "none", organizations may pay full or pro-rated initial compensation.

2) When a beneficiary moves from an employer group to a non-employer group plan, in which the MARx report lists the prior plan type as "none", organizations may pay full or pro-rated initial compensation for a beneficiary's first year of enrollment in a plan.

3) For unlike plan changes (e.g., MA-PD to PDP or PDP to Cost Plan), occurring after January 1 in which the MARx report indicates the beneficiary had prior plan history (regardless of plan type), organizations must pay pro-rated initial compensation according to the number of months in the plan. For example, a change from a PDP to an MA-PD effective May 1 is an unlike plan change resulting in a pro-rated initial compensation of 8/12 (May thru December) of the MA-PD initial compensation rate.

CMS expects organizations to immediately correct their processes and to provide agents/brokers with notification of payment requirements.

No reason for the swoop and churn crowd to change Beneficiaries coverage every year. This needs to go out to the Beneficiaries. Arm them with knowledge, so they can be forewarned.

Not a popular idea, I know. Might help with persistency.

 

[kamp]

All this means to me is that the powers that be and the lobbyists in Washington have gotten in bed with the insurance companies.

It allows the companies to rip off the agents.

I think there is no way this flies. So, basically if you take someone off a PDP and put them on an MA for the first time, then they can pay you a prorated initial amount. Lol. Okay.

Well that's it for me in the MA business. Good riddance.

 

[finalexpenseguru]

but they still pay the true up right?what's the big deal you just get it over time instead of all of front.. I don't see the big deal

 

[kamp]

but they still pay the true up right?what's the big deal you just get it over time instead of all of front.. I don't see the big deal

They advised today that they do not do that. The prorated amount includes the true up..

So, let's say you write a new to MA in July your commission would basically be the $207 then the $17 renewal starting the next month.

You will not get the other half of the true up.

This is of course, according to someone at UHC. Remarkable I haven't got any correspondence from any other companies about this change. Only UHC..

Something seems fishy to me.

 

[SKJ58]

From UHC today:

Type of enrollment
(as indicated on CMS MARx report) CMS Compensation Rate CMS Process Guideline (Full or Pro Rata)

New to MA with no prior plan history
Initial rate Full or Pro Rata (UnitedHealthcare pays full)

Unlike plan change
- MA or MAPD to PDP or cost plan
- PDP to cost plan or MA
- Cost plan to MA, MAPD or PDP
Initial rate Pro Rata

Like plan change
- PDP to PDP
- MA, MAPD or MMP to another MA, MAPD or MMP
- A cost plan to another cost plan
Renewal rate Pro Rata

Employer Group Plan to Non-Employer Group Plan
Initial rate Full (12 months) if no prior plan history; Pro Rata if prior plan history

 

[kamp]

From UHC today:

Type of enrollment
(as indicated on CMS MARx report) CMS Compensation Rate CMS Process Guideline (Full or Pro Rata)

New to MA with no prior plan history
Initial rate Full or Pro Rata (UnitedHealthcare pays full)

Unlike plan change
- MA or MAPD to PDP or cost plan
- PDP to cost plan or MA
- Cost plan to MA, MAPD or PDP
Initial rate Pro Rata

Like plan change
- PDP to PDP
- MA, MAPD or MMP to another MA, MAPD or MMP
- A cost plan to another cost plan
Renewal rate Pro Rata

Employer Group Plan to Non-Employer Group Plan
Initial rate Full (12 months) if no prior plan history; Pro Rata if prior plan history

Why haven't we heard any of this from the other carriers? I think it's something UHC is interpreting incorrectly because they don't want to pay agents.

I am looking at the CMS rule they are referencing and I still don't see this. Further, this memo just came out last week. Why weren't they paying full true up's before this the last two months on certain business?

 

[Chazm]

Looks to me they're saying they will pay new to Medicare in Full just like I got paid this month.

 

[car_jog]

What I'm confused about is the true-up payment for Unlike Plan Change and Like Plan Change. Will UHC continue to pay it the following month, the following Jan or not at all?

I've had issues with UHC TrueUps for the past two months as well.

 

[kamp]

What I'm confused about is the true-up payment for Unlike Plan Change and Like Plan Change. Will UHC continue to pay it the following month, the following Jan or not at all?

I've had issues with UHC TrueUps for the past two months as well.

Lady who was a "top" commission specialist told me to my face today you will not get the other part of the true up..just prorated. lol

None of this adds up.

 

[No name]

Why haven't we heard any of this from the other carriers? I think it's something UHC is interpreting incorrectly because they don't want to pay agents.

I am looking at the CMS rule they are referencing and I still don't see this. Further, this memo just came out last week. Why weren't they paying full true up's before this the last two months on certain business?

I wrote 24 new to MA plans last month for 10/01 effective dates and got paid 51 for each one of them. Then I got a charge back of 51 and got paid 102 on each. I called the help desk and aaked why I didn't get paid the 408 and I was told that they have been paying me wrong for years and are just catching up with it and will start paying me the corect way from now on. So basically I got paid 408 divided by 12 times 3 months on the plan equals 102. Im so annoyed with UHC. Every time I call the help desk I can't get the same answer twice. No other carriers know anything about this either so it's just confusing. The way I read this email is that we will get the initial payment when switching someone from a pdp plan to MA plan if they are new but it's how and when we will get it that's in question. From the chart, how do you interpret it. It's says Cms compensation rate - initial and then to the right says Cms process guideline pro-Rata. So it looks like it's how and when we will be paid and on Cms website it says we must be paid the initial payment in the first plan year which is Jan 1st-December 31st

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I wrote 24 new to MA plans last month for 10/01 effective dates and got paid 51 for each one of them. Then I got a charge back of 51 and got paid 102 on each. I called the help desk and aaked why I didn't get paid the 408 and I was told that they have been paying me wrong for years and are just catching up with it and will start paying me the corect way from now on. So basically I got paid 408 divided by 12 times 3 months on the plan equals 102. Im so annoyed with UHC. Every time I call the help desk I can't get the same answer twice. No other carriers know anything about this either so it's just confusing. The way I read this email is that we will get the initial payment when switching someone from a pdp plan to MA plan if they are new but it's how and when we will get it that's in question. From the chart, how do you interpret it. It's says Cms compensation rate - initial and then to the right says Cms process guideline pro-Rata. So it looks like it's how and when we will be paid and on Cms website it says we must be paid the initial payment in the first plan year which is Jan 1st-December 31st

Maybe I'm just looking for the answer I want. Maybe we won't get tru ups anymore. I just wish that there was a straight answer. Even that dumb email doesn't give a straight answer. It's the first thing in black and white that semi explains what's going on but still not clear