Category: Uncategorized

Oct. 2024 (8)

CMS Announces Medicare Advantage and Part D Proposed Rule for CY 2026: Key Impacts for Brokers and TPMOs

Sacramento, Ca- The Centers for Medicare & Medicaid Services (CMS) has announced the proposed rule for Contract Year (CY) 2026 affecting Medicare Advantage (MA) and Medicare Part D programs. These updates aim to improve access to care, address barriers, and enhance transparency for Medicare beneficiaries. Brokers and Third-Party Marketing Organizations (TPMOs) should understand the implications of these changes and have the opportunity to provide feedback.

  1. Marketing Oversight
    • CMS proposes increased oversight of advertisements and marketing practices to protect beneficiaries from misleading content. These changes may require brokers and TPMOs to adjust marketing strategies to comply with stricter regulations.
  2. Provider Directories Integration
    • MA plans will be required to share full provider directories with CMS for inclusion in Medicare Plan Finder. This change aims to enhance transparency and enable beneficiaries to make informed decisions, potentially altering how brokers present plan options.
  3. Prior Authorization Reforms
    • New guardrails are proposed to reduce inappropriate use of prior authorization processes. Brokers will need to stay informed about these updates, which aim to streamline care access for beneficiaries.
  4. Anti-Obesity Medication Coverage
    • CMS proposes reinterpreting Part D rules to cover anti-obesity medications. This expansion may influence client plan choices and discussions regarding health benefits.
  1. Medical Loss Ratio (MLR) Updates
    • Adjustments to reporting requirements for MA and Part D MLRs aim to promote transparency and address concerns about vertical integration.

Watch for the Opportunity: Stay alert for when the comment period opens to submit your feedback.

Read the Proposal: Review the unpublished document here.

Stay Tuned: Once the comment period opens, check the Federal Register for the opportunity to submit your comments.

These proposed changes directly affect how brokers and TPMOs operate, interact with clients, and comply with marketing and administrative requirements. By submitting comments, you can:

  • Provide insights on how these changes impact your operations and client interactions.
  • Suggest practical adjustments to proposed policies.
  • Contribute to shaping a regulatory framework that supports Medicare beneficiaries and the professionals who serve them.

To review or comment on the CY 2026 MA and Part D proposed rule during its 60-day public comment period, visit the Federal Register.

For more information on the CY 2026 MA and Part D proposed rule, view the fact sheet

View the full Press Release here.

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For over 30 years, SAHU has worked to improve our members’ ability to meet the health, financial and retirement security needs of all Californians and Americans through education, advocacy, and professional development. For more information, please visit: sahu-ca.com. 

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CMS Releases 2025 Medicare Premium and Deductible Updates

Sacramento, Ca- CMS has released the 2025 Medicare premium and deductible adjustments, along with significant changes resulting from the Inflation Reduction Act.  These changes include an increase in premiums, caps on out-of-pocket drug expenses, and expanded eligibility for financial assistance. CAHIP-NorCal is sharing this information to help brokers and their clients stay updated on the ever-changing Medicare landscape and better understand how these updates may impact Medicare coverage in the coming year.

With the premium increases and plan terminations happening frequently, CAHIP-Norcal encourages all Medicare beneficiaries to work with a broker who specializes in senior health benefits so that you can feel confident in your health coverage and avoid coverage gaps, or unexpected cost increases.

At a Glance: 2025 Costs:

  • Part A (Hospital Insurance):
    • Inpatient hospital deductible: $1,632 (+$32 from 2024)
    • Daily coinsurance (61st–90th day): $408 (+$8)
    • Daily coinsurance (lifetime reserve days): $816 (+$16)
  • Part B (Medical Insurance):
    • Monthly premium: $174.70 (+$9.80)
    • Annual deductible: $266 (+$14)
  • IRMAA (Income-Related Monthly Adjustment Amounts):
    • Premiums range from $243.10 to $594.00, based on income levels.

New for 2025

  • Under the Inflation Reduction Act, beneficiaries will see capped out-of-pocket costs for Part D prescription drugs, with a maximum annual limit of $2,000 starting in 2025.
  • Expanded Low-Income Subsidy: The Extra Help program is broadened to offer full benefits to individuals with incomes up to 150% of the federal poverty level.
  • Price Negotiations: Medicare will implement negotiated prices for certain high-cost prescription drugs.

For full details, visit the CMS announcement here.

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For over 30 years, SAHU has worked to improve our members’ ability to meet the health, financial and retirement security needs of all Californians and Americans through education, advocacy, and professional development. For more information, please visit: sahu-ca.com. 

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CAHIP-Norcal Invites the Community to Help Bless 25 Families This Thanksgiving

Sacramento, California – November 15th, 2024

Sacramento, CA – With just 10 days left, CAHIP-Norcal is calling on the Sacramento community to help in the final stretch of the 2024 Turkey Drive to support River Oak Center for Children.

CAHIP-Norcal has set a goal again this year to provide Thanksgiving meals for 25 River Oak families in need, ensuring they have a joyful holiday meal.

“We’ve seen firsthand how much of an impact this drive has on local families, and with just 10 days left, we are confident that the generosity of our CAHIP members and the Sacramento community will help us reach our goal,”said David Brabender, President of CAHIP-Norcal.

CAHIP-Norcal invites the community to donate to the Turkey Drive, with all proceeds going directly to River Oak Center for Children. The donations will directly support the purchase of Thanksgiving meals for local families in need.

How to Contribute:
Donate to the 2024 River Oak Center for Children Turkey Drive through the GoFundMe campaign:
Donate Here

Deadline: Donations are being accepted until November 25, 2024. Your contribution will help ensure 25 families receive the items they need for a delightful Thanksgiving meal.

About River Oak Center for Children:
The River Oak Center for Children provides vital services to children and families in the Sacramento area, focusing on behavioral health support, family services, and resources to improve the well-being of at-risk children and families.

To learn more about this event and other upcoming events, visit our website at

cahip-norcal.org/event/.

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For over 30 years, SAHU has worked to improve our members’ ability to meet the health, financial and retirement security needs of all Californians and Americans through education, advocacy, and professional development. For more information, please visit: sahu-ca.com. 

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CAHIP President, Rosamaria Marrujo – Represents the Agent/Broker Community at the Covered California Press Conference Ahead of Open Enrollment

Sacramento, California – October 30, 2024 —

Covered California launched its 2025 open enrollment period yesterday with a press conference at the California State Library in Sacramento. Secretary Xavier Becerra of the U.S. Department of Health and Human Services joined state leaders and key representatives from the health insurance industry to emphasize the importance of accessible health coverage and health literacy for Californians.

Rosamaria Marrujo, CEO of Trusted American Insurance Agency and President of the California Association of Health Insurance Professionals (CAHIP), attended the event representing the agent and broker community. Highlighting the vital role brokers play in expanding healthcare access, Marrujo stated, “It was wonderful to meet Secretary Becerra and showcase the importance of agents and brokers in the community.”

During the event, Covered California’s Executive Director Jessica Altman acknowledged and thanked the contributions of brokers, expressing appreciation for their continued service.

Highlights of Covered California’s Open Enrollment for 2025:

  • New Financial Assistance for Californians: Beginning Nov. 1, increased state funding through Covered California’s cost-sharing reduction program will provide enhanced support, especially for those above 200% of the federal poverty level. The program offers no-deductible plans and reduced out-of-pocket costs for over 800,000 enrollees.
  • Expanding Eligibility for DACA Recipients: For the first time, Deferred Action for Childhood Arrivals (DACA) recipients can enroll in Covered California plans, providing an additional estimated 40,000 Californians access to affordable health coverage.
  • “Let’s Talk Health” Literacy Campaign: Covered California launched this statewide initiative to improve health literacy, partnering with local libraries to offer in-language resources and educational events to help consumers understand their health insurance options.
  • Record-Low Uninsured Rates in California: California’s uninsured rate has fallen from 17.2% in 2013 to a historic low of 6.4% in 2023, illustrating the success of outreach and financial support programs in expanding access to health coverage.

With open enrollment running through Jan. 31, 2025, uninsured Californians are encouraged to explore their coverage options. 

Trusted American Insurance Agency’s CEO, Rosamaria Marrujo, is a dedicated advocate for advancing access to affordable healthcare for all Californians. As she continues her work at the state level, she is committed to representing brokers statewide and highlighting the essential support they provide to their communities. 

Visit CAHIP’s Newsroom to learn more about on-going healthcare and legislative updates. If you are interested to learn more about how to get involved and directly support state and national Political Action Committees program visit our Legislative Programs page.

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For over 30 years, SAHU has worked to improve our members’ ability to meet the health, financial and retirement security needs of all Californians and Americans through education, advocacy, and professional development. For more information, please visit: sahu-ca.com. 

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Swinging Success: 2024 SAHU Golf Tournament Recap!

Sacramento, California May 30, 2024— The SAHU Golf Tournament, held on May 16th at The Ridge Golf Club in Auburn, was an outstanding event filled with sunshine, friendly competition, and memorable moments. With a total of 102 golfers and 20 vendors attending, the day was buzzing with activity. From manning the holes to driving drink carts, everyone played a part in making this tournament a tremendous success. A special shout-out to this year’s golf tournament sponsor, Word & Brown, for their generous support!

Tournament Highlights and Winner Celebrations:

1st Place Winner: Aetna Foursome

  • Noah Woehler (hit a Hole-in-One at hole #12!)
  • Daniel Hawkins
  • Tyrone Sales
  • Jacob Woehler

2nd Place Winner: Cypress Dental Foursome

  • Andrew Garnett
  • Chuck Richesin
  • Ryan Andrew
  • Mike Updegraff

1st Place Mixed Team: Capitol Insurance Solutions Foursome

  • Maia Francis
  • Jackie Fitzhenry
  • Tim Murphrey
  • Josh Hedger

Closest to the Pin Winners:

  • Men: Dylan Asherman
  • Women: Carmen Perea

Longest Drive Winners:

  • Men: Daniel Hawkins
  • Women: Marissa Herndon

Danny Langarica from Cal Choice remarked, “Yesterday was one of the best SAHU Golf Tournaments I’ve ever been to. So much fun!” This sentiment was echoed by many attendees, highlighting the success and enjoyment of the day. 

A huge thank you to all our sponsors! Your support was essential in making this event a success, and we truly appreciate it.  We look forward to seeing you all again next year!

  • Event Sponsor: Word & Brown
  • Social Media Sponsor: Berkley Accident and Health
  • Party Tee Sponsor: Mutual of Omaha
  • Margarita Sponsor: Western Health Advantage
  • Tee Sponsor: Dickerson Insurance Services
  • Drink Cart Sponsor: Colonial Life
  • Cannon Hole Sponsor: Anthem
  • Longest Drive Sponsor: Q Benefits
  • Tee #10 Lunch Platinum Sponsor: Amwins
  • Hole-in-One Sponsor: Paycor

To learn more about SAHU’s events, becoming a member or sponsor, please visit our website, sahu-ca.com.

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For over 30 years, SAHU has worked to improve our members’ ability to meet the health, financial and retirement security needs of all Californians and Americans through education, advocacy, and professional development. For more information, please visit: sahu-ca.com. 

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Voter Voice

We need your help. CAHU is gearing up for a very heavy year of legislative and regulatory action. At moment’s notice, we may need your help communicating CAHU’s position on critical issues. To make CAHU’s “one voice” as effective and efficient as possible we have a simple, online system – VoterVoice.

Click the button below to learn more and make your voice heard.

Get Started

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