MEDICARE
Sponsored by AGA
CMS Checklist for Enrollment of Medicare Part C MA Plans and Medicare Part D PDPs
Consistent with 422.2274(c)(12) and 423.2274(c)(12), plans must ensure that all agents and brokers (employed, captive, and independent) discuss the following CMS developed list of items during the marketing and sale of an MA or Part D plan, prior to the beginning of the enrollment process:
2024 Medicare Advantage and Part D Star Ratings
The Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Advantage (Medicare Part C) and Medicare Part D Star Ratings each year to measure the quality of health and drug services received by consumers enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans). The Star Ratings system helps Medicare consumers compare the quality of Medicare health and drug plans being offered so they are empowered to make the best health care decisions for them. An important component of this effort is to provide Medicare consumers and their caregivers with meaningful information about quality alongside information about benefits and costs to assist them in being informed and active health care consumers.
CMS opens door to expanded Medicare coverage of diagnostic PET scans for Alzheimer’s disease
After potential drug treatments for Alzheimer’s disease came a-knocking this year, the Centers for Medicare and Medicaid Services have now opened up the door to wider coverage of PET diagnostic scans.
Previously, CMS had limited reimbursements for the imaging procedure, which is capable of highlighting the disease’s telltale clumps of beta amyloid proteins within the brain and distinguishing Alzheimer’s from other causes of dementia or memory loss.
Under a decade-long nationwide policy, the agency had said they would only pay for one brain scan per person over the course of the patient’s lifetime, and then only if that person was also enrolled in a clinical trial for Alzheimer’s.
The Real Costs of the New Alzheimer’s Drug, Most of Which Will Fall to Taxpayers
The first drug purporting to slow the advance of Alzheimer’s disease is likely to cost the U.S. health care system billions annually even as it remains out of reach for many of the lower-income seniors most likely to suffer from dementia.
Medicare and Medicaid patients will make up 92% of the market for lecanemab, according to Eisai Co., which sells the drug under the brand name Leqembi. In addition to the company’s $26,500 annual price tag for the drug, treatment could cost U.S. taxpayers $82,500 per patient per year, on average, for genetic tests and frequent brain scans, safety monitoring, and other care, according to estimates from the Institute for Clinical and Economic Review, or ICER. The FDA gave the drug full approval July 6. About 1 million Alzheimer’s patients in the U.S. could qualify to use it.
GROUP BENEFITS
Sponsored by Word&Brown
New California Law Takes A Step Toward Single-Payer Healthcare
Gov. Gavin Newsom signed a bill Saturday that sets the stage for California to work toward universal healthcare, such as a single-payer system that progressive activists have sought for years.
The law could help California obtain a waiver that would allocate federal Medicaid and Medicare funds to be used for what could eventually become a single-payer system that would cover every California resident and be financed entirely by state and federal funds.
California’s health secretary will have to offer recommendations on crafting the federal waiver by June 1, 2024, under Senate Bill 770.
HSA vs FSA: Help employees find the best fit during open enrollment
By tailoring your communications and education during open enrollment, you can help employees choose the benefits that will best meet their needs throughout the coming year.
Another open enrollment season is officially upon us, and as employees ponder the benefit choices your organization is offering, they are likely paying extra attention to benefits that support their financial needs and situation. As record-high inflation continues to affect individuals, families, and organizations that provide health benefits, solutions that support physical and financial wellbeing for employees are more important than ever. The good news is, you may already have two essential solutions in your toolbox: a flexible spending account (FSA) and health savings account (HSA).
CalCPA Health is a program many brokers have been aware of for years.
Those who aren’t familiar with CalCPA Health should learn about them and start telling your clients about their benefit offerings.
Brokers Need to Know:
- CalCPA Health is a California domiciled carrier who has been around since 1959 – providing excellent benefit plans to CPA and financial service firms of all sizes.
- CalCPA Health’s January 2024 small group rates are coming in at 2-3.5% above already competitive 2023 rates. Depending on the plan and rating area, CalCPA Health will be extremely competitive to standard plans this open enrollment.
- Medical, Dental and Vision plans are available for more than CPAs. Learn more!
- CalCPA Health has very user-friendly HSA administration capabilities for employers and employees. They offer the largest selection of HSA plans in California.
INDUSTRY NEWS
Rite Aid’s bankruptcy plan stirs worries of new ‘pharmacy deserts’
Rite Aid’s plan to close more stores as part of its bankruptcy process could hurt access to medicine and care, particularly in some majority Black and Hispanic neighborhoods and in rural areas, experts say.
The drugstore chain said late Sunday that its voluntary Chapter 11 process will allow it to speed up its plan to close under performing stores. The company runs more than 2,000 stores, mostly on the East and West coasts.
UCSD Health access for 60,000 Anthem Blue Cross members in San Diego hangs in balance
Anthem Blue Cross recently delayed plans to notify thousands of its beneficiaries statewide that they will be assigned different doctors in 2024 because it has been unable to come to a new contract agreement with the University of California’s five health systems.
Both sides said Friday that they have agreed to extend the contract, set to expire on Dec. 31, through Mar. 1, 2024. The extra two months provides a bit more runway for negotiations that, if unsuccessful, could affect about 600,000 Anthem members with UC doctors — roughly 60,000 living in San Diego County.
Listening to Black Californians: How the Health Care System Undermines Their Pursuit of Good Health
CHCF commissioned a study that listens deeply to Black Californians talking about their experiences with racism and health care. This report summarizes in-depth interviews with 100 Black Californians and 18 focus groups, as well as a statewide survey of 3,325 adult Black Californians.
HEALTHCARE PROVIDER
Our purpose:
To better every life we touch through the way we care.
Regal Medical Group is an affiliate of Heritage Provider Network (HPN), which has provided affordable and quality healthcare through its network of medical groups for 30 years.
As one of the largest physician-led healthcare networks in Southern California, we contract with thousands of doctors and hundreds of hospitals and urgent care centers to give you the best options to manage your health, wherever you call home. We also help you stay healthy and active between doctor visits with valuable resources like fitness and nutrition classes, disease management programs, and more.
Gain access to broker content – marketing materials, network information, specialist finders and more! Register here
PROFESSIONAL DEVELOPMENT
Special thanks to Russ Williams for his new Professional Development Program for California Brokers readers.
Russ Williams contributes articles on professional growth for readers of California Broker Magazine. He serves as a mentor-advisor and offers one-on-one professional consultations based on The Clarity Conversation. This 9-Session Self-Renewal Consultation focuses on overcoming nagging personal-professional challenges to re-claim personal and professional clarity to renew your influence for good at home, at work, and in the community.
Managing Clarity INFLUENCE: THE BOLD IDEA
“If I were required to guess off-hand…what is the bottom cause of the amazing material and intellectual advancement of the last fifty years, I should guess that it was the modern-born and previously non-existent disposition on the part of men to believe that a new idea can have value.”
Mark Twain
The great 19th century American humorist and political/social commentator, Mark Twain, unearthed the hidden jewel that moves the human spirit…the belief that my new idea has value.
SUBJECT MATTER EXPERT
Get More Leads:
Social Security Program For Medicare Agents
For most individuals, Social Security will represent a significant portion of their future retirement income. Individuals who seek assistance in determining the optimal time for filing Social Security benefits are often the same individuals who need guidance in making Medicare plan decisions. The RSSA® program will transform your Medicare insurance agents into the go-to Social Security experts. As a Registered Social Security Analyst®, your agents will receive referrals from Baby Boomer’s friends and family, CPAs, and other centers of influence. They will be trained to host Social Security optimization events, workshops and seminars using RSSA Roadmap® software, scripts, and PowerPoints.
INDUSTRY CALENDAR
October 2023
Oct. 19, 11:30 AM–12:00 PM, “What Advisors Should Know About Open Enrollment, 1 HR. CE Credit Presented by Marilyn Monahan Register
Oct. 25, 3:30 PM, “NABIP Power Hour! Register
CONFERENCES
Oct. 22-24, LIMRA Annual Conference, Gaylord National Resort & Convention Center, National Harbor, MD, Register
Oct. 31-Nov. 2, ITC InsurTech Connect, Las Vegas, NV Register
November 2023
Nov. 2 @ 11:30 am -1:30 pm PST, WIFS-LA & NAIFA-LA present “What’s Going On With Long Term Care Insurance Around The Country?” Register
Nov. 07, 9:00-11:00am PST, CAHIP Golden Gate Membership Meeting: “Is Parity Working? Mental Health and Substance Use Disorder Claim Advocacy for Brokers Register
Nov. 8, 9am PST, Q4 State of NAIFA, Register
Nov. 9 @11:30am-12:30 pm PST, Dickerson Insurance “What Advisors Should Know About Broker Compensation: The Past, Present and Future.” Register
NOTE: Dickerson offers variety of ongoing CE credit courses, found @
https://dickerson-group.com/upcoming-webinars
Nov. 14, 12:00-2:00pm PST, CAHIP OC “CAA Gag Clause Prohibition & Attestation Requirements” Register
Nov. 15, 10:00-11:00am PST, CAHIP LA Medicare Agents Quarterly: Coffee Chats, Register
December 2023
Dec. 07 2023@11:30 AM – 12:30 PM, 1 Hr. CE Credit – Presented by Dave Fear Sr., What Advisors Should Know About Telemedicine & Virtual Care Benefits, Register
Dec. 12, 2023@ 5:00 PM to 7:45 PM, Newport Beach Parade of Lights Harbor Cruise Balboa Pavilion, 400 Main St, Newport Beach, CA 92661, Register,
**On-site or walk-in reservations will not be ACCEPTED**
Dec 14, 2023@4:00 PM – 7:00 PM, “CAHIP GG Save the Date! Holiday party, Save The Date!
Dec 15, 2023@5:00 PM to 8:00 PM, “CAHIP-LA Annual Holiday Party, TBD, Save The Date!
2024
Jan. 22 @ 10 am–5pm PST, CAHIP Innovation Expo, Sheraton Universal, LA. Register: CAHIP.com
March 25-27, Ellevate Women’s Leadership Summit 2024 @ JW Marriott Las Vegas. Register
May 6-8, CAHIP Capital Summit @ Kimpton Sawyer Hotel, Sacramento, Register
June 23-26, Society for Human Resources Management SHRM24 Annual Conference and Expo @ Chicago, Register
