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If you’re a Medicare beneficiary with higher income, you may be subject to the Income-Related Monthly Adjustment Amount (IRMAA) for your Medicare Part B and Part D premiums. However, if your income has recently decreased due to qualifying life events, you may be eligible to appeal the IRMAA determination. Here’s what you need to know about how to appeal an IRMAA.

What is an IRMAA

The Medicare Income-Related Monthly Adjustment Amount (IRMAA) is an extra charge added to Medicare Part B and Part D premiums if the beneficiary’s income exceeds certain thresholds. The Social Security Administration (SSA) determines IRMAAs based on the tax return from two years prior. In other words, a 2025 IRMAA is based on 2023 income.

IRMAA brackets 2025

When you can appeal an IRMAA

Medicare beneficiaries may appeal an IRMAA redetermination if they experience a significant life-changing event that cause a reduction in income. Qualifying events include:

1. Marriage, divorce, or annulment
2. Death of a spouse
3. Retirement or reduction of working hours
4. Loss of a pension or settlement of an employers pension plan
5. Loss of income-producing property due to a disaster or other circumstance

Any of these situations may cause a decrease in income. This provides grounds for an appeal.

How to File an IRMAA Appeal

To file an appeal, beneficiaries must complete Form SSA-44, Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event. Here’s how to do it:

1. Download the Form – Obtain Form SSA-44 from the Social Security website or by at the local Social Security office.
2. Complete the Form – Provide details about the life-changing event, including supporting documentation (such as a marriage certificate, employer statements, or tax returns).
3. Submit the Form – Either mail or deliver the completed form and supporting documents to the local Social Security office.
4. Await a Decision – SSA will review the request and notify the beneficiary of the outcome. If they deny the appeal, the beneficiary may request a further review.

To Sum it up

If your income changes due to a qualifying event, don’t hesitate to appeal an IRMAA determination. Many beneficiaries successfully lower their Medicare premiums through this process. Be sure to gather all necessary documentation and submit the appeal as soon as possible to avoid overpaying.

For more details, visit the official Social Security Administration website or contact your local SSA office.

Medicare Supplement (Medigap) insurance is one of many great products for Medicare agents to offer their clients. They continue to provide a good source of income to agents with their stable commission structure and renewal income. The Medicare Supplement commissions 2025 remain the same as they have been in prior years. We will explain what to expect regarding payment of these commissions below.

How Medicare Supplement Commissions Work

Medigap commissions are structured differently than Medicare Advantage (MA) or Part D plans. Instead of receiving a one-time upfront payment, Medigap agents typically earn level commissions over multiple years. Here’s an overview of the commission structure:

1. Initial Year Commission – Agents earn a commission based on a percentage of the first-year premium, typically between 20 and 22%.
2. Renewal Commissions – In most cases, Medigap policies pay renewal commissions for a period of 6 years.
3. Varying Payouts by State – Some states and carriers impose limits on commission percentages, affecting how much agents can earn.

How Agents Receive Medicare Supplement Commissions

Agents typically receive their commissions through one of the following methods:

Direct Deposit – Most carriers pay commissions electronically on a monthly or biweekly basis.

Advanced Commissions – Some insurers offer advance payments of commissions (e.g., 9 or 12 months upfront) based on projected renewals.

As-Earned Commissions – Commissions are paid out as the policyholder pays their premium.

General Payment Structure

A typical Medigap commission structure follows this breakdown:

First-Year Commission: about 21% – 22% of the annual premium

Renewal Commission (Years 2-6): percentage rates vary by area and carrier.

Payment Frequency: Monthly, biweekly, or advanced lump sums based on carrier agreements

Learn more about commission payment structures

Factors That Influence Commission Rates

Several factors determine how much an agent earns from selling a Medigap policy. These factors include; carrier-specific rates; each carrier sets its own commission structure (unlike PDP & MA/MAPD plans). Each state has its own regulations; some have specific commission caps (CA & FL). In other instances, commission rates are based on age of enrollee and plan type.

Medicare Supplement vs. Medicare Advantage Commissions

Medicare Supplement commissions are generally lower in the first year compared to Medicare Advantage, but the long-term renewal structure and coverage type make them more sustainable. Medigap policies also tend to have lower attrition rates, meaning agents can build a long-term residual income.

Click here to watch a YouTube video on MA & PDP commissions 2025

Example using 22% commission and 12-month advance:

For agents selling Medicare Supplement plans, commissions remain a steady and reliable income source. While initial-year payouts may be lower than Medicare Advantage, the ongoing renewal structure provides financial stability.

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Please note: These payment amounts vary by carrier and product. Not all carriers pay 22% for enrollments. This amount varies quite a bit. Be sure you check each carrier’s rate in the specific area you plan to market the plans in.

Anyone enrolled in a Medicare Prescription Drug Plan (PDP) or a Medicare Advantage plan with drug coverage (MAPD), you may occasionally find that a medication prescribed by Their doctor is not covered by their drug plan. This is where a formulary exception can help. Right now you may be asking; what is a formulary exception?

A formulary exception is a formal request asking your Medicare drug plan to cover a medication that is not on its formulary (list of covered drugs) or to waive certain coverage restrictions. Here’s what you need to know about how formulary exceptions work and how to request one.

When do you need a Formulary Exception

We list below a few reasons why a Medicare beneficiary might need a formulary exception:

This is a common reason; the prescribed medication is not on the enrollee’s plan formulary. In other words, it isn’t covered. If the doctor believes it’s medically necessary, the enrollee can request an exception.

Some plans require enrollees to try lower-cost drugs (step-therapy)before covering a more expensive one. If the alternatives are ineffective or cause harm, the enrollee can request an exception.

In some cases, a plan may impose quantity limits on the medication beneficiaries receive within a specific time frame. If the doctor prescribes a larger amount than the drug plan covers, the beneficiary needs an exception.

If the necessary medication is on a higher-cost tier, beneficiaries can request a lower copay by asking the insurer to move it to a lower tier. This is referred to as a tier exception and it does not apply to specialty-tier drugs.

How to request a Formulary Exception

1. The beneficiary should talk to their doctor to explain the situation. The doctor must provide a medical reason that the drug is necessary and why a lower cost alternative is not effective.
2. The next step is to submit a formal request. The beneficiary must contact the drug plan and request a coverage determination. They should follow the official request process as explained by their plan provider and include supporting documents from their doctor.
3. Once these steps are completed, the beneficiary waits for a decision. They should receive this within 72 hours of the request. If the enrollees health is at risk, they may request an expedited decision (within 24 hours).
4. If the request is denied, the enrollee has the right to file an appeal. This process provides multiple channels for the beneficiary if they feel it is necessary.

Important takeaways

A formulary exception helps beneficiaries get coverage for medications that drug plans do not typically cover. Their doctor must provide medical justification for the request. In the event that the plan denies the request, the beneficiary can appeal the decision.

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

Understanding formulary exceptions can help ensure beneficiaries receive needed medications and avoid unnecessary health risks.

To answer the question; what is the Medicare GEP; The Medicare GEP is an opportunity for individuals who missed their initial chance to sign up for Medicare Part A and/or Part B to enroll. It runs from January 1 to March 31 each year. This allows eligible individuals to enroll in Medicare coverage, though late penalties may apply.

Who needs the GEP

The GEP is for individuals who did not sign up for Medicare during their IEP (Initial Enrollment Period) and do not qualify for an SEP (Special Enrollment Period).

When does coverage begin

As of 2023, individuals who enroll in Medicare during the GEP will have their coverage begin the month after they enroll. Prior to 2023, coverage did not begin until July 1, which led to significant delays in accessing benefits.

Late enrollment penalties

Individuals who sign up during the GEP may have to pay an LEP (late enrollment penalty). This can increase monthly Medicare costs:

Part A penalty

For those who must pay a premium for Part A, the monthly premium could increase by 10%. This will be in place for twice the number of years they were eligible but didn’t sign up.

Part B Penalty

The monthly Part B premium will increase by 10% for each full 12-month period the beneficiary was eligible but didn’t enroll. This penalty is permanent and remains in place for as long as they have Part B.

Medicare Advantage, Part D and Supplement enrollment

If an individual enrolls in Medicare during the GEP, they can sign up for a Medicare Advantage (Part C) or a Medicare Part D prescription drug plan at this time. Coverage for these plans begins on the month following the enrollment. Although late enrollment in Part D or Medicare Advantage plans that include prescription drug coverage may include a lifelong penalty.

Medicare supplements can be a little more difficult to get after the individual’s Medigap open enrollment has passed. When this is the case, some states require enrollees to undergo underwriting which can lead to denial or higher premiums.

Avoiding the need for the GEP

Beneficiaries can avoid using the GEP (General Enrollment Period) and getting potential LEPs:

Sign up for Medicare during the Initial Enrollment Period, which starts three months before the 65th birthday and ends three months after.

Those who have employer-sponsored coverage should confirm whether they qualify for a Special Enrollment Period (SEP) when that coverage ends. If they do, be sure to enroll before the SEP ends.

The Medicare GEP is an important opportunity for those who miss their initial chance to enroll in Medicare. However, because of potential late penalties and delays in coverage, it’s best to sign up during the Initial Enrollment Period or a Special Enrollment Period when possible. Understanding enrollment deadlines helps ensure that beneficiaries get the healthcare coverage they need and avoid unnecessary costs.

If you’re a Medicare agent, you may receive calls from clients asking if Medicare covers their annual checkup. Most likely, your answer will confuse them. Many do not understand the difference between Medicare wellness visits vs checkups. Some people use these terms interchangeably. However, these are actually two different types of appointments. Understanding the distinction can help beneficiaries make the most of their Medicare benefits.

What is an annual wellness visit

An annual wellness visit is a preventive service that Medicare Part B covers. This visit helps beneficiaries and their providers create or update a personalized prevention plan based on current health and risk factors.

During this visit, the doctor reviews the beneficiary’s medical history, medications, height, weight, and blood pressure. They also assess cognitive function and risk factors for conditions like dementia. The beneficiary receives personalized health advice and screenings. The doctor and beneficiary may use this visit to discuss advance care planning and develop or update a prevention plan.

Medicare covers 100% of the cost for an annual wellness visit. In other words, there is no copay or deductible if your provider accepts Medicare assignment.

What is an annual checkup

An Annual Checkup (Routine Physical Exam) is a comprehensive medical evaluation that goes beyond the preventive focus of an annual wellness visit. Unlike the annual wellness visit, Medicare does not cover routine physicals. Those who request an annual checkup, may pay out of pocket unless they have insurance that covers it. During an annual checkup, the doctor may perform a physical exam, listen to the heart and lungs as well as order lab tests such as blood work. The provider assess overall organ function and diagnose medical issues.

Because an annual checkup involves diagnostic and treatment-related services, Medicare does not cover this visit unless it is used to address health concerns under medical necessity.

Why this matters for Medicare beneficiaries

Many Medicare beneficiaries schedule an “annual physical” expecting it to be fully covered, only to find out later that Medicare does not pay for it.

In order to avoid unexpected costs; beneficiaries who want a preventive visit covered by Medicare should ask for an “annual wellness visit.”

Click here to learn more about Medicare annual wellness visits

Anyone who needs a full physical exam including diagnostic tests, or lab work should check on the potential costs.

Understanding the difference between these visits ensures beneficiaries receive needed care and helps them avoid unexpected medical bills.

Before an agent can contact a potential client, they must be aware of the Medicare permission to contact rules. CMS puts these rules in place to protect Medicare beneficiaries.

Permission to Contact

Before we go over the permission to contact rules, we will explain what PTC (permission to contact) is. The PYTC guidelines were put in place to protect Medicare beneficiaries from receiving unsolicited communications and high pressure sales tactics. Any agent who wants to contact a potential client must follow all CMS marketing and communications guidelines.

For an agent to receive permission to contact in a complaint way, the potential client must initiate contact. In other words, the potential client must grant permission for the agent to contact them before the agent can do so.

Please note; agents do not need a PTC to contact their current Medicare clients.

Watch a YouTube video on Medicare marketing rules

Click here for a quick updated one-to-one consent rule video

When you need PTC

When an agent wants to speak with a potential Medicare client, they must have PTC. This is important especially if you plan to discuss either Medicare Advantage or PDP plans. Keep in mind; if you discuss Medicare Supplement plans, you will probably discuss PDP plans as well.  Even though CMS rules do not apply to Medicare Supplements, the TCPA guidelines do apply. That is why, it is important to get PTC whenever you plan to contact a potential client for any sales meeting.

Please note; you do not need a PTC to send out unsolicited emails to potential clients. All emails must contain an option to opt-out and the email must not contain information that would classify it as marketing material. That is anything with specific benefits or plan information that could sway a potential client towards a specific plan choice. All email communications must follow the CAN SPAM Act laws.

How to collect a Medicare Permission to contact

What you can do:

1. Always keep business cards with your contact information available for events you attend or just in case a potential client needs one. That makes it easy for people to contact you. Additionally; current clients may want a couple cards to give friends or family if they need an agent.
2. If you have a website, make sure there is a contact form on it so clients can request that you contact them.
3. When you send out emails, be sure to include your contact information as well as a contact form if they want more information or assistance.
4. Business reply cards are also a way to obtain PTC. If the prospect wants more information, they just fill out the card and send it back to you.

What you can’t do:

1. Agents are not permitted to go door-to-door looking for clients. If you do not have a scheduled appointment, you cannot go to someone’s home.
2. Do not send a direct message to a prospect through any social media platform.
3. Never cold call prospects to sell either a Medicare Advantage or PDP plan.
4. Do not contact a friend or relative of a current client without their consent. Each person must provide PTC.

After you have the PTC, it is good for up to 12 months. If you have not contacted the prospect within that time frame, you will need another PTC before attempting to contact them.

Permission to Contact and Scope of Appointment differences

Although both the SOA and the PTC serve a similar purposes, there are some important differences. Each protects Medicare beneficiaries from unfair sales practices. You need to have PTC before you contact the prospect and then you can collect a SOA.

The SOA is a form that specifies which healthcare products the beneficiary wants to discuss during their appointment with the agent. Learn more about SOAs.

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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.

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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.

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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.

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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.

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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.