CMS OUTLINES MEDICARE PRIVATE PLAN SALES-AGENT TRAINING GUIDELINES

The Centers for Medicare & Medicaid Services (CMS) is encouraging Medicare private health and drug plans to meet minimum standards and cover a range of topics in the training the plans provide to both in-house and subcontracted agents.
In a March memo to plan sponsors, CMS said a review of training programs provided by 40 plans had allowed it to identify a series of “best practices” that the agency “strongly recommends,” but is not requiring, that plans adopt. For example, CMS recommends that plans require prospective agents to answer 80 percent of the questions correctly in order to sell the companies’ products and only be allowed two chances in the same year to pass the same test.

CMS also recommended that agent training for private fee-for-service plans cover a range of subjects, including how these plans work with providers and the rules that determine who will be locked into the plan for the year after enrolling and under what conditions people can change or drop out of a Medicare private health plan. Agent sales presentations should provide prospective members with specific disclaimers that explain how private fee-for-service plans work and information on limits on enrollees’ annual out-of-pocket spending. CMS does not specify whether agents selling plans with no out-of-pocket limits, or with limits that exclude certain services, should inform prospective enrollees of these gaps in the plans’ coverage.

-Adapted from: “CMS Outlines Agent Training Standards For Private Plans”, MEDICARE WATCH, a biweekly electronic newsletter of the Medicare Rights Center, Vol. 11, No. 7: April 1, 2008.

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