In 2025, one of the changes to the Part D program is a $2,000 out-of-pocket maximum for MAPD/PDP beneficiaries. CMS will also put a prescription payment plan program in place. The program is referred to as “smoothing” and begins Jan 1, 2025. It is part of the Inflation Reduction Act of 2022. What is Medicare Smooothing; this program gives beneficiaries an opportunity to use a payment plan to spread out the cost of prescription medications over the year. CMS put this program together to help mitigate the cost of prescrption drugs.
Click here to learn more about the prescription payment program
What is Medicare Smoothing
Medicare Smoothing is a way to even out the out-of-pocket costs that Medicare beneficiaries may incur each year. Unlike other health insurance plan costs, such as premiums, coinsurance and co-pays that vary significantly each year, Medicare Smoothing provides a predictable expense for Medicare drug plan beneficiaries.
This approach spreads out medication costs over a period of time, rather than allowing them to spike in any given month. Beneficiaries who take advantage of this program can reduce the financial strain of sudden large medication expenses.
How Does Smoothing work
As of January 1, 2025, Medicare beneficiaries have the option of smoothing out-of-pocket costs for Part D coverage. Every Medicare Part D plan sponsor must provide plan enrollees the option to pay their cost-sharing in monthly payment amounts.
Beneficiaries can enroll in the smoothing program at the start of each plan year or any time during the plan year.
Once the beneficiary elects to use this option for payment of their covered medications, the carrier determines the first payment amount. This amount is based on a maximum monthly cap. The cap is determined by calculating the annual out-of-pocket maximum ($2000 in 2025), minus the out-of-pocket costs incurred to date, divided by the number of months left in the current year.
To determine payment amounts for subsequent months, the maximum monthly cap is calculated using the total remaining out-of-pocket costs from the previous month that the beneficiary has not been billed for and any additional out-of-pocket costs incurred divided by the number of months remaining in the plan year.
Benefits of Smoothing
Financial Predictability
By spreading out expenses, Medicare Smoothing provides beneficiaries with a clearer picture of their healthcare costs. This is one way to help them control the budget and also provides some peace of mind.
Reduced Financial Strain
Large, unexpected medical bills can be a burden for anyone on a fixed income. Medicare Smoothing helps mitigate some financial risks by providing a consistent cost structure.
Enhanced Access to Care
With more predictable costs, beneficiaries may be more likely to seek necessary medical care without fear of incurring overwhelming expenses.
Additionally
Medicare Smoothing is a great way to manage healthcare costs, especially for those on a fixed income. By spreading out expenses and using the advice of a licensed Medicare agent, beneficiaries can achieve greater financial stability. As with any financial strategy, a professional should consider individual needs to develop a plan tailored to each specific situation.
Medicare agents – watch a quick YouTube video on the Medicare commission 2025 final update
Please note: in 2026 price negotiations will start for expensive drugs that do not have a generic alternative.
Learn the details of the price negotiation program
To view more images by this artist, click here
As of July 18 2024, CMS published an update on the Medicare Final Rule. The update states that all commission payments will stay as they were prior to the CMS Final Rule changes. Commissions payments for MA and PDP plans remain the same for the rest of 2024 and 2025 while the stay is in effect. This means, the addtional $50 and $100 payments to brokers and uplines is no longer an option. Uplines will continue to receive over ride payments as they do now.
At some point, in 2025, the will be a final decision on the CMS Final Rule. Once that happens, the commission payment structure is subject to change.
Click here to download commission chart for 2025
Due to the fact that; a lawsuit was filed against the validity of some provisions in the Medicare Final Rule. Many organizations feel that CMS and the Department of Health and Human Services does not have the authority to place restrictions on their income. The lawsuit also states parts of the rule are arbitrary and were put in place without following proper procedure.
A federal court in Texas put a stay on some provisions of the CMS contract rule 2025 Final Rule on July 3, 2024, to amend current broker compensation for Part D and Medicare Advantage plan sales. Medicare Advantage insurers and marketers now have to wait and see what the final outcome will be for their businesses.
Once the judge makes his decision, all parties involved will have an opportunity to appeal the decision. If this happens, there is no way to predict when we will know the final outcome.
The 2025 AEP and the carriers
There are only a few short months before the start of AEP on October 15th. Because of this, each carrier seems to be making an independent decision on how to proceed with their 2025 benefits. The decision how to pay agents/brokers until the court makes a final ruling also seems to depend on the carrier.
Many carriers have already decided to reduce benefits and plan service areas due to the increased financial burden CMS has placed on them. Some carriers may exit the market altogether and a few will expand into new markets.
What all this means for Agents
As of today, agents are feeling very uncertain as to what their future business looks like. No matter what the outcome, this AEP will be interesting with all the plan changes and the uncertainty of the PDP market
CMS designed specific policies to stop incentivizing the sale of one Medicare product over another. They aimed to pull back MA/MAPD marketing money that carrieres were providing agents. There is a some speculation that smaller companies do not have the same budget to work with as the large competitiors. This gives the bigger companies an unfair advantage.
Click here to learn more about the proposed compensation changes
Because carriers are responsible for the actions of anyone marketing their plans, all advertisements must pass CMS guidelines before they are approved for use.
To view more images by this artist, click here
As of March 7, 2024, the FTC has put an update to the telemarketing sales rules in place. This update imposes additional record-keeping and prior-express-written consent requirements. These updates include new rules for the DNC registry. They ban almost all telemarketing robo calls to consumers. Important; the TSR prohibits robocalls that use voice cloning technology.
More about the TSR
In 1985, the FTC (Federal Trade Commission) put the TSR (Telemarketing Sales Rules) in place. The FTC enforces this regulation. It safeguards consumers from abusive telemarketing practices.
The rules have been updated due to the fact that; unwanted telemarketing calls have steadily increased and are a real annoyance for many people. The FTC recognized the need to protect individuals from the potential for these calls to lead to fraud.These updates represent an important step forward in consumer privacy and stopping unwanted telemarketing calls.
Click here to see the FTC’s amended rule
What the changes mean
Take a look below to review the amendments to the FTC’s telemarketing rules put in place to safeguard consumers.
Restrictions on Robocalls
One of the most important changes is stricter regulation on robocalls. Telemarketers must have specific recorded consent from consumers before they call. This is an effective way to make sure consumers have agreed to any contact. This cuts down on the number of unsolicited calls as well as reduces the risk of fraudulent calls reaching the individual.
Do Not Call Registry
With the added regulations, the protection the National Do Not Call Registry provides is even greater than before. This gives consumers a choice to opt out of receiving unwanted, telemarketing calls. As before, telemarketers must comply with this registry and cannot call numbers on the DNC registry. Although now, they can contact individuals who have given consent or are exempt.
Transparency
When a telemarketer places a call, they must let the recipient know who they are and why they are calling immediately. This allows the consumer to decide if they want to continue the conversation or to end it.
Penalties
In an effort to ensure compliance with updated regulations, the FTC has strengthened it’s enforcement of penalties for unlawful practices. Anyone who violates the laws will face penalties that include substantial fines. The FTC will hold anyone who is non compliant accountable for their actions. The TCPA is very clear on the fines and penalties for anyone who contacts a consumer on the DNC registry.
Agents
These regulatory changes may be a challenge if you use telemarketers as a lead source. It is important to use only lead companies that comply with all state and federal regulations. Anytime the lead company violates the rules, the agent can end up paying a hefty fine. This is because the person who hires the marketing service is held responsible for any non compliant acts.
It is imperative that all telemarketers obtain consent from the person they are calling.
Agents & agencies who offer Medicare coverage to clients must retain scopes of appointment as well as recorded voice enrollments for a period of 10 years. Click here to read the full CMS communications guide.
Learn what agents need to know before a Medicare phone sale – watch our Youtube video.
Telemarketing regulations
The TSR applies to all telemarketers who make outbound calls from within the United States as well as from overseas.
All records including call scripts, vendor contracts and promotional materials must be kept for a period of 5 years.
Any consent to contact record must include name, phone number and a copy of the request. The reason for the request as well as the consent and date it was provided.
If the call requires prior written consent, the consent must include the legal name of the person/seller who will receive the consent as well as the brand name of the product being offered. This ensures the consumer is aware who they are delaing with and for what reason.
Starting on October 15, 2024, telemarketers must keep call records with all call details. Click here to see the details. Section 310.5 (a)(2)
Summary
Telemarketing sales rule updates take a step further to prohibit deceptive or abusive practices. This includes, making false claims or misrepresenting material information to obatian payment for goods or services. TSR also prohibits telemarketers from making unsolicited calls that may be coercive or abusive. It restricts the times marketers can make calls to consumers. Telemarketers must clearly disclose the reason for the call.
Click here to view more images by this artist
As of May 2024, several organizations including: the Americans for Beneficiary Choice, the National Association of Benefits and Insurance Professionals, the Council for Medicare Choice, and the Fort Worth Association of Health Underwriters filed a lawsuit to block CMS Final Rule. The organizations argued that CMS does not have the authority to put limits on their compensation.
As of July 3, 2024; the U.S. District Court for the Northern District of TX ordered a stay against the CMS Final Rule. Organizations claiming the Final Rule exceeds CMS’s statutory authority filed the lawsuit. Although the outcome of the Final Rule is yet to be decided, the stay provides Medicare Advantage insurers and marketers a little relief for the near future of their businesses.
What happens next
The plaintiffs in this case requested a ruling by the end of this month. When Judge Reed O’Connor granted the stay, he included his intention to provide a ruling as requested.
Whatever the judge decides, both parties are able to appeal the decision. If this is the case, it will cause a greater delay in the final outcome and more uncertainty.
2025 AEP
This year has not been easy with all the uncertainty the proposal of the Final Rule has caused. That has not changed with the outcome still undecided. Until there is a resolution, this year’s AEP continues to raise questions for all involved.
CMS Final Rule and the carriers
Carriers will have to scramble to decide what benefits to offer and how to navigate plan designs and whether to move forward with the proposed benefit cuts. The recalculations of the star ratings are also cause for concern with the carriers. Getting a handle on all the moving parts is tricky to say the least.
Because the Medicare AEP starts October 15th, Medicare Advantage insurers who decide to go back to paying compensation the way they did before may face the challenge of last-minute changes in the event the court rules in CMS’s favor.
Some Medicare carriers are considering a reduction in benefits as well as their service areas as an answer to growing medical costs and regulatory changes. While others may exit the market altogether. On the other hand, a few hope to gain a greater market share where others pull back.
Many carriers have outlined their strategy based on the implementation of the Final Rule. At this point, adding to third-party marketing spending contradicts their plans. It remains to be seen if insurers will implement a work around and provide incentives to agents/brokers for greater sales.
The effect of the Final Rule on Brokers/Agents
CMS designed specific policies to pull back some MA/MAPD plan marketing. The reason behind this is to lessen incentives that may cause brokers/agents to be biased and sell based solely on compensation instead of what’s best for the client. There is also the idea that this gives smaller companies, who cannot afford to pay as much in marketing incentives, an opportunity to compete on a more level playing field. CMS rules also state brokers/agents must keep records of all interactions with potential clients to protect them from unlawful practices.
Click here to learn more about the proposed compensation changes
Because Carriers are held accountable for the actions of anyone marketing their plans, all advertising must pass strict CMS guidelines before it is approved for use. Many carriers may lean more towards using in-house agents than independent agents as they are easier to manage.
So far, there has been no comment by CMS about the ongoing litigation.
To view more images by this artist, click here
In many cases, long-term care insurance is an important financial planning tool. LTC policies provide financial assistance for the cost of care for chronic illnesses, disabilities or injuries associated with aging. Policies cover; nursing home care, assisted living facility care, home health aides, adult daycare and more. Although many older adults require long term care, there are some who do not. We will discuss; what happens with unused LTC policies.
Approximately 70% of Americans will need long-term care at some point. Although the level of care and length of time needed varies by individual. The likelihood of a need for long-term care increases with age. The premium for a LTC policy can be difficult to afford for many people especially on a fixed income.
Agents, click here to learn why you should offer ancillary health products
What happens if you don’t use the policy
If you spend your hard-earned money on a plan and never need it, do you just lose all that money? Is there any value in a LTC policy if you never use it? The answer to that question depends on the type of LTC policy the beneficiary chooses. 
Traditional LTC policies
Beneficiaries who opt for a traditional LTC policy can expect payment of the contracted amount if they require long term care. With these policies, if the beneficiary does not require these services, the policy has no value and can end up costing quite a bit.
Those who purchase traditional policies may have a difficult time maintaining coverage due to the rising costs as their age increases. Policies do not usually have a guaranteed premium amount. When this happens, many seniors find themselves unable to afford the policy and end up dropping the coverage.
There are partnership policy options for those who wish to purchase a traditional LTC policy. Partnership policies are a way for policyholders to protect assets if they exhaust long-term care benefits and must apply for Medicaid. Each state has specific requirements for partnership policies and provide protection against inflation.
Hybrid LTC policies
Hybrid LTC policies may be a good alternative to traditional policies. They provide value even if the beneficiary does not require long term care. Hybrid policies may be combined with either a life policy or an annuity. In other words, there is value in this option in different circumstances.
With a hybrid policy, beneficiaries who decide to discontinue coverage may be able to leave with some cash. Annuity based plans provide the annuity’s value less the surrender charges. Those who add a return of premium rider could leave with their entire plan cost back. In this scenario, the beneficiary does not lose. If the beneficiary dies without using the policy, their heirs may receive a tax-free death benefit similar to a life insurance policy.
What to consider when purchasing a LTC policy
The premiums for LTC coverage may be expensive, therefore think carefully about your budget when choosing a plan. Age, health, coverage amount, elimination period are a few things that contribute to the cost of coverage. Many plans offer optional features, like inflation protection or a non-forfeiture benefit, that may also be important to consider.
In some situations, there are discounts on coverage. Some examples include; if the enrollee is in good health or if the policy is purchased by a couple.
Information for Agents
We have a number of long term care products available to offer your clients. Options include: traditional as well as fixed annuity & long-term care rider, Life and long term care or chronic illness rider. We also have several, affordable short-term care plans available. To find out more about our products; contact our office at 203-796-5403 or email teal@croweandassociates.com.
Agents who want to join the Crowe team; click her for online contract
Already contracted with Crowe, click here to add carriers to your existing contact
The bottom line
By comparing the different coverage options, elimination and benefit periods, as well as costs, beneficiaries can make informed decisions. A licensed insurance agent can also add valuable insights into benefit options and costs.
If you like the image in this post and want to view more by this artist, click here
Due to the CMS’ Medicare Final Rule, changes have been made to both Part C and Part D Medicare Advantage commissions 2025. The CMS has tried to discourage plan providers from financially incentivizing agents to offer one plan over another using the following compensation rules:
- Prohibiting enrollment incentives that could cause potential agent bias
- Implementing fixed commission amounts for MA and PDP sales.
- Placing a cap on any non-salary agent compensation
- The elimination of separate admin fee payments by carriers
Medicare Advantage Commissions 2025: Notes
The increases listed below include the additional $100 payment for initial MA commissions and $50 payment for MA renewal commissions.
ADDITIONAL NOTE: A federal court in Texas stayed the provision of the CMS Final Rule that would add the additional $100 and $50 to the CMS max allowable compenstation due to two pending lawsuits. Depending on carrier interpretation, the changes created by the Final Rule may not be applied for the 2025 plan year. If they are not, the commissions listed below would be reduced by $100 initial and $50 renewal for all states and all products (MAPD and PDP)
In addition to the extra payment listed above, there was a commission increase due to an increase in the Fair Market Value (FMV) of MA and PDP plans. The maximum broker compensation below reflects the increase.
We assume carriers will add the additional $50 payment to current MA cases but that is not confirmed.
We also assume a number of PDP plans will not be paying commission in 2025. This is due to the additional $100 and $50 increase that will be applied to PDP plans. If carriers make a PDP plan “non-commissionable” they do not pay commission and do not pay the additional $100 and $50 payments.
Maximum commissions for Medicare advantage plans 2025
It is important to note: all commission rates are not the same. They vary by state they are available in.
In the sates of both CA and NJ, the initial commission rates have increased from $762 per member for the year to $880 per member for the year. This is an increase of 15.49% YOY. The renewal commissions for CA and NJ have gone up from $381 per member for the year to $440 per member for the year. This also adds up to an increase of 15.49%.
The states of CT, DC and PA have had an increase in initial MA commissions from $689 per member for the first year to $805 per member for the first year. This adds up to an increase of 16.84% YOY. Renewal commissions for CT, DC and PA have increased 16.81%. Renewal commissions will go up from $345 per member per year to $403 per member per year.
Both Puerto Rico and the U.S. Virgin Islands initial MA commissions have gone up from $418 per member for the year to $528 per member for the year, this amounts to an increase of 26.32% YOY. The renewal commissions have increased from $209 a member for the year to $264 per member for the year, this is equivalent to an increase of 26.32%.
In all other states not listed above, the initial MA commission amounts have increased 18.82% YOY from $611 per member for the year up to $726 per member for the year. Renewal commissions have increased at a rate of 18.63% from $306 per member for the year to $363 per member for the year.
If you are interested in becoming a Medicare agent; click here to learn more
Visit our Events & information page for our latest webinars, information and agent events!
Maximum commissions for PDP plans 2024:
The commission rates for PDP plans are the same in all states.
Initial commission rates for PDP plans have gone up by 109% YOY. This means commissions have gone from $100 per member for the year to $209 per member for the year. Commissions for PDP plan renewals have also increased by 110% YOY. Commissions have now gone from $50 per member each year to $105 per member each year.
Medicare Advantage Commissions 2025: Side by side comparison
**See “ADDITIONAL NOTE” above regarding CMS max commission amounts
| Product | Region | 2024 | 2025 | % Increase | 2024 | 2025 | % Increase |
| MAPD | National | $611 | $726 | 18.82% | $306 | $363 | 18.63% |
| CT, PA, DC | $689 | $805 | 16.84% | $345 | $403 | 16.81% | |
| CA, NJ | $762 | $880 | 15.49% | $381 | $440 | 15.49% | |
| Puerto Rico, U.S. Virgin Islands | $418 | $528 | 26.32% | $209 | $264 | 26.32% | |
| PDP | National | $100 | $209 | 109% | $50 | $105 | 110% |
Learn why Crowe and Associates is a great choice for your FMO
Subscribe to our YouTube channel and watch our informative videos
To view more images by this artist, click here
Understanding ACA enrollment periods is crucial for agents offering the plans as well as for potential enrollees. We will go over the opportunities both individuals and families have to enroll in health coverage.
Open Enrollment Period
The Open Enrollment Period (OEP) is the primary time each year individuals and families can sign up for health insurance through the ACA marketplace. Each year, the OEP begins November 1st and ends on January 15th. In some cases, the enrollment deadline is extended for a specific reason.
Important dates:
November 1st – Open enrollment begins. Coverage starts January 1st.
December 15th – This s the last day to enroll in or change plans for coverage to start January 1st.
January 1st – Coverage begins for anyone who enrolled in a plan by December 15th nd paid their premium.
January 15th – Open enrollment ends; this is the last day of the year individuals/families can either enroll in or change healthcare plans without a Special Enrollment period.
February 1st – Coverage begins for those who enrolled between December 16th and January 15th and paid their first premium.
During this enrollment period, individuals/families can:
- Enroll in a new health insurance plan.
- Renew their current plan.
- Make changes to an existing plan.
Please note: Plans for those who use the OEP for enrollment begin on January 1st of the following year. Those who miss the OEP may not be able to enroll in or change their current plan until the next year’s OEP, unless they qualify for a Special Election Period.
Special Enrollment Period
The Special Enrollment Period (SEP) allows individuals/families to either enroll in or change health insurance plans outside the OEP. The SEP is available to those who experience specific life events.
These life events include:
Loss of health coverage: What qualifies as loss of health coverage; loss of either job-based coverage, Medicaid, or CHIP.
Changes in household: Here are examples of changes in a household; getting married or divorced, either having a baby or adopting a child, or a death in the family.
Changes in residence: This includes; moving to a different zip code or county, another state, or when you move to or from the place where you attend school.
Other qualifying events: Changes in your income (gains or losses) that affect the coverage you qualify for, gaining membership in a federally recognized tribe, becoming a U.S. citizen, leaving incarceration, or AmeriCorps members who are either starting or ending their service.
In most cases, the individual/family has 60 days from the date of the qualifying event to enroll in a plan through the SEP.
Medicaid and CHIP Enrollment
Medicaid and the Children’s Health Insurance Program (CHIP) offer free or low-cost coverage to millions of Americans, including qualifying low-income people, families and children, pregnant women, the elderly, and people with disabilities. Unlike marketplace plans, you can apply for and enroll in Medicaid and CHIP any time of the year. Remember; enrollment in either Medicaid or CHIP gives the enrollee an SEP for a marketplace plan.
If you are an insurance agent, here are some helpful links:
Click here to watch a video on Crowe ACA offerings for agents & agencies
Watch a demo of our ACA agent portal
Click here to add ACA to your Crowe contracts
Enrollment tips
- Mark Your Calendar: Keep track of important dates for the OEP and plan ahead to gather necessary documents and information.
- Check for SEP Eligibility: Those who miss the OEP, should check if they qualify for an SEP.
- Explore Medicaid and CHIP: If your income is low, you may qualify for Medicaid or CHIP, which have year-round enrollment.
- Compare Plans: Compare different plans available in the marketplace to find one that best suits your needs and budget.
- Seek Assistance: Navigating health insurance can be complex. Don’t hesitate to seek help from certified navigators, agents, or brokers.
Understanding and taking advantage of the ACA enrollment periods is essential to ensure you have the health coverage you need.
If you like the image in this post, click here to view more by this artist
Since the start of the introduction of the Affordable Care Act (ACA), there’s been a growing demand for professionals with the knowledge and skills to provide assistance to enrollees. ACA certification and training are one of the ways agents can stay up-to date on plan options and proper enrollment practices. This allows agents to help individuals make informed decisions and get access to healthcare.
Learn about our ACA sales contracting
Certifications agents need to offer ACA plans
Agents who want to offer ACA plans through the federal exchange site (healthcare.gov), must complete the FFM (Federally Facilitated Marketplace) certification. Although the ACA plans operate differently than Medicare does, the CMS also oversees ACA training. Agents complete this certification through CMS’ MLMS (Marketplace Learning Management System). One important thing to note; the FFM certification doesn’t cover insurance products sold through any of the state-based marketplaces.
FFM certification does not cover products sold in states that have their own state-based marketplace, The following states have state-based marketplaces that require agents to take their specific certifications:
CA – the state’s marketplace is Covered California
CO – the state’s marketplace is Connect for Health Colorado
CT – the state’s marketplace is Access Health CT
Please note: Access Health CT certification for 2024 for both Brokers and CACs is closing on July 31. Certification for Open Enrollment and for 2025 will start in September (Date TBA). Those who certify before 7/31 will need to certify again in September for 2025.
DC – the state’s marketplace is DC Health Link
ID – the state’s marketplace is Your Health Idaho
KY – the state’s marketplace is Kynect
ME – the state’s marketplace is CoverME
MD – the state’s marketplace is Maryland Health Connection
MA – the state’s marketplace is Health Connector
MN – the state’s marketplace is Mnsure
NV – the state’s marketplace is Nevada Health Link
NJ – the state’s marketplace is Get Covered NJ
NM – the state’s marketplace is beWellnm
NY – the state’s marketplace is New York State of Health
PA – the state’s marketplace is Pennie
RI – the state’s marketplace is HealthSource RI
VT – the state’s marketplace is Vermont Health Connect
VA – the state’s marketplace is Virginia’s Insurance Marketplace
WA – the state’s marketplace is Washington Healthplanfinder
When do agents need to complete certifications
Certifications for states on the Federal Exchange as well as many state-based marketplaces must be completed annually. However, although some state-based training, such as NY, is required every 2 years. When there are changes to the ACA, CMS provides updated training modules.
Find out why you should offer ACA plans through Crowe:
Watch a Youtube video on ACA contracting with Crowe and Associates
Click here to view a demo of our ACA portal for agents and agencies
FFM certification
Agents who need to complete FFM (Federally Facilitated Marketplace) can access CMS’s Enterprise Portal to complete their FFM certs. If you don’t already have an account, you can create one. Once you are in the portal, go to choose “Add Application” and click on the FFM/Request for MLMS Training Access and follow the instructions.
The states that require FFM training: AL, AK, AZ, AR, DE, FL, GA, HI, IL, IN, IA, KS, KY, LA, ME, MI, MS, MO, MT, NE, NH, NM, NC, ND, OH, OK, OR, SC, SD, TN, TX, UT, VA, WV, WI and WY.
New ACA agents vs. returning agents
Agents who are new to the ACA market must take the entire training course while returning agents can take a shortened version of the course.
New agents: click here for the CMS Marketplace training guide for 2024
Returning Agents: click here for CMS’ Marketplace training guide for 2024
The entire FFM certification consists of 10 training modules and four test; this takes a few hours to finish. A score of 70% or higher is required to pass the tests although agents who do not pass them can retake them. The refresher training only takes about an hour and a half to finish. There is no cost to the agent to take either course.
To check that CMS has updated your FFM cert status, use your NPN on the Agent and Broker FFM Registration Completion List (RCL), just enter your NPN to check. Please note, it may take a few days for CMS to update the system.
FFM certification assistance
CMS provides technical assistance for agent who experience issues while completing the FFM course. Call the Marketplace service desk at 1-855-267-1515 for portal password resets and issues as well as registration and training questions. Agents can also contact the help desk via email at: FFMProducer-AssisterHelpDesk@cms.hhs.gov
Offering ACA plans is a great way to grow your business and assist more members of your community.
To view more images by this artist, click here
Each year, Medicare agents have to take several tests and certifications before they can offer products to their clients. This year, our AHIP 2025 test tips will help get you up and running for a successful 2025.
Most MA/MAPD and PDP carriers require agents to pass the AHIP although, UHC does not require it, they have their own certification. The 2025 exam is available starting June 24th, 2024. The 2025 AHIP covers any business you write for the rest of 2024 as well as through 2025.
Watch our YouTube video ” AHIP Test Tips 2025″
The AHIP is a CMS compliant course that is updated each year. This ensures the training is accurate as well as relevant to current CMS regulations. For this reason, the AHIP 2025 test tips is a great tool for agents to use and complete the AHIP successfully.
Please note: In order to pass the exam, you must receive a grade of 90% to pass the exam. Agents have 2 hours to complete the exam and have 3 attempts to pass. The exam consists of 50 multiple choice questions. Those who do not pass after the third attempt, must pay for and retake the course.
Important; if you do not pass in the first 3 attempts, some carriers will not allow you to market their products for the year.
New agents who want to join the team at Crowe; click here for online contracting
If you are a Crowe agent who wants to add a carrier to your existing contract; click here
The cost for AHIP:
AHIP course and exam has a cost of $175. Agents can get a $50 discount by taking it through one of the major carrier’s sites (UHC, Aetna, Humana, etc.). Any agent who is part of the Pinnacle financial team can also receive are a $50 discount as well. All you need to do is go to pfsinsurance.com sign in, click on certifications tab and then the AEP Toolkit; from there you scroll down and see a link for the:
Click here for the Pinnacle AHIP discount
Please note; the 2025 AHIP is very similar to the 2024 AHIP
There are some new concepts and rules you need to be aware of. Click on the link below to watch our video and learn more:
Here is what the AHIP covers:
The first part consists of 5 modules
- Medicare basics; fee-for-service and eligibility as well as benefits
- The different types of Medicare Advantage & prescription drug plans (Part D)
- Who is eligible and what is covered
- Nondiscrimination training
- Requirements for marketing and enrollment of Medicare Advantage as well as Part D/PDP plans
It is important to download each module once you are in it. This is suggested to help you complete the test later. If you took the 2024 AHIP, you only need to click through the slides on modules 4 & 5. We recommend clicking on modules 1-3 so you can download the content. It is also not a bad idea to complete the practice tests at the end of ALL modules; many of those questions will be on the test.
Each module has a 20 question practice test at the end. Pay attention to the practice questions; most of the test questions come from there.
Once you finish all modules and the exam, do not forget to take the second part of the AHIP.
The second part covers fraud, waste, and abuse
- Learn how to spot fraud, waste, and abuse (FWA)
- Find out what the Medicare industry is doing to detect fraud
- What are the legal tools that combat FWA
- Understand the human as well as the financial cost of fraud waste and abuse
- Review general compliance requirements for Medicare Parts C and D fraud, waste, and abuse.
- Find out who commits fraud, waste, and abuse
- What are loophole and obligations to reporting fraud, waste and abuse
Once you successfully complete everything, remember to download your AHIP certificate. In some cases, carriers allow you to transmit your score directly from the AHIP site, but some require you to upload it into their dashboards yourself.
For updated news, webinar, zoom and agent events, click here
To view more images by this artist; click here
If you are in Medicare sales, I am sure you have heard many uplines are adding ACA contracts. We will go over some reasons to add ACA health insurance sales to your business.
The Affordable Care Act (ACA) provides healthcare options for millions of Americans. Additionally, healthcare agents have an opportunity to make a difference in the lives of many individuals who need healthcare.
ACA Health Plans
The ACA introduced reforms to improve access to healthcare and enhance the quality of coverage. Health Insurance Marketplace and ACA-compliant health plans must adhere to standards, such as covering essential health care services and prohibiting discrimination based on pre-existing conditions. Subsidies and tax credits provided by the ACA, make health coverage more affordable for eligible individuals and families. To learn more about the ACA, visit healthcare.gov.
Reasons to add ACA health insurance sales
Providing access to necessary healthcare services
ACA health plans are crucial to many underserved individuals who otherwise do not receive the care they need. This is especially true in many low income communities. Agents helping individuals find affordable coverage options and the expansion of Medicaid eligibility, are both ways to ensure more people have access to medical care.
Protecting enrollees
Plans that comply with ACA regulations protect enrollees from the high cost of medical treatment and coverage denials. Selling these plans allows agents to advocate for their clients’ interests and guide them towards the best options for their coverage needs and budget.
Financial benefit
Agents who offer ACA health plans have the ability to earn commissions as well as various sales incentives. Because there are thousands of people who need coverage and the demand continues to grow, there is a real need for qualified professionals who can navigate the complexities of the insurance enrollment process.
If you are an agent who wants to get set up to offer ACA plans, click here to learn more
Certifications and Training:
Selling ACA health plans requires a solid understanding of healthcare regulations, insurance products, and customer needs. Although there are not as many certifications with the ACA as in the Medicare world, there are trainings and credentials required that vary by market and carrier. A few things agents need to have before they offer ACA plans:
- Health Insurance License: Obtaining a state-issued health insurance license is a prerequisite for selling ACA health plans. This license demonstrates your understanding of insurance laws and regulations, as well as your commitment to ethical sales practices.
- E&O Insurance: Agents need to have a valid certificate of E&O insurance to cover themselves for any mistakes they make that could prompt legal action by the client.
- ACA Marketplace Training: The Centers for Medicare & Medicaid Services (CMS) offer training courses for agents and brokers seeking to assist consumers with Marketplace enrollment. These courses cover topics such as eligibility determination, plan selection, and enrollment assistance.
Watch a few YouTube videos on the ACA:
Find out what Crowe has to offer ACA agents and agencies
Learn more about ACA contracting
Watch a demo of what our ACA portal has to offer
Why offer ACA plans
For those agents looking to make a positive impact on people’s lives while building their business, selling ACA health plans could be the perfect fit for you. Medicare agents can use this opportunity to build a long-lasting relationship with your client. This will lead to a greater trust and knowledge of the client’s needs and wants for coverage and can lead to more Medicare leads in the long run.
By demonstrating competency and commitment to providing good service, agents can become a trusted resource in the community for various types of healthcare coverage.