What MACRA Means For The Future Of Medicare Sales

General, Medicare, News June 24, 2019 0
What MACRA Means For The Future Of Medicare | Senior Market Advisors

MACRA will go into effect on January 1, 2020. It could make a huge difference in what plans you sell to new Medicare eligibles, and how you sell them. Your sales strategy could be affected in a big way.

What is MACRA?

MACRA, or the Medicare Access and CHIP Reauthorization Act, is a federal law that was signed in April of 2015. In 2020 it will prohibit the sale of Medicare Supplement (Medigap) policies that provide coverage for Part B deductibles (C, F, and High Deductible F).

You will not be able to sell those plans to newly eligible Medicare beneficiaries. However, the change will not affect beneficiaries who are already enrolled in Plan C and Plan F, so they can still renew those Medigap plans.

Another part of MACRA is a value-based payment system for providers. In 2015, the goal was to have 50 percent of Medicare treatment charges based on the quality of service (through alternative payment methods) by the end of 2018.

By 2020, everything will go through MIPS, or the Merit-Based Incentive Payment System. Physicians will receive a score based on quality, use of resources, practice improvement, and meaningful use of certified technology. That score will determine pay adjustments.

Physicians who are in their first year of Medicare service or are below the CMS-standard patient volume threshold will not operate under this system. The changes do not apply to hospitals.

How MACRA Will Affect Medicare Supplement Sales

You will still be able to sell Medicare Supplement plans A, B, G, K, L, M and N to newly eligible Medicare beneficiaries, and the coverage for each plan will remain unchanged. That means your sales strategy in your meetings won’t have to change much.

If a client would’ve received the most benefit from Medigap Plan F, before the 2020 changes, suggest Plan G instead. It offers the same coverage, except it does not offer coverage for the Medicare Part B deductible. Explain to your new clients that they will have to pay the Part B deductible no matter which Medicare Supplement plan they choose.

MACRA and Medicare Advantage Sales

MACRA does not directly change Medicare Advantage (MA) plans, but it may change what plans you sell. A MA plan will be a better fit for some clients than a Medicare Supplement plan, so you’ll want to contract with many different carriers.


That way you can present your clients with an unbiased array of plan options, and you can pitch the best plans for them, rather than only having a couple of options that might not cover every service they need.

How to Use MIPS in Your Pitches

The merit-based system under MACRA means that doctors who provide low-quality care will not earn as much as high-quality doctors. This will push doctors to work harder and treat their patients better.

Use the MIPS (Merit-based Incentive Payment System) to your advantage when you make your pitch. If your clients express concern about their quality of care, tell them that CMS (Centers for Medicare and Medicaid) pays doctors based on their performance. Or, if your clients aren’t happy with their doctors and they’re eligible to make changes to their coverage, suggest plans that local doctors with high MIPS scores accept.

MIPS can be a selling tool if you know what your clients need, so regular follow-up calls are a big part of customer retention and client satisfaction.

Contract With Us

At Senior Market Advisors, we provide agents with the tools for success, including the most up-to-date information about CMS changes and federal laws.

When you contract with us, you gain access to all of the major carriers so you can provide your clients with options so they can choose the Medicare insurance plan that will best suit their needs. We also offer sales training and marketing support from an experienced in-house team. Ready to start? eContract with us now.

This post was originally published on November 20, 2017, by Anastasia Iliou and was updated by Troy Frink on June 24, 2019.

Anastasia Iliou
Anastasia Iliou
Senior Content Manager at Senior Market Advisors
Anastasia graduated from Belmont University with a Bachelor's degree in Songwriting. When she's not writing, she's on a mission to visit all 50 states in the U.S (and to date has reached 41). Anastasia loves writing music, hiking, and playing with her pets (hedgehog, dog, and two cats). She loves animals (but not so much bugs) and spends her free time volunteering for The Elephant Sanctuary in Tennesee.