The Ins and Outs of Washington How Medicare Plans are Impacted Dwane McFerrin RHU, CLU, CFP, CLTC, LLIF Chair, NAHU Medicare Working Group Member, NAHU National Legislative Council Janet Trautwein, CEO of NAHU

Regulation CMS proposed 120.4.4 Agent websites 100.7 Essentially eliminates override payments on an enrollment basis Agent websites 100.7 CMS filing required if mentioning PDP or MAPD Medicare Supplement – first dollar coverage Plan F not available to new Medicare eligibles 1/1/2020 Cost Plans going away in 2019 – highly likely to be implemented 120.4.4 would remove management overrides but CMS was hit hard with criticism with no parties supporting their proposal. Secretary Price has told NAHU that this is going away CMS proposed reigning in agent websites and requiring filing if even mentioning Medicare Advantage or Part D. Not sure how it can be managed with social media but it is likely to be passed in MMGs in June NAIC has moved to remove first dollar coverage Plan F 1/1/2020 for newly Medicare eligibles. About 57 million can still buy Plan F but it would require underwriting. GI product would move to D and G. Expect a high deductible G to be introduced. States like WI, MN and ND have Cost plans (hybrid-type plans that exclude Part D) and they can no longer be sold 1/1/2018 and anyone having the plan type will lose it 1/1/2019. Expect disruption and new plans being filed in these states next year.

Regulation New Medicare cards starting in April 2018 Unique, randomly-assigned number Lessens identity theft, fraud Completed by April, 2019 21-month transition period for providers

Legislation Agent Service Role Observation Status OEP Reinstatement Increased role of agent Observation Status S. 568 and H.R. 1421 OEP Reinstatement Single Payer Proposals NY and CA COBRA as Creditable Coverage Agents have been stiff-armed on calling the carrier on behalf of the agent but this is changing as CMS has confirmed that other than privacy requirements, there are no special requirements for PDP and MAPD where the client has to initiate the service call. UHC has implemented a change where agent can report claims problems and make changes in providers. Expect other carriers to follow suit. Observation Status has not only bipartisan support for ending the practice of preventing rehabilitation services for those caught in observation status instead of admittance for 2 midnights, there is a class action lawsuit that can also end this practice by hospitals. of S. 568 and H.R. 1421, the Improving Access to Medicare Coverage Act of 2017. These bills address Medicare’s “two-midnight” policy and would allow observation stays to be counted toward the three-day mandatory inpatient stay for Medicare coverage of a skilled nursing facility As part of the 21st Century Cures Act, the OEP switch period from 1/1 to 3/31 will be reintroduced in 2019 to allow seniors to make plan switches. NY and CA are proposing single payer plans to address all ages including Medicare in their state in response to the failure of the ACA. Not sure if the legislation will be passed into law.

NAHU Encouraging Innovations Incenting consumers through coordinated care and health improvement measures Reduce medical costs

Other Priorities Chronic Care Act BENES Act S. 870 Value-based Insurance Design Section 301 expands testing of the model BENES Act Communication on enrollment, avoiding delays