Archive for the ‘Enrollment Periods’ Category

Every year, CMS will send a letter to all Medicare beneficiaries who are enrolled in “Low Performing Plans”.  These are plans that have a star rating of 2.5 stars or less for THREE consecutive years.  You can identify a low performing plan on the Ritter Medicare Quote Engine or on the Medicare Plan Finder tool (located at http://www.medicare.gov) by looking for this symbol next to the plan:  poorperformer

This year, CMS says that they will be sending the letter around the middle of February.  I have included a screen shot of the model letter below.  Medicare beneficiaries who are enrolled in these plans will have one SEP to move into a higher performing plan (a plan with 3 stars or better).

Some insurance companies will allow the agent to make a sales presentation to Medicare beneficiaries who would like to take advantage of this Special Election, however, the actual enrollment will need to be performed by the Medicare beneficiary calling into 800-Medicare or enrolling via the Medicare.gov plan finder.

Here is the letter that the Medicare beneficiaries will receive (you can click to enlarge):LPP_letter_2014



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Getting familiar with your State Pharmaceutical Assistance Program is a great way, not only to help your Medicare beneficiary clients, but also to unlock special elections to enroll in Medicare PDP or Medicare advantage plans with Part D.  Medicare beneficiaries who are enrolled in an SPAP get one Special Election Period per year to change their Prescription Drug plan (whether stand alone or integrated into Medicare advantage).

Depending on the state, the Medicare beneficiary may qualify for a reduced (or eliminated) deductible, premium savings, enhanced formulary, reduced copays and the elimination of the doughnut hole.  These programs can save your clients hundreds and perhaps thousands of dollars each year, depending on the state and the individual circumstances.

Additionally, enrolling in a state pharmaceutical program for the first time opens an immediate SEP for an enrollment into a Medicare plan which includes prescription drugs.

Here is a link to the Medicare website which has information and links to each of the state’s Pharmaceutical Assistance Programs.  This is a handy resource to keep bookmarked!

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Do you need insurance product training? RitterIm.com has an up-to-date posting of all the top carriers’ trainings on our event calendar. Registration is “one click” away at Ritter Insurance’s “Events’ Calendar”! (You must be logged in to register!)
  • Monday, August 29th; Coventry AEP Broker Seminar is being held in Grantville, PA and is open to PA agents.  Universal Health Care Certification Training is being held in St. Petersburg; Houston, TX; Mt. Vernon, IL and Tupelo, MS. 2012 Altius Product Training seminar is being held in South Jordan, UT. Foresters New Producer Training and Foresters Producer’s Guide to Member Benefits seminars are both open to all agents.
  • Tueday, August 30th; Baltimore Life Tele-sales Training for Silver Guard Products Using INSpeed webinar is open to all Baltimore licensed agents. Coventry HAPA-CCP2012 Product Training seminar is being held in Mars, PA. Coventry AEP Broker Seminar is being held in Lancaster, PA. Coventry Health Care of Texas 2012 Medicare Broker Product Training seminar is being held in Plano, TX. Coventry, Part D Prescription Drug Benefit-All the Details seminar is being held in Augusta, GA. Florida; CoventryCCP Product Training webinar is open to all FL agents. Coventry SFL Onsite CCP Product Training seminar is being held in Stuart, FL. Universal Health Care Certification Trainings are being held in Fairfax, VA; Kansas City, MO; Stuart, FL; Houston, TX; Jackson, MS and Greensboro, NC. Genworth Roundtable Discussion to Grow Senior Market Business seminar is being held in Missoula, MS. Foresters LifeFirst Training webinar is open to all agents.
  • Wednesday, August 31st; Coventry HAPA-CCP 2012 Product Training seminar is being held in Boardman, OH. Coventry AEP Broker Seminar is being held in Allentown, PA. Coventry Health Care of Texas 2012 Medicare Broker Product Training seminar is being held in Houston, TX. Universal Health Care Group Face to Face Trainings are being hosted in Springs, MD; St. Louis, MO; Boca Raton, FL; San Antonia, TX; North Dublin, OH; Monroe, LA and Raleigh, NC.
  • Thursday, September 1st; Coventry HAPA-CCP 2012 Product Training seminar is being hosted in Monroevill, PA. Coventry 2012 Personal Care Product training seminar is being hosted in Rockford, IL. Coventry Health Care of Texas 2012 Medicare Broker Product Training seminar is being hosted in Antonio, TX. Universal Health Care Certification Meeting are being held in Orlando, FL; Rockville, MD; Perrysburg, OH; Grapvine, TX and Fayettevill, NC. Foresters PlanRight Training and Foresters SMART UL Training webinars are open to all agents. Aetna 2012 Product Training webinars open to agents in CT, DE, ME, NJ, NY, PA, VT, NH and Ri.
  • Friday, September 2nd;  Universal Health Care Certification Meeting seminar is being held in Charlotte, NC.
  • Monday, September 5th; There are no scheduled training. Happy Labor Day!

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Ritter Insurance Marketing is committed to bringing, the agent, up to date insurance news. Below are two articles to help keep you in the know.

The 2011 Medicare AEP: Winners and Losers

The No-risk Referral

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This past week we held webinars for Caremore, Preferred Care partners and Bravo to review their Special needs plans.  Below you will find a copy of the presentation along with any supporting materials.  We did record the webinars so click on ‘Link to recording’ to listen.   

Caremore presentation
Caremore website
Certification page on wiki
Link to recording

Preferred Care Partners presentation
Preferred Care Partners website
Certification page on wiki
Link to recording – coming soon

Bravo presentation
Bravo website
Certification page on wiki
Link to recording

Basics of SNP Blog Link

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We would like to thank everyone who attended one of our ADP webinar training events. We covered a lot of information during the events and there where great questions that we didn’t get a chance to answer due to time, so below we’ve posted the answers. If you have a question about ADP that was not answered during the training or below, please submit your questions by posting a comment. Also, attached is a 2011 Election Period Booklet.

Q and A

Q - SEP- Does SEP apply if PFFS termed for 12/31/10, employer automatically place him into their Med Adv plan. Can we still move them into Med Sup?
A – Yes, they would be able to use the ADP to return to original Medicare and enroll into a PDP.  They would also have 63 days starting January 1st to purchase a Medicare supplement under Guaratee Issue. 

Q - If client didn’t elect to have part B at the time of eligibility but then applies later does this create a SEP?
A - No, it doesn’t create a SEP but the client would have their ICEP

Q – If a beneficiary’s Part D plan doesn’t renew effective January 1st, how long does the beneficiary have to enroll into another Part D plan?
A - They would have a SEP through the month of January for a February 1st effective date.

Here is the 2011 Election Period Booklet for you to download.

If you missed our ADP webinar training and would like to attend out next ADP event on January 13th at 2:00 PM (EST) click here.

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Outlined below are the dates for Year End Application Submissions as provided by CMS. 

Paper enrollment forms and disenrollment requests received via U.S. Mail delivery on Monday, January 3, 2011, regardless of U.S. Postal Service postmark, may be considered “received” on Friday, December 31, 2010, and thus accepted as AEP elections.

Paper enrollment forms and disenrollment requests received Tuesday, January 4, 2011, through Friday, January 7, 2011, with a U.S. Postal Service postmark on or before December 31, 2010, may be accepted and considered received on the postmarked date.

AEP requests received in the mail after January 7, 2011, regardless of postmark, must be denied.

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Here is a story from Business Week which talks about the Annual Enrollment Period for 2011 Medicare Advantage plans and the lack of an Open Enrollment for 2011 from January 1st – March 31st.  The Open Enrollment from 1/1/11 through 3/31/11 has been replaced by an Annual Disenrollment Period from January 1st to February 14th, 2011 where the only option for a Medicare Beneficiary in an Medicare Advantage plan is to go back to Original Medicare.

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The New York Times reports:  Medicare enrollment season is approaching, and many experts say they believe it promises to be a turbulent one – “a perfect storm,” said Paul Gada of Allsup, a provider of Medicare plan selection services.

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On my “Learn about Medicare Advantage Page”, I have links to the Chapter 2 Enrollment Guidance from CMS and also to some specifics on this Special Election Period (SEP) and the other SEP’s.  Here is a link to that page for the Medicare Advantage SEP:

Here is the Section on SEP’s for Non-Renewals (Where Health plan voluntarily disenrolls the members) and Terminations (where CMS terminates a Health plan’s contract):

30.4.3 – SEPs for Non-renewals or Terminations

In general, SEPs are established to allow members affected by non-renewals or terminations ample time to elect a new plan. Effective dates during these SEPs are described below. CMS has the discretion to modify this SEP as necessary for any non-renewals or terminations when the circumstances are unique and warrant a modified SEP.  In particular:

  • Non-renewals – A SEP exists for members of MA plans that will be affected by plan or contract non-renewals and plan service area reductions that are effective January 1 of the contract year. In order to provide sufficient time for members to evaluate their options, the SEP begins October 1 and ends on January 31 of the following year.

Enrollment requests received from October 1 through December 31 will have an effective date of January 1. Enrollment requests received in January will have an effective date of February 1.

MA organization Termination of Contract and Terminations/Contract Modifications by Mutual Consent.

An SEP exists for members of plans who will be affected by a termination of contract by the MA organization or a modification or termination of the contract by mutual consent (42 CFR §§422.512 and 422.508(a)(1)). The SEP begins two months before the proposed termination effective date, and ends one month after the month in which the termination occurs.

Please note that if an individual does not elect an MA plan before the termination effective date, he/she will be defaulted to Original Medicare on the effective date of the termination. However, the SEP will still be in effect for one month after the effective date of the termination should the individual wish to subsequently elect an MA plan (for a current, not retroactive, effective date).  Beneficiaries affected by these types of terminations may request an effective date of the month after notice is given, or up to two months after the effective date of the termination. However, the effective date may not be earlier than the date the new MA organization receives the enrollment request.

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