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Medicare Part B is an important part of Original Medicare, covering many medical services such as; doctor visits, outpatient care, preventive services, and durable medical equipment. Individuals getting close to Medicare eligibility need to understand how to apply for Medicare Part B. Understanding the enrollment process can help avoid penalties and ensure healthcare coverage is not interrupted.

Who Needs to Enroll in Medicare Part B

Not everyone is automatically enrolled in Part B. Below is a list of the Individuals who need to self-enroll in Part B:

1. Those who are not receiving either Social Security or Railroad Retirement Board (RRB) benefits at least 4 months before they turn 65.
2. Anyone who delayed enrolment because they were enrolled in employer sponsored health coverage.
3. Some disabled individuals that qualify for Medicare need to enroll in Part B.

When can you enroll

1. Initial Enrollment Period (IEP)

This is a seven-month window starting three months before the 65th birthday, including the birthday month, and ending three months after. For those who enroll early, coverage begins the first day of the birth month.

2. Special Enrollment Period (SEP)

Individuals may qualify for a SEP if they delayed Part B due to employer-sponsored coverage. They have eight months from the end of employment or loss of health plan to enroll without penalty.

3. General Enrollment Period (GEP)

Those who miss their IEP and don’t qualify for an SEP can enroll during the GEP. The GEP runs from January 1 to March 31, with coverage starting the first day of the month following the enrollment submission. When this is the case, a late enrollment penalty may apply.

Learn more about Medicare enrollment periods

How to enroll in Part B

Determine Your Enrollment Method

Those who are already receiving Social Security benefits will be automatically enrolled in Part B. When that is not the case, you must apply manually through SSA (Social Security Administration).

There are a few ways to apply for Part B

Online: Visit SSA.gov and complete the online application.
By Phone: Call the Social Security Administration at 1-800-772-1213 (TTY: 1-800-325-0778).
In-Person: Visit your local Social Security office (appointment recommended).

Step 3: Submit Form CMS-40B

If you’re enrolling due to a Special Enrollment Period, you must complete Form CMS-40B (Application for Enrollment in Medicare Part B) and possibly Form CMS-L564 (Request for Employment Information) to prove employer coverage.

Step 4: Wait for Confirmation

Once your application is processed, you’ll receive a Medicare card with your Part B coverage start date.

Delayed Part B

If you have employer coverage, you can opt out of Part B when first eligible. However, ensure that your employer plan qualifies for delayed enrollment without penalties.

Avoid Late Enrollment Penalties

For every 12-month period you delay enrollment without qualifying coverage, your Part B premium increases by 10%—for life. Enrolling on time prevents unnecessary costs.

Watch a YouTube video on OEP, SEPs & LEPs

Enrolling in Medicare Part B is a straightforward process, but timing is key to avoiding penalties and ensuring seamless healthcare access. If you’re unsure about your eligibility or enrollment timeline, consult the Social Security Administration or a Medicare advisor for guidance.

Medicare Supplements, also called Medigap plans, are insurance policies private insurance companies offer to fill the “gaps” after Original Medicare pays it’s portion of approved medical expenses. Understanding what Medicare Supplements cover is essential for Medicare agents and anyone considering enrollment in a Medigap plan to reduce healthcare costs and enhance Medicare benefits.

Medicare Supplement plan overview

Medicare Supplement plans are standardized by the federal government, meaning the coverage provided by each plan of the same name (Ex. all Plan Ns) is the same across all insurance carriers. However, premiums vary based on provider and service area. There are 10 standard Medigap plans available in many states, labeled A, B, C, D, F, G, K, L, M, and N. Each plan letter provides a different level of coverage to meet varying healthcare needs and budgets.

Learn about Medicare premiums & deductibles

What Medicare Supplements cover

Medicare Supplement plans provide coverage once Original Medicare pays its portion of the cost for approved healthcare costs. See below for what Medicare supplements cover:

Medicare Part A coinsurance for hospital costs

All Medigap plans cover the coinsurance for hospital costs under Medicare Part A for up to an additional 365 days after Medicare benefits are exhausted.

Medicare Part B Coinsurance or Copays

Many Medigap plans cover the 20% coinsurance for outpatient services under Medicare Part B. Plan K and Plan L provide partial coverage, while Plan N may require a small copay.

Blood (First 3 Pints)

Original Medicare does not cover the first three pints of blood needed for some medical procedures. Medigap plans cover this expense.

Part A Hospice Care Coinsurance

Hospice care is covered by Medicare, but beneficiaries may have to pay coinsurance for certain medications and respite care. Medigap plans cover these costs.

Skilled Nursing Facility (SNF) Coinsurance

After 20 days in a skilled nursing facility, Medicare requires a daily coinsurance payment. Most Medigap plans cover this expense.

Medicare Part A Deductible

The Part A deductible for hospital stays can be substantial. Many Medigap plans, including Plans B, C, D, F, G, and N, cover this deductible.

Medicare Part B Deductible (Only for Plans C and F)

Plans C and F cover the Medicare Part B deductible; however, these plans are only available to beneficiaries who were eligible for Medicare before January 1, 2020.

Medicare Part B Excess Charges

If a healthcare provider does not accept Medicare’s approved amount as full payment, they may charge an additional amount of up to 15%. Plans F and G cover these excess charges.

Foreign Travel Emergency Care

Some Medigap plans (C, D, F, G, M, and N) provide coverage for emergency medical care during international travel, up to plan limits.

What Medicare Supplements don’t cover

Although Medigap plans cover many out-of-pocket expenses, there are some services they do not cover:

Prescription Drugs

Medigap plans do not include drug coverage. Beneficiaries must enroll in a Medicare Part D plan for prescription drugs.

Long-Term Care

Supplements do not cover services like custodial care in a nursing home or assisted living facility.

Dental, Vision, and Hearing

Routine dental, vision, and hearing services are not included in Medigap coverage.

Private-Duty Nursing

Typically, these services are not covered.

Watch a YouTube video on Medicare enrollment periods

What to consider when choosing a supplement

It is important to evaluate current healthcare needs and potential medical expenses to help determine the level of coverage needed. Budget is another big consideration before choosing a plan. One more important factor before enrollment is eligibility. Some plans require underwriting for anyone who is outside a guaranteed issue period. There are plans (C & F) that are no longer available to anyone who turned 65 after Jan 1, 2020.

Medicare Supplements provide invaluable financial protection by covering the out-of-pocket expenses left by Original Medicare. By understanding what these plans cover and how they work, you can make an informed decision that ensures peace of mind and comprehensive healthcare coverage. For those considering enrollment in a Medigap plan, a licensed Medicare agent can help provide guidance and compare options to find the plan that best meets coverage needs.

DSNPs or Dual Eligible Special Needs Plans are Medicare Advantage plans specifically for individuals who qualify for both Medicare and Medicaid. If you are a Medicare agent, you may know about recent changes in enrollment periods for DSNP members. Some agents are wondering, what are fully integrated DSNPs.

Fully integrated DSNPs are a unique type of plan that provides comprehensive coordination between Medicare and Medicaid benefits. If you’re assisting clients with dual eligibility, understanding fully integrated DSNPs is essential.

What Does “Fully Integrated” Mean

A fully integrated DSNP plan goes beyond the standard DSNP by seamlessly coordinating all Medicare and Medicaid benefits under one umbrella. This integration ensures that members receive comprehensive, streamlined care without the confusion of navigating 2 separate programs.

Key features of fully integrated DSNPs:

Single plan design – Plan members have one plan that administers both Medicare and Medicaid benefits. This simplifies coverage and reduces administrative headaches.

Care coordination – These plans include a dedicated care team that provides the member with holistic support to manage medical, behavioral, and social service needs.

Combined benefits: Fully integrated DSNPs combine Medicare and Medicaid services, including medical, prescription drug, and long-term care benefits.

HIDE and FIDE: Understanding the Integration Levels

Fully integrated DSNPs can vary in how they coordinate benefits. Two common models are Highly Integrated Dual Eligible (HIDE) and Fully Integrated Dual Eligible (FIDE) plans. The main difference between the two plans is the level of integration.

Highly Integrated Dual Eligible (HIDE) Plans

HIDE plans provide a significant amount of benefit coordination between Medicaid and Medicare. This plan option may not fully integrate all services. In general, these plans focus on aligning medical and behavioral benefits. Although, in some cases, Medicaid benefits such as; LTSS, some skilled nursing facility care or behavioral health may be managed through the DSNP or an affiliated Medicaid managed care plan.

The HIDE plans are a good option for those who prioritize coordinated medical and behavioral health but may not require extensive long-term care services.

Watch a quick YouTube video on 2025 DSNP SEP changes

Fully Integrated Dual Eligible (FIDE) Plans

FIDE plans represent the highest level of integration, combining Medicaid and Medicare benefits, including long-term care, under one plan. This ensures a single point of contact for all healthcare needs. The plans provide comprehensive coverage and total coordination of care. This includes LTSS, nursing facility care for a period of at least 180 days per year and behavioral health services. It also includes medical supplies, equipment and appliances.

Plans are best for those with complex health needs requiring seamless access to long-term care, medical, and behavioral health services.

For a more detailed definition DSNP plan types, click here

Benefits of Fully Integrated DSNP Plans

Fully integrated DSNPs offer several advantages for eligible individuals:

Simplified coverage

Members no longer need to juggle multiple insurance cards or deal with separate billing for Medicare and Medicaid. One plan manages all medical services.

Enhanced care coordination

These plans emphasize comprehensive care management, with dedicated care coordinators ensuring members receive the right care at the right time.

Additional benefits

Many fully integrated DSNPs offer extra perks such as dental, vision, hearing, transportation, and OTC allowances that are not always available with standard Medicare or Medicaid coverage.

Cost savings

In most cases, fully integrated plans have little to no out-of-pocket costs for covered services, as Medicaid typically covers premiums, copays, and other costs.

Who Is Eligible for Fully Integrated DSNPs

Eligibility for a fully integrated DSNP plans require dual eligibility for both Medicare and Medicaid. Specific criteria vary by state but generally require eligibility for Part A and enrollment in Part B as well as qualification for enrollment in the state’s Medicaid program.

Important: fully integrated DSNPs are not available in all states. Availability depends on state-specific Medicaid programs and participating insurance carriers.

Examples of Fully Integrated DSNPs

Medicare-Medicaid Plans (MMPs) – These are a type of fully integrated DSNP operating under state-specific agreements with the federal government.

Programs of All-Inclusive Care for the Elderly (PACE) – While not technically a DSNP, PACE programs also provide fully integrated care for dual-eligible individuals.

Considerations When Choosing a Fully Integrated DSNP

If your client is considering enrolling in a fully integrated DSNP, it is still important to check the provider network and prescription coverage. Once you establish the client’s providers are in network and medications are on formulary, consider the desired additional benefits.

Agents who are ready to join the team at Crowe; click here for online contract.

Fully integrated DSNP plans provide a powerful solution for individuals eligible for both Medicare and Medicaid, offering simplified coverage, enhanced care coordination, and valuable additional benefits. Understanding the differences between HIDE and FIDE plans can help you choose the right level of integration based on your or your client’s needs.

As a Medicare agent, your upline plays a pivotal role in your success. They provide the support, tools, and resources necessary to help you grow your business and serve your clients effectively. However, there may come a time when you feel your current upline is not meeting your needs. Knowing the best time to change uplines can make the transition smoother and ensure your business continues to thrive.

Watch a quick YouTube video and learn about our programs & offerings

Why consider changing uplines

Changing uplines is a significant decision that agents should not take lightly. Common reasons for considering a change include:

Lack of support: If your current upline doesn’t provide adequate training, mentorship, or marketing support, it may be difficult to grow your book of business.

Limited resources: Some uplines do not offer the tools needed or outdated technology. This can slow an agent’s efficiency and ability to compete in the market.

Find out about our quoting tolls Sunfire & Connecture

Poor communication: An unresponsive or disengaged upline can make agents feel isolated and unsupported.

Conflict of values: In some instances, the way an agent does business and their goals may no longer align with their upline’s approach. If this is the case, it may be time to look for a better fit.

Better Opportunities: A new upline might offer more competitive commission structures, better carrier relationships, or enhanced resources.

2025 agent commission amounts

Transfer blackouts/freezes

During the months of September through December, most Medicare carriers go into a blackout/freeze on upline transfers. During this time, agents cannot transfer their contracts to a new upline. It does not matter if they use an immediate release or a self-release.

Agents who plan to start the clock with the carriers for a self release, must get the timing right. This will ensure they are receive their release before September to avoid the blackout/freeze. Be extremely careful that your release will not end any time during the blackout period, because you will have to wait until January when the blackout/freeze ends.

When is the best time to change uplines

The best time to consider making the switch is in the first quarter of the year. The reason is simple: if there are any delays in getting the release (sometimes these are unforeseen) there is plenty of time to straighten it out and be ready to sell before AEP starts.

This also allows agents to concentrate on their certifications and make their AEP plans.

It is best to start your research well before you make the switch to ensure you make the best decision and avoid having to switch uplines again in the future. Be sure any upline you consider offers training, tools and marketing programs that fit with your goals.

Consider your year-end performance

This is important to help see areas where the biggest changes are required and where you can improve. This helps agents understand where their current upline may have been a disadvantage and what a new upline can provide that will aid their growth and success. If the review shows you gaps in support, resources or other areas, it may be time to make a change.

When a Better Opportunity Arises

If you’re approached by a new upline offering significantly better opportunities, don’t ignore it. You could miss out on a great opportunity.

Be sure to look carefully at what they are offering before you make you initiate a release. Look at factors like commission structures, who owns your book of business (in case you decide to move again), training programs and sales tools and anything that is important to you.

Types of releases

In general there are 2 different ways to receive a release from you current upline and transfer your contracts to another upline.

Immediate (signed) Release

In the best of circumstances, agents may request and receive an immediate release from their current upline to transfer their contracts to a new upline.

If this is the case, be sure the release is signed by the top of the hierarchy. In most cases, this means an FMO. Releases signed by any part of the hierarchy other than the top do nothing but waste time. Although some carriers accept a general release, others require their own specific form signed & submitted.

Self-release

When the agent doesn’t receive an immediate release, they can start the release process on their own. Agents should check the requirements of each carrier to begin the process.

The most common way to initiate a self-release is for the agent to put in intent to transfer with each carrier. When this is the choice, agents may continue to write business and earn commissions. Keep in mind, the current upline will continue to be paid overrides on your business. Each carrier has it’s own process for this. In many cases, the waiting period for the release to be finalized is 90 days.

In some cases the agent may be able to transfer their contracts after 6 months of non-production with their current upline. Although, this is not usually a realistic option as most agents cannot afford to go without commission for 6 months.

Changing your upline

Making a change to your Medicare upline is a significant decision that can greatly impact your business. Carefully considering the timing to ensuring a well-planned transition, can help set you up for greater success. The key is to prioritize long-term goals and choose an upline that aligns with your vision.

If you are ready to join the team at Crowe, click here for online contract

If you’re contemplating a change, take time to evaluate your options thoroughly and make an informed decision. The right upline can be a game-changer for your career, providing the tools and support you need to reach new heights.

There are a some important things to think about for those on Medicare and working past 65. This can be a tricky question to answer. Do you need Medicare Part A or Part B?  Will you have a penalty for taking them later?  What counts as a valid reason not to take Medicare?  Read below for the details.

Medicare Part A

We will keep Medicare Part A brief as it is free to most people as long as they have worked and paid Medicare taxes for a period of 40 quarters (10 years). In other words, why would you not sign up for it; it is free and can be sued in addition to employer coverage. You can sign up for premium free Part A up tp 3 months before turning 65 or any time after you turn 65.

Those who do not qualify for premium free Part A will follow similar rules as enrollment into Part B. Please read below to learn more:

Do you need part B if you are still working

Many people need to enroll in Medicare Part B when they turn 65.  Although there are some exceptions. One of the most common exceptions is for individuals working past 65. Because Part B is not free to most people, there are a few things to consider when making this decision:

Those who are working or have a working spouse and getting coverage through their employer can delay Part B enrollment in most cases.  The key is that the individual must be working and getting coverage.  Both must be happening in order delay enrolling in part B.

Receiving coverage through an actively working spouse is also a valid reason not to enroll in Medicare Part B. 

The number of employees matters

Additionally, the employer must have 20 or more employees.  In either situation above, the person must be receiving coverage through an employer of 20 or more employees.  If the employer has less than 20, Part B of Medicare should be elected at age 65.

The 20 or more employees has always been the rule. although in the past, it was rarely enforced. As a result, people working with coverage through an employer of less than 20 often waived part B without issue.  In the last few years, this rule has been enforced. This can lead to the denial of medical claims.

Click here to sign up for Medicare online

Working past 65 with Medicare: Cobra and other mistakes

It is very common for people to think they do not need to enroll in Medicare Part B if they have COBRA.  COBRA is not a valid waiver for delaying Part B enrollment.  Keep in mind, either the individual or their spouse must be working as well as getting employer coverage.  People with COBRA are not actively working.

Getting coverage through an employer without actively work for them is also an issue.  Those who work and have coverage or coverage through a working spouse, must be covered through their current employer.  For example, if John is working and loses his job and enrolls in COBRA and then immediately gets a job somewhere else.  Although he is actively working and has coverage, it is not through the employer he is currently working for.

VA coverage

VA coverage is a waiver for Medicare Part D.  It is not a waiver for Medicare B.  The standard rules apply for those with VA coverage.

What happens if someone neglects to enroll in Part A and or Part B

Those who do not enroll in Medicare when they should are likely to pay a penalty. The penalty is 10% of the Medicare Part A or Part B premium for each year they didn’t sign up and did not have creditable coverage (through employment).

Watch a YouTube video on Medicare enrollment periods to learn more

Those who lose coverage due to retirement or a loss of group coverage qualify for an SEP. The special election period for Medicare runs 8 months from the date individuals either retire or lose group coverage. 

Individuals who miss their IEP and SEP for either Part A and or Part B have to wait for the Medicare general election period .  This enrollment period runs from January 1 through March 31 each year. Medicare benefits begin the month following the month of enrollment.

Why Switch from Medicare Supplement Plan F to Plan G

There are some good reasons to switch from Plan F to Plan G. We will compare Medicare supplement Plan F vs Plan G to help illustrate. For years, Medicare Supplement Plan F has been a popular choice for beneficiaries seeking comprehensive coverage. However, recent changes and market trends have led many to consider switching from Plan F to Plan G. While both plans offer great benefits, Plan G provides similar coverage at a lower premium cost.

Key Similarities Between Plan F and Plan G

Both Plan F and Plan G are Medigap plans designed to fill the gaps in Original Medicare (Part A and Part B). Both plans offer comprehensive coverage, including:

1. Medicare Part A deductible
2. Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are exhausted)
3. Medicare Part B coinsurance or copayments
4. Part B excess charges (the amount a provider can charge above Medicare’s approved amount)
5. The first three pints of blood
6. Skilled nursing facility (SNF) care coinsurance
7. Foreign travel emergency coverage (80% up to plan limits)

The only difference is that Plan F covers the Medicare Part B deductible, while Plan G does not.

Why Switch to Plan G

Plan F Is No Longer Available to New Beneficiaries

As of January 1, 2020, Plan F is no longer available to individuals who became eligible for Medicare after that date. This change, part of the Medicare Access and CHIP Reauthorization Act (MACRA), was implemented to reduce overall healthcare costs.

Due to the fact that Plan F is closed to enrollees who turn 65 after Jan, 1, 2020, its risk pool is aging. This can lead to higher premiums over time as the pool becomes more expensive to insure.

Lower Premiums

Plan G often has significantly lower monthly premiums than Plan F does. While Plan G requires beneficiaries to pay the Medicare Part B deductible out-of-pocket ($257 for 2025), the savings in premiums can more than make up for this cost.

For example, if Plan F costs $50 more per month than Plan G, you’d save $600 each year by switching to Plan G. The savings would easily offset the $257 deductible.

Similar Comprehensive Coverage

Aside from the Part B deductible, Plan G provides identical coverage to Plan F. After meeting the deductible, Plan G covers all Medicare-approved expenses just like Plan F does.

Premium Stability

Because Plan G is open to new enrollees, its risk pool is younger and more diverse compared to Plan F. This dynamic helps keep premiums more stable over time.

In contrast, Plan F’s closed risk pool may lead to disproportionately higher premium increases as it’s enrollee population ages.

Making the switch sooner rather than later ensures you can take advantage of Plan G’s cost savings without disruption to your coverage.

Things to consider

Health Underwriting

Beneficiaries outside their initial enrollment period or guaranteed-issue period, may need to go through medical underwriting to switch plans. This means, insurers evaluate health status and may deny coverage or charge higher premiums based on pre-existing conditions.

Evaluate Your Healthcare Needs and budget

All potential enrollees should carefully calculate out-of-pocket costs, including the Part B deductible, to ensure Plan G is a cost-effective choice.

Enlist the help of a licensed agent

Because navigating Medigap plan changes can be complex, a licensed Medicare agent can help compare premiums, evaluate options, and explain the implications of switching plans. Agents can help submit the application to ensure it is done correctly as well as advise clients when to cancel their current coverage.

It is very important to confirm eligibility to enroll in or change plans and be aware if underwriting will apply.

Learn about Medicare enrollment periods – watch a quick YouTube video

More thoughts on Plan G

Switching from Medicare Supplement Plan F to Plan G is a practical choice for many beneficiaries seeking to reduce their healthcare costs without sacrificing coverage. With lower premiums, stable pricing, and nearly identical benefits, Plan G offers exceptional value especially for those who don’t mind paying the Part B deductible.

Those considering the switch should consult a licensed Medicare agent to ensure a seamless transition and take advantage of the savings and benefits Plan G has to offer. Making an informed decision now can lead to significant cost savings and peace of mind in the years to come.

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For a look at upcoming agent events and to view our webinar schedule, click here

The question; why sell Medicare supplement HDG is easy to answer. As healthcare costs continue to rise, more Medicare beneficiaries are looking for affordable yet comprehensive medical coverage. High Deductible Plan G (HDG) has emerged as an attractive choice, combining the robust benefits of traditional Medicare Supplement Plan G with significantly lower premiums. For insurance agents, promoting HDG can be a win-win offering value to clients while providing a competitive edge in the Medicare market.

Understanding High Deductible Plan G

High Deductible Plan G works in a similar way to standard Plan G. Both plan options cover the same benefits once the beneficiary meets an annual deductible. For 2025, the deductible for HDG is set at $2,870. In other words, beneficiaries pay out-of-pocket for Medicare-covered expenses until they meet this threshold. Once the beneficiary reaches the deductible, the plan covers:

1. Medicare Part A coinsurance and hospital costs.
2. Medicare Part B coinsurance or copayments.
3. The first three pints of blood
4. Skilled nursing facility (SNF) care coinsurance.
5. Part A hospice care coinsurance/copays.
6. Foreign travel emergency coverage (up to plan limits).

The other difference between a standard Plan G and a HDG plan is the premium. HDG premiums are significantly lower than those for standard Plan G, making it an appealing option for cost-conscious beneficiaries.

Why agents should sell HDG

1. Appeal to cost-conscious clients: HDG is an excellent solution for beneficiaries who want comprehensive coverage and are willing to pay a higher deductible in exchange for lower monthly premiums. Many retirees on fixed incomes consider this a good option, especially those in good health who do not expect many healthcare expenses.
2. Growing market: With healthcare costs on the rise, there is a growing trend toward high-deductible health plans. Educating clients about HDG allows agents to tap into this expanding market of budget-conscious Medicare beneficiaries.
3. Competitive edge: Offering HDG plans show the agents ability to provide diverse options tailored to individual financial and healthcare needs. Agents who can explain the cost-benefit analysis of HDG effectively are more likely to earn trust and build long-term client relationships.
4. Cross-selling opportunities: Beneficiaries who choose HDG may still need assistance with other healthcare expenses. Agents can use this opportunity to cross-sell ancillary products such as dental, vision, and hearing plans, hospital indemnity or cancer heart attack and stroke coverage.
5. Client Retention: The affordability of HDGs are an excellent option for clients who might otherwise drop supplemental coverage due to cost concerns. By proactively offering HDG, agents can retain clients who might otherwise feel Medicare Supplements are unaffordable.

Click here to get some tips to maintain your book of business

How to Sell HDG Effectively

1. Be sure you educate potential clients. Clearly explain how HDG works. Be sure to emphasize the trade-off between lower premiums and the higher annual deductible. Use understandable examples to illustrate potential cost savings.
2. Explain the flexibility of the plans. Emphasize that HDG offers the same benefits as standard Plan G after the deductible is met. Clients can enjoy peace of mind knowing they’re protected against catastrophic expenses.
3. Put the focus on the plan’s affordability. Compare HDG premiums with standard Plan G and other Medicare Supplement plan premiums. Showcase how the premium savings can outweigh the deductible for clients who have minimal healthcare needs.
4. Use calculators or other tools to demonstrate potential savings with HDG, tailored to the client’s unique circumstances. This personalized approach can make the benefits of HDG more understandable.
5. Be prepared to address common objections, such as concerns about meeting the deductible. Highlight strategies for managing out-of-pocket costs and reassure clients about the plan’s comprehensive benefits.

Watch a quick YouTube video on selling ancillary products

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A few more things to consider

Medicare Supplement HDG Plans offer a winning combination of affordability and comprehensive coverage, making it a valuable option for many Medicare beneficiaries. For agents, HDG plans provide an opportunity to meet the needs of cost-conscious clients, differentiate themselves in a competitive market, and build lasting client relationships.

By focusing on education, affordability, and personalized service, agents can successfully position HDG plans as a smart choice for Medicare beneficiaries.

The Next 15 Drugs for Medicare Price Negotiations

In a landmark move aimed at reducing prescription drug costs, HHS has announced the new drugs for price negotiations. The list contains 15 drugs. This initiative, part of the Inflation Reduction Act (IRA), represents another step toward making life-saving medications more affordable for millions of Medicare beneficiaries.

What started the Medicare drug price negotiations

In the past, Medicare was prohibited from negotiating drug prices directly with pharmaceutical companies. However, in 2022 the IRA was signed into law and Medicare gained the authority to negotiate prices for some specific high-cost drugs covered by Medicare Part B and Part D. The object of this program is to lower out-of-pocket medication costs for beneficiaries and reduce healthcare spending.

The list of drugs for the second cycle of negotiations:

1. Ozempic, Rybelsus, Wegovy
2. Trelegy Ellipta
3. Xtandi
4. Pomalyst
5. Ibrance
6. Ofev
7. Linzess
8. Calquence
9. Austedo, Austedo XR
10. Breo Ellipta
11. Tradjenta
12. Xifaxan
13. Vraylar
14. Janumet, Janumet XR
15. Otezla

More about the negotiations

The second cycle of the price negotiations allow drug companies with a selected drug until February 28, 2025 to make the decision weather or not to participate. CMS will consider the clinical benefits of the selected drug. It will also take into consideration how it meets medical needs as well as it’s impact on specific populations. CMS also considers the manufacturers’ Costs for research, development, production and distribution.

The first 10 drugs  

The first 10 drugs chosen for negotiations were announced by the Dept. of HHS in August 2023. During the first cycle of negotiations, Medicare reached an agreement with the drug manufacturers on all 10 of the drugs. The new lower prices for those drugs is due to go into effect as of January 1, 2026.

The negotiated rates for the first 10 drugs will be between 38 to 79 % less than their current list prices. In 2026, could save Medicare beneficiaries about $1.5 billion in out of pocket costs.

Watch a quick YouTube video on the$2,000 drug cap

Moving forward, CMS plans to choose 15 more drugs in the third cycle of negotiations. After the third cycle, they plan to choose as many as 20 additional drugs for the subsequent cycles.

Take a look at the CMS fact sheet on the drugs chosen for the Drug Price Negotiation Program

Medicare commissions are not as straight forward as we want them to be. Many agents are confused when they receive their commission deposits. That is why reading Medicare Commission Payments Explained may help unravel the mystery. It is important to note: commission payments require a certain amount of attention to detail.  

CMS and commissions

Each year the maximum allowable commissions for Medicare Advantage and PDP sales is set by CMS. The amounts vary by state and can usually be found online once they are available. Unfortunately, there are many different situations that determine how much of that commission an agent receives for each sale.

For the last several years, CMS has consistently raised the commission rates. The renewal amount differs from the amount agents receive for an initial enrollment. Renewal commission amounts also change annually and add up to half the amount of the initial enrollment commission rate. The rates are decided by state and each state is put into a group. The state groupings are (CA and NJ), (CT, PA and DC), (Puerto Rico and US Virgin Islands) and all the other states are in the “National” bucket.  The highest pay goes to CA and NJ, followed by CT,PA and DC, then the national bracket.  Puerto Rico and Virgin Islands pay the lowest amounts.

Watch a recorded webinar to learn more about commission payments CLICK HERE TO VIEW.

Initial payment, true up and pro-rata

In 2025, the max commission for an MAPD sale in CT is $705 with renewals at $353 for the year.  That sounds easy enough, but it is not that simple.  The amount of commission an agent receives depends on the situation.  We provide a breakdown below:

Medicare Advantage commission payments – new to Medicare 

If your client is new to Medicare, the carrier pays the full commission in two payments:  the intial payment, then the true up payment.  The two will total up to the full amount.  The renewal commission rate will be half of the full amount and pays over the course of 12 months starting in January. (Regardless of the effective date of the original sale).

New to Medicare Advantage but not new to Medicare 

If the client enrolls in a Medicare advantage plan for the first time, the commission is the same as a new to Medicare enrollment. The difference is how the carrier pays it out.  The commission is pro-rated.  In other words, the payment amount is based on the month the plan is effective.  So if someone is enrolled for a June 1 effective date, the agent receives 50% of the full commission. (They will be in the plan for 6 out of the 12 months.)  If the person is enrolled for a March 1 effective date, the agent receives 75% of the commission and so on. The renewal starts in January and the agent receives the full renewal amount.

Click here to find out what the 2025 commission rates are

Changing from one Medicare Advantage to another 

When your client changes from one MA/MAPD plan to another, the agent receives the same amount when they renew an MA/MAPD plan (half the new enrollment commission).  If you enrolled a PA client in an MAPD plan with a Jan 1 start date, the commission is $353. However, plan changes are also pro-rated and if you enroll a PA client in a plan with a March start date, you receive 75% of the $353. In other words, $264.75.

See what to do about non-commissionable PDP plans

Commission payments for AEP

The commission rules do not change during AEP although when agents receive their payment does.  Any clients agents enroll during AEP will not pay out until January. Insurance carriers are not permitted to pay them before then enrollment goes into effect. Therefore, most carriers pay out sometime during January.

Use the links below to learn more about our Medicare lead program and T-65 seminar program:

Medicare lead program

Medicare sales seminar program

Click here if you are ready to fill out an online contract and join the Crowe team

For millions of beneficiaries, Medicaid provides a much needed lifeline. This ensures they receive access to essential healthcare services. However, one common question Medicaid beneficiaries have is does Medicaid coverage renew automatically. Although the answer depends on the state and specific circumstances of each enrollee, understanding the Medicaid renewal process helps avoid a lapse in coverage.

Medicaid renewal, also known as redetermination, is the process each state uses to determine if a beneficiary is still eligible for Medicaid benefits. Periodically, each state must verify the beneficiary’s income, household size, and other factors to ensure they still qualify for the program.

Click here to apply for Medicaid in each state

Does Medicaid coverage renew automatically

The short answer is: In some cases, Medicaid renewals are automatic, while others require the beneficiary to provide information to their resident state for renewal.

Automatic (passive) renewal

In many states, if the Medicaid office can verify eligibility through their databases (e.g., tax records, Social Security information, or unemployment benefits), coverage may renew automatically. If this happens, beneficiaries receive a notice in the mail informing them that coverage has been renewed without further action required.

Active Renewals

If eligibility cannot be verified automatically, beneficiaries must complete a renewal form and provide the requested documentation. States may typically send a renewal notice by mail or email depending on the beneficiary’s preferences. The notice includes instructions as well as a deadline to submit the required information.

What Triggers the Need for Renewal

Medicaid renewal usually occurs annually, though the exact timing varies according to when each beneficiary first receives Medicaid. Some reasons for renewal are a change in household size or a change in income. State policies differ and may change and require information for a renewal.

How to prepare for Medicaid renewal

Whether renewal is automatic(passive) or requires action, the following tips can help ensure a smooth process:

Beneficiaries must notify their state Medicaid office immediately if their address, phone number, or email changes. This ensures they receive renewal notices and other important information. They should also watch their mail for important notices and respond quickly. It is also important to keep recent pay stubs, or tax returns as proof of income.

Be aware of the deadline for renewal to respond in a timely manor and avoid a lapse in coverage.

Click here to learn the difference between Medicare and Medicaid

What If the renewal deadline passes

Failing to complete the renewal on time can result in a termination of benefits. However, most states offer a grace period that allows beneficiaries to submit renewal documents and have coverage reinstated retroactively.

Whether renewal is automatic or requires action, keeping your information updated and responding promptly to notices are imperative to maintain benefits.

Additional information

Most states have expanded Medicaid programs that cover anyone with a household income below a specific level.

In each individual state, the Medicaid qualification is based on several factors including income, size of the household, disability or other factors. The specific qualifications vary by state. Some states have expanded Medicaid coverage. When that is the case, Medicaid qualification is based solely on income. Most states accept those with household income less than 133% of the federal poverty level.

It is important to know: every state has a different renewal process for Medicaid beneficiaries. To locate a department of Social services in your area; click here for the department of Social Services.