Recent CMS Guidance Impacts Humana’s Payment Process
The following information is from Humana. If you have any questions, please contact AMAC Broker Services at 1-888-776-6565 or via email at [email protected]
Or contact Humana at [email protected].
Amendments to contracts containing information about The Centers for Medicare & Medicaid Services’ (CMS) recently issued updated guidance regarding when an agent should be paid full or pro-rated initial year compensation were sent in November 2015 to Humana’s contracted agencies. For your reference, we’ve included the updated CMS guidance below:
There are three scenarios affecting how an organization may pay full or pro-rated initial compensation.
- For a beneficiary’s first year of enrollment in a plan, in which the MARx report lists the prior plan type as “none,” organizations may pay full or pro-rated initial compensation.
- When a beneficiary moves from an employer group to a non-employer group plan, in which the MARx report lists the prior plan type as “none,” organizations may pay full or pro-rated initial compensation for a beneficiary’s first year of enrollment in a plan.
- For unlike plan changes (e.g., MA-PD to PDP or PDP to Cost Plan), occurring after January 1 in which the MARx report indicates the beneficiary had prior plan history (regardless of plan type), organizations must pay pro-rated initial compensation according to the number of months in the plan. For example, a change from a PDP to an MA-PD effective May 1 is an unlike plan change resulting in a pro-rated initial compensation of 8/12 (May thru December) of the MA-PD initial compensation rate.
For further clarification, the chart below is a brief summary of how the new CMS guidance will affect payments:
|Type of Enrollment
(as indicated on the CMS MARx report)
|Description||Humana Commission Payment|
(prior plan type listed as “none” on MARx report)
(i.e. age-in, new to Medicare,
or enrolls from original Medicare)
|Full Initial Sale commission|
|Unlike Plan Type Change
(prior plan history indicated on MARx report)
|PDP only to MA or MAPD
MA or MAPD to PDP only
|Initial Sale commission will be
pro-rated based on the
number of months the member will be enrolled in the plan.
|Employer group plan to a
non-employer group plan
when MARx report indicates prior plan type as “none”
|Group plan to individual plan||Full Initial Sale commission|