CMS Marketing Guidelines on Agent In Good Standing May Affect Medicare Advantage or Medicare Part D Renewal Commission Payments for Independent Agents

Feeds:: Posts; Comments

CMS Marketing Guidelines on Agent In Good Standing May Affect Medicare Advantage or Medicare Part D Renewal Commission Payments for Independent Agents

October 27, 2009 by Craig

I haven’t seen much talk about this, but there is a new provision in the Managed Care Manual under Chapter 3 – Marketing Guidelines (click to view manual). If you go to page 153 in section 120.5.4, you will find the following in the third bullet:

Plan sponsors should pay compensation in accordance with the structure in place when the enrollment occurred so long as the agent is in good standing and the member is still enrolled. Further, the commission structure of the receiving health plan (rather than the losing health plan) applies to any replacement enrollment. An agent is in good standing if (s)he is appointed to sell in the State (if required), annually trained and tested, and maintains a passing score of 85 percent.

It seems that Plans are interpreting this that they can only pay renewal commissions to agents who are “in good standing”, meaning they are still (1) appointed with the company and (2) certified for the current year. This would mean that, if you have business on the books with a Medicare Advantage or Part D carrier, you will be required to re-certify every year in order to continue getting paid.

I have some questions in to plans on this topic. To be safe, I’m recommending that, if you have business on the books with a Medicare Advantage or Part D carrier, you GET RECERTIFIED regardless of whether or not you intend on selling new business in the current year.

Posted in CMS | 7 Comments

7 Responses

on March 6, 2010 at 2:13 am | Reply Roger

Thought I would let every know, if you are looking for a knowledgable friendly insurance agent to help you understand the complicated Medicare minefield, call Doug or Douglas Samulak. He represents a group of Medicare Advantage plans for Arcadian Health plans. I was confused about what I needed when I was ready to retire. Doug took all the time in the world to explain it all to me in very understandable terms. He didn’t sell me anything. He helped me realize what I needed. The fact that he represented a company that had a product to fit my needs what almost secondary. If you have Medicare and want to talk to some one that knows what they are talking about, call Doug Samulak at Arcadian Health Plans.
on November 1, 2009 at 10:58 am | Reply Frank

This should concern all older agents. We work hard to take care of our families and build a sizable renewal. What happens when an agent gets sick or die? I had a very good friend (75 years old) who continued to work and grow his MA business. He died to years ago. The current CMS guidelines allows companies to stop paying his renewals. This is wrong and it must be changed.
on October 30, 2009 at 12:23 pm | Reply Greg O

CVS SilverScript is very clear – you must be recertified in the current year to get paid a renewal.
on October 29, 2009 at 9:05 am | Reply G. Avery

Craig,

Thanks for your help; however, I think it’ll take “an act of Congress” to get this act of injustice overturned.
- on November 1, 2009 at 6:18 pm | Reply Craig
  
  G:
  
  I am working with CMS on this. I’m hoping to have some positive news to report very soon! (Don’t hold your breath, but it’s looking favorable).
  
  Craig
on October 28, 2009 at 4:03 pm | Reply G. Avery

Another MA negative. They just keep piling up.
- on October 28, 2009 at 9:20 pm | Reply Craig
  
  Gary:
  
  I’m working on getting clarity on this. Only reason I blog it is that I alway try to keep everyone updated “up to the minute”. I’m hoping that I can get this interpretation overturned and I’ve spent considerable time working on this potential problem, already. I’ll blog if I can get this over turned in favor of paying renewals.