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Home 2023 May (Page 2)
Medicare Advantage Enrollment Trends

Medicare Advantage Enrollment Trends

By Ed Crowe | General Articles | 0 comment | 18 May, 2023 | 0

Medicare Advantage  Enrollment Trends

 

There are continually increasing populations of people who become eligible for Original Medicare and Medicare Advantage plans each year in the United States. Since 2006, the amount of enrollees for Medicare Advantage plans has grown steadily.  In 2022, more than 28 million people are enrolled in a Medicare Advantage plan, accounting for nearly half or 48 percent of the eligible Medicare population. This number also accounts for nearly half of the federal Medicare spending.  Let’s explore the Medicare Advantage enrollment trends.

 

In 2022, the average Medicare beneficiary has access to nearly 40 Medicare Advantage plans, which is the largest number of plans available in over a decade. This looks like 2.2 million new beneficiaries between 2021 and 2022, which is an eight percent increase in enrollees.

 

Employer Group Versus Individual Plans

 

In 2022, of the 28.4 million beneficiaries enrolled in Medicare Advantage.   The smallest percentage were enrolled in special needs plans, at a mere 16%. The next smallest group of beneficiaries was those enrolled in union-sponsored or employer-offered Medicare Advantage plans.   These account for 18% of the total. The largest group of beneficiaries by far is those in individual plans –  open for general enrollment.   This group makes up 66% of the 28.4 million beneficiaries. That is about two thirds of this group, or approximately 18.7 million people. Since 2021, that is an increase of about 1.3 million enrollees. However, the share of those in individual plans open for general enrollment has not increased.  It remains steady at about two thirds of the enrollment since 2018.

 

Medicare Advantage Plans By State

 

The share of Medicare beneficiaries who are enrolled in Medicare Advantage Plans varies greatly by state and has a very wide range of percentages across the country. However, in 25 of the states, at least half of those eligible for Medicare Advantage plans are enrolled in them. The more rural a state is, the more likely it is to have lower funding for Medicare and lower enrollment in Medicare Advantage plans. South Dakota, North Dakota, Wyoming, and Arkansas are the states with the lowest Medicare Advantage enrollment, which is less than twenty percent, or fewer than one fifth of eligible beneficiaries. Puerto Rico, on the other hand, has the highest percentage of enrolled beneficiaries, with 93% of Medicare beneficiaries also enrolled in a Medicare Advantage plan. This is largely thought to be due to policy choice, as many people in Puerto Rico are dually enrolled automatically in Medicare and Medicaid.

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Medicare easy pay form

Medicare easy pay form

By Ed Crowe | General Articles | 0 comment | 16 May, 2023 | 0

Medicare easy pay form

The Medicare Easy Pay form is a quick option for individuals who are either still working or not collecting social security yet for some other reason. This option will ensure you never miss a Medicare payment.  This is a great way to avoid the complications that could occur if you neglect to pay your Medicare premium.

Once you receive a bill from Medicare, you can sign up for Medicare easy pay.  Medicare easy pay automatically deducts your Medicare premiums on the 20th of each month from either your checking or savings account.

Learn more abut signing up for Medicare A & B

There are 2 ways to enroll in Medicare easy pay:

  1.  The fastest option is online.  You can either log in to an existing account or create an account.  Once you log in, click on “My Premiums” and follow the links from there to sign up and fill out the online form.
  2. Another option is to Click here to download the Medicare easy pay form.  This option takes longer (from 6-8 weeks) for your deductions to begin.  In the meantime, you need to be sure you pay your premiums in a timely manner.  You can do this either online through your account or by using the paper bill you receive.  Mail the completed form to: Centers for Medicare & Medicaid Services,  Medicare Premium Collection Center, P.O. Box 979098, St. Louis, MO 63197-9000.

Once easy pay begins:

  1.  Each month you receive a statement that tells you how much will be deducted from your bank account.
  2. The premium is deducted from your bank on the 20th each month.  Your bank statement will show a payment marked “CMS Medicare Premiums”.

Click here to download Understanding your Medicare easy pay statement.

If your payment is rejected, you will receive a notice that provides instructions to get the payment in to Medicare.  Once your account is up tp date, your easy pay will start up again as scheduled. Medicare will send you a notice if the premium amount changes. The new rate will automatically be deducted from your account on file.

More Medicare easy pay information:

What to do if you need to change the  banking information for our automatic payments:  simply log into your Medicare account and choose “My Premiums” and “see of change my Easy Pay” form there you can complete a quick online form.

If you do not like to do online forms, you can mail a completed SF-5510 form.  Click here to download the Medicare easy pay form.  Be sure that you indicate the change you want to make on the form.  You can mail the form to the address indicated above.  Again, this will take a long time to update (possibly 6-8 weeks).  It can take about 4 weeks to stop Medicare easy pay deductions.

If you are having trouble with the Medicare easy pay; please contact 1-800-MEDICARE (1-800-633-4227)  TTY users call 1-877-486-2048 for assistance.

 

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Medicare AEP 2023

Medicare AEP 2023

By Ed Crowe | General Articles | 0 comment | 12 May, 2023 | 0

Medicare AEP 2023

Medicare AEP 2023 (Annual Enrollment Period) is an important time of year for both Medicare beneficiaries and agents. During this time of year, beneficiaries can make changes to their Medicare coverage for the upcoming year. For agents, it is an opportunity to help clients choose a Medicare plan that fits their individual healthcare needs and budget.

There are many things agents can do to prepare for AEP:

Review the latest CMS guidelines

It’s essential for agents to stay updated with the latest guidelines from CMS during AEP. Agents should review all current information, including plan changes, cost sharing, and formulary updates. They can access this information either on the CMS website, the Medicare & You handbook, and other reliable sources.  This includes carrier websites once they release the new plan information.

Be Sure to get all your certifications done on time

One of the most important certifications each year is the annual AHIP certification.  The AHIP for the 2024 AEP will open on June 20th, 2023.  This test will be good for the rest of this year and in 2024.

You also need to complete product training and certifications for each carrier that you are contracted with so you are ready to sell on time and have a good understanding of the products that you are offering.

Reach out to clients

Agents should reach out to their clients before AEP to remind them about the upcoming enrollment period and to schedule appointments to go over their plan options for next year. Once AEP starts,  they can also provide their clients with educational resources to help them understand their options and make informed decisions.

Understand your clients’ healthcare needs

Agents must understand the healthcare needs and preferences of their clients to recommend the best plan for them. They can do this by asking their clients questions about their current healthcare coverage, medication needs, and healthcare providers. Agents can also review their clients’ medical history to ensure they choose a plan that meets their specific needs.

Identify plan options

Once you understand the clients’ healthcare needs, it is easier to find the plans that offer the best choices for each individual.  You should always consider the client’s budget, preferred doctors, and prescription medications when reviewing the available plans.  You can quickly compare the costs and benefits of different plans with the use of an online quoting and enrollment site such as; Sunfire or Connecture.  This will help clients make informed decisions by showing them a side-by-side plan comparison.

Stay organized

The AEP can be a busy time for agents, and staying organized is crucial to ensure you provide quality service to your clients. Agents can use tools such as calendars, spreadsheets, and customer relationship management (CRM) software to stay on top of appointments, deadlines, and client communications.

The Medicare AEP is an essential time for agents to maintain their book of business and be sure their clients are happy with their Medicare coverage for the next year.  It is also important that your clients feel they can contact you with any questions or problems they may with their Medicare coverage throughout the year.

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Medicare Coverage While Out of the Country

Medicare Coverage While Out of the Country

By Ed Crowe | General Articles | 0 comment | 12 May, 2023 | 0

Medicare Coverage While Out of the Country

Do beneficiaries have Medicare coverage while out of the country?  To put it simply: medical coverage outside of the United States for Medicare beneficiaries is extremely limited. The definition of “outside of the United States” means outside of the continental United States and its territories. There are only three situations in which coverage under Medicare can be provided to a beneficiary outside of the United States.

  1. The beneficiary is in the United States and has a medical emergency, but the closest hospital or facility that can treat them is a foreign one (a foreign one meaning one outside of the country) rather than a local one.

  2. The beneficiary is traveling through Canada in order to get to or from Alaska and the closest hospital or facility that can treat a medical emergency is a Canadian one. Medicare determines on a case-by-case basis who qualifies for this, because it is dependent on the travel being considered “without reasonable delay.” Without reasonable delay is an arbitrary definition, and must be determined individually.

  3. The beneficiary lives in the United States but the closest hospital that can treat them is a foreign one, regardless of medical emergency. The foreign hospital has to be closer than the closest United States hospital to be considered for Medicare coverage.

Even in these exceptional situations above, Medicare will only pay for Medicare-approved services. Medicare Part A will cover hospital care when the beneficiary has been formally admitted to a hospital. Medicare Part B will cover emergency ambulance and doctor services that occur before and during the hospital stay. If administered outside of the United States, dialysis services are not covered.  Additionally, prescription drugs outside of the United States are not covered.

Managed Care Plans

For those beneficiaries who have a Medicare Health Plan like Medicare Advantage rather than Original Medicare, the previous three situations are still the exceptions under which they will cover foreign medical services. Medicare Advantage plans, although privately held, still have to follow the guidelines and laws set by the federal government.

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Sell Medicare Supplemental Plans

Sell Medicare Supplemental Plans

By Ed Crowe | General Articles | 0 comment | 11 May, 2023 | 0

Sell Medicare Supplemental Plans

 

For agents who are on the fence about whether or not selling Medicare Advantage and Supplemental plans is right for them, here are five reasons that selling Medicare can be a lucrative and helpful career move.

 

  1. The Large Market

According to PEW polls, over 10,000 people celebrate their 65th birthday every day in the United States. That is a large and accessible market. Medicare Supplements is also a needed service for the elderly, who will very likely need this medical and hospital coverage as they continue to age. The size of the client pool will continue to increase and the market will not get saturated.

 

  1. High Profit Potential

Medicare Supplement sales tend to offer high sales commissions even in the first few years of experience as well as annual residuals. In this way, selling Medicare Supplements can provide ongoing compensation for the agents who sell it. The plans also require very little servicing on the client’s behalf and that limits the ongoing work that the agent will have to put into maintaining those clients.

  1. Competitive Rates

Coverage is standardized across each plan, because of the guidelines set up by the federal government that the contracted private insurance plans have to follow. This means that beneficiaries will receive the same benefits regardless of the company that is servicing their supplemental plan. The differences are in premium costs and locations, which means that insurance agents need to have access to the best carriers in order to provide for their clients.

 

  1. Help Clients You Already Have

As an insurance agent, it is very likely that some of the clients you already have qualify or are soon to qualify for these insurance plans. Be proactive by reaching out to your business clients when they approach their 65th birthdays and let them know that you can help them access Medicare Supplemental Plans.

 

  1. The Ease of Getting Started

There is no specific certification to get in order to sell Medicare Supplemental Insurance Plans.  Additionally, there is no enrollment period during which you have to sign up to sell them. It is a year-round opportunity to help your clients and make significant income.

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Medicare Part D History Timeline

Medicare Part D History Timeline

By Ed Crowe | General Articles | 0 comment | 11 May, 2023 | 0

Medicare Part D History Timeline

Let’s take a brief look at the Medicare Part D history timeline.  Medicare Part D, or Medicare Prescription Drug Coverage, is not a part of the Original Medicare as provided by the federal government. The federal government contracts with private companies to sell this particular kind of supplemental Medicare insurance. There are two main sources of Part D coverage.

Stand Alone Plans

The first is Prescription Drug Plans, or PDPs. These are standalone companies that sell only prescription drug coverage and do not provide hospital or medical insurance coverage. United HealthCare is an example of the companies who provide these plans through their contracts with the federal government.

MAPD Options

The second source of coverage for Medicare Part D plans are Medicare Advantage Prescription Drug Plans, or MA-PDs. These are Medicare Advantage Plans, which cover hospital, medical, and prescription drug coverage in a single plan. In other words, these Medicare Advantage Plans cover Original Medicare and prescription drug coverage.  Medicare Part C is another name for MAPD. There are four main categories of MA-PD plan types.

 

Health Maintenance Organizations (HMOs):

These follow what is called a gatekeeper model, meaning that every aspect of the beneficiary’s coverage is controlled by the plan and the plan’s membership. The primary care physician must belong to the HMO, the beneficiary must choose specialists that are within the plan, and the prescription drug coverage must be taken from the HMO as well instead of a separate prescription drug plan (PDP).

 

Preferred Provider Organizations (PPOs):

This is similar to the previous HMO plan in that the beneficiary must choose a primary care physician, but they do not need to have a referral to see a specialist. While they can choose care out-of-network, they will pay more to do so. In PPOs as well as HMOs, the beneficiary must take the prescription drug coverage offered with the plan rather than choose a separate PDP.

 

Private Fee for Service Plan (PFFSs):

These are by far the most flexible plans, in which beneficiaries can choose any licensed provider in the United States who is authorized to provide services and agrees to treat them. Like the PPOs, however, members may pay more in fees if they choose to go to a provider who is not a member of the licensed group of practitioners that are contracted with the insurance company. Some PFFSs provide a prescription drug plan and some do not. If the PFFS provides a prescription drug plan, the beneficiary has to take the coverage offered. If the PFFS does not provide drug coverage, then they can choose to get their prescription drug coverage through a separate PDP.


Special Need Plan (SNP): There are three segments of the population who are eligible for these Special Needs Plans. 1. People who are considered dual eligible, meaning they have qualified for both Medicare and Medicaid. 2. People who are institutionalized. And 3. People who have chronic conditions. People who belong to an SNP must take the prescription drug coverage provided and may not go through a separate PDP to access alternative coverage.

Put your knowledge of the Medicare Part D history timeline to use.

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Medicare Supplement guaranteed issue rights

Medicare Supplement guaranteed issue rights

By Ed Crowe | General Articles | 0 comment | 11 May, 2023 | 0

Medicare Supplement guaranteed issue rights

If you are enrolled in Original Medicare, you might consider enrolling in a Medicare Supplement (also referred to as Medigap or Med Supp) plan.  Medicare Supplement plans cover some of the out-of-pocket costs that Original Medicare does not cover.  These costs include things like; deductibles, co-pays, and coinsurance.   When you enroll in a Medicare Supplement plan, you need to understand your guaranteed issue rights.

What does Guaranteed Issue mean?

It means that you have the ability to enroll in a Medicare Supplement plan without having to undergo medical underwriting. In other words;  the insurance company cannot ask you any health-related questions or deny you coverage based on your health status.  These rights apply only in certain situations which are specified by law.

You have guaranteed issue rights in the following situations:

  1. You are in your Medigap Open Enrollment Period:  The Medigap-Open-Enrollment-Period is a six-month period that starts the first day of the month in which you are both 65 or older and enrolled in Medicare Part B. During this time, you have guaranteed issue rights and can enroll in any Medicare Supplement policy sold in your state, regardless of your health status.
  2. You lose your Medicare Advantage Plan or Medicare Supplement policy: If you are enrolled in either a Medicare Advantage plan or a Medicare Supplement policy and the plan stops offering coverage in your area, you have guaranteed issue rights to enroll in a Medicare Supplement plan within 63 days of losing your coverage.
  3. You move to a new state:  If you move to a new state and your current Medicare Supplement policy is not available in your new location, you have guaranteed issue rights to purchase a Medicare Supplement plan within 63 days of moving.
  4. You have a trial right to a Medicare Advantage Plan: If you enroll in a Medicare Advantage Plan for the first time and within the first 12 months of enrollment you decide to disenroll.  You have guaranteed issue rights to enroll in a Medicare Supplement plan within 63 days of disenrollment.
  5. Your Medicare Supplement insurance company goes bankrupt: If your Medicare Supplement insurance company goes bankrupt and you lose your coverage as a result, you have guaranteed issue rights.  You have 63 days to enroll in a Medicare Supplement policy.

What if  You Don’t qualify for a Guaranteed Issue Policy?

You may still be able to enroll in a Medicare Supplement plan.  The only catch is, the insurance company can ask you health-related questions.  If they do not like the answers, they can deny you coverage based on your health.  Additionally, if the plan accepts you with a pre-existing condition, you may have to pay a higher premium amount for your coverage

Just to summarize; it is important to understand your rights when it comes to enrolling in a Medicare Supplement plan.

If you have guaranteed issue rights, you can enroll in a plan without going through medical underwriting.  This can save you time and money.  If you do not have guaranteed issue rights, you may still be able to purchase a policy, although you should prepare to answer health questions and potentially pay a higher premium.

For more details on your guaranteed Issue rights; click here

If you need help choosing the best Medicare option, give us a call at 203-796-5403 and speak to a licensed Medicare sales agent.

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History Medicare and Medicaid

History Medicare and Medicaid

By Ed Crowe | General Articles | 0 comment | 11 May, 2023 | 0

A Brief History of Medicare and Medicaid

Groom yourself for trivia night with this brief history of Medicare and Medicaid.  Original Medicare, or what is known as Parts A and B (hospital and medical coverage), is a relatively new feature in the United States. It was signed into law on July 30, 1965, by then-President Lyndon B. Johnson. Of course, changes have been made since then. In 1972, Medicare was expanded to cover people with disabilities, people with end-stage disease requiring dialysis or kidney transplants, and people who select Medicare at age 65 and older. Additionally, more benefits, such as prescription drug benefits have been added.

 

At first, Medicaid only offered benefits to a certain group of people: those receiving cash assistance from the federal government. Medicaid has changed since then as well, as a much larger group is covered now, including: low-income families, pregnant women, people with disabilities regardless of age, and those who need long-term care. Under these newer laws, states have the responsibility and ability to change their Medicaid programs to best cover their vulnerable populations, thus ensuring the best use of the federal and tax dollars that cover Medicaid.

Y2K Changes

In 2003, the largest change was made to the Medicare and Medicaid program in over 38 years: The Medicare Prescription Drug Improvement and Modernization Act. Medicare Advantage Plans or Medicare Part C became available under the MMA. This act also expanded Medicare to include an optional prescription drug benefit, known as Part D. Medicare Part D went into effect in 2006.

 

Since 2006, the largest change to Medicare and Medicaid has come with the Affordable Care Act (ACA).    ACA  created the health insurance marketplace and subsidized health insurance for millions of Americans. As a result, Medicare and Medicaid have been able to better coordinate how they cover their beneficiaries and provide quality health care services.

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History of Medicare Advantage

History of Medicare Advantage

By Ed Crowe | General Articles | 0 comment | 11 May, 2023 | 0

History of Medicare Advantage

The origins of Medicare Advantage,  also known as Medicare Part C, are in the 1970s.  Medicare is ever evolving.   Let’s discuss the high level history of Medicare Advantage.  The details are consistently redefined even today.

In a nutshell,  the greater part of the  3 decades following the 1970s bring beneficiaries major changes.

Balanced Budget Act of 1997

The Balanced Budget Act of 1997  established the new Part C of Medicare – Medicare + Choice.  Medicare Choice is an early version of what we know today as Medicare Advantage.  Additionally, the Balanced Budget Act aimed to earn federal savings within the Medicaid system in three areas. The gross federal Medicaid savings comes from three sources: Repeal of minimum payment standards from hospitals, nursing homes, and community health centers.

History of Medicare Advantage – Medicare Modernization Act

In 2003,  the Medicare Modernization Act passed.  Medicare Part D, prescription drug coverage and benefits, are established.  At this time, Medicare Choice Plans are officially renamed Medicare Advantage Plans. Before 2003, Medicare offered no prescription benefits or coverage. Because of this new coverage, beneficiaries can recently get all of their medical needs covered in one place, with one cohesive plan, and with one convenient ID card.

Privatized insurance companies begin to offer Medicare Advantage plans.  These companies contract with the United States government to provide plans that fit strict guidelines. MAPDs typically cover the same benefits as Original Medicare, in addition to extra coverage including out-of-pocket maximums, some minimal dental coverage, some hearing coverage, and, in most cases, prescription drug coverage.  Private insurance companies offer Medicare Advantage (MA) plans.  Insurance carriers contract with the program. Medicare Advantage plans provide hospital, outpatient, and, usually, prescription drug coverage.   These plans supplant benefits under Medicare parts A, B, and D.   However, plans are risk-based plans.   Advantage plans are not universal plans covered by the federal government.  And, there is variation in the quality and quantity of benefits that purchasers receive. They are ubiquitous, though, with over 98% of beneficiaries having had access to privatized plans in 2017.

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Medicare Annual Enrollment 2023

Medicare Annual Enrollment 2023

By Ed Crowe | General Articles | 0 comment | 10 May, 2023 | 0

Medicare Annual Enrollment 2023

As we get closer to the end of the year, many people start thinking about the Medicare Annual Enrollment 2023.  During this time of the year, you can make changes to your Medicare coverage for the upcoming year.   It is important to note; each year Medicare plans change.  Some plans add benefits to a plan or change the way they cover a medication.  Whether you’re a first-time Medicare beneficiary or have been on Medicare for years, you should check your plan each year to stay informed about the changes that may effect your coverage for the following year.

When is Annual Enrollment 2023:

Medicare Annual Enrollment begins October 15, 2022 and ends on December 7, 2022.  During this time, you’ll be able to make changes to your Medicare coverage for the upcoming year.

What changes can I make during  the Medicare AEP

  1. Beneficiaries of  Original Medicare may change to a Medicare Advantage plan.
  2. If you are on a Medicare Advantage plan you can change to Original Medicare.
  3. You may decide to enroll in a PDP (Part D, prescription drug plan).
  4. You can also change from one Medicare Advantage plan to another.
  5. Some people switch from one PDP plan to another.
  6. Other individuals may choose to drop their Part D coverage altogether.

 

Things to consider before changing your Medicare coverage:

  1. Each year you should review your healthcare coverage. Many people find it invaluable to enlist the expertise of a licensed insurance agent for this.  Because there are so many plan options it can get confusing.  Make sure you understand your current coverage so it will be easier to compare it with the best plan choices for next year.
  2. Think about your health care needs especially if they have changed.   If possible, try to consider what you may need in the upcoming year.
  3. If you are on a Medicare advantage plan, be sure to check that your health care providers will still be in-network.  Providers and facilities (hospitals, labs, out patient clinics) do make changes during the year and if you skip this step, it could be very costly.
  4. Members of PDP plans need to carefully check their plan’s formulary.  Private insurance companies do change these each year and something that is covered this year may not be next year.  It is possible there is a prescription drug plan that is a better fit for you for next year.
  5. If possible, it is a good idea to look at the total cost of this year’s plan (plan premium, deductibles, co-pays and co-insurance) to see if you can save money next year. It is important to think about your budget as well as your healthcare needs.

There are many resources to help you learn more about the Medicare Annual Enrollment 2023:

  1. Visit the Medicare.gov website: The official Medicare website provides information about all aspects of  Medicare.
  2. State Health Insurance Assistance Programs (SHIPs): SHIPs offer free, personalized Medicare counseling and assistance.  These programs can also provide valuable information on programs for those with a limited income.
  3. Medicare and You Handbook: The Medicare and You Handbook is a comprehensive guide to Medicare that is updated each year and mailed to all Medicare beneficiaries.
  4. Call a local insurance agent.  Make sure the agent is licensed and appointed to sell the most competitive plans in your area.  If you find a reliable and knowledgeable agent, this will help narrow down the choices for you to make an informed decision.

The Medicare Annual Enrollment 2023 is an important time of year for Medicare beneficiaries to review and make changes to their coverage. By staying informed and considering your health care needs, you can make the best decisions for your health and budget.

Please note;  any changes you make during the Medicare Annual Enrollment period will not take effect until January 1, 2024.

There are other enrollment periods that yo may be able to take advantage of during the year.

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    29 July, 2025
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    What Does Medicaid Cover

    What Medicaid Covers: A Guide for Dual Eligibles and Younger Beneficiaries Medicaid

    29 July, 2025

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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800 MEDICARE to get information on all options.

Not affiliated with the U. S. government or federal Medicare program. This website is designed to provide general information on Insurance products, including Annuities. It is not, however, intended to provide specific legal or tax advice and cannot be used to avoid tax penalties or to promote, market, or recommend any tax plan or arrangement. Please note that [Agency Name], its affiliated companies, and their representatives and employees do not give legal or tax advice. Encourage your clients to consult their tax advisor or attorney.

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Online Enrollment- Enroll prospects online without the need for a face to face appointment. Access to all major carriers with the ability to compare plan benefits and prescription drug costs. Link to recorded webinar https://attendee.gotowebinar.com/recording/2899290519088332033

All agents receive a personalized enrollment website. Prospects can use the site to compare plans, check doctors, run drug comparisons and enroll in plans. Agents are credited for all enrollments. Click Here

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