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Home 2024 February
Medicare annual wellness visits

Medicare annual wellness visits

By Ed Crowe | General Articles | 0 comment | 29 February, 2024 | 0

Medicare annual wellness visits

For Medicare beneficiaries, it is very important to stay vigilant with their health care.  Medicare annual wellness visits (AWV) are an essential tool to maintain good health.  Unfortunately, many beneficiaries are unaware of how significant this is and what it entails.  In this post, we discuss the importance of wellness visits and their benefits.

Understanding Medicare Annual Wellness Visits

Medicare Annual Wellness Visits (AWVs) are preventive care appointments.  These appointments help assess and maintain the overall health of Medicare beneficiaries. Unlike traditional annual physical exams, AWVs focus on preventive care planning, risk assessment, and health promotion.  The purpose of these appointments in not to diagnose or treat existing conditions. Please note; anyone who has has Medicare Part B for over 12 months, is eligible for an annual wellness visit.  It is important to understand; these visits are not a physical exam.

There is not cost for the visit as long as the provider accepts Medicare assignment and the Medicare Part B deductible does not apply. Although, if your provider preforms additional test, you may have to pay the Part B deductible as well as co-insurance.  In the event these services are not cover under the preventative visit.

Why are annual wellness visits so important

  1. Prevention Over Cure: When providers use this approach, they prioritize preventive care, to detect potential health risks early on.  This helps prevent them from escalating into serious conditions. By identifying risk factors and developing personalized prevention plans, beneficiaries can take proactive steps towards better health outcomes.
  2. Comprehensive Health Assessment: AWVs provide beneficiaries with a comprehensive overview of their current health status.  By taking a holistic approach that includes screenings for cognitive impairment, depression, and functional ability, all aspects of health are addressed and monitored.
  3. Establishing a Baseline: Regular AWVs enable healthcare providers to establish a baseline of a beneficiary‘s health status.  This facilitates better care management and early detection of changes in health in subsequent visits.
  4. Patient-Centered Care: ensures patient-provider communication is a priority.  This fosters open dialogue about health concerns, lifestyle factors, and goals. This collaborative approach allows beneficiaries to actively participate in their healthcare decisions and take steps toward good health.
  5. Cost-Effective Care: Preventive care, as emphasized in AWVs, is proven to be more cost-effective in the long run compared to treating advanced diseases.  Medicare can reduce healthcare costs by investing in preventive measures to avoid chronic conditions.

Watch a YouTube video on the changes to Medicare Part D coverage

Components of an annual wellness visit

  1. Health Risk Assessment: Beneficiaries undergo a thorough assessment of their medical history, current health status, and risk factors for chronic diseases.
  2. Personalized Prevention Plan: Based on the health risk assessment, healthcare providers develop a personalized prevention plan that fits the individual’s needs and goals. This may include recommendations for screenings, vaccinations, lifestyle modifications, and community resources.
  3. Health Education: AWVs offer an opportunity for beneficiaries to receive education on various health topics.  This helps them make informed decisions about their well-being.
  4. Review of Medications: Healthcare providers review the beneficiary’s current medications to verify they are safe, effective, and appropriate for their needs.
  5. Referrals and follow-up visits: If necessary, healthcare providers refer beneficiaries to specialists or other healthcare services for further evaluation or treatment. Follow-up appointments are scheduled, when needed, to check progress and adjust the plan accordingly.

To sum it up

Medicare annual wellness visits are an important tool for the promotion of good health and well-being of Medicare beneficiaries.  When we  prioritize preventive care, health assessments, and patient-centered approaches, beneficiaries have the information they need to be proactive in their healthcare and wellbeing.

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NABIP final rule

NABIP final rule

By Ed Crowe | General Articles | 0 comment | 28 February, 2024 | 0

NABIP final rule

Many Medicare agents, brokers and agencies are concerned about the NABIP final rule.  This is due to the huge impact on the way they do business moving forward.  The CMS proposed rule we are talking about is CMS-4205-P.  If this rule goes through as it was originally written, there will be many changes to the landscape of the insurance industry. As many of you know NABIP has been a huge supporter of agents and agencies by lobbying on our behalf to make sure we are able to stay in business and continue to provide essential help to our clients.

Who is NABIP

NABIP stands for the National Association of Benefits and Insurance Professionals.  They represent over 100,000 licensed health insurance agents, brokers, general agents, consultants and professionals.  They have over 200 chapters throughout America.  Members of NABIP provide help to millions of clients ensuring they understand their health coverage options and that they can afford the coverage they need.  They also provide help with claims issues and coverage questions.

Click here to learn more about NABIP

What is the final rule we are talking about

As we mentioned earlier, the proposed rule we are all so concerned about is  CMS -4205-P.  Although there are several good policies included in the 486 page document, there are a few things that concern us.  You can find this This information  on pages 236-248 and they apply to agent/broker compensation.  Unfortunately,  independent agents are being lumped into the TPMO category.  In many instances these organizations do business in a very different way than independent agents do.

Watch a YouTube video on the CMS proposed rule 

Access the entire 486 page document by clicking here

Once you are on the page, just enter the document number,CMS-4205-P, in the search bar.  Remember to read pages 236-248 to see the proposed changes to compensation.

We have attached a copy of the document produced by NABIP’s PR team to hand out a their Capitol conference.  The document explains how agents/agencies use the administrative fees in question as well as what Medicare agents do and what their FMOs provide.  In other words, they explain the value of agents and FMOs to make a clear distinction of the importance of the services we all provide.  This is extremely important so that people in the government have a clear understanding of how our industry as a whole functions and makes use of the money we receive from the carriers.

Click here to view the NABIP flyer

What NABIP provides it’s members

Members are eligible for many educational opportunities including: advanced designation programs,, CE classes and online learning, conferences and networking opportunities. NABIP also offers members access to it’s publications and business development tools.

As we all see by their recent efforts, they advocate on the state and federal levels to advance the best interests of health insurance professionals.

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Medicare Educational Events

Medicare Educational Events

By Ed Crowe | General Articles | 0 comment | 27 February, 2024 | 0

Medicare Educational Events

Although Medicare educational events are a good way to generate Medicare leads, it is important that you follow all rules put in place by CMS before hosting one. It is important to remember that educational events are very different from sales event and conduct them accordingly.

These events are an opportunity to build relationships with local beneficiaries.  Agents can make them aware of the products and services they offer and that they are available to help answer their questions.  If you make a good impression, the beneficiary may ask the agent to help them make the right plan choice when it is time for them to enroll.

Although agents may not discuss specific plans during an educational event, they can hand out generic materials that offer basic information.  It is important to remember, agents must advertise the event as educational.

Click here to see the difference between educational and sales events.

How to Promote Educational Events

There are several ways to advertise events including newspaper and radio ads, flyers, direct mailers or online with email, Facebook or on your website. Although, there are guidelines to follow.  Educational events must be marketed as educational.  All advertisements must contain the disclaimer: “for accommodations of persons with special needs at meetings call (insert a phone number and TTY number).

Click here to watch our Medicare Educational Best Practices YouTube Video

Follow the guidelines below to help ensure your compliance.

What you can do at an educational event 

  1. Provide your business card and contact information to beneficiaries who wish to initiate contact with you.
  2. Answer any questions event attendees ask you.
  3. Hand out generic educational materials on the different Medicare plan choices available.
  4. Have business replay cards available for those who wish to be contacted to schedule future appointments.
  5. Provide a light meal or snack as long as the cost is $15 or less per person.

What you cannot do at an educational event

  1. Provide enrollment applications or marketing materials with specific plan information such as benefits or premiums to attendees.
  2. Offer cash gifts or offer rebates for plan enrollments.
  3. Collect SOAs or schedule future appointments.
  4. Require guests to sign in, they can provide contact information if they choose to.  Remember, a sign in sheet is not permission to contact.
  5. Schedule future appointments, if beneficiaries want to meet in the future, they can contact you with the information on your business card or a business reply card.
  6. Do not host a marketing/sales event in the same area as your educational event within 12 hours.  This applies to the same building or any adjacent buildings.
  7. Answers to beneficiaries’ questions should be generic and not promote any specific plan or package of benefits.
  8. Hold a one-on-one event, events must be in a group setting.

Learn about our T-65 seminar sales program and the other things Crowe has to offer both agents and agencies.

Compliance

It is important to remember that both CMS and carriers are serious when it comes to compliance.  A carrier can send a secret shopper to your educational event and if they see any violation, agents could face:

  1. Administrative hearings and penalties
  2. Cease and desist orders.
  3. License suspension or even revocation.

Watch a few videos on more compliance information

Learn about the 48-hour scope of appointment rules

Elements for a Medicare compliant call recording – click here

Find out about the Medicare marketing rules

If you follow the rules, keep up on carrier plan updates and get yourself out there in front of clients, you can build a successful Medicare business.

 

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Final expense life insurance

Final expense life insurance

By Ed Crowe | General Articles | 0 comment | 27 February, 2024 | 0

Final expense life insurance

Because the costs for funerals can add to the stress of losing a loved one, Final Expense life insurance may be a good choice to provide financial relief for your client’s family. Crowe and Associates offers agents contracts with several of the top final expense carriers who offer level, graded and guaranteed issue types of plans.

Final expense carriers

Crowe is contracted with top Final Expense carriers in all 50 states.  A few of the carriers we offer are: AIG, Foresters, Mutual of Omaha, TransAmerica, Cigna, Baltimore Life, Columbian Life, Royal Neighbors, and Gerber.  We offer agents the best rates for all types of FE plans.  Plan types include, single pay, level and graded as well as guaranteed issue.

Free quote site

Crowe agents have access to a free web-based quote site.  This site can quickly quote and compare final expense plans.  Just add in some basic information (state, age and desired benefit amount) and see plan costs and benefits side by side.  Additional information: our quote site is powered by FEX Quotes.

Watch a quick YouTube video on how to quote Final Expense and Medicare Supplements

Quote all carriers in one place

We give our agents access to a quote site that quotes all final expense plans we offer at no cost.  This includes immediate death benefit plans, graded plans and guaranteed issue plans.

Choose the carriers you want to start with

It is usually a good idea to start with a few carriers. The cost of a policy is a good place to begin, however, many plans ask beneficiaries underwriting questions. It is important to consider your client’s health and their ability to pass underwriting.  You may want to contract with a well-priced immediate death benefit carrier and a couple well priced GI issue companies.

Take a look at our product guide to see which companies you may want to start with.  The product highlight sheet provides plan benefits for several companies that include; maximum face value, commissions and underwriting.

Click here to view our FE highlight sheet. 

Contracting

Because many carriers are “same time contracting” you don’t have to wait for your contracting to be processed before you write a policy. Once you submit your first application, the carrier processes your contract.

Click here to join the team at Crowe.

Crowe agents who want to add Final Expense carrier to your existing contracts – click here.

Commissions

Many of the carriers we contract with offer starting commissions of 115%.  Some carriers offer advance commission payouts for agents with good credit.  All our agents receive both new and renewal commission payments directly from the carrier.  In other words, our agents own their own book of business.  Agents have access to all carrier incentive programs.

Contact our office for a username and password to start quoting today.

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How to sell Medicare advantage plans

How to sell Medicare Advantage plans

By Ed Crowe | General Articles | 0 comment | 26 February, 2024 | 0

How to sell Medicare Advantage plans

Learning how to sell Medicare advantage plans can take time.   There are certain steps an agent should take when getting started.  This includes contracting with the most competitive carriers in the areas you plan to sell, having a full understanding of Original Medicare, Medicare Advantage plans, Medicare supplements and part D plans and understanding enrollment rules.  Read below to see how to get started.

Contracting with Carriers

CLICK HERE TO GET CONTRACTED WITH CARRIERS

Agents need to find the most competitive carriers in the areas they plan to market in.  We suggest taking time to study the carriers plans to determine which ones offer the best overall benefits.  This can be done by comparing plans on Connecture or Sunfire.  Agents that do not have access to either system may compare on the Medicare plan finder.  It is suggested agents access Connecture or Sunfire at some point as it is a better way to quote, compare and enroll prospects long term.

Learn how to choose the right Medicare carriers; watch a YouTube video

Here are some of the benefits to consider when if you are trying to see which carriers offer the most  competitive plans:

  • Out of pocket maximum
  • Primary and specialist copays
  • Inpatient hospital copay
  • Ancillary benefits:  Ancillary benefits have become very important when it comes to comparing plans.  It can certainly be argued that people should not be picking plans based on ancillary benefits such as dental.  The reality however is that people do tend to focus on those benefits more than they should so they need to be taken into consideration
    • Dental
    • Vision
    • OTC
    • Transportation
    • Additional benefits that provide monthly allowances from various expenses
  • Network is important when it comes to offering plans.  Selling a plan with a limited network can lead to a lot of client turnover. It takes time to determine the strength of a carriers network.  We suggest reaching out to the broker managers with each carrier to get a better understanding of the network strength of the plans they represent.

Certifications

Annual certifications are a reality with those that offer Medicare Advantage and Part D plans.  Annual completion of the AHIP certification is also required.  New agents should be aware they will need to complete certifications for every carrier they plan to get appointed with and sell.

How to sell Medicare Advantage plans: Education

It is critically important to put the effort in to fully understand Medicare benefits.  All aspects of Medicare benefits.  This includes Original Medicare benefits, enrolment periods and rules for getting Medicare A and B, Medicare advantage benefits, Medicare Supplement benefits and Medicare Part D benefits.  In addition, a strong knowledge of the enrolment periods and special elections for the above listed products is also needed.   Agents selling Medicare supplements in underwritten states need to understand when prospects can apply using guaranteed issue vs. policies applications that will need to go through underwriting.

Getting in front of enough prospects: Leads, marketing, referrals and maintaining a book of business

The absolute most important part of succeeding in Medicare sales is having a strategy to get in front of enough prospects.  This is the number one reason Medicare producers do not make it in the business.  Finding a reliable lead source is critical to success.  Agents need to be aware of the reality regarding leads.  None of them are easy.  Working leads is anything but easy and requires thought, time, effort and tracking to make them work. Learn about various types of Medicare leads

In addition to leads, agents need to focus on multiple aspects of building a book of business.  Examples would be obtaining referrals from existing clients, building referral sources with centers of influence, passive marketing through a website and social media and a number of other avenues.  How to grow and manage a Medicare book of business

There is a common tendency for agents to put in time, effort and money into writing new clients without thinking about their current clients.  It is far less expensive and time consuming and expensive to keep existing clients vs. writing new ones.  As a result, it makes sense to focus on maintaining existing clients.

How to sell Medicare Advantage plans:   How Medicare commissions work

Cash flow is commonly a problem for new agents.  More than 50% of new agents start a career in Medicare and do not fully understand how Medicare Advantage commission pay out.  CMS lists the max allowable commission for Medicare Advantage and Part D in every state.  The maximum is not always paid out depending on the scenario.  Agents should take time to understand when they will be receiving full commission vs. partial payments. Renewals are a main driver when getting into the business.  It is prudent to understand renewals and factor them into the overall cash flow equations.  Video on how commissions pay

How to sell Medicare Advantage plans: Selling other products for more immediate cash flow

Successful Medicare producers make substantial income due to the amount of renewal payments involved vs. other product lines.  The most difficult part for new producers is managing lack of cash flow in the early years while they build up a large renewal stream.  It is wise to write other products that have more front loaded commissions while writing Medicare cases.  Examples of other product lines would be hospital indemnity plans, cancer, critical illness, dental and vision plans.   Non health related products such as final expense, standard life, annuities and disability insurance can also be Incorporated.   Lastly, ACA business can not only be an additional source of revenue but can be a great lead source for Medicare production.

 

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Benefits and programs for Medicare sales agencies

Benefits and Programs for Medicare Sales Agencies

By Ed Crowe | General Articles | 0 comment | 26 February, 2024 | 0

Benefits and Programs for Medicare Sales Agencies

Crowe and Associates offers a number of unique benefits and programs to assist Medicare sales agencies.   Benefits include multiple sources of marketing money, enrollment platforms, help obtaining higher overrides and more.  Please see below for a full list of our services for Medicare sales agencies.

Commissions

  • All commissions are set up to pay directly from the carrier to the agent or agency
  • Always full CMS max allowable commission and the agent or agency owns the book
  • LOA commissions can be set up for agencies that receive all commissions and pay them to their agents

Overrides

  • Crowe has the ability to set up agencies up to and including the FMO override level
  • Some carriers will require minimum amounts of sub agents to obtain certain levels
  • Agency contract level terminology varies to some degree by carrier but in general the levels are:
    • GA,MGA, SGA, FMO (Typically an FMO level contract is an override of $125 to $175 depending on the company
    • Overrides are paid directly by the carrier when the carrier offers that option.  If the carrier will not pay them directly they will be paid by Crowe/Pinnacle Financial Serives
  • Note:  Override payments are not one time payments.  They will pay as long as the case is on the books.  If the agency principal writes business, they will receive overrides on their own business and sub agent production.

Recruiting with Crowe $500 a month lead program

  • Crowe and Associates offers a lead reimbursement of $500 per month to every agent in our hierarchy
  • The lead program includes our agency partners and their sub agents
  • Agencies can use the program to recruit agents to their downline:  Crowe will pay for the program and it will cost the agency nothing

Marketing money from carriers

  • Crowe/PFS receives marketing dollars from carriers for AEP, OEP and often during lock in
  • We distribute money to agency partners who request it.
  • Reimbursements we provide can cover up to 75% of the money spent for leads, marketing and advertising up to large lump sums of money
  • Marketing money is often available from multiple carriers including Humana, Aetna, Cigna, Anthem and Wellcare

Unique lead sources

  • Agencies and agents are eligible for reimbursement with any lead or marketing they choose
  • We make a number of unique lead programs available to our agency partners
    • T-65 Seminar program
    • Pre-set Medicare leads
    • Inbound calls leads

Enrollment platforms and call recording

  • Agencies and their sub agents have access to Connecture, Sunfire and MyMedicarebot at no cost
  • All three platforms provide call recording, CRM functions and voice enrollment

Quote site in addition to Sunfire and Connecture

  • All agencies and their sub agents have access to multiple quoting platforms at no cost
  • CSG:  Quotes and comparisons for Medicare Supplements, Medicare Advantage, hospital indemnity, vision and dental
  • FEX:  Final expense quotes and comparisons
  • Annuity Rate Watch: Platform will quote and compare fixed, MYGA and fixed indexed annuities.  The system will also quote and compare income riders and SPIA payouts

Contracting and recruiting

  • Crowe and PFS will provide contracting services for all agencies and sub agents
  • We will never compete with our agencies or recruit any sub agents affiliated with them or agents they are recruiting
  • Each agency will be provided with their own white label contracting link with their branding to contract future agents

Website and logo building

  • Websites can be created for sub agents upon request at no cost
  • Logo design is available for those that need one
  • Websites have a consumer facing quoting and enrollment site for agencies and sub agents

Guidance on growing a Medicare agency

  • Crowe and Associates started in 2005 as a single producer agency (Ed Crowe who obviously lacked any creativity naming the agency)
  • Utilizing his experience building Crowe and Associates, Ed works with agency partners to develop strategies to increase agency growth
  • Help planning and funding agent recruiting including recruiting meetings
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Part D LEP appeal form

Part D LEP appeal form

By Ed Crowe | General Articles | 0 comment | 23 February, 2024 | 0

Part D LEP appeal form

If a Medicare beneficiary does not sign up for a Medicare Part D plan during their IEP (initial enrollment period) and has a period of more than 63 continuous days without having a creditable prescription drug plan, they will incur a LEP (late enrollment penalty).  If they receive an LEP, they can file a Part DLEP appeal form.

In some cases, a Part D plan provider imposes an LEP on a beneficiary once they enroll in a plan.  If the plan provider believes there has been a lapse in creditable drug plan coverage for over 63 days and is imposing the penalty , they must send a written notice to the enrollee. The enrollee receives a LEP reconsideration request form with the letter informing them of the penalty. This gives the enrollee the opportunity to initiate a Part D late enrollment penalty appeal.

Click here to download the LEP Reconsideration Request Form

Agents – find out about Medicare commissions 2024

Reconsideration Notice

If the enrollee receives a Part D LEP reconsideration notice, it includes an explanation of their right to request a reconsideration of the LEP.  Any Part D plan provider who adds the LEP to the enrollees plan premium must send the enrollee a letter notifying them of the imposition of a Late Enrollment Penalty as well as instructions to complete the LEP reconsideration request form.

Please note: either the enrollee or their representative can request a reconsideration, of the LEP.  The LEP reconsideration request form provides a list of situations when a review can be requested.

Learn about Part D enrollment

To view a sample LEP reconsideration notice – click here.

Reconsideration Request

If an enrollee wants to request a reconsideration of the LEP, they must submit the form, “Part D LEP Reconsideration Request Form C2C” .  Once the form is completed, use one of the methods below to send it in:

To send the form by standard mail; C2C Innovative Solutions, Inc., Part D LEP Reconsiderations, P.O. Box 44165, Jacksonville, FL 32231-4165

If you prefer to send it by courier or tracked mail, use the following address; C2C Innovative Solutions ,Inc., Part D LEP Reconsiderations, 301 W. Bay St., Suite 600, Jacksonville, FL 32202

For faster results, enrollees can send either by fax to; 833-946-1912 or they can go to the website https://www.c2cinc.com//Appellant-Signup create an account and upload the completed form there.
In the event the enrollee has a friend, family member or doctor send the request, that individual must be their representative. If this is the case, the representative must complete the last page of the reconsideration request form.   They can either fill the form out on line or print it and fill it out.

Click here to download the LEP Reconsideration Request Form

LEP appeal process

The LEP appeal process is conducted by an IRE (independent review entity) that has a contract with Medicare. The IRE notifies the enrollee of the final LEP decision within 90 days of receiving the request.  This includes the dismissal of the request.

Please note:  Enrollees who receive Extra Help,  do not have to pay the Late Enrollment Penalty.  Click here to learn more about Extra Help programs.

Additional information; if the enrollee has income above a certain level, they may be assessed an IRMAA, click here to learn what that means.

Find out the effect of the Medicare drug cap for 2025

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Benefits of Medicare Part C

What does Medicare Part C cover

By Ed Crowe | General Articles | 0 comment | 22 February, 2024 | 0

What does Medicare Part C cover

If you watch TV, I’m sure you have heard about Medicare Part C.  Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare (Parts A and B).  Private insurance companies offer these plans to beneficiaries.  In this post, we will answer the question; what does Medicare Part C cover.

Medicare Part C plans must cover all of the services that Original Medicare covers (except for hospice care, which is still covered under Part A), and they may offer additional benefits such as dental, vision, hearing, and prescription drug coverage. While Original Medicare (Parts A and B) offers essential coverage, many beneficiaries opt for additional benefits through Medicare Part C.

Basics of Medicare Part C coverage

Hospital insurance (Part A)

This includes inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.

Medical insurance (Part B)

This includes doctor’s services, outpatient care, preventive services, and some DME (durable medical equipment).

Prescription drug coverage (Part D)

Many Medicare Advantage plans include prescription drug coverage.  Part D coverage is not part of Original Medicare.  When it is included in a Part C, Medicare advantage plan, it is called an MAPD plan.  If it is not included, the plan is called an MA only plan.

Additional benefits

Many Medicare Advantage plans offer additional benefits not covered by Original Medicare, such as routine dental, vision, and hearing care, fitness programs, transportation services, and over-the-counter allowances for certain health-related items.

More Medicare Part C Benefits

Medicare Advantage plans often have annual out-of-pocket maximums.  This can limit the amount beneficiaries spend on healthcare services in a given year. Additionally, some plans have low or no cost $0 premiums.  This is a way for some fairly healthy beneficiaries to save money compared to the cost of a Medicare supplement and drug plan.

Many Medicare Advantage plans offer coordinated care through provider networks. This means beneficiaries have access to a network of doctors, specialists, and hospitals who work together to manage their healthcare needs.  This leads to more integrated and efficient care.

Things to consider

  • Network Restrictions: Some Medicare Advantage plans have provider networks, meaning beneficiaries may need to see doctors and specialists within the plan’s network to receive full coverage. It’s essential to check if your preferred healthcare providers are in the plan’s network.
  • Plan Options: Medicare Advantage plans vary in terms of benefits, costs, and coverage options. It’s crucial to research and compare different plans to find the one that best meets your healthcare needs and budget.
  • Prescription Drug Coverage: If you choose a Medicare Advantage plan that includes prescription drug coverage (Part D), ensure that it covers your specific medications and pharmacies

Click here to learn about the Pros and Cons of MA plans

Medicare Part C (Medicare Advantage) plans,  provide beneficiaries comprehensive coverage, additional benefits, and coordinated care, Medicare Advantage plans provide valuable healthcare options for millions of Americans. However, it’s essential to consider your healthcare needs carefully and compare plan options before enrolling in Medicare Part C to ensure you select the right plan choice.

Watch a YouTube video on Advantage vs Supplement plans

It is always a good idea to enlist the help of a licensed agent when making important health insurance choices.
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Vaccines covered by Medicare

Vaccines covered by Medicare

By Ed Crowe | General Articles | 0 comment | 20 February, 2024 | 0

Vaccines covered by Medicare

Medicare prescription drug plans cover wide variety of prescription drugs, this includes several vaccines covered by Medicare.  Medicare covers vaccines in more than one way; either by Part D  or by Part B (medical coverage) or Part C MA/MAPD plans that may provide coverage for all the parts of Medicare.  It all depends on the type of vaccination and what facility the patient receives it at. As of January 2023, all vaccines covered by Medicare should be free to beneficiaries. This means they should not have any cost-sharing such as; co-pays, co-insurance or deductibles.

Find out about Medicare Part D enrollment periods

Part B covers vaccine coverage

In many cases, if the vaccination is part of a treatment for an illness or injury, it is usually covered by Part B.  In other words, if a beneficiary gets a puncture wound, they may need a tetanus shot. When this is the case, the vaccination falls under Medicare Part B coverage (Part C, if they have an MA/MAPD plan).  If the beneficiary opts to receive a tetanus booster shot, that charge falls under their Part D plan.

Watch a quick YouTube video on enrollment periods including Part B late enrollment

Here are some common vaccines that Part B covers:

*Flu

*Covid 19

*Pneumonia

*Hepatitis B – in cases where the individual is at high to intermediate risk.

*Some necessary vaccines needed to treat an injury, illness or exposure to a disease.

Part B covers some drugs

In some instances, Part B covers drugs beneficiaries do not normally give themselves.  In other words drugs that you receive either in a doctor’s office or in an outpatient hospital setting.

A few of the drugs covered by Part B

  1. Flu shots (including seasonal and H1N1 Swine flu)
  2. Pneumonia (pneumococcal) vaccines.
  3. Leqembi (generic name – lecanemab) – This is a new medication used to treat symptoms of Alzheimer’s.
  4. Injectable osteoporosis drugs, such as Prolia or Xgeva, if the beneficiary meets the criteria.
  5. Antigens that the doctor prepares and provides instruction to administer.  The patient may self- administer the drugs with proper instruction and supervision.
  6. Drugs the beneficiary uses with DME (durable medical equipment) such as; infusion pumps or nebulizers.

Part D vaccine coverage

Part D Vaccines are provided in an effort to prevent illness as opposed to treating one.  Medicare Part D plans cover commercial vaccines if they are reasonably necessary.

Some vaccines covered by Part D

  1. Shingles vaccines
  2. Tdap (tetanus-diphtheria-whooping cough) vaccines
  3. In cases that a PDP plan’s formulary does not list a vaccine, it must provide coverage if a physician prescribes it as a prevention measure.

Learn about the Medicare Part D drug cap

As of January 2023, patients with Medicare Part D plans or MAPD plans pay no out-of-pocket costs for adult vaccines.  This is part of the Inflation Reduction Act of 2022.  If the patient is charged a vaccine administration fee at the time of service, they can submit this amount to their Part D plan for full reimbursement.

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Inbound Medicare Call Leads

Inbound Medicare Call Leads

By Ed Crowe | General Articles | 0 comment | 16 February, 2024 | 0

Inbound Medicare Call Leads

Agents who work with Crowe and Associates have access to Consumer Direct Inbound Medicare Call leads for $42.   It is easy to enroll in this program; agents log into the Live Client App, choose the lead locations, register for the pay wallet and can start taking calls. The system has built in call recording, a CRM and allows agents to track, work and disposition leads.  All leads have a 90 second call buffer.   Read below for more information on the agent portal and the leads.  Leads are available in English and Spanish.

Crowe agents can register for the lead portal here

Help with lead costs

Inbound call leads are eligible for our $500 a month lead reimbursement.  Any agent who works with Crowe can submit costs on a monthly basis and get reimbursed $500 a month toward those costs.  In addition, agents can also submit the lead expense to Crowe for carrier marketing money reimbursement.  Agents receive carrier money is based on estimated sales and total lead spend.

Learn about our $500 a month lead program

Learn about carrier reimbursement requests

About Inbound Medicare Call Leads

Inbound call leads are very different than a live transfer lead.  With a live transfer, the consumer is contacted, talks to a 3rd party and is then transferred to the agent.  It is important to note; live transfer leads can lead to major compliance and legal issues.  With an inbound call lead the consumer is the one that initiates the call (usually from an ad online) and dials direct to the agent.  Permission to call is built into the ad and the call is a direct inbound and waives the need for a 48 hour scope of appointment. Inbound calls are exclusive leads vs. a warm transfer that may be shared.

Are you looking for face to face appointments?  CLICK HERE FOR OUR PRE SET APPOINTMENT LEADS

About the Live Client portal

The Live Client portal allows agents to set parameters and receive inbound call leads.  Agents can set the times of day they are available to receive leads as well as the area they want to receive them in. In addition, they can set a daily budget to ensure they will only get the number of leads they have budgeted for.   The portal has a CRM built in and allows for agents to easily disposition and track leads.

Click here for Medicare carrier contracting

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