Medical Mutual of Ohio: MedMutual Advantage® PPO Plans Available for Year-Round Enrollment

Sourced from MMO’s Special Broker Update Email from 1/26/22:

 

Medical Mutual is happy to announce our MedMutual Advantage PPO plans received Medicare’s highest rating, 5 out of 5 Stars, for 2022. The Centers for Medicare and Medicaid Service (CMS) rates Medicare Advantage plans annually on the quality of their health and drug services.

  • Medical Mutual was awarded 5 out of 5 Stars for providing members access to the care they need when they need it and helping them quickly make any necessary healthcare appointments
  • Medical Mutual achieved 5 out of 5 Stars for providing top-notch customer service
  • Medical Mutual attained 5 out of 5 Stars by delivering the highest quality healthcare coverage to their members on a consistent basis

Because of this high ranking, Medicare beneficiaries can use the one-time 5-Star Special Enrollment Period (SEP) anytime until Nov. 30, 2022, to switch to a MedMutual Advantage PPO plan. Medicare Advantage plans are a great choice for clients who are looking to change and upgrade their access to healthcare coverage.

How to Apply:

If your clients prefer to enroll in a MedMutual Advantage PPO plan during this SEP with a paper application, they will need to use an updated Enrollment Form instead of the one included in the enrollment booklet. This updated form is available on MyBrokerLink. We have also updated our online application for this SEP. The online application is our preferred enrollment method. When filling out either form, your client should indicate that he or she is joining a plan with a 5-Star Enrollment Period.

Marketing Collateral Material Available:

We are developing a number of marketing materials you can use with your clients during this SEP, including fliers, postcards and advertisements. Your Medical Mutual Account Manager can help you identify the appropriate material for your audience and customize it with your contact information.

5-Star SEP Marketing Rules & Limitations:

  • Clients can only switch to a 5-Star rated plan one time during the SEP
  • Any reference to the overall Star rating must make it clear the rating is “5 out of 5 Stars” for Medical Mutual’s 2022 MedMutual Advantage PPO plans. This should not imply that our highly rated 4.5-Star HMO plans are available during the SEP
  • Medicare clients can be informed the 5-Star SEP is available and they can be enrolled in a 5-Star plan from Dec. 8, 2021-Nov. 30, 2022
  • You are not permitted to specifically reach out to clients enrolled in lower-rated plans nor tell them to specifically request this SEP
  • You can put out general marketing communications or announcements to all clients who have the option to switch to a 5-Star plan during this SEP and encourage them to contact you to learn more

Marketing Material Requirements:

  • All materials must include the appropriate disclaimer that refers to Star ratings:
    • “Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.”
  • Marketing materials cannot specifically target enrollees in poor performing plans

You may include CMS’ gold star icon on materials that clearly relate to the contract that received 5 out of 5 Stars. It is prohibited to create your own gold star icon.

 

 

Broker Notice Regarding Third Party Marketing

Cornerstone Senior Marketing will now file third-party marketing materials requiring CMS approval for all our sales/broker partners.  This includes uniquely created materials or those purchased from a third-party lead source vendor¹.

Action Required:

Any advertisement or mailer that mentions a premium, a benefit, a cost/copay, or getting your Part B paid for (even in a general fashion) needs to be sent for approval.  This includes mailers, newspaper or magazine ads, TV/Radio commercials, bulletin boards, flyers, presentations, etc.

Please use this link below to submit any marketing materials that meet the above description that you plan to use, for compliance review. 

If you’re unsure your marketing material requires CMS approval, please submit it for review.  We’re here to help by offering compliance reviews for all marketing and/or communication materials, anytime.

If you are an agency with down line agents, please reach out to them and have them submit their materials as well, as you are responsible for their compliance with CMS regulations.

¹The lead vendors listed below will arrange filing through HPMS, for CMS approval, any marketing pieces that fall within the guidance above.  You DO NOT need to submit  materials to Cornerstone Senior Marketing from these lead vendors.  

Target Leads, Kramer Direct, Main Street, Arm Leads, and Lead Concepts

NEW! Aetna Supplemental E-Signature Option for CSG E-Apps

Exciting News! 

 

Aetna Senior Supplemental has approved their security questions signature for CSG Actuarial E-Apps! Agents can now EASILY capture signatures over the phone or in person with this option.

This is approved for all over the phone/remote sales.

If you have any further questions, please reach out to your CSM Representative.

GPM HEALTH & LIFE – OKTA REGISTRATION REMINDER

The final registration deadline for Okta is extended to February 24, 2022. We encourage you to register for Okta immediately, to avoid business disruption. Okta is a two-factor authentication process. SPA login credentials cannot be shared.

SET UP INSTRUCTIONS

 

STAR RATINGS

The Medicare Star Rating system was instituted by CMS back in 2007 to focus on improving plans and enable Medicare beneficiaries to compare plans.  CMS began publishing the Medicare Part C and D Star Ratings annually in 2009, where the stars measure the quality of health and drug services.

Medicare Star Ratings measure more than 30 different topics in five categories for MA plans and 14 topics in four categories for part D prescription drug plans.  Plans that are both MA and Part D are measured across more than 45 topics in 9 categories, and results come from member surveys and information that plans and healthcare providers submit to Medicare.

When discussing Star Ratings with a Medicare beneficiary, it’s helpful to let them know how the plans are rated.  The Star Rating categories include preventive services, management of chronic conditions, drug pricing and patient safety as well as customer services and member experience, including member complaints and performance.

Medicare uses the gathered data to rate the plans.  A plan can get a rating between 1 and 5 stars.  A 5-star rating is considered excellent.  If a Medicare Advantage Plan, Medicare drug plan, or Medicare Cost Plans with a 5-star rating is available in the beneficiary’s area, they can use the 5-star Special Enrollment Period to switch from their current Medicare plan to a Medicare plan with a “5-star” quality rating.  The special Enrollment Period can only be used once between December 8 and November 30.

MAPD TO PDP

If a beneficiary moves from a Medicare Advantage Plan that includes prescription drug coverage to a stand-alone Medicare Prescription Drug Plan, they will be disenrolled form the Medicare Advantage Plan, including the health benefit and will be returned to Original Medicare for coverage of their health services.  Beneficiaries can only switch to a 5-star Medicare Prescription Drug Plan if one is available in their area.

MAPD TO MA 

If a beneficiary moves from a Medicare Advantage Plan that has drug coverage to a 5-star Medicare Advantage Plan that doesn’t, they may lose their prescription drug coverage and must wait until their next enrollment opportunity go get drug coverage.  They may also have to pay a Part D late enrollment penalty.

ENROLLMENT 

In addition to the Medicare 5-Star Special Enrollment Period, there are certain Medicare enrollment periods during which a Medicare eligible beneficiary may enroll in a 5-Star Medicare Advantage Plan. 

Medicare Initial Enrollment Period

  • Sign up for a 5-Star plan or any plan of any rating, when first eligible for MA
  • Eligibility begins once enrolled in both Medicare Part A and Part B (and does not have End-Stage Renal Disease).
  • Only eligible to enroll in plans offered in their area.
  • 7-month Medicare Initial Enrollment Period begins 3 months before turning 65 years old, includes the birthday month, and continues for 3 months thereafter.

Medicare Annual Enrollment Period

  • Medicare beneficiaries already enrolled in Part A and/or Part B may sign up for an MA plan during the fall Annual Enrollment Period, October 15 to December 7, each year.
  • If already enrolled in an MA plan, may use this time to switch to a different MA plan.

Between April 1 and June 30

  • For those who already had Part A of Medicare but waited to sign up for Part B during the Medicare general Enrollment Period (January 1 to March 31 each year), they can sign up for a Medicare Advantage plan between April 1 and June 30.

A Special Election Period

  • Being enrolled in an MA plan with fewer than 5-Stars is not the only way to qualify for an SEP. Special Enrollment Periods may be granted to individuals for a variety of circumstances, such as living outside the U.S. at the time of their initial Medicare eligibility or residing in a long-term care facility.

5-Star Plan Marketing Limitations 

You can let your Medicare eligible clients know that SEPs are available and that you can enroll them in a 5-Star plan if they’d like to switch.  You cannot reach out to specific clients who are enrolled in lower-rated plans, and you cannot ask your clients to request an SEP.  When in doubt, keep your communications brief and informative, then direct prospects and clients to call you for more information.

MEDICARE ADVANTAGE OPEN ENROLLMENT PERIOD

The 21st Century Cures Act eliminated the Medicare Advantage disenrollment period that previously took place each year from Jan 1 to Feb 14.

Starting in 2019, and continuing annually, OEP is in effect from Jan 1 to Mar 31, allowing a beneficiary enrolled in a Medicare Advantage plan (with or without drug coverage), a one-time opportunity to make plan changes.

WHAT CAN A BENEFICIARY DO DURING OEP? 

  • Switch to another Medicare Advantage Plan (with or without drug coverage).
  • Drop current Medicare Advantage Plan and return to Original Medicare, Parts A & B.
  • If a beneficiary returns to Original Medicare during OEP they can sign up for a stand-alone Medicare Part D Prescription Drug Plan.

IMPORTANT:

  • Only one change is allowed, effective the first day of the following month after receipt of the application.
  • Beneficiaries CANNOT switch from a Medicare Supplement to an MADP or switch from one PDP to another PDP. 

MARKETING GUIDELINES FOR OEP

  • Plans, agents, and brokers may NOT knowingly conduct any OEP marketing to Medicare Advantage members, which includes knowingly targeting or sending any unsolicited marketing materials by telephone, direct mail, social media, or email. 

Examples of “knowingly” targeting during OEP

  1. Providing unsolicited materials referencing OEP or the ability to make an additional enrollment change.
  2. Any message that calls out OEP (including timeframe) even in an educational context.
  3. Calling former enrollees who elected a new plan during AEP.
  4. Engaging in promotional activities which intend to use the OEP as an opportunity to acquire sales.

APPROVED MARKETING ACTIVITIES DURING OEP 

  • Focus on SEP elections such as age-ins, relocating, loss of group coverage, etc.
  • Marketing for any 5-Star Rated Plans in your regional area.
  • Contacting and working with Dual-eligible and LIS beneficiaries.

Ultimately, OEP activity must be initiated by the member. However, if a beneficiary contacts you and asks about their eligibility to enroll into a plan (but does not make any explicit reference to OEP) you can review their information and utilize OEP to help them with their plan change.

OEP Example: Mr. B is enrolled into a Medicare Advantage Plan during AEP.  He used the MA AEP to switch to a new MA plan, effective January 1. Unfortunately, a few of his drugs are not on his new plan’s formulary and his doctor is out of network. Mr. B can use his OEP election from Jan 1 to Mar 31 (OEP) to change plans in February, with an effective date of March 1.

January 2022 Compliance Corner: OEP Marketing Do’s & Don’ts

Information sourced from Cornerstone Senior Marketing’s Medicare Agent Marketing Guidelines & our Agent Compliance Guide

 

OPEN ENROLLMENT PERIOD

During the Medicare Open Enrollment Period (OEP) which runs from January 1 to March
31 each year, beneficiaries can switch from one Medicare Advantage plan to another or go
back to Original Medicare. However, during OEP agents may not knowingly target or send
unsolicited marketing materials to any MA or Part D enrollee. “Knowingly” takes into account
the intended recipient as well as the content of the message.

During OEP, agents may:
• Conduct marketing activities based on other enrollment opportunities, such as:
○ Marketing to age-ins (who have not yet made an enrollment decision),
○ Marketing for a 5-star plan, and
○ Marketing to dual-eligible and LIS beneficiaries who, in general, may make changes once per
calendar quarter during the first nine months of the year.

• Send marketing materials when a beneficiary makes a proactive request; and

• Have one-on-one meetings at the beneficiary’s request

 

During OEP, agents may not:
• Conduct activities or send unsolicited materials advertising the ability/opportunity to
make an additional enrollment change or referencing the OEP;

• Specifically target individuals who are in the OEP because they made a choice during
Annual Enrollment Period (AEP) by purchase of mailing lists or other means of
identification;

• Call or otherwise contact former enrollees who have selected a new plan during the AEP.

 

MARKETING TIP: OEP is a great time to shift to Age-In or other SEP activities. We also
suggest using this time to reach out to your clients who enrolled in a plan during AEP to
check in to confirm they know how to use their benefits or if they have any question. Doing
so will go a long way with customer retention and satisfaction, will help reduce member
complaints, and can spark a request for permissible marketing information.

WellCare: OEP – Top 10 Leading Counties & Plans

Sourced from WellCare Broker Communication from 1/20/22:

Open Enrollment Period: Top 10 Leading Counties & Plans

Our top 3 plans dominating in our top counties are:
• Wellcare No Premium (HMO)
• Wellcare Dual Access (HMO D-SNP)
• Wellcare Giveback (HMO)

Current Elective SEP Codes:
• SEP LIS
• SEP Medicaid

 

 

If you have any questions regarding WellCare plans and benefits please contact your Cornerstone Senior Marketing representative for more information.

AultCare 5-Star Rated MA for 2022

Excellent!

PrimeTime Health Plan is rated a 5-Star Medicare Advantage Plan for 2022 by the Centers of Medicaid and Medicare Services (CMS).This rating is considered excellent by CMS.

Members have a one-time Special Enrollment Period (SEP) to enroll in a Medicare Advantage 5-Star plan and brokers are able to market the 5-Star PrimeTime Health Plan year-round (between December 8, 2021 through November 30, 2022), as opposed to waiting for the Annual Enrollment Period, starting October 15 each year.

An exclusive opportunity…

Cornerstone Senior Marketing is the only FMO that offers broker contracting with AultCare. Get appointed now and add the 5-Star rated MA PrimeTime Health Plan to your product portfolio.

PrimeTime Health Plan in NE Ohio

Medicare Advantage Plans are available in select NE Ohio counties:

Carroll | Columbiana | Harrison | Holmes | Mahoning | Medina | Portage | Stark | Summit | Trumbull | Tuscarawas | Wayne

Contact your Sales or Service Rep to discuss additional benefits of adding AULTCARE to your product portfolio.

Jaime Lebron NE Ohio | 216-503-4509

AultCare PrimeTime Choices Med Supp GI

Med Supp Guaranteed Issue Advantage.

Through the end of May, 2022, AultCare offers clients to move from Plan F to Plan G from any carrier or within the PrimeTime network and anyone coming from an existing/active Plan C supplement plan will receive the Guaranteed Issue to downgrade to Plan G, M or N. 

Enrollment app enhancements….

A new PrimeTime Choices Enrollment Application is available with upgraded features that mirror the current Medicare Advantage submission process.  The enhancements include:

  • Single submission for both member and broker information, eliminating the need for brokers to submit a separate form.
  • Attachments can be included with your submission
  • A progress gauge 
  • Ability to print the completed application before submission
  • A confirmation message when the submission process is complete

For 35 years, AultCare has provided quality healthcare at an affordable cost to the Ohio communities it serves, state-wide for the PrimeTime Choices Medicare Supplement Plan.

Cornerstone Senior Marketing offers our broker partners the exclusive opportunity to contract with AultCare and offer their plans as a significant part of a well-rounded product portfolio.