AEP Readiness Agent Guidance
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Questions? We are here to help! | Contact your CSM Representative or call 614-763-2255
Medicaid Unwinding – KFF Release
Eight to 24 Million Could Lose Medicaid Coverage by May 2024 Due to the End of Pandemic-era Enrollment Protections
State Policies Will Help Shape How Many People Are Disenrolled, Including Some Who Remain Eligible
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’s for CA, CO, KY, NY, OR & TX
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
- This does not mean that active marketing can occur.
- The SEP is only for the purpose of providing a SEP to impacted individuals who had a valid election during the incident and were unable to make that election due to the emergency.
- This does not mean we initiate waiving of authorization or referral requirements.
- This does not extend waiving of prior authorizations, referrals etc.
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:
- Reside, or resided at the start of the SEP eligibility period described in this guidance, in an area for which a federal, state or local government entity has declared a disaster or other emergency or they do not reside in an affected area but rely on help making healthcare decisions from one or more individuals who reside in an affected area; and
- Were eligible for another election period at the time of the SEP eligibility period; and
- Did not make an election during that other valid election period due to the disaster or other emergency.The SEP starts as of the date the declaration is made, the incident start date or, if different, the start date identified in the declaration, whichever is earlier. The SEP ends two full calendar months following the end date identified in the declaration or, if different, the date the end of the incident is announced, whichever is later.
Tips for completing applications
- Select “SEP” in the “Select Enrollment Period” field
- Enter code “DST” in the “SEP Code” field
- Enter the date the customer was affected by the disaster in the “SEP Date field”
- In the “Special Enrollment Period” section: Make sure you select the special enrollment period that applies to the customer in addition to selecting the “DST” box that states “I was affected by a weather-related emergency or major disaster (as declared by the Federal Emergency Management Agency (FEMA)). One of the other statements here applied to me, but I was unable to make my enrollment because of the natural disaster.” Both are required to be completed.
For telephonic applications, ensure that the following fields are completed:
- In the “Special Enrollment Period section: Select the actual enrollment period the customer qualified for that was missed, and
- Select the check box next to the statement that reads “I was affected by a weather-related emergency or major disaster (as declared by the Federal Emergency Management Agency, or by federal, my state or my local government).One of the other statements on this page applied to me, but I was unable to make my request because of the disaster.” This creates the DST and the second code Enrollment requires to process the application.
Cap Con 2023
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.
Jaime Lebron Cornerstone Senior Marketing
Left to Right: Suzanne McClain-Broker | William Barrett-Aetna | Shawn Kasych-Ohio State Lobbyist | Ingrid Martin-Beam Dental | Jaime Lebron – Cornerstone Senior Marketing
Post AEP – Special Enrollment Periods
Initial Enrollment Periods & Other New-To-Medicare Situations
- I’m new to Medicare.
- I already have Hospital (Part A) and recently signed-up for Medical (Part B). I want to join a Medicare Advantage Plan.
- I’m new to Medicare, and I was notified about getting Medicare after my Part A and/or Part B coverage started.
- I had Medicare prior to now, but I’m now turning 65.
Special Enrollment Period
- I’m in a Medicare Advantage Plan and have had Medicare for less than 3 months. I want to make a change.
- I moved to a new address that’s outside my current plan’s service area, or I recently moved and this plan is a new option for me.
- I moved back to the U.S. after living outside the country.
- I was released from jail.
- I recently got lawfully presence status in the U.S.
- I live in a long-term care facility, like a nursing home or rehabilitation hospital.
- I recently moved out of a long-term care facility, like a nursing home or rehabilitation hospital.
You Lose Or Have A Change In Your Current Coverage
- I left coverage from my employer or union (including COBRA coverage).
- I lost other, non-Medicare drug coverage that’s as good as Medicare drug coverage (credible coverage), or my other, non-Medicare coverage changed and is no longer considered credible.
- I lost my coverage because Medicare ended its contract with my plan. I got a letter from Medicare saying I could join another plan.
- I dropped my coverage in a PACE (Programs of All-Inclusive Care for the Elderly) plan.
- I lost my Special Needs Plan because I no longer have a condition required for that plan.
- I lost my coverage because my plan no longer covers the area that I live or it ended its contract with Medicare.
- I recently had a change in my Medicaid (newly got Medicaid, had a change in my level of Medicaid, or lost Medicaid).
- I recently had a change in my Extra Help paying for my drug costs (newly got Extra Help, had a change in my level of Extra Help, or lost Extra Help).
- I was enrolled in a plan by Medicare (or my state) and I want to choose a different plan.
- I’m in a State Pharmaceutical Assistance Program, or I’m losing help from a State Pharmaceutical Assistance Program.
Other Special Situations
- I dropped a Medicare Supplement Insurance (Medigap) policy when I first joined a Medicare Advantage Plan. It’s been less than 12 months since I left my Medigap policy. I want to switch to Original Medicare so I can go back to my Medigap policy, and I’m joining a Drug Plan (Part D)
- I was affected by an emergency or a major disaster (as declared by the Federal Emergency Management Agency, or by Federal, my state, or my local government). One of the other statements on this page applied to me, but I was unable to make my request because of the disaster.
- I’m in a plan that was recently taken over by the state because of financial issues. I want to switch to another plan.
- I’m in a plan that’s had a star rating of less than 3 stars for the last 3 years. I want to join a plan with a star rating of 3 stars or higher.
- I am enrolling in a 5-star Medicare plan.
- I requested Medicare information in an accessible format. I got less time to make my decision, or I didn’t get it in time to make a choice before my enrollment period ended.
- I lost my Medicare Advantage Plan with drug coverage because I lost Medical (Part B) coverage. I want to join a Medicare drug plan.
- I dropped my Cost Plan with drug coverage and switched to Original Medicare. I want to join a Medicare drug plan.
- I live in or (within the past 2 months) moved out of a long-term care facility, like a nursing home or rehabilitation hospital. I want to join a Medicare drug plan.
- Other.
LeadCENTER Now Available through MedicareCENTER
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
MORE Exciting Additions to MedicareCENTER – Made Just For You
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.
Call Recording Petition
Reverse the New CMS Medicare Call Recording Requirements
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.
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
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.