CMS May 27 Memo on MA and PDP Commissions

Jun 3, 2016

  1. Brian Anderson
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    Brian Anderson Executive Editor

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  2. djones745
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    djones745 New Member

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    Whoa a raise? That's a first in my 1 year tenure in the insurance industry :err:
     
  3. mikedalton
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    mikedalton Expert

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    Getting that full amount is almost impossible. CMS guidelines makes them prorate the commissions. Even if they have a PDP which all do since Medicare automatically puts them on one the commission is prorated. I've signed up 10 new to Medicare Advantage so far this month and instead of getting $4300 I'll get about $2150 because they have a PDP.. If anybody has any ideas on how to actually make money at Medicare Advantage anymore please let me know.
     
  4. JRcares
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    JRcares New Member

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    Thank you for posting this good news!
     
    JRcares, Jun 13, 2016
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  5. WCMason
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    WCMason Guru

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    Medicare only auto-enrolls LIS into a PDP when first eligible. If you get them turning 65 there is no prior PDP and full year true-up for partial year enrollment.
     
    WCMason, Jun 13, 2016
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  6. alphawave2k
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    alphawave2k Super Genius

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    The marginalization of independent agents by CMS and the insurers marches on, particularly regarding Medicare plans. Case in point related to this thread. I had a T-65 prospect whom I urged to go to DFACS and/or SS office to officially get their Medicaid status, which they clearly qualified for....AGI of <$15k, etc.
    After visiting with them, getting the SOA, searching for "better fit" plan etc, and helping them get their situation clarified before I could write them up on a DSNP plan, they informed me "they already signed them up with Silverscripts PDP plan".
    When I asked who "they" were, they weren't sure. I asked if they spoken with another agent, thinking maybe an unscrupulous agent signed them up for a PDP plan, when they could have been much better off on a full MAPD, DSNP plan.
    Funny that I say unscrupulous agent, but here we have a complicit government agency doing something not in the best interest possibly, of an enrollee, and it's within CMS protocol.
    Sure, I can go back and sign them up with an MAPD plan, but the commission now is 1/2 since they have already used their IEP option?
     
  7. WCMason
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    WCMason Guru

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    Two things: you may have saved the sale if you had helped the prospect find out Medicaid status rather than urging the prospect to go find that out on their own. Second, if that drug plan has not taken effect all is not lost yet. If you write the MA to replace the drug plan before it starts you should get full true up comp.
     
    WCMason, Jun 13, 2016
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  8. alphawave2k
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    alphawave2k Super Genius

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    Thanks for your input. I did try to help the prospect to the extent I could...I may have made an error by calling on their behalf and saying I was an agent (idiotic full disclosure), and the govt phone jockey would no longer field the inquiry. So I told them to go physically go to the offices....not sure how to intervene on behalf of some of these folks, who honestly don't have a clue as to where to go, and how to do some of these things (I say that w/o any arrogance or prejudice), since it's clear they don't know these things.
    In my naivete, I thought "they" would confirm their status and at the same time learn to be a little pro-active by teaching them how to fish a little, but witness end result. Their birthdate was in May, and their plan was active June 1, so unfortunately opportunity for True-up already passed. Only thing is now to switch them to a better plan as a full dual.
    So to wrap this little ditty up, wouldn't someone who is Full Dual be better off in a DSNP vs straigth Medicare/Medicaid+PDP? If so, which is what I would then to think, that move by whomever should not be allowed. We all know the govt is screwing all of us, but this is w/o a doubt a blatant disregard for someone who given their position, was nonetheless steered into a situation not in their best interest.
     
  9. TN_agent
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    TN_agent Guru

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    Not necessarily. There are networks of doctors to deal with for a DSNP. I have had people I couldn't move to one even though they were desperate for dental work, because their pain doctor didn't take any SNPs (but did take Medicaid) and there was no way they were going to switch pain doctors.

    With the FDBE/Medicaid crowd, you always need to do all the work for them or you WILL lose them to another agent or the SHIP of each state. Just the way it is with that market. They will go with the option that requires the least amount of effort for them.

    You could have downloaded a paper QMB/SLMB application, filled it out with them and faxed it in for them along with proof of incomes, that is what I have had to do with some people. It is a lot of work and I don't do it often. You may find it easier not to get the true-up and just switch them after someone else has already figured out their initial eligibility.
     
    TN_agent, Jun 13, 2016
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  10. grod
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    grod Super Genius

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    I've done this too, and it's a lot of work, but if you intend to help and make sure you enroll them into the plan, this is the way to do it. After we mail the application, I tell them to mark their calendar 45 days out and be on the lookout for a response letter, and then call me. Of course, I have it on my calendar to follow up. Also, some companies, such as UHC will help verify if they are dual eligible or not and give you their Medicaid number.
     
    grod, Jun 14, 2016
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