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Why use a Medicare agent

If anyone asks why use a Medicare agent, we can provide you with some good reasons anyone should consider using a Medicare agent.

Because Medicare agents complete hours of training on both compliance regulations and the Medicare products available in their area, they are well versed on the plans available and provide valuable information to clients. They can provide clients and potential clients comparisons of several plan options and help find the Medcare plan that best fits their needs.

To learn the difference between Medicare Advantage and Medicare Supplements, click here

Compare plan choices

Because health insurance coverage is such an important decision, it is important for clients to understand all their choices. Choosing the wrong plan can be a very costly mistake.  For this as well as many other reasons, the help of a licensed Medicare agent is essential. A Medicare agent can go over the client’s list of wants/needs for coverage and find plan options that are right for them. Agents help clients weigh the benefit of each plan. Medicare plan benefits, rules, and exceptions may be overwhelming to sort out without a trained professional.

To find out about our quoting tools, Connecture and Sunfire, click here

Consider the client’s current coverage

It is important to consider the client’s current Medicare coverage and find out what about the plan works or does not work for them.  With this information in mind, it is easier to find help them decide whether they should stay in their current plan or if there are better options available to them.

Agents do not charge for their service

As a Medicare agent, you cannot take money from the client for the advice you provide.  This means clients receive expert advice at no cost.  This service is provided for free.  That is one deal you cannot beat!

Medicare agents receive payment through a couple different ways depending on the type of agent they are.  Agents who are employed by and insurance company receive payment based on their agreement with their employer.  Many other agents who are not captive with a carrier, receive payments through the commissions they earn.  They may receive this payment directly from the carrier or if they are LOA, they receive payment from their up-line.  Either way, the amount they make is based on their total number of sales made.

Please note: commission amounts vary based on the plan type and carrier as well as the level each individual agent is contracted at.

Find out about commission levels for 2024

How clients choose a Medicare agent

Here are some things clients may consider when they choose a Medicare agent.

1.  The first way clients choose an agent is usually word of mouth.  If you have done a great job helping their friends, relatives or co-workers, believe me they will hear about it.  People love to tell their friends about an agent who really did a good job for them.  That is why all your clients need to know that you are there to answer any questions or concerns they have.
2. Clients feel better knowing they are working with an experienced agent someone who understands the plan benefits and how they work.  Be sure you are up to date on all the plans in the areas you sell in as well as what the rules for enrollment are.
3. Offer many different carries and plan types for each area you sell in.  Clients want to work with an agent who has access to all the best plans in their area.  Each client is an individual and one plan type may not be the best choice for every client. Do not offer only Medicare Advantage plans as some clients are better off with a Supplement and PDP plan.

Click here for a scope of appointment

A knowledgeable and caring Medicare agent is a very valuable resource for the community. If you make sure you are well informed and truly enjoy helping those who need advice on Medicare coverage, you can become a successful agent with the right amount of time, effort & training.

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Starting a Medicare agency

If you are a licensed Medicare agent and would like to expand your Medicare business into a Medicare agency, here are a few things to do before starting a Medicare agency.

1. File and register your LLC or Corp with the state that you plan to have your headquarters in.
2. Go to your state department of insurance to apply for the appropriate license under your LLC or Corp.
3. Purchase E&O insurance (errors & omissions) for your agency.  This protects business owners from lawsuits connected to insurance sales.
4. Choose one person to act as the principal of your agency.  This person should be listed on any state license you apply for.  Be sure the individual is licensed in any state you wish to do business in as they will be listed as principal on any license your agency applies for.
5. Check all CMS compliance laws and be sure that both your agents and agency follow all applicable rules.  The agency principal must complete AHIP annually on behalf of themself and the agency.

Click here to learn the CMS final rule for 2025

Humana Vantage broker portal

The Humana Vantage broker portal is an invaluable tool for Humana appointed agents.  If you are appointed with Humana and have your Humana writing number, you can access the Vantage broker portal.  Just go to humana.com, go to the sign in and enter your username and password.  For new agents, just click to activate your online profile and use the prompts to setup your Humana portal access.

Click here to add Humana to an existing Crowe contract or to start a new contract with Crowe.

Licensing, Certification and Contracts

In this section of the portal agents find their status for licensing, certification and contracts. This helps agents stay up-to-date and ready to sell.

Education

The education section takes you to Humana MarketPoint University.  Once you are in MarketPoint, you have access to complete certifications and any training you need.  You can also access training webinars and job aids.

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What is a Medicare HRA

If you are in Medicare sales, you may have heard the term HRA.  In this post we will explain what is a Medicare HRA and why insurance carriers use this tool.

What is a Medicare HRA

HRA stands for Health Risk Assessment.  Medicare Advantage plans must do an HRA for every beneficiary within 90 days of their initial enrollment.  MA/MAPD plans require qualified health care professionals to conduct HRAs for existing members once a year.  These assessments are an important tool for both health plans and providers.  Insurance carriers use HRAs to identify the health status of members.  Once the HRA is completed,  insurance companies make risk adjustments and providers can put a managed care plan in place when necessary.  Clients may decide to have the HRA done either in a provider’s office or at home.

The HRA is required by CMS for all members of both Medicare Advantage and traditional Medicare fee-for-service plans.  If the member is enrolled in a traditional Medicare Fee-for-service plan, The member’s initial (welcome to Medicare) or preventative visit is used for the HRA.  When the member is enrolled in a MA/MAPD plan, the member will be asked to have the HRA.  Medicare advantage plans must make a “best effort” to have the member complete the HRA each year.

Click here to watch a quick YouTube video on Medicare Advantage vs. Medicare Supplement plans

HRAs (Health Risk Assessments) help collect important information

The information obtained through a HRA provides a view of the enrollee’s general health, health risk factors, as well as a glimpse into their ability to complete activities of daily living.  All these factors provide a view of overall health as well as find gaps in care and provide a basic diagnosis.

Any information obtained can help providers and health plans to create population health initiatives as well as to put an individual health plan in place.  The plan may include care management, coordination of care, identification of  high-risk individuals and the development of comprehensive care plans with referrals to suitable care team members.

Agents who want to offer Medicare Advantage plans, click here for online contracting

How to conduct a Health Risk Assessment

CMS has not put any specific format in place to conduct the assessments.  In many cases, a health care professional asks the beneficiary a series of questions. The questions cover a large range of topics that include family medical history, the beneficiaries current health, their lifestyle and their willingness to adapt behaviors that can improve their health.  The answers provided all correspond with a numerical value that determines the weighted risk value and health of the beneficiary.

Because Medicare Advantage companies receive payments from Medicare for each enrollee, Medicare uses this information to help calculate the payments. Health plans receive a prospective capitated payment that is based on the projected cost of care for each beneficiary.  Medicare adjusts the payment according to the amount of risk the company assumes per enrollee.  This helps ensure the company is able to cover the costs for the care for it’s enrollees.  That is why so many Medicare Advantage plan carriers offer their agents an incentive to ensure that new plan enrollees have the HRA completed.

For CMS to accept the HRA for the risk-adjusted payment, it must be either documented in the patient’s medical record or performed as a face-to-face visit with a licensed medical provider and the beneficiary.

Learn about CMS’ Part D drug cap

HRAs are an important tool

HRAs along with a good care management team are a great way to identify and support the specific health care needs of the individual to ensure improved health and better quality of life.

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CMS 72 hour rule

The CMS 72 hour rule is one of the many laws in place to help make the Medicare program run smoothly.   The Centers for Medicare & Medicaid Services (CMS) sometimes refers to their three-day rule as the 72‐hour rule.

This rule states that outpatient diagnostic or other services preformed within 72 hours before a hospital stay must be billed as part of the hospital stay.  The hospital cannot bill these diagnostic tests as separate procedures.

Click here to view the CMS 72-rule information

When a beneficiary undergoes diagnostic services within 3 days before a hospital stay, the services are considered inpatient and are included with the bill for the hospital stay. This is true for any diagnostic test or service provided in the hospital facility within a 3-day period before a patient’s admission.

A few examples of outpatient diagnostic services that the rule applies to include:

1. Lab tests
2. Radiology
3. CT Scans
4. Cardiology
5. EKG
6. EEG
7. Nuclear Medicine
8. Osteopathic test

Other times hospitals may add in-patient services together 

In some instances, under the 72-hour rule,  hospitals may bundle unrelated outpatient services with an inpatient surgery.  Although, if the outpatient service is not diagnostic, the hospital can bill it as a separate charge.

Medicare agents, watch a quick YouTube video on the CMS final rule 2024 for agent compensation

To better understand; please take a look at the example below.

If a beneficiary has an in-patient surgery scheduled in the next 3 days, but she trips and falls and goes to the hospital for an x-ray, the hospital can include the bill for her x-ray with her in-patient surgery bill.  This is true even if it is un-related. In most cases, the patient receives a separate bill for the individual service. If this patient has in-patient surgery within 3 days of the diagnostic test (x-ray), the hospital adds the cost of the x-ray with the surgery charges. The surgery can be completely unrelated to the area she had an x-ray of.

It is important to note, that because the nature of the service provided was diagnostic, it can be included in the in-patient charges.  Although, if the service a patient receives is not diagnostic but a service such as physical therapy, the provider bills this service separately and cannot include it in the in-patient bill.

How does the 72 hour rule help

CMS has this rule in place to stop providers from double-billing Medicare.   Both CMS and the OIG (Office of Inspector General) actively enforce the rule.  This helps prevent fraud and over payment for medical services.   If a provider is caught not complying with this rule, they face thorough investigations as well as the responsibility of paying for the recovery of overpayments they received.  Providers may also lose out on payments for services they provided.

The 72-hour rule helps limit both overpayments and underpayments.  It is important that hospitals ensure their billing and coding representatives understand the rule and how to apply it.

Learn about the Medicare call recording rules 

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UHC Jarvis login

Agents who are appointed to offer UHC/AARP Medicare plans can access many helpful tools in the UHC Jarvis portal.  In order to access the Jarvis portal, you must have a writing number and a UHC Jarvis login.

Do you want to add UHC to your appointments, click here to contact online with Crowe

Once you are in the portal, you can either sign in with your One Healthcare ID or register for a One Healthcare ID .  You can also login through the One Healthcare mobile app.

To learn more about the mobile app, click here.

When you get to the Home page, you will see a menu at the top of the page.  If you hover over the items, you will see a drop-down menu with several options for each category.

Sales Tools

In this section you have the following options:

Sales Materials with this tab, you can order or download applications or enrollment guides.

Medicare Medicaid Eligibility lookup.

Plan Search with this tab, you have the ability to look up available plans in an area once you enter a zip code.

LEAN is an online enrollment HUB.  LEAN includes a scope of appointment and voice signature options for applications.  There are also tools to lookup providers and medications.

Marketing Resources includes forms for events including new event request and cancellation forms.  There are also a marketing sales event checklists as well as sample verbiage.

Application Status

This tab is pretty self-explanatory.  Once you are in this screen, you can view a list of clients and see details of their application and enrollment.  This includes their member ID.

Commissions

Commissions Search this tab is useful for both agents and agencies. Run a report by agent and date.

Statements and More use this tab to download statements by date.

Commissions Calendar view the calendar and to see when commissions are set to be paid each month.

Direct Deposit access your direct deposit information and update it when necessary.

Assignment of Commissions this tab allows you to download an assignment of commissions form as well as view a FAQ sheet.

Release view instructions for releases.

1099 instructions to get a copy of your 1099.

Successor Agent this area is used for the transfer of both members and commission payments.

Book of Business

Use this tab to view a complete list of your clients.  Agents can apply filters to narrow down their search by area, status or name.

The final tab is Knowledge Center

Medicare Product Portal view the UHC product portfolio and search for available plans in a specific market area.

Training and Certifications form here you will access the Learning Lab where you can view product training and continuing education resources.

Agent Guide this area provides rules, policies and procedures for marketing UHC products.

Portfolio Overview view all the plan types UHC offers.

Selling Resources from here, you can access resources and product guides to find out what’s new and what benefits members can expect.

Enrollment Resources here you will access LEAN (The Landmark Electronic Application Navigator).  This tool makes enrollments quicker and easier. LEAN supports all Medicare Plans, including Medicare Supplement. Agents can use LEAN as a website on either desktop or laptop as well as mobile app for iOS and Android tablets.

Agent News View special election periods as well as several other announcements.

Member Experience in this tab you can view examples of common communications members receive from the plan based on the plan type.

Compliance Access resources for CMS sales and marketing compliance information.

Forms agents can easily find forms for events, scopes, PTC, commissions or other forms pertaining to specific plan types.

Click here to watch a quick YouTube video on the scope of appointment rules

FAQs learn how to find anything you need in Jarvis.

The top of the Home page shows enrollment statistics

View at a glance, how many applications are pending, how many have been approved in the last 60 days and how many active members you have.  There are links to view clients in each one of the categories.

There is a scrolling news feed with recent information as well as a plan finder and application status tool.  The center of the screen provides quick links to tools such as:

Medicare & Medicaid lookup

LEAN

UHC Agent Toolkit

Book of Business

Prescription Drug Lookup cost estimator

Pharmacy Finder

Dental Provider lookup

Medical Provider lookup (Rally)

Renew Active Fitness locator shows locations of clubs, classes and provides information for members to join a Fitbit community etc.

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Humana Vantage login

Medicare agents who contract to offer Humana Medicare plans should make sure they have a Humana Vantage login. Vantage provides access to several helpful tools that will make it easy to find answers to both agent and client questions.

How to access Vantage

You need to be contracted to sell Humana and have your writing ID before you can access Vantage.  Once you are ready to go, visit the Humana website.  Once you are on the site, click sign in on the top right corner of the screen and enter your username and password.  If you forgot your username or password, click the links below the sign in button and reset either one.

Contract with Crowe to offer Humana Medicare plans, click here

Are you a new to the Humana Vantage site

If this is your first time on the site, just click activate online profile to follow the prompts to get set up.

There are several sections on the Vantage home screen.

Licensing, Certification and Contracts

Licensing, Certification and Contracts lets agents know what their current status is for all Humana licensing and certifications.

Education

Agents can find a link to the Humana MarketPoint University (aka HMU) in the Education section.  In MarketPoint University, agents can complete certifications and courses as well as find training webinars and job aids.

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United Healthcare OTC catalog 2024

Members of participating UHC Medicare advantage plans have access to the United Healthcare OTC catalog 2024.  There are 3 different types of UHC Medicare Advantage plans that have their own OTC benefit package.  Members of all 3 plan types can access their OTC benefit through their UCard.  The UCard is more than just a member ID card, it is a way to access all the extra benefits UHC members receive.

Members of these plans have access to an over-the-counter credit.  United Healthcare adds the credit to members UCards either monthly or quarterly.  This depends on the plan each member enrolls in.  To find out if your plan offers this benefit and the details, check the evidence of coverage for your plan.

Member can shop in over 55 thousand participating stores.  Participating stores include CVS, Kroger, Walgreens, Walmart as well as Meijer, Sam’s Club and Save A Lot.
Shopping in stores provides a greater product selection for members that include both generic and Brand-name items.  Members also have the option to order items online, by phone or through the mail.

Please note:  This year the OTC catalog is too large to add as a download to the blog, that is good for plan members!  Members can call the member services number on the back of their card to request a copy be mailed to them.

The best way to see the OTC items is either online or through the mobile app.

View the catalog with the UHC Mobile app  – click here for instructions

Click here to access the OTC store finder

Unused benefits for Plans that provide a monthly combined credit for OTC/Healthy Foods/Utilities expires at the end of each month.

Ways to order OTC items

Members of participating UHC MAPD (non-SNP plans) have 4 ways to order OTC items with their UCard or prepaid card. In 2024, 68% of all non-DSNP members have access to the OTC benefit.

UHC 2024 OTC (Non-SNP) brochure

1.  Order in store at one of over 55k participating locations.

2.  Purchase OTC items online whenever it’s convenient for you 24/7.

3.  Use the phone to order OTC items.

4.  Use the mail order form in the OTC catalog to order items.

Please note, items ordered either online, over the phone or by mail will usually be delivered within 2-3 days of receipt.  Orders over $35 are eligible for free shipping.

Click here to download the 2024 UCard Quick Reference Guide

Information for C-SNP members

UHC 2024 OTC and Healthy Foods (CSNPs) brochure

C-SNP members have access to a monthly credit for OTC benefits as well as healthy foods benefits on their UCard.

Members have a few ways to shop for OTC items.

1. In store
2. Online through the member portal
3. Use the catalog and purchase items by mail.

Delivery is free on orders of $35 or more.

C-SNP members can choose from thousands of healthy food items including meat, fruit. vegetables, dairy bread cereal and much more.  There are a few ways to shop for healthy foods using the monthly allowance on the UCard.  Delivery is free with Walmart or Roots.

In 2024, there are 42 C-SNP plans that offer the OTC healthy food card.  In past years, this benefit was only available on the DSNP plans.

1. Shop for healthy foods in store
2. Choose from the items online through the member account,
3. Use the UnitedHealthcare mobile app to check your account balance or locate local retailers.  Use the scan to find available products and check outin stores without your UCard.

Orders can be placed by calling 1-888-628-2770 (TTY: 711). You can talk to an agent Monday to
Friday, from 9 AM to 8 PM local time. Please have your order ready before you call. 

OTC benefit information for D-SNP members

UHC 2024 OTC, Healthy Foods and Utilities Credit (DSNPs) members

OTC benefits for D-SNP plan member in 2024 include over-the-counter items as well as healthy foods and utilities benefit.  This benefit is loaded onto the UCard each month and member can choose to use it in any of the ways mentioned above.  Credits are loaded onto the UCard each month

D-SNP members can decide to use their benefit to shop one of the following ways.

1. In one of the thousands of participating stores.
2. They can also choose to shop online through the member portal.
3. Members may also use the catalog to order items through the mail using the form in the catalog.

Members can purchase Healthy Foods in one of the following ways:

1. Members can shop in-store
2. Online through the member portal
3. They may also use the catalog to choose food items and have them shipped to their home, the same as with OTC items.  Home delivery is free with Walmart or enrollees may choose Roots for fresh produce and premade meal delivery.

The utility benefit can help members pay electric bills, water and sewer usage, sanitation, heating or internet service. FOr utilities, the service address must be the same as the member’s home address that is on file with United healthcare.

Member can request a replacement catalog online or by contacting member services. 

The number for each plan’s member services team is found on the back of the member ID card.

Medicare agents- get contracted to sell United Healthcare plans

Additional information

In most cases, United Healthcare will answer member inquiries.  There are some benefits supported by different vendors depending how the member orders the product.  Items that are ordered online, over the phone or with the catalog will be filled by Solutran.   Some orders are supported by Walmart.

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Medicare prescription payment plan

The Medicare prescription payment plan is also referred to as “smoothing“. This is a way to help Medicare beneficiaries pay for the high cost of prescription medications.  The Medicare prescription payment plan is one small part of the inflation reduction act of 2022.

Watch a quick YouTube video on potential changes to commissions in 2025

When will the program start

In 2025, Medicare Part D (PDP) plan enrollees have a chance to opt for a prescription payment program.  The plan will help beneficiaries pay out-of-pocket costs for prescriptions.  Everyone in a PDP plan has a chance to enroll in the payment program, it is not based on income.  Enrollees have the option to enroll before the plan year starts or during any month of the year.   Please note, the payment plan does not include plan premium payments.

Here are some of the details

Participation in the Medicare prescription payment plan is optional.  PDP plan enrollees must choose to be part of the program.  Once an enrollee joins the program, and has out-of-pocket prescription costs, they receive a monthly bill to cover those costs.  Any out-of-pocket costs for prescriptions are included even during the deductible phase of PDP coverage.  There is no minimum out-of-pocket amount required before anyone can join.  Participants receive a monthly bill as long as they remain part of the program.

How is the monthly payment amount decided

There will be an annual cap of $2,000 on out-of-pocket costs in 2025.  The amount each beneficiary pays for their monthly plan depends on a few different factors.  It is not as easy as dividing $2,000 over the course of 12 months.

Learn more about the Part D drug cap

1. The Medicare prescription payment plan will deduct the out-of-pocket amount beneficiaries have already paid before enrollment in the program.
2. Any remaining costs are then divided by the number of months left in the year.

CMS will create a payment calculator so Part D beneficiaries can decide if enrolling in the payment plan is a good idea or not.

CMS is still working out the details of this program

We do not know exactly how the prescription payment program will work yet because the details have not been finalized by CMS yet.  We will post additional details as they are available to the public.

Please note:  This program is set to start in 2025, the same year the annual drug cap will be set at $2,000.  In other words, no Part D enrollee will pay more than $2,000 out-of-pocket for their prescriptions.

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UHC Care Advantage IESNP Prequalification

• If the member is dual or has any level of drug help, they MAY automatically qualify for the plan.  Please do not assume they qualify.  Check Jarvis to see if they show as eligible.
• If the member does not show as eligible in Jarvis, you will need to have them do the WellSky assessment call to see if they qualify.   It is very important the Wellsky assessment is done before you submit the application.  Once the assessment is completed you will get a notice stating if they are eligible or not.  If eligible, you can submit the application.
• This plan is available to anyone that can qualify either by having some level of help (MAKE SURE TO CHECK JARVIS TO SEE IF ELIGIBLE) or if they don’t have drug help, they can qualify through the Wellsky call.
• You can put a full dual or someone with any level of help in this plan, but the more obvious candidate would be someone on drug help only or someone that has no help at all.  The benefits of the plan will look far superior to the benefits of any non-dual MAPD plan.  It is also a very good Medicare supplement replacement option given the low MOOP of the plan ($1,600 in most states and as low as $500 in some)  This is especially true in states with high Medicare supplement rates like NY and CT.

UHC Care Advantage IESNP Prequalification – Broker Eligibility

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