Judge Halts CMS Limit on Medicare Advantage Pay

July 3, 2024

The actual decision can be downloaded here.

The summary of the action is as follows:

In plain English, the court decision can be summarized as follows:

Background:
Medicare is a federal health insurance program for the elderly and disabled. There are different parts, including Medicare Advantage (MA) and Part D, provided by private insurers under government contracts. The Centers for Medicare and Medicaid Services (CMS) set rules to regulate how insurers compensate agents and brokers who help enroll beneficiaries in these plans.

Key Issue:
CMS recently introduced a new rule (the “Final Rule”) that set fixed rates for administrative payments to agents and brokers, which were previously uncapped. This rule also introduced restrictions on contract terms and prohibited sharing personal beneficiary data without consent.

Plaintiffs:
The plaintiffs, including Americans for Beneficiary Choice (ABC) and the Council for Medicare Choice (CMC), argued that the new rule would harm their business operations and filed for a stay (a temporary halt) of the rule's effective date.

Court's Decision:
The court granted a stay for parts of the new rule but denied others. Specifically:

1. Stay Granted:
– The Fixed Fee and Contract-Terms Restrictions are temporarily halted. The court found these parts of the rule to be likely arbitrary and capricious because CMS did not adequately substantiate its decisions or address reliance interests and public comments.

2. Stay Denied:
– The Consent Requirement (related to sharing personal beneficiary data) remains in effect because ABC did not show a substantial likelihood of success in challenging this part.

Implications:
The court decided to temporarily halt parts of the rule while litigation continues, as the plaintiffs showed they could suffer irreparable harm. The parties must now submit a joint schedule for summary judgment briefing by July 17, 2024.

Conclusion:
The court's decision means that certain agent and broker compensation restrictions will not take effect immediately, giving the plaintiffs temporary relief while the case proceeds.

 

Medicare Supplement Training

Life Insurance and the LAPro Tool

In this week's meeting, Laura from Senior Market Sales joined us to walk through the process of using the Lead Advantage Pro tool to write life insurance applications. We also discussed a few carriers in detail and where they fit into writing life products for seniors.

 

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Massive Changes Ahead for Supps & Advantage

Never-before-seen rate increases on Medicare Supplements and shocking changes coming on Part D for 2025 – how will this impact our clients? And the exodus of Medicare Advantage plans – major carriers announcing losses and, now, pullbacks for 2025.

Note and links to articles are under the video:

     


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Upcoming Group Plan Opportunities | 4-15-24 Meeting

We announced a new agency manager for SSN and discussed a little-known impact of the “Inflation Reduction Act” that will impact millions of seniors for AEP at the end of 2024. Don't miss this (around 36 minutes into the video).

See the notes under the video:

 

     


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April 8 2024 Meeting

Improving office process and communication to clients.

This office meeting happened when Chris was on the Barcelona, Spain trip with Mutual of Omaha, so you'll see some of those video clips in this video.

Notes under the video:

     


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CIGNA Urgent Update March 2024

Cigna is sunsetting the CHLIC brand for Medicare Supplement.

However, this differs significantly from what we have seen in the industry with simple name changes or block of business sales.

 

Please see below for details and resources:

     


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Controlling the Call – Internal Meeting March 4, 2024

Our calls can last 20 minutes or longer, even when the answer is delivered within two minutes. The only way we are going to reach all those waiting for our help is by taking control of the call and ending the call when necessary.

Meeting notes under the video:

     


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Medicare Supplement Outlook Feb 26 2024 Updates

Updates from the industry and better ways to communicate to make sure that scheduled appointments are not a waste of time.. join the discussion from February 26, 2024.

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December 18, 2023 Internal Agency Meeting

AEP Results Recap

Video:

Correction to the Video:
It is not Blue Shield of CA that is rejecting (in December) MAOEP Medicare Supplement applications until January 1.
It is United American / Globle Life. They say they can be submitted January 1 for February 1 effective dates.

     


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AARP -UHC Supplement Changes for 2024

These changes are set to take effect December 15, 2023 and will affect all states, where approved.
The video addresses many more underwriting questions that will be added and various changes to the interpretation of certain conditions.

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Confusion with Preferred Pharmacies and Part D Insights

Insight from the SMS pharmacist on staff, explaining the pharmacy costs when it, at first, appears confusing. There is also a discussion on the “Max Out of Pocket” with Part D for 2024 and how that actually works.

He also talks about submitting a new application after the first one, if you had to. What are the options there when using our tools.

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