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What is a Medicare trial right

When a beneficiary enrolls in Original Medicare (they may also be enrolled in a Medicare Supplement plan and a Part D/PDP plan) and now want to try a Medicare Advantage plan. Medicare trial rights provide the chance to enroll in a Medicare Advantage plan and have 12-month trial period. During this time, beneficiaireis can decide if an MA/MAPD plan is a good choice. If the Medicare Advantage plan isn’t what they wanted, they can switch back to Original Medicare. Once they switch back, they have the option to purchase a Medicare Supplement and PDP plan if they choose to.

Medicare agents, learn about Medicare OEP, SEPs and late Part B enrollment

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When can a beneficiary can use a Medicare trial right

Beneficiaries who joined a Medicare Advantage plan when you were first eligible for Medicare

If a beneficiary enrolls in a Medicare Advantage plan when they first enroll in Medicare (IEP), they can switch to Original Medicare during the first year of enrollment in the MA/MAPD plan. The trial right lets them leave an MA/MAPD plan and enroll in a Medicare Supplement plan and a PDP plan. They can choose any plan available in their local area.

Those who dropped a Medigap policy to join a Medicare Advantage plan for the first time

When a beneficiary disenrolls from a Medigap policy to try out a Medicare Advantage plan, they have 12 months to go back to Original Medicare if they don’t like MA/MAPD plan. Beneficiaries can purchase a Medciare Supplement and PDP plan. When they do this, they do not have to go through underwriting to qualify for the Medicare Supplement plan.

More trial right information

Please note: beneficiaries can use the trial right period only once. However, there are other opportunities for clients to change their coverage.

Click here to learn about enrollment periods

It is important to remember, beneficiaries can apply for a Medicare Supplement plan as early as 60 days before their MA/MAPD plan ends. They cannot enroll in a Medicare Supplement more than 63 days after MA/MAPD coverage ends.

Find out what Medicare Advantage plans don’t cover

Note: If you leave a MAPD plan during a trial right and go back to Original Medicare and a Medicare Supplement plan, you should also enroll in a Medicare PDP plan at that time.

Before using a trial right

Beneficiaries should understand their current plan benefits completely. This includes coverage, costs and provider networks. A licensed agent can help provide a comparison of plan choice and help clients make an informed decision. It is important to consder all health care needs and costs before making a plan change.

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Medicare Agents as well as clients need to understand the differences between participating vs non-participating providers. This is a choice that can greatly impact the costs of the beneficiary’s healthcare. We will go over what each one means and the potential impact they can have.

Participating providers

Participating providers have agreed to accept Medicare and take assignment. This means the provider agrees to Medicare’s approved amount as full payment for covered healthcare services. In other words, these providers are contracted with Medicare and have agreed to their payment terms.

Why this benefits patients

Lower Out-of-Pocket Costs

Because participating providers accept Medicare’s approved amount, in may cases, beneficiaries only pay a standard 20% coinsurance after they meet their annual deductible. This can save beneficiaries hundreds of dollars.

Easier Billing

When a beneficiary works with a participating provider, the provider bills Medicare and the insurnace company directly. This takes the burden off the patient and helps expedite the process.

No Balance Billing

Beneficiaries are not charged any more than the Medicare-approved amount for covered services. This practice ensures there are no unwanted surprise bills for beneficiares to pay.

For example: If a beneficiary visits a participating provider for a medical treatment and Medicare approves a fee of $100, the beneficiary is responsible for paying 20% coinsurnace ($20). As long as they have already met their annual Part B deductible. The provider bills Medicare for the remaining $80.

Non-Participating providers

Non-particiating providers do not have a contract with Medicare. Therefore, they do not have to accept Medicare’s approved amount for medical charges as payment in full. In some instances, they may choose to accept Medicare on a case-by-case basis.

What this means for patients

Higher Costs

Non-participating providers can charge patients up to 15% over the Medicare-approved amount. This is called the “limiting charge.” When this occurs, beneficiaries could pay up to 35% of Medicare’s approved amount for healthcare services as opposed to the 20% they would pay using a provider who accepts assignment.

Billing concerns

In some cases, patients may need to pay the cost of medical care upfornt and then request reimbursement from Medicare. Usually Medicare reimburses 80% of the Medicare approved payment amount. This does not include the excess charges. The pateint will have to deal with all the paperwork and it will take time for Medicare to process.

For example, if an enrollee sees a non-participating provider and the Medicare-approved amount for the service is $100, the provider could charge up to $115. Medicare would reimburse the enrollee 80% of the $100 ($80) and the enrollee would be responsible for paying the remaining $35 ( 20% coinsurance ($20) plus the $15 limiting charge).

Opt-Out Providers

Just to make things more interesting, there’s a third category of providers called opt-out providers. These providers have opted out of Medicare entirely. These providers sign an agreement to be excluded from Medicare for two years and can charge their own rates. Using one of these providers is the most expensive choice a benficiary can make. When this is the case, Medicare will not cover any of the medical costs, and patients must pay out-of-pocket for the entire fee.

Choosing which type of provider to use

Choosing between participating and non-participating providers depends on many factors:

1. Cost: If managing costs is important, participating providers are generally the better choice since they do not charge more than the Medicare-approved amount.
2. Provider Preference: In some cases, the doctor or specialist a patient prefers to use might be a non-participating provider. When this happens, patients need to consider the additional cost and decide if the benefit the doctor provides is worth it.
3. Convenient billing: If the patient does not want the hassle of the billing paperwork and waiting for reimbursement, using a participating provider streamlines the process significantly.

Understanding the differences between participating vs non-participating providers is crucial for effective healthcare planning. Participating providers offer predictability and lower out-of-pocket costs, while non-participating providers may offer more flexibility at potentially higher costs and administrative burden.

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Because sometimes Medicare clients need more than just prescription medications, agents need to understand Medicare DME coverage to ensure clients get all the medical coverage they need.

What is DME

DME refers to medically necessary equipment such as wheelchairs, walkers, hospital beds and many more items that medical providers prescribe for use in the patient’s home. Unfortunately, not every medical device used in the home qualifies as DME. In order for Medicare to provide payment for DME, it needs to mee the following requirements:

1. A provider must deem the equipment medically neccessary.
2. It must be durable, in other words, it can withstand repeated use.
3. The equipment should last for at least 3 years of use.
4. The patient uses the DME in their home.
5. DME is only used by those who are either sick or injured.

Some items that qualify as DME

• Support surfaces including air-fluidized beds
• Blood sugar meters and test strips
• Blood pressure monitors
• Canes
• Catheters
• Commode chairs
• Continuous Positive Airway Pressure (CPAP) machines
• Crutches
• Hosptial beds
• Infusion pumps and supplies
• Nebulizers
• Oxygen equipment
• Patient lifts
• Prosthetic devices
• Walkers and wheelchairs

The items above are just a partial list to provide a general idea of what Medicare covers. To view a more complete list go to Medicare.gov. If you are unsure if an item qualifies, contact Medicare directly to verify coverage 1-800-633-4227.

Medicare DME coverage

DME is covered by Medicare Part B. Please note; enrollees must meet their Part B deductible before Medicare pays. Once the enrollee meets the deductible, Medicare pays 80% of the Medicare-approved amount. The enrollee is responsible for 20% coinsurance for the Medicare-approved cost.

Medicare only covers DME when the enrollee purchases it from a supplier who is enrolled in Medicare. In addition, suppliers enrolled in Medicare may be either participating or non-participating. Take a look below for further explanation:

DME supplier participation

1. If the supplier is not enrolled in Medicare, they can charge any price they want and Medicare will not cover the cost.
2. Some suppliers are enrolled in Medicare are non-participating. When this is the case the supplier can charge whatever they like. Medicare only covers 80% of the Medicare approved cost; the client pays whatever is left over.
3. Suppliers enrolled in Medicare and participating can only charge the Medicare approved amount and Medicare covers 80% leaving 20% for the client. This is the best scenario and will cost the client much less than the other 2 options.

In other words, Medicare covers DME when it is obtained from a supplier enrolled in Medicare at 80% of the Medicare approved amount.

Medicare Advantage DME coverage

As a rule, Medicare Advantage plans provide at least what Original Medicare covers. This means, enrollees of MA/MAPD plans recieve the same coverage for DME as Original Mediare enrollees. The plan pays 80% of the Medciare approved amount leaving the enrollee the remaining 20%. In some cases, MA/MAPD plans provide additional benefit amounts for specific suppies and enrollees pay little to nothing. The best way to know if to check the plans outline of coverage.

Medicare Supplement DME coverage

Medicare Supplements provide additional coverage for those who have Original Medicare. Each supplement letter provides specific coverage amounts.  Please take a look at the list below to see how each plan covers DME. Please note; for all plans (except C & F) clients must meet the Part B deductible before Medicare covers any Part B medical expense.

1. Enrollees in plans A, B, C, D, F, G, M, & N do not pay the remaining 20% left after Orignal Medicare pays it’s 80% of covered DME expenses, these plans cover that portion of the cost.
2. Those enrolled in Plan K will have to pay 50% of the remaining 20% not covered by Original Medicare.
3. Plan L pays 75% of the remaining 20% not overed by Orignal Medicare. Enrollees will have to pay the remaining portion of DME costs.

The Medicare Supplement outlines of coverage do not list DME because it falls under Part B coinsurance.

Medicare DME coverage

It is important to make sure your cleints follow th eproper steps to receive DME coverage from Medicare.

Provide a prescription from a Medicare provider

The only way an enrollee receives coverage for DME is when their provider states it is medically necessary. Your client will only receive DME coverage if their provider writes a prescription for it. In some instances, Medicare may also request further documentation from the provider to prove the neccessity.

Enrollees do not have to submit any paperwork to the insurance company. The DME supplier obtains all the documentation from the medical provider and submits it from there. Enrollees can verify the prescription with their medical provider.

Learn why it’s a good idea to use a Medicare agent

Use only Medicare suppliers

It is importnat to be sure that enrollees use only Medciare DME suppliers, if they don’t they will end up paying much more than they should. The best choice is to use a Medicare approved supplier that accepts assignment. This ensures the client gets the best pricing available fo rth esuplies they need.

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If you are in the field of Medicare sales, you have probably heard of Mediare SNP plans. Although some of you may be wondering, what are Mediare SNP plans.

SNP plans are Medicare Advantage Special Needs Plans. They provide coverage for enrollees with specific health conditions or situtations. We will go over the basic types of SNPs and the criteria for eligibility.

Medicare Advantage SNPs

Medicare Advantage SNPs are a specific kind of Medicare Advantage (Part C, MA/MAPD) plan that provides specific healthcare coverage for qualified individuals. These plan options differ from standard Medicare Advantage Plans that are available anyone who ie eligible for Medicare. The SNP plans are available only to individuals who qualify, offering tailored benefits, providers, and drug formularies that fit the needs of the covered condition.

The three primary types of SNPs

Chronic Condition SNPs (C-SNPs)

These plans are designed to provide coverage for individuals who suffer from severe or disabling chronic conditions. Examples include diabetes, cardiovascular disorders, chronic heart failure, and chronic lung disorders or ESRD. The disorder covered depends on the insurance carrier and the coverage area. C-SNPs provide specialized care coordination and benefits that are tailored to manage each specific condition.

Dual-Eligible SNPs (D-SNPs)

DSNP plans are designed for those who are eligible for Medicare as well as Medicaid. These plans are meant to coordinate benefits between the Medicare and Medicaid programs. They offer comprehensive coverage as well as additional support services to address the unique needs of dual-eligible beneficiaries.

Find out who qualifies for state Medicaid benefits

Institutional SNPs (I-SNPs)

ISNPs are available to individuals who live in institutional settings like nursing homes or who may require home nursing care. The ISNP plans focus on providing healthcare services that beneficiaries need when they are in these settings. This ensures the resident receives the care they need to avoid unnecessary vists to the hospital.

SNP plan eligibility

Eligibility for a specific SNP plan depends if the individual meets the criteria of the plan type.

C-SNPs: The individual must be diagnosed with one of the covered, qualifying chronic conditions.

D-SNPs: Potential enrollees must meet th eincome limits and be both Medicare and Medicaid eligible.

I-SNPs: Beneficiaries must either live in an institution or require institutional-level care at home.

Click here to learn about OEPs, SEPs and late Part B enrollment – watch a YouTube video

Why chooose a SNP plan

Some of the advantages of choosing an SNP plan over a standard Medicare Advantage plan or Original Medicare are:

Customized Care Coordination

SNP plans provide tailored care management and coordination for an individual’s specific health care needs. For example, C-SNPs offer specialized programs to manage chronic health conditions, while D-SNPs coordinate benefits between Medicare and Medicaid, to simplify the process for beneficiaries.

Comprehensive Coverage

Many SNP plans include additional benefits not typically covered by Original Medicare, such as vision, dental, and hearing services, as well as transportation to and from appoitnments, OTC benefits and wellness programs.

Focused Provider Networks

In most cases, SNPs usually have a network of providers who specialize in treating the specific conditions of plan members. This ensures that beneficiaries receive high-quality, specialized care.

Cost-Effectiveness

For some beneficiaries, SNPs are a more cost effective alternative to other plan choices. Individuals enrolled in D-SNPs generally have lower out-of-pocket costs due to Medicaid coverage, while the chronic condition management in C-SNP plans aim to avoid costly hospitalizations.

Choosing the Right SNP

For individuals thinking about enrolling in an SNP plan, it’s always a good idea to enlist the help of a licensed Medicare agent who can advise you on the best plan options available to suit your needs. Here are some things to consider:

Eligibility: Based on your health condition, living situation or dual-eligibility status, determine if you meet the criteria for a SNP plan.

Compare plans: Look at the available SNPs in your area side by side. Consider benefits, provider networks, plan formulary and overall costs.

Agents: click here to see a Sunfire quoting and enrollment tool demonstration

Consult healthcare providers: Have your agent verify that your providers ar ein network with nay plan you are considering. Beneficiaries can also contact their providers to see which plans they are in network with.

Look at added benefits: Consider any extra benefits each plan offers and wich ones are more valuable to you. Many plans offer dental, vision , hearing, OTC, transportation services and fitness benefits.

Check plan ratings: Medicare provides star ratings for all Medicare Advantage Plans, this includes SNPs. These ratings provide insights into the plan’s quality and overall performance.

Medicare Advantage SNPs play an important role in providing personalized, comprehensive care for individuals with specific healthcare needs. By understanding the different types of SNPs, eligibility requirements, and the benefits they offer, beneficiaries can make a well-informed decision to ensures they receive the best possible care tailored to their unique circumstances.

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Because End-Stage Renal Disease (ESRD) is a serious medical condition that affects many people, understanding ESRD and Medicare coverage is very important for agents and beneficiaries. For individuals who suffer from ESRD, it is essential to access needed healthcare coverage to manage this condition. Luckily, Medicare provides coverage designed to meet the needs of ESRD patients. In this post, we discuss ESRD it’s affects and the ways Medicare covers the treatments.

What is ESRD

End-Stage Renal Disease (ESRD) is also know as end-stage kidney disease or kidney failure. ESRD occurs when an individual suffers a gradual loss of kidney function until the final stage where waste builds up in the body to a dangerous level. Once an individual reaches the final stage or ESRD, kidneys no longer function requiring medical treatment. Treatments include dialysis or a kidney transplant to keep individuals alive.

There are several symptoms of ESRD that may include the following:

1. Nausea/vomiting
2. Loss of appetite
3. Changes in urination
4. Fatigue and weakness
5. Headache
6. Fluid retention and swelling (edema) in feet and or ankles
7. High blood pressure (hypertension)
8. Chest pain if fluid builds up around the heart
9. Shortness of breath
10. Muscle cramps or twitching
11. Anemia
12. Bone disease
13. Cardiovascular problems
14. Complications related to dialysis or transplantation

The management of ESRD requires a multidisciplinary approach. Individuals must adhere to a strict schedule of medical appointments and treatment regimens. This may involve dietary restrictions, and changes to lifestyle.

Enrolling in Medicare for ESRD

Individuals who need to enroll in ESRD Medicare should go to their local Social Security office. Social Security handles ESRD Medicare enrollments. Providers and/or dialysis centers must send documentation to the Social Security office to verify ESRD and explain each individual’s course of treatment. For those too ill to enroll themself, a family member or designated person can enroll you.

ESRD and Medicare Coverage

Medicare provides tailored coverage options for individuals with ESRD. In general, Medicare eligibility for individuals who suffer from ESRD begins either immediately if they are recieving dialysis or after a kidney transplant.

When does ESRD Medicare coverage start

The start of Medicare coverage of ESRD depends on the treatment plan.

1. Those who start a home dialysis training program (self-dialysis), will be Medicare eligible the first day of the first month the home dialysis program starts. Patients must start the program before the third month of dialysis. In addition, the doctor must verify they expect the patient to complete the program and continue home dialysis once the program ends.
2. Anyone who receives dialysis either at an in-patient or out-patient facilty is eligible for Medicare the first day of the 4th month they receive dialysis. In other words, if an individual recieves dialysis on Feb 20, they are eligible for ESRD Medicare on May 1st.
3. For those who receive a kidney transplant, Medicare coverage begins the month they are admitted to a Medicare approved hospital for the transplant or when they recieve needed health services before the transplant.
4. Individuals must receive the transplant within 2 months after the Medicare coverage starts.

Medicare’s coverage of ESRD

Medicare Part A

Medicare Part A (hospital Insurance) covers inpatient kidney transplants or dialysis at a Medicare-approved facility. Please note; individuals must meet the hospital deductible before Medicre pays. In 2024, the deductible is $1,632. Additionally, If the beneficiary is in the hospital in excess of their benefit period, they pay daily co-insurance.

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Medicare Part B

Medicare Part B (Medical Insurance) provides coverage for doctors’ visits, outpatient care, medical supplies as well as a portion of dialysis treatments. This includes dialysis equipment and supply costs and fees for transplant surgeons. Generally, patients pay a 20% coinsurance if they choose a provider that accepts Medicare assignment.

Important; Medicare pays for the kidney donor’s hospital stay and follow-up care. There is no cost sharing for the donor’s care. The recipient of the kidney should not recieve a bill for the donor’s care.

Outpatient dialysis

As long as the patient receives outpatient dialysis in a Medicare approved facility, Part B covers the cost. In most cases the patient pays 20% coinsurance for each session. This includes most dialysis medications, equipment, supplies and lab tests.

Home dialysis

Medicare Part B provides coverage of certified home dialysis. They pay a set fee that includes the training cost to learn to administer home dialysis. Supplies, lab tests, most dialysis medications, and home dialysis equipment are included in the fee Medicare pays. Again, most patients pay 20% coinsurnace toward treatment cost.

Please note: ESRD Medicare does not cover surgery or cost for services needed to prepare the patient for dialysis before they are Medicare eligibile. In other words, Medicare does not pay the cost of surgery to create the access point for a dialysis machine. Patients who have coverage prior to Medicare, will use that coverage to pay the costs for services.

Immunosuppressants

Medicare Part B will covers immunosuppressants for patients who:

1. Are only eligible for ESRD Medicare. Medicare coverage ends 36 months after a successful transplant.
2. Were enrolled in Medicare Part A when they received the transplant.
3. Are enrolled in Medicare Part B when they fill their immunosupressant prescrptions.

Once a patient receives a transplant, they must take immunosuppressant drugs for life to prevent rejection of the new kidney.

If the patient was not enrolled in Medicare Part A when they got transplant surgery, Part B will not pay for immunosuppressants. This is true even for those whpo had other insurance coverage that paid for the transplant surgery. Patients not enrolled in Part A when they received their transplant may need Medicare Part D to cover the costs of immunosuppressants.

Immunosuppressive drug benefit

Patients who’s ESRD Medicare benefits reach their end, 36 months after a transplant, may be eligible for the Medicare immunosuppressive drug benefit (Part B-ID benefit). This benefit covers only immunosuppressant drugs. It does not cover any other Part B benefit or services. If the patient has other insurance options, Part B-ID may not be a great choice.

How to qualify for Part B-ID

1. The patient must not be on Medicaid or other health insurance plan that covers immunosuppressants.
2. Patients must qualify for Part B immunosuppressants before the loss of Medicare ESRD coverage.

The cost for Part B-ID coverage is a set percentage of the standard Part B premium. To enroll in the plan, contact Social Security 877-465-0355.

Medicare Part C

Medicare Part C (Medicare Advantage) plans provide the same benefits as Original Medicare (Parts A and B) but may have seperate cost restrictions. Medicare Advantae plans cannot set higher cost sharing for either outpatient dialysis or immunosuppressant drugs then Original Medicare. In many cases, Part C (Medicare Advantage) plans include addtional benefits like dental, vision, OTC and prescription drug coverage. There are some Medicare Advantage plans that offer specific coverage for individuals with ESRD.

Medicare Part D

Medicare Part D (Prescription Drug Coverage), provides coverage for prescription medications. This includes those required for ESRD treatment.

Other insurance coverage

Those enrolled in private or employment based insurance when they become eligible for ESRD Medicare will have their private or employer based coverage as primary for 30 months. The 30 months begin as sson as the patient is eleigible for ESRD Medicare even if they did not sign up for it.

The 30 months are referred to as the coordination period. It begins the month they are eligible for ESRD Medicare coverage. During this time, patients do not have to sign up for ESRD Medicare immediately as long as their private or employment based insurance is in effect. The existing insurance pays first and ESRD pays second for health costs. In the event the patient does not have othe rcoverge, ESRD Medicare pays as soon as it goes into effect.

It is a good idea to enroll in ESRD even if your current coverage pays as primary during the 30 month period. Medicare ESRD may help cover deductibles, copays as well as coinsurance. Enrolling in ESRD Medicare when the 30-month coordination period begins will automatically make Medicare ESRD the primary payer at the end of the coordination period.

ESRD coverage end

Those enrolled in Medicare soley due to ESRD will lose coverage due to the following:

1. If the patient no longer requires dialysis, coverage ends 12 months after the last treatment date.
2. When the patient has a successful transplant; meaning the new kidney is not rejected after 36 months. At that time, Medicare ESRD coverage ends.

Medicare provides comprehensive coverage for those who are living with ESRD. Understanding the ESRD coverage provided by Medicare helps individuals effectively manage this condition.

In the area of insurance sales, mastering the art of selling Medicare over the phone requires a unique set of skills. Unlike face-to-face interactions, phone sales require an ability to communicate effectively, build rapport, and convey trust solely through your voice. The following tips for telesales can help agents hone their phone sales techniques and excel in this competitive field.

Watch a YouTube video on the key elements for a compliant phone recording

Most sales are a numbers game, the more people you reach, the better the chance of making a sale. The same rule applies for telesales training. The more prospects an agent calls, the more at ease they become starting a conversation.

Know Your Audience

It is crucial to understand the demographics, needs, and concerns of Medicare-eligible individuals before contacting anyone. Agents should tailor their approach and language to resonate with each individual, emphasizing the benefits and coverage options that matter most to them.

Be Prepared

Before making any calls, agents must have a solid understanding of the various Medicare plans available. This includes Original Medicare, Medicare Advantage, and Medicare Supplement plans. To be prepared to address questions or concerns, agents must be up to date on coverage details, costs, and enrollment periods.

Click here to learn about consumer direct inbound call leads – watch our video

Build Trust and Rapport with prospects

The first thing agents should do when placing a phone call is establish trust. Every call should start with the agent introducing themself and explaining the purpose of the call in a friendly and professional manner. Taking the time to actively listen to the prospect’s needs and concerns is imperative. It is important to demonstrate empathy and understanding throughout the conversation.

Click here for more Medicare sales tips

Focus on Benefits

Do not bombard prospects with technical details about different plans. It is best to focus on the benefits they will receive, how each plan can improve their quality of life, provide peace of mind, and save them money on healthcare.

Use Examples

Share real-life examples of how Medicare coverage has made a positive impact on others. Personal anecdotes help prospects visualize themselves benefiting from the coverage you’re offering. Sharing stories also helps build a bond between the agent and the prospect.

Find out what you can’t say when selling Medicare

Ask Open-Ended Questions

Encourage dialogue by asking open-ended questions that prompt prospects to share their healthcare needs and preferences. This keeps the conversation going naturally as well as helps you gather valuable information about what products would best suit them.

Address Objections with Empathy

It’s inevitable that prospects will have objections during sales calls. Instead of dismissing objections, acknowledge them with empathy and address them head-on. Offer solutions that align with the prospect’s needs and concerns.

Follow Up and Follow Through

After a call is finished, it is very important to follow up with prospects as promised. Agents can send personalized follow up emails, letters or call to reiterate key points discussed during the call and offer further assistance. A consistent follow-up lets prospects know you are committed to helping find the best Medicare solution.

Stay Compliant

All agents should be aware of all communications & Medicare regulations and compliance guidelines. This ensures your sales practices adhere to both ethical & industry standards. Agents who use misleading or deceptive tactics can damage their credibility in the business community and may suffer serious regulatory consequences. Always follow all permission to contact rules!

Learn how to make an AOR change

Continue Learning

Because the Medicare landscape is always changing, with plan changes, regulations, and market trends, agents need to stay informed. This can be accomplished by attending training sessions, webinars, and industry conferences. These are great options to help sharpen skills and stay ahead of competitors.

Find out how to get Medicare leads

Additional tips for telesales

Incorporating the tips for telesales into your Medicare sales strategy can help build stronger relationships with prospects, and ultimately increase sales. Please keep in mind, mastering phone sales requires dedication and is an ongoing task.

Agents who want to join the team at Crowe, click here for online contracting.

The better an agent can validate an prospects objection and propose an acceptable solution with your services, the better you will overcome objections.

Important; listen closely to your prospects to get a sense of their interest in the information you are offering. In some cases, it’s better to hang up early and spend time on the next prospect

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There are some Medicare Part D changes 2025 coming to (MAPD/PDP) plans.  One of the biggest changes is the discontinuation of the Medicare donut hole in 2025.  In January 2024, CMS released a draft of the new Medicare Part D payment policies.

Click here to get more details on the changes coming to prescription drug coverage in 2025

Key points

Removal of the Donut Hole/Gap phase – The coverage gap phase will merge with the former initial coverage phase. This phase will become the “Standard Coverage Phase”.

There will only be 3 coverage phases. They are Deductible, Standard & Catastrophic.

The Out of Pocket (OOP) threshold for each beneficiary is dropping to $2,000 annually.

The end of the Donut Hole/Gap discount program (CGDP) will place more emphasis on the Manufacturer Discount Program. There will be changes to the drugs that are discounted and how they count towards the OOP.  This also changes who is responsible for the cost of the drugs beyond a set amount.

Watch a YouTube video on Medicare Part D changes

The drug plans will pay similar amounts as in previous years, although a larger part of their responsibility starts much earlier than in previous years.  In other words, drug plans will pay more money on more enrollees overall.

Click here to learn all the details of the Medicare Part D redesign

The new design for prescription coverage consists of three phases of coverage.

1. The first phase is the “Annual Deductible Phase”.  In this phase enrollees pay 100% of their prescription drug cost until they meet the deductible of $590.
2. The second phase is the initial coverage or “Standard Coverage Phase”.  This phase was formerly the initial coverage phase merged with the Donut Hole/Gap phase. During this phase, after the enrollee meets the spending threshold (OOP) of $2,000 for CY 2025, they complete this phase and move into the catastrophic phase.
3. The third phase is the “Catastrophic Phase”. During this coverage phase, the enrollee does not pay any cost sharing for covered Part D drugs.

Learn about the CMS 2025 proposed rule

It is very likely the added costs drug companies incur will result in either higher Part D plan premiums as well as changes to MAPD plan benefits and/or costs.

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Dental plans without waiting periods are a rare find. Most dental plans require a 12 month wait before covering most dental expenses beyond basic cleanings and preventative services. For that reason alone, these plans are a great addition to any healthcare agent’s product offerings. We will go over a few more reasons agents may want to sell these plans.

Click here to watch a video on the benefits of ancillary plan sales.

Why offer these dental plans

Large Provider Network

The network for these plans is one of the largest dental networks in the country. This means, finding an in-network provider will be easy for most clients. As any agent will tell you, one of the most important benefits of a dental plan is getting the negotiated rate for using an in-network provider, this benefit can save enrollees much more than the plan maximum benefit amount.

3 Plan choices available

There are 3 coverage options in this network. The first option offers a benefit amount of $1,000. Other plan options offer coverage amounts of $1,500 and $2,000.

Plans provide 100/80/50 coverage. 100% coverage for preventative and diagnostic services. Preventative consists of, exams, cleanings, bitewing, full x-rays, fluoride treatments and space maintainers. Coverage of 80% for basic services that consist of, filings, simple extractions, oral surgery, root canals and sealants. There is 50% coverage for major dental services from day 1. Major services include, crowns and gold restorations, bridge work, full and partial dentures, denture repair and implants.

That’s correct, coverage from day 1! This is available for any enrollee even if they did not have prior dental coverage.

Plans are available to anyone

Plans are available in all 50 states to anyone between the ages of 18 and 100 years of age. These plans are offered by an association that uses one of the largest dental networks available. The deductible for the plans is $50 per person with a maximum family deductible of $150.

There are 4 options for coverage:

1. Member
2. Member and spouse
3. Member and child
4. Family

Watch our YouTube video for more information on these dental plans

More benefits of selling these plans

This coverage also includes a carryover benefit of 50%. That means, if the member does not use a portion of their benefit (up to 50%) it can be carried over to the next calendar year and added to that annual benefit maximum.

Agent information

Commissions for agents who sell these plans is 12% paid as earned, for the life of the policy. Higher commission amounts are available for agencies who have subagents selling plans.

Agents have a personalized portal they can use to enroll clients. There is also the option of customer self-enrollment through a consumer facing function on the portal.

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In the realm of health and life insurance, there’s a concept that can cause some confusion: elimination periods. In this post, we answer the question; what are elimination periods and explain how they can impact insurance coverage.

Understanding Elimination Periods

Elimination periods, also called waiting periods, are a common feature in both life and health insurance policies. They represent the duration of time that must pass after an approved event occurs before an insurance company pays a benefit. Although the specifics vary between life and health insurance coverage, the underlying purpose remains the same: to manage risk.

Life Insurance

Life insurance elimination periods typically come into play upon the policyholder’s death. This period serves as a buffer, ensuring that the policy has been in force for a specified duration before the death benefit is paid out to beneficiaries. Longer elimination periods may result in lower premiums. This usually results in a cost savings for policyholders. While shorter elimination periods provide quicker access to benefits, they may come with higher premiums.

Health Insurance

In health insurance, elimination periods are often associated with long-term care or disability coverage. Health Insurance waiting periods are similar those in life insurance. They require a waiting period before beneficiaries receive coverage. For example, in long-term care insurance, elimination periods determine when coverage for services like nursing home care or home healthcare begins. Disability insurance policies may have elimination periods that work in a similar fashion, they dictate when income replacement benefits are payable after a qualifying illness or injury.

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Understanding the Significance

The reason for elimination periods is to mitigate the risk for insurance companies. By imposing a waiting period, insurers can make certain that coverage is provided for more significant or long-term issues rather than minor, short-lived ailments. From the insured’s perspective, elimination periods can affect financial planning during times of illness or injury. In some instances, elimination periods can be covered by additional products, such as short-term care policies for beneficiaries waiting for long term care insurance to kick in.

The Impact on Coverage

Financial Preparedness

These wait times require individuals to have financial reserves or alternative sources of income to cover expenses. Understanding the length of the elimination period is crucial for financial planning.

Policy Customization

Many insurance policies offer flexibility in choosing elimination periods. Opting for a longer waiting period typically results in lower premiums, while shorter waiting periods come with higher premiums. Balancing these factors requires careful consideration based on individual circumstances.

Long-Term Care

In long-term care insurance, elimination periods range from a few days to several months. The length chosen affects when benefits become available for services such as nursing home care, home healthcare, or assisted living facilities. Adding a short-term care policy can provide coverage during the waiting period of a long-term care policy.

Disability Insurance

For disability insurance, elimination periods can vary widely depending on the policy. Individuals who pay higher premium amounts may have shorter waiting periods. This can minimize the financial impact of a disability.

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Making Informed Decisions

When selecting a health insurance policy, it’s essential to thoroughly understand the elimination period terms and their implications. Here are a few things to consider before choosing insurance coverage:

Assess Your Needs: Evaluate your financial situation, including savings, emergency funds, and potential sources of income during an illness or disability.

Understand Policy Options: Compare elimination periods offered by different insurance providers. Consider how each option aligns with your financial capabilities and risk tolerance.

Seek Professional Advice: Consult with insurance agents or financial advisors for personalized guidance based on specific circumstances and insurance needs.

Review Regularly: Life circumstances change, so periodically agents should review your insurance coverage to ensure it continues to meet evolving needs. Adjustments may be necessary as your financial situation, health status, or family dynamics change over time.

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A professional insurance agent can help assess your needs, explain coverage options, and ensure that you make the best choice.

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In the area of personal finance, choosing the right life insurance policy can play an important role. Life insurance provides a financial safety net for your loved ones in the event of your passing. However, navigating the many life insurance options can be confusing. It is essential to understand the different life insurance options to make a well-informed decision.

Term Life Insurance

Term life insurance is a straightforward and affordable option. It provides coverage for a specific period of time, such as 10, 20, or 30 years. If the policyholder passes away during the term, the beneficiaries receive a death benefit. Although, if the policyholder outlives the term, the coverage expires, and there’s no payout. Term life insurance is a great option for those looking for temporary coverage, such as to replace income during the working years or to cover a mortgage.

Whole Life Insurance

Whole life insurance is sometimes referred to as permanent life insurance. Whole life provides coverage for the entire lifetime of the policyholder. In addition to the death benefit, these policies accumulate cash value over time, policyholders can access the cash through loans or withdrawals. Although premiums are typically higher than term life insurance, they remain level throughout the policyholder’s life. Whole life insurance provides protection as well as a savings component. This makes it a good option for long-term financial planning and estate protection.

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Universal Life Insurance

Universal life insurance is another type of permanent life insurance that offers flexibility in premium payments and death benefits. Policyholders can adjust the coverage and premium payments according to their changing financial needs. Universal life policies also accrue cash value, which earns interest over time. Policyholders can use the cash value to offset premiums or to withdraw for their own financial use. Universal life insurance provides a blend of flexibility and lifelong coverage. This makes it a good choice for those who want a customizable insurance option.

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Variable Life Insurance

Variable life insurance combines death benefits with investment options. Policyholders have the opportunity to allocate a part of their premium to various investment accounts, such as stocks, bonds, or mutual funds. The cash value of the policy fluctuates based on the performance of the investments. Although variable life insurance offers the potential for higher returns, it also comes with greater risk and requires active management. This policy choice may be good for individuals who are comfortable with investment risk and are looking for greater cash value potential.

Indexed Universal Life Insurance

Indexed universal life insurance is a variation of universal life insurance. It offers policyholders an opportunity to earn interest based on the performance of a stock market index, such as the S&P 500. Policyholders can participate in market gains while they are protected from market downturns, as the policy’s cash value is often subject to a minimum interest rate guarantee. Indexed universal life insurance gives policyholders a balance of market-linked returns and downside protection. That makes it an attractive option for those who want growth potential as well as reduced risk.

Choosing the right life insurance policy depends on various factors, including financial goals, risk tolerance, and stage of life. It’s essential to assess all needs carefully, A qualified insurance professional can help determine suitable options for potential enrollees.

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