Wellcare PDP Class Action Suit

[newbie2001]

Not much is affected here in Florida...but what happens if 2025 is another bad year for MAPD? Don' trust any company 100%. Bank your money as best you can. That's been said on here for years.

We’re all gonna end up selling life insurance for NAA here before long

 

[Chazm]

Just got the Annual Comp update from UHC. Bad news....numerous regions will have non-commissionable MAPD plans, some even starting Oct. 1. Not every plan or service area is affected. I looked primarily at Virginia, where non-comm plans mostly in rural SE part of state, parts of the Shenandoah Valley and some Richmond areas. Northern Virginia, MD and DC will still pay MAPD. PDP not affected....all still payable.

I suspect this may in part be linked to eventually withdrawing plans from those markets. If carriers don't really want any more enrollments, cutting off agent comp is a good way to put a damper on them.

Thankfully, 93% of my book is Med Supp anyway. However, about 90% of those also have PDPs I've written. Wellcare is gonna cost me about $12K with their move.

HERE IS WHAT'S ODD: This stems from CMS concerns of agent's "steering" biz to get bonuses, trips, etc that would influence enrollment choices. Yet if agent's can't get paid by Wellcare (or any other company) that alone seems plenty incentive to suggest a plan where they can get paid! Look, I think most agents want to do right thing for the consumer, but they won't be able to do this without compensation.

I posted on here some weeks back with this idea: Forget being "certified" or taking any comp for PDP plans. Instead, offer "review" services for a fee ($100 a person) and "coach" as many people as you want during AEP as well as year-round. Then send them direct to the carrier to enroll. No SOA, no recorded call issues.... You want my time and expertise regarding drug coverage? Paypal me. I don't see this as any conflict if I'm selling Medigap only going forward.

You can’t offer any MAPD or PDP plans if you want to collect a fee.

 

[InsuranceGuy29]

Just got the Annual Comp update from UHC. Bad news....numerous regions will have non-commissionable MAPD plans, some even starting Oct. 1. Not every plan or service area is affected. I looked primarily at Virginia, where non-comm plans mostly in rural SE part of state, parts of the Shenandoah Valley and some Richmond areas. Northern Virginia, MD and DC will still pay MAPD. PDP not affected....all still payable.

I suspect this may in part be linked to eventually withdrawing plans from those markets. If carriers don't really want any more enrollments, cutting off agent comp is a good way to put a damper on them.

Thankfully, 93% of my book is Med Supp anyway. However, about 90% of those also have PDPs I've written. Wellcare is gonna cost me about $12K with their move.

HERE IS WHAT'S ODD: This stems from CMS concerns of agent's "steering" biz to get bonuses, trips, etc that would influence enrollment choices. Yet if agent's can't get paid by Wellcare (or any other company) that alone seems plenty incentive to suggest a plan where they can get paid! Look, I think most agents want to do right thing for the consumer, but they won't be able to do this without compensation.

I posted on here some weeks back with this idea: Forget being "certified" or taking any comp for PDP plans. Instead, offer "review" services for a fee ($100 a person) and "coach" as many people as you want during AEP as well as year-round. Then send them direct to the carrier to enroll. No SOA, no recorded call issues.... You want my time and expertise regarding drug coverage? Paypal me. I don't see this as any conflict if I'm selling Medigap only going forward.

I don't see this as a red flag for all MAPD. There's still a good bit of money to go around, it's still very competitive, and they still want business. This is definitely not the case for PDP's.

But since the government tightened the noose for these companies, they made it much harder to operate with MAPD's in less denser-populated areas.

As a result, all of these companies are moving their MAPD plans to where they can survive and make the most money....and that's in big cities and their surrounding metropolitan suburban areas.

I genuinely feel horrible for any agents writing in country/rural areas, because all these companies are chopping plans out there. It sucks for our clients because now many of them have little-to-no choices for MAPD plans out there, now.

I know I sound like a broken record, but this is what happens when big liberal government meddles in things they know nothing about.

Choices always get extremely limited. Same thing happened under Obama with the ACA. Many carriers left the rural areas and some have no insurers or maybe 1, if they're lucky.

 

[Dave G]

The Annual Comp update I just got listed the following plans and counties in Florida as non-commissionable:
- Medicare Advantage H2406-018 / Broward and Miami-Dade
- Dual Complete H2509-001 / 35 Counties
- Dual Complete R0759-003 / ALL Counties

 

[Chazm]

The Annual Comp update I just got listed the following plans and counties in Florida as non-commissionable:
- Medicare Advantage H2406-018 / Broward and Miami-Dade
- Dual Complete H2509-001 / 35 Counties
- Dual Complete R0759-003 / ALL Counties

The ones that no one writes. Old plans

 

[MedicareWAA]

We need a WellCare whistleblower.

 

[LostDollar]

Look, I think most agents want to do right thing for the consumer, but they won't be able to do this without compensation.

Caveat, not an agent.

I joined the forum in the fall of 2016.

Maybe I am remembering wrong, but your statement above seems to me to be a significant change from the attitude many posting agents expressed in 2016 and 2017.

Many did not want to take AHIP and fuss with all the restrictions of selling Part D.

The common expression seemed to be that agents should do the PDP help for clients, even though they received no money, because if they did not, another agent would offer the help and would take the client and their MedSupp business because the original agent who sold the Medigap plan would not also help with the PDP.

There appears to have been a significant change from that attitude of 7 years ago. to one today expecting compensation, specifically for the service of plan finding assistance, with no consideration of how not doing PDP help will affect Medigap client retention.

 

[sshafran]

Just turned on the Kamala interview - she's talking about how great the inflation reduction act is.

She's clueless

 

[sshafran]

Caveat, not an agent.

I joined the forum in the fall of 2016.

Maybe I am remembering wrong, but your statement above seems to me to be a significant change from the attitude many posting agents expressed in 2016 and 2017.

Many did not want to take AHIP and fuss with all the restrictions of selling Part D.

The common expression seemed to be that agents should do the PDP help for clients, even though they received no money, because if they did not, another agent would and would take the client and their MedSupp business because the original agent who sold the Medigap plan would not also help with the PDP.

There appears to have been a significant change from that attitude of 7 years ago. to one today expecting compensation, specifically for the service of plan finding assistance, with no consideration of how not doing PDP help will affect Medigap client retention.

Simple. There was a day and a time when it was little more simple, and we had fewer clients. The medicare.gov had the list ID which we could save.

Now, more complex; we pay for software, and with the cost of living and cost of marketing, we don't want to not sell.

 

[LostDollar]

I posted on here some weeks back with this idea: Forget being "certified" or taking any comp for PDP plans. Instead, offer "review" services for a fee ($100 a person) and "coach" as many people as you want during AEP as well as year-round. Then send them direct to the carrier to enroll. No SOA, no recorded call issues.... You want my time and expertise regarding drug coverage? Paypal me. I don't see this as any conflict if I'm selling Medigap only going forward.

caveat, not an agent.

I don't think sending them to the carriers to enroll gives the appearance of independent review when CMS has an all carrier enrollment platform available.

I think you would be risking complaint actions that could cost you your license with every person you did that with.

Conflict of interest is the term I am looking for. There is actual conflict of interest and there are circumstances where a reasonable person could believe conflict of interest existed, even if it did not.

With your example, a person who has a problem with the product recommended to them could complain to an insurance commissioner or CMS that the agent was not acting in an independent manner.