Compliance Bulletins
Value-based Care: Transforming Medicare for the Better
Value-based care (VBC) is a health care payment model that shifts the focus from the volume of services provided to the quality of care delivered. This paradigm shift aims to improve patient outcomes, reduce costs, and enhance the overall efficiency of the health care...
AgencyBloc and SunFire to Forge New Integration that Empowers Insurance Agencies
The #1 recommended provider of insurance growth enablement solutions for the health, senior and benefits industries, and SunFire, the leading Medicare quoting and enrollment platform, are excited to announce an upcoming integration designed to streamline Medicare...
Marketing Rules for health plans
People representing Medicare plans aren't allowed to: During the meeting, Medicare plans and people who work with Medicare can't: Charge you a fee to process your enrollment into a plan. Steer you into a particular plan. Communicate incorrect information about their...
Are You Ready to Sell Your Life Insurance Book of Business?
You’ve built a successful career helping clients navigate the world of life insurance. Now, you might be contemplating the next chapter. Selling your book of business can be a strategic move, but it’s crucial to understand your readiness before embarking on the sales...
Affordable Care Act Tax Credits Work Despite Fraud and Should be Expanded
Official data show an 88 percent increase in individuals signing up for Marketplace coverage between 2020 and 2024. The nonpartisan Congressional Budget Office projects an average of 6.9 million more enrollees due to this policy over the next decade. ARTICLE
Medicare Supplement Open Enrollment: What to Know
If you miss open enrollment, underwriters will review the state of your health when you try buying a Medigap plan. Based on their assessments, you could: Pay higher premiums Face a coverage waiting period for preexisting conditions Be denied a plan altogether...
Humana Exiting Medicare Advantage in 13 Markets
Humana reaffirmed its full-year guidance but is leaving 13 Medicare Advantage (MA) markets next year, Chief Financial Officer Susan Diamond said during the Wells Fargo Healthcare Conference on Wednesday. Other members will have fewer plans to choose from in certain...
Medicare Statistics and Facts In 2024
From Original Medicare to Medicare Advantage to Medicare Supplement, different plan options abound. Below, we explore a variety of Medicare facts and statistics that reveal the choices older adults are making to cover the costs of their health care. ARTICLE
New Medicare Part D Out-Of-Pocket Spending Cap is an Important Improvement for Enrollees Facing High Prescription Drug Costs
Under the Medicare Part D benefit, which provides prescription drug coverage for nearly 56 million Medicare beneficiaries, many enrollees were originally required to pay 5 percent of their prescription drug costs, with no limit, even after their out-of-pocket spending...
Centene is said to be ending broker commissions for Medicare Part D
Being the largest Part D player, the move is expected to save hundreds of millions of dollars for Centene (CNC). Many brokers believe the new strategy aims to drive members towards Medicare Advantage plans, which also offer Part D coverage and draw higher funding from...
6 Milestones and How They Might Change Your Life Insurance Needs
Life is full of life-changing moments. Moving to a different city, starting a new job, becoming a first-time parent (or grandparent). But it’s also full of uncertainty — and how long we have left to enjoy life’s many milestones is one of those uncertainties. That’s...
Why this year’s Medicare Annual Notice of Change will be vital reading for beneficiaries
If you’re on Medicare, you’ll be getting one or two Annual Notice of Change letters in your mail or email this September about your 2025 coverage and costs. You may be tempted to ignore what looks like junk, as nearly a third of recipients do, according to an eHealth...
Unleash Market Potential: ACA Cuts Uninsured Rates, Expands Opportunities
Since its inception in 2010, the Affordable Care Act (ACA) has been a catalyst for reducing uninsured rates among U.S. minority groups, creating significant market opportunities for licensed sales agents. From 2010 to 2022, the uninsured rate among Black Americans was...
Lower Drug Prices Announced Under Medicare Negotiation Program
CMS today announced the agreed-upon lower prices for all 10 drugs selected for price negotiations under the Inflation Reduction Act (IRA). These drugs are considered some of the most expensive and frequently dispensed throughout the Medicare program. According to CMS,...
Medicare Advantage in 2024: Enrollment Update and Key Trends
Medicare Advantage enrollment has been on a steady climb for the past two decades following changes in policy designed to encourage a robust role for private plan options in Medicare. After a period of some instability in terms of plan participation and enrollment,...
Medicare Advantage in 2024: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization
In 2024, three quarters (75%) of enrollees in individual Medicare Advantage plans with prescription drug coverage pay no premium other than the Medicare Part B premium, which is a big selling point for beneficiaries, particularly those living on modest incomes and...
Top Life Insurance Statistics for 2024
The state of the life insurance industry is continuously evolving, and understanding trends and changes can help you choose the right policy. Life insurance offers financial support for your dependents after you pass away, helping them cover your final expenses and...
How much and why ACA Marketplace premiums are going up in 2025
For 2025, across 324 insurers participating in the 50 states and DC, this analysis shows a median proposed premium increase of 7%, which is similar to last year. Based on a more detailed analysis of publicly available documents from insurers in 10 states and DC,...
Registration and Training for Marketplace Agents and Brokers
Agents and brokers who are new to the Marketplace this year, or who did not complete plan year 2024 registration and training, will be required to take the full Individual Marketplace training for plan year 2025. New agents and brokers can take Individual Marketplace...
Signing Up for Medicare and Social Security at the Same Time? 2 Things You Need to Know
Age 65 is a big milestone in the context of retirement planning, because that's when seniors are eligible to sign up for Medicare. In fact, you can enroll in Medicare three months before the month of your 65th birthday to get the ball rolling. You may be thinking of...
CMS Releases 2025 Medicare Part D Bid Information and Announces Premium Stabilization Demonstration
Today, the Centers for Medicare & Medicaid Services (CMS) is releasing preliminary technical Medicare Part D bid information for contract year 2025 to help Part D plan sponsors finalize their Part D and Medicare Advantage (MA) offerings and prepare for Medicare...
Senators Propose Criminal Penalties, Consumer Protections to Stop Rogue Health Insurance Brokers
The bill, titled the Insurance Fraud Accountability Act, would hold fraudulent insurance brokers and marketers criminally responsible for profiting off of deceptive marketing schemes into health care insurance plans. ARTICLE
New Medicare Rule Could Force Seniors to Switch Health Insurance Plans
A new Medicare rule could wind up forcing seniors to switch health insurance plans or face a significant penalty. Many seniors who continue to work past 65 are still on their employer's health plan instead of the government-run Medicare. However, a new update to...
CMS Statement on System Changes to Stop Unauthorized Agent and Broker Marketplace Activity
The Centers for Medicare & Medicaid Services (CMS) is committed to protecting consumers from bad actors and ensuring the program integrity of the Federally-facilitated Marketplace (FFM). That’s why CMS is taking additional action to address increases in...
Medicare Rebate for 64 Medications to Start Rolling Out: Here’s What to Know
People on Medicare will see coinsurance savings on prescriptions for 64 different medications available through Medicare Part B over the next few months, the US Department of Health and Human Services announced this week. ARTICLE
In 2024, A Majority of States Offer Medicare Advantage Plans to Their State Retirees, with 13 Offering Medicare Advantage Exclusively
Until fairly recently, employer-sponsored health benefits for Medicare-age retirees were typically designed to supplement, wrap around or coordinate with traditional Medicare. These plans often cover some or all of Medicare’s coinsurance and deductibles, and sometimes...
Federal Report: ACA Dramatically Increased Health Coverage
The Affordable Care Act (ACA) dramatically improved health insurance coverage rates, and recent decisions by Congress and the Administration related to its implementation have boosted both coverage and affordability, according to a new report from the Department of...
2024 MA Enrollment Trends & What They Mean for This AEP
According to a March report from Chartis, MA enrollment likely peaked in 2020, with a significant increase of 1.5 million new Medicare enrollees compared to only 1.3 million new enrollees this past year. While MA remains a popular choice for seniors, the enrollment...
Amazon’s Affordable Pharmacy program rxPass opens up to Medicare users with Prime
Amazon launched its RxPass in 2023, giving Prime customers access to generic medications that treat more than 80 common health conditions for $5 a month on top of a Prime subscription. Now, Amazon is expanding the program to Prime members on Medicare insurance,...
CMS is recalculating 2024 Medicare Advantage Star Ratings
"In light of the rulings issued in SCAN Health Plan v. Department of Health and Human Services and Elevance Health v. Department of Health and Human Services, CMS will recalculate and update the Star Ratings for Contract Year 2024 (CY 2024) used for Contract Year 2025...
Medicare Advantage is Vital to Safeguarding Medicare’s Future
As policymakers evaluate the long-term outlook for Medicare, the focal point should be on Medicare beneficiaries and how to best serve them – today and tomorrow. Policy should be aimed at meeting the health and financial needs of today’s beneficiaries while ensuring...
Study indicates positive outcomes for new approach to Medicare/Medicaid dual enrollment
People enrolled in both Medicare and Medicaid often face financial insecurity, complex health conditions and high rates of disability. “Receiving some benefits through Medicaid and others through Medicare creates a number of challenges for this vulnerable group of...
No Goal, No Win: How to Refine Your Marketing Efforts in 2024
The success of your marketing efforts isn’t a matter of chance; it’s a direct result of your clearly defined goals. Whether you aim for brand awareness, active engagement, or lead generation, having a roadmap to your desired success is crucial. ARTICLE
Here’s What Happens When You Don’t Sign Up for Medicare on Time
Many people can't wait until their 65th birthday to arrive so they can obtain health coverage through Medicare. But then there are some people who don't sign up for Medicare when they're initially eligible to do so. In some cases, failing to enroll in Medicare on time...
Wyden Urges CMS to Crack Down on Fraudulent Health Plan Changes
Washington, D.C. – Senate Finance Committee Chair Ron Wyden, D-Ore., sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure urging CMS to enforce civil monetary penalties established by Congress on brokers who submit...
AHIP Report: Understanding the Value of Medicare Supplement Coverage for Nearly 14 Million Americans
The new report describes the various types of Medicare Supplement plans, demographics of who chooses to enroll in these plans, which are the fastest growing plans, and how enrollment breaks down state by state. ARTICLE
Mounting headwinds in Medicare Advantage market haven’t stopped growth
The Medicare Advantage market is at an inflection point. The past few years have seen unprecedented enrollment growth, fueled by a rapidly increasing senior segment and an enabling regulatory environment. While growth this year remained strong, it was slower than in...
What you Need to Know About CMS’s Lead-Generation Guidelines
Confused about the October 8, 2021, Centers for FMO & Medicaid Services’ (CMS) advisory regarding the marketing of FMO Advantage (MA) and associated prescription drug (MAPD) plans? Here are a few key points to help demystify the latest update and help you comply...
October Compliance Bulletin CB0011-21
Sales and Enrollment Best Practices
Sales and Enrollment Best PracticesCB0009-21August 19, 2021DO: Take notes to refer back to & avoid asking consumer to repeat information already provided Engage the consumer throughout by asking open-ended questions and summarizing for their understanding Show a...
Referrals
ReferralsCB0007-21June 9, 2021Due to an increase in inquiries regarding referrals and referral bonuses and CMS’s updated direction advising “CMS no longer includes requirements about referral fees paid to non-agents/brokers in the FMO Communications and Marketing...
Ransomware – What is it and how to watch for it
Ransomware – What is it and how to watch for itCB0006-21May 26, 2021Ransom malware, or ransomware, is a type of malware that prevents users from accessing their system or personal files and demands ransom payment in order to regain access. The number one cause of...
Tips for Social Media
Tips for Social MediaCB0004-21April 13, 2021Here are a few reminders about the types of content you can’t post. Don’t share, repost or tag content by or with clients or followers without their express permission. Do not post disparaging, threatening, harassing,...
Keeping Information Secure While Working Remote
Keeping Information Secure While Working RemoteCB0003-21March 3, 2021During this continued time of uncertainty, while we continue to work remote, we want to be sure to remain compliant when interacting with the consumer PHI/PII. As a sales agent, consumers entrust you...
CMS News
CMS News CMS NEWS FOR IMMEDIATE RELEASE February 22, 2021 Contact: CMS Media Relations CMS Media Inquiries Attention: Agents who conduct sales in Texas CMS Offers Comprehensive Support to the State of Texas to Combat Winter Storm The Centers for FMO &...
Extra Help Program
Extra Help ProgramCB0001-21February 12, 2021As always, we thank you for your support and cooperation. For questions or comments, please email us at Compliance@NSGACommunications.com or you may call the toll-free number listed below. FOR AGENT USE ONLY. NOT...
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