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QMB Program CT

The QMB Program CT is an essential program available to Medicare beneficiaries who meet the income requirements and reside in Connecticut.  The QMB program provides the highest level of financial help to those who qualify.  It assures that beneficiaries can receive the medical care they need.

In some instances, Medicare beneficiaries may face significant out-of-pocket costs for their healthcare services. When this occurs, the Medicare Qualified Medicare Beneficiary (QMB) program provides much needed assistance.

What is the Medicare QMB program:

The Medicare QMB program is a state-administered program that helps Medicare beneficiaries who have a limited income pay for things such as; Medicare premiums, deductibles, coinsurance, and copayments. QMB stands for “Qualified Medicare Beneficiary,” this refers to people who meet certain income and asset criteria.

How do you qualify for the Medicare QMB program:

A person must be enrolled in Medicare Part A and Part B and have limited income and resources. In 2023, the income limit for QMB eligibility in Connecticut is $2,564 per month for individuals and $3,468 per month for married couples. There is no asset limit to qualify for this program.

The Medicare QMB program in Connecticut covers the following:

1. Medicare Part A premiums: Part A includes coverage for; inpatient hospital stays, skilled nursing facility care, hospice care, and home health care. The QMB program covers the monthly premium for Part A if either you or a spouse has not worked enough quarters to qualify for free Medicare Part A.
2. Medicare Part B premiums: This portion of Medicare covers doctor visits, outpatient care, preventive services, and medical equipment.
3. Deductibles, coinsurance, and copayments for covered services.
4. Medicare Advantage premiums: The QMB program covers the monthly premium for Medicare Advantage plans.
5. Part D prescription drug costs are covered by the QMB program.

There are 3 different levels of extra help available in CT:

As you will see, all three levels of MSP pay for the Medicare Part B premium.

1.  QMB is the highest level of help in CT.  If your monthly income is either at or below $2,564 (single) or $3,468 (couple), you may qualify for this level of extra help.  QMB program covers; Part B premium, Medicare deductibles as well as co-insurance.
2. SLMB is the next level of extra help in CT.  You may qualify for this level of help if your monthly income is either at or below $2,807 (single) or $3,797 (couple).  This level of help pays for your Part B premium only.
3. ALMB is the last level of extra help available to CT Medicare residents.  To qualify for this level of help, your monthly income must be either at or below $2,989 (single) or $4,043 (couple).  This program pays for your Part B premium only and is subject to available funding.  People who receive Medicaid are not eligible for this program.

When you are accepted into any of the three levels of MSP, you are automatically enrolled into the LIS (Low Income Subsidy).

This program is also called “Extra Help”.  LIS pays the cost of a Medicare Part D (prescription coverage) benchmark plan, or part of a non-benchmark plan.  LIS also pays your Part D annual deductible, co-insurance, or co-pays on your prescription medications.  This applies even if you reach the coverage gap.  Another benefit if LIS enrollment is, you are allowed a Special election period to change your MA or Part D plan anytime during the first 3 quarters of the year

To sum it up; the QMB program CT is a valuable resource for those who qualify and are struggling to pay their Medical costs.

How to apply for the Medicare QMB or MSP help in Connecticut?

You can apply for the Medicare QMB program in Connecticut by contacting either the State of Connecticut Department of Social Services (DSS) or the Medicare Savings Programs (MSP) unit. There are a few ways to apply; online, by mail, or in person.

To apply online,  visit the DSS website and complete an application. To apply by mail, just download an application from the DSS website.  You can schedule an in-person meeting by calling the MSP unit 1-800-842-1508.  Important: you must provide documentation of your income and assets, as well as your Medicare information.

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Medicare Enrollment Periods 2023

CMS regulates when beneficiaries can change Medicare Advantage and PDP plans.   This article addresses Medicare enrollment, not MAPD/PDP enrollment.

General Enrollment Period 

The General Enrollment Period (GEP) runs from January 1 through March 31. Coverage begins the first of the following month for beneficiaries enrolling  in Medicare during the GEP.  In previous years, coverage did not begin until July 1.

Initial Enrollment Period 

The Initial Enrollment Period (IEP) is the seven-month period.   Medicare beneficiaries can enroll 3 months prior and up to 3 months after their  65^th birthday month.  IEP includes three months before, the month of, and three months after someone’s 65^th birthday month.  Prior to  2023, people who enrolled in Medicare during the last three months of their IEP had to wait up to three months for coverage to begin.   That is no longer the case.   Coverage is effective the first of the month after the month of enrollment.

Special Medicare Enrollment Periods 2023

CMS established Special Enrollment Periods (SEPs) for Part B and premium Part A for those with an exceptional circumstance. SEP allows expand Medicare enrollment opportunities, reduce gaps in coverage, and prevent late enrollment penalties.

ISEP – New to Part B

This election period applies to beneficiaries new to Part B.  Side note:  a MAPD/PDD application must be submitted prior to the Part B effective date in order to use the ISEP.

SEP – Emergency or Disaster

This special election period offers beneficiaries that missed an enrollment opportunity due to a government declared an emergency.   FEMA disasters are an example.  Click here for additional disaster SEP information. 

SEP for  Loss of Coverage 

An individual can use this SEP if their employer, employer plan, or someone acting on behalf of their employer gave them incorrect information that caused them to delay Medicare enrollment.  In addition, this SEP applies when an individual loses group coverage.   CMS allows a full 2 months for enrollment after the loss of creditable coverage.

SEP for Formerly Incarcerated Individuals

This SEP is for individuals who are released from incarceration on or after January 1, 2023.   Formerly incarcerated people may be eligible for a Special Enrollment Period to enroll in Premium Part A and Part B. They won’t have to pay a late enrollment penalty if they enroll using the SEP.

Coverage start date is the first day of the month following the month of enrollment.   Alternately, retroactive coverage can be requested up to 6 months in the past.  Note: retroactive premiums apply.

SEP to Coordinate with Termination of Medicaid Coverage

This SEP, also called the Medicaid SEP, is for people who lose Medicaid eligibility.   CMS allows a change for 3 months from either the day of ineligibility or notification, whichever is longer.

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What part of Medicare covers hospice

If you are going through a difficult time with a loved one, you may ask; what part of Medicare covers hospice.

First let us explain what hospice is:

Hospice care provides support and comfort to patients who have a terminal illness and have decided to focus on improving the quality of their remaining life rather than seeking curative treatment. Medicare covers hospice care for all eligible beneficiaries. In the next few paragraphs, we’ll take a closer look at how Medicare covers hospice care.

Who is eligible for Medicare hospice coverage?

To be eligible for Medicare hospice coverage, a patient must meet the following criteria:

1. The patient must be eligible for Medicare Part A (hospital insurance).
2. The patient must be diagnosed with a terminal illness and have a life expectancy of six months or less.
3. The patient must choose hospice care instead of curative treatment for their terminal illness.

What services does Medicare hospice cover?

Once a patient is deemed eligible for Medicare hospice coverage, they are entitled to receive a range of services related to their terminal illness. These services may include:

1. Medical care: This includes visits from a hospice doctor, nursing care, medication management, medical equipment and supplies.
2. Support services: Hospice care providers may offer counseling and emotional support to patients as well as their families.
3. Respite care: In some cases, a patient’s caregiver may need a break from providing care. Hospice care providers can offer short-term respite care to relieve the caregiver’s burden.
4. Bereavement services: Hospice care providers may offer bereavement counseling and support to family members after the patient has passed away.
5. Spiritual and religious services: Hospice care providers may offer spiritual and religious support to patients and their families.

How much does Medicare hospice coverage cost?

For most Medicare beneficiaries, Medicare coves 100% of the hospice care cost. This means, the patient does not have to pay out-of-pocket for hospice care. However, patients who receive care from a hospice provider that is not Medicare-certified may end up will a bill for some of the costs.

Please note;  while hospice care is covered 100% by Medicare, other services that a patient may receive while in hospice care, such as treatment for an unrelated illness, may or may not be covered by Medicare.

In conclusion, Medicare covers hospice care for eligible beneficiaries, including medical care, support services, respite care, bereavement services, and spiritual and religious services. Medicare typically covers 100% of  hospice care cost, but it’s important for patients to choose a Medicare-certified hospice provider to avoid any unexpected costs. Hospice care can provide comfort and support to patients with terminal illnesses and their families during a difficult time.

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Medicare supplement sales

Although Medicare covers many medical expenses for qualified individuals, it doesn’t cover everything.  That is why many health care agents go into Medicare supplement sales. Medicare supplement plans, also known as Medigap plans, help fill the gaps in Medicare coverage.

If you want to offer Medicare supplement plans to your clients, there are several things you should know:

First, it’s important to understand the basics of Medicare as well as the different types of Medicare supplement plans.

This information will help clients choose the plan that best meets their needs. You may have to ask questions about your client’s health, budget, and preferred providers, as well as explaining the plan differences.

There are four parts to Medicare: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). Medicare supplement plans are designed to work with Parts A and B.  There are 10 standardized Medigap plans available in most states.

There 10 Medigap plans available in most states are;  A, B, C, D, F, G, K, L, M, and N.

Each plan has its own set of benefits, so it’s important to understand what each plan covers and how it works with Medicare. Here are some of the key differences between the plans:

• Plan F: This plan provides the most comprehensive coverage, covering all of the benefits listed above. However, it is no longer available to new enrollees as of 2020.
• Plan G: This plan is similar to Plan F, but it does not cover the Part B deductible. It has become a popular alternative to Plan F since it provides similar coverage at a lower cost.
• Plan N: This plan has lower premiums than Plans F and G, but it requires some cost-sharing.  This includes copays for doctor visits and emergency room visits.

Please note;  Medigap plans are standardized. This means that each plan must offer the same benefits, regardless of which insurance company is offering the plan.

Because supplement plans have their own benefits, it’s important to understand what each plan covers and how it works with Medicare. For example, some Medigap plans may cover deductibles, copayments, and coinsurance, while others may provide coverage for foreign travel emergency care or skilled nursing facility care.

In addition, it’s important to be aware of the rules and regulations surrounding Medicare supplement sales.

For example, there are strict guidelines around marketing and advertising, and it’s important to follow these guidelines to avoid any legal issues.

It is extremely important to build relationships with clients and provide any assistance you are qualified to offer.  This may include answering questions about Medicare and Medigap plan coverage and plan enrollment.

In conclusion, selling Medicare supplement plans can be a rewarding career path for salespeople who are passionate about helping others. By understanding the basics of Medicare, the different types of Medigap plans, and the rules and regulations surrounding Medicare supplement sales, salespeople can help clients make informed decisions and provide ongoing support and assistance.

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What will Medicare pay for

Because many people are unsure what will Medicare pay for, we are providing a quick summary of the parts of Medicare and what they cover.

Medicare is a federal health insurance program.  It provides coverage to people who are either 65 years or older, people with disabilities, and those with end-stage renal disease.  There are four parts of Medicare plans: Part A, Part B and Part C, as well as Part D.

What Medicare Part A pays for:

Part A or hospital insurance covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services.

1. Inpatient Hospital Stays: Part A pays for the cost of a semi-private room, meals, nursing care, and other hospital services and supplies. It also covers the cost of surgeries, anesthesia, and other medically necessary procedures.
2. Skilled Nursing Facility Care: If you need to stay in a skilled nursing facility for a short period after being discharged from the hospital, Part A covers the cost of a semi-private room, meals, nursing care, and therapy.
3. Hospice Care: If you have a terminal illness, Part A covers hospice care services, including pain relief, counseling, and medical care.
4. Home Health Care: Part A covers some home health care services if you are homebound and need skilled nursing care, physical therapy, or speech-language pathology services.

What Medicare Part B pays for:

Part B is also called medical insurance. It covers medically necessary services and preventive services that are not covered by Part A. Here’s what Part B pays for:

1. Doctor’s Services: This includes office visits, consultations, and surgical procedures.
2. Outpatient Services: Part B covers services that include diagnostic tests, laboratory services, and imaging tests.
3. Preventive Services: These services  include flu shots, cancer screenings, and annual wellness visits.
4. Durable Medical Equipment: Beneficiaries receive coverage for the purchase of durable medical equipment, including wheelchairs, walkers, and oxygen equipment.
5. Ambulance Services are covered if they are medically necessary.

What Medicare Part C pays for:

Medicare Part C or Medicare Advantage (MA plans). It is an alternative to Original Medicare, which includes Part A and Part B. Medicare Advantage plans are offered by private insurance companies. In most cases, they include additional benefits, such as vision, dental, and hearing coverage. Medicare Advantage plans must cover all the services that Original Medicare covers, but the cost-sharing and rules may be different.

What Medicare Part D pays for:

Some people refer to these plans as prescription drug coverage.  Private insurance companies offer this coverage to cover the cost of prescription drugs.  Part D plans typically have a formulary, which is a list of drugs that the plan covers. The cost-sharing and rules for Part D plans may vary.

In conclusion, Medicare covers a wide range of medical services.  This includes hospital stays, doctor’s visits, preventive care, medical equipment, and prescription drugs. Understanding what each part of Medicare covers can help you make informed decisions about your healthcare needs.

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Medicare Advantage sales

Medicare Advantage Sales: A Guide for Insurance Agents

Medicare Advantage plans, also known as Medicare Part C, are becoming a very popular choice for many Medicare beneficiaries. Because of this fact, many Medicare agents earn a good portion of their commission through the sale of MA plans.  These plans are an alternative option to the Original Medicare plans that Medicare offers.  In this blog, we go over a few things you need to know about the sale of MA plans.

Understanding Medicare Advantage Plans

Before we dive into Medicare Advantage sales, it is important to understand what these plans are. Medicare Advantage plans provide benefits similar to Original Medicare (Part A & Part B).  Original Medicare does not offer these plans.  Only private insurance companies can offer these plans to beneficiaries.  Most plans include additional benefits such as vision, dental and hearing coverage.  Many MA plans also provide prescription drug coverage (Part D).

These plans typically have either a low or no plan premium.  It is important to note;  MA plans have restrictions on which doctors and hospitals you can use. In addition, beneficiaries must continue to pay their Part B premium even while enrolled in a Medicare Advantage plan.

Eligibility for MA Plans

To be eligible for a Medicare Advantage plan, individuals must be enrolled in both Medicare Part A and Part B, and live within the plan’s service area. There are several instances when enrollment in these plans typically occurs.  They can enroll during their Initial election period (IEP) or during the Annual Enrollment Period (AEP) which takes place from October 15th through December 7th each year. However, individuals may also be able to enroll in a Medicare Advantage plan during certain special enrollment periods (SEPs).

Selling Medicare Advantage Plans

Now that you understand what Medicare Advantage plans are and who is eligible for them, let’s discuss how to sell these plans as an insurance agent.

1. Obtain the necessary licenses and certifications: In order to sell Medicare Advantage plans, you must be licensed as an insurance agent and certified to sell Medicare Advantage plans by both  the insurance carrier and Centers for Medicare and Medicaid Services (CMS).
2. Know your products: It’s important to understand the various Medicare Advantage plans offered by different insurance companies, as well as the benefits, costs, and restrictions associated with each plan. This knowledge will allow you to help clients choose the best plan for their needs.
3. Develop a marketing strategy: Medicare Advantage sales require a targeted marketing strategy. You may want to consider advertising in local newspapers or on social media, attending community events, and offering educational seminars.
4. Build relationships with clients: As with any sales business, building relationships with clients is key to success. Make sure to follow up with clients after they enroll in a plan to ensure they are satisfied with their coverage and answer any questions they may have.
5. Stay up-to-date with changes: Medicare Advantage plans can change from year to year, so it’s important to stay informed of any updates or changes to the plans you offer. This will ensure that you can provide accurate and up-to-date information to your clients.

 2023 MA commissions

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In conclusion, selling Medicare Advantage plans can be a rewarding business opportunity for insurance agents. By obtaining the necessary licenses and certifications, knowing your products, developing a marketing strategy, building relationships with clients, and staying up-to-date with changes, you can successfully sell these plans to Medicare beneficiaries.

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AHIP certification cost

New Medicare agents have many questions when they are just starting out. One thing they may ask about is the AHIP certification cost.

Medicare Advantage plans are becoming more and more popular with Medicare beneficiaries. That makes it more important than ever for Medicare agents to take the annual AHIP exam in order to be certified to sell either Medicare Advantage or prescription drug plans.

First, let’s review what the Medicare AHIP certification is:

AHIP stands for America’s Health Insurance Plans, which is an industry organization that works with Medicare to provide training and certification for agents who sell Medicare Advantage plans. The AHIP certification is required for agents who wish to sell Medicare Advantage plans or prescription drug plans. The AHIP program covers a range of Medicare topics that include; eligibility, benefits, and enrollment.

Find out more about AHIP

How much does the Medicare AHIP certification cost:

Currently, the cost of the AHIP certification is $175 per year. However, this cost may be reduced if the agent is affiliated with a Medicare Advantage plan or if they have a discount code.  Some insurance companies may either pay for the certification or reimburse their agents for the cost of the certification.

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In addition to the AHIP certification, agents must also complete carrier-specific training:

In order to sell Medicare Advantage plans, agents must complete carrier-specific training in order to be ready to sell each year.  Some insurance companies may require agents to complete in-person training to maintain their certification.

It’s important to note;  the cost of the Medicare AHIP certification is just one of the costs associated with selling Medicare Advantage plans. Agents must also pay for their own marketing materials, travel expenses, and other business-related costs. They also have to pay for errors and omissions insurance.  This is important to protect them in the event of a lawsuit or other legal action.

In conclusion, the cost of the Medicare AHIP certification is generally $175 per year. Agents also incur many other expenses during the course of doing business.  Any time agents can save money, it is helpful. It’s important for agents to factor in these costs, as well as other business-related expenses, when deciding whether to sell Medicare plans. Ultimately, the potential earnings from selling Medicare plans should far outweigh the costs of certifications and other expenses for agents who are successful in this field.

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Delaying Medicare Part B

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AHIP Discount Code

The Medicare AHIP for 2023 will be available on June 20th.  The cost will remain $175 for the 2023 certification course and exam.  The certification is $125 when taken through a number of the insurance company certification portals with the AHIP discount code built in.  Read below for additional updates on the 2023 certification.

Important: Current year AHIP certifications do not count toward the next AEP.  For example, if you take and pass AHIP in 2023 you cannot use it during AEP from October 15th to December 7th of 2023.  AEP business written during this time is effective for a 1-1-2024 start date.  As a result, you need the 2024 AHIP to write the business.   The 2024 AHIP will come out in June of 2023.  If you are looking to write MA or PDP business at that point, it is best to simply take the 2024 AHIP and skip the 2023 AHIP.  The 2024 AHIP will allow you to write business for the remainder of 2023.

AHIP discount code: $175 vs. $125

Accessing AHIP through the official Portal will cost $175.  2023 AHIP (Medicare + Fraud, Waste and Abuse (MFWA)) became available on June 20th 2023.  It is best to wait to take AHIP through a portal with the discount code.  That is how you get to take the course with the AHIP discount code built in.  The cost is reduced to $125 for those taking the course through a portal with the AHIP discount code built in.

CLICK HERE TO TAKE AHIP AT THE DISCOUNTED RATE OF $125

Course Content

The basic Medicare portion of the course will cover:

• Basics of Medicare fee-for service benefits (Original Medicare A and B)
• Different types of MA/MAPD and PDP plans
• Who is eligible and review of the benefits
• Training on nondiscrimination
• Requirements and rules for marketing and enrollment

Fraud, Waste, and Abuse (FWA) will cover:

• How to identifying FWA
• Overview of efforts being made to detect FWA
• Different methods to report FWA
• Review of 2023 MA/MAPD and Part D compliance requirements (Changes for 2024 already being proposed)

AHIP discount code: Recorded webinar on exam

Watch a recorded webinar on how to pass the 2023 AHIP exam 

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• We pay agents $500 per month toward all Medicare marketing and lead costs
• Seminar program averaging 50+ T-65 prospects per seminar (Agent does not need to invite attendees)
• Online enrollment and call recording through Connecture and Sunfire at no cost to agents
• 50% co-op on seminar costs
• Free agent websites

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Delayed Enrollment In Medicare Part B

When it comes to delayed enrollment in Medicare Part B, there are multiple factors to consider.  There are valid reasons why someone should and could delay enrollment in Medicare part B without a penalty.  However, the rules for who can delay are very specific. Failure to follow them can lead to delayed enrollment penalties in the future.  Read further to make sure you are following the rules.

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Who should considered delayed enrollment in Medicare Part B?

The majority of people turning 65 should enroll in both Medicare Part A and Medicare Part B.  Part B has a monthly premium that is either deducted out of the Social Security check or billed quarterly for those not receiving Social Security payments.  Those receiving SS payments when they turn 65 will be automatically enrolled in Medicare.  Those not receiving SS payments will need to manually enroll either at a local SS office or online CLICK FOR ONLINE ENROLLMENT

For some people it may make sense to delay enrolling in Medicare part B.  This often is the case for those that are working past the age of 65 or those getting coverage through a spouse working past age 65,  There are three specific conditions that need to be met in order to waive Medicare Part B and not be subject to a penalty down the road.

Delayed enrollment in Medicare Part B:  Conditions to waive B

• Actively working or getting coverage through an actively working spouse.  If your are working and getting coverage through work, you may be able to waive Medicare Part B.  Same goes for someone that is getting coverage through a working spouses employer coverage.
• Having coverage through the current employer.  The coverage needs to be through the working spouses employer.  If the spouse is working but getting coverage through Cobra, a past employer or an indvidual plan of some type, you cannot waive Medicare part B
• The employer group most have 20 or more employees.  If the employer has less than 20 employees you should enroll in Medicare Part B even if still working and getting coverage through work

Comparing the employer coverage to Medicare

Just because someone is meeting the criteria to waive part B does not mean the necessarily should.  The current employer plan monthly cost and benefits need to be compared to the cost of Orignal Medicare with a supplement and Part D drug plan or with a Medicare Advantage plan. It is simply a matter of seeing which way will provide more benefits for less premium.

Other things to look out for

• Delayed enrolllment in Medicare Part B can tricky.   For example: VA coverage is a valid waiver for Medicare Part D (drug coverage)  It is NOT, a valid waiver for Medicare Part B
• Cobra can be a valid waiver for Medicare Part D but it is not a valid waiver for Medicare Part B
• Working but having coverage through a plan from a former employer or COBRA is not a valid waiver for Part B
• PEO:  If you work for a small group less than 20 that is part of a PEO you may have an exception to the group of 20 or more rule.  Some PEO’s have a waiver for all their groups which allows the ones with less than 20 employees to be considered a group of 20 or more.

Delayed enrollment in Medicare Part B: Change in the Medicare GEP

Those who miss their initial enrollment in Medicare Part B have two possible election options.   The first is a Part B special election period and the second is the Medicare Part B general election period.

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