A provider who has developed a strong relationship with a particular payer or health plan, may find it advantageous for both parties to co-brand a Medicare Advantage plan and market each other’s services. Provider-Sponsored Health Plans
Do Medicare Advantage plans include drug coverage?
Most Medicare Advantage Plans include drug coverage (Part D). In most cases, you’ll need to use health care providers who participate in the plan’s network. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services.
What are the marketing guidelines for Medicare Advantage?
The Marketing guidelines reflect CMS' interpretation of the marketing requirements and related provisions of the Medicare Advantage and Medicare Prescription Drug Benefit rules (Chapter 42 of the Code of Federal Regulations, Parts 422 and 423).
What are the pitfalls of Medicare Advantage plans?
Pitfalls of Medicare Advantage Plans. Also known as Part C, these plans, which private insurers provide as an alternative to traditional Medicare, must provide the coverage required by Medicare at the same overall cost level. However, what they pay can differ depending upon your overall health.
Do I have to sign up for Medicare Part A and B?
You have to sign up for Medicare Part A and Part B before you can enroll in Medicare Advantage Plan. In general, Medicare Advantage Plans do not offer the same level of choice as a Medicare plus Medigap combination.
Which of the following areas is the marketing of Medicare health plans prohibited?
Participating in any marketing activity—such as distributing and accepting enrollment applications, conducting sales presentations, and soliciting beneficiaries—is not allowed in areas where individuals receive or wait to receive healthcare service. These areas include: Exam rooms.
What must all Medicare Advantage sponsors have in place in order to meet CMS guidelines?
Medicare Advantage Plans Must Follow CMS Guidelines In the United States, according to federal law, Part C providers must provide their beneficiaries with all services and supplies that Original Medicare Parts A and B cover. They must also provide any additional benefits proclaimed in their Part C policy.
How can providers announce new affiliations with a managed care plan?
A new affiliation announcement may be made once within the first 30 days of a new contract agreement (in these announcements, Plan/Part D Sponsors may allow contracted providers to name only one Plan/Part D Sponsor). This may be done through direct mail, e-mail, by telephone, or advertisement.
What is the biggest disadvantage of Medicare Advantage?
Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.
Do Medicare Advantage plans have to follow Medicare guidelines?
Medicare Advantage Plans, sometimes called “Part C” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D).
What is first tier downstream and related entities?
First Tier, Downstream, and Related Entities (FDRs) are defined by CMS as any party that enters into a written arrangement with a Medicare Advantage organization or Part D plan sponsor to provide administrative services or healthcare-related services.
Which of the following is not considered unsolicited contact with a Medicare eligible consumer?
Which of the following is not considered unsolicited contact with a Medicare eligible consumer according to CMS regulations and UnitedHealthcare's rules, policies, and procedures? Mailing a marketing brochure to the consumer via postal mail.
What is considered unsolicited contact?
Unsolicited direct contact with a consumer that was not requested or initiated by the consumer is prohibited and includes in-person (e.g., door-to-door marketing), telephonic (e.g., outbound telemarketing), electronic (e.g., email, voicemail messages, text messages) solicitation.
Are Medicare Advantage plans subject to Erisa?
Since Medicare Advantage plans are considered to be self-funded, as the retirees pay extra for them, they fall under Federal ERISA laws.
Why are Medicare Advantage plans being pushed so hard?
Advantage plans are heavily advertised because of how they are funded. These plans' premiums are low or nonexistent because Medicare pays the carrier whenever someone enrolls. It benefits insurance companies to encourage enrollment in Advantage plans because of the money they receive from Medicare.
Can you switch back to Medicare from Medicare Advantage?
Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. Your coverage under traditional Medicare will begin January 1 of the following year.
Who is the largest Medicare Advantage provider?
AARP/UnitedHealthcareAARP/UnitedHealthcare is the most popular Medicare Advantage provider with many enrollees valuing its combination of good ratings, affordable premiums and add-on benefits. For many people, AARP/UnitedHealthcare Medicare Advantage plans fall into the sweet spot for having good benefits at an affordable price.
How does Medicare work with other insurance?
When there's more than one payer, "coordination of benefits" rules decide which one pays first. The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" (supplemental payer) ...
How many employees does a spouse have to have to be on Medicare?
Your spouse’s employer must have 20 or more employees, unless the employer has less than 20 employees, but is part of a multi-employer plan or multiple employer plan. If the group health plan didn’t pay all of your bill, the doctor or health care provider should send the bill to Medicare for secondary payment.
How long does it take for Medicare to pay a claim?
If the insurance company doesn't pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should have made. If Medicare makes a. conditional payment.
What is a group health plan?
If the. group health plan. In general, a health plan offered by an employer or employee organization that provides health coverage to employees and their families.
What is the difference between primary and secondary insurance?
The insurance that pays first (primary payer) pays up to the limits of its coverage. The one that pays second (secondary payer) only pays if there are costs the primary insurer didn't cover. The secondary payer (which may be Medicare) may not pay all the uncovered costs.
When does Medicare pay for COBRA?
When you’re eligible for or entitled to Medicare due to End-Stage Renal Disease (ESRD), during a coordination period of up to 30 months, COBRA pays first. Medicare pays second, to the extent COBRA coverage overlaps the first 30 months of Medicare eligibility or entitlement based on ESRD.
What is the phone number for Medicare?
It may include the rules about who pays first. You can also call the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627 (TTY: 1-855-797-2627).
How to advertise Medicare?
Medicare private plans are allowed to conduct certain activities. For instance, companies can market their plan through direct mail, radio, television, and print advertisements. Agents can also visit your home if you invite them for a marketing appointment. However, insurance agents cannot: 1 Call you if you did not give them permission to do so 2 Visit you in your home, nursing home, or other place of residence without your invitation 3 Provide gifts or prizes worth more than $15 to encourage you to enroll (gifts or prizes that are worth more than $15 must be made available to the general public, not just to people with Medicare) 4 Disregard federal and state consumer protection laws for telemarketing, the National Do-Not-Call Registry, or do-not-call-again requests (you can register online for the National Do-Not-Call Registry or by calling from the number you wish to register) 5 Market their plans at educational events or in health care settings (except in common areas) 6 Sell you life insurance or other non-health products at the same appointment (known as cross-selling), unless you request information about such products 7 Use the term “Medicare-endorsed” or suggest that their plan is a preferred Medicare plan#N#Plans can use Medicare in their names as long as it follows the plan name (for example, the Acme Medicare Plan) and the usage does not suggest that Medicare endorses that particular plan above other Medicare plans 8 Imply that they are calling on behalf of Medicare
What are the rules for selling Medicare?
Insurance companies selling Medicare private plans must follow certain rules when promoting their products. These rules are meant to prevent plans from presenting misleading information about a plan’s costs or benefits, also known as marketing fraud. Medicare private plans are allowed to conduct certain activities.
Can Medicare agents visit my home?
For instance, companies can market their plan through direct mail, radio, television, and print advertisements. Agents can also visit your home if you invite them for a marketing appointment . However, insurance agents cannot:
Can Medicare be used in their name?
Plans can use Medicare in their names as long as it follows the plan name (for example, the Acme Medicare Plan) and the usage does not suggest that Medicare endorses that particular plan above other Medicare plans. Imply that they are calling on behalf of Medicare.
What are the Medicare marketing guidelines?
The Marketing guidelines reflect CMS' interpretation of the marketing requirements and related provisions of the Medicare Advantage and Medicare Prescription Drug Benefit rules (Chapter 42 of the Code of Federal Regulations, Parts 422 and 423).
Can Medicare Advantage and Prescription Drug Plans use one document?
The guidelines allow organizations offering both Medicare Advantage and Prescription Drug Plans the ability to reference one document when developing marketing materials.
How to choose between Medicare and employer coverage?
Choosing between Medicare and employer coverage. If you are eligible for both Medicare and employer coverage, you will generally have three options: Keep both types of coverage. Drop your employer coverage and just have Medicare. Delay Medicare enrollment and just have employer coverage.
What is Medicare payer?
When enrolled in both Medicare and employer insurance, each type of coverage is called a “ payer .”. Which type of coverage pays first depends largely on the size of your employer.
How old do you have to be to be on Medicare?
Being under 65 years old with a disability. If you are under 65 but are enrolled in Medicare because of a disability and are also covered by an employer health plan, the employer will serve as the primary payer if it has more than 100 employees. With fewer than 100 employees, Medicare becomes the primary payer.
How long do you have to enroll in Medicare?
When your employer coverage does finally end, you will be given eight months to enroll in Medicare Part A and Part B, and you’ll have 63 days to enroll in a Medicare Advantage plan before facing any late enrollment penalties.
Can you keep Medicare and Cobra?
If you are first enrolled in Medicare and then become eligible for COBRA, you may keep both types of coverage . Medicare will serve as the primary payer, and COBRA will act as the secondary payer.
Is Medicare a primary or secondary payer?
Medicare acts as the secondary payer. Medicare categorizes a company of fewer than 20 employees as “small.”. If you are an active employee at a small company, Medicare will be the primary payer. Any employer coverage you receive will be the secondary payer.
Is tricare a primary payer?
TRICARE. For active military members with TRICARE, TRICARE works as the primary payer, and Medicare is the secondary payer. Retired members of the military who receive TRICARE for Life are required to enroll in Medicare Part B if eligible, and Medicare will serve as their primary payer. Veterans Affairs (VA)
Can an agent hold a sales event immediately following an educational event?
Agents are now permitted to schedule and hold a sales event immediately following an educational event. The attendees must be made aware of a change from educational event to marketing event and given the opportunity to leave prior to the event beginning.
Can agents improvise their presentation?
Additionally, agents are allowed to improvise their delivery of the presentation and content they’d like to cover before accepting an application at a sales appointment. Now only “talking points” need to be submitted to CMS by the carriers, allowing agents the freedom to conduct a more interactive sales presentation.
Can an agent contact potential clients via email?
Due to a change reflected in the 2019 Medicare Communications and Marketing Guidelines (MCMG) and now updated in CFR 42, agents are permitted to make unsolicited direct contact with potential enrollees via email. However, the email must have an opt-out option in order to remain compliant. Additionally, the content of any unsolicited email cannot intend to steer a recipient into choosing or retaining a plan. A compliant email would promote your services rather than any specific plans.
What is Medicare Advantage Plan?
A Medicare Advantage Plan is intended to be an all-in-one alternative to Original Medicare. These plans are offered by private insurance companies that contract with Medicare to provide Part A and Part B benefits, and sometimes Part D (prescriptions). Most plans cover benefits that Original Medicare doesn't offer, such as vision, hearing, ...
What is Medicare Part A?
Original Medicare. Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). To help pay for things that aren't covered by Medicare, you can opt to buy supplemental insurance known as Medigap (or Medicare Supplement Insurance). These policies are offered by private insurers and cover things that Medicare doesn't, ...
Can you sell a Medigap plan to a new beneficiary?
But as of Jan. 2, 2020, the two plans that cover deductibles—plans C and F— cannot be sold to new Medigap beneficiaries.
Do I have to sign up for Medicare if I am 65?
Coverage Choices for Medicare. If you're older than 65 (or turning 65 in the next three months) and not already getting benefits from Social Security, you have to sign up for Medicare Part A and Part B. It doesn't happen automatically.
Does Medicare cover vision?
Most plans cover benefits that Original Medicare doesn't offer, such as vision, hearing, and dental. You have to sign up for Medicare Part A and Part B before you can enroll in Medicare Advantage Plan.
Does Medicare automatically apply to Social Security?
It doesn't happen automatically. However, if you already get Social Security benefits, you'll get Medicare Part A and Part B automatically when you first become eligible (you don't need to sign up). 4. There are two main ways to get Medicare coverage: Original Medicare. A Medicare Advantage Plan.
Do I need Part D if I don't have Medicare?
Be aware that with Original Medicare and Medigap, you will still need Part D prescription drug coverage, and that if you don't buy it when you first become eligible for it—and are not covered by a drug plan through work or a spouse—you will be charged a lifetime penalty if you try to buy it later. 5.
What happens if you don't register an event with a carrier?
Furthermore, if you fail to register an event with a carrier, you could lose out on sales commission and have your contract revoked.
How to distribute giveaways?
Distribute giveaways with your contact information on it 1. Use absolute or qualified superlatives. Give away promotional items that include plan name, logo, toll-free number, and/or carrier website 2. Use contact information provided by attendees for raffles or drawings for any other purpose.
What is the responsibility of a carrier for a sales event?
Exact reporting deadlines and requirements vary from carrier to carrier, but carriers are responsible for maintaining accurate records of all their agents’ educational events and informal and formal sales events. The earlier you submit your events to carriers, the sooner you’ll be able to start advertising them.
Do you have to disclose the products you plan on reviewing?
Additionally, you must include the following disclaimer on all advertisements and invitations for your event: “For accommodation of persons with special needs at sales meetings call <insert phone and TTY number>.”.
Seminars & Educational Events
Medicare seminars are meant to inform the public. If an interested party wants to contact you after your event, great! You have a lead. While you can’t ask for permission to contact at an educational event, the client can ask YOU. It has to be the client’s idea – even if you invited your preexisting clients to the seminar.
Marketing Activities & Materials
People with higher income are more likely to be able to purchase ancillary policies. They’re more willing to buy strictly precautionary policies. Even though they’re your best bet for cross-selling, you legally cannot target based on income. However, you can market to the general public and hope the wealthy attend!