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Effects of Affordable Care Act Coming to Medicare Agents

—March 4, 2013

After getting signed into law three years ago, we are now starting to see changes take effect from the Affordable Care Act (aka PPACA, Health Care Reform, or Obamacare) and how it will overhaul much of the health care system. Two of the major changes include the new health insurance exchange program as well as reductions to Medicare Advantage reimbursements.

Medicare Advantage Reimbursements

Many are wondering exactly how this is going to affect Medicare Advantage in 2014. With the release of CMS’s “45 Day Notice” letter, we can now see there will be a lot of provisions not only to the base payment rates, which could be cut by more than 8%, but there will also be a lot of methodology changes that could cut payments received by Medicare Advantage sponsors. It included significant alterations in how risk adjustments are determined, how CMS calculates the key fee-for-service cost in each county and how much plans may increase a beneficiary’s total cost.

Dwane McFerrin, Vice President Medicare Solutions at SMS, says, “If these cuts are enacted as proposed, it could lead to more consolidation in the market, narrower HMO networks and service area reductions. Carriers were anticipating cuts but those proposed exceeded expectations. What's particularly frustrating is that cuts were essentially averted in an election year but now we seem to have CMS doubling the anticipated cuts for 2014.”

Health Care Exchanges

With the health exchange open enrollment beginning October 1st, which overlaps with the Annual Election Period for Medicare Advantage and Part D, this will be a very busy time for agents who sell both major medical and Medicare products. Many agents will need to find ways to keep up with all of the enrollments coming in during this very busy time.

Are you an agent that sells both major medical and Medicare products? If so, look to Senior Market Sales for technology solutions to save you time and money. With our proprietary App-by-Email and Agent Initiated Consumer Online Enrollment (AICOE) methods you will be able to handle the busy enrollment season with a lot more ease.

Call Senior Market Sales at 1-877-645-0147 for more information!

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