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Sales Dialer Discount

If you are like many Medicare agents, you are doing a lot of work from home.  That is why Crowe and Associates and ProspectBoss are offering agents a special sales dialer discount.

Any agent contracted through Crowe and Associates for at least 1 carrier, is eligible to take advantage of this offer.  Our agents have access to the Prospectboss.com Power Dialer CRM system at a reduced monthly cost on both programs listed below.  The Power Dialer CRM integrates a 3 line power dialer and a CRM (Customer Relationship Management) system.  Take a look at our pricing below. Please note, agents need to be contracted with at least one Medicare plan through Crowe and Associates in order to access the discounts.

Discounted Sales Power Dialers programs and rates:

• 3-line dialer with unlimited calling for $89.00 a month Triple your productivity! This is an exclusive 3-line dialer link for Crowe and Associate agents.

• 3-line dialer with unlimited calling and unlimited data for $199 a month.  Unlimited data allows you to run and download unlimited phone lists and contact info both scrubbed and non DNC scrubbed.

If you choose the data option, the monthly rate provide access to the dialer, CRM, and data as well as other features.

ProspectBoss offers many tools that can help you grow your book of business from the comfort of your own home.

Learn about the ProspectBoss Time management CRM dialer productivity tool

Read how to triple productivity with ProspectBoss

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What is Medicare Part C

Many people see television ads telling them they need Medicare Part C.  In this post we answer the question; What is Medicare Part C and do you actually need it.

Medicare Advantage (Part C), gives Medicare beneficiaries an alternative coverage option to Original Medicare.  Medicare A & B provide coverage for essential health care benefits such as; doctor visits and hospitalization.  Part C (MA plans) take the place of your Medicare Part A & Part B benefits and are available through private insurance companies.  They also provide many value added benefits such as prescription coverage (Part D), dental, hearing, vision, OTC benefits and more.

More details about Part C:

All Medicare Advantage (Part C) plans are offered by private insurance companies.  MA/MAPD (Part C) carriers are regulated by CMS and must provide beneficiaries the same level of medical coverage that Original Medicare (A&B) provides.

Most Part C (MA/MAPD) plans offer a very competitive premium, many plans have a $0 premium as well as low out-of-pocket costs.  This gives people a very cost effective way to get the healthcare coverage they need.

If you opt for a MA/MAPD (Part C) plan, you should be aware of the plan’s provider network and confirm that your doctors are in-network with your selected plan.  Even if you choose a PPO plan, using an out-of-network provider can be a costly mistake.

Each year, during the AEP, you have an opportunity to either enroll in or out of your current Medicare plan.  The AEP starts on Oct. 15th and ends on Dec 7th.  If you are enrolled in a MA/MAPD, you have an extra opportunity to change your coverage options starting Jan 1 and ending March 31 each year; this is called the OEP.

Summary – Why Choose a Medicare Advantage Plan (Part C):

Part C (MA/MAPD) plans provide comprehensive coverage including additional benefits such as; dental, vision, hearing, prescriptions, OTC, rides to appointments and more. They also cover Medicare A & B charges for doctors and hospitals. Many plans include Part D, prescription drug coverage.  All you need is one card to cover your medical costs.

Because MA/MAPD plans have annual out-of-pocket maximums, beneficiaries can feel safe knowing the cost of their annual healthcare has a limit.  Plans also offer clear costs for services.  Some carriers offer coordination of care benefits which is a great way for all our providers to stay in the loop on your care needs.

There are several different plan options to suit your personal needs including; HMO, PPO, PFFS, DSNP, ISNP, etc.

A Medicare Advantage plan (Part C) is not for everyone:

It is important to consider many factors before choosing Medicare Part C coverage.  Some things to think about are; your personal healthcare needs as well as your budget. With careful research and an understanding of the plan’s features, you can make an informed decision that supports your health and well-being.

One of the most important points is to make sure our providers are in-network with the plan you choose.

Consider any medical conditions you may have an dhow often you will require medical attention.  It may be a better bet to join a Medicare Supplement and prescription drug plan depending on your personal health needs.  There are co-pays, deductibles and out-of-pocket maximums to think about with a Part C plan.

Make sure you are aware of the plans Star Ratings to be sure yo consider a good quality plan.

Remember; plans change every year.  Benefits are added and taken away.  That is why it is important to work with a knowledgeable, licensed Medicare agent to help you sort out all your plan options during the AEP or OEP enrollment periods.

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Choosing Medicare Drug Coverage

There are many things to consider when choosing Medicare drug coverage (Medicare Part D).  This is a very important decision that can cost you quite a bit if you are not careful.

Steps to help you choose the best Medicare drug coverage to fit your needs:

Decide what your medication needs are.

Make a list of all your current medications.  It is important to include the dose and how often you take them.  It is also important to consider which pharmacy you will use. Each plan has a list of preferred pharmacies that offer you a lower cost share when you use them.  You may also need to consider medications your doctor may add to your list in the near future.

Review your current coverage.

If you are new to Medicare and decide to go with Original Medicare (Part A and Part B), you need to purchase a stand-alone prescription drug plan (Part D).   Alternatively, you might opt for a Medicare Advantage plan (Part C) that includes prescription drug coverage.  These plans are referred to as MAPD plans.

If you already have either a Part D plan or an MAPD plan, you should review your plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC) document each year.  These resources will provide valuable notice of any changes in coverage, costs, or formulary for the upcoming year.

Know the Medicare enrollment periods.

It is important that you understand when you can enroll in a PDP plan.  For most people there are 2 main enrollment periods.  The initial Enrollment Period (IEP) occurs when you first become eligible for Medicare. It typically starts three months before your 65th birthday, includes your birth month, and extends for three months afterward.  Each year, The Annual Enrollment Period (AEP) Starts Oct 15 and runs until Dec 7 .  During this time, you can make changes to your Medicare coverage.

There are also some SEPs (Special Election Periods) where you can make changes to your plan.  Click here to learn more about SEPs.  

Please note; certain individuals who have a qualifying disability also have the option to enroll in a Medicare Part D (PDP) plan.

Compare the plan’s total cost.

Because there are many factors that make up the total cost for a Medicare plan, it is important to consider the plan premium, the cost of your medications, deductibles, copayments and co-insurance.  You also need to be aware of the coverage gap and catastrophic coverage thresholds, as these may affect your total out-of-pocket costs.

There are a couple ways to compare plan costs.  One of the best ways is to locate a licensed Medicare agent who is certified to offer plans from a variety of local carriers.  Agents should have access to online quoting tools that can show you plan comparisons. Comparisons include a cost breakdown of each prescription as well as plan premiums and other coverage information.  Agents are a great free resource.  They can help advise you on how coverage works and which plan will suit your personal needs.

Click here to view our YouTube video of Sunfire vs. Connecture Medicare quoting sites

You can also do a plan quote on your own by visiting medicare.gov and using the plan finder.  This is a free resource although, it does not offer a consultation like an agent can.

Consider each plan’s star rating.

Each year, Medicare provides star ratings for both PDP plans and MA/MAPD plans.  These ratings are based on many factors  and have a scale from 1 to 5 stars.  A rating of 1 is the lowest and 5 is the highest ranking.  Each plan is rated on the quality of the plan which is decided by customer satisfaction of care and customer service provided.

Remember:

Over time, both medication needs and health status changes; it is important to review your Medicare drug coverage each year during AEP.  This will help you prepare for the year ahead and keep costly surprises to a minimum, although none of us has a crystal ball.

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Medicare rules for physical therapy

If you are like many people, you may need physical therapy at one time or another.  Physical therapy (P.T.) can be a lengthy and expensive process.  If you are a Medicare beneficiary, you might ask about the Medicare rules for physical therapy coverage.

Why do you need physical Therapy:

Physical Therapy is provided to evaluate and treat injuries or diseases that impede your ability to function.  The goal of P.T. is to either improve or maintain current function as well as to slow the decline.

When it comes to physical therapy and Medicare coverage, in most cases, it is covered by Medicare Part B.  Medicare Part B covers outpatient services, including medically necessary physical therapy, occupational therapy, and speech-language pathology services.

In some cases, Medicare Part A covers Physical therapy if it is received as inpatient rehabilitation.  This is usually connected to an inpatient hospital stay.

Please note: members of Medicare Advantage plans need to check their evidence of coverage for benefit and coverage information.  If you do not have a copy, call the member services number located on the back of your ID card to get coverage details.

Physical therapy eligibility and medical necessity:

Although Medicare Part B covers physical therapy, it is important to understand that not all therapy sessions are eligible for reimbursement. Medicare requires that the therapy services are medically necessary to address a specific condition or injury.  Additionally, your doctor or healthcare provider must prescribe and oversee the therapy sessions.

Caps and Exceptions:

In the past, Medicare put annual therapy caps in place to limit the benefit amount members could use. However, as of 2018, Medicare has removed these caps.  This is because of MACRA (Medicare Access and CHIP Reauthorization Act). This change gives beneficiaries access to necessary therapy services without the stress of being cut off due to an arbitrary cap.

Although these days there is an annual “soft cap” in place, all this means is, providers must track their patients’ progress and state that the Pt is medically necessary, and coverage will be provided.  Once a patient gets close to the threshold, providers must use a KX modifier when submitting claims to prove services are medically necessary.

In 2023, the threshold is $2,230 for PT and SLP services combined.  For OT services it is $2,230.  This is a total annual coverage amount even if a patient seeks therapy for several different conditions during the course of the benefit period.  All services count toward that patient’s threshold. This threshold (soft cap) is not intended to prevent Medicare patients from obtaining medically necessary care.  It is just in place to avoid abuse of the system and track a patient’s progress to ensure the medical necessity.

Please note; as long as your physical therapy is medically necessary there is not limit on outpatient therapy services in one year.

What is the cost for physical therapy:

Under Medicare Part B, most beneficiaries pay an annual deductible. Once you meet your deductible, you must pay the 20% of the Medicare-approved amount for covered therapy services. If you have a Medicare Supplement plan, that plan pays the 20% left after your deductible is met and Medicare pays its part.  It’s important to verify that your therapy provider accepts Medicare assignment, which means they agree to accept the amount that Medicare deems reasonable for their services as payment in full.

Requirements for therapy providers:

To make sure Medicare covers the services you receive, your physical therapy must be provided by a qualified healthcare professional who meets Medicare’s standards. This rule applies to licensed physical therapists (PTs), licensed occupational therapists (OTs), as well as licensed speech-language pathologists (SLPs).

Documentation and Progress Reporting:

In order to receive continued coverage of physical therapy sessions, your provider must document your progress regularly.  Documenting helps justify the medical necessity of ongoing therapy as well as provides insight into your functional improvements. It is also important to attend all recommended therapy sessions and actively participate in your treatment plan.

Once you know the rules and requirements for Medicare coverage for physical therapy, you can move forward with your recovery without having to worry about any possible financial strain your treatment may cause. It is imperative that you communicate with your healthcare provider and therapy team to maximize the benefits of Medicare’s coverage and work towards achieving your health and wellness goals.

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How to Choose an Annuity

Annuities can be an integral part of financial wellness plans for the golden years of your life, as well as a plan for the future of your family’s financial security. But, like many financial decisions, choosing an annuity can be intimidating. Here are four simple steps to choosing an annuity and starting to safeguard you and your family’s future during your retirement:

 Choose when payouts begin

There are two options for the date that payouts begin on an annuity. The first is called deferred, meaning that payouts will begin in the future at a previously determined date. The second is called immediate, which means payouts begin shortly after the first premium is paid. In this case, the premium is a lump sum.

 Select the rate of return deciding how to choose an annuity

This selection depends very much on the level of financial risk that you are comfortable taking. There are three usual options:

• Guaranteed/Fixed

These payouts are based on the amount that is guaranteed in the contract. The company bears the investment risk so the client doesn’t have to, and the payments are typically the same regardless of timing.

• Variable

Although some variable annuity contracts may offer minimum payout guarantees, both the account payout and the earnings are variable and not guaranteed with this type of annuity.

• Indexed

This is a combination of the two previous, essentially. Indexed rate of returns provide a minimum guaranteed interest rate and an interest rate tied to the market index.

  Select payout term when  – how to choose and annuity

These are very similar to life insurance terms. There are five types:

• Lifetime of policyholder

• Lifetime with remainder of funds to beneficiary

• Guaranteed for five, ten, fifteen, twenty years, etc.

• Joint and survivor

Of these, all of them except for the “lifetime of policyholder” allow remaining funds to be transferred to a survivor or beneficiary at the end of the policyholder’s life.

 Select payout type

There are two standard types of payouts on an annuity. Lump sum withdrawal is when the policyholder receives all the funds at once, and some fees can apply to this. The other type, annuitize contract, is when monthly payments are sent to the specified recipient in the previously chosen payout term.

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How Does Hospital Indemnity Insurance Work?

No one wants to end up in the hospital. Despite hospitals being a healthcare hub full of solutions for most ailments that people experience, most of us avoid going to them at all costs. This is often due to the fact that it can be prohibitively expensive to access hospital services, particularly if people have little to no insurance. However, hospital indemnity insurance is one solution to this problem.

What is Indemnity Insurance?

One of the most common forms of insurance, including hospitalization insurance, is called indemnity insurance. Indemnity insurance is also called fee-for-service. Policyholders can use any doctor or hospital, they are not confined to a network. Either the beneficiary or the service provider sends the bill to the insurance company, who then reimburses the holder or the provider. Typically, there is a deductible that the beneficiary must meet before the insurance starts to kick in. Then, the insurer usually pays a certain percentage of the “usual and customary” costs from the services. This percentage is usually around 80%, and usual and customary fees are healthcare field standards for what something usually costs. These indemnity plans may not pay for preventative care.

Hospital Indemnity Insurance

Now, hospital indemnity insurance functions as most indemnity insurance policies do. It is a supplemental insurance plan that is supposed to pay for the hospital admissions costs that are not covered by other standard policies. Because the majority of Americans do not have the savings to cover unplanned medical bills, this can be a very useful financial safety net if someone is admitted to the hospital or the ICU due to injury or illness. The payments from the insurance company can be used to cover any of the costs associated with the hospital admission, including copays, deductibles, and even food, rent, or other bills.

There are also guaranteed issue policies that require no disclosure of medical history in order to enroll. One of the major differences between standard insurance policies and indemnity policies is to whom the payments are made. Indemnity insurance policies for hospitalization make payments directly to the hospitalized person, the policy holder, rather than the hospital. This allows for much more flexibility as to where the money goes and how it is used.

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Medicare Scams

There are several reasons why Medicare is rife with people trying to scam beneficiaries and businesses alike. For one, the rise of automated and exclusively-online enrollment means that it can be easier to use technology to scam the unsuspecting. Additionally, the population who uses Medicare is mostly elderly, and the elderly are often targets of scams. Medicare also covers an enormous population of people – 65 million at last count in 2023.   Additionally,  more people become eligible and enroll each year. The federal Medicare program continues to warn beneficiaries to watch out for scammers.  Warning particularly people who try to take Medicare ID numbers in order to file false claims. The purpose of Medicare scams is to obtain Medicare payments, which is usually done by filing false claims for services, items, procedures, or equipment. It is estimated that Medicare fraud costs taxpayers billions of dollars each year.

Here are the top three Medicare scams to watch out for right now.

1. Offers of free genetic testing

With how popular DNA testing has become, it’s no wonder scammers have been using that buzz to commit fraud. The “free genetic testing” is offered under the guise of helping test for diseases or susceptibility to certain illnesses, and find the right medications. The offers most often come over the phone but there are some reported door-to-door attempts as well.

2. Calls or emails about free medical equipment

Scammers are also disguising themselves for other scams. Some people attempting to commit fraud are pretending to be Medicare representatives and making unsolicited calls to people under the guise of offering them free medical devices such as back braces, canes, walkers, or even wheelchairs. These callers have been reported to be extremely persistent, even asking the beneficiaries to accept the equipment simply because it is free if they do not need it. When the beneficiaries agree, the scammers then ask for their Medicare ID number, which gives them access to their private medical information and records.

3. Solicitations for other services

These attempts at fraud are sometimes called Medicare Call Scams. Often they are robocalls, but there are live people making these calls as well. Their goal is to get the Medicare ID number, social security number, or other personal information about their targets. The scammers often do this by doing their research, knowing some things about their target, and pretending to be Medicare representatives.

In order to protect themselves against these three common scams, Medicare beneficiaries should always remember that Medicare will not reach out to beneficiaries via call or email unless they are answering their inquiry. Medicare will also never offer free gifts, medical equipment, or any other service for free. Calls requesting health care information should, as a rule, not be trusted.

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Medicare Supplement Plan N

There are a large variety of Medicare Supplement plans to choose from. Medicare Supplement Plans, also known as Medigap, are plans that private insurance carriers sell to Medicare beneficiaries to remedy some of the gaps in coverage that occur in Original Medicare. Medicare supplemental plans can help pay the beneficiary’s share of out-of-pocket costs such as copays, coinsurance, or other fees. Medigap policies are named after letters of the alphabet in all but three of the continental United States.

Increasing Popularity

Medicare Supplement Plan N has become increasingly popular due to its wide range of coverage. Plan N covers 100% of the Medicare Part B coinsurance costs. Beneficiaries are left to cover a $20 copay for office visits and a $50 copay for emergency room visits. These low costs are appealing to many purchasers. Medicare Plan N also provides the following benefits:

• For hospitalization, Plan N pays for Part A (of Original Medicare) coinsurance plus coverage for an additional 365 days after Medicare benefits end. That is an entire year of additional hospitalization coverage.

• Plan N also pays for Part B’s coinsurance, excluding a $20 copay for office visits and a $50 copay for emergency rooms. Copayments for hospital outpatient services are also covered.

• The first three pints of blood each year are paid for by Plan N coverage.

• Perhaps most vitally for many seniors, Plan N covers the hospice care Part A coinsurance.

• Skilled nursing facility care is covered under Plan N.

• The Medicare Part A deductible for hospitalization is covered under these benefits.

• And, Plan N provides travel abroad medical emergency help.

There was a previously very widely used Medicare Supplement Plan called Medigap Plan F. Plan F was discontinued in 2020, and carriers were no longer allowed to enroll additional beneficiaries in Plan F. Because of this new gap where the popular plan no longer exists, Plan N is one of the Medigap plans that is growing increasingly popular because of its wide range of coverage.

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What Are Medicare Savings Programs?

At last count, in 2023, there were over 65 million Americans enrolled in the federal healthcare program Medicare. There are additional people qualifying for and enrolling in Medicare every day. It is an extremely valuable program that helps to ensure that some of the most vulnerable populations have the access to healthcare that they need. However, it is not a perfect program, and, despite its subsidization by the government, there are out of pocket costs (OOP costs) associated with Medicare. Most people will not have to pay a premium for Part A (hospital insurance), but the majority of enrollees will pay a premium for Part B, which is medical insurance. There are also copayments, deductibles, and coinsurance. All of these costs can add up quickly, particularly if a beneficiary has chronic health issues.  What Are Medicare Savings Programs?

That’s why there are Medicare Savings Programs. Medicare Savings Programs are special benefit programs.    State Medicaid agencies sponsor these programs. They are designed to help adults who have limited assets and income by relieving some of the out of pocket expenses associated with Medicare.

MSP Levels

There are four different Medicare Savings Programs (MSPs) that help to cover premiums, deductibles, coinsurance, and copayments.

1. Qualified Medicare Beneficiary (QMB): This program helps to pay for Part A premium and Part B premium. It also covers deductibles, coinsurance, and payments.

2. Specified Low-Income Medicare Beneficiary (SLMB): This program helps pay for Part B premium.

3. Qualifying Individual (QI): This also helps pay for Part B premium.

4. Qualified Disabled Working Individual (QDWI): This helps pay for Part A premium.

Beneficiaries cannot choose the program that they want to enroll in. Rather, they will be assigned to the program that most closely matches their assets and income, as well as other details that the enrollee provides on their application. The guidelines for who qualifies for which program differ by state.

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Medicare Advantage vs. Medicare Supplements/Medigap

While Medicare does cover the majority of elderly Americans and provide access to some essential health services, there are many aspects of healthcare that are not covered at all by the federal program. To fill in these gaps, many eligible people end up enrolling in a Medicare Advantage policy or a Medicare Supplement policy, also known as Medigap. But which is the right choice for your unique situation? Here’s a comparison Medicare Advantage vs. Medicare Supplements/Medigap.

Medicare Advantage

• Many plans have $0 deductibles, no copay for a primary care doctor’s visit, and lower copays for specialists.

• Beneficiaries are restricted to a list of certain doctors, hospitals, and suppliers.

• The beneficiary must also be enrolled in Original Medicare (Parts A and B).

• Most policies do include at least some Part D coverage (prescriptions), as well as limited hearing, vision, and dental.

• There are limited policies available that allow for out-of-network provider coverage.

Medicare Advantage is provided by private insurance carriers, and essentially replaces Original Medicare as your primary insurance provider. Some plans require more authorizations to access care under these plans. Most people will have over 30 Medicare Advantage policies to choose from, but not all plans are available in all areas.

Medicare Supplements/Medigap

• These programs can be expensive, but the monthly payments are predictable.

• Plans K and L have annual out-of-pocket cost limits.

• Limited plans available do cover some vision, dental, and hearing services.

• International travel coverage is available.

• Beneficiaries will have to enroll in Part D separately, as Medigap does not provide prescription coverage.

• These policies only cover one person – spouses need separate plans.

There are 10 Medigap plans to choose from that provide standardized care and help pay for things like deductibles, coinsurance, and copays. In 2018, about 34% of the people enrolled in Original Medicare had coverage provided by Medicare Supplements to help cover costs – which is over 11 million people. These plans can help make the out-of-pocket costs more predictable and easier to budget. One thing that people do report positively from Medigap plans is the lack of restriction on in or out of network healthcare. The estimated average monthly premium can range from $150 to $200 a month, depending on the state that you live in and the insurer.

Depending on your situation, both Medicare Advantage and Medicare Supplement (Medigap) policies can be helpful for coverage gaps in healthcare for beneficiaries of Original Medicare.

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