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The CarePartners OTC catalog 2025 give beneficiaries of participating plans plenty of great ways to use their benefit. We will provide the different ways to order products as well as access to the OTC catalog.

Click here to download the 2025 OTC catalog

How to order products

1. Enrollees can order OTC products 24/7 online at medlineotc.com/cpct. They can also track their order and view their OTC balance. Just create an online account and follow the prompts.
2. Plan enrollees can also order products by mail. Just use the order form located at the back of the OTC catalog follow the instructions and mail to: Medline, PO Box 18522, Palatine, IL 60055.

CarePartners OTC catalog 2025 – ordering information

More about mail orders

When an enrollee places an order, they should have their card number and member ID handy. The online portal is a great way to track orders, view previous orders and monitor your OTC benefit balance. Once Medline processes the order, the member should receive the items in about 4 days or less.

Mail orders can take as many as 4 weeks to process. It is always faster to order items from the online portal, medlineotc.com/cpct. If an item in your mail order is out of stock, Medline will process it without the items. Enrollees may order additional products that go over the monthly or quarterly benefit allowance. When this happens, they must pay the additional balance with a credit card. Neither cash nor checks are accepted with mail orders.

Additional OTC Information

The process of OTC products may change during the year. Beneficiaries who wish to find up to date product information should visit medlineotc.com/cpct.

Please remember; the OTC benefit is for use by CarePartners members only.

Due to the personal nature of the products, returns are not permitted. In the event the enrollee receives a damaged item, they can call Medline OTC Benefit Services at 1-833-569-2331 (TTY: 711), Monday – Friday, 7 a.m. – 7 p.m. CST, within 30 days of receiving the item.

Some items are dual-purpose, enrollees may use them for a medical condition or for general well-being. When this is the case, beneficiaries can purchase the item with the OTC benefit after they speak with their personal care provider and ensure it is not covered under the plan’s Part B or D benefit.

Click here to learn about the Medicare Part D drug cap for 2025

When a member has a question about benefits, they can call the customer service number on the back of their membership card.

Covered OTC items

The Connecticare OTC catalog 2025 covers CMS approved OTC health care items. Some of the product categories include:

• Allergy, sinus, and combination liquids and tablets.
• Cough, cold, and flu liquids and tablets.
• Dental care products such as floss, toothbrushes, toothpaste, and denture care.
• Elevated toilet seats and accessories.
• Protective gloves
• And more!

What’s not covered

• Covid Tests.
• Diabetes care items: these supplies are covered by the plan’s medical benefit.
• Foot care that includes foot moisturizers, exfoliators and cleansers, odor and wetness treatments or insoles/inserts.
• Food items.
• Non-prescription hearing aids
• Oral care that includes mouthwash and breath remedies.

Please note: the products listed above lists are subject to change.

The chart below shows the OTC benefit of each plan

Beneficiaries must use all OTC benefits within the specified benefit period. OTC benefits do not roll over.

Connecticare beneficiaries can access the 2025 Connecticare OTC catalog, by clicking the preceding link or signing into their online account.

Where to use the Connecticare 2025 OTC benefit

• Beneficiaries can pick up covered OTC items at the following retailers: CVS, Rite Aid, Walgreens, Walmart, and more. (In-store is only available for DSNP members).
• Use the following link to locate additional participating locations: myBenefitsCenter.com or by downloading the app.
• Click on this link to find a detailed list of covered OTC items Download PDF

How to Get Your Covered Eligible Items in 2025

ConveyBenefits:

1. Sign in to conveybenefits.com/connecticare and choose items.
2. Call 855-858-5940 (TTY:711) Monday – Friday, 8 a.m. until 8 p.m.
3. Download, fill out, and return the mail order form in the following link conveybenefits home delivery catalog.

CVS OTC Home Delivery:

1. Sign in to mybenefitscenter.com to choose items and place an order.
2. Cal 833-875-1816 (TTY: 711) Monday – Friday, 9 a.m. to 8 p.m.
3. The CVS home delivery catalog coming soon.

How to order Connecticare OTC 2025 mail order items

The following plans: ConnectiCare Passage Plan 1, ConnectiCare Choice Plan 2, ConnectiCare Choice Plan 3, and ConnectiCare Flex Plan 3 plan members receive OTC items by mail-order only. They cannot use their benefit in store and do not receive an OTC card.

1. Plan members can go to connecticare.nationsbenefits.com and choose items and follow the prompts to complete the checkout process.
2. To order by mail; fill out the mail order form and mail it to Nations Benefits, 1700 N. University Drive, Plantation, FL 33322
3. Contact Nations benefits by phone at 877-239-2942 (TTY: 711) Monday – Friday, 8 a.m. to 8 p.m.

In general, beneficiaries receive OTC items in the mail within 7 business days after the supplier receives their order. When the order total is over the available OTC balance, beneficiaries must provide an alternate payment method. Enrollees can use a credit card either online or over the phone. Those who use mail order can use a check for payment if they prefer.

Click here to learn the differences between HMO & PPO plans

Please note:

The quantities, sizes, and prices may change based on product availability and manufacturer. Beneficiaries may receive a similar product of equal or greater value in the event a chosen item is out of stock.

Reimbursement

For those who cannot use their OTC benefit in one of the ways mentioned above; you can request a refund by downloading and filling out this reimbursement form. Just mail the completed form your completed paper claim form to ConnectiCare Claims Department, P.O. Box 4000, Farmington, CT 06034-4000. Please include a copy of your receipt for covered items and Connecticare will send a refund check to you.

If you have any questions:

Members should check their plans evidence of coverage or cost sharing guide to review their OTC allowance. Enrollees can also call ConnectiCare Medicare Connect Concierge at 800-224-2273 (TTY: 711). From Oct. 1 until March 31, enrollees can call from 8 a.m. to 8 p.m., seven days a week. Starting April 1 to Sept. 30, they can call from 8 a.m. to 8 p.m., Monday through Saturday.

Medicare Part D IRMAA 2025 is important for beneficiaries and agents to understand. The Social Security administration adds the IRMAA costs for Medicare Part D into the plan premium for each enrollee’s plan. Part D plans have a wide range of premiums. They can range from $0 to as much as $150 or more per month. The price of each plan depends on the area each beneficiary lives in as well as the plan they choose.

What is IRMAA

IRMAA (income-related monthly adjustment amount) is a surcharge on Medicare Part B as well as Medicare Part D plan premiums. It applies to Medicare beneficiaries who have gross income over a specific amount.

Click here to learn about Medicare Part B IRMAAs

How IRMAA amounts are decided

The IRMAA Income amounts are decided annually on a sliding scale and include 5 different income brackets. In the event the Social Security administration determines a client must pay an IRMAA, they will send a premium notice that includes an explanation of the charge.

The IRMAA amounts are based on the beneficiaries’ income from 2 years before the present year.  For example: a 2025 IRMAA is based on the beneficiary’s income from 2023.  Because income changes from year to year, the IRMAA amount also changes accordingly.

The following IRMAA Part D premium surcharges are based on 2023 income amounts.

Please note: individuals enrolled in a Medicare Advantage plan that includes prescription drug coverage, will pay the Part D IRMAA as well as the plan premium. If their plan has a $0 premium, they will still have to pay the Part D IRMAA. Social Security also adds The IRMAA to the beneficiaries’ Part B premium.

How to appeal the IRMAA

Beneficiaries can appeal an IRMAA determination in the event they feel it is an error or if they experience a life changing event that results in lower income. Some events that can result in loss of income include divorce, loss of a spouse or loss of employment or other sources of income. The beneficiary can file for a redetermination with the Form SSA-44.

In the event the beneficiary disagrees with the redetermination, they can request a third level appeal through OMHA (Office of Medicare Hearings and Appeals).

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The amount of income a beneficiary makes can affect the amount of their Medicare Part B & Part D premiums. Individuals with higher-than-average incomes pay more for Part B and D benefits. Due to the fact that most beneficiaries do not pay for Part A, no IRMAA applies even when a beneficiary pays for the Part A benefit. The U.S. Social Security Administration decides the new income threshold amounts each year. In this post, we explain the Medicare Part B IRMAA 2025.

IRMAA

The term IRMAA stands for income-related monthly adjustment amount. IRMAA is a fee beneficiaries pay on top of Medicare Part B & Part D premiums when they have income over the annual threshold amounts. In 2025, Medicare beneficiaries earning more than $106,000 annually will pay the IRMAA. This amount is added to their Part B and Part D premiums.

The SSA put the Part B IRMAA in place in 2007. The Part D IRMAA did not go into effect until 2011.

How beneficiaries pay the Medicare Part B IRMAA

When a Medicare beneficiary receives their Social Security retirement benefit, the Part B premium is deducted from their monthly check. This includes any IRMAA surcharge amounts. The IRMAA is calculated using a sliding scale based on income brackets. Each year IRMAA amounts change due to inflation.

There is a hold harmless provision that prevents Social Security payments from decreasing from one year to the next. However, this rule does not apply to beneficiaries who pay an IRMAA.

In 2025, most monthly Social Security benefits will increase by about $50 a month. In addition, the Part B premium will most likely increase to $185. This amounts to an increase of about $10 per month. This keeps the hold harmless from going into effect in most cases.

Who pays the IRMAA

The average person will never pay an IRMAA. Only about 7% of those who receive Social Security benefits will pay an IRMAA. There are currently almost 67 million people who receive Social Security benefits and about 4.9 million beneficiaries pay the IRMAA.

How income determines the IRMAA

Tax returns from two years prior determines the beneficiaries’ IRMAA. In other words, the beneficiaries’ tax return from 2023 will determine their IRMAA surcharge for 2025. The amount of an individual’s IRMAA is recalculated each year. For 2025, individuals with an income over $106,000 will pay an IRMAA.

If the Social Security administration determines a beneficiary has an IRMAA, they receive a notice to inform them of the surcharge. Please refer to the chart below for all income levels and IRMAA amounts.

How to appeal an IRMAA

If a beneficiary receives an IRMAA determination, they can appeal the determination. Those who have a significant loss of income from a life changing event can file for a redetermination. To file for a redetermination, beneficiaries need to fill out Form SSA-44. A few life-changing events may include a divorce, death of a spouse of loss of income due to retirement or other reason.

Click here to watch a YouTube video on Part B IRMAAs

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If the SSA denies the appeal, OMHA (the Office of Medicare Hearings and Appeals) conducts a third level appeal process.

Medicare Advantage plans, also known as Medicare Part C, are popular choices for seniors who want Additional benefits not offered by Original Medicare. However, choosing the right plan means understanding the enrollment periods, each of which has specific rules and dates. Here’s a breakdown of the Medicare Advantage enrollment periods and who is eligible to use them.

IEP (Initial Enrollment Period)

The Initial Enrollment Period is the first opportunity for beneficiaries to enroll in a Medicare Advantage plan. The IEP is a seven-month period is when beneficiaries first become eligible for Medicare, which generally happens when they turn 65. It includes:

1. The three months before their 65th birthday month
2. Their birthday month
3. The three months that follow their birthday month

During this time, they can enroll in Medicare Parts A and B and a Once both are in place, they may decide to enroll in a Medicare Advantage plan. This period is very important to ensure beneficiaries enroll in coverage that includes Part D (prescription drug) coverage to avoid facing potential penalties. One way to avoid this is to include an MAPD (Medicare Advantage Prescription Drug Plan).

AEP (Annual Enrollment Period)

The Annual Enrollment Period, often called the Open Enrollment Period, runs from October 15 to December 7 each year. During AEP, Medicare plan enrollees can make changes to their Medicare Advantage, prescription drug plans, or Medicare Supplement plans including:

1. Switching from Original Medicare to a Medicare Advantage plan
2. Changing from one Medicare Advantage plan to another
3. Moving from a Medicare Advantage plan back to Original Medicare
4. Changing from one Prescription plan to another

This period allows enrollees to review and adjust healthcare coverage based on current health needs and changes to the following year’s Medicare plan options.

MA-OEP (Medicare Advantage Open Enrollment Period)

The Medicare Advantage Open Enrollment Period takes place annually from January 1 to March 31. However, this period is only available to individuals who are already enrolled in a Medicare Advantage plan. This period It allows for limited changes, including:

• Switching to a different Medicare Advantage plan
• Dropping a Medicare Advantage plan and returning to Original Medicare (with the option to add a Part D prescription drug plan)

Please note; during the MA-OEP, enrollees can only make one change and cannot switch from Original Medicare to a Medicare Advantage plan. This period is a great way to change plan choices for those who discover their current Medicare Advantage plan doesn’t meet their coverage needs.

SEPs (Special Enrollment Periods)

Special Enrollment Periods are triggered by specific life events, these events provide an opportunity to make changes outside the regular enrollment periods. Common scenarios that qualify for SEPs include:

1. Moving: Enrollees who move to a new address outside their plan’s service area, can switch to a plan in the new service area
2. Loss of employer coverage: Those who lose employer-based health coverage qualify for an SEP
3. Qualifying for financial assistance: Enrollees who qualify for some financial assistance programs such as Medicaid or Part D Extra Help, may be eligible for an enrollment period
4. Moving in or out of a nursing home
5. Enrollees whose plan goes out of business
6. Weather or disaster related emergencies that cause enrollees to miss a valid enrollment period

These SEPs allow enrollees to adjust their Medicare Advantage coverage to meet their needs. This ensures beneficiaries are not left without the necessary coverage.

Five-Star SEP

All Medicare Advantage and PDP plans are rated on a scale of one to five stars, with five stars representing the highest quality. Beneficiaries can switch to a five-star Medicare Advantage plan if there is one is available in their area. They can do this even when they are outside a normal enrollment period. Enrollees can use this opportunity only once per year, from December 8 through November 30.

This SEP encourages beneficiaries to look for the highest rated plans. This encourages plan providers to provide higher levels of service and benefits.

Click here to download medicare.gov understanding Medicare Advantage Plans booklet

How to make the most of the Medicare Advantage enrollment periods

1. Review coverage annually: Health needs and plan costs change year-to-year, so it’s beneficial to reassess coverage options every AEP.
2. Consider budget and health needs: Look closely at premiums, out-of-pocket costs, the provider network and medication coverage (if appropriate) when evaluating plans.
3. Use SEP opportunities wisely: Major life changes can unlock SEP opportunities. Be sure to act within the timeframe allotted when these events occur.
4. Compare plan ratings: Medicare’s plan rating system provide insight into quality and satisfaction levels of available plans. Switching to 5-star plan can give enrollees peace of mind.

Navigating Medicare Advantage enrollment periods may seem overwhelming, but understanding these opportunities can help ensure that enrollees are in the best possible plan for their healthcare needs.

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Many Medicare agents have heard about the value of cross selling; we will explain how cross selling boosts client retention.

Cross selling can boost client retention

Retaining clients in the Medicare insurance space is both challenging and essential, especially given the competitive nature of the industry. One way agents can increase client retention is cross-selling. It is important to know, cross selling isn’t only about increasing sales. It’s a customer-focused approach that can enhance your clients’ experiences, meet their needs, and build lasting relationships. Cross-selling Medicare-related products can lead to greater client loyalty and retention.

Watch a quick YouTube video on how to sell ancillary in 5 minutes

How cross selling boosts client retention

Cross-selling is the practice of offering products that compliment your clients existing coverage to meet any additional needs they have. For Medicare beneficiaries, these additional products might include:

• Dental, Vision, and Hearing Plans: These services are often not covered by Medicare, making them valuable add-ons for clients.
• Hospital Indemnity Insurance: Provides a cash benefit for hospital stays, which can help offset the cost of high copays or deductibles.
• Cancer, Heart Attack & Stroke: This product is also called critical illness, and it is not difficult to sell. Plans provide a one-time payment after a diagnosis is made. 
• Long Term Care/Short Term Care: As clients age, they may consider long-term care insurance to cover potential assisted living or nursing home costs.
• Final Expense or Burial Insurance: Plans help beneficiaries plan for end-of-life expenses, easing the financial burden on their loved ones.

Each of these products fills gaps in Medicare coverage, helping clients avoid unexpected medical expenses and have a more robust coverage portfolio. Keep in mind, it is important to understand the client’s budget before you show them quotes that fill their coverage needs.

Stronger Client Relationships

Cross-selling enhances the relationship between agents and clients by allowing agents to provide a one-stop solution for various health coverage needs. Purchasing multiple products from one trusted advisor helps clients feel their agent knows all their needs and can coordinate coverage options. Over time, this leads to greater loyalty, as clients appreciate having an agent who goes beyond basic Medicare plans to provide greater coverage solutions.

This personalized approach also allows agents to stay in regular contact with clients, building rapport and trust. For example, an annual review meeting to discuss any changes to Medicare Advantage or Supplement plans can be an opportunity to address new needs for dental, vision, or hearing coverage.

Please note: any product not included on the original scope of appointment must be entered onto a new form and in some cases, a follow up appointment must be made to discuss these products.

Click here to find out more about the SOA rules

Increased Client Satisfaction

Clients who have multiple policies with the same agent are more likely to be stay with that agent. Their agent can provide comprehensive tailored coverage. This ensures clients are less likely to shop around for other options or leave for competitors.

With a diversified insurance portfolio that’s thoughtfully assembled, clients have fewer reasons to look for alternatives. For example, a client who has a Medicare plan plus dental coverage, and hospital indemnity insurance is far less likely to leave than a client who only has a Medicare plan.

Increased revenue can translate to better service

Cross-selling generates additional revenue, enabling agents to invest more into client services, technology, and communications. This can translate into better customer service such as easier appointment scheduling, regular newsletters and reminders about important events.

Enhanced service can give clients more reasons to stay, as they recognize the added value their agent provides.

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Meeting needs for different stages of life

Medicare clients, typically 65 and older, experience changes in healthcare needs over time. Life events such as retirement, chronic illness, or the need for long-term care can prompt clients to seek additional coverage. By proactively offering products that address these changing needs, agents can retain clients as they age.

When agents anticipate and respond to these needs, they reinforce their role as trusted advisors. This increases the likelihood they will retain their clients.

Learn how to close a Medicare sale

Education is key in cross selling

Cross-selling Medicare products requires a balance of education and transparency. Ensuring that clients understand each product and its value is crucial. This includes explaining coverage gaps in Original Medicare, discussing out-of-pocket costs, and answering any questions about benefits.

Educating clients on each product works with their current coverage builds trust, as clients feel empowered rather than pressured. Ethical cross-selling focused on education not just commissions is a best practice that can foster client loyalty.

Listen to the client and boost client retention

Getting to know clients is an important part of the sales process. It helps identify health concerns and gaps in their coverage. Pay attention when a client mentions a concern or family history of cancer or other critical illness. Listening to clients as well as learning how to cross-sell life and health products helps you reach client retention goals.

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IRMAA Brackets 2025

Agents need to understand the Medicare IRMAA brackets 2025 this can have an impact on their clients’ budget for next year. It can affect their Medicare Part B costs as well as their Part D costs.

What is an IRMAA

IRMAA is an additional charge added to both Medicare Part B and Medicare Part D premiums.  An IRMAA applies to beneficiaries who have an income level above a specific annual pre-determined amount.  Income amounts are decided on a sliding scale each year and consist of 5 income brackets.   When the Social Security administration determines a beneficiary must pay an IRMAA, they send a notice of the additional premium as well as an explanation.

The IRMAA is decided using the income from 2 years prior.  In other words: IRMAA amounts in 2025 are based on 2023 income. 

The Determination of Part B and Part D premiums are calculated by adding the current Part B or Part D premium to amount of the IRMAA. 

Part B & Part D IRMAA income brackets & surcharge amounts 2025

Please note:  The IRMAA for married Medicare beneficiaries who file separate tax returns are higher if they lived together for any amount of the year.

Paying the IRMAA

Because Part B and Part D are 2 separate IRMAAs, beneficiaries make the payments n different ways. The CMS automatically adds the Part B IRMAA to the monthly premium bill. Beneficiaries pay the Part D IRMAA directly to Medicare.

IRMAA for Part B

Here are a few ways to pay your Part B IRMAA

1. Send your payment to Medicare through the mail. You can send either a check, money order or credit or debit card information by filling out the coupon attached to the bottom of your bill. If you are sending payment without the coupon, be sure to put your Medicare number in the memo of the check.  Send payments in the return envelope that comes with your invoice and mail payments to Medicare Premium Collection Center, P.O. Box 790355, St Louis , MO 63179-0355.
2. The quickest way to pay is online with your secure Medicare account.  You can use a credit or debit card or pay through either your checking or savings account.
3. Use Medicare Easy Pay to have Medicare deduct your premiums from your savings or checking directly each month.  Please note; it can take up to 8 weeks for automatic deductions to begin.  Be sure you pay the premiums another way until it is set up.  You can also use your bank’s online bill payment service if they offer one.

Part D IRMAA

On the other hand, you must pay the IRMAA for Part D directly to Medicare.  The beneficiary must pay it even if their employer or a third party (e.g., retirement system) pays their Part D premiums. They receive a monthly bill from Medicare for the Part D IRMAA.  This amount can be paid using the same method used to pay for their Part B premium.

Usually, beneficiaries receive the bill the same month it is due.  The premiums are always due on the 25th of each month. In the event that you miss a payment, or send it in late, it is included with the next bill.

How to request a redetermination

The SSA (Social Security Administration) bases their determination of who owes an IRMAA on the income reported on tax returns from the  2 years before you pay the IRMAA.  If SSA does decide you owe an IRMAA, they send you an initial determination notice.  When you receive this notice, you will also get information explaining how to request a new initial determination.

If Social Security receives a new initial determination, they may revise the amount owed or take the IRMAA away all together.  To request the redetermination, either schedule an appointment with your local Social Security office or submit the following form:

Medicare IRMAA Life-Change Event form

You need to provide documentation of your correct income or of the life-changing event that has affected your income level in a negative way.

Here are examples of acceptable life-changing events:

1. Death of a spouse, a divorce or annulment or a marriage
2. If either spouse stops or reduces the number of hours they work
3. When either spouse loses a pension
4. Loss of income due to income producing property loss because of a natural disaster, fraud or similar circumstances

Click here to download an IRMAA appeal form

If you had an amended tax return, you can call the representatives at SSA +1 800-772-1213 and say you want to lower your (IRMAA) Medicare Income-Related Monthly Adjustment Amount.   Use the fact that Social Security used outdated or incorrect information when calculating your IRMAA.

Medicare’s one to one consent rules have become increasingly more complex in recent years. Both the Centers for Medicare & Medicaid Services (CMS) and the Federal Communications Commission (FCC) have imposed rules to safeguard consumers.

One-to-One Consent

One-to-one consent refers to requirements that each individual must provide consent for specific interactions, particularly with regard to healthcare and telecommunication interactions.

At its core, “one-to-one consent” means each individual interaction requires separate and specific consent. This applies to businesses that gather, use, or share personal information, which includes sensitive data related to healthcare or communication preferences. For organizations subject to CMS and FCC rules, failure to obtain the correct form of consent can lead to penalties, litigation, or loss of trust with clients and consumers.

For CMS, consent standards often pertain to healthcare communications. CMS oversees programs like Medicare and Medicaid, its regulations ensure that beneficiaries’ personal health information is protected and that there is explicit consent before using or sharing it.

The FCC and consent

In general, the FCC regulations focus on telecommunications and includes phone calls, texts and email communications. The FCC requires individuals to give permission before a company can contact them for marketing purposes.

The FCC’s regulation on consent comes from the Telephone Consumer Protection Act (TCPA), is in place to prevent unsolicited robocalls, telemarketing, and other unwanted communications. The TCPA mandates that individuals must provide prior express consent before businesses or organizations contact them via certain channels, including:

Telemarketing calls require written consent if they’re automated or involve a pre-recorded message. For non-telemarketing calls, prior express consent is sufficient, but it must be clear and documented.

Text Messaging follows the same standards as calls; organizations need explicit consent to send promotional or transactional messages.

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The TCPA incorporates the Do-Not-Call registry requirements and allows individuals to opt-out of telemarketing calls.

The TCPA allows consumers to revoke consent at any time. It must be easy for the consumer to opt out and honored immediately by the organization. Non-compliance can result in fines or lawsuits. The increased use of automated dialing systems makes it more important for businesses to ensure they follow the regulations closely.

The CMS and consent

Due to concerns about patient privacy and data security, CMS consent requirements are even more strict. In particular, the Health Insurance Portability and Accountability Act (HIPAA) plays a significant role in setting the privacy standards enforced by CMS. HIPAA requires protected health information (PHI) be treated with a high level of confidentiality, and patients give specific consent for each use or disclosure of their PHI.

Any provider, organization or individual under CMS jurisdiction must have documented consent for communications to share personal information with third parties, except under certain treatment or operational exceptions.

Anyone using digital communication (emails, texts, or calls) must obtain explicit consent to do so.

Individuals must have the right to withdraw (opt out) their consent to communications. CMS requires those who contact potential clients to clearly explain how to revoke consent, usually through a simple opt-out option or written request.

Additionally, CMS enforces the need for clear explanations regarding what individuals are consenting to. This ensures no information is hidden in fine print or hard-to-understand language.

How FCC and CMS regulations differ

FCC Regulations primarily focus on consumer privacy in communication channels for marketing or solicitation purposes. The purpose is to avoid unwelcome communications and provide consumers control over who can contact them. The new FCC rules go into effect as of January 27, 2025.

CMS Regulations focus more on healthcare privacy, ensuring that information remains private and that individuals are fully aware of and agree to any sharing of their data.

Impact on Businesses and Consumers

One-to-one consent regulations are essential for both protecting consumers and clarifying business obligations. This empowers Individuals to make informed decisions about their private data. For telecommunication, consumers benefit from reduced unsolicited marketing and better control over their contact preferences.

For businesses, these regulations require meticulous record-keeping, clear communication protocols, and potentially, investment in new technology to capture, document, and manage consent. Companies that fail to comply face financial penalties and potential legal action, but more importantly, they risk damaging their relationship with consumers.

How this effects agents

After October 1, 2024, agents who make outbound calls can only contact leads that need provide a CMS-compliant One-to-One consent.

Lead companies that supply inbound warm transfers must have written consent from the consumer. They can also get a real-time one-time verbal consent to transfer the call to another TPMO. Please note: the verbal consent must be recorded clearly state the TPMO’s name. A generic permission to transfer is not acceptable.

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The CMS rule restricts sharing consumer information with affiliates or other entities without prior written consent from the consumer.

What about inbound calls

This rule does not apply to direct inbound calls.

Agents who use Medicare leads

Agents using Medicare leads must be sure their lead company has recorded written consent specifically in your name for the warm transfer.

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The Medicare Extra Help program is a federal assistance program that provides financial aid to Medicare beneficiaries who have limited income and resources. It helps pay for costs associated with Medicare Part D prescription drug plans, including premiums, deductibles, and co-pays.

The program is administered by both the SSA and the CMS. The goal of the program is to make needed medications accessible to those who need them.

Benefits of the Extra Help Program

For those who qualify, Extra Help provides savings on prescription drug costs. Some of the program benefits include:

Lower Monthly Premiums

Extra Help covers some or all of the monthly premiums for Medicare Part D prescription drug plans. The amount covered depends on the level of Extra Help an individual qualifies for and the specific Part D plan they select.

Reduced Deductibles

With Extra Help, enrollees pay lower or even zero deductibles on their prescription drug plans. This allows beneficiaries to access their medication benefits without needing to pay a high upfront cost.

Low Co-pays or Coinsurance

Extra Help reduces co-pays, or coinsurance amounts for prescription drugs. In most cases, beneficiaries pay no more than $4.50 for generic drugs and $11.20 for brand-name drugs in 2024. The cost for 2025 have not been announced yet.

No Late Enrollment Penalty

Medicare imposes a late enrollment penalty on those who delay Part D enrollment and did not have creditable coverage from another source. Those who qualify for Extra Help do not pay the penalty.

Elimination of the Coverage Gap

The Medicare Part D “donut hole” (coverage gap) can cause additional expenses for beneficiaries. Those who receive Extra Help don’t have to worry about this. They receive consistent coverage with reduced costs all year. Please keep in mind; in 2025 the coverage gap will be eliminated.

Watch a quick video explaining the $2,000 drug cap for 2025

Who’s Eligible for Extra Help

For an individual to be eligible for Extra Help, they need to have income and assets at or below the amount set by the SSA each year. In 2024, the approximate eligibility requirements are as follows:

Income Limit: In 2024 the income limit for Single individuals is $22,590, while the income limit for married couples is $30,660. These amounts do not apply to Alaska and Hawaii, those states have their own income parameters.

Asset Limit: for individuals is $17,220, while the limit for married couples is $34,360. Assets include things like cash, bank accounts, investments, and property that is not your primary place of residence.

Click here to view the Medicare.gov fact sheet for Extra Help

How to Apply for Extra Help

Online Application: The quickest way to apply is online through the Social Security Administration at ssa.gov.

Phone Application: Call the SSA at 1-800-772-1213 (TTY: 1-800-325-0778) and apply over the phone. An SSA representative will guide you through the application process and can answer any questions you may have.

Paper application: Those who wish to use a papaer application can do so, click here for application. Once the application is completed, mail it to: Social Security Administration, Wilkes-Barre Direct Operations Center, P.O. Box 1020, WIlkes-Barre, PA 18767-9910.

In-Person Application: Visit your local Social Security office to apply in person. You may also be able to get assistance through certain Medicare health plans or local state health programs.

After submitting your application, the SSA will determine your eligibility and send you a notice explaining your benefits. If you qualify, you’ll automatically start receiving assistance with your Medicare Part D costs.

Extra Help and Medicaid

Many people who qualify for Extra Help may also qualify for additional savings programs either through Medicaid or their state’s Medicare Savings Programs (MSP). Those who are eligible for both Medicaid and Extra Help, receive the maximum level of assistance possible, which can result in very low (or even zero) out-of-pocket costs for prescription drugs.

Those aready enrolled in Medicaid, Supplemental Security Income (SSI), or MSP Programs, may automatically qualify for Extra Help do not need to apply. If that is the case, the beneficiary receives a notice from Medicare confirming eligibility for Extra Help.

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Additional information

Anyone who may be eligible should apply. The application process is straightforward, and the savings can make a significant difference in Part D costs. This program can make a difference in the lives of those who require medications for a better quality of life and otherwise may not be able to afford it.

Understanding how to close a Medicare sale is essential. There are millions of people enrolling in Medicare every year. Agents who master the art of closing can build a large book of business while helping clients find the best coverage for their unique needs. We will provide a few ideas to help increase your chances of closing a Medicare sale.

Build Trust and a good rapport

Trust is essential in Medicare sales. Clients are trying to navigate complex health insurance options and avoid costly mistakes. They may feel overwhelmed or frustrated. Keep this in mind when you speak with a client. Here are some ways to help set your client at ease:

The most important thing you can do is listen actively. Provide clients an opportunity to express their concerns, preferences, and questions. This shows them that you understand their needs and wants and that you will try to find what the best plan for them.

Because Medicare choices are complicated, it is important to be transparent with clients. Break down the plan options and prepare to discuss the pros and cons of each one.

Stay educated on Medicare plan choices and regulations. Both of these things change every year. Understanding what is going on will help clients feel confident that they can trust that you are knowledgeable and capable. This will help put them at ease.

Understand the client’s needs

Keep in mind, every client has unique budget concerns and healthcare needs. it’s essential to understand each client’s personal situation completely before making any recommendations.

Asking questions about the client’s specific medications and providers is extremely important. Agents must make sure both doctors and medications are covered under each plan. How much can they afford to spend on out-of-pocket costs? Does your client have a low income where they may qualify for specific plans that offer additional benefits? You need to learn which benefits are most important to each client?

By listening to their answers, you can provide options that meet their needs. This helps narrow down the options and find a plan that they are happy with.

Be able to explain the parts of Medicare

Because Medicare has several parts, each with its own coverage and rules, you must understand each part and explain how they work so clients know what they are choosing. Providing a brief summary of each part will give clients a good understanding without overwhelming them.

Overcome Objections

Objections are a natural part of the sales process. Beneficiaries may have concerns about cost, network restrictions, or unfamiliarity with Medicare’s options. That is why agents need to be prepared to handle objections.

If the client is worried about costs, it is important to express empathy and find some affordable options or look for ways they can save on costs. You may need to help them apply for Extra Help or Medicare Savings Programs.

You will need to provide examples of how each option can work for them in specific situations. In many cases, you will need to do some calculations to help them decide which plan comes out better for their budget.

If they use several providers, look for plans that have a larger network and avoid network restrictions. When you have clients who travel, find a plan that gives them coverage wherever they go. Again, the answer to all these questions comes down to listening to the client.

Click here to learn the differences between PPOs and HMOs

Next Steps

Uncertainty causes clients to hesitate. Be sure you answer all their questions as best you can. The next thing you need to explain is the enrollment process. It will help to walk the potential client through the process.

The first step of enrollment is eligibility. It may help to explain Medicare enrollment periods, such as the Initial Enrollment Period (IEP) and Special Enrollment Periods (SEPs). This can ensure they understand when they should apply.

Next, explain what documents they will need and where they can apply. You may provide a paper application, a link to a carrier site or even a phone number. It all depends on the plan, the carrier and the tools you have available.

Watch our YouTube video on updates to Sunfire and Connecture quoting and enrollment tools

Make sure clients know that you are there if they have questions or concerns if any issues some up. You should let them know you will contact them regularly to check in and provide them with your contact information if they want to get in touch with you.

Closing Technique

Once you’ve addressed all questions and provided the necessary information, it’s time to close the sale and write the application. Here are a few closing techniques that can help with Medicare sales:

Assumptive Close: “This plan seems to be a good fit for your health needs, shall we go ahead and start the enrollment?

Choice Close: “Between the two plans we discussed, which do you feel is the best fit for you?”

Summary Close: “Just to recap, all your doctors participate with this plan it covers your prescriptions and also has a lower premium. Would you like to go ahead and enroll?”

These approaches to closing encourage commitment without pressuring the client. This encourages them to feel comfortable and confident in their decision.

Follow-Up

Following up after the sale is just as important as the initial sales process. Agents should contact the client to let them know their plan is approved. They also need to contact them to see how the plan is working for them. Making sure they are happy with their choice goes a long way to let them know you care about their satisfaction and are not there only for the sale. Let them know you’re available if any issues arise. A simple follow-up builds trust and can lead to referrals or renewal business. Both are invaluable in this industry.

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Closing a Medicare sale isn’t about hard selling; it’s about understanding your client’s needs, educating them on their options, and guiding them toward a solution that will benefit them most. We as agents are here to provide a service. Clients need Medicare coverage it is just a matter of sorting out the plan that best suits their needs. Helping clients make an educated choice is our goal.

By building rapport, being transparent, and confidently addressing any objections, you can create a closing experience that makes clients feel secure in their choice.