Aetna Offers NEW HMO & DSNP Plans in NE Ohio for 2020

For 2020, Aetna has a new $0 premium MAPD plan, the Aetna Medicare Premier (HMO) H0628-005.  Aetna  also has a new 2020 Dual Eligible Special Needs Plan, the Aetna Medicare Assure (HMO D-SNP) H5337-001. Both plans offers your Northeast Ohio clients a strong provider network and impressive supplemental benefits!

Learn more about our new Aetna Medicare Premier (HMO)

The 2020 Aetna Medicare Premier (HMO) H0628-005 is available in Ashland, Belmont, Columbiana, Cuyahoga, Geauga, Harrison, Jefferson, Knox, Lake, Lorain, Mahoning, Medina, Morrow, Portage, Richland, Stark, Trumbull, Tuscarawas and Wayne counties. Benefits include:

  • Comprehensive provider network  
  • No referrals required
  • $0 annual medical deductible
  • $10 PCP/$30 Specialist (in-network)
  • Plan allowances on dental, vision & hearing benefits—No dental network
  • Over-the-counter (OTC) benefit—$45 allowance per quarter
  • 24 one-way non-emergency trips per year
  • SilverSneakers® fitness benefit—Free membership at participating
    fitness facilities

Discover the new Aetna Medicare Assure (HMO D-SNP)

The 2020 Aetna Medicare Assure (HMO D-SNP) H5337-001 is available in Belmont, Carroll, Columbiana, Coshocton, Cuyahoga, Franklin, Fulton, Guernsey, Lake, Lorain, Lucas, Mahoning, Medina, Montgomery, Morgan, Muskingum, Ottawa, Portage, Stark, Summit, Trumbull, Tuscarawas, Wayne and Wood counties. Benefits include:

  • $0 or low-cost monthly premium
  • Access to the Aetna HMO statewide provider network
  • $3,000 dental allowance, including dentures and crowns
  • Robust hearing and vision benefits
  • 40 one-way non-emergency trips per year
  • 28 home-delivered, post-discharge meals, at no cost
  • 40 one-way non-emergency trips per year
  • SilverSneakers® fitness benefit
  • OTC benefit—$210 per quarter
  • $150 fall prevention package

 

For more information contact Cornerstone’s Jaime Lebron, Sales Director of NE Ohio.

Intergrity Aquires North American Senior Benefits

Integrity Marketing Group, LLC (“Integrity”), the nation’s largest independent distributor of life and health insurance products, today announced it has entered into a definitive agreement to acquire North American Senior Benefits (“NASB”), an insurance marketing organization based in Lawrenceville, Georgia. As part of the deal, NASB Co-Founder Seixas “Chad” Milner III, Co-Founder and President Craig Harvey, and the other NASB equity partners will become owners in Integrity. Financial terms of the contract were not disclosed.

https://integritymarketing.com/newsdetails?id=46

WellCare Agent Resources

WellCare Agent Services:

866-822-1339

WellCare Agent Services can assist your with resetting your system passwords, agent onboarding, 2020 application status, enrollment questions, HRA set up and sales compensation question.

*Note: They do not assist with benefit or provider/formulary lookup.

WellCare Eligibility (SPOP):

866-822-1339 option 2; or

866-211-0544

State Prompts: 1- IL & IN,

3 – OH, 4 – MI

SPOP can assist with Medicaid & Medicare eligibility and is open 7 days a week from 8am to 2am EST. They also have ability to validate MBI’s. At the end of the call, they will provide a confirmation number. Please include this on your application to assist with enrollment processing.
WellCare Request for Information (RFI):

866-822-1339 option 3

Request for Information (RFI) process is designed to assist with correcting inaccurate and/or missing information submitted on enrollment applications; and agents are permitted to resolve on behalf of the beneficiary. Please have the beneficiary information ready prior to calling in by checking your Agent History – Application Search Tool in Agent Connect
MeridianCare Agent Hotline:

866-821-2650 MI/OH

866-821-2540 IL/IN

Agent Hotline can still assist you with CCP benefit questions, 2019 application status and provider/formulary search.

*Note: If you are unable assign a PCP on an application due to WellCare’s provider search, please contact Agent Hotline to assist with locating the provider and documenting PCP/member information to ensure the PCP is assigned to the members account.Also, please include the PCP NPI on the application if the WellCare Provider ID is not available but the PCP is in network.

Aetna Medicare Supplement November Updates

NEW AND EXCITING:

New underwriting process and application tracker

Starting October 1, our underwriting process will give you faster decisions for underwritten Aetna Medicare Supplement applications. We have not altered our underwriting philosophy in any way. Most applications will have a decision within a few minutes. This exciting change also comes with an updated online application tracker, to give you clearer visibility to those decisions.

Changes: Point-of-sale telephone interview and voice signature option

To help make the underwriting process even easier for you, we’ll no longer require or offer a point-of-sale telephone interview as of October 1, 2019. We’ll also be discontinuing the voice signature option.

  • If any point-of-sale interviews are still pending after October 1, the phone line will still be available to use until those interviews are complete.
  • Instead of a voice signature, you’ll continue to have 3 easy signature options for your electronic applications: security question signature, in person signature, email signature.

Our new underwriting process

Once we receive your Medicare Supplement electronic application, we will provide one of the following underwriting decisions within a few minutes:

  • Approved
  • Needs further review
  • Declined

We will also provide decisions on your paper applications once we have verified all required information has been included with the submission. This review may delay how soon the decision is displayed on the website.

  • Approved applications will be processed as normal.
  • If an application needs further review, the application will be reviewed by our underwriting staff.  And if necessary, our associates will call your client with targeted questions for clarification. This new telephone interview process will be easier for your client, as we will not need to review all health questions.
  • If an application is declined, we’ll send the applicant (and you) a letter with details about how to get a copy of the information used to help with the underwriting decision. The application tracker on the agent website will show if an application is declined. A copy of the letter will be accessible within 24 hours.

MACRA 2020

Are you wondering how MACRA works and how it will affect you and your clients?  I have attached a cheat sheet that will help you have a better understanding of MACRA.

Aetna has launched their MACRA 2.0 strategy in 15 states with more coming either later this year or early next year.  Watch for your e-bulletins for more information.

August launches for MACRA 2020 – SC, IL, LA, AZ and TN

July launches – AL, GA, IA, MI and MS

September launch – FL

October launches – OH, NC, KS and PA

 What does all this mean?

Aetna plan F rates will be on average within $15-$20 a month of our plan G rates and our plan F rates have been lowered. You will be able to offer a high deductible G with effective dates after 1/1/20

 Why is Aetna putting out rates that are so competitive on plan F?

There are tens of millions reasons why.  After 1/1/20 anyone on a Medicare Supplement currently or Medicare eligible by 12/31/19 will still be able to purchase plan C, F and HIF after 1/1/2020. These clients that would like to receive a very competitive plan F rate with us will need to go through underwriting so this with be a very healthy group of insureds which can mean lower rate increases.

 

Aetna has a new agent services phone number: 866-272-6630

New Quoting App!

Aetna has launched their new app for quoting all products.  You no longer have to save the link to you home page. All you need to do is download our “quote on the go” app from the app store.  You can quote every product Aetna offers in one easy format!

UnitedHealthcare Plan Faces Medicare Sanction

UPDATE FROM UHC REGARDING THE SANCTIONS IN OHIO:

In Ohio, this effects only Dual Plan H5322-028 (Light Blue banded kit), which is now Closed to New Enrollment for 2020.  Members on this plan can remain for as long as they like.  Agents will continue their AOR status and be paid their renewal commissions.

The reason for this sanction is: the aggregate medical loss ratios of  the 9 states included in this plan number,  were less than the CMS required 85%.   So in essence UHC didn’t lose enough money on that plan.

To note: Ohio was not a contributor to the low losses ratio, UHC had plenty. 

UHC has replaced H5322 with H8125-002 for those 75 counties, so they can continue to serve Dual beneficiaries in the State of Ohio.

This does not affect the other Dual Plan H5253-059 (Purple banded kit) which serves Metropolitan 13 counties in Ohio.

All UHC Ohio Plans starting with: H5253 are all 4.5 stars plans and not effected!

 

By

UnitedHealthcare is facing enrollment restrictions next year in one of its Medicare Advantage health plan contracts, regulators say, because the insurer hasn’t been spending a large enough share of revenue on the health care needs of enrollees.

The sanction from the Centers for Medicare and Medicaid Services (CMS) applies to just one of United’s many contracts with the federal government to sell Medicare Advantage health plans and doesn’t apply to coverage sold in Minnesota.

Minnetonka-based UnitedHealthcare, the nation’s largest health insurer, says it fell out of compliance due to federal legislation that reduced the insurer’s tax liability last year. The sanction applies to a health plan contract for coverage sold in nine states to less than 1% of the company’s roughly 6 million Medicare Advantage members. The states include Florida, Georgia, Kansas, New Hampshire, New Jersey, Ohio, Oklahoma, Texas and Virginia.

“CMS imposed enrollment sanctions on a subsidiary of UnitedHealthcare … because the organization did not meet a Medical Loss Ratio (MLR) of at least 85% for a third consecutive year,” CMS said in a response to Star Tribune questions.

“This enrollment suspension will be in effect for contract year 2020,” the federal agency said. The federal MLR rule “requires that a percentage of revenue should be used for patient care, rather than for other items [such] as administrative costs or profit.”

UnitedHealthcare is one of the nation’s largest sellers of Medicare Advantage plans, a newer form of Medicare coverage in which enrollees opt to receive federal health insurance benefits through a private managed care company. In 2019, roughly one-third of Medicare beneficiaries are opting for Medicare Advantage coverage, according to the Kaiser Family Foundation, as opposed to receiving benefits through the original Medicare program.

The federal government monitors the share of revenue that Medicare Advantage plans spend on patient care needs, vs. the amount spent on administration and kept as profit. This measure is called the “medical loss ratio,” and it’s a standard way for regulators and consumers to assess the profitability of health plans.

When a Medicare Advantage plan’s MLR drops below 85% for three consecutive years, the government can suspend new enrollment in the plan while letting current enrollees maintain the coverage. In a Sept. 11 letter to UnitedHealthcare, CMS said the medical loss ratio (MLR) was 71.3% in 2016, 83.9% in 2017 and 84.1% in 2018 for health plans within the contract that’s being sanctioned.

In a response to Star Tribune questions, UnitedHealthcare said the MLR last year fell below the mark — despite added benefits — because the company saw a financial benefit from the federal Tax Cut and Jobs Act, which became law in late 2017. The company says it subsequently factored the change into its calculations and anticipates achieving an MLR above 85% in 2019.

“While we won’t be enrolling new members in [this contract] for 2020, existing members will continue to receive the same level of care and support, including an increase in their coverage and benefits,” the insurer said in a statement. “UnitedHealthcare also has additional Medicare Advantage plans available in many of these markets.”

“We anticipate that we will achieve the MLR threshold in 2019 for [this contract], which will allow us to resume enrollment in these plans in 2021,” UnitedHealthcare said.

The health plan contract that’s being sanctioned primarily provides coverage for people who quality for benefits from both Medicare and the state-federal Medicaid program. UnitedHealthcare officials have said these products for “dually eligible” enrollees are an important growth area for the company.

If the MLR for a Medicare Advantage plan falls below the 85% mark for five years, the government can terminate its contract with the health plan. CMS says the regulatory action against UnitedHealthcare is the first time the agency has suspended enrollment in a Medicare Advantage plan due to noncompliance with the MLR rule.

Allwell 2020 AEP Helpful Tips & Trends

Administrative Payment Payouts, SEP Notice, MBI Locator, and Ascend Resources

AEP is in full swing and it’s important that Allwell keeps you, their brokers, informed and up-to-date on any and all information that will help you be more successful. Below are some hot topics Alllwell wanted to share with you.

 

Tip # 1: Administrative Payment Payouts

Don’t forget that when you initiate a VBE ($50) and Blue Button ($30) you will receive an extra $80 in administrative payments.*

VBE payouts have already started so make sure you are logging into your Allwell Broker Portal to keep track of your payments.

Blue Button payouts will commence as of November 20, 2019.

Administrative Payments are paid out on a weekly basis.

For any questions or concerns about your administrative payments please call Broker Services at 1-844-202-6811

Tip # 2: Special Enrollment Period (SEP) for Beneficiaries Affected by Severe Weather

If your client or client’s authorized representative has been affected by severe weather as documented by the Federal Emergency Management Agency (FEMA) and were not able to enroll, dis-enroll, or switch their Medicare health or prescription drug plan due to the disaster, they may be eligible for an SEP. If your client qualifies for an SEP they have four (4) full months from the day the disaster occurred to enroll, dis-enroll or switch their plan.

When enrolling your client for a weather related emergency or major disaster SEP within the Ascend online application you must make sure to use the correct election selection in the election period section of the application.

The election you need to choose is: “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.”

For more information about SEP please visit: https://www.cms.gov/AboutCMS/AgencyInformation/Emergency/Downloads/MedicareBeneficiaryDisasterEnrollmentQsandAs.pdf

For more information about areas that qualify as a disaster area please visit: https://www.fema.gov/disasters

Tip # 3: How do I Help my Client Locate their Medicare Beneficiary Identifier (MBI) Number?

It is important that you use your clients MBI number on the enrollment application when enrolling your client into an Allwell plan. If you don’t use your client MBI number the application process is slowed down considerably.

Your client can find their MBI number by:

  • Looking on their newly issued Medicare Health Insurance Card
  • Calling the Medicare help line at 1-800-633-4227
  • Logging into their gov account

If your client is new to Medicare and doesn’t have a Medicare card yet, they can get their Medicare number by logging into their Social Security Account

Tip # 4: Find Valuable Documents and Videos in the Ascend Resource Library

The online Ascend platform is so much more than just an online application platform. Once logged into the portal you can access the Resource Library where you can find valuable documents and videos to assist you in all your Allwell Sales. You will find documents such as Evidence of Coverage, Summary of Benefits, Sales Presentations, VBE training, Blue Button demo training and much more.

For More Information on Using the Allwell Online Application Platform, Ascend Check out Allwell’s FAQs

ASCEND FREQUENTLY ASKED QUESTIONS

Medical Mutual November Updates

Medicare Supplement Updates:

  • MMO’s Medicare Supplement rates have been approved. Soon you will be able to quote and enroll members electronically. Click here to view the rate sheet. Please note, effective Jan. 1, 2020, members’ rates will be based on age and gender.
  • Medicare Supplement renewals for 2020 are scheduled to mail shortly. As a reminder, current members will renew at the new business rates. Members will not receive a renewal notification until the anniversary month. The renewal will include any rate updates in coordination with the member’s gender and age.
  • As you reach out to your Medicare Supplement members, remember to ask if they would like to add the Supplement Plus plan to their coverage. This plan provides dental, vision and hearing benefits for only $28 a month.
  • Effective Jan. 1, 2020, Medicare Supplement plans C, F and High-Deductible F will no longer be available for sale to members newly eligible for Medicare.
    • Newly eligible members are defined as individuals who turn 65 years old on or after Jan. 1, 2020, or anyone who first becomes eligible for Medicare benefits due to age, disability, or end-stage renal disease, as defined by the Centers for Medicare and Medicaid Services (CMS), on or after Jan. 1, 2020.
    • Applicants eligible for Medicare prior to Jan. 1, 2020, will be allowed to purchase plans C, F, or High-Deductible F.
  • MMO made enhancements to the Medicare Supplement commission statement, which now lists the commission amount.
  • November is the last month you can submit Medicare Supplement applications without medical underwriting. Members are eligible to move from their current Medicare Supplement plan to any Medical Mutual Medicare Supplement plan without medical underwriting. All applications must be received by Nov. 30, 2019, for a Dec. 1, 2019, effective date

Medicare Advantage Updates:

  • If you are selling Medicare Advantage in Cuyahoga, Medina or Summit counties, be sure to order the Secure Enrollment kit. This is the only kit that includes our new competitive Secure plan, which offers the following features:
    • Low monthly premium of $15 ($0 premium for full low-income subsidy)
    • $3,700 maximum out of pocket
    • Primary care physician visit is $0, specialist visit is $30
    • Over the counter (OTC), dental, vision and hearing benefits
    • SilverSneakers® program
    • Post-discharge transportation
  • ChenMed in Central Ohio has been added to the Medicare Advantage HMO network.
  • Effective Jan. 1, 2020, the Physician’s Group of Southeastern Ohio (PGSEO) and Canyon Medical Center physicians will no longer be part of Medical Mutual’s Medicare Advantage network.

 

As a reminder, please be sure to submit termination requests to the appropriate email to ensure their timely processing. Click here to view the contact sheet.

Aetna to WellCare Billing Transition for Members

Members transitioning from Aetna to WellCare will need to complete a new EFT form for WellCare. The completed form must be mailed (not faxed) and include a copy of a voided check. The mailing address is on the EFT form.

MORE: Important….and encouraged!
Members can also go on to the Member WellCare Portal and select credit card payments, or choose to draft their online checking or savings to make payment on their desired date.

IN THE WORKS: Notification to transitioning members
Aetna is planning a post card campaign to those Aetna EFT transitioning members notifying them to re-register via the portal or call center.

WELLCARE – EFT FORM

Wellcare 2020 Enrollment App Updates Now Available

Update Required!

We are excited to announce that the WellCare Enrollment Platform is ready for 2020! This mobile application is available on Apple, Android, and Windows 10, and designed to save you time and improve the experience of enrolling new members.

*The Windows and Android versions are now available; Apple will be released later today.

*If you have the 2019 app installed, a manual update is required for 2020.

Advantages:

  • Perfect companion to the WellCare electronic Scope of Appointment capture.
  • No paper application is required when the WellCare Enrollment Platform is used.
  • No cellular/wireless data access, no problem. There are online AND offline modes included.
  • No time lost faxing paper applications.
  • Electronic applications are processed in a fraction of the time compared to paper.

2020 New Features:

  • Seminar section (optional) for preloaded events.
  • EFT (Electronic Funds Transfer) form built into the app.
  • Medicare ID double-entry confirmation built in.
  • Policy premium entry (not required) included.

For additional information and instructions to remove the 2019 Mobile SOA and Enrollment app and download the 2020 Mobile SOA and Enrollment app, please click the link below.

 

WELLCARE ENROLLMENT APP UPDATES

 

As always, your CSM team is here to help! For more information or questions please contact your Cornerstone Senior Marketing representative.

 

Cleveland Clinic, Amwell Join Forces to Create New Virtual Medicine Venture

Article courtesy of  Anjalee Khemlani at Yahoo Finance- 10/22/2019

The Cleveland Clinic — one of the premier hospitals in the U.S. — and telemedicine company American Well are joining forces to expand the use of remote medical services.

In an announcement made on Monday, the two medical giants plan to create a new venture — called The Clinic— to bolster the use of web-based health care delivery. Telemedicine can be used as a way to treat chronic patients who often have the burden of commuting to health facilities, and to treat as elderly patients, a demographic where use of technology have been steadily increasing.

And the latter is a new opportunity for many companies, as the expansion of Medicare Advantage coverage gives them access to the largest payor in the country: The government.

Enter the Cleveland Clinic, whose physical presence in Toronto, London and Abu Dhabi gives it influence that extends beyond U.S. shores.

That helps the institution “very much understand the need to, or obligation…to deliver a Cleveland Clinic level of care to patients around the globe,” William Morris, executive medical officer, told Yahoo Finance.

The Clinic, which will be based in Cleveland, shows that while a physical health center is important, “it’s not the only means to do it,” Morris added .

Cleveland Clinic and Amwell didn’t provide much in the way of details about The Clinic’s costs and operating structure. The new vehicle is being funded by a capital infusion from both the parent companies, yet neither disclosed the amount.

“Both institutions are committing their brand reputation, resources and certainly capital,” Morris said.

“We know that this takes money and focus and effort, and both parent organizations are supporting this and going to nurture this, so it’s going to be unbelievably successful.”

Amwell president and co-CEO Roy Schoenberg told Yahoo Finance that the numerous kinds of health care experiences and expectations can be served via telehealth.

“Today, telehealth and most of the work that was done between us over the last five years, has been around people who proactively needed to reach a clinician for usually an urgent care issues,” he said.

Bolstering technology to narrow the gap between patients and physicians — and getting the latter necessary care — “is a frontier that we all need to challenge ourselves with,” Schoenberg added.

With Cleveland Clinic already a growing force in virtual medicine, Morris believes the new venture will benefit from both of its “parents” as he called it.

“We have years of experience about what works,” he said. In addition to other key elements like cost and profit, Morris added that the industry needs to “dramatically shift our mindset in the care delivery and how we consume the technology. And so we are confident that there is profitability or revenue, but that’s not the goal.”

Ultimately, The Clinic aims to change the way telehealth is used — and both feel confident they can achieve that by joining forces.

“This is not something that can be done by either technology alone, or by the conditions alone, which is the reason why we came together to create the company,” Schoenberg said.