Blog

Medicare Questions

Best Medicare  Questions for a Sales Meeting with a Prospective Client: Basics and Healthcare

Medicare agents have a number of ways to reach prospective clients. One of those ways is to hold education and sales events. While education events cannot lead to enrollments, sales events can and should. With these questions, agents will be able to learn about their prospective and offer them the best plans and support for their insurance needs.

Medicare Questions – Basic

Other than the obvious starters like “how can I help you today?” there are a number of basic information questions that agents will need to ask during their sales meeting:

• Do you make your own health care decisions?

Agents need to know this because they must speak to the person who is making the healthcare decisions directly.

• What is your date of birth?

This determines what the perspectives are eligible for.

• Which zip code and county do you live in?

This answer determines which plans are available to the prospective.

• Are you currently on Medicare? Have you applied for Medicare?

Some people receive Medicare earlier than 65 due to disability.

• Do you receive Social Security payments?

If they are receiving SS payments prior to the age of 65, they will automatically be enrolled in Medicare A and B.

• Do you/your spouse still work? Do you plan to work past 65? Do you get coverage from your job?

If this is the case, the perspectives may want to waive their initial application for Medicare part B, which would not result in a sale.

Medicare Questions – Health

Although it is prohibited to ask a prospective customer about their health directly, agents will need to know certain things in order to best serve their clients.

• How often do you go to the doctor?

• Have you had any inpatient stays or outpatient surgeries?

• Do you have any scheduled for the future?

• Please provide a list of the medications you take and the doctors you visit

This will enable the agent to make sure that they can find a plan that covers their needs as well as has as many of those doctors in-network as possible.

All of this information will give the agent a good idea of whether or not the prospective will need a Medicare Supplement plan. The agent can also then run the list of medications through Connecture or Sunfire, both tools which will tell the agent which plan covers more of those necessary medications.   Be sure to subscribe to our youTube channel for updated platform demonstrations.

These basic information and healthcare questions will give the agent what they need to begin the process of helping their prospective enroll in the Medicare insurance plan that is right for them. There are also financial questions and other information that are needed, which will be in a second blog post.

Medicare agents – Learn what Crowe and Associates has to offer 

Ready to contract?   Begin here.

Subscribe to our YouTube channel.   We provide weekly training and informational webinars.

Click here to view more images by this artist

AHIP 2024 test tips

Each year over 100,000 agents and brokers take the AHIP course.  AHIP is a CMS compliant course.  It is updated every year so that the training is both accurate and relevant to the current CMS regulations.  That is why the AHIP 2024 test tips are a great resource to help ensure your successful completion of the AHIP exam.

You must receive a grade of 90% to pass the exam and you are allowed 3 attempts to pass.  You have 2 hours to complete the 50 question exam.  If you do not pass after the third attempt, you will need to retake the course and pay again.  It is important to note; some carriers will not allow you to sell if you do not pass the exam in the first 3 tries.

This year the 2024 exam is available starting June 21st, 2023.  The exam will cover any business you write from now until the end of 2023 as well as through 2024.

Most carriers require you to take the AHIP, although UHC does not require AHIP.  UHC does however, require certifications for Med Supp sales.

The cost for the AHIP course:

The cost of $175 includes the exam although you can get a $50 discount by taking it through one of the major carrier’s sites (UHC, Aetna, Humana, etc.).  Agents who are part of the Pinnacle financial team are eligible for a $50 discount as well.  All you need to do is go to pfsinsurance.com sign in, click on AEP Toolkit and from there you will scroll down and see a link for the:

Pinnacle AHIP discount.  

Please note; this year’s 2024 AHIP is very similar to last year’s 2023 AHIP

There are some new concepts and rules you need to be aware of.  Click on the link below to watch our video and learn more:

Take a look at our YouTube video ” AHIP Test Tips 2024″

Here is what the AHIP course covers:

The first part of the course covers Medicare and consists of 5 modules

• Medicare basics; fee-for-service and eligibility as well as benefits
• The different types of Medicare Advantage & prescription drug plans (Part D)
• Who is eligible and what is covered
• Nondiscrimination training
• Learn the requirements for the marketing and enrollment of Medicare Advantage as well as Part D prescription drug plans

You can download each module once you click on it.  This is allowed and suggested to help you complete the test later.  If you took the AHIP in 2023, you only need to click through the slides on modules 4 & 5 although, we recommend clicking on modules 1-3 as well so you can download the content.  It is also not a bad idea to complete the practice tests at the end of ALL modules since  those are the questions that will be on the test.

Each of the 5 modules has a 20 question practice test at the end.  Pay very close attention to the practice questions; most of the test questions come from there.

Once you finish the 5 modules and the exam,  remember to take the second part of the AHIP.

The second part of the course covers fraud, waste, and abuse

• Learn how to spot fraud, waste, and abuse (FWA)
• Find out what the Medicare industry is doing to detect fraud
• What are the legal tools that combat FWA
• Understand the human as well as the financial cost of fraud waste and abuse
• Review general compliance requirements for Medicare Parts C and D fraud, waste, and abuse.
• Find out who commits fraud, waste, and abuse
• What are loophole and obligations to reporting fraud, waste and abuse

After everything is successfully finished,  remember to download your AHIP certificate.  In many cases you can transmit your score to the carriers from the AHIP site, but some will need you to upload it into their dashboards yourself.

For updated news, webinar, zoom and agent events, click here

To view more images by this artist; click here

Medicare Dual Plans

Medicare dual plans are also called dual eligible special needs plans.  A Dual Eligible Special Needs Plan are know as a D-SNP. Plans are Medicare insurance plans that enrolls beneficiaries who are entitled to both original Medicare on a federal level and their state’s Medicaid plan. Depending on the state, many individuals on these plans will receive assistance with out-of-pocket costs, among other things. D-SNP plans are Medicare Advantage plans.

There are limited eligibility categories for this plan. To be eligible for dual enrollment, individuals must meet at least two categories simultaneously, one from Medicare eligibility and one from Medicaid eligibility.

To be qualified for original Medicare, an individual must be 65 years or older, a citizen of the United States of America, and live here the majority of the year. For some people who have chronic conditions such as end-stage renal failure, some cancers, or ALS, Medicare eligibility can come earlier because of their condition.

Medicaid requirements for enrollment are more complex, however, because they are state-dependent and can differ greatly by where an individual lives in the country. Generally speaking, those who are eligible for Medicaid must fall under a certain income threshold to be eligible for these benefits. There are some exceptions in Connecticut. For example, there are some disabilities that automatically qualify people for Medicaid benefits, known as Husky in Connecticut. The majority of the time, people who are 65 years or older and make under a certain percentage of their state’s income thresholds are considered dual eligible, or qualified to enroll for a D-SNP.

How Do You Know If You Qualify for One of the Medicare Dual Plans?

Despite the differences in state qualifiers, individuals who answer yes to the following questions are typically qualified for a D-SNP.

• Do you qualify for Medicaid or get financial assistance from your state?

• Enrolled in Medicare parts A and B?

• Do you live in the coverage area of the dual enrollment plan’s insurance carrier?

Potential beneficiaries able to answer yes to these three questions are likely eligible for a Dual Enrollment Special Needs Plan.

Licensed Health Insurance Agents

Sell Medicare all year long.  We offer $500 to every agent for Medicare leads.   Join our free lead program by clicking here.

Become appointed here.

Subscribe to your YouTube Channel.

Chronic Special Needs Plan

What is a Chronic Special Needs Plan? A C-SNP is an acronym that stands for a Chronic Conditions Special Needs Plan. This is a type of Medicare Advantage plan specifically designed for beneficiaries who have a chronic illness or condition. Many of the insurers who provide these plans claim that the purpose of the benefits of a C-SNP is to allow those with the coverage to have improved health outcomes and more flexibility and choice while managing their condition(s).

Conditions

There are many conditions that qualify beneficiaries for a C-SNP. Some of the more common ones are diabetes, end-stage renal disease, chronic lung diseases, chronic heart failure (or CHF), and cardiovascular disorders. For beneficiaries with diabetes, an endocrinologist will work with their primary care doctor to determine the best course of action. For those beneficiaries with end-stage renal disease, their care team will include their primary care doctor and a nephrologist, or kidney specialist. This specific coverage is available in Connecticut. Those with chronic lung disorders who qualify for a C-SNP will have coverage for oxygen supplies and other medical equipment, and for ongoing care for beneficiaries with heart diseases, a cardiologist will join their individual health care team.

In some parts of the country, there are C-SNP plans that consider a multitude of other conditions for enrollment. Coverage includes some mental conditions.  These include schizophrenia, certain autoimmune disorders, dementia,   Some neurological disorders such as Parkinson’s, and HIV or AIDS are also included.  C-SNP aims to provide better health outcomes for beneficiaries with these specific pre-existing conditions.

Although beneficiaries enrolled in a C-SNP will still have to pay their Medicare part B premiums, they often have access to more services with fewer out-of-pocket expenses. Some of these services can include meal delivery if necessary, prescription drug coverage, transportation to health-related appointments, preventative care such as routine screenings and physicals, dental, vision, and hearing coverage, and even a fitness membership benefit at no additional cost.

Licensed agents

Sell Medicare all year long.  We offer $500 to every agent for Medicare leads.   Join our free lead program by clicking here.

Become appointed here.

Subscribe to your YouTube Channel.

Medicare Sales vs Educational Events

There are strict guidelines for how to ethically market and sell Medicare insurance plans. According to the Center for Medicare and Medicaid Services, the Marketing Guidelines reflect their interpretation of the marketing requirements and related provisions of the Medicare Advantage and Medicare Prescription Drug Benefit rules.  Regulations apply to both types of event.  In addition, different regulations apply to  how each can be marketed. Learn the differences of  Medicare sales vs educational events.

Medicare Sales vs Educational Events:  Medicare Educational Events

These events are purely for education and communication. This is not a sales event. However, for many agents and agencies, this is a good time to get to know their prospective clients and teach them about what kind of services they can provide. Most of the people who attend these educational events are future beneficiaries, current beneficiaries, and their caregivers, all looking for information to make the best informed decisions they can about their healthcare.

Agents may not discuss specifics of plans during educational events.  However, the are permitted to hand out generic marketing materials, and even collect the contact information of interested parties. Set up all sales appointments for a later time.  This is a hard and fast rule.   Educational events must be advertised as education, as well. Snacks, promotional materials, business cards, and education materials are all encouraged to be given out or displayed during educational meetings. Agents are allowed to answer questions that are asked, but may not provide information beyond those answers related to sales. These educational meetings must be in a group format, and should not be one on one.

Medicare Sales vs Educational Events:  Medicare Sales Events

Medicare Sales Events are events in which the purpose is to discuss plan-specific information and enroll beneficiaries in a Medicare plan. There are typically two categories of sales events: formal sales events and informal sales events. Formal sales events entail presenting plan-specific information to an audience. Agents present Informal sales events at a kiosk or a table.   These present information at an individual’s request, not to a captive audience. The marketing materials for sales events may include things like carrier benefits, benefit structures, premiums, cost-sharing, and comparisons to other plans, as the purpose of these events is to eventually collect enrollment applications.

Just like an educational event,  clearly advertise sales events as such.  Additionally, the rule includes both informal and formal events.   Prohibited marketing tactics include requiring attendees to sign in or provide contact information.  Prohibited items include full meals or subsidized meals, give away rebates and cash prizes.  Do not discuss non-healthcare related products.  Prizes etc are prohibited at Medicare sales events.   This rule maintains the ethics of the agents and the agencies that provide the services advertised.

Agent Resources

Every agent gets $500 to cover monthly lead costs. – No gimmicks!  No production requirements to start.

Learn why to work with a better FMO.

Click here to begin contracting. 

Subscribe to your YouTube Channel.

UHC assisted living IESNP

The UHC assisted living IESNP plans are a great option for clients who are either moving into an assisted living, independent living, or memory care community and congregate housing.  The plan is also available to people receiving care at home. Additionally, members that need help with Activities of Daily Living (ADL’s) or instrumental Activities of Daily Living (IADL) are likely eligible for the plan.   A few examples of IADL’s are:  housekeeping, managing money, food prep, transportation or even managing medications.

Click here for additional UHC Assisted Living Plan information

This is a 5 star Medicare Advantage PPO plan!

This plan provides much needed resources to help clients navigate the transition and make life much easier.  Plans are available to both Dual and non-dual members.

It is very important to note:

These plans are exclusively offered by agents contracted with either Crowe and Associates or Pinnacle Financial Services!

If you would like to get contracted with Crowe and Associates to offer these plans; click this link

Click here for a map of the IESNP coverage area

Before you can offer these plans, there are 2 steps for training:

1.  Use the link below to complete the first step.  Once you have completed the fist step ( IESNP training video) be sure you scan the code using the camera on your phone.

   • Click here for IESNP training page (Need to be logged into the PFS site to access)  (Training called “UHC Assisted Living Plan Training”)

2.  After you complete the first step, you will receive a notification.  In a couple days, the certs are loaded into your Jarvis portal.  You will find the certification in Jarvis’ knowledge center in the “Invitation only” section.

Use this link for step by step screen shot instructions on the entire certification process

There are many great benefits offered with these plans:

The UnitedHealthcare Assisted Living Plan (IESNP) includes a dedicated care team– including a nurse practitioner and physician assistant- that help to customize a plan of care that covers your client’s needs.  This team has over 20 years experience in care coordination.  They work with both families and providers to keep everyone updated on the client’s healthcare needs.  The care team is available by phone 24 hours a day, 7 days a week to help assure any concerns your client has are addressed.

To view the ALC flyer, click here

Another important benefit of these plans is the extremely low OOP.  The OOP for the plans is between $1,500 and $1,600 annually!  The plan has a very low OOP vs. other non dual Advantage plans.   A member needs to be eligible for the plan but they DO NOT need to be a dual member to qualify.   As a result, this can be an increadible option for those not receiving any type of help from the state or for members that are drug help only.

Take a look at some additional benefits including  great dental coverage!

Verification of eligibility: 

Option 1:  Check eligibility in UHC Jarvis portal

You must have log in credentials for the PFS website to access the page:

CLICK TO ACCESS PAGE  Click on “2023 LOC Process”   

This plan has dual-type extra benefits but as well as a clinical element.  Members have access to in-person care either at a facility or in their own home from a UHC employed nurse, nurse practitioner or PA.  They also have a care coordinator that would organize the care from the clinician and help with things like medication management.

Access to WellSky once certifications are completed:

Registration
1. User will receive an email from WellSky (no-reply@wellsky.com) with information provided for
registration.
2. User will select the link in the email, provide the temporary password, and the user will be
prompted to create a new password.
3. Remember to save the URL, username, and password for future use. Users do not have to
access the portal to keep their account active.

Enhancements to Medicare Advantage for 2024

CMS is constantly looking at the regulations that govern the sale, provision, and use of Medicare and Medicaid. They examine the experiences of the insurers that are contracted by the government to provide the insurance plans.  Additionally, they examine the experiences of the beneficiaries who purchase them. Any amendments they choose to make are intended to take effect the following year. In 2023, CMS looked at the rules surrounding Medicare Advantage in particular.  What changes are planned for Medicare Advantage 2024?

CMS Final Rule

The CMS issued a final proposal on April 5th of 2023 for the enhancement of Medicare Advantage. They did not address the comments that the public had given on the proposed amendments.   However,  did say that they plan to address them at a later, more appropriate date. The amendments proposed have to do with prior authorization and how that affects beneficiaries’ access to healthcare. Previously, prior authorization meant that beneficiaries who had Medicare Advantage health insurance plans had to essentially request permission before receiving care. That indirectly means that beneficiaries could be denied care. (Traditional Medicare does not require prior authorization.) There were concerns that Medicare Advantage customers were not receiving the same quality of care as Original or Traditional Medicare beneficiaries because of these rules.

Changes to Medicare Advantage 2024

This is about to change, however, as the new rules proposed by CMS are designed to make sure that Medicare Advantage customers have the same access to necessary tests, scans, prescriptions, and procedures that their counterparts in Original Medicare to. The American Medical Association says that the new rules have, “taken important steps towards rightsizing the prior authorization process.” UnitedHealthcare, which is just one of the insurers with Medicare Advantage plans, says it plans to reduce their number of denials of care by nearly three million a year.

CMS’ new rule requires that prior authorization policies may only be used to confirm the presence of a diagnosis.  This ensures that the treatment is medically necessary. CMS is also requiring that all Medicare Advantage plans develop committees to ensure that denials and approvals are working effectively to get beneficiaries the care they need within the new guidelines. Finally, the new rules require that a prior authorization approval is effective for the entire course of treatment as long as medically reasonable and necessary to avoid disruptions in care.

All together, beneficiaries and insurers alike hope that these new regulations will help ensure that Medicare Advantage plans provide equitable access to care moving forward.

Licensed agents

We offer $500 to every agent for Medicare leads.   Learn more.

Click here to start contracting.

Subscribe to your YouTube Channel.

How CMS Makes Changes

Each year, the Center for Medicare and Medicaid Services (CMS) can make adjustments to guidelines and rules for the upcoming year. These regulations can make adjustments or modifications to many things, affecting both providers and beneficiaries. CMS’ proposed regulations can affect which services must be provided under law, how beneficiaries can access those services, and even which companies qualify to be contracted insurers under the law.  Learn how CMS makes changes.

Because these rulings affect so much of the Medicare system, they must be published so that people can be informed of them. The Federal Register is the publication that CMS uses to disseminate the new rulings and information. While a rule is in the proposal stage, CMS allows public comment. The next step is for the CMS to send a set of proposed amendments to the Code of Federal Regulations (CFR). This does not, however, amend the CFR immediately.

Public Comment Period

Once the public comment period has ended for the proposed regulations and amendments, the CMS can develop and publish the final regulation. However, it is not immediately effective. If the new or amended regulation affects a large portion of the population or a large profit margin (typically defined as $100 million dollars or more), then the amended regulations are only effective 60 days after the publication date. If the regulation does not affect the margin of people or profit, then it is effective much sooner, at thirty days after publication.

When the CMS sends the regulation to have it published, it also forwards the information to the Government Accountability Office (GAO) as well as both houses of Congress for review. There are certain instances in which the amended regulations can be effective immediately. When the CMS thinks that the delay might cause further damage, that it is contrary to the best interest of the public, or if the delay is unnecessary, impractical, or otherwise not the best way forward, they can find cause to waive the normal delay period.

Licensed Medicare Agents

Learn about NABIP.

Already licensed and certified to sell Medicare?  We are one of the nation’s most successful FMOs.   We offer our agents top of the line tools at no cost.   Learn the details here. 

Get $500 every month for leads!

  Click here to appoint with a better FMO.

Subscribe to our YouTube Channel.

Click here to view more images by this artist

Crowe and Associates Events and Information

The Crowe and Associates Events and Information page will be updated every Tuesday and Friday.  We will post registration links to future agency Zoom meetings and Webinars along with links to recently recorded webinars.  Additional information such as carrier updates and other notable Medicare updates will be posted as needed.

Upcoming Webinar topics and registration links

TBA

It is a good idea to register for our webinars even if you cannot attend.  We will send you a recording so you can view it when you have an opportunity.

Some of our recent Webinars

• • Cross Selling CLICK HERE TO WATCH
  • Medicare Express Leads CLICK HERE TO WATCH
  • Lead Star TCPA & CMS Compliant Leads CLICK HERE TO WATCH
  • Canadian Medstore CLICK HERE TO WATCH
  • Using HealthSherpa for ACA Enrollments  CLICK HERE TO WATCH
  • Wellcare National HIDE/FIDE and DSNP Training  CLICK HERE TO WATCH
  • Advanced Diabetes Supply – US Med CLICK HERE TO WATCH
  • Reminder Media CLICK HERE TO WATCH
  • Crowe & Associates ACA contracting for agents & agencies CLICK HERE TO WATCH
  • Link to all recorded webinars CLICK TO VIEW

Crowe Agency Zoom Meetings

(Meetings will start with quick updates and then open to all attendees for questions and discussion)

Next Meeting: TBA

Recent Carrier, Product and Medicare Updates

• CMS has announced 2026 Medicare commission rates, click here for details
• AHIP 2026 is available to agents as of June 23, 2025, Pinnacle offers agents a $50 discount, to access the discount go to pfsinsurance.com, click on services, then certifications from there you will see the AHIP link.  If you do not have a Pinnacle login, please contact our office 203-796-5403 for assistance.
• Do not wait until the last minute to do your 2026 carrier certs, click here to access the Pinnacle website to see which ones are available.  Once you are logged in; click on the agent services tab, then choose certifications; from there you can access a list of carrier certs for 2026.  Click on each carrier to view availability and instructions.  If you need a Pinnacle login, contact our office 203-796-5403.
• Proposed Rule CMS 4208-P, click here to learn about new regulations for our industry

Up-Coming Events

Agent events are paused until after AEP, but we will post them as soon we have some.

Contracting

Click here to begin a new contract or add carrier to existing Crowe and Associates contract.

Click here for intent to move instructions.   Not all carriers are listed.  Call the office for carrier instructions not listed.

Training and Agent Benefits

Introducing – BOSS 4 Agents

This all-in-one platform is available to all our agents and providing a CRM, Sales, Marketing & Metrics in one convenient location.  Call our office 203-796-5403 to learn more.

Click here to request a free agent website.  You must own a site URL before making a request

Subscribe to our YouTube Channel.

Shop for E&O.

$500 Free Medicare Lead program.

Learn more about agent programs including T-65 marketing seminars.

Cigna Medicare Supplements CT

Cigna is launching new plans in Connecticut.  The Cigna Medicare Supplements CT have improved rates plus some added features which include a multi-policy discount and no application fee.  The new prices will be in effect for 7-1-2023 start dates.  Very soon you will start to see the new rates when you run a Med Supp quote.

Learn how to run a quote using Sunfire

Cigna Medicare Supplements CT: Agent incentives:

Cigna is offering a number of incentives for agents who sell their Medicare supplements in CT.  The language in the incentives is geared toward an underwritten state and not a GI state like CT.  We will try to get clarification on the incentive details.  Take a look below and see what Cigna has to offer contracted agents:

Learn more about Medicare supplement sales

Cigna Medicare Supplement Contracting

Existing Crowe agents can add the Cigna Medicare supplement through this link:  CLICK TO ADD PRODUCT

Agents not with Crowe can use this link to get contracted:   CLICK FOR CONTRACTING

Find out why you should work with Crowe and Associates

What is the Medicare Supplement OEP

Access free training videos; Click here

To view more images by this artist; click here