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Trinity Health Plan of New England

Trinity Health Plan of New England is a private health insurance plan that offers both HMO and PPO options at an affordable price.  These plans are available to Connecticut residents in the counties of Hartford as well as Tolland.

To learn more about Trinity Health Plans; Click here

Both Trinity’s HMO and PPO plans offer many value based benefits that include:

1. A $0 plan premium
2. Primary care visits with no co-pay
3. Mail order, Tier 1 & 2 drugs have a  $0 copay
4. No cost virtual care visits (see SOB for details)
5. Some plans offer $0 medical deductibles
6. A travel allowance of up to $3,500
7. Dental coverage
8. Over-the-counter allowance
9. Vision hardware allowance
10. Acupuncture treatments are covered
11. ED drug coverage
12. Meals delivered to your home after an in-patient hospital stay

For a look at the 2023 PPO Summary of Benefits; click here

HMO 2023 Summary of Benefits; click here

Another great benefit Trinity Health Plan of New England offers is the extra $600 annually in your Social Security check!

This benefit gives members an extra $50 in their social security check each month.  It is basically a partial reimbursement for their Medicare Part B premium.  Take a look at the SOB for each plan for more details.

These plans cover Every one of the top 100 drugs.

If you don’t see your drug on our formulary?  Trinity can either provide formulary alternatives or a one-time (30-day) transition fill during the first 90 days of enrollment.
You may also request a formulary exception if you need to.  You can check the formulary on TrinityHelathofNE.org/Medicare and check applicable drug requirements as well as quantity limits for specific drugs.

Insulin is covered at an affordable rate so members receive access to necessary care for their diabetes.  Members do not pay more than $35 for a 1 month supply of each insulin product covered by your plan.

Take a look at the 2023 OTC catalog – Click here

Trinity Health Plan of new England – Pharmacy network:

Trinity is partnered with over 66,000 retail chains as well as independent pharmacies nationwide.

Some of the pharmacies include:

Costco Pharmacy, Saint FrancisRx Pharmacy, CVS Pharmacy, Sam’s Club Pharmacy, Medicine Shoppe, Shoprite Pharmacy, Price Chopper Pharmacy, Stop & Shop Pharmacy, Walmart Pharmacy & Walgreens.

To view a complete list of pharmacies either visit us online at; TrinityHealthOfNE.org/Medicare of call 866-934-9524 (TTY:711).

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Medicare Insulin $35

The Medicare Insulin $35 copay Part D Senior Savings Model (SSM) will continue in 2023.   The recently passed program called the “Insulin Now Act” will continue a program that began in 2001.  The program puts a cap of $35 for a one month supply of certain brands and types of Insulin.

Part D costs with the program

The cost for Insulin in the program will be capped at $35 per month for a one month supply.  There are a number of pharmaceutical manfaturers participating in the program. (See list below) The fixed cost will provide substantial savings to those with Part D drug plans (Either through a stand alone Part D plan or a Medicare Advantage plan).  The Insulin prescriptions will not be subject to the usual cost aspects of a Medicare Part D plan.  This includes any initial plan deductible, Initial coverage phase and Part D Coverage Gap.  It does not apply during the catastrophic coverage phase so the cost may change at that time.

The Medicare Insulin $35 copay SSM: Participating Pharmaceutical Manufacturers
1. Eli Lilly and Company
2. MannKind Corporation
3. Mylan Specialty L.P.
4. Novo Nordisk, Inc. and Novo Nordisk Pharma, Inc.
5. Sanofi-Aventis U.S. LLC

Medicare Insulin $35 copay:  Quoting plans

Please note; the $35 program does not cover every type of insulin.  Some of the more expensive name brand drugs for diabetics such as Jardiance or Trulicity will not be capped at $35. You can access a list of the Insulins that will be capped at $35 Part D insulin saver program list 2023

Starting with the 2023 Medicare AEP, drug comparisons on a number of systems will reflect the $35 cost cap on Insulin.  Online comparison sites such as Connecture, Sunfire and  Medicare.gov plan finder will all reflect the new cap of $35.

Changes to Medicare for 2023

In addition to the Medicare Insulin $35 copay cap, there will be other changes to Medicare for 2023.  There are the usual changes to the Medicare premiums, deductibles and copays.  In addition, there is a new type of Medicare Part B and new rules for those with delayed Part B enrollments.

Learn about the changes to Medicare benefits, premiums and enrollments here

Watch a video about the changes here

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SilverScript SmartRx 2023 PDP Changes for 2023

The SilverScript SmartRx 2023 PDP plan will have some changes.  It will be important for Medicare agents to know what is changing and how to quote and compare the plans for 2023.  The plan will not pay commission on new sales for 2023.   As a result, some quote and comparison sites will not show the plan when running drug comparisons.  Read below to learn more.

Commission

Name Change

Premium 

SilverScript SmartRx 2023: Quoting and comparing  

The plan not being commissionable for new sales in 2023 creates some challenges for us as agents.  The plan will continue to have a very low premium for 2023.  Depending on the medication list of clients it may still come out the best for them in 2023. Luckily commissions will still be paid on existing cases.   The challenge is quoting and comparing the plan for existing clients.   Since the plan will not pay commission for new 2023 sales, it is not on a number of quote and comparison sites.  Here is where you can and cannot look to see the plan in 2023:

Connecture 

Sunfire

MyMedicareBot 

SilverScript SmartRx 2023: Register for a webinar on Connecture, Sunfire and MyMedicareBot

Medicare.Gov Plan Finder: 

In addition to access to Connecture, Sunfire and MyMedicareBot at no cost, Crowe and Associates offers a number of other agents benefits

Click here for agent benefits and programs

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Medicare hierarchies and contracting

Medicare hierarchies and contracting provides a review of the sales structure for independent agents, agencies and top of hierarchy (TOH) organizations.  This focuses on Medicare Advantage plans but the general concept applies to most product types.  However, commissions, override amounts and structures will vary.  We will also cover general carrier contracting for all levels including; independent agent, agencies, TOH.

Independent Medicare Advantage and PDP contracted agent

Independent agents are able to hold contracts with multiple carriers.  In some cases the agents are able to contract directly with insurance carriers or go through a hierarchy (upline).  Some carriers only allow agents to contract through an upline.

CMS max allowable compensation for MA and PDP (street commission)

Every year CMS sets the maximum allowable commission an independent agent can receive for Medicare Advantage sales.  The amounts listed as the max amount for a new MA sale and the max amount for a MA renewal. The renewal is half the initial amount.  The PDP commissions work the same way.   CMS breaks the states up into 4 groups.  The comp for each group is different. Groups are:

• CA and NJ:  Highest compensation
• CT, PA and DC:  2nd highest compensation
• National:  All other states not listed above and 3rd lowest compensation
• Puerto Rico and the U.S Virgin Islands:  Lowest compensation

Click here for the max commission amounts for 2023

Top of hierarchy organizations (Called FMO’s or NMO’s)

FMO’s and NMO’s are companies that contract with insurance carriers.  They receive compensation above what Medicare lists as the max compensation.   Both independent agents and agencies (more on agencies later) can contract through an FMO instead of direct with the insurance company.  Some insurance companies will only contract agents through an FMO.  The agent can access multiple insurance company contracts through the FMO.  In most cases, the agent is paid directly by the insurance company at the max allowable CMS compensation.  This is the case even though they contract through the FMO.  That means, the agent owns the book of business.  If they left the FMO for another FMO or went direct to an insurance carrier, their renewals and book of business would go with them.

The FMO receives an override (an set amount of money per sale)

When insurance agents sell a Medicare plan the FMO receives an override.  As a result, the more an agent sells the more overrides the FMO receives. The concept is designed to incent the FMO to help the agent sell more. This is done through training, contracting assistance, marketing programs, incentives, leads, agent services or a number of other value added programs. The FMO also receives overrides when cases renew.

If the FMO contracts an independent agent to receive commissions directly from the carrier, the agent receives the full CMS commission from the carrier. (Street commission direct pay)  The FMO will then receive the full override.  Override amounts can vary from carrier to carrier but we will use $125 as an example.  Every time the street agent sells a policy the FMO will receive a $125 override payment.  In most cases, the override is half the amount for renewal payments.

Medicare hierarchies and contracting:  Agencies under FMO’s

In many cases an independent agent will contract through a local agency or an agency with a contract level below the FMO level.  If this is the case, it is still common for agents to paid the full CMS commission directly from the insurance carriers.   In some cases the agents have the carriers pay the commission to the agency and then the agency pays it out to the agents.  This is called an LOA or commission assignment arrangement. (More on this later)

In general there are 3 levels of agencies under an FMO.  The level determines how much the agency will receive as an override.   Please note: overrides are one pool of money, they are not additional amounts above what the FMO receives.  When an FMO has an agency under them, they are giving up the portion of their override the agency is receiving.

Agency contract levels

GA-General Agent:

An agency at the general agent level receives a $50 override per sale.  The amount of override on the renewal is usually half of the initial override.  In most cases, the general agent needs to have at least 5 contracted and certified sub agents in order to get the GA level with any carrier.

MGA- Master General Agency:

Override of $75 per enrollment and half that amount upon cases renewing:   Minimum of 10 contracted and certified sub agents to have the MGA level

SGA-Senior General Agency:

Override of $100 per enrollment and half that amount upon cases renewing:  Minimum of 20 contracted and certified sub agents to have the SGA level.  This level also requires production minimums in addition to the min number of sub agents.

The amount of override paid to the agency under an FMO is deducted from the amount of override they would receive with a street agent only.   Example:  Street agent under an MGA agency that works through an FMO.   Agent get the max allowable commission paid directly from insurance carrier.  The MGA gets a $75 override and the FMO gets a $50 override (assuming the FMO was getting a $125 override)

Levels:

The agency levels are all splitting one pool of money for overrides. (assuming a $125 FMO override level)   If an FMO has a GA under them, the GA gets $50 and the FMO gets $75)  If an FMO has an SGA under them, the FMO gets $25 and the SGA gets $100.   If the SGA has a GA under them, the SGA gets $50 and the GA gets $50)

• FMO ($125)
• SGA ($100)
• MGA ($75)
• GA ($50)
• Street agent (gets full CMS commission paid directly from the insurance company regardless of how many agencies in hierarchy)
• Note:  PDP plans also have override payments but they are substantially less than MA plans

Medicare hierarchies and contracting: commission payment methods

Direct pay:  In most cases, independent agents are paid directly from the carrier.  This is often the case for agents appointed directly with a insurance company and also often the case when contracted through an upline. (FMO,SGA,MGA,GA) When an agent is set up as direct pay from the insurance carrier, the agent owns the book of business and the commissions.

LOA contract/Commission assignment

In some cases an agent will not have their commission paid directly to them.  The agent is writing the business but the insurance company is not paying the compensation direct to the agent but to another agent or  an entity/agency.  The agent or entity receiving the commissions are then paying the agent based on some type of agreed upon amount. The amount paid is usually an amount below the CMS maximum amount.

This is often the case for a w-2 agent writing business for a company or agency.  It can also be used for a 1099 agent when the upline is providing some type of value in exchange for a portion of the commission.   In this case, the writing agent does not own the book of business.  If they leave the upline, the commissions will continue to be paid to that upline at whatever terms and conditions had been agreed upon.

Medicare hierarchies and contracting: Contracting agencies and sub agents

Any agency cannot contract another agency under them at the same level.  For example, if an SGA wants to bring on another agency, the highest level the agency could be is an MGA. IN other words; they must be one level below the upline.

Having commissions paid to an entity:

Medicare Advantage and Part D commission can pay to an entity.  In order for the entity to be paid, it must hold an insurance license.  Further, the entity must have a listed principal (person) and that principal must be contracted and certified with any given carrier for the entity to be able to receive commissions

Individual person as an agency: 

An individual can be considered either a GA, MGA or SGA.  This is the case when they meet the minimum amount of sub agents required by a carrier. An individual they can be given an agency contract as an individual.  Having an entity with an insurance license is not a requirement for most insurance companies

Agency with producers (sub agents) in other states

In order for an agency to receive overrides in any given state, that agency must hold an insurance license in that state and be appointed and certified with that carrier.  This can be problematic when an agency brings on a producing agent that is licensed in states the agency is not licensed in.

Medicare Savings Program CT 2023

If you are either a Medicare beneficiary, eligible to receive Medicare or a Medicare agent who offers plans in CT, you need to understand the Medicare Savings Program CT 2023.  This can be a very useful tool for some clients who have a lower income.

The amount of extra help you receive depends on your gross income level.  Single people will use their gross income to determine eligibility and level of help.  Married couples’ eligibility depends on their combined gross income.  The monthly income limits in the chart below are effective as of March 1, 2022.

If your income falls either at or below the income levels listed below, If you are not sure if you are eligible to receive extra help; we have listed the income levels below:

There are 3 different levels of MSP:

The level of help you receive is based on your gross income.  Please see below for MSP levels and what they provide:

Click here for income level chart.

QMB – this level of extra help pays your Part B premium, all Medicare deductibles and co-insurance.

Income levels for QMB are as follows:  Individual, $2,390 of gross income per month,  couples, $3,220 per month.

SLMB – this level pays your Part B premium only.

The income levels for SLMB are as follows:  Individual, $2,617 of gross income per month, couples, $3,525 per month.

ALMB – this level will provide payment of your Part B premium and is subject to availability of program funds. If you receive Medicaid, you cannot participate in this program.

Income levels for ALMB are as follows:  Individual, $2,786 gross income per month and couples, $3,754 per month.

To apply online, please visit www.connect.ct.gov, under ‘Apply for Benefits.’

Formulario de Renovación de programas de ahorro de Medicare (W-1QMBS)

Click here to download a CT MSP application

If you receive any of these levels of MSP coverage, you are automatically enrolled in the Low Income Subsidy (LIS), also called “Extra Help” with Medicare.  Once you are enrolled in LIS, Medicare pays the full cost of your Medicare (Part D) prescription drug coverage i fit is a benchmark plan.  Medicare will pay a portion of anon-benchmark plan.  They will also provide payment of your annual Part D deductibles, co-insurance or co-pays.  This does not change if you hi the coverage gap (donut hole).

Once you have LIS, you have a special enrollment period to change either Part D or Medicare Advantage plan.

If you need more information about the LIS, please visit www.socialsecurity.gov or call 1-800-Medicare (TTY: 1-800-325-0778).