People representing Medicare plans aren't allowed to: Ask for your personal information (like your Medicare, Social Security, bank account, or credit card numbers) over the phone unless it’s needed to verify membership, determine enrollment eligibility, or process an enrollment request. Plans don't need your personal information to give a quote.
Can a company hire an independent agent to sell Medicare plans?
In other situations, the companies hire independent agents/brokers who are not employees to sell the companies' Medicare plans.
What are the rules for meeting with a Medicare agent?
Independent agents and brokers selling plans must be licensed by the state, and the plan must tell the state which agents are selling their plans. If you're going to meet with an agent, the agent must follow all the rules for Medicare plans and some specific rules for meeting with you.
What happens if I apply for extra help with Medicare?
If you applied for Extra Help paying for Medicare prescription drug coverage, someone from the plan may contact you if any information is missing from your application. Come to your home uninvited to sell or endorse anything. Call you unless you’re already a member of the plan. If you’re a member, the agent who helped you join can call you.
Are Medicare agents/brokers employees of the contracted company?
Sometimes these agents/brokers are employees of the contracted company. In other situations, the companies hire independent agents/brokers who are not employees to sell the companies' Medicare plans.
When marketing Medicare Advantage plans What must an agent do?
Tell you where to find information about the plan (website, business cards, customer service number) Discuss different plan options. Provide and collect enrollment forms if you have the right to enroll.
What can an agent do during Ma OEP?
Agents and brokers are limited in marketing activities during the Medicare Advantage Open Enrollment Period (MA OEP) however, are able to: Conduct marketing activities that focus on other enrollment opportunities, including but not limited to:. Send marketing materials only when a beneficiary makes a proactive request.
What are the cons of a Medicare Advantage program?
Cons of Medicare AdvantageRestrictive plans can limit covered services and medical providers.May have higher copays, deductibles and other out-of-pocket costs.Beneficiaries required to pay the Part B deductible.Costs of health care are not always apparent up front.Type of plan availability varies by region.More items...•
During which enrollment period are agents/brokers prohibited from promoting marketing activities for Ma MAPD plans?
Marketing During OEP Is Limited. Section 40.7 clarifies what brokers can and cannot do during the Medicare Open Enrollment Period (January 1 – March 31). In short, brokers cannot knowingly (or intentionally) market to Medicare Advantage or Part D enrollees during OEP.
What is the difference between AEP and OEP?
AEP stands for Medicare Annual Enrollment Period and OEP stands for Medicare Open Enrollment Period. Depending on the context, OEP can refer to many other Medicare enrollment windows.
How many times can you change during OEP?
MA OEP allows Seniors enrolled in a Medicare Advantage plan to make a one-time change to the way they receive their Medicare benefits by either switching from a Medicare Advantage plan to Original Medicare or switching from one Medicare Advantage plan to another Medicare Advantage plan (with or without prescription ...
What is the difference between Original Medicare and Medicare Advantage?
Original Medicare covers inpatient hospital and skilled nursing services – Part A - and doctor visits, outpatient services and some preventative care – Part B. Medicare Advantage plans cover all the above (Part A and Part B), and most plans also cover prescription drugs (Part D).
Are Medicare Advantage plans too good to be true?
Medicare Advantage plans have serious disadvantages over original Medicare, according to a new report by the Medicare Rights Center, Too Good To Be True: The Fine Print in Medicare Private Health Care Benefits.
Who is the largest Medicare Advantage provider?
UnitedHealthcareUnitedHealthcare is the largest provider of Medicare Advantage plans and offers plans in nearly three-quarters of U.S. counties.
What actions are prohibited during marketing sales events?
Cannot send unsolicited text messages and leave voicemail messages. May call or visit beneficiaries who attended a marketing/sales event prior permission is given and documented. Cannot approach beneficiaries in common areas (i.e. parking lots, hallways, lobbies, sidewalks).
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.
Are agents permitted to call former members who have voluntarily disenrolled or current members in the process of disenrolling to market plans or products?
Calls to former clients who have disenrolled or to current members who are in the process of voluntarily disenrolling to market plans or products. Clients who are voluntarily disenrolling from a plan should not be contacted for sales purposes or be asked to consent in any format to further sales contacts.
Can you advertise for OEP?
Because of this, there are many marketing regulations when discussing OEP, and OEP cannot be discussed directly in advertisements or marketing strategies. Agents CAN: Conduct marketing activities that focus on other enrollment periods only.
Can OEP be used more than once?
The Plan C submits the enrollment request on January 18, 2019 using the MA-OEP. The Plan C enrollment request will reject with a TRC 108 because the MA-OEP election is used more than once in the same calendar year.
Can a member can add or drop prescription drug coverage during the annual election period AEP?
During AEP, you can shop for a new plan, switch your Medicare Advantage plan, change from Original Medicare to a Medicare Advantage plan, and add or remove prescription drug coverage*.
What is OEP new?
In 2019, a Medicare Advantage Open Enrollment Period (OEP) will run from January 1–March 31. If a beneficiary is enrolled in a Medicare Advantage plan, they'll have a one-time opportunity to: Switch to a different Medicare Advantage plan.
When is the best time to enroll in Medicare?
The best time to enroll in Medicare is during your Medicare Initial Enrollment Period. For most people, this seven month period begins three months before your 65th birthday, includes your birthday month, and ends three months after your 65th birthday.
Can you compare Medicare plans?
When you speak with an agent, you can compare plans from a number of different insurance providers. Some of the Medicare plan options that may be available to you can include:
What happens to a broker if they don't comply with Medicare?
Agents/brokers are subject to rigorous oversight by their contracted health or drug plans and face the risk of loss of licensure with their State and termination with their contracted health or drug plans if they don't comply with strict rules related to selling to and enrolling Medicare beneficiar ies in Medicare plans.
What is agent broker compensation?
Below is a link to a file containing the amounts that companies pay independent agents/brokers to sell their Medicare drug and health plans. Companies that contract with Medicare to provide health care coverage or prescription drugs typically use agents/brokers to sell their Medicare plans to Medicare beneficiaries.
When do brokers receive initial payment?
Generally, agents/brokers receive an initial payment in the first year of the policy (or when there is an “unlike plan type” enrollment change) and half as much for years two (2) and beyond if the member remains enrolled in the plan or make a “like plan type” enrollment change.
Do brokers have to be licensed in the state they do business in?
Agents/brokers must be licensed in the State in which they do business, annually complete training and pass a test on their knowledge of Medicare and health and prescription drug plans, and follow all Medicare marketing rules.
When does MA default enrollment start?
As outlined in the 2019 guidance, only MA organizations who meet the criteria outlined and are approved by CMS to conduct default enrollment for coverage effective dates of January 1, 2019 , or later.
When is the MA model enrollment period?
All enrollments with an effective date on or after January 1, 2021, must be processed in accordance with the revised guidance requirements, including the new model MA enrollment form. MA plans are expected to use the new model form for the 2021 plan year Annual Enrollment Period (AEP) which begins on October 15, 2020.
What does it mean to work with an independent Medicare insurance agent?
Working with an independent Medicare insurance agent means you get to choose policy options from different companies. Independent agents and brokers are more likely to give unbiased plan recommendations and advice. But they may not have in-depth knowledge of these plans.
What is the benefit of working with an independent Medicare broker?
One of the benefits of working with an independent Medicare broker or agent is that they represent many health insurance companies. They can present you with plan options from different carriers, increasing your chances of finding the right fit.
What can a Medicare broker do?
A Medicare agent or broker can help you narrow down your options and pick the best one. To do this, they’ll learn about your health goals and budget. They’ll present you with options to meet your goals within your budget. They can help you enroll in the plan you choose.
How complex is Medicare?
Medicare can be complex. There are numerous plans, plan combinations, benefits, rules, and exceptions — all of which can be confusing. Buying health insurance is a huge investment, so you want to find a plan that meets your needs. An ethical and knowledgeable agent or broker can help you get the best value for your money. Agents or brokers who sell health insurance products related to Medicare have to pass a test on their knowledge of Medicare every year. 3
What is independent insurance?
Independent. An independent agent can partner with and sell policies for different insurance companies. The agent can choose the specific policies they want to sell from a multitude of providers.
Can captive agents sell Medicare?
Agents who represent a particular health insurer can only sell you plans from that insurer. These captive agents are typically experts on all the options their company offers. But you won’t learn about plans from other Medicare insurance companies.
