Protecting Your Clients from Medicare Flex Card Scams: A Guide for Health Insurance Agents

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As a health insurance agent, it’s important to be informed about potential scams and fraudulent activity that may affect your clients. One such scam that has been making its way around is the Medicare Flex Card scam. Understanding what the Medicare Flex Card is and how it can be used is crucial in helping your clients avoid potential scams.

Firstly, let’s define what Medicare Advantage plans are. Medicare Advantage plans are an alternative to traditional Medicare, where private insurance companies provide coverage instead of the government. These plans often offer additional benefits beyond what is covered under traditional Medicare, such as dental, vision, and prescription drug coverage.

Some Medicare Advantage plans also offer a “flex card,” which is a prepaid debit card that can be used to pay for certain health-related expenses not covered by Medicare. These expenses can include copays, deductibles, and even gym memberships.

Unfortunately, scammers have caught on to this and have begun creating fake Medicare Advantage flex cards. These cards are often used to steal personal data from seniors, such as their Medicare number and other sensitive information.

As a health insurance agent, it’s important to educate your clients about the potential for Medicare Flex Card scams. Encourage them to be wary of unsolicited calls or offers and to never give out their sensitive information unless they are sure the person or organization is legitimate. It’s also important to advise them to check their Medicare statements regularly to ensure that they haven’t been billed for any fraudulent services or equipment.

If your clients are interested in a Medicare Advantage plan with a flex card, be sure to do your research and only work with reputable insurance companies. Verify the legitimacy of the company and the plan, and never provide your clients’ data unless you are sure they are legitimate.

In addition to the Medicare Flex Card scam, there are other Medicare scams to be aware of. Some scammers will call seniors and claim to be from Medicare, asking for personal data, such as their Medicare number or Social Security number. Others may offer free medical equipment or services, only to bill Medicare for unnecessary or nonexistent treatments.

By staying informed about potential Medicare scams and educating your clients about the importance of protecting their sensitive data, you can help them avoid becoming victims of fraud. Remember to always protect your clients’ privacy and be wary of unsolicited offers or calls. By working together to prevent Medicare scams, we can help seniors access the healthcare they need without falling prey to fraudulent activity.

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How the Medicare Prescription Drug Inflation Reduction Act is Tackling Rising Drug Prices

The Centers for Medicare and Medicaid Services (CMS) recently announced the implementation of a new program called the Medicare Prescription Drug Inflation Reduction Act. This program aims to reduce the rising cost of prescription drugs covered under Medicare Part B. The new program will reduce coinsurance rates for 27 Part B drugs, with savings expected to start from April 1.

The rising cost of healthcare is a growing concern for many Americans, particularly seniors and those with disabilities who rely on Medicare for their healthcare needs. Prescription drugs are a significant component of healthcare costs, and the cost of these drugs has been on the rise for several years. The new program is part of a broader effort by CMS to address the issue of rising drug prices and make healthcare more affordable and accessible.

The Medicare Prescription Drug Inflation Reduction Act is an important initiative that is expected to benefit millions of Americans. The savings from reduced coinsurance rates are expected to be significant, with beneficiaries potentially saving thousands of dollars each year.

The Part B rebates program is just one part of a larger initiative by CMS to reduce healthcare costs for seniors and those with disabilities. In addition to reducing coinsurance rates, CMS is also working to negotiate prices directly with drug manufacturers. By negotiating prices, Medicare hopes to pass on the savings to beneficiaries, making healthcare more affordable and accessible.

The issue of rising drug prices is not unique to the United States. Countries all over the world are grappling with the same issue, and many have taken steps to address it. One solution that has been implemented in several countries is the use of reference pricing. Under this system, the government sets a price for a particular drug, and drug manufacturers are required to sell the drug at that price. Some experts believe that reference pricing could be a solution to the rising cost of drugs in the US.

Another solution that has been proposed is allowing Medicare to negotiate prescription drug prices directly with drug manufacturers. Currently, Medicare is not allowed to negotiate prices, which means that beneficiaries often have to pay high prices for necessary medications. Allowing Medicare to negotiate prices could potentially save billions of dollars each year.

The issue of rising drug prices is complex and multifaceted, and there is no single solution that will solve the problem. However, initiatives like the Medicare Prescription Drug Inflation Reduction Act are an important step towards making healthcare more affordable and accessible for all Americans.

As healthcare agents, it is essential to stay informed about new initiatives like the Medicare Prescription Drug Inflation Rebate Program. By staying informed, agents can provide their clients with the latest information and help them make informed decisions about their healthcare. Healthcare agents play a vital role in helping clients navigate the often-confusing world of healthcare. Initiatives like the Medicare Prescription Drug Inflation Rebate Program can be an important tool in that effort.

The MPDIRA is an essential initiative that aims to reduce the rising cost of prescription drugs covered under Medicare Part B. This program will reduce coinsurance rates for multiple Part B drugs, potentially saving beneficiaries thousands of dollars each year. The program is part of a broader effort by CMS to reduce healthcare costs for seniors and those with disabilities. As healthcare agents, it is essential to stay informed about new initiatives like this one and help clients make informed decisions about their healthcare.

Are you contracted to sell Medicare plans yet? Learn more here!

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Everything Your Customers Need to Know About How Employer-Sponsored Health Plans Compare to Medicare for Prescription Drug Costs

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When it comes to prescription drug costs, there can be significant differences between employer-sponsored health plans and Medicare. Understanding the differences between the two can help your clients save money and ensure you help them get the coverage they need. Here’s what your customers need to know about employer-sponsored health plans and Medicare.

Cost: 

Generally speaking, employer-sponsored plans tend to pay more for drugs than Medicare. This is because employers often negotiate discounts with drug manufacturers, allowing them to offer lower drug costs than Medicare.

Coverage: 

Employer-sponsored health plans may provide more comprehensive coverage for prescription drugs than Medicare. Some employer-sponsored plans may cover drugs not covered by Medicare.

Out-of-pocket costs: 

While employer-sponsored health plans may pay more for drugs than Medicare, they may also require higher out-of-pocket costs. Employer-sponsored plans may have higher co-pays, coinsurance, and deductibles than Medicare.

Formularies: 

Employer-sponsored health plans and Medicare may have different formularies, which are lists of drugs that are covered and excluded. Make sure customers check the formularies for both types of plans before making a decision.

Specialty drugs: 

Many employer-sponsored plans have higher copays and coinsurance for specialty drugs. Medicare, on the other hand, has lower copays and coinsurance for specialty drugs.

Prior authorization: 

Employer-sponsored plans may require prior authorization for certain drugs, while Medicare generally does not.

Step therapy: 

Employer-sponsored health plans may require step therapy for certain drugs, while Medicare does not.

Employer-sponsored health plans and Medicare can have significant differences as far as prescription drug costs. Understanding the differences can help customers make an informed decision about which plan is best for them. Make sure to emphasize to clients that they should compare the cost, coverage, and out-of-pocket expenses for each plan before making a decision.

Your next step as an agent is to learn how Medicare Advantage Plans (MAPD) and Prescription Drug Plans (Part D) play a role in helping your clients control their prescription drug costs. Work with Agility to learn more!

Are you contracted to sell Medicare plans yet? Contact us to get started today!

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How Robocallers Are Preying On Elderly With Fake Medicare Offers

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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.

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Medicare Patients Are Keeping the Telehealth Habit Post-Vaccines

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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.

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The Critical Role Agents Play in Medicare Plan Enrollment

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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?

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What you need to know about Medicare Part B Premiums for 2023

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Medicare just made a big announcement regarding their Part B Premiums for 2023. 

These standard premiums will drop by 3% next year. The monthly premium for Medicare Part B will reduce by $5.20 by 2023. This will also lower the deductible for Part B. 

The government made this announcement on Tuesday, September 27. Here’s more info about this incentive to share with your customers:

Thanks to Medicare Part B’s projected spending on Aduhelm, a medication to battle the onslaught of Alzheimer’s, the premium for this program dropped more than expected. Medicare spent less than expected on Aduhelm, meaning they could spend more on Part B, which in turn led to a reduction in 2023 premiums. 

Medicare Part A, on the other hand, raised its deductible per benefit period, which starts upon admission to a hospital, to $1,600 in 2023, from its current amount of $1,556. This amount applies to the first 60 days of inpatient hospital care. 

After the 61st day and through the 90th day, however, coinsurance will cost at least $400 a day. The price of coinsurance will go up by $11 from the current amount this year.

Moreover, IRMAAs are effective in January as well, for individuals with a gross income of over $97,000. Those filing jointly must expect an extra monthly charge if their net income is over $194,000 instead of 2022’s ceiling of $182,000.

Interested in selling Medicare? Visit us through Agility Insurance Services to learn more. 

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2023 Medicare Announcement

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2023 Medicare Advantage and Part D Rate Announcement

 

 

 

 

 

 

 

In April, the Centers for Medicare & Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2023 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the Rate Announcement). CMS’s goals for Medicare Advantage and Part D mirror our vision for the agency’s programs as a whole, which is to advance health equity; drive comprehensive, person-centered care; and promote affordability and the sustainability of the Medicare program.

In the CY 2023 MA and Part D Advance Notice, CMS solicited comments on a variety of topics, including seeking input on promoting health equity in Medicare Advantage and Part D plans. CMS appreciates the submitted comments and will consider them in future policymaking.

This fact sheet discusses the provisions of the Rate Announcement, which can be viewed by going to: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Announcements-and-Documents.html and selecting “2023 Announcement.”

Net Payment Impact

The chart below indicates the expected impact of the policy changes and updates on MA plan payments relative to 2022.  

Year-to-Year Percentage Change in Payment

Impact

2023 Advance Notice

2023 Rate Announcement

Effective Growth Rate

4.75%

4.88%

Rebasing/Re-pricing

N/A[1]

0.39%

Change in Star Ratings

0.54%

0.54%

Medicare Advantage Coding Pattern Adjustment

0%

0%

Risk Model Revision

0%

0%

Normalization

-0.81%

-0.81%

MA risk score trend[2] 

3.50%

3.50%

Expected Average Change in Revenue

7.98 %

8.50%

 

Part C Risk Adjustment

CMS will continue the CY 2022 policy to calculate 100% of the risk score using the 2020 CMS-HCC model, which was phased in from CY 2020 to CY 2022, as required by section 1853(a)(1)(I) of the Social Security Act, as amended by the 21st Century Cures Act. We are also continuing our policy of calculating risk scores for MA enrollees using diagnoses exclusively from MA encounter data submissions and fee-for-service (FFS) claims. CMS solicited and received comments on whether enhancements can be made to the CMS-HCC risk adjustment model to address the impacts of social determinants of health on beneficiary health status by incorporating additional factors that predict the relative costs of MA enrollees and will consider all comments received on this topic for future policymaking.  

Part C End Stage Renal Disease (ESRD) Risk Adjustment

For CY 2023, we are finalizing the revised risk adjustment model for payment to MA organizations and additional demonstrations and programs (such as Medicare-Medicaid Plans (MMPs)) where the demonstration also uses the MA risk adjustment models) for enrollees with ESRD in order to improve the prediction of costs for these enrollees. The revised model is calibrated on more recent data, using CMS’s current approach to identify risk adjustment eligible diagnoses from encounter data records. It also incorporates improvements previously made to the Part C CMS-HCC model, specifically the clinical updates and revised segmentation, which accounts for the differential cost patterns of dually eligible beneficiaries.

Program of All-Inclusive Care for the Elderly (PACE) Risk Adjustment

For CY 2023 payment to PACE organizations, we will continue to use the 2017 CMS-HCC model to calculate non-ESRD risk scores as we have done since CY 2020, the 2019 CMS-HCC ESRD models to calculate ESRD risk scores as we have done since CY 2019, and the 2020 RxHCC model to calculate Part D risk scores as we have done since CY 2020.

Medicare Advantage Coding Pattern Adjustment

Each year, as required by law, CMS makes an adjustment to plan payments to reflect differences in diagnosis coding between MA organizations and FFS providers. For CY 2023, CMS is finalizing a coding pattern adjustment of 5.9%, which is the minimum adjustment for coding pattern differences required by statute. CMS received a number of recommendations from stakeholders regarding approaches to estimate the MA coding pattern adjustment. These included recommendations that CMS apply a higher coding pattern adjustment than the statutory minimum and that CMS consider approaches that take into account differences in coding patterns across MA plans. CMS continually reviews MA coding patterns and continues to assess how we calculate the MA coding pattern adjustment, how best to apply it, and what the appropriate level of the adjustment should be. Ensuring that the coding pattern adjustment policy appropriately addresses differential coding in MA is essential and we will consider these recommendations in the development of future coding pattern adjustment proposals.

Medicare Advantage Normalization Factor

CMS calculates normalization factors annually to keep the FFS risk score at the same average level over time. For CY 2023, CMS will use the methodology typically used for calculating the normalization factor, which is to project the payment year risk score using a trend that is based on five historical years of FFS risk scores under the payment year model. However, for CY 2023, we proposed not to update the years of FFS risk scores used in the trend as we typically do – that is to remove the earliest year’s FFS risk score and add the most recent year’s FFS risk score that is available – because of concerns that the changing use of services in 2020 due to the COVID-19 pandemic resulted in an anomalous 2021 risk score, which is based on diagnoses from 2020 dates of service. Including the anomalous 2021 risk score would result in a projection that significantly underestimates what the FFS 2023 risk score is likely to be. CMS is finalizing the proposal to not update the years in the trend and instead use the same years of FFS risk scores that were used to calculate the 2022 normalization factors, 2016 through 2020.

Part D Risk Adjustment

For CY 2023, we are finalizing our proposal to implement an updated version of the RxHCC risk adjustment model for Part D sponsors other than PACE. The RxHCC model is used to adjust direct subsidy payments for Part D benefits offered by stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug plans (MA-PDs). The recalibrated RxHCC model includes a clinical update to the RxHCCs based on ICD-10-CM diagnosis codes rather than ICD-9-CM codes used in the prior models. The recalibrated model also includes an update to the data years (2018 diagnoses to predict 2019 costs) using the same approach we use to filter diagnoses from encounter data records for risk score calculation, including the risk adjustment allowable CPT/HCPCS codes.

Puerto Rico

The proportion of Medicare beneficiaries who receive benefits through the MA program (as opposed to FFS Medicare) is far greater in Puerto Rico than in any other state or territory. The policies proposed and finalized for 2023 will continue to provide stability for the MA program in the Commonwealth and to Puerto Ricans enrolled in MA plans. These policies include basing the MA county rates in Puerto Rico on the relatively higher costs of beneficiaries in FFS who have both Medicare Parts A and B, continuing the statutory interpretation that permits certain counties in Puerto Rico to qualify for an increased quality bonus adjusted benchmark, and applying an adjustment to reflect the nationwide propensity of beneficiaries with zero claims.

Part C and D Star Ratings

The Rate Announcement includes information and announces updates in accordance with the Star Ratings regulations at §§ 422.164, 422.166, 423.184, and 423.186.

The Rate Announcement includes information about the date by which plans must submit their requests for review of the appeals and complaints measures data, lists the measures included in the Part C and D Improvement measures and the Categorical Adjustment Index for the 2023 Star Ratings, and lists the states and territories with Individual Assistance designations that began in 2021 from the nationwide FEMA major disaster declarations used in the definition of an affected contract for the extreme and uncontrollable circumstances adjustment for the 2023 Star Ratings.

Additionally, CMS solicited feedback in the CY 2023 Advance Notice on a number of different potential measurement concepts and methodological enhancements, including the following:

  • Plans to enhance current CMS efforts to report stratified Part C and D Star Ratings measures by social risk factors to help MA and Part D sponsors identify opportunities for improvement. Nearly all stakeholders supported stratified reporting, and we will begin sharing confidential stratified reports with contracts this spring.

  • The development of a Health Equity Index as an enhancement to the Part C and D Star Ratings program to summarize measure-level performance by social risk factors into a single score used in developing the overall or summary Star Rating for a contract.  

  • The development of a measure to assess whether plans are screening their enrollees for health-related social needs such as food, housing, and transportation. 

  • How MA organizations are transforming care and driving quality through value-based contracts with providers to use in the potential development of a Part C Star Ratings measure.

CMS will take the feedback received into consideration as we continue to explore ways to further drive health equity and high quality care.

Interested in selling Medicare? Visit us through Agility Insurance Services to learn more. 


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