Can Social Workers Enroll Eligibles in MAPDs, MAs, And/or PDPs?

[InsuranceAgt]

I'm a licensed agent, with completed 2012 Medicare certifications for the upcoming AEP. Local residents of two rural towns in my area have told me that social workers and/or employees at the local hospitals have been enrolling eligible beneficiaries in MAs, MAPDs, and PDPs. For example, one individual I presented to last AEP told me that he had been working with a social worker whom he said was "steering him" toward the plan I presented. During our meeting he decided that the plan I presented would not only be the best choice for his mother (for whom he had POA), but also for himself, as he was also an eligible beneficiary. He wanted to meet again with his social worker before enrolling. Subsequent to our meeting, the individual enrolled himself and his mother via that social worker instead of calling me, or returning the enrollment forms I left with him. This happened with a few other beneficiaries I presented to as well last season. Having spent the AEP last year working in this very geographically spread-out, sparsely populated rural area, this was a very frustrating thing, given not only our time and investment as agents, acting in full compliance, but also given the additional time and dollars spent to travel and service a rural market like this.
The 2012 AEP looks like it's getting off to the same type of start based on an ad I saw in a small, local, weekly publication advertising an event for next week. The advertisement does not use the term "educational event" in the ad, as prescribed by CMS. It notes the presenter's credentials as a social worker with the local hospital. The ad notes how this particular social worker has "counseled hundreds of residents and helped them navigate their way through the complex world of these insurances in addition to other health care insurances including PART-D...." The ad promotes the presentation under the guise of discussing Medicare and Medicaid Assistance programs...

Wondering if anyone can shed some light on the compliance factor with regard to social workers enrolling beneficiaries and also with regard to how CMS would view this type of presentation in light of either sales or educational "Event" regulations. I can attach a copy of the ad if anyone would like to see it. I have a letter ready to shoot to Surveillance at cms-dot-hhs-dot-gov with a copy of the ad in PDF, but am concerned about protecting my anonymity since the area is so small and tight-knit. Local repercussions could be really ugly in this market.

Thanks for any input from seasoned senior market agents.

CJ Steinhaus

 

[arnguy]

Re: Can Social Workers Enroll Eligibles in MAPDs, MAs, And/or PDP

I do not do the senior market, but IMHO advice by a social worker apparently is OK; however, a social worker enrolling clients into MA's appears to me to be crossing the line. My advice would be to drop a dime on those people to CMS. Senior market experts on here may give you advice to the contrary.

 

[Norwayguy]

Re: Can Social Workers Enroll Eligibles in MAPDs, MAs, And/or PDP

I do not do the senior market, but IMHO advice by a social worker apparently is OK; however, a social worker enrolling clients into MA's appears to me to be crossing the line. My advice would be to drop a dime on those people to CMS. Senior market experts on here may give you advice to the contrary.

Waste of time, I would bet you they are not recieving a commission and have no insurance license to risk, this is the same as a pharmacist recommending PDP plans. I would also bet that the money for this seminar and its advertisements are coming from your own pocket as grant money from the state.

 

[DS4]

Re: Can Social Workers Enroll Eligibles in MAPDs, MAs, And/or PDP

Wondering if anyone can shed some light on the compliance factor with regard to social workers enrolling beneficiaries

Anyone can enroll someone. With no commission.
Now if you want a commission, that is another story.

 

[InsuranceAgt]

Re: Can Social Workers Enroll Eligibles in MAPDs, MAs, And/or PDP

Waste of time, I would bet you they are not recieving a commission and have no insurance license to risk, this is the same as a pharmacist recommending PDP plans. I would also bet that the money for this seminar and its advertisements are coming from your own pocket as grant money from the state.

Great; so social workers get no money for enrolling beneficiaries, while I pay tax money to enable them to rob me of commissions that I actually go out and work for......
Plus I have to learn and comply with all CMS's rules, but these people can play "insurance advisor" and "steer" people toward specific plans or groups of plans with no regulation by or sanctions from CMS. Ok, I think I'm beginning to understand.....

 

[DS4]

Re: Can Social Workers Enroll Eligibles in MAPDs, MAs, And/or PDP

Great; so social workers get no money for enrolling beneficiaries, while I pay tax money to enable them to rob me of commissions that I actually go out and work for......
Plus I have to learn and comply with all CMS's rules, but these people can play "insurance advisor" and "steer" people toward specific plans or groups of plans with no regulation by or sanctions from CMS. Ok, I think I'm beginning to understand.....

The glory days of health insurance are behind us. Going forward, you will work harder and harder for less and less.
Get used to it or get out now.
Chumps.....anything to add???

 

[CHUMPS FROM OXFORD]

Re: Can Social Workers Enroll Eligibles in MAPDs, MAs, And/or PDP

Of course. Get out! To the few that are staying...you are running out of time. Concentrate on anything but individual health insurance.

There. I feel better now.

 

[InsuranceAgt]

Re: Can Social Workers Enroll Eligibles in MAPDs, MAs, And/or PDP

Anyone can enroll someone. With no commission.
Now if you want a commission, that is another story.

If the social worker(s) is/are employed by the hospital/provider, do CMS provider rules apply to them as employees of the provider? Specifically referring to these items from the AHIP 2012 certification modules:

"Providers must not.... "Accept enrollment applications for MA, MA-PD, or PDPs..." or "Distribute materials/applications within an exam room setting.... "

Would there be a loophole they could take advantage of if the employees/social workers sit with the beneficiaries and enroll them online as opposed to accepting or collecting a paper app.?

 

[Norwayguy]

Re: Can Social Workers Enroll Eligibles in MAPDs, MAs, And/or PDP

If the social worker(s) is/are employed by the hospital/provider, do CMS provider rules apply to them as employees of the provider? Specifically referring to these items from the AHIP 2012 certification modules:

"Providers must not.... "Accept enrollment applications for MA, MA-PD, or PDPs..." or "Distribute materials/applications within an exam room setting.... "

Would there be a loophole they could take advantage of if the employees/social workers sit with the beneficiaries and enroll them online as opposed to accepting or collecting a paper app.?

Let it go, CMS is not going to do anything, your DOI is not going to do anything you are wasting valuable time and energy on this.

Its the same as Dave Ramsey giving advice over the radio without a license, its the same as your neighbor helping you make a decision on your health plan there is no repercusion and absolutely nothing you can do as an agent.

 

[insurance0707]

Re: Can Social Workers Enroll Eligibles in MAPDs, MAs, And/or PDP

I think in the AHIP training they mentioned that providers couldn't just basically show/steer one insurance companies plan information, they had to make all of the other plan information available as well. So many regulations, I just mainly focused on what pertained to the agents but I'm sure there was something about that. All though a social worker isn't really a provider but they are employed by the hospital..