Poor Performing Plan SEP
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- 18,980
How do you find out if a person qualifies for that? I have a life insurance client that also has Todays Options PFFS MA plan. He has no other SEP but would love to get out of it before this AEP.
Is it a low performing plan?
Found this on Agent Pipeline:
As you may know, CMS released their 2013 star ratings for Medicare Advantage and Prescription Drug plans last month. While we saw 11 Medicare Advantage plans receive five stars for “excellent performance”, we saw many more that are considered “poor” or “below average” performers.
This year, CMS will be sending letters to all beneficiaries that are enrolled in plans considered to be “poor” or “below average” advising them it may be wise for them to look into other plan options during the AEP or the MADP. These letters will be going out to beneficiaries currently enrolled in the 26 Medicare Advantage and Prescription Drug plans that have performed poorly over the past 3 years.
You can find a copy of the letter here.
CMS has also created an SEP allowing beneficiaries one chance to move from a “poor” performing plan to one that is rated 3-Star or higher after January 1, 2013. This SEP is not agent driven however, so in order for someone to take advantage of this, the individual must call 1-800-MEDICARE. There are no timeframes, end dates, etc. associated with this SEP and CMS will be granting the SEP on a case-by-case basis. Beneficiaries will be receiving letters regarding this as well.
On a side note, this is not to be confused with the 5-Star SEP that allows agents to enroll a beneficiary into a 5-Star rated plan any time during the year.
So, it will not make you any $$, but you can do good customer service by advising a move if the client is truly being hurt by the plan.
As you may know, CMS released their 2013 star ratings for Medicare Advantage and Prescription Drug plans last month. While we saw 11 Medicare Advantage plans receive five stars for “excellent performance”, we saw many more that are considered “poor” or “below average” performers.
This year, CMS will be sending letters to all beneficiaries that are enrolled in plans considered to be “poor” or “below average” advising them it may be wise for them to look into other plan options during the AEP or the MADP. These letters will be going out to beneficiaries currently enrolled in the 26 Medicare Advantage and Prescription Drug plans that have performed poorly over the past 3 years.
You can find a copy of the letter here.
CMS has also created an SEP allowing beneficiaries one chance to move from a “poor” performing plan to one that is rated 3-Star or higher after January 1, 2013. This SEP is not agent driven however, so in order for someone to take advantage of this, the individual must call 1-800-MEDICARE. There are no timeframes, end dates, etc. associated with this SEP and CMS will be granting the SEP on a case-by-case basis. Beneficiaries will be receiving letters regarding this as well.
On a side note, this is not to be confused with the 5-Star SEP that allows agents to enroll a beneficiary into a 5-Star rated plan any time during the year.
So, it will not make you any $$, but you can do good customer service by advising a move if the client is truly being hurt by the plan.
Oh I thought he meant something new as in the last few days. Yes, the client has to call Medicare but you CAN still get commission. I'm in the process of switching a lot over
- 18,980
I think it is and so does he but I don't know if CMS agrees.
How would I find out if CMS considers it a low performing plan?
How do you get a commission when they have to call Medicare? Is it possible to only get SEP approval from Medicare (so you can do the enrollment)?
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jdeasy, CMS is mailing letters to members of the "bad" plans. Also, there is probably a more direct way to find the star ratings but you can certainly get them on the medicare.gov plan finder.
- 18,980
I have found out now that there are only 2 PFFS plans here and one of them is a poor performing plan. I now have to find out if that's the one he has.
Another question for anyone, if it is one that qualifies and he has the SEP, is that also GI for a med sup?
The way I read the "Choosing a Medigap Policy" booklet he would. But that's how I want to read it.
Good question because from what I can tell, the Choosing a Medigap 2012 makes no mention of this SEP.
