- 15,319
Part C is for the birds.
- Thread starter dandan
- Start date
- 1,183
Quite often seniors will refer to MA as a supplement even if they have been told otherwise. (Besides, I've never seen any kind of supplement for $28, but maybe things are different elsewhere). But if what dandan posted is true, I doubt this agent was compliant in his presentation since he apparently just knocked on her door.
- 1,183
How do you think they will change it for next year? My understanding is that the rules for 10/1-11/15 this year were similar to last year.
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- Thread starter
- #44
- 598
Yes I know Med Supps are not Part C plans. The lady thought that is what she was buying and that is what she told me. No he was not compliant, yes he cold called.
I have an appointment to see her and her daughter tomorrow morning, I will get all of the facts straight at that time. If it was a cold call I will give her daughter all the information she needs to make a complaint.
I have an appointment to see her and her daughter tomorrow morning, I will get all of the facts straight at that time. If it was a cold call I will give her daughter all the information she needs to make a complaint.
- 15,319
Good luck. People who don't play by the rules (as stupid as they might be) make us all look bad.
I was speaking with a broker rep for Aetna yesterday who mentioned that a rival company's rep and staff were able to submit 500 applications on 11/15. Wonder how that happened! Oh yeah, I know. They referred to the time prior to 11/15 as the "pre-enrollment" period.
I keep looking on CMS but can't find that time frame.
Rick
- 15,319
CMS cancelled the LEOP period in July. That was the big rules change for 2007.
My guess is that in the next year or two we will have open enrollment for MA plans year 'round. Or at least allow an SEP if the doctor no longer accepts the plan.
CMS has made it too hard for a senior to receive benefits. This has to change. If we enroll a senior in an HMO (for example) and as of 5/1 the doctor drops out of the plan - or drops dead - what is the senior to do? He or she is locked into a program that might not provide the benefits needed.
Don't get me started on PFFS. A large medical group in one of the counties in which I work is thinking about dropping Pyramid due to claims problems. What if this happens in May? Hundreds of seniors will lose all access to their doctors. This group probably has 30-50% of the business in this area!
While I understand that insurance carriers like the lock-in provisions, how is this rule expanding the choices seniors have in their health care? Isn't that what Part C was supposed to do?
Rick
- 2,370
In the past, Medicare+Choice plans had year round enrollment (prior to it being called Part C).
They (the carriers) were also allowed to make mid year improvements to their plans. So, if their benefits were sub-par for the area, they could make mid year improvements.
Medicare tried in the past (I think around year 2000) to do the lock in like they have now. AARP voiced their opinion (which was no) and they overcame it. I am surprised that they allowed it this time.
A SEP for doctors leaving the network would probably be the closest thing they will get for changing plans. That is probably one of the reasons PPO plans are becoming more and more popular.
They (the carriers) were also allowed to make mid year improvements to their plans. So, if their benefits were sub-par for the area, they could make mid year improvements.
Medicare tried in the past (I think around year 2000) to do the lock in like they have now. AARP voiced their opinion (which was no) and they overcame it. I am surprised that they allowed it this time.
A SEP for doctors leaving the network would probably be the closest thing they will get for changing plans. That is probably one of the reasons PPO plans are becoming more and more popular.
- 7,790
Dandan, which breed of bird are you referring to, a vulture perhaps?:bump:
I'm going to jump in here and make a statement (or two) that may not be compliant, but here goes:
1) The same genius that gave us the AEP during the two busiest national holidays was probably the same one that caused all the carriers to re-work their training programs prior to this year's AEP. What a fiasco! I don't know about the rest of you, but I am still trying to get some of my contracts signed for 2008 because the carriers are backlogged with paperwork from the re-training and can't get the 2008 contracts processed. We are now well into the short selling season. No foresight, no compromise, no discussion, just dictate regulations.
2) Rick is right on the money. These regulatory geniuses have not considered how an agent operates his business. They assume an agent only represents one carrier. Look at all the rules about seminars and "compliant" communications. Not one of the rules takes into account an agent or agency that carries multiple products, much less MA plans.
3) Therefore I am left to read between the lines. I run an insurance business. I try to be compliant with the specific rules regarding MA plans, but I keep in mind that those MA rules do not apply to my other products, such as Med Sups, FE, and LTC. So when I have a seminar, I can keep it compliant by not conducting an MA sales presentation and call it "educational". However, there is no way I am not going to mention that my business also offers MA plans. If the client is interested in an MA plan, we schedule a sit-down and I go over it with him/her one-on-one.
4) If I schedule an MA sales event, I will pick the product I think most appropriate to the area and submit my event schedule to the FMO I am contracted with that product. I can then post advertisement for that product-specific event. If I should mention at the event that I also carry another MA plan, so what? CMS has been advised of the event and has the opportunity to be a part of the audience. Why should they care what plan I talk about? The public is served. I am not baiting and switching... I am following CMS rules and this is where it leads.
This is the rub! All the carriers have submitted their advertisement to CMS for approval with the flyers, etc. written in such a way as to presume that is the only MA product to be presented. Since we have to use the carrier's CMS approved literature, and can't alter it one iota, we are restricted in our advertising another plan on the same event flyer. In order to advertise multiple plan presentations, we must submit multiple event schedules and post multiple compliant flyers or newspaper ads. Because of this, I just make my seminar an educational event, which does not preclude sales of any of my products.
Most FMOs carry more than one insurance company's product, so they are not served by agents having a product-specific sales event. There are some that are company sponsored, and they are happy with things the way they are. This is government approved discrimination. Such bias should be forbidden by a regulatory agency of the government, but it goes on all the time. (I won't get on a soap box here, but I can name quite a few instances, some of which have been corrected by legislation due to public outcry, others in the same ilk should have been.)
Lastly) I have not even considered a health fair! I think it is a waste of time. I am sure most other agents agree. Is the public served well in this scenario? I think not.
1) The same genius that gave us the AEP during the two busiest national holidays was probably the same one that caused all the carriers to re-work their training programs prior to this year's AEP. What a fiasco! I don't know about the rest of you, but I am still trying to get some of my contracts signed for 2008 because the carriers are backlogged with paperwork from the re-training and can't get the 2008 contracts processed. We are now well into the short selling season. No foresight, no compromise, no discussion, just dictate regulations.
2) Rick is right on the money. These regulatory geniuses have not considered how an agent operates his business. They assume an agent only represents one carrier. Look at all the rules about seminars and "compliant" communications. Not one of the rules takes into account an agent or agency that carries multiple products, much less MA plans.
3) Therefore I am left to read between the lines. I run an insurance business. I try to be compliant with the specific rules regarding MA plans, but I keep in mind that those MA rules do not apply to my other products, such as Med Sups, FE, and LTC. So when I have a seminar, I can keep it compliant by not conducting an MA sales presentation and call it "educational". However, there is no way I am not going to mention that my business also offers MA plans. If the client is interested in an MA plan, we schedule a sit-down and I go over it with him/her one-on-one.
4) If I schedule an MA sales event, I will pick the product I think most appropriate to the area and submit my event schedule to the FMO I am contracted with that product. I can then post advertisement for that product-specific event. If I should mention at the event that I also carry another MA plan, so what? CMS has been advised of the event and has the opportunity to be a part of the audience. Why should they care what plan I talk about? The public is served. I am not baiting and switching... I am following CMS rules and this is where it leads.
This is the rub! All the carriers have submitted their advertisement to CMS for approval with the flyers, etc. written in such a way as to presume that is the only MA product to be presented. Since we have to use the carrier's CMS approved literature, and can't alter it one iota, we are restricted in our advertising another plan on the same event flyer. In order to advertise multiple plan presentations, we must submit multiple event schedules and post multiple compliant flyers or newspaper ads. Because of this, I just make my seminar an educational event, which does not preclude sales of any of my products.
Most FMOs carry more than one insurance company's product, so they are not served by agents having a product-specific sales event. There are some that are company sponsored, and they are happy with things the way they are. This is government approved discrimination. Such bias should be forbidden by a regulatory agency of the government, but it goes on all the time. (I won't get on a soap box here, but I can name quite a few instances, some of which have been corrected by legislation due to public outcry, others in the same ilk should have been.)
Lastly) I have not even considered a health fair! I think it is a waste of time. I am sure most other agents agree. Is the public served well in this scenario? I think not.
- 1,255
Return regulation and compliance back to the states. This is just another example of our government out of control. It's double layers of insanity.
And the least able or capable Medi- eligible's are left out in the cold. I have a low income (Not Duel) client I could help lower her Rx annual OoP by $2,000 and she just can't navagate the system. How is that in the public best interest.
And the least able or capable Medi- eligible's are left out in the cold. I have a low income (Not Duel) client I could help lower her Rx annual OoP by $2,000 and she just can't navagate the system. How is that in the public best interest.
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