CSM’s Employee Spotlight Featuring: Tania Wade

Congratulations Tania Wade for her second year of service with Cornerstone Senior Marketing!

Tania plays a vital role on our Service Team, bringing over 30 years of exceptional customer service experience. She excels in providing informative education and value-added research to our agents. Tania is dedicated to finding solutions and addressing any questions or issues that arise. Additionally, she has embarked on her journey towards obtaining her ACS (Associates in Customer Service) degree this year and has recently completed certification in ‘CX 50 (Customer Experience) – Impact Cx: The Quest’ via LOMA.

Cornerstone Senior Marketing appreciates Tania for her outstanding service to our agents!

Interesting Read: Chartis: A look at Medicare Advantage enrollment trends in 2024

Medicare Advantage (MA) growth has broadly slowed, but the biggest players in this space continue to claim the lion’s share of this expansion, according to a new report from healthcare consultant Chartis.

The analysis found that 1.7 million lives were added to the MA rolls for the 2024 plan year, and, of those, 1.4 million, or 86%, were captured by the three largest insurers in this segment: UnitedHealthcare, Humana and Aetna. Aetna, in particular, had a strong showing during the annual enrollment period, adding 476,000 enrollees, or 60% of those who signed up during that window.

READ FULL ARTICLE 

Deft Research: Which MA supplemental benefits do Duals want most?

Take a Look into Duals’ Supplement Preferences

At Deft Research, we’re dedicated to uncovering Medicare insights that help carriers, agencies and marketers serve clients better. And every month, we share select insights on our blog.

 

This month, we’re exploring some of our most profound learnings about Duals and their interest in MA supplemental benefits. In our 2024 National Dual Eligible Benefit Design Study, we took a closer look at the importance of Dual’s unique needs, as well as Duals’ preferences for supplemental benefits. Our takeaway? 

 Of the eight supplemental benefits we tested, dental benefits emerged as the most important for Duals and low-income non-Duals (LINDs). 

READ THE BLOG

 

Get our Free Snapshot on Duals

Based on our 2024 National Dual Eligible Benefit Design Study, this one-page infographic offers a birds-eye view into Medicare Advantage plan design preferences among Dual eligibles and low-income non-Dual seniors.

It’s perfect for a quick overview. Plus, some of our findings may cause you to rethink your plan designs.

 

DOWNLOAD THE FREE DUALS SNAPSHOT

ADS & Devoted Health Ohio Teaming Up to Help Diabetic Clients

ADS is excited to share that Advanced Diabetes Supply has now signed a limited contract with Devoted Health in Ohio!!Agents, you can begin referring your Ohio Devoted members who need a meter and test strips to ADS starting NOW!www.northcoastmed.com/laura-clinansmithWhile ADS is now able to provide a meter, test strips and other ancillary supplies like needles and syringes, they are NOT able to serve those members who are using a CGM (Dexcom or Libre) at this time.

ADS is excited to extend their services to your members with Devoted in Ohio.

 

If you have any questions, please reach out to your CSM Rep! 614-763-2255

CSM’s Employee Spotlight Featuring: Jaime Lebrón

Congratulations Jaime Lebrón for 7 years of service with Cornerstone Senior Marketing!

Jaime is paving the way for Medicare agents up in the Northeast corner of Ohio, as 2024 marks his 30th year in the insurance industry. Jaime plays a vital role with developing relationships with brokers and understands the value of a true partnership. He is constantly out in front of brokers educating and helping the independent agent or agency learn more on how to grow their business organically.

Cornerstone Senior Marketing wants to thank Jaime for his excellent service to our agents!

Medical Mutual Signs Agreement to Acquire Paramount Health

MMO Broker Update 1/29/2024:

Today, Medical Mutual announced its intent to purchase Paramount Health, a Northwest Ohio-based health insurance company. Paramount, which offers Medicare Advantage, Individual ACA, commercial group and short-term insurance plans, is headquartered in Toledo and does business primarily in Ohio and Michigan.

FULL DETAILS HERE…

Prepare for a potential shift in the Medicare Agent/FMO distribution model

Exclusively from our partners at Deft Research:

The Value of the Health Insurance Agent/FMO Model

DEFT RESEARCH SPECIAL EXECUTIVE RESEARCH BRIEF

 

CLICK HERE TO READ FULL BRIEF 

CMS Newsroom: Biden-Harris Administration Proposes to Protect People with Medicare Advantage and Prescription Drug Coverage from Predatory Marketing…

FOR IMMEDIATE RELEASE
November 6, 2023

Biden-Harris Administration Proposes to Protect People with Medicare Advantage and Prescription Drug Coverage from Predatory Marketing, Promote Healthy Competition, and Increase Access to Behavioral Health Care in the Medicare Advantage Program

Today, the Biden-Harris Administration is proposing important steps to strengthen Medicare Advantage and the Medicare Prescription Drug Benefit Program (Part D). As part of his Bidenomics agenda, President Biden has worked to increase competition in the health care industry and other sectors, lower costs for families, and make sure every American has access to affordable, high-quality health care.

The Centers for Medicare & Medicaid Services’ (CMS’) proposed rule will help people with Medicare select and enroll in coverage options that best meet their health care needs by preventing plans from engaging in anti-competitive steering of prospective enrollees based on excessive compensation to agents and brokers, rather than the enrollee’s best interests. The proposed guardrails protect people with Medicare and promote a competitive marketplace in Medicare Advantage, consistent with the goals of President Biden’s historic Executive Order on Promoting Competition in the American Economy.

The proposed rule will also improve access to behavioral health care by adding a new facility type that includes several behavioral health provider types to Medicare Advantage network adequacy requirements. CMS is also proposing policies to increase the utilization and appropriateness of supplemental benefits to ensure taxpayer dollars actually provide meaningful benefits to enrollees. Additionally, the proposed rule would improve transparency on the effects of prior authorization on underserved communities and proposes more flexibility for Part D plans to more quickly substitute lower cost biosimilar biological products for their reference products.

“The Biden-Harris Administration remains committed to making health care more affordable and accessible for all Americans. By ensuring Medicare recipients have the information they need to make critical decisions about their health care coverage, we are doing just that,” said U.S. Department of Health and Human Services Secretary Xavier Becerra. “Promoting competition in the marketplace helps to lower costs and protect access to care while making the whole process more transparent and accountable.”

“CMS continues to improve the Medicare Advantage and Part D prescription drug programs and maintain high-quality health care coverage choices for all Medicare enrollees,” said CMS Administrator Chiquita Brooks-LaSure. “People with Medicare deserve to have accurate and unbiased information when they make important decisions about their health coverage. Today’s proposals further our efforts to curb predatory marketing and inappropriate steering that distorts healthy competition among plans.”

CMS has previously taken unprecedented steps to address predatory marketing of Medicare Advantage plans, such as banning misleading TV ads. Many people on Medicare rely on agents and brokers to help navigate Medicare choices. CMS is concerned that some Medicare Advantage plans are compensating agents and brokers in a way that may circumvent existing payment rules, inappropriately steer individuals to enroll in plans that do not best meet their health care needs, and lead to further consolidation in the Medicare Advantage market. To further protect people with Medicare through stronger marketing policies and to promote a competitive marketplace in Medicare Advantage, CMS is proposing added guardrails to plan compensation for agents and brokers, including standardization. These proposals are consistent with the statutory requirement that CMS develop guidelines to ensure that the use of compensation creates incentives for agents and brokers to enroll individuals in the Medicare Advantage plan that is intended to best meet their health care needs.

CMS also proposes to strengthen and improve access to behavioral health care by adding a new facility type, which includes marriage and family therapists, mental health counselors, addiction medicine clinicians, opioid treatment providers, and others, to CMS’ Medicare Advantage network adequacy requirements. This proposed addition builds on changes finalized last year to strengthen these requirements and would ensure people with Medicare Advantage can access vital mental health and substance use disorder treatment.

“The people we serve are at the center of the Medicare program, and we work each day to make sure the program works for them. Agents and brokers play an important role in guiding people with Medicare to the option that is tuned in to their medical needs. Our proposals on how plans compensate agents and brokers seek to support a competitive marketplace that best serves people with Medicare,” said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare.

Currently, 99% of Medicare Advantage plans offer at least one supplemental benefit. Over time, the benefits offered have become broader in scope and variety, with more rebate dollars directed toward these benefits. CMS is committed to ensuring these offerings are effectively reaching enrollees and actually meeting their needs, and not just used for attracting enrollees. In today’s rule, CMS proposes requiring Medicare Advantage plans to send a personalized notification to their enrollees mid-year of the unused supplemental benefits available to them to encourage higher utilization. Furthermore, CMS is proposing additional requirements designed to help ensure that benefits offered as special supplemental benefits for the chronically ill (SSBCI) are backed by evidence. CMS is also proposing new marketing and transparency guardrails around these benefits. These proposals will help ensure a robust and competitive Medicare Advantage marketplace made up of plan options with meaningful benefits.

Additionally, CMS is concerned that certain prior authorization policies may disproportionately inhibit access to needed care for underserved enrollees. To provide additional safeguards, CMS is proposing to require that Medicare Advantage plans include an expert in health equity on their utilization management committees and that the committees conduct an annual health equity analysis of the plans’ prior authorization policies and procedures. This analysis would examine the impact of prior authorization on enrollees with one or more of the following social risk factors—eligibility for Part D low-income subsidies, dual eligibility for Medicare and Medicaid, or having a disability—compared to enrollees without these risk factors. These analyses would have to be posted publicly to improve transparency into the effects of prior authorization on underserved populations. To further promote health equity, CMS is also proposing to streamline enrollment options for individuals with both Medicare and Medicaid, providing more opportunities for integrated care.

To support competition in the prescription drug marketplace, CMS is also proposing to provide more flexibility to substitute biosimilar biological products other than interchangeable biological products for their reference products to give people with Medicare more timely access to lower-cost biosimilar drugs. This proposal would permit Part D plans to treat such substitutions as maintenance changes so that the substitutions apply to all enrollees, not only those who begin the therapy after the effective date of the change, following a 30-day notice.

There will be a 60-day comment period for the notice of proposed rulemaking, and comments must be submitted at one of the addresses provided in the Federal Register no later than January 5, 2024. The proposed rule can be accessed at the Federal Register at https://www.federalregister.gov/public-inspection/2023-24118/medicare-program-contract-year-2025-policy-and-technical-changes-to-the-medicare-advantage-program

View a fact sheet on the proposed rule at cms.gov/newsroom.

View the CMS Blog Important New Changes to Improve Access to Behavioral Health in Medicare at https://www.cms.gov/blog/important-new-changes-improve-access-behavioral-health-medicare-0

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Protect Your Clients: Ohioans on Medicare Urged to Protect Against Scams During Open Enrollment

For Immediate Release
October 26, 2023

Don’t Get Scammed! Ohioans on Medicare Urged to Protect Against Scams During Open Enrollment

COLUMBUS — Ohio Department of Insurance Director Judith L. French is urging Ohioans on Medicare to protect themselves against scams to take their personal information during Medicare’s Oct. 15 to Dec. 7 open enrollment period to select coverage for 2024.

“With the barrage of plan options and marketing pitches, it can be difficult to discern if something is legitimate or fraudulent,” French said. “Be wary of any Medicare communication seeking personal information or money in exchange for help with Medicare enrollment or services.”

How to protect yourself:

  • Never give personal information, including Medicare, Social Security, bank account, and credit card numbers, to anyone who contacts you unsolicited by telephone, email, text, or in person, such as door-to-door sales.
  • Medicare will never call you to sell anything, visit your home, or enroll you over the phone unless you called first.
  • Medicare or Medicare health plans will only call and request personal information if you’re a plan member or you called and left a message.
  • Only give certain personal information to your doctors, insurance companies acting on your behalf, or trusted people in the community officially working with Medicare such as the Ohio Senior Health Insurance Information Program (OSHIIP), which is a program of the Ohio Department of Insurance.
  • Never purchase gift cards as payment for anything.

Report fraud and predatory sales practices:

  • OSHIIP partners with Ohio’s Senior Medicare Patrol (SMP) to detect and report wrongdoing. The SMP provides education and response to reported Medicare fraud, waste, and abuse. Contact SMP at 800-488-6070 and proseniors.org/ohio-smp.
  • If you feel an insurance agent is using high-pressure, fraudulent, or dishonest sales practices, contact the Ohio Department of Insurance Fraud and Enforcement Division at 800-686-1527 or the SMP.

Medicare has implemented new marketing guidelines for representatives of Medicare plans, including prohibiting asking for personal information, such as bank account or credit card numbers over the phone, unless it is needed to process an enrollment request.

OSHIIP Director Chris Reeg recently testified before the United States Senate Finance Committee in Washington, D.C. on the topic of cracking down on deceptive practices and improving senior experiences.

OSHIIP representatives are available at 800-686-1578, or by email, oshiipmail@insurance.ohio.gov, and insurance.ohio.gov to answer Medicare questions.

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AultCare’s Prime Time Health Plan 5-Star Plans in Ohio for 2024

Aultcare Broker Communication 10/18/23:

 

PrimeTime Health Plan Earns a 5-Star Rating AGAIN!

Empower yourself with great news you can use as we kick off the Medicare Annual Enrollment Period (AEP)! PrimeTime Health Plan (PTHP) has once again achieved an excellent rating of five out of five stars from the Centers for Medicare and Medicaid Services (CMS). This is the third year in a row that we have received this prestigious designation, and the fourth year overall.

Why a 5-Star Rating Is Important

CMS assigns ratings each year to help Medicare-eligible individuals compare Medicare Advantage and prescription drug plans. Earning the highest rating possible is a result of our team’s dedication to quality of care and quality of service, which helps our members to live better, healthier lives.

Additional Enrollment Opportunity

Because of our five-Star Rating, we can market, and you can sell our plans throughout 2024.

Please contact your PrimeTime Health Plan sales representative if you have questions or need additional information.