This was a question from one of our clients this past week. They sell Medicare Advantage policies and, as a prerequisite to selling these policies, are required to go through AHIP’s marketing certification for MA policies. By going through this Medicare training and signing an agreement with the carrier, are they HIPAA compliant?
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Statistically, the number of Humana’s MAPD/PDP enrollments that result in an allegation against an agent is just a small fraction of a single percent. The number of allegations that are founded as a result of investigation are just a fraction of allegations themselves, which is outstanding. Here are my root cause reasons for these strong compliance outcomes:
Over the last several months I had heard it all. Medicare Advantage is going away. The days of the Balanced Budget Act are back. Time to call in the dogs and put out the fires. But wait, a 3.3% increase to reimbursement rates? What happened to the 8% reduction? Looks like all the anxiety over Medicare Health Plans was for not.
Time and time again we have seen this play out in similar fashion. Government programs are introduced or adjusted, and instead of detracting from the potential of the market, it creates more opportunity than ever before. This phenomenon goes all the way back to the inception of the Medicare trust fund, to the standardization of Medicare supplements, to the MMA, and now Health Reform known as the Patient Protection and Affordable Care Act. Contrary to initial reactions, history shows us that these laws have created enormous opportunities for agents and agencies who are prepared.
We can’t forget the importance of service, ethics, and compassion for clients in our roles as insurance professionals. I was reminded of this when I fielded a call last week from a plan member, who had some legitimate concerns. I rarely speak with the members themselves, so this caught me off guard at first. The lady on the line was noticeably upset, a bit frightened even, and looking for someone that would help her. She had just received notification that her Medigap plan was going to experience a significant rate hike for both she and her husband, and while she never came out and said it, I could sense that affordability of this new premium was a major challenge. She shared that it was very difficult to reach her agent, and after several attempts, was told that there was nothing that could be done, and that the reason for the increase was “Obamacare”. Her husband, also an older gentlemen, struggles with hearing on the phone, so she was stepping up to the challenge of finding solutions on behalf of them both. This woman was very sharp, and perceptive, but obviously needed someone with the expertise to advise her of any and all options available to reduce their cost of coverage. Having recently celebrated a birthday, her research revealed that there may be some favorable rules within this time period that might allow their to select another plan in their state of residency. Her existing agent had already written this option off.