New CMS regulations complicate open enrollment process for seniors
Beginning October 1, 2022, the Centers for Medicare & Medicaid Services (CMS) will require all phone calls relating to Prescription Drug Plans (Part D) or Medicare Advantage Prescription Drug Plans (MAPD) to be recorded by a third party.
How did we get here? You have probably seen the misleading TV commercials featuring celebrities such as William Shatner, George Foreman, and Joe Namath touting “free” health insurance plans offering enticing benefits not available from “Original Medicare.”
Some of these commercials even mention “free” groceries and rides to doctor appointments! Seniors are encouraged to call toll-free numbers which connect to call centers – these call centers are not the Centers for Medicare & Medicaid Services (CMS).
The primary job of the direct marketing representatives in these call centers is to encourage the senior to change their existing Medicare Supplement Plan, Part D, or MAPD over to a plan that offers "additional benefits."
Unfortunately, the new plan may not cover all prescriptions or even have physicians in the plan's provider network. In some cases, the plans recommended were not available in the beneficiary's county or area. Most plans also have out-of-pocket exposure.
This has happened to some of our own clients.
And, we have then found it very difficult to assist them, because when these direct marketing centers make changes to plans, we are no longer the “agent of record” and cannot help!
The Centers for Medicare & Medicaid Services (CMS) has taken notice of these greedy sales tactics. But the agency’s new regulations, which requires recording of every phone call about any of your plans, will likely not help and will very possibly cause more harm.
This requirement will put a nearly impossible burden on agents who are helping Medicare beneficiaries choose a suitable plan for their needs and will very likely NOT deter predatory direct marketing schemes.
Licensed and certified independent agents are NOT in the business of enrolling clients into plans which do not meet their needs, and which are not in the best interest of the client.
Petitions are now circulating, asking CMS to reverse this requirement for agents. But in the meantime, when these regulations come into effect on October 1, 2022, our job of serving you well becomes much more complicated, especially during the open enrollment period for MAPD and Part D drug plans.
We know this is going to be a very difficult adjustment and a frustrating change to our normal process, and we are sorry for the inconvenience. Unfortunately, due to this new government regulation, we have no choice. And although we are not from the government, we ARE here to help. Thank you for your understanding and assistance as we navigate these new and more difficult times.
What do we need from you?
In order to protect your information and our continued service to you, we must make the following changes:
During AEP, you can submit your prescriptions online through your own private upload link. No paper needed! Request your link here. This is our preferred method for the quickest turn around time and it's easy-peasy! Outside of AEP it will need to be submitted via paper/pdf.
If you are only able to do paper, it should be sent to us via the electronic upload link, fax, mail or email.
All questions pertaining to your Part D or MAPD plans should be emailed or mailed to us, if possible.
We will not be able to take any prescriptions over the phone to review your plan options for 2023.
Because of the recording requirements, we will not be able to call and remind you to send in your paperwork this year.
We plan to make plan suggestions or ask questions about your prescriptions in writing via email, if possible.
All plan changes that you approve will be done electronically, unless you prefer to make an appointment to briefly stop by the office to sign a paper form.
Our preferred submission for all applications is electronic. This has the least amount of room for error when processed by the carrier.