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The Forgotten SEP Code That Every Agent Should Know

January 20, 2017

CMS, Medicare, Medicare Advantage, SEP, star ratings

Another open enrollment has come and gone.  So selling Medicare plans are over correct?  What if we told you that there is another SEP out there that allows a client to join or switch to a plan that has been awarded the coveted 5 stars by CMS?

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A Matter of Perspective

Simply put, insurance agents work in a world of regulations.  Many, many, many regulations.  You have to be licensed.  You have to maintain that license with continuing education.  You have to certify in multiple areas for multiple products and multiple carriers, in areas as diverse as Fraud, Waste, & Abuse training for life insurance (and other products), special certification for Long Term Care Insurance, AHIP certifications for ACA and Medicare product, carrier Medicare product certifications, etcetera, etcetera.

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CMS Increases ACA Oversight & Wants to Classify Provider Networks

February 18, 2016


What can we expect from CMS in 2017?  More oversight, that is what.  CMS intends to take on a bigger regulatory role in reviewing ACA premium rates and categorizing provider networks for qualified health plans (QHPs) offered via the 36 insurance exchanges that rely on the federal platform.

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CMS Wants Bigger Role in Rate Review

February 11, 2016



Under the ACA, exchange administrators are required to consider rate increases when making certification decisions. Previously, CMS flagged so-called “outlier” rates, which were substantially higher than others, and then asked that state’s department of insurance to provide a rationale for approving the increase. The agency often deferred to states in allowing substantial rate increases. When carriers submit initial 2017 rates this year, however, CMS proposes conducting a rate review of QHP increases over 10% according to the letter.

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