The Centers for Medicare and Medicaid Services (CMS) recently announced new restrictions on marketing for Medicare Advantage Plans and other health care policies. With the new rules, it is more important than ever for Agility agents to understand the Medicare Advantage marketing guidelines and the policies associated with them. In this blog post, we’ll explore what the new rules mean for agents selling Medicare Advantage plans and the strategies available to stay compliant with these plans.

Under the new CMS guidelines, agents selling Medicare Advantage plans can no longer use promotional materials that could mislead, confuse, or exaggerate the benefits of their plans. This means that all marketing materials must be clear, and accurate, and not promote any plans inappropriately. Additionally, agents selling Medicare Advantage plans must provide consumers with detailed information about each plan, including out-of-pocket costs, services covered, and formulary information.

In addition to the new restrictions, CMS now requires that all Medicare Advantage plans to adhere to the same ethical standards as traditional Medicare plans. This restricts agents from offering any gifts, rewards, or other incentives to customers in order to encourage them to enroll in a particular plan. Agents selling Medicare Advantage plans are also prohibited from aggressive sales and marketing tactics, such as cold calling or door-to-door marketing.

It is important for Agility agents to note that they also must abide by all local and state laws regarding marketing and advertising for Medicare Advantage. For example, some states may have laws regulating the use of telemarketing or direct mail campaigns by Medicare Advantage plans.

The new restrictions from CMS are designed to protect consumers from deceptive marketing practices and ensure that they are fully informed about the benefits of Medicare Advantage plans. It is important for Agility agents’ consumers to understand the new rules and the policies associated with these plans in order to make the best decisions for their healthcare needs.

By following the Medicare Advantage marketing guidelines, Agility agents can be sure their customers are getting the most accurate and helpful information about the plans available. Moreover, agents should also take the time to thoroughly research each plan and understand all of the costs, benefits, and limitations associated with Medicare Advantage. With a little research and knowledge of the new rules, agents can help consumers make informed decisions and navigate the Medicare Advantage landscape with confidence and integrity.

Stay up to date with Medicare Marketing Guidelines by attending our Medicare Training Series live events!

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Your customers want to keep their children healthy, and one of the best ways to do this is by providing them with access to affordable health care. Fortunately, the state of Florida is committed to helping parents provide their children with this essential service through its Children’s Health Insurance Program (CHIP). This program offers benefits to qualifying families and helps them to secure the medical care their children need. In this article, we’ll look closer at the CHIP program, its benefits, and how you can guide your client to enroll their child in this vital program.

What is Florida’s CHIP Program?

Florida’s CHIP program is an initiative that provides free or low-cost health insurance to qualifying children in the state. It is funded by the federal and state governments and administered by the Florida Healthy Kids Corporation. The program is designed to provide comprehensive healthcare coverage to children that are not eligible for Medicaid or have other health insurance. The benefits provided by CHIP include doctor visits, hospital stays, vaccinations, prescriptions, vision and dental care, mental health services, and other essential services.

Who Qualifies for the CHIP Program?

In order to qualify for the CHIP program, a child must meet specific eligibility criteria. Generally, children must be under the age of 19 and be residents of the state of Florida. They must also meet the financial requirements set out by the program, which is determined by the state’s Department of Children and Families. Additionally, undocumented immigrant children, foster children, and adopted children can all qualify for the program, regardless of their parent’s immigration status.

What Are the Benefits of the CHIP Program?

CHIP provides a range of benefits to families in the state of Florida, including access to quality health care for their children. The program covers a wide range of services, including primary care visits, hospital stays, prescription drugs, immunizations, vision and dental care, mental health services, and other essential services. The program also covers preventive care and screenings, such as physicals, vision and dental exams, and more. Additionally, CHIP provides access to specialists, such as pediatricians and pediatric subspecialists, for those who need them. Finally, the program also covers the cost of transportation to get to and from the doctor.

Remember…

For families with children who are aging out of the Children’s Health Insurance Program (CHIP) due to age or income, there is an option to transition to an Affordable Care Act (ACA) plan. A Special Enrollment Period (SEP) is available for families to enroll in an ACA plan to ensure continuity of healthcare coverage for their children. This SEP can be used even if the normal Open Enrollment Period has ended. Families should contact their healthcare provider and research the ACA plans available in their area to identify the best option for their family.

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The Temporary Special Enrollment Period (SEP) is a crucial aspect of healthcare for consumers who have lost their Medicaid or Children’s Health Insurance Program (CHIP) coverage. With the unwinding of the Medicaid continuous enrollment condition, many people are losing access to these important programs, putting their health and well-being at risk.

The Temporary SEP provides a lifeline to these consumers by allowing them to enroll in a new health insurance plan outside of the standard enrollment period. This gives them the opportunity to secure the coverage they need, even if they have missed the regular deadline for enrollment.

To be eligible for the Temporary SEP, consumers must have lost their Medicaid or CHIP coverage due to the unwinding of the Medicaid continuous enrollment condition. They must also be seeking new health insurance coverage through an insurance service like Agility Insurance Services.

The Temporary SEP is a time-limited opportunity, and consumers should act quickly to enroll in a new health insurance plan. They can do this by reaching out to Agility Insurance agents.

It’s important to note that the Temporary SEP is only available to consumers who have lost their Medicaid or CHIP coverage due to the unwinding of the Medicaid continuous enrollment condition. If consumers have lost their coverage for another reason, they may not be eligible for the Temporary SEP and may need to enroll during the next open enrollment period.

Consumers who take advantage of the Temporary SEP can choose from a range of health insurance plans that meet their needs and budget. They may be eligible for financial assistance to help pay for their insurance premiums, and can also compare plans to find the one that best meets their needs.

In conclusion, the Temporary SEP is a valuable opportunity for consumers who have lost their Medicaid or CHIP coverage due to the unwinding of the Medicaid continuous enrollment condition. It provides a lifeline to these consumers, giving them the chance to secure the health insurance coverage they need. By taking advantage of the Temporary SEP, they can protect their health and well-being, and ensure they have access to the care they need.

Agility Producer Support
(866) 590-9771
support@enrollinsurance.com

 

Robocallers are taking advantage of elderly people who may not be aware of how to protect themselves from scams, by offering fake Medicare plans. These calls are not only costing unsuspecting individuals large amounts of money, but they are also violating rules put in place by the Federal Trade Commission (FTC).

Robocallers are using fear tactics to convince elderly people to buy fake Medicare plans. They will tell the individuals that they are receiving a special offer and that if they do not take advantage of it right away, they might miss out on it. They might even pretend to be from a legitimate company.

Unfortunately, many elderly people will fall for these scam calls because they are not aware of the dangers of giving out personal information or credit card details over the phone. Even if the conversation does not involve money, the elderly person might still be vulnerable to identity theft.

The FTC has a few rules for robocallers, as well as other telemarketers. They must display their phone number and the name of the company they are working for. They must also tell you who they are calling on behalf of, and stop calling when you ask them to.

If you or someone you know has fallen victim to a robocall scam, it is important to report it to the FTC. You can also register your phone number with the National Do Not Call Registry. This will help to reduce the number of unwanted calls you receive.

It is important to be aware of the dangers of robocalls and to take precautions to avoid falling victim to one of their scams. There are a number of resources available to help educate and protect elderly people, such as the FTC and the National Do Not Call Registry. With these, you can help to ensure that elderly people are better protected from robocalls. As an agent, taking these measures becomes even more crucial.

Agility Producer Support
(866) 590-9771
support@enrollinsurance.com

As the world slowly gets back to some semblance of normalcy in 2023, millions of Medicare patients are continuing to access telehealth services to manage their health and wellness. This is despite the fact that vaccinations against the Covid-19 virus are now available in the US.

The American Medical Association (AMA) recently conducted a survey of more than 2000 Medicare patients to better understand their telehealth habits in 2021. The survey revealed that a whopping 55% of respondents have used telehealth services in the past month, with an additional 8% planning to do so.

The survey also revealed that the primary reason for continuing to use telehealth is convenience. In fact, 43% of respondents cited convenience as a major factor in their decision to continue using telehealth services. Other popular reasons given included avoiding travel time (30%), comfort and privacy (20%), and affordability (17%).

The survey also revealed that the elderly are more likely to continue using telehealth services. Of the respondents aged 65 and older, 64% said they had used telehealth in the past month, with an additional 8% planning to do so.

The survey results are certainly encouraging, as they show that millions of Medicare patients are continuing to embrace telehealth even after vaccinations become available. This is likely due to the sheer convenience of telehealth, which allows patients to access medical care without having to leave the comfort of their own homes.

Overall, the survey results suggest that telehealth is here to stay, even after the Covid-19 pandemic has been brought under control. This is good news for the healthcare industry, as it means that patients will be able to continue accessing the medical care they need without having to worry about potential exposure to the virus.

Agility Producer Support
(866) 590-9771
support@enrollinsurance.com

Medicare beneficiaries have the right to choose their own coverage, and this is where you come in. The help of a licensed agent or broker can be invaluable in guiding clients through the process. Agents and brokers possess the specialized knowledge to answer questions and provide advice on a wide range of Medicare plan options from private insurance companies, such as Medicare Advantage and supplemental plans.

Medicare contracted agents and brokers are trained to understand Medicare information and be able to explain it to clients in terms they can understand. They have access to real-time information about Medicare plan availability, premium costs, and coverage benefits. They can also help compare different plans and make sure consumers are enrolled in a plan that meets your needs.

Furthermore, agents and brokers are a great resource for seniors who are trying to make sense of the various Medicare programs. For example, they can help decide if a Medicare Advantage plan is right for an individual or explain the differences between a Medigap policy and a Medicare Part D prescription drug plan. Instead of trying to find the answers for themselves, people can rely on the expertise of an agent or broker.

Having the help of an agent or broker is especially important if someone is nearing the end of an Initial Enrollment Period and need to make sure they are enrolled in the right plan. Agents and brokers can help make sure people don’t miss critical enrollment dates. They can also help individuals get the most out of their benefits by applying for low-income subsidies or other assistance programs.

In short, agents and brokers are an important part of the Medicare landscape. Agents and brokers have the knowledge, experience, and resources to help people make informed decisions about their Medicare plan. 

Are you contracted to offer Medicare Plans yet?

Agility Producer Support
(866) 590-9771
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Tennessee has long been a leader in providing quality healthcare coverage through its Tenncare Medicaid program. Recently, the state has taken steps to make sure that their citizens are receiving the most up-to-date coverage and the best possible service. In this blog post, we’ll explore how Tennessee is working to reduce the redetermination process for Tenncare coverage, and what it means for Medicaid health plans in the state.

Tennesseans have long relied on Tenncare as their source of health coverage. However, there have been issues with the redetermination process, with some patients not receiving the coverage they need in a timely manner. This is especially true for those who are already struggling financially and have limited access to healthcare.

Fortunately, Tennessee has recently made strides to reduce the redetermination process. They have implemented an automated system too quickly and accurately assess a patient’s eligibility for Tenncare coverage. This system allows Tenncare to quickly process applications and provide coverage to those who need it most.

In addition to this automated system, Tennesseans will also benefit from new regulations that ensure that Tenncare coverage is provided in a timely fashion. The new regulations require Tenncare to inform individuals within 21 days of their application if they are approved or denied coverage. This will reduce the wait time for those seeking coverage, and make sure that they are not left without the coverage they need.

Finally, Tennesseans will benefit from the expansion of Medicaid health plans in the state. Tenncare has recently added additional plans to its network, giving Tennesseans more options for health coverage. This expansion of choices will give Tennesseans the opportunity to find an affordable plan that fits their needs.

Tennessee is taking the necessary steps to ensure that all Tennesseans get the coverage they need in a timely and efficient manner. The steps they are taking to reduce the redetermination process for Tenncare coverage and expand Medicaid health plans in the state are sure to benefit all Tennesseans. With these changes, Tennesseans can rest assured that they are getting the quality healthcare coverage they need.

Take a look at how Agility can help you with consumers that have lost their Medicaid coverage

Agility Producer Support
(866) 590-9771
support@enrollinsurance.com

Medicare Advantage (MA) plans received more than 2 million prior authorization requests in 2021, of which about 6% were denied. This statistic, sourced from the Kaiser Family Foundation (KFF), illustrates the challenges MA users face in receiving the necessary treatments and medications.

Prior authorization is a practice used by health insurance companies to control costs by ensuring that procedures, treatments, and medications are medically necessary and prescribed for the right reasons. The process often requires the patient’s doctor to submit an authorization request beforehand, and the insurance company reviews it to decide whether or not to approve the procedure.
The KFF report found that the denial rate for prior authorization requests is much higher in MA plans than in traditional Medicare. The percentage of denied requests increased by 10% between 2020 and 2021. While the reasons for the increase are unclear, they may be related to new requirements that MA plans have implemented in response to the COVID-19 pandemic.
The report also found that certain specialties had higher denial rates than others, such as cardiology (17.5%), gastroenterology (13.2%), and radiation oncology (13.1%). This means that patients in these specialties may face even more difficulty in obtaining the treatments and medications prescribed by their doctors.

It is important to note that prior authorization is not only about controlling costs, but also ensuring that patients receive the treatments and medications that are most suitable for them. However, the high denial rate for prior authorization requests can add additional barriers for patients in need of medical care.

The KFF report highlights the need for MA plans to review their prior authorization requests and reduce the denial rate. Doing so would result in greater access to medically necessary treatments and medications for Medicare Advantage users.

 

Agility Producer Support
(866) 590-9771
support@enrollinsurance.com

We’re on a mission to make sure your clients, get the most out of their Oscar plan. That’s why we’re shining the spotlight on the Oscar Essentials this month. And, first up is account creation!

With an Oscar account, your clients can take control of their healthcare experience like never before. Imagine being able to search for in-network care, select a primary care physician (PCP), refill prescriptions with ease, and even pay bills with just a few clicks. The possibilities are endless!

So, how can you help your clients take advantage of these amazing benefits? It’s easy! Just follow these simple steps:

  1. Open your Book of Business

  2. Select a client and click on the “Engagement” tab on the right-hand side

  3. View your member engagement checklist

  4. Select account creation

  5. Send an email by clicking on the “Email client tutorials” button

  6. Hit “task complete”

  7. Repeat for each of your clients.

Don’t let your clients miss out on the essential benefits of their Oscar plan. Get started today and help them unlock the power of Oscar!


Why do thousands of agents enjoy being part of the Agility family so much? Find out here!

Agility Producer Support
(866) 590-9771
support@enrollinsurance.com

Exciting news for healthcare consumers in Texas! Blue Cross Blue Shield of Texas has announced that Ascension, one of the largest non-profit healthcare systems in the country, will remain in their network. This means that patients who have health insurance through Blue Cross Blue Shield will continue to have access to Ascension’s vast network of hospitals and clinics across Texas.

Ascension’s non-profit commitment to providing high-quality, compassionate care to its patients is well known. With its extensive network of facilities, Ascension offers a wide range of services, from primary care to specialty care and everything in between. By keeping Ascension in their network, Blue Cross and Blue Shield is ensuring that its customers have access to the care they need, when they need it.

This decision is a big win for Blue Cross Blue Shield customers, as well as for Ascension. It’s not just about having access to quality care, but also about ensuring that patients have access to the care they need at a price they can afford. By keeping Ascension in its network, Blue Cross Blue Shield is helping to make sure that its customers are getting the best possible value for their healthcare dollars.

The decision to keep Ascension in the Blue Cross Blue Shield network was not an easy one, and the two organizations worked hard to come to an agreement that would benefit everyone involved. This shows their commitment to working together to provide the best possible healthcare to Texas residents.

This is fantastic news for those who have health insurance through Blue Cross Blue Shield of Texas. By keeping Ascension in their network, Blue Cross Blue Shield is demonstrating its commitment to providing its customers with access to the best possible care, at an affordable price. Whether you’re in need of primary care, specialist care, or anything in between, Blue Cross Blue Shield and Ascension are working together to make sure you have the care you need, when you need it.

Agility Producer Support
(866) 590-9771
support@enrollinsurance.com