10 minute read
Interview with Steve Kuhtz from Sierra First Insurance Services
BY PHIL CALHOUN
Phil: Steve welcome to Cal Broker and special issue for July focused on Medicare.
We want to get to know you and First Sierra. We also want to dive into your thoughts about the upcoming challenges for Agents going into the 2025 Annual Election Period.
Steve: First Sierra Insurance Services provides top level Value Based Services to its independent agents.
Our why story is very simple. We are an agency built by agents for agents. We found a need in the market and we were able to address that need because of our experience being agents in the field.
We have over 300 agents spread out throughout California and Nevada. Over the years we have added additional internal support staff to assist our agents. We have also added tools such as a multi-carrier enrollment and quoting platform and an integrated CRM system all available to our agents.
Phil: What are your biggest challenges and how will you work through them?
Steve: The biggest changes we see coming are from the Carrier challenges with the changes being delivered by CMS. The work through is that everyone will be expected to deliver better service to the Beneficiaries. Efficient use of our agents time will be the key to keeping a stable book of business.
Phil: Well it's unique to have a FMO like your agency that is a fit for all brokers, new to Medicare and also those seasoned brokers with experience and an existing book of business.
Steve: We Provide Services that are focused on the value our brokers need and find helpful and not on simply on the volume of services offered. We find that this provides better outcomes, excellent performance and greater success for our agents.
Phil: As a Value Based Agency what solutions do you provide agents?
Steve: We provide the following:
• Online quoting and enrollment platforms that allow for side by multi carrier comparison for the Agent and Beneficiary. Allowing for the Beneficiary to make the best decision for their needs.
• CRM systems that provide a secure encrypted storage of client PHI.
• Access to a back office to answer questions regarding Marketing Compliance, Contracting, Training, Commissions, general questions, application issues and client service issues
• Updates to the markets as new information hits the streets so agents are informed, and
• Commission Protection Options for agents.
Phil: OK. To learn more about First Sierra our subscribers can go to www.firstsierrainsuranceservices.com
Now let’s turn to your take on 2025 changes in Medicare plans. Tell us about the Part D plan changes---
Steve: The Inflation Reduction Act of 2022 requires several changes to plans in 2025
• Out of pocket cost will be limited to $2,000
• Plans will allow patients to pay deductibles over 12 Months.
• Recommended Vaccines will be required to be available at no cost.
The Part D changes will impact the structure of the plans offered by the carriers. Changes coming in 2025 will affect premiums, formularies and plans offered. Brokers need to be informed by their trusted advisors about the changes and what options clients will have to get the coverage they needed.
Phil: So brokers need support and assistance to provide what their clients need.
Steve: Yes, we are planning to provide the resources our agents and brokers need as this will be a big challenge to agents with a lot of active PDP’s. To help we have our multi-carrier quoting, and enrollment platform will provide agents the opportunity to quickly and efficiently run prescription drug cost comparison quotes. It will allow them to assist members virtually in a quick and compliant manner. I wish we had a crystal ball to know exactly how broker comp and premiums will change, but in our opinion, we feel that there will be a general increase in plan premiums and some carriers could cease broker comp completely. The good news is that by October 1, or maybe just before we will have a better understanding of what the changes will look like.
Phil: WHAT About MAPD and the drug coverages?
Steve: The CMS Final Rule for 2025 and Inflation Reduction Act of 2022 regarding MAPD Plans is still being digested by carriers.
Other challenges to Carriers will be:
• SSBCI - Also known as Value Added Benefits in plans.
• Carriers will now need to prove the utilization of the benefit in the plan. From what we are hearing the carriers will have to show high utilization of those benefits and then somehow relate that back to improved member health. Possibly showing that cost savings allows them to afford routinely picking up medications and not putting off other health services.
• Carriers will also need to prove the equity of the benefits in the plan. This means does it increase the health and wellbeing of the beneficiaries in the plan.
If the carriers cannot prove the above as adding value they will need to remove the benefit. The impact on brokers will be that benefit plans will change drastically and they will need to either explain why
they beneficiary should remain on this plan or give them a similar alternative.
Phil: WE HEAR Star Ratings are going to be impacted in 2025.
Steve: YES, reductions and methodology changes to the plans will mean plans have received Star Rating reductions and this will drive down plan reimbursement and cause major plan benefit changes from the 2024 to 2025 plan year. Brokers wlll need to prepare as more clients will be shopping plans.
Methodology changes can also affect plan reimbursements again. With plan benefit changes from the 2024 to 2025 plan year, clients will be shopping plans.
Phil: What about the Dual Market changes?
Steve: There will be several including:
Going back to monthly (SEP)changes vs Quarterly changes. Clients can change plans more frequently.
Also, there will be a large push for beneficiaries into the Aligned Dual Plan. This will givee us more opportunities in this market space.
There is currently talk about these changes may end up with individuals being passively enrolled in the aligned Dual Plans. Agents will be bypassed by Medicare auto enrolling beneficiaries. This will leave agents without compensation and beneficiaries without an advocate they have enjoyed in their relationship with their agent.
Another impact expected is how the changes will limit the number of Dual Plans in services areas, by removing the Dual look a like plans. Personally we feel that this is actually is good for Medicare beneficiaries, specifically in counties with aligned plans. It also helps agents with the stability of their book of business, less plan switching by the beneficiaries.
Phil: In the past few changes have impacted the Medicare Supplements. What is new here?
Steve: We expect to see larger than usual rate increases on the Medicare Supplement Plans. Recently multiple large carriers have announced large increases in their premiums. Agents will need to make sure they are up to date on premium increases and will need to be more proactive in running rate checks for their clients and keeping them informed. If rates continue to increase we may see more beneficiaries moving from Med Sup to MAPD especially in counties with large network support, even if the MAPD has a premium.
Phil: Marketing Compliance was a major issue this past year. What is up for 2025?
Steve: Call recording has not changed and remains the same as last year. Best practice is to record all enrollment calls/calls that discuss plan benefits for MA and PDP. Agents are responsible for securely storing that data for 10 years. We provide a call recording feature that also securely stores the data for the required time frame and can be easily accessed. Also, our online enrollment and quoting platform offers call recording and storage. In addition to the tech we also provide in-depth training to all of our agents on all of the compliance updates that directly affect them.
Phil: It can be confusing to determine what is considered Marketing and what is considered communication? we definitely suggest that brokers do their research to look up the definition of both.
Steve: Right we also see the confusion. From the disclaimers that are required to the need to get marketing tools approved. At First Sierra will review any marketing materials our agents plan to use or are using. If it is a marketing piece that needs CMS approval we will inform the agent and assist in getting the CMS approval.
Phil: What about scope of appointments (SOA) and PTC?
Steve: No real changes here, seems to be staying the same as last year.
SOA are good for a year from the date of signature or less if the beneficiary asks them to not reach out. SOAs need to be securely stored for 10 years. They can be obtained through a paper version and also electronically. Our electronic enrollment platform does offer agent the ability to obtain an electronic SOA and will also store this for the agent for the required 10 years. We do also have approved PDF versions of SOA’s and PTC cards that agents can use. For storage we recommend agents store them securely in either their own CRM system or in the one provided to them through us.
Phil: Protecting private health information (PHI) is anorther concern.
Steve: Seems Blue Shield is one of the few carriers performing broker enrollment audits. We see PHI and brokers this way: There has been a focus on recent audits for agents on how they control and protect PHI. Typically in these situations carriers are asking the agent what steps they are taking to protect the information. We highly recommend the use of a CRM system. We have done many webinar trainings on compliance, making agents aware of what is to be protected and how they should be protecting that information. We also provide tools to our agents such as our multi-carrier online enrollment platform and most recently added CRM system. These are of course optional for agents to use, but do provide the data protection level that is being asked for.
Phil: Thank you Steve... for this insight into 2025 AEP. Sounds like First Sierra provides a wide range of service and support for agents and brokers.We look forward to your input in the coming months as more CMS details are revealed so we can keep our subscribers informed. If a subscriber wants to connect and learn more please go to www.firstsierrainsuranceservices.com
Steve: Thank you for the opportunity to share the services we offer at First Sierra. We are committed to helping more agents and we encourage those interested to contact us. We feel it is important to work with Cal Broker and continue to provide subscribers with up to date and valuable information so they can be a trusted advisor to their clients.
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Steve Kuhtz is a Clovis native and holds a Bachelor of Science Degree in Business Administration from California State University, Fresno. He has been in the Insurance and Financial Services industry since 1993.
In 2002, Steve saw a need for a higher standard of client service, so he started a new insurance agency with Robert Diehl. Kuhtz Diehl Insurance has been dedicated to maintaining high standards of service ever since.
In 2009, Steve and Rob started First Sierra Insurance Services, a Medicare General Agency. Offering outstanding agent service and support, First Sierra Insurance has grown to approximately 400 agents throughout California, Nevada, and Oregon. In addition to the home office in Fresno, First Sierra Insurance has offices in Sacramento, Bakersfield, Pasadena, Manhattan Beach, and San Jose.
Outside of work, Steve enjoys sailing, participating in triathlons, snow skiing, water skiing, boating, backpacking, biking, swimming, and travel.
559-251-0501 Office
2150 N. Winery Ave. Fresno, CA 93703
