AEP Readiness Agent Guidance
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Questions? We are here to help! | Contact your CSM Representative or call 614-763-2255
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Questions? We are here to help! | Contact your CSM Representative or call 614-763-2255
A new KFF analysis finds that between 8 and 24 million people across the United States could be disenrolled from Medicaid during the unwinding of the program’s continuous enrollment provision. Read full article here.
SEP information provided by CIGNA – 3/7/2023
This is an important announcement for agents with customers in California, Colorado, Kentucky, New York, Oregon, and Texas and for those with business in those states. The counties below are under a state designated SEP due to an emergency.
CALIFORNIA
State declaration: Severe Winter Storms
SEP Incident Date: 03/01/2023 – Ongoing
This SEP declaration is effective: 03/01/2023 – Ongoing
Impacted counties for SEP purposes: Amador, Kern, Los Angeles, Madera, Mariposa, Mono, Nevada, San Bernardino, San Luis Obispo, Santa Barbara, Sierra, Sonoma, and Tulare
Declaration information Updated
FEMA declaration: Severe Winter Storms, Flooding, Landslides, and Mudslides
SEP incident dates: 12/27/2022 – 03/01/2023
This SEP declaration is effective: 12/27/2022 – 03/31/2023
Impacted counties for SEP purposes: Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Fresno, Glenn, Humboldt, Inyo, Los Angeles, Madera, Marin, Mariposa, Mendocino, Merced, Monterey, Napa, Nevada, Placer, Sacramento, San Benito, San Diego, San Francisco, San Joaquin, San Luis Obispo, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Siskiyou, Solano, Sonoma, Stanislaus, Sutter, Tehama, Tuolumne, Trinity, Tulare, Ventura, and Yolo
COLORADO
Declaration information Updated
FEMA declaration: Fuel Supply Chain Risk
SEP incident dates: 12/31/2022 – 05/31/2023
This SEP declaration is effective: 12/31/2022 – 05/31/2023
Impacted counties for SEP purposes: All counties
KENTUCKY
State declaration: Severe Winter Weather
SEP incident dates: 03/03/2023 – Ongoing
This SEP declaration is effective: 03/03/2023 – Ongoing
Impacted counties for SEP purposes: All counties
NEW YORK
Declaration information Updated
State declaration: Healthcare Staffing Shortages
SEP incident dates: 09/27/2021 – 04/21/2023
This SEP declaration is effective: 09/27/2021 – 05/31/2023
Impacted counties for SEP
Declaration information Updated
State declaration: Rikers Island Correctional Center Staffing Shortage
SEP incident dates: 09/28/2021 – 04/29/2023
This SEP declaration is effective: 09/28/2021 – 06/30/2023
Impacted counties for SEP purposes: Bronx, Kings, New York, Richmond, and Queens
purposes: All counties
OREGON
State declaration: Severe Winter Weather
SEP incident dates: 02/25/2023 – 04/30/2023
This SEP declaration is effective: 02/25/2023 – 04/02/2023
Impacted counties for SEP purposes: Multnomah
TEXAS
State declaration: Severe Winter Weather
SEP incident dates: 02/04/2023 – Ongoing
This SEP declaration is effective: 02/04/2023 – Ongoing
Impacted counties for SEP purposes: Anderson, Bastrop, Blanco, Burleson, Burnet, Caldwell, Delta, Denton, Falls, Hays, Henderson, Hopkins, Hunt, Kendall, Lamar, Lee, Leon, Milam, Red River, Robertson, Shelby, Smith, Travis, and Williamson
IMPORTANT: Please be aware
SEP for Government Entity-Declared Disaster or Other Emergency
42 CFR 422.62(b)(18)
(Rev. 2, Issued: August 12, 2020; Effective/Implementation: 01-01-2021)
An SEP exists for individuals affected by a disaster or other emergency declared by a Federal, state or local government entity who were unable to, and did not make an election during another valid election period. This includes both enrollment and disenrollment elections.
Individuals are eligible for this SEP if they:
Tips for completing applications
For telephonic applications, ensure that the following fields are completed:
Cornerstone Senior Marketing’s Jaime Lebron recently attended the Captial Conference in Washington, D.C., as a member of NABIP-NEO, where he met with Congressional leaders and heard updates from CMS. The NABIP chapters meet annually to interact with congressional leaders and CMS regarding insurance industry regulation updates and legisltive issues that impact brokers and consumers.
Left to Right: Suzanne McClain-Broker | William Barrett-Aetna | Shawn Kasych-Ohio State Lobbyist | Ingrid Martin-Beam Dental | Jaime Lebron – Cornerstone Senior Marketing
Initial Enrollment Periods & Other New-To-Medicare Situations
Special Enrollment Period
You Lose Or Have A Change In Your Current Coverage
Other Special Situations
Real-time leads available through MedicareCENTER!
Timely leads are important to your success as a Medicare agent. That’s why we’re so excited to share that LeadCENTER now connects with your CRM in MedicareCENTER, allowing you to set up campaigns and have quality leads delivered right to your account — all at the flip of a switch!
All it takes is a few quick steps to get the leads you need — delivered when and how you want. You’re in control!
• Follow prompts in MedicareCENTER to set up campaigns in LeadCENTER
• Check-in with the flip of a switch to start getting leads — exactly when you’re ready
• Choose lead types and sources based on your unique business
• Get real-time leads delivered right to your MedicareCENTER account
View our great resources below for more information and how to get started!
LEADCENTER GETTING STARTED VIDEO
Exciting additions in MedicareCENTER – made just for you!
Personal Agent Websites & Send Quote Capability
MedicareCENTER has new exciting enhancements for hard-working agents just like you! Discover new ways to use this FREE platform that help you serve your clients and run your business better, like Personal Agent Websites and Send Quote function!
Personal Agent Websites, found under your Account profile, are URL links unique to you that can be shared with clients who prefer to shop and enroll on their own – and you still get the commission! Share your Personal Agent Website link in emails and other marketing communications for a smart and simple way to give clients the freedom to choose coverage that fits their needs at their convenience. Find out more in the Help Guide below.
PERSONAL AGENT WEBSITE HELP GUIDE
Another exciting enhancement you’ll love is Send Quote. You could already compare up to three plans for clients in MedicareCENTER’s CRM. Now, you can generate custom plan comparison charts to send directly to clients — offering another way for them to choose a plan that best fits their needs. Find out more in the Help Guide below.
MedicareCENTER will be providing the way to meet CMS requirements — to make it easy for you.
In the recently passed CMS regulations, licensed and certified independent agents are included in the definition of a Third Party Marketing Organization (TPMO) and as such, will be required to record phone calls that result in enrollment of a Medicare Advantage or Prescription Drug Plan. A petition has been designed to get the attention of CMS to remove the agent/broker language from the TPMO definition.
To sign, and share information about this petition, please click the link below.
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
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
Medicare Annual Enrollment Period
Between April 1 and June 30
A Special Election Period
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.