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Trinity Health Plan of New England

Trinity Health Plan of New England is a private health insurance plan that offers both HMO and PPO options at an affordable price.  These plans are available to Connecticut residents in the counties of Hartford as well as Tolland.

To learn more about Trinity Health Plans; Click here

Both Trinity’s HMO and PPO plans offer many value based benefits that include:

1. A $0 plan premium
2. Primary care visits with no co-pay
3. Mail order, Tier 1 & 2 drugs have a  $0 copay
4. No cost virtual care visits (see SOB for details)
5. Some plans offer $0 medical deductibles
6. A travel allowance of up to $3,500
7. Dental coverage
8. Over-the-counter allowance
9. Vision hardware allowance
10. Acupuncture treatments are covered
11. ED drug coverage
12. Meals delivered to your home after an in-patient hospital stay

For a look at the 2023 PPO Summary of Benefits; click here

HMO 2023 Summary of Benefits; click here

Another great benefit Trinity Health Plan of New England offers is the extra $600 annually in your Social Security check!

This benefit gives members an extra $50 in their social security check each month.  It is basically a partial reimbursement for their Medicare Part B premium.  Take a look at the SOB for each plan for more details.

These plans cover Every one of the top 100 drugs.

If you don’t see your drug on our formulary?  Trinity can either provide formulary alternatives or a one-time (30-day) transition fill during the first 90 days of enrollment.
You may also request a formulary exception if you need to.  You can check the formulary on TrinityHelathofNE.org/Medicare and check applicable drug requirements as well as quantity limits for specific drugs.

Insulin is covered at an affordable rate so members receive access to necessary care for their diabetes.  Members do not pay more than $35 for a 1 month supply of each insulin product covered by your plan.

Take a look at the 2023 OTC catalog – Click here

Trinity Health Plan of new England – Pharmacy network:

Trinity is partnered with over 66,000 retail chains as well as independent pharmacies nationwide.

Some of the pharmacies include:

Costco Pharmacy, Saint FrancisRx Pharmacy, CVS Pharmacy, Sam’s Club Pharmacy, Medicine Shoppe, Shoprite Pharmacy, Price Chopper Pharmacy, Stop & Shop Pharmacy, Walmart Pharmacy & Walgreens.

To view a complete list of pharmacies either visit us online at; TrinityHealthOfNE.org/Medicare of call 866-934-9524 (TTY:711).

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Medicare Insulin $35

The Medicare Insulin $35 copay Part D Senior Savings Model (SSM) will continue in 2023.   The recently passed program called the “Insulin Now Act” will continue a program that began in 2001.  The program puts a cap of $35 for a one month supply of certain brands and types of Insulin.

Part D costs with the program

The cost for Insulin in the program will be capped at $35 per month for a one month supply.  There are a number of pharmaceutical manfaturers participating in the program. (See list below) The fixed cost will provide substantial savings to those with Part D drug plans (Either through a stand alone Part D plan or a Medicare Advantage plan).  The Insulin prescriptions will not be subject to the usual cost aspects of a Medicare Part D plan.  This includes any initial plan deductible, Initial coverage phase and Part D Coverage Gap.  It does not apply during the catastrophic coverage phase so the cost may change at that time.

The Medicare Insulin $35 copay SSM: Participating Pharmaceutical Manufacturers
1. Eli Lilly and Company
2. MannKind Corporation
3. Mylan Specialty L.P.
4. Novo Nordisk, Inc. and Novo Nordisk Pharma, Inc.
5. Sanofi-Aventis U.S. LLC

Medicare Insulin $35 copay:  Quoting plans

Please note; the $35 program does not cover every type of insulin.  Some of the more expensive name brand drugs for diabetics such as Jardiance or Trulicity will not be capped at $35. You can access a list of the Insulins that will be capped at $35 Part D insulin saver program list 2023

Starting with the 2023 Medicare AEP, drug comparisons on a number of systems will reflect the $35 cost cap on Insulin.  Online comparison sites such as Connecture, Sunfire and  Medicare.gov plan finder will all reflect the new cap of $35.

Changes to Medicare for 2023

In addition to the Medicare Insulin $35 copay cap, there will be other changes to Medicare for 2023.  There are the usual changes to the Medicare premiums, deductibles and copays.  In addition, there is a new type of Medicare Part B and new rules for those with delayed Part B enrollments.

Learn about the changes to Medicare benefits, premiums and enrollments here

Watch a video about the changes here

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SilverScript SmartRx 2023 PDP Changes for 2023

The SilverScript SmartRx 2023 PDP plan will have some changes.  It will be important for Medicare agents to know what is changing and how to quote and compare the plans for 2023.  The plan will not pay commission on new sales for 2023.   As a result, some quote and comparison sites will not show the plan when running drug comparisons.  Read below to learn more.

Commission

Name Change

Premium 

SilverScript SmartRx 2023: Quoting and comparing  

The plan not being commissionable for new sales in 2023 creates some challenges for us as agents.  The plan will continue to have a very low premium for 2023.  Depending on the medication list of clients it may still come out the best for them in 2023. Luckily commissions will still be paid on existing cases.   The challenge is quoting and comparing the plan for existing clients.   Since the plan will not pay commission for new 2023 sales, it is not on a number of quote and comparison sites.  Here is where you can and cannot look to see the plan in 2023:

Connecture 

Sunfire

MyMedicareBot 

SilverScript SmartRx 2023: Register for a webinar on Connecture, Sunfire and MyMedicareBot

Medicare.Gov Plan Finder: 

In addition to access to Connecture, Sunfire and MyMedicareBot at no cost, Crowe and Associates offers a number of other agents benefits

Click here for agent benefits and programs

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Medicare Savings Program CT 2023

If you are either a Medicare beneficiary, eligible to receive Medicare or a Medicare agent who offers plans in CT, you need to understand the Medicare Savings Program CT 2023.  This can be a very useful tool for some clients who have a lower income.

The amount of extra help you receive depends on your gross income level.  Single people will use their gross income to determine eligibility and level of help.  Married couples’ eligibility depends on their combined gross income.  The monthly income limits in the chart below are effective as of March 1, 2022.

If your income falls either at or below the income levels listed below, If you are not sure if you are eligible to receive extra help; we have listed the income levels below:

There are 3 different levels of MSP:

The level of help you receive is based on your gross income.  Please see below for MSP levels and what they provide:

Click here for income level chart.

QMB – this level of extra help pays your Part B premium, all Medicare deductibles and co-insurance.

Income levels for QMB are as follows:  Individual, $2,390 of gross income per month,  couples, $3,220 per month.

SLMB – this level pays your Part B premium only.

The income levels for SLMB are as follows:  Individual, $2,617 of gross income per month, couples, $3,525 per month.

ALMB – this level will provide payment of your Part B premium and is subject to availability of program funds. If you receive Medicaid, you cannot participate in this program.

Income levels for ALMB are as follows:  Individual, $2,786 gross income per month and couples, $3,754 per month.

To apply online, please visit www.connect.ct.gov, under ‘Apply for Benefits.’

Formulario de Renovación de programas de ahorro de Medicare (W-1QMBS)

Click here to download a CT MSP application

If you receive any of these levels of MSP coverage, you are automatically enrolled in the Low Income Subsidy (LIS), also called “Extra Help” with Medicare.  Once you are enrolled in LIS, Medicare pays the full cost of your Medicare (Part D) prescription drug coverage i fit is a benchmark plan.  Medicare will pay a portion of anon-benchmark plan.  They will also provide payment of your annual Part D deductibles, co-insurance or co-pays.  This does not change if you hi the coverage gap (donut hole).

Once you have LIS, you have a special enrollment period to change either Part D or Medicare Advantage plan.

If you need more information about the LIS, please visit www.socialsecurity.gov or call 1-800-Medicare (TTY: 1-800-325-0778).

Medicare Changes 2023

The Medicare changes 2023 includes the 2023 benefits and major changes in Part B enrollment rules.   The standard benefit changes for 2023 Medicare A and B benefits are listed below.  This includes premiums, deductibles and copays.  In addition, there are some changes to part B enrollment time frames.  There are also some notable changes to the Medicare Part D model plan design which is detailed below.

Rather learn about this information via a recorded webinar?  Review our webinars on YouTube

Big changes to Medicare Part B enrollment

The Beneficiary Enrollment Notification and Eligibility Simplification Act (BENES ACT) creates some major changes for Medicare Beneficiaries effective 1-1-2023.

Changes to Part B enrollment

• Those in the last 3 months of their Medicare Part B IEP will be able to get a part B effective date the month after they apply!
• Those applying for Medicare Part B through the Medicare Part B General Election Period will have their Medicare B start the month after they apply.  They will no longer need to wait for a July 1 start date!
• There will be a number of Medicare Part B SEP’s for those applying outside of their IEP or the Medicare GEP
  • Those that had an emergency or disaster during their Medicare B IEP or Medicare B GEP
  • An employer or health plan made an error or material misrepresentation of information as it relates to the members Medicare enrollment
  • Those formerly incarcerated
  • Those that lose Medicaid

Medicare Agents!  Learn how to hold Medicare T-65 educational seminars to explain the important changes to Medicare prospects.  (Averaging 60 attendees per seminar)

Medicare Changes 2023:  Part A of Medicare

The Medicare Part A premium and deductible will be changing slightly for 2023.  Medicare Part A includes inpatient hospital, skilled nursing, hospice, inpatient rehab and some home health care services.

• Inpatient hospital deductible (if admitted): Changing from $1,556 in 2022 to $1,600 in 2023
• Co-insurance will be $400 per day from day 61 through 90  ($389 in 2022)

Medicare Part A monthly premiums

Medicare enrollees age 65 and over with fewer than 40 coverage quarters and people with disabilities may voluntarily enroll in Medicare Part A at no monthly cost. Those with at least 30 quarters of coverage or were married to someone with at least 30 quarters of coverage may buy into Part A at a monthly premium.  The premium will be $278 a month starting in 2023.  This is $4.00 more a month than 2022. Individuals without other coverage and less than 30 quarters of coverage and individuals with disabilities without other coverage or have exhausted other entitlement will pay the full premium. The amount in 2023 will be $506 a month.  This is an increase of $7.00 a month compared to 2022.

Medicare changes 2023: Part B of Medicare

• Medicare Part B premium for 2023:  Monthly B premium will be $164.90 which is a reduction of $5.20 a month compared to 2022
• Annual Medicare Part B deductible:  The deductible for 2023 will be $226 which is a reduction of $7.00 a month from 2022

Medicare Changes 2023: IRMAA (Income Related Monthly Adjustment Amount)

Those with higher incomes pay more for the monthly Medicare Part B premium.  Please keep in mind, IRMAA income is based on the income of the individual from 2 years prior to the current year.  It is adjusted every year going forward.

Immunosuppressive Drug Coverage only

Beginning in 2023, Medicare enrollees who are 36 months after kidney transplant and no longer eligible for Medicare , have the option to continue Part B to cover immunosuppressive drugs. There will be a premium of $97.10 to do so.  This program will coordinate with MSP for those eligible for the program.This is a limited Part B that will cover immunosuppressive drugs only.

The 2023 Part B monthly premiums for higher earning beneficiaries with immunosuppressive drug only Part B coverage are listed in the table below:

Premiums for high-income beneficiaries with full Part B coverage who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Medicare Changes 2023: Higher earning beneficiaries with immunosuppressive drug only Part B coverage that are married and lived with their spouse at any time during the year, but file a separate return.

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Call Recording Connecture Sunfire MyMedicarebot

Connecture, Sunfire and MyMedicarebot are 3 different Medicare quote and enrollment platforms. Agents working with Crowe and Associates and PFS insurance have access to all at no cost. Agents can access all 3 through Connect4Medicare.com (You need a username and password to access the site).  Call or email our office if you do not have a username and password.

WANT TO GO STRAIGHT TO THE CALL RECORDING VIDEO EXAMPLES FOR EACH SYSTEM?  SCROLL TO THE BOTTOM OF THIS BLOG POST

All 3 systems work in a similar manner by letting agents quote and compare plans and enroll prospects without the need for a face to face meeting.  They will also have the ability to record calls compliant with the new CMS call recording rules.  READ ABOUT THE NEW MEDICARE CALL RECORDING RULES FOR AGENTS HERE  There are a number of features common to all 3 systems which are listed below.  The call recording features are further down the blog post.

Common features for Connecture, Sunfire and MyMedicarebot

• Basic CRM function that saves client contact information, applications, scope of appointment documents, drug lists, doctors lists and plan history
• Create plan comparisons and email or text them to prospects and clients
• Run drug and doctors lists against the plans to see what comes out best
• The system is similar to the Medicare plan finder.  The differences are you can save all the info and you are the selling agent when using one of the 3 platforms
• Record all phone calls to be compliant with the CMS call recording requirements.  (Saves recording for the 10 years required)
• Enroll prospects over the phone via text or email (Connecture and Sunfire)  MyMedicareBot is voice signature for the scope and enrollment without the need for email or text
• Access to PURL links that allows clients and prospects to quote and compare plans and ultimately enroll in a plan on their own.  (You will be the AOR if they do)  The PURL is specific to the agent and has the agents contact information.  It can be added to a website or sent as a link through email.  Learn about the PURL
• Ability to see and compare all plans available in the area even if agent is not appointed with the company
• Watch recorded webinar on Connecture, Sunfire and Medicarebot
• You can submit your health risk assessment through Connecture & Sunfire
  • Connecture HRA carriers 2023 – Click here
  • Sunfire HRA Carriers 2023 – Click here

Update: All platforms will provide call recording at no cost to the agent.  It was initially thought there would be an extra cost to for the recording feature through Connecture but PFS insurance has made the decision to cover the additional cost for agents

Access MyMedicarebot, Connecture and Sunfire through Connect4Medicare site

MyMedicarebot

• MyMedicarebot is voice signature:  No need to email or text scopes or enrollment links
• There is a downside due to the limited number of carriers available
• Current carriers available:
  • Aetna – Quote/Enroll
  • Cigna – Quote/Enroll
  • Humana – Quote/Enroll
  • UnitedHealthcare – Quote/Enroll
  • Wellcare – Quote/Enroll
  • Anthem – Plans to be Quote only by 10/15!
  • Agents will be able to quote and compare all plans doing business in a given county but will only be able to send quotes and enroll the ones listed above

Connecture

• Connecture if making a number of improvements for 2023.  This includes the ability to enroll prospects into ancillary products such as dental, vision and hospital indemnity plans.  It will also have a feature to show drug savings programs for off formulary medications.
• Connecture has a comprehensive number of carrier available for enrollment and the ability to see carriers that the agent is not contracted to sell
• Click to see new Connecture Features for 2023

Sunfire

• Sunfire has a large number of upgrades for 2023 such as ability to pre fill the entire SOA, Access to plan history, MBI, drug help and dual status and a number of other features by giving agents access to the Marx system (limited version but still incredibly useful)
• Ability to see all plan benefits and all extra benefits on the initial 3 plan comparison without the need to drill down on benefit details.
• Very user friendly platform for agents and prospects
• Ability to see agent ready to sell (RTS) with all carriers in all states

Call Recording Connecture Sunfire MyMedicarebot:  Videos of call recording features using the links below

CLICK FOR CONNECTURE RECORDING VIDEO 

SUNFIRE RECORDING VIDEO 1

SUNFIRE RECORDING VIDEO 2

MyMedicarebot RECORDING VIDEO 

Free Medicare lead and marketing program

Crowe and Associates offer a Medicare lead program to agents!  $500 per agent per month toward any Medicare lead or marketing costs

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CMS Call Recording Requirements

CMS call recording requirements for insurance agents are a result of the CMS Final Rule set for October 1, 2022.  The rule expands the definition of who is a TPMO to include independent Medicare agents, agencies and brokers. The rules are applicable to MA/MAPD and Part D products.  Because CMS does not regulate Medicare supplement products, CMS does not include them in the new rule.  TPMO stands for Third Party Marketing Organization and now includes NMO’s, FMO’s, agencies, brokerage, independent agents and brokers.   This blog will provide an outline of the changes from the Final Rule and also how agents can be compliant with them for the 2023 AEP.

The new rules

The new rules are applicable to all TPMO’s.  The definition of a TPMO has been expanded to include both independent agents and agencies. Agents need to be compliant with the new rules by October 1, 2022.  Here are the main points to know:

• Record all calls with Medicare beneficiaries in their entirety, including the enrollment call. The rule is including the entire “chain of enrollment” which requires agents to record inbound and outbound calls, enrollments calls and any calls leading up to the enrollment and post enrollment.  (If the call is going to lead to a Medicare Advantage or PDP or the attempt to make a sale)  The recording must be available for 10 years
• The addition of a TPMO disclaimer on enrollment phone calls and any marketing materials;  the agent must state the TPMO disclaimer within the first minute of the enrollment/sales call.
• TPMO disclaimer must also be displayed on all Medicare marketing materials (Not Medicare supplements) which includes emails, websites, newspaper ads, flyers, mailers or any other promotional advertising method
• NOTE:  Call recording is NOT required when meeting for a face to face meeting.  There is also no recording requirement for educational events
• Zoom Calls:  Some carriers are stating Zoom calls are a face to face meetings.  (CMS is stating Zoom calls are not face to face and recording is needed)

CMS call recording requirements: The TPMO disclaimer

Here is the disclaimer which must be used for sales calls and on all marketing materials as well as all marketing communications:

“We do not offer every plan available in your area.  Any information we provide is limited to those plans we do offer in your area.  Please contact Medicare.gov or 1-800 MEDICARE to get information on all options.”

Immediate steps for agents

Take the following steps to be compliant with the new rule for October 1, 2022.

• Add the TPMO disclaimer to your website
• Have the TPMO disclaimer on all email communications
• Easiest way is to add the disclaimer to your email signature line
• Add TPMO disclaimer to all marketing materials including print and TV ads.
• Use an enrollment platform that can record calls and keep them for the required 10 years  (We offer Connecture, Sunfire and MyMedicareBot at no cost)
• If you do not have access to an enrollment platform, add a service to record all calls at the office or home.  Many companies offer the service at a surprisingly low cost ($25 to $45 a month).

Connecture, Sunfire and MedicareBot offer call recording and 10 year recording storage at no cost to our agents! Learn about all three systems and watch 3 minute demonstration videos of the call solutions for each

CMS Call Recording Requirements:  Other questions and rule enforcement

Many agents are asking if they need to record all calls vs. recording only the enrollment calls.  The CMS rules make it clear; the expectation is to record all calls in the “chain of enrollment”.  This means you should record all calls leading up to the sale.  This includes the sale as well as post enrollment calls.  The unanswered question is;  how will CMS regulate it. It is reasonable to assume the carriers (They ensure compliance of CMS rules for TPMO’s) will only ask for the actual enrollment call when doing compliance checks.  Keep in mind; this is not guaranteed, so the way to be sure of 100% compliance is to record all calls.  There will likely be many agents that record the sales/enrollment call only.  Only time will tell if that is enough to stay in good standing with compliance checks.

Learn about our T-65 Medicare seminar program!  Averaging 65+ prospects per seminar!  Our agents and agencies can run seminars throughout the year using this turnkey seminar program.

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