With the changes to Private Fee for Service (PFFS) coming on January 1st, 2011 which require “networking” in many counties, there will be a large number of non-renewals as of 12/31/2010. Now is the time to start thinking about your marketing plans for this fall!
Some agents are not aware that there is an SEP for MA Plan non-renewals. According to the CMS 2011 Call Letter, you can begin marketing on October 2nd, 2010. Here is a description of the SEP from my “Learn about Medicare Advantage” page.
Letters will be mailed on or around October 2nd. You will need this letter as proof of the SEP. The SEP will allow you to take an enrollment in October for a 1/1/2011 effective (you can also take an enrollment in October for a 11/1/2010 effective or an enrollment in November for a 12/1/2010 effective, but I generally don’t recommend it since in most cases MOOP’s/deductibles, etc. will start over).
If you have clients who are impacted, make sure you are appointed and certified early to avoid the rush (every year we see 4-6 week delays in licensing/appointment turn around times) and to be sure you have your supplies in time to start enrolling.
For clients who do not have an SEP, you can begin marketing on October 1st, however, you cannot take an enrollment form until November 15th.
Remember, even with existing clients, a Scope of Appointment Form is almost always required to be signed in advance any time you meet with a beneficiary about a Medicare Advantage or Part D plans (walk ins would be an example of an exception).
[...] 3.Information on Special Election Period for Medicare Advantage Plan … Aug 7, 2010 … The AARP Medicare Direct PFFS plan is being cancelled in Arizona but I heard from someone at Universal that their PFFS plan will continue. … http://blog.ritterim.com/2010/08/07/information-on-special-election-period-for-medicare-advantage-plan-non-renewals/ [...]
I heard Cigna is no longer offering PFFS policies. Do you think more carriers will drop them in 2011?
Dave:
I hear there are 1,000,000 medicare beneficiaries losing the PFFS plan in 2011. I haven’t been able to verify this number. I can guarantee you it will be very large, though.
Do you understand what will happen to PFFS plans in 2011. I thought they must be cancelled if there are network plans in the service area. The AARP Medicare Direct PFFS plan is being cancelled in Arizona but I heard from someone at Universal that their PFFS plan will continue. How can that be – unless they create a network (which Universal doesn’t have in Arizona). And if the plan has a network, how is it PFFS?
Denise:
It is possible to continue with PFFS in “Network” counties as long as the MCO signs on enough providers to meet CMS’ minimum for network adequacy. Then the plan can be accepted “out of network” in the same way it has in the past, as long as an “out of network” provider is deemed. You can think of a networked PFFS a little bit like a PPO, only the “out of network” benefits are the same as the in network.
There aren’t many carriers who are choosing to do this since you can’t manage care as well with PFFS as you can with a PPO. Does this help?