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2020 Medicare Agent and Broker Compensation Announced | CMS | RBI

2020 Medicare Agent and Broker Compensation Announced

The Center for Medicare and Medicaid Services released a memo on May 29th, 2019. The CMS made the annual announcement detailing the compensation limits for 2020.

AHIP Certification 2020 discount training medicare

The Center for Medicare and Medicaid Services released a memo to Medicare Advantage Organizations, Prescription Drug Plan Sponsors, Section 1876 Cost Plans, and Medicare-Medicaid Plans detailing Contract Year 2020 Agent and Broker Compensation Rate, Referral/Finder’s Fees, Submissions, and Training and Testing Requirements for 2020.

The CY 2020 FMV cut-off amounts for all organizations & referral/finder’s fees are as follows:

Medicare Advantage Organizations, Prescription Drug Plan Sponsors, Section 1876 Cost Plans, and Medicare-Medicaid Plans 2020 Agent and Broker Compensation Rate, Referral/Finder’s Fees, Submissions, and Training and Testing Requirements 2020 compensation and referral/finder’s fee

Policies sold for a January 1st, 2020 effective date will be eligible for this new compensation as long as the selling carrier decides to pay the Maximum CMS Allowable Commission.

Needless to say, Medicare Advantage is more attractive than ever to sell as a Broker.  If you’ve ever thought about selling Medicare Advantage, now is a good time to consider getting into this market . The 2020 Medicare Broker Compensation is more robust than ever with this new announcement. Many beneficiaries (21 Million and counting) prefer a Medicare Advantage plan, and with the new broker compensation for 2020, the gains for brokers are obvious.

Give us a call at 1-800-997-3107 to find out which carriers pay Top Commission in your market! Click here to contract now!

See below for the memo in it’s entirety, titled “Contract Year 2020 Agent and Broker Compensation Rate Adjustments, Submissions, and Training and Testing Requirements.”

2020 Agent and Broker Compensation Rate, Referral, Submissions, and Training and Testing Requirements


2020 ahip discount certification



2020 ahip discount certification
OEP
Medicare cost-sharing

2020 Medicare Agent and Broker Compensation Announced | CMS | RBI

2020 Medicare Agent and Broker Compensation Announced

The Center for Medicare and Medicaid Services released a memo on May 29th, 2019. The CMS made the annual announcement detailing the compensation limits for 2020.

AHIP Certification 2020 discount training medicare

The Center for Medicare and Medicaid Services released a memo to Medicare Advantage Organizations, Prescription Drug Plan Sponsors, Section 1876 Cost Plans, and Medicare-Medicaid Plans detailing Contract Year 2020 Agent and Broker Compensation Rate, Referral/Finder’s Fees, Submissions, and Training and Testing Requirements for 2020.

The CY 2020 FMV cut-off amounts for all organizations & referral/finder’s fees are as follows:

Medicare Advantage Organizations, Prescription Drug Plan Sponsors, Section 1876 Cost Plans, and Medicare-Medicaid Plans 2020 Agent and Broker Compensation Rate, Referral/Finder’s Fees, Submissions, and Training and Testing Requirements 2020 compensation and referral/finder’s fee

Policies sold for a January 1st, 2020 effective date will be eligible for this new compensation as long as the selling carrier decides to pay the Maximum CMS Allowable Commission.

Needless to say, Medicare Advantage is more attractive than ever to sell as a Broker.  If you’ve ever thought about selling Medicare Advantage, now is a good time to consider getting into this market . The 2020 Medicare Broker Compensation is more robust than ever with this new announcement. Many beneficiaries (21 Million and counting) prefer a Medicare Advantage plan, and with the new broker compensation for 2020, the gains for brokers are obvious.

Give us a call at 1-800-997-3107 to find out which carriers pay Top Commission in your market! Click here to contract now!

See below for the memo in it’s entirety, titled “Contract Year 2020 Agent and Broker Compensation Rate Adjustments, Submissions, and Training and Testing Requirements.”

2020 Agent and Broker Compensation Rate, Referral, Submissions, and Training and Testing Requirements


2020 ahip discount certification



2020 ahip discount certification
OEP
Medicare cost-sharing

Medicare Educational Events for Newbies

Join us on Thursday, March 21st, and take part in RBI’s “Medicare Educational Events for Newbies” webinar.

This Webinar starts at 9:00 AM MST. Here are a few of the topics that will be covered!

    • New Medicare Educational Event rules for 2019!
    • How to grow your business with Medicare Educational Events
    • Best Practices for compliantly generating business from these events

To ask questions and participate, you’ll need the following:

  1. Access to an internet connection and computer (or mobile)
  2. A phone or microphone to call in with
  3. Questions you need answering!

What’s the big deal about MA-OEP?

Join us on Thursday, March 7th, to take part in RBI’s “What’s the big deal about MA-OEP?” webinar.

Back due to popular demand, we are hosting another LIVE webinar session of “What’s the big deal about MA-OEP?” We will start off this webinar with a presentation about the new Medicare Advantage Open Enrollment Period and will cover topics like:

    • Who can use this new enrollment period?
    • What are the marketing restrictions regarding MA-OEP?
    • Why this enrollment period is good for beneficiaries
  • How to take advantage of other agents poor follow-up work and how to grow your business during MA-OEP!

To ask questions and participate, you’ll need the following:

  1. Access to an internet connection and computer (or mobile)
  2. A phone or microphone to call in with
  3. Questions you need answering!

What’s the big deal about MA-OEP?

Join us on Thursday, February 7th, to take part in RBI’s “What’s the big deal about MA-OEP?” webinar.

We will start off this webinar with a presentation about the new Medicare Advantage Open Enrollment Period and will cover topics like:

    • Who can use this new enrollment period?
    • What are the marketing restrictions regarding MA-OEP?
    • Why this enrollment period is good for beneficiaries
  • How to take advantage of other agents poor follow-up work and how to grow your business during MA-OEP!

To ask questions and participate, you’ll need the following:

  1. Access to an internet connection and computer (or mobile)
  2. A phone or microphone to call in with
  3. Questions you need answering!

2019 Medicare Cost-Sharing

Medicare cost-sharing

RBI National Sales Manager: Charlie Ferrell

Charlie started his senior insurance career after a brief 30-year stint in the restaurant industry. In the 13 years since then, he has been blazing trails and setting standards for excellence all over! A native son of Utah, he has been a state manager for RBI as well as a managing general agent for UHC, Coventry, Molina and other carriers! Charlie came to RBI as the National Sales Manager in 2015, and is an invaluable resource for our agents and staff for marketing, compliance, and sales topics! Charlie’s field experience with senior insurance sales has made him an expert in our insurance CRM: Medicare Sales Engine. If all of that wasn’t enough, Charlie specializes in the Dual-Eligible market and is leading the charge behind RBI’s new “Dual Eligibles for Newbies” seminars!

2019 Medicare Cost-Sharing

Medicare has released the 2019 Medicare cost-sharing amounts and MOOP for standardized Medicare Supplement Plans. Without further ado, here it is!

Medicare cost-sharing

Part A: Hospital Insurance

Hospital

  • $1,364 (+$24) deductible per benefit period.
  • $341 (+$6) for days 61-90.
  • $682 (+$12) for 60 lifetime reserve days (days 91-150.)

Skilled Nursing

  • $170.50/day (+$3) for days 21-100.

Part A premium

  • $437 if you’ve worked less than 30 quarters.
  • $240 if you’ve worked over 30 quarters but less than 40.

Part B: Medical Insurance

  • $135.50 premium. Deductible remains at $185.
  • Cost-sharing remains the same for Part B services, Medicare pays 80% and the beneficiary pays 20%.

Part D: Prescriptions

Deductible: $415

  • The standard part D deductible for 201 is $415.  Many plans however have eliminated the deductible entirely.

Initial coverage limit: $0 – $3,820

  • After the deductible has been met, beneficiaries enter into stage 2, the Initial Coverage Limit.  At which point beneficiaries will either pay 25% or more typically they will have co-pays for tiers 1 – 5.
  • Once the retail amount (what you pay + what the carrier pays) of your prescriptions reaches $3,820 for the year, beneficiaries will enter into gap also known as the “doughnut hole.”

Coverage Gap/Doughnut hole: $3,820 – $5,100

  • Once in stage 3, more commonly referred to as the “Gap” or the “Doughnut-Hole” beneficiaries will be paying 25% for brand name drugs and 37% for generics.
  • After out-of-pocket (what you and the manufacturer pay) costs reach $5,100 beneficiaries will enter into stage 4 or “Catastrophic Coverage.”

Catastrophic Coverage

Medicare cost-sharing

  • Once in stage 4, beneficiaries will pay the greater of:
    • 5% OR
    • $3.40 copay for generics and $8.50 copay for all other drugs.

Prescription drug coverage premiums range from $12.70 and up.

Part C – Medicare Advantage plans

Premiums for Medicare Advantage plans range from $0 and up.

Max-out-of-Pocket: $6,700

Cost sharing for Medicare Supplement plans

  • Deductible for the High Deductible plan F is $2,300
  • MOOP
    • Plan K: $5,560
    • Plan L: $2,780

We hope everyone is having a successful AEP and thank you all for your hard work!  While AEP ends in a little over a week, it’s important to remember that there is an incredible year-round opportunity in the Medicare market that most agents aren’t taking advantage of.  To jump start your business in the new year, the time to start is RIGHT NOW!  Plan out community events and any marketing necessities to keep the momentum going.  If you want help with marketing, contact us to do a MAPS plan.

Not yet contracted with RB Insurance Group?  Give us a call today to learn how RBI will take your Medicare business to new heights! 1-800-997-3107!



2020 ahip discount certification
Medicare cost-sharing
Aetna certification

Medicare Broker Compensation Announced 2019

2019 Medicare Broker Compensation Announced

The Center for Medicare and Medicaid Services released a memo on May 28th, 2018 detailing the compensation limits for 2019.

The Center for Medicare and Medicaid Services released a memo on May 28th, 2018 detailing the compensation limits for 2019.

The CY 2019 FMV cut-off amounts for all organizations are as follows:

Policies sold for a January 1st, 2019 effective date will be eligible for this new compensation as long as the selling carrier decides to pay the Maximum CMS Allowable Commission.

Needless to say, Medicare Advantage is more attractive than ever to sell as a Broker.  If you’ve ever thought about selling Medicare Advantage, now is a good time to consider getting into this market . The 2019 Medicare Broker Compensation is more robust than ever with this new announcement. Many beneficiaries (21 Million and counting) prefer a Medicare Advantage plan, and with the new broker compensation for 2019, the gains for brokers are obvious.

Give us a call at 1-800-997-3107 to find out which carriers pay Top Commission in your market! Click here to contract now!

See below for the memo in it’s entirety, titled “Contract Year 2019 Agent and Broker Compensation Rate Adjustments, Submissions, and Training and Testing Requirements.”

2019_Writing_Agent_FMV_Compensation



2020 ahip discount certification
OEP
Medicare cost-sharing

2018 Medicare Cost-Sharing

Medicare cost-sharing

RBI National Sales Manager: Charlie Ferrell

Charlie started his senior insurance career after a brief 30-year stint in the restaurant industry. In the 12 years since then, he has been blazing trails and setting standards for excellence all over! A native son of Utah, he has been a state manager for RBI as well as a managing general agent for UHC, Coventry, Molina and other carriers! Charlie came to RBI as the National Sales Manager in 2015, and is an invaluable resource for our agents and staff for marketing, compliance, and sales topics! Charlie’s field experience with senior insurance sales has made him an expert in our insurance CRM: Medicare Sales Engine. If all of that wasn’t enough, Charlie specializes in the Dual-Eligible market and is leading the charge behind RBI’s new “Dual Eligibles for Newbies” seminars!

2018 Medicare Cost-Sharing

Medicare has released the 2018 Medicare cost-sharing amounts and MOOP for standardized Medicare Supplement Plans. Without further ado, here it is!

Medicare cost-sharing

Part A – Hospital Insurance

Hospital

  • $1,340 (+$24) deductible per benefit period.
  • $335 (+$6) for days 61-90.
  • $670 (+$12) for 60 lifetime reserve days (days 91-150.)

Skilled Nursing

  • $167.50/day (+$3) for days 21-100.

Part A premium

  • $422 if you’ve worked less than 30 quarters.
  • $232 if you’ve worked over 30 quarters but less than 40.

Part B – Medical Insurance

  • $134 premium. Deductible remains at $183.
  • Cost-sharing remains the same for Part B services, Medicare pays 80% and the beneficiary pays 20%.

Part D – Prescriptions

Deductible – $405

  • The standard part D deductible for 2018 is $405.  Many plans however have eliminated the deductible entirely.

Initial coverage limit – $3,750

  • After the deductible has been met, beneficiaries enter into stage 2, the Initial Coverage Limit.  At which point beneficiaries will either pay 25% or more typically they will have co-pays for tiers 1 – 5.
  • Once the retail amount (what you pay + what the carrier pays) of your prescriptions reaches $3,750 for the year, beneficiaries will enter into gap also known as the “doughnut hole.”

Coverage Gap/”Doughnut hole” TROOP- $5,000

  • Once in stage 3, more commonly referred to as the “Gap” or the “Doughnut-Hole” beneficiaries will be paying 35% for brand name drugs and 44% for generics.
  • After out-of-pocket (what you and the manufacturer pay) costs reach $5,000 beneficiaries will enter into stage 4 or “Catastrophic Coverage.”

Catastrophic Coverage

Medicare cost-sharing

  • Once in stage 4, beneficiaries will pay the greater of:
    • 5% OR
    • $3.35 copay for generics and $8.35 copay for all other drugs.

Prescription drug coverage premiums range from $12.70 and up.

Part C – Medicare Advantage plans

Premiums for Medicare Advantage plans range from $0 and up.

Max-out-of-Pocket – $6,700

Cost sharing for Medicare Supplement plans

  • Deductible for the High Deductible plan F is $2240 (+40)
  • MOOP
    • Plan K – $5240 (+$120)
    • Plan L – $2660 (+$60)

We hope everyone is having a successful AEP and thank you all for your hard work!  While AEP ends in a little over a week, it’s important to remember that there is an incredible year-round opportunity in the Medicare market that most agents aren’t taking advantage of.  To jump start your business in the new year, the time to start is RIGHT NOW!  Plan out community events and any marketing necessities to keep the momentum going.  If you want help with marketing, contact us to do a MAPS plan.

Not yet contracted with RB Insurance Group?  Give us a call today to learn how RBI will take your Medicare business to new heights! 1-800-997-3107!



2020 ahip discount certification
OEP
Medicare cost-sharing

2018 Medicare Broker Compensation Limits Now Released!

AHIP Certification 2020 discount training medicare

2018 Medicare Broker Compensation Announced!


The Center for Medicare and Medicaid Services released a memo on May 30th, 2017, detailing the compensation limits for 2018.

The CY 2018 FMV cut-off amounts for all organizations are as follows:

2018 Medicare Broker Compensation

CMS’s 2018 Medicare Broker Compensation

Policies sold for a January 1st, 2018 effective date will be eligible for this new compensation as long as the selling carrier decides to pay the Maximum CMS Allowable Commission.

Needless to say, Medicare Advantage is more attractive than ever to sell as a Broker. If you’ve never thought about selling Medicare Advantage, it’s a good time to consider getting into this side of the business. The 2018 Medicare Broker Compensation is more robust than ever with this new memo. Many beneficiaries prefer a Medicare Advantage plan, and with the new broker compensation for 2018, the gains for brokers are obvious.

Give us a call at 1-800-997-3107 to find out which carriers pay Top Commission in your market! Click here to contract now!

See below for the entire actual memo entitled “Contract Year 2018 Agent and Broker Compensation Rate Adjustments, Submissions, and Training and Testing Requirements.”

CY 18 Agent Broker CompensationTraining Testing Requirements



2020 ahip discount certification
Medicare cost-sharing
Aetna certification

The straight facts on observation status and Medicare

According to Medicareadvocacy.org, there was more than a 400 percent increase in Medicare-recognized observation status hospital stays lasting up to 72 hours between 2006 and 2011. Observation status means a beneficiary receives hospital care without being considered inpatient, making them ineligible for the Medicare Part A benefit as they transition to skilled nursing facility (SNF) care. Hospitals are currently not required to disclose observation status to patients. Patients may learn about their status if they ask first, but the unfortunate reality is most of them discover they were not inpatient and did not have their SNF care covered by Medicare when the bill comes.

Medicare requires beneficiaries to stay in the hospital for a minimum of 72 hours before it covers SNF care. Calculating the three hospital days can be complicated, however, due to how the rule is written. Health care policy experts say care improvements have made the rule outdated and an obstacle to accessing SNFs for seniors — three days is now a long time to treat many common senior health issues. What makes this rule especially challenging for beneficiaries is “observation status,” which does not count toward the three days necessary to unlock the SNF benefit.

This will change in August 2016. Congress passed the NOTICE Act this summer, which requires hospitals to give written notice of observation status hospitalization that lasts more than 24 hours to Medicare beneficiaries within 36 hours of their stay. This reform will protect seniors from unexpected bills, but it will not be implemented until next summer.

So, what can you do now to help your clients avoid high costs related to hospitalization and SNF care? First and foremost, remind them to be proactive about their health care and to ask questions. Talk to them about their Medicare rights and specifically go over how Original Medicare counts hospital days for the SNF benefit. If you’re selling Medicare Advantage during AEP, your client will appreciate knowing that most of these private Medicare plans cover SNF care from the first day.

Agents also have a year-round opportunity to sell hospital indemnity products to their senior clientele as well as non-Medicare-eligible individuals to help them out. Just remember these products may cover your client under observation as well as admittance depending on the company — it does not equate to the minimum essential coverage.

Appeals and Form CMS-1696, the Appointment of Representative

Humor me with this post. It deals with appeals.

Say your client Fred is really upset. He feels the prior authorization for his electric scooter should have been approved, but his Medicare Advantage carrier has denied it. It happens: Providers occasionally submit a weak authorization request and sometimes carriers might even make mistakes. When either of these happen, who do plan members like Fred turn to after a confusing conversation with customer service? He of course will call his insurance agent.

You can help your clients make an appeal with the Form CMS-1696. Image courtesy of iStock Photo

Medicare-agents-use-Form-CMS-1696

Back when I was young and foolish As a former carrier appeals supervisor, I know a few things about appeals. The following paragraphs assume you actually want to work with an appeal situation:

Start with customer service. A surprising number of issues might be resolved with a couple of calls. If your client isn’t comfortable on the phone or just can’t digest the information (this seems to be happening a lot recently), get on a 3-way call with him or her. Agents tend to be more attuned to customer service lingo.

If necessary you can help initiate step one in the process. An “organization determination” can even be done in advance to clarify if a procedure or service will be covered. If you have no luck with this, move to the more formal appeal process Level 1. A detailed overview of the steps through all levels of appeals is available here.

If your client is incapable of dealing with the process I suggest you become an unofficial advisor. Just note that carriers do not appreciate agents getting directly involved as the client’s representative in the formal appeal process unless you are a relative. It’s preferable that a client’s competent friend or family member become involved. You can coach the parties, but it’s not advisable that your agent name appear any documents. Your client can appoint a representative with a simple Form CMS-1696, which I’ve linked to right here. Include it with the rest of the appeal information.

I’ve utilized this form a few times on behalf of my older relatives who invariably buy their Medicare insurance from some other agent who does not return phone calls (We will deal with that type of unwelcome charity work in a future blog post).

For assistance with an appeal situation our affiliated agents can call me here at RBI. Just dial (800) 997 3107. I would not consider it charity work, so feel free to call or even email me.

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