MAPD Compliance

[thomasm]

Currently my book consists of 87% Medicare Supplement and 13% FE. I've been certified for over 2 years now, but haven't written any MA or Stand-alone PDP plans, because I'm still not sure how to do it compliantly, due to the fact that my marketing activities are heavily weighted on canvassing/cold calling. (considered illegal and even unethical by CMS.)

Even with 40% MA penetration rates in my county, because I'm targeting the right demographics, most of the time when I'm explaining to someone new to Medicare the 2 options, I get them sold on the freedom to choose any doctor that accepts Medicare. But for the ones that are dead set on MA, I'm tired of just walking away.

What the most compliant way to handle this?

Option A?

Get scope signed. Schedule an appointment 48 hours in advance. In the "Initial Method of Contact" section of the SOA, write: Medigap presentation. Prospect requested information on Medicare Advantage/PDP Plans.

or Option B?

Thank them for their time, but tell them you can't help them with "those kind of plans." Move on to the next Medigap prospect.

 

[Team Manning]

Complete your AHIP training, and you'll learn everything you need to do to stay complaint. Personally, I would go with option 1. Add it to your arsenal.

 

[yogooglethis]

Currently my book consists of 87% Medicare Supplement and 13% FE. I've been certified for over 2 years now, but haven't written any MA or Stand-alone PDP plans, because I'm still not sure how to do it compliantly, due to the fact that my marketing activities are heavily weighted on canvassing/cold calling. (considered illegal and even unethical by CMS.)

Even with 40% MA penetration rates in my county, because I'm targeting the right demographics, most of the time when I'm explaining to someone new to Medicare the 2 options, I get them sold on the freedom to choose any doctor that accepts Medicare. But for the ones that are dead set on MA, I'm tired of just walking away.

What the most compliant way to handle this?

Option A?

Get scope signed. Schedule an appointment 48 hours in advance. In the "Initial Method of Contact" section of the SOA, write: Medigap presentation. Prospect requested information on Medicare Advantage/PDP Plans.

or Option B?

Thank them for their time, but tell them you can't help them with "those kind of plans." Move on to the next Medigap prospect.

If initial contact was OB call for med supp that generated a MA appointment the correct response for initial contact is OB call .Just be aware that CMS frowns on what they call bait and switch strategies so if a significant percentage of your MA enrollments where generated from OB call initial contact you could have a problem if one of these MA consumers ever filed a complaint against you for any reason.The complaint form from the carriers have anywhere from 10-30 questions that the agent has to answer involving the enrollment and the first question always is " how did you make initial contact with the consumer?". If the carrier or the DOI is suspicious of an agents marketing method they then can ask to see all of your SOA forms you ever submitted and they will look to see if there is a pattern of bait and switch tactics.

IMO this will probably be a moot point within the next 2 years as there will probably be the same restrictions for cold calling med supp as there is MA because it's obvious that discussion about one of the products will bring up discussion of the other.

 

[steveadlman]

I follow Option B. Like you I prospect for Med Supps not MA's. If they want a MA I move onto the next prospect.

 

[thomasm]

IMO this will probably be a moot point within the next 2 years as there will probably be the same restrictions for cold calling med supp as there is MA because it's obvious that discussion about one of the products will bring up discussion of the other.

Has CMS expressed any intention of doing this?

Any states trying to push this through?

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CMS frowns on what they call bait and switch strategies

Who baiting and switching who? Agents or the MA carriers? What good is a $0 premium plan going to do for someone who can't afford the MOOP!

You really do get what you pay for!

 

[Newby]

Currently my book consists of 87% Medicare Supplement and 13% FE. I've been certified for over 2 years now, but haven't written any MA or Stand-alone PDP plans, because I'm still not sure how to do it compliantly, due to the fact that my marketing activities are heavily weighted on canvassing/cold calling. (considered illegal and even unethical by CMS.) Even with 40% MA penetration rates in my county, because I'm targeting the right demographics, most of the time when I'm explaining to someone new to Medicare the 2 options, I get them sold on the freedom to choose any doctor that accepts Medicare. But for the ones that are dead set on MA, I'm tired of just walking away. What the most compliant way to handle this? Option A? Get scope signed. Schedule an appointment 48 hours in advance. In the "Initial Method of Contact" section of the SOA, write: Medigap presentation. Prospect requested information on Medicare Advantage/PDP Plans. or Option B? Thank them for their time, but tell them you can't help them with "those kind of plans." Move on to the next Medigap prospect.

If they are showing interest in MA on an FE or Med Sup appointment, I tell them that I can also help them with MA but it has to be a completely separate appointment. This is required for their protection so they are not a victim of baiting and switching. I can have you sign a permission to meet again to discuss MA plans (Scope of Appointment form) now and meet with you again later this week.

Works fine for me but I never work that far from home base. If you are traveling all over I don't know how you would do it compliantly.

For RX plans I just help them with the Medicare website. No need to be the agent on those things.

 

[yogooglethis]

Has CMS expressed any intention of doing this?

Any states trying to push this through?

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Who baiting and switching who? Agents or the MA carriers? What good is a $0 premium plan going to do for someone who can't afford the MOOP!

You really do get what you pay for!

I believe there is a few state DOI that impose this restriction already.There has already been proposed federal legislation imposing marketing restrictions on med supps like those on MA and IMO it's bound to happen in the Nanny State we live in.


Why would a senior lay out 3000.00 in annual in med sup/pdp premium if their financial situation is so precarious that a 6700.00 one time loss would financial devastate them ?

How much is the MOOP seniors can't afford? The one that's 6700 that happens to less than 1% of MA consumers? The MOOP that's less than 300 OOP for the very healthy ones or the MOOP that's less than 1000 OOP for the majority of MA consumers?

Everybody talks about the MA MOOP but there is also a risk of over insuring when paying premiums for a med sup/pdp combo or what I like to call the LOOP ( lowest out of pocket possible ) . The vast majority of Med sup consumers Medicare cost share amounts they would be responsible to pay if they had Medicare only is usually way less than the average $3,000.00 (in Fl.) LOOP that the average monthly Med sup/pdp premiums imposes on them.

 

[thomasm]

We don't have those crazy premiums up here that you have down in Florida.