Inflation Reduction Act raises Medicare Part D prescription costs by 42-57%

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Inflation Reduction Act raises Medicare Part D prescription costs by 42-57%
by Julia SpencerWed, December 6th 2023, 8:30 AM EST

L PASO, Texas (KFOX14/CBS4)

Medicare will be increasing the cost of prescription drugs in Part D of their plans.

People enrolled in the Medicare Part D plan will see a 42% to 57% increase in price of their prescription drug medication, according to Healthview Services.

The increase is a result of the new Inflation Reduction Act that pans to lower out of pocket costs to $2,000 dollars in 2025 compared to $7,000 in 2023.

If a patient is enrolled in the premium Medicare plan, also known as Medicare Advantage, they will not be seeing an increase in their prescription drug plan because prescription drug costs are already embedded into the plan.

Read full article here

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

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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

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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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Overall Satisfaction with Medicare is High, But Beneficiaries Under Age 65 With Disabilities Experience More Insurance Problems Than Older Beneficiaries

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Juliette Cubanski, Maiss Mohamed, Tricia Neuman, and Gary Claxton
Published: 

While most people with Medicare are adults age 65 or older, Medicare also covers millions of younger people who qualify for Medicare based on having a long-term disability, or diagnosis with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease). In 2022, 7.7 million people under age 65 with disabilities were covered by Medicare, representing 12% of all Medicare beneficiaries. Younger beneficiaries who qualify for Medicare because of disability are more likely than those who qualify based on age to have lower incomes and education levels, to be Black or Hispanic, and to be in worse health.

Medicare covers the same benefits for people of all ages, regardless of how they qualified for Medicare, and Medicare coverage options and financial assistance programs are generally the same – the main exception being that people under age 65 with disabilities do not have a guaranteed issue right to purchase Medigap supplemental policies. However, perhaps related to their different pathways to Medicare eligibility and because the program was originally designed to cover older adults, with coverage for younger people with disabilities added later, Medicare generally does not work as well for people under age 65 with disabilities. This conclusion is based on KFF analysis of surveys dating back to 2008 but not more recent than 2019. According to previous analysis, beneficiaries under age 65 with disabilities have reported worse access to care, more cost concerns, and lower satisfaction with care than those age 65 or older.

To get a more current understanding of how Medicare is working for older adults and younger people with disabilities, this brief analyzes data from the 2023 KFF Survey of Consumer Experiences with Health Insurance, a nationally representative survey of 3,605 U.S. adults with health insurance. This brief focuses specifically on the 885 adults with Medicare, including 165 adults under the age of 65 with disabilities.

This analysis provides a window into the challenges facing people with disabilities as they navigate the health insurance system by focusing on the experiences of younger adults on Medicare who qualify for the program due to having a long-term disability. The analysis highlights the ways in which beneficiaries under age 65 with disabilities may be less well served by the Medicare program than older beneficiaries. (While people with disabilities are also included among the population of Medicare beneficiaries age 65 or older, the survey sample is insufficient to focus on this group specifically.) People with disabilities who are covered by private insurance or Medicaid are likely to face similar challenges using their coverage. Insights from this analysis could help to inform efforts to strengthen the Medicare program, particularly for younger adults with disabilities.

Key Takeaways

  • Overall, people with Medicare are more satisfied with their health insurance coverage than adults with other types of insurance, but among people with Medicare, those under age 65 with disabilities are less likely than those age 65 or older to give positive ratings to the overall performance of their insurance coverage (79% vs. 92%) and some features of it, such as the quality and availability of providers.
  • Overall, a majority of Medicare beneficiaries under age 65 with disabilities say they experienced a problem with their health insurance in the last year (70%), compared to half (49%) of those age 65 or older. This includes a larger share of those under age 65 with disabilities who say they experienced denials or delays in getting prior approval (27% vs. 9%) or insurance not paying for care they received that they thought was covered (24% vs. 8%).
  • A relatively small share of all Medicare beneficiaries who said they had a problem with health insurance in the past year reported difficulty accessing care as a direct result of these problems, but access problems were more likely to be reported by Medicare beneficiaries under age 65 with disabilities than those 65 or older. At least one in five Medicare beneficiaries under age 65 with disabilities who reported problems say they were unable to receive recommended treatment (24%) or experienced significant delays in receiving medical care or treatment (21%), compared to very small shares of those 65 or older who said the same (6% for both).
  • Medicare beneficiaries under 65 with disabilities were more likely to experience difficulty with the health insurance enrollment process and comparing insurance options compared to beneficiaries age 65 or older, including figuring out if their income qualifies them for financial assistance (30% vs. 11%).
  • Cost concerns related to insurance are an issue for Medicare beneficiaries of all ages, particularly when it comes to monthly premiums and out-of-pocket costs for prescription drugs, but a larger share of people with Medicare under age 65 with disabilities than those age 65 or older report certain problems. More than one in three people with Medicare under age 65 with disabilities report they had a problem paying a medical bill in the past 12 months (35%), compared to one in ten (9%) of those 65 or older. People with Medicare under age 65 with disabilities were also more likely to report delaying or going without specific health care services due to cost, such as dental care (42% vs. 24%), prescription drugs (18% vs. 10%), and doctor visits (14% vs. 4%).
  • About half of people with Medicare under age 65 with disabilities self-report fair or poor physical health, compared to 19% of those age 65 or older, since, by definition, people under age 65 qualify for Medicare based on having a long-term disability. The higher rate of poorer self-reported health among beneficiaries under age 65 could contribute to a higher rate of health insurance problems.
  • Three in 10 people with Medicare under age 65 with disabilities self-report fair or poor mental health status, compared to 1 in 10 (9%) of those age 65 or older, and a larger share also report problems related to mental health care availability and access, including reporting that there was a mental health therapist or treatment they needed that wasn’t covered by insurance (27% vs. 7%), and being unable to receive mental health services or medication in the past year they thought they needed (18% vs. 5%).

READ FULL ARTICLE

Devoted’s 2024 Star Ratings for Ohio are Confirmed

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Press Contact
devoted@crosscutstrategies.com

Devoted Health Achieves 5 out of 5 Medicare Advantage Star

Rating for Florida and Ohio HMO Plans
94 percent of Devoted members in rated plans are enrolled in 4-Star plans or higher

 

 

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

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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.

Just Released: 2024 Medicare Parts A & B Premiums & Deductibles

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On October 12, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2024 Medicare Part D income-related monthly adjustment amounts.

 

CLICK TO READ THE FULL CMS RELEASE

AEP Readiness Agent Guidance

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READY TO SELL

Have you completed all your 2024 certifications? Check our resource page for quick access and tips.

 

2024 Medicare Certification Resources

 

DISCLAIMER REQUIREMENT

CMS updated the language on the required TPMO disclaimer. Agents now have to include both organization AND plan counts as part of this disclaimer. Click below to review the new language in it’s entirety.

 

2024 CMS Final Ruling FAQ Fact Sheet

 

TELEPHONIC 2024 ENROLLMENTS WITH HUMANA 

Effective for 2024 MAPD sales, Humana will require all appointed agents to use an approved telephonic sales script when doing Humana business over the phone. This script was developed by Integrity and approved for use by Humana (and many other Medicare Advantage carriers) to meet the Humana requirement.  The script does include both enrollment and Scope of Appointment (SOA) language.  Note the script needs to be read on a recorded line.

 

Humana Field Agent Telephonic Sales Script

COMPLIANCE UPDATE

In the 2023 Final Rule, CMS provided new requirements for all selling agents this AEP. A couple of things to highlight: Call recordings are required for Sales, Marketing, and Enrollment calls. Make it a point to review the pre-enrollment checklist with your members. Also, be sure to review the new required elements with your clients before enrolling them. For a complete guide to a compliant sale, download our checklist below.

 

2024 Final Rule Compliance Checklist

NON-ELECTRONIC/PAPER APPS

Compiled by our Service Team, use this handy reference for the rare occasion a you need to submit a paper application.

 

Paper App Submission Email | Fax | Mail

 

GENERAL/CARRIER SPECIFIC AEP TIPS

Make every app count!  Application tips and guidance for a successful AEP can be found in this ‘must have’ reference guide.

 

2024 AEP Tips and Guidance General/Carrier

COMPLIANT MARKETING

With new compliant rules and greater scrutiny on marketing activities, it’s more important than ever to maintain compliance in your marketing. We’re here to help!  Send marketing materials to us for review.  We are also your go-to for filing pieces that require CMS review and approval.

 

2024 Agent Medicare Compliance Guide
Compliance Review Submission

SERVICE, SUPPORT, AND MORE!

We’ve got your back.  Reach out when you need help, or get 24/7 assistance from our plentiful online resources.  The Service Team are here with solutions and our website features tools, training, and information to answer every question. Check out the Agent Toolkit, Resource Center, Event Calendar, Carrier Bonus/Sales Contests and Recent News!

 

CSM Service Team Contact List
Cornerstone Senior Marketing Website

MEDICARECENTER

This FREE platform is chock-full of new features and enhancements including Policy Management, Ask Integrity AI technology, 48-Hour SOA Tracking, update to the Personal Agent Websites & more!

 

If you are a new user to MedicareCENTER and have access, be sure to look at the Learning Center for videos, trainings, and guides to help you this AEP!

 

Go To MedicareCenter.com

 

VIEW PREVIOUS TRAININGS AVAILABLE 24/7 FROM OUR WEBINAR LIBRARY

 

WEBINAR LIBRARY

 

Questions? We are here to help! |  Contact your CSM Representative  or call 614-763-2255

Important: 2024 Field Agents Telephonic Sales 

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New Requirement for Humana Appointed Agents:  2024 Telephonic Sales Field Agent Script

Effective for 2024 MAPD sales, Humana will require all appointed agents to use an approved telephonic sales script when doing Humana business over the phone. 

 Click the link below to download a script, developed by Integrity, and approved for use by Humana (and many other Medicare Advantage carriers) to meet the Humana requirement.  The script does include both enrollment and Scope of Appointment (SOA) language.  Note the script needs to be read on a recorded line.

 Agents that want to use an approved script for telephonic sales outside of Humana, may use the script below as a reference and, depending on the carrier, may also use this script for their SOA and enrollment. 

Cornerstone Senior Marketing will host a webinar on October 11th about this new Humana requirement and to review the Field Agent Telephonic Script in greater detail.  Please register for this webinar if you have questions about this new requirement and/or can benefit from a run-through of the script.

***A recording will be posted inside our Webinar Library shortly after the webinar has concluded.

 

Humana Call Script 2024 – presented by Matt Fry

Wednesday, October 11, 2024

CLICK HERE TO REGISTER

 

DOWNLOAD A COPY HERE: 2024 FIELD AGENT TELEPHONIC SALES SCRIPT

 

 

Cigna: Corrected Updates to the 2024 Medicare Advantage Enrollment Guide

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Cigna Agent Communication from 10/5/2023:

Corrected benefits and updated digital copies.

Please review this email before meeting with customers to ensure you are presenting the correct benefit information.

We discovered a few errors in the 2024 Cigna Healthcare Medicare Advantage Enrollment Guide.

What you need to know:

  • You do not need to order new sales kits. You can continue to use the guides that have been printed and distributed. We just need your help making sure the customer gets the correct benefit information.
  • Corrected copies of the Enrollment Guide have been posted to Producers’ University and CustomPoint. You can find the updated guide in Producers’ University by visiting the Resource Center.
  • To address the correct benefits, please follow the steps below.

How to get the correct benefit information

 

  1. Print and use these corrected pre-enrollment checklists.

These should replace the checklists in your printed guide.

NOTE: You must be logged in to Producers’ University directly or through CignaForBrokers single sign-on to access these documents.

 

2. Review the list of benefit corrections below.

Make sure your customer understands the benefits offered with their selected plan. The benefits listed below are not available with all plans.

Transportation: The benefit for routine, non-emergency transportation was listed as 60 miles instead of 70 miles. Prior authorization is required for trips exceeding 70 miles one-way.

In-home support: Our in-home support program provides a variety of helpful services and companionship virtually through a telephone, smart phone, or computer. This is a change from 2023.

 Services can include help coordinating transportation and meal/grocery delivery. Companionship includes virtual visits focused on social check-ins, games, even art classes and virtual museum tours.

 

  1. Update your training and customer/telephonic scripts with the corrected benefit information.

 

 

Thank you for your understanding. We appreciate your help, and we are sorry for the inconvenience.