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BCBSTX Expands Medicare Advantage Market Area, Choices

Blue Cross & Blue Shield of Texas: Medicare, Group & Retail

BCBSTX Expands Medicare Advantage Market Area, Choices As you may have just heard, Blue Cross and Blue Shield of Texas (BCBSTX) is increasing its footprint in the Medicare Advantage (MAPD) market. In addition to expanding the market area to 59 Texas counties, new MAPD products will be introduced.


BCBSTX Expands Medicare Advantage Market Area, Choices
Get Certified and Receive a Gift Card

recognition of your costs related to training and testing to become
Medicare Certified to sell our Blue Cross Medicare AdvantageSM and Blue Cross MedicareRxSM plans, we will provide a $50 Visa Gift Card to agents who complete our required 2022 product certification no later than Sept. 1, 2021.

The gift card is not compensation for the sale or renewal of
any policy or enrollment. Supplies are limited to the first 5,000

To take advantage of this offer:

  • You must be a current resident licensed agent within the state of Texas to qualify.
  • No sales or marketing of 2022 Medicare plans is allowed until your annual Medicare certification is complete.
  • Only agents within our GA, NMO and directly-contracted channels are eligible.
  • Those under our TMO, EGA and preferred channels do not qualify.

Your time is valuable – we hope this small effort will help you complete our 2022 product certification by Sept. 1.


Transparency in Coverage, Consolidated Appropriations Act: August Update

The Consolidated Appropriations Act of 2021, which includes the No Surprises Act, is the most significant health care law since the Affordable Care Act. The Transparency in Coverage Final Rule,
which imposes significant federal transparency obligations on
insurers, is one of the first of its kind. Both sets of requirements
impose significant requirements on health insurance issuers and group
health plans.

What you need to know: Review our update about the impact of the new Acts.

*A Change in 90-Day Supply Coverage to Apply for Some 2022 Pharmacy Networks

Based on the group’s pharmacy
network, some members may only have 90-day supply retail coverage at an
Extended Supply Network pharmacy starting Jan. 1, 2022.

The impact: The change applies to some Custom Fully Insured and Administrative Services Only (ASO) Large Group and National Accounts. Learn more about this supply coverage change and the advantages it offers.

*2022 Drug List Change for BCBSTX Pharmacy Custom Fully Insured Groups

Starting Jan. 1, 2022, and upon
renewal, BCBSTX will be moving our pharmacy benefit Custom Fully
Insured groups to the Performance drug list from the Basic or Enhanced
drug lists.

What to expect: The change applies to Custom Fully
Insured groups (Large Groups and National Accounts). There are some
exceptions to this change. Learn more about this drug list transition.

Deadline Approaching: MSP Data Collection Required via BAESM by Sept. 8

Next week, we will begin sending “reminder” emails to renewing groups
with 1-150 employees that haven’t provided their 2021 Medicare
Secondary Payer (MSP) information to us. The easiest way to provide this
information is via Blue Access for EmployersSM (BAE).

Action needed: Remind your groups to submit the required information by Sept. 8. Read the FAQs to get all the details.

*Blue DirectionsSM Offers Options for Employers of Varying Sizes, Join Aug. 24 Webinar

Blue Directions has three options
available to fit the needs of your clients, regardless of their size
or benefits administration needs. Available to groups with 51+

How it works: Join the Aug. 24 webinar to get the details.


American Rescue Plan SEP Ends Sunday

Resuming standard SEP enrollment.
The American Rescue Plan (ARP) Special Enrollment Period (SEP) is
ending Sunday, Aug. 15. Beginning Monday, Aug. 16, we’ll resume
standard SEP enrollment processes.

Suspending training requirements: This year,
writing producers selling off-exchange policies because of an SEP do
not have to affirm completion of the SEP training in order for them or
their agencies to be eligible for compensation. The suspension of SEP
training requirements is for plan year 2021 only.

Reference and resource tool: Our 2021 SEP training for off-exchange enrollment PDF is
a great tool to help you and your clients have a smooth enrollment
process. Although the training requirement has been suspended for plan
year 2021, we encourage you to save and use the training as a resource.

Reminder: Marketplace Automatically Lowering Premiums for Some Members

What’s changing: Last week,
we told you that Marketplace members who are eligible for premium tax
credits, but who haven’t updated their income information on 
Leaving site icon
 since April 2021, will soon have their premiums reduced automatically. Lower premiums are a result of the American Rescue Plan Act Leaving site icon.

When? The premiums will be adjusted starting with September invoices, which are delivered mid-August.

Member communications: The Marketplace is notifying affected members by mail PDF.
We’re sending a notice of the billing change to affected members with
their September bill, delivered around mid-August. We’re also sending a
separate email to the same audience. The
billing insert
 PDF and the email share the same content.

Who’s affected: Marketplace members who will see lower premiums in September are those who:

  • Currently qualify for premium tax credits
  • Haven’t updated their household income data since April 2021, and
  • Haven’t opted out of receiving premium tax credits

Who’s NOT affected: Members who actively
redetermined during this SEP won’t be impacted; their premiums were
already adjusted. Also, members who opted out of subsidy payments won’t
see any changes. They can opt back in by updating their accounts via Leaving site icon.

Are You Ready for Medicare AEP?
The Medicare Annual Enrollment Period (AEP) opens Oct. 15 and runs through Dec. 7.

Certification required: As a reminder, you must complete both the AHIP certification Leaving site icon and Blue Cross and Blue Shield of Texas’ (BCBSTX) annual training
Leaving site icon to begin marketing/selling our Medicare Advantage/PDP products.

Take advantage of Medicare training: In just
30 minutes, these webinars can help you prepare to sell Medicare, and
learn how to help clients select and enroll in a plan.

Next sessions:

  • Aug. 12 – Certify with BCBSTX
  • Aug. 17 – Virtual selling and DocuSign
  • Aug. 19 – BCBSTX Supply Portal
Help Small Group and Mid-Market Sales and Renewal Kits

Find all the tips, tools, forms and product information to sell or renew your Small (1-50) and Mid-Market (51-150) groups.

Next Small Group deadlines:
  • Oct. 1 renewals: paperwork is due Sept. 1
  • Nov. 1 renewals: paperwork is due Oct. 4
  • See all 2021 PDF due dates.

Why it matters:
The expansion increases access to and choice for new coverage options
for Medicare-eligible individuals throughout Texas and the growing
population of adults aging into Medicare. These changes will be
implemented for the Medicare Annual Enrollment Period, which opens Oct.

  • Some of the new markets are located in rural and underserved areas.
  • Some new MAPD plans (HMO and PPO) include $0 premiums and enhanced benefits beyond traditional Medicare.

More information coming: The expanded market
areas and new products will be discussed in detail during the upcoming
Producer Road Shows beginning in September. Watch for your invitations.

Get your BCBSTX Contracting Today >

Agility Producer Support
(866) 590-9771
[email protected]