Medicare Broker Update

Prepare for the 2025 AEP season: Complete your AHIP certification today!

As the 2025 Annual Enrollment Period (AEP) approaches, Medicare brokers must ensure they are fully prepared to assist clients with their Medicare Advantage Prescription Drug (MA-PD) and Prescription Drug Plans (PDP). One of the essential steps in this preparation is completing your America's Health Insurance Plans (AHIP) certification. This certification is mandated by insurers, including Blue Shield of California, to ensure brokers and agents are compliant with the Centers for Medicare & Medicaid Services (CMS) guidelines and regulations.

If you were certified last year, you must renew your certification this year before January 1 of the new year to receive renewal commissions on your active book of business. If you are not certified to sell Blue Shield's MA-PD or PDP plans, we cannot, by law, pay you commissions on that business.

2025 Medicare Broker Certification Product Training and Exam will be available beginning in July.

We've updated and improved the process and interface for how you complete your Blue Shield Product Certification. Our job aid will help guide you through the process.

Step 1: Complete your AHIP certification

• Only pay $125 by using our Blue Shield of California link.
• You must complete your AHIP certification and transmit your results to Blue Shield before moving to Step 2.

Step 2: Log into your Broker Connection account and visit the MA-PD and PDP certification.

• Follow the links to the Blue Shield- "Shield Learns" portal
• Complete the MA-PD/PDP product certification. You'll have 4 attempts to pass. To pass, you'll need a score of 85% or higher

For questions or more information, please email MedicareBroker@blueshieldca.com.

Medicare Supplement Rate Action Effective July 1, 2024

The Medicare Supplement rate adjustment announced in March is here. At Blue Shield of California, our commitment remains strong in building a healthcare system deserving of our family and friends.

Effective July 1, 2024, we implemented a rate adjustment for some of our Open Medicare Supplemental Plans. This adjustment is part of our strategy to ensure sustainable affordability and competitive benefits as our members age.

Here are the key details to help you assist your clients effectively:

Medicare Supplement Plans July 1, 2024, Rate Action

Plans impacted by the Rate Action:

• Open Plans F Extra, G, G Extra, G Inspire, and N
• July 2024 Rate Sheets

*Please note Plan G Inspire was closed to new enrollments effective April 1, 2024, and will be withdrawn from the market effective January 1, 2025. Please refer to the April 2024 Med Supp Plan G Inspire Closure FAQs.

Plans NOT impacted by the Rate Action:

• Open Plan A
• All Closed Plans

Average annual premium increase:

• Plans F Extra, G, G Extra and N receive an average annual premium increase of 7.9%.
  • Regions 1 to 6, 8 to 9: The average is 8.1%.
  • Region 7: The average is 3.3%.
    • The average applies to all affected plan types; however, the impacted percentages vary based on age and region. (Please assess member rates on an individual basis.)
• Plan G Inspire receives an average annual premium increase of 8.4%.
  • Regions 1 to 6, 8 to 9: The average is 8.6%.
  • Region 7: The average is 3.8%.
    • The average applies to all affected plan types; however, the impacted percentages vary based on age and region. (Please assess member rates on an individual basis.)
• Members outside of their rate guarantee will see only one premium increase per year that takes into account their age on July 1 annually.

Medicare Supplement Optional Supplemental Dental Plan Rate Action

None, rates will remain the same for the following plans:

• Dental PPO 1000 – $37.40
• Dental PPO 1500 – $56.10

As brokers, your guidance will be crucial in helping clients navigate these changes. For more detailed rate information and to better prepare for client inquiries, please review our July 1, 2024, Rate Action FAQs.

Streamline your workflow with our new self-service BOR changes

We're excited to introduce our online Broker of Record (BOR) service, designed to make your workflow more efficient. Here's what you need to know:

Key Features:

• Online Requests: Easily submit BOR change requests online for Small Group Off Exchange lines, Medicare Supplement, and IFP Off Exchange lines of business.
• Status Tracking: Our Online Client List feature effortlessly tracks your request status. Real-time updates ensure that your submissions are processed promptly without the need for additional information.
• Easy Access: Submit requests digitally and access the most updated forms through our platform for a smoother, more efficient experience.
• Guided Tours: Navigate the submission process easily using our Guided Tours, User Guides, and Quick Links. Reduce manual errors and ensure a seamless experience by clicking the Site help link at the top of any page on Broker Connection.

Take advantage of these tools:
Utilize these features to enhance your workflow and ensure your commissions are processed promptly. Please review our FAQs or log in to your Broker Connection account for more details.

Your feedback is crucial as we continue to improve our systems. If you have any questions, don't hesitate to reach out.

Boost Your Earnings with continued HRA support!

Thank you for your ongoing commitment to guiding our clients through the Health Risk Assessment (HRA) form process. Your dedication significantly impacts our ability to connect members with vital care coordination services and ensures they receive the right care. Moreover, completed HRA forms are crucial for determining Blue Shield's Medicare star rating.

To further acknowledge and reward your efforts, we continue to offer a $100 incentive for every HRA form successfully completed and electronically submitted for a new D-SNP plan member. Your participation not only enhances the members' experience but also contributes to the overall quality and performance of our Medicare plans.

Business Rules Scenarios:

• An HRA incentive will be paid when a beneficiary moves from a MAPD to a D-SNP plan.
• Moving from a D-SNP to a MAPD plan does not qualify for an HRA incentive.
• If a beneficiary reenrolls in a D-SNP plan within the same calendar year, the HRA incentive will be paid only for the initial enrollment.
• If a beneficiary enrolls in a D-SNP plan and submits an enrollment with another broker for the same plan and effective date, the HRA incentive is paid for the initial enrollment.

Additional Reminders:

• Try to answer as many questions as possible.
• Please ensure demographic information (phone/email/address) is accurate.
• Ensure that enrollment is submitted electronically through the compare plans and enroll system. Paper applications are not eligible.
• This incentive is exclusively available to individual brokers.
• Clients must be new D-SNP plan members and remain in the plan for at least one month.
• Incentives will be paid out only once per member for each calendar year.
• Incentives are paid in the month following the member's effective date and with the commission for the initial enrollment.

Please review our HRA flyer or Video for more information. You can also visit the Contact Us page if you need further assistance.

* HRAs can be submitted 90 days from the D-SNP enrollment effective date to qualify for the incentive.

Protect Your Clients: Beware of Medicare Scams Leading Up to AEP

As the Annual Enrollment Period (AEP) approaches, it's important to remind your clients about the heightened risk of Medicare scams. Scammers often take advantage of the confusion surrounding Medicare to exploit unsuspecting beneficiaries. Here are some key points to share with your clients to help them stay vigilant and protected.

Common Medicare Scams to Watch Out For:

1. Fake Medicare Representatives: Scammers may call or visit, claiming to be from Medicare. Remember, Medicare will never call or visit to sell anything.
2. Fraudulent Offers: Offers for "free" medical supplies or services in exchange for a Medicare number are often scams. Remind clients never to share their Medicare number over the phone unless they initiate the call.
3. Phishing Emails: Emails that appear to be from Medicare or other healthcare providers asking for personal information can be fake. Advise clients to verify the sender and not click on suspicious links.
4. False Claims of Cancelled Coverage: Scammers may threaten that a client's Medicare coverage will be cancelled if they do not provide personal information. Reassure clients that Medicare will not cancel coverage over the phone.

Tips for Protecting Clients:

• Educate and Inform: Regularly update your clients about common scams and how to recognize them.
• Verify Information: Encourage clients to verify any information they receive with their trusted Medicare representative.
• Report Suspicious Activity: If clients suspect they've encountered a scam, advise them to report it immediately to Medicare.

For more detailed information and tips on protecting your clients from Medicare scams, visit our News Center.

We can help ensure a safe and secure AEP for all our clients by staying informed and cautious. Let's work together to protect our Medicare community.

Register for success: Sign up today for an upcoming broker training session

We're committed to providing you with the tools and resources to help our members navigate the complicated and evolving healthcare space. Broker training events allow you to interact and ask questions with our Blue Shield team of subject matter experts. Join one of our trainings or contact your Broker Manager for more information.

Topics Include:

• Take your Business to a New Level – Learn Online Enrollment (DRX)
• How to Market on Social Media (Broker Connections – Online Tools)
• Navigate Broker Connection and Provider Networks
• How do Dual Eligibles Qualify for Dual Coverage (LIS, Medi-Cal Coverage)

Broker Training Webinar Schedule
Also, bookmark the News and Announcement page on Broker Connection for helpful information and FAQs.

Upcoming holiday schedules

Our offices will be closed on Thursday, July 4, to celebrate Independence Day. We will resume regular business hours on Friday, July 5. We hope you have a wonderful and safe holiday with your loved ones!