Medicare Marketing Guidelines

[AndreaSti]

Those of us that work the Part D market, know the drill. First, get a list of the insureds current Rx's. Input into plan finder and get the ranking from best to worst.
If the best PDP is a carrier I'm certified for, I then enroll. If not, I will still electronically enroll the insured directly.
This approach is very unbiased.
Now if the pharmacist at CVS inputs the Rx's, and, the best plan is Humana Walmart Preferred, what is the CVS pharamist going to do???
The CVS pharmacist will do what is best for CVS.

Exactly the points I was trying to make on my last post!

 

[Bob_The_Insurance_Guy]

I don't do MA's, Bob, but isn't asking for the prospect's medications a violation of CMS regulations with regard to the sale of a MA plan?

I don't ask for it, they provide it to me in their initial email as an "oh, by the way..".

Yes it is a violation, but not one I have to concern myself with, since they are providing it to me before I have to ask. That is why I like working strictly referrals in this market. CMS has total control over what I say to the prospect, but has NO control over what I say to the person providing the referral.

 

[maniacagent]

I don't see how we can be responsible agents if we don't know what prescriptions people are on----I had occasion to speak with a man who needed a plan for his wife, an MS patient taking a $45000 a month drug...fortunately the man told me this without me asking him.....however I could have made the grave mistake of signing her up on an MA plan and found her drug to be covered (as it was) at only a fraction of her current reimbursement......I believe she only pays $35 a month now for it through his employer's plan where she is his dependent.

Had I put her on an MA I would have my A&&&&$#@ in a ringer....as the reimbursement would have left them with a copayment off the charts. I had thought of putting her on a supplement and searched MEDICARE.GOV for her prescription, also found only plans with VERY HIGH copays.
I feel even if I had signed her up on a good supplement and left them to their own devices for finding a plan D I would be putting myself at risk for a lawsuit.

 

[Russ]

I don't see how we can be responsible agents if we don't know what prescriptions people are on----I had occasion to speak with a man who needed a plan for his wife, an MS patient taking a $45000 a month drug...fortunately the man told me this without me asking him.....however I could have made the grave mistake of signing her up on an MA plan and found her drug to be covered (as it was) at only a fraction of her current reimbursement......I believe she only pays $35 a month now for it through his employer's plan where she is his dependent.

Had I put her on an MA I would have my A&&&&$#@ in a ringer....as the reimbursement would have left them with a copayment off the charts. I had thought of putting her on a supplement and searched MEDICARE.GOV for her prescription, also found only plans with VERY HIGH copays.
I feel even if I had signed her up on a good supplement and left them to their own devices for finding a plan D I would be putting myself at risk for a lawsuit.

Exactly. That rule is beyond stupid. Thought about making up a small sign and holding it up to ask them...."""What meds are you on?"""

 

[just2help]

Believe it or not, I have read the CMS Guidelines (between naps!). The sentence in question is this: " Materials that mention Medicare or plan specific benefits must be submitted to CMS for review and approval or File & Use if applicable via the plan sponsor." What is not clear is whether the word "Medicare" in this sentence is a noun or an adjective. In other words, are they referring to the mention of the word Medicare or are they referring to mentioning Medicare specific benefits?

Has anyone heard an opinion from "Big Insurance" yet?