Medicare Industry Insider

Helping your clients and their families through their most difficult times requires you to be aware of ways to help them make the best of a bad situation. Listen in to hear about insurance and legal decisions you should be making and caregiver resources to help you through the process.
 
Informational Sources:
- What is Hospice: https://www.medicare.gov/what-medicare-covers/what-part-a-covers/how-hospice-works
- https://www.medicareinteractive.org/get-answers/medicare-covered-services/hospice/drug-coverage-under-hospice#:~:text=After%20you%20elect%20hospice%2C%20Medicare,not%20your%20Part%20D%20plan.  
- https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care#:~:text=Hospice%20is%20an%20approach%20to,in%20a%20separate%20hospice%20center
- https://www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/
- https://www.kff.org/mental-health/issue-brief/10-things-to-know-about-medicaid/
- https://www.medicaid.gov/medicaid/benefits/hospice-benefits/index.html 
-  Respite program locator map: https://archrespite.org/us-map    
- https://www.medicare.gov/hospitalcompare/search.html
- https://eldercare.acl.gov/Public/Index.aspx
 

It's important to know how to access and use CMS Data to better serve your clients, strategically market, and know what resources are available to them. Listen in to ensure you stand out to your clients based on your knowledge of the industry and how you can help them.
 
Informational Sources:
Provider Payments: https://www.cms.gov/medicare/payment/fee-schedules
Broker Compensation: https://www.cms.gov/medicare/payment/fee-schedules
https://www.cms.gov/priorities/key-initiatives/healthplan-price-transparency
https://www.cms.gov/healthplan-price-transparency/plans-and-issuers
Cross walk:  https://www.cms.gov/research-statistics-data-and-systemsstatistics-trends-and-reportsmcradvpartdenroldataplan-crosswalks/2023-part-cd-plan-crosswalk
Landscapes:  https://www.cms.gov/medicare/coverage/prescription-drug-coverage
https://www.cms.gov/data-research/monitoring-programs/improper-payment-measurement-programs/payment-error-rate-measurement-perm/corrective-action-plan-cap-process#:~:text=A%20CAP%20is%20a%20narrative,improper%20payments%20in%20each%20program
https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/corrective-action-plans
CAP Process: http://www.cms.gov/research-statistics-data-and-systems/monitoring-programs/perm/downloads/2013correctiveactionpowerpoint.pdf
 
Enrollment Data: See what is selling in your neck of the woods and ensure you are licensed with competitive plans. This can also indicate what carriers are in network with doctors and hospitals locally 
By Plan: https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/monthly-enrollment-plan  
By State: https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/monthly-enrollment-state  
By County/plan/state: https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/ma-state/county-penetration 
Strategic Planning Tool – The Medicare Enrollment Dashboard: Monitor enrollment statistics issued by CMS while developing your business plan for AEP and beyond. https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/monthly-ma-enrollment-state/county/contract 
Dashboard: https://data.cms.gov/tools/medicare-enrollment-dashboard 
Star ratings 
What Star Ratings Mean- what is it measuring: https://www.cms.gov/medicare/health-drug-plans/part-c-d-performance-data  
www.cms.gov/files/document/2023-medicare-star-ratings-fact-sheet.pdf 
 
Medicare Communications & Marketing Guidelines 
CMS Newsroom https://www.cms.gov/about-cms/contact/newsroom  
 
LIS Data - resources for LIS clients  
https://www.cms.gov/training-education/partner-outreach-resources/low-income-subsidy-lis 
Where can I learn more about the LIS? 
LIS notices and mailings. 
Consumer mailings (PDF) 
Information partners can use on: Reassignment (PDF) 
Medicare Limited Income NET Program 
LIS Resource Limits Memo (PDF) 
Fact Sheet – What to Do if You No Longer Automatically Qualify for Extra Help 
Apply online for extra help and get additional information at Social Security Administration
Employer and Union Retiree Drug Subsidy:  
https://www.cms.gov/medicare/coordination-benefits-recovery/employer-services/union-retiree-drug-subsidy 
 
Appeal forms – drugs https://www.cms.gov/medicare/appeals-grievances/prescription-drug/forms   https://www.cms.gov/medicare/appeals-grievances/prescription-drug/exceptions  

Join our special edition “A Christmas Medicarol” episode as we walk you through the past, present, and future of the Medicare Industry!
 
Informational Sources:
- https://www.cms.gov/about-cms/who-we-are/history 
- www.cms.gov/about-cms/agency-information/history/downloads/medicare-and-medicaid-milestones-1937-2015.pdf   
- https://www.cms.gov/about-cms/agency-information/history/downloads/quiz08.pdf  
- https://www.aarp.org/health/medicare-insurance/info-2023/history-of-medicare.html#:~:text=Medicare's%20first%20beneficiaries%20had%20a,Truman%20did%20enroll%20%E2%80%94%20was%20%243  
- https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet  
- https://www.aarp.org/politics-society/advocacy/info-2023/medicare-insulin-benefit.html
- https://www.aarp.org/health/medicare-qa-tool/does-medicare-cover-shingles-shot/
- https://www.aarp.org/health/medicare-insurance/info-2022/prescription-drug-coverage-changes.html
- https://www.aarp.org/politics-society/advocacy/info-2022/drugmakers-penalties-price-hikes.html
- https://medicareadvocacy.org/medicare-enrollment-numbers/ 
- https://www.cms.gov/newsroom/news-alert/cms-releases-latest-enrollment-figures-medicare-medicaid-and-childrens-health-insurance-program-chip 
- https://www.smsteam.net/wp-content/uploads/FAQ-Marketing-Rules.pdf  
- https://www.aarp.org/health/medicare-qa-tool/donut-hole-coverage-gap/
- https://qualitynet.cms.gov/
- https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/hospital-readmissions-reduction-program-hrrp
- https://www.aha.org/hospital-acquired-condition-reduction-program/hospital-acquired-condition-reduction-program
- https://www.cms.gov/medicare/health-safety-standards/guidance-for-laws-regulations/hospitals/rural-emergency-hospitals
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9978943/#:~:text=Results,older%20per%20county%20in%202011
- https://bettermedicarealliance.org/wp-content/uploads/2020/03/BMA_WhitePaper_MA_Bidding_and_Payment_2018_09_19-1.pdf
- https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/
- https://www.kff.org/medicaid/issue-brief/how-many-people-might-lose-medicaid-when-states-unwind-continuous-enrollment/
- https://www.cnn.com/2023/07/20/politics/medicaid-disenrollments-pause-cms/index.html)
- https://www.cbsnews.com/news/medicaid-children-uninsured/
- https://www.ncoa.org/article/medicare-star-ratings
 
 
 
 
 
 
 
 
 

You don't want to miss this episode! Listen as Rachel and Chalen discuss how an FMO and agent partnership can build and maintain that agent's success.

Each year CMS evaluates and makes changes to the payment models based on services that are provided, but there is always a debate on who deserves cuts and who deserves payments. Join us as we dive into different payment models and discuss what that means.  
 
Informational Sources:
- https://www.cms.gov/newsroom/fact-sheets/fy-2023-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective  
- https://relentlesshealthvalue.com/episode/aee16 
- https://www.federalregister.gov/public-inspection/2023-14624/medicare-and-medicaid-programs-cy-2024-payment-policies-under-the-physician-fee-schedule-and-other
- https://www.cms.gov/medicare/physician-fee-schedule/search/overview
- https://www.americanactionforum.org/insight/site-neutral-payments/#:~:text=Site%2Dneutrality%20is%20the%20policy,surgical%20center%2C%20or%20physician's%20office.  
- https://www.aha.org/fact-sheets/2023-05-22-fact-sheet-medicare-site-neutral-legislative-proposals-would-jeopardize-access-care  
 

Many veterans can seriously benefit from coverage beyond their earned benefits, while others may have adequate health care access. Listen as we discuss ways to serve this population that can improve outcomes and quality of life. 
 
Informational Sources:
- https://www.nbcnews.com/news/us-news/thousands-workers-leave-va-flood-new-cases-quota-demands-rcna103013 

While scams and predatory marketing are now commonplace, they are getting harder to spot for one of the largest targeted groups; seniors. Listen in on how an agent should combat these calls, emails, and other forms of scams to stay competitive, protect their clients, and root out bad actors.
 
Informational Links:
- https://www.helpguide.org/articles/abuse/elder-scams-and-senior-fraud-abuse.htm#:~:text=Elder%20fraud%20cost%20Americans%20over,those%20who%20are%20living%20alone.
- https://www.fool.com/research/elder-fraud-financial-abuse-statistics/ 
- https://www.wgal.com/article/dmva-warns-veterans-about-pension-poaching/43581703 
 

Being an engaged member of the Medicare community will help you create opportunities to be at the right place at the right time. Listen in to learn how to stay involved and informed in the Medicare industry!

Between industry events, allocation of money, and the service of your clients, learn in detail what the clients experience with Medicare so you can better plan for the upcoming AEP.
 
Informational Sources:
- https://www.cms.gov/newsroom/fact-sheets/fact-sheet-2024-medicare-advantage-and-part-d-rate-announcement
- https://deftresearch.com/
 

Join us as we weigh the pros and cons of technological advancements in the health and medical field.
 
Informational Sources:
- https://www.nytimes.com/2023/05/27/nyregion/avianca-airline-lawsuit-chatgpt.html?smid=url-share  
- https://puschnguyen.com/insurance-company-artificial-intelligence/  
- https://www.beckersasc.com/asc-coding-billing-and-collections/cigna-sued-over-new-ai-powered-claims-system.html#:~:text=Healthcare%20and%20insurance%20company%20Cigna,July%2024%20report%20from%20Forbes
- https://www.forbes.com/sites/richardnieva/2023/07/24/cigna-sued-over-algorithm-allegedly-used-to-deny-coverage-to-hundreds-of-thousands-of-patients/?sh=6656d4ed4b14
- https://www.kff.org/private-insurance/issue-brief/claims-denials-and-appeals-in-aca-marketplace-plans/
- https://www.hopkinsmedicine.org/henriettalacks/
- https://www.genome.gov/about-genomics/policy-issues/Genetic-Discrimination
- https://telehealth.hhs.gov/providers/preparing-patients-for-telehealth/telehealth-and-remote-patient-monitoring