Are you ready for some OEP?

Are you ready for some OEP?
Medicare OEP – October 15, 2014 through December 7t, 2014
Affordable Care Act OEP – November 15, 2014 through February 15, 2015
• The phone lines will be muted
• You may type you questions in the GoToMeeting box on the right
• All Q&A will be sent in a follow up email
• Recorded webinar will be posted at
• New carrier surprise!
• Certification
• ACA – FFM & CMS Enterprise portal
• Medicare – AHIP & FWA
• Medicare
• New carrier surprise!
• Plus, a new regional MAPD from the Houston area!
• Marketing
• Community, Provider, Faith Based
• Retail
• Walmart
• H.E.B.
• Leads
• Looking forward, what to expect?
What was our August 2013 mindset?
• – “we are ready for enrollments”
• Who is a Navigator?
• What is a subsidy? And what will my penalty be if I do not enroll?
• How will the DHHS and CMS be able to handle two open enrollments
at once?
• What is a health insurance exchange?
• What is a SHOP exchange?
• What is a SHOP exchange tax credit?
• What will BCBSTX pay the agents?
• What does “pay or play” Mean?
And what is our August 2014 mindset?
• What did we learn for the first OEP in 2013?
• Is really ready this time?
• What other health insurance companies will jump off the sideline,
and where will they jump?
• Will the SHOP Exchange function, and if so when?
• How will the IRS collect back all of the subsidies that were over paid?
• Am I ever going to get paid on all of my cases?
• Why will my doctor not accept Obamacare? (What does this mean?)
BCBSTX Updates
• “POR” - Producer of Record Letters
• For cases July 2014 and forward, but commissions will not be paid retro-active
to original effective date
• Currently being accepted
• “AOR” - Agent of Record Letters
• From January 1, 2014 effective dates that were not connected to an agent
• No longer being accepted
BCBSTX Updates
• Deadlines for 2015 certification
• FFM Certification deadline for current agents is September 15, 2014
• Re-contracting – make sure you have received your link!
• You must have completed your re-contracting by September 1, 2014
• Call Producer Services if you have not received your link at 855-782-4272
• Commissions – email [email protected] on the clients
you have not been paid for
• Snap Shot Bonus – September 2014 payment
BAP Enhancements
• Seeing your production made easier
• Commissions
• Quotes
• Online apps
• Status
BCBSTX 2014 OEP Stats
• Off Exchange = 375,000 apps
• representing 550,000 lives
• On Exchange = 100,000
• representing 150,000 lives
• Total 475,000 apps
BCBSTX ACA Enrollment Statistics
Bronze = 32% of total sales
Silver = 59%
Gold = 9%
56% Female / 44% Male
80% received a subsidy
Average age off exchange was 36
Average age on exchange was 42
Catastrophic = 0.6%
Platinum – not offered
Biggest issue with BCBSTX
• List bill – has to be paper for now; no electronic enrollments
• “Qualifying Events” must be paper app only for now
• The HMO network
• Were doctors “auto-assigned”?
• Did they know they were “auto-assigned”?
• Solutions being worked on:
• New systems are being developed to verify if the premium has been paid
when checking in at the provider’s office
• In Texas, only 10% of the potential marketplace was enrolled
• 39% of the existing uninsured population is Hispanic
• 3,100,000 uninsured left in TX
• BCBSTX wants the Hispanic population
• Instructions are online at
• Federally Funded Marketplace
• New carrier surprise!
• Medicare & FWA
• $125 if you register via a specific company Medicare Advantage website
AHIP Reimbursement up to $125
Write 5 MAPD applications with any combo of the following carriers:
We are super proud to announce our new affiliation with Humana!
• H1
• Individual and Family coverage
• Medicare
• Medicare Advantage
• Medicare Supplements
• Prescription Drug Plans
New Regional plan: Memorial Hermann MAPD
• Lead program to move up to 44,000 Medicare Shared Savings Plan
enrollees in the 2015 Memorial Hermann MAPD
• 100% iPad enrollment = 100% compliant!
• Provider marketing opportunities
• Contact Tanya or John at 800-442-4915 for store assignments
• H.E.B. (up to 70 stores so far)
• Walmart (up to 160 stores nationwide so far)
• Memorial Hermann leads – up to 44,000!
• New website to develop consumer leads for our “Marketing Partners”
• Coming soon!
• Medicare and ACA leads via SEO, compliments of TBI!
H.E.B. for ACA and Medicare Marketing
The Brokerage
has been
awarded 70
locations (new Walmart opportunity)
• New rules, strict protocols!
• $500 buy in
• May be reimbursed up to 100% by
TBI with production
• Branded shirts to be purchased
by participants
What to expect moving in the 2015 OEP
• Annual redetermination of subsidies
• Many will keep the plan they have from 2014
• Per CMSs’ wishes to make things smoother from 2014 to 2015
• “IRS come to Jesus meeting in April 15, 2015”
• CMS prefers to keep the disruption to a minimum and focus on
getting more people insured
Questions and Comments
Please type your questions or comments in the Q&A box to the right of
your screen. We will answer all questions and send a follow up email to
all participants.

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