By Larry Shoemaker, Clinebell Ltd
On April 4, CMS released the Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F). This clarifies the direction of the Medicare insurance distribution system. I am commenting on a few key items. 1327 pages of material will be published in the Federal Register later in April.
Agent compensation for initial enrollments will increase by $100, not the $31 proposed. However, this offset includes the cost of the training services, technology services and other support services provided by FMOs! This shifts responsibility from FMO’s and insurance companies to all agents. How this affects agents is concerning. Some liaison functions of FMO’s will be difficult for the insurance companies to duplicate. And agents are not experts in the specialized services FMO’s provide.
Also, the effect on call centers and TV ads is yet to be known. (Cheering allowed)
Happily, there are marketing opportunities that come from concerns CMS raised about Advantage plans performance. See opportunities highlighted in our previous articles.
CMS said many Advantage plans offer many underutilized supplemental benefits. They are concerned rebate dollars have gone toward advertising those benefits. The Final Rule requires Medicare Advantage plans engage in outreach efforts so that enrollees are aware of the supplemental benefits available to them.
We know clients have difficulties accessing or using those benefits. This is an educational opportunity for us. However, we need educational materials that meet any compliance rules CMS, and the insurance companies impose. And an efficient means of educating our clients and prospects.
Other underutilized benefits are SSBCI benefits for the chronically ill. SSBCI benefits are services such as food, prescription delivery, and housing support. Many doctors are unaware of CSNP plans, much less how these plans work for the benefit of patients and providers!
How do we develop these marketing opportunities into effective activities? And time is short. The bureaucrats may take their time. However, the first company with a functional program will be the winner.
A marketing problem has been restrictions on naming our providers in marketing materials. We needed compliance approvals from the named insurance companies. Now, CMS’ TPMO Disclaimer! mandates that we disclose with whom we are contracted! Clinebell Ltd solved that in our TPMO Sales Tool. The Tool shows the organizations you are contracted with in a service area and the ones you are not. This is in addition to the correct Disclaimer for the service area. For more information, see https://youtu.be/0xrvkBNwufE
We face a lot of change. CMS owes us a clear plan for the role of FMO’s in the insurance distribution system. Our future may be much clearer by AEP. How we solve these challenges will involve a lot of planning. Along with the other things we do!
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