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Medicare General Enrollment Period – Who Can Use It

Medicare offers several enrollment windows, and knowing which one applies to your situation is essential for avoiding coverage gaps and late-enrollment penalties. One key enrollment period; especially for those who missed their initial opportunity, is the Medicare General Enrollment Period (GEP).

For those who didn’t sign up for Medicare when first eligible, the GEP may provide a second chance to enroll. Let’s break down what the GEP is, who qualifies to use it, and what to expect.

Understanding the Medicare General Enrollment Period

The Medicare General Enrollment Period runs every year from January 1 to March 31. It exists to help individuals who:

• Did not enroll in Medicare Part A and/or Part B during their Initial Enrollment Period (IEP), and
• Do not qualify for a Special Enrollment Period (SEP)

During the GEP, eligible individuals can sign up for Medicare Part A (if they have to pay a premium for it), Medicare Part B, or both.

Watch a YouTube video on Medicare Enrollment Periods

Who Can Use the GEP

You may be able to use the Medicare General Enrollment Period if:

1. You turned 65 and missed your Initial Enrollment Period
2. You left employer coverage and did not enroll during a Special Enrollment Period
3. You declined Medicare when first eligible and later changed your mind
4. You were not automatically enrolled and never completed enrollment

You cannot use the GEP if

You already enrolled or declined Medicare during your IEP or SEP
You currently qualify or applied for a Special Enrollment Period (for example, due to loss of employer coverage)

When Coverage Begins After Enrolling

Unlike past years when coverage began in July, Medicare’s updated rules mean that coverage starts the first day of the month after you enroll during the GEP.

For example:

• Enroll in January – Coverage starts February 1
• Enroll in March – Coverage starts April 1

What About Late-Enrollment Penalties

If you’re enrolling during the GEP because you didn’t qualify for a Special Enrollment Period, be aware that late-enrollment penalties may apply:

• Part B penalty: 10% increase for each full 12-month period you didn’t enroll when eligible
• Part A penalty: Applies if you’re required to pay a premium and delayed enrollment

These penalties typicallylast for a lifetime, so enrolling as soon as you’re eligible; or using a SEP if qualified, is critical.

If you an agent who is ready to join Crowe team; click here for online contracting

Can You Enroll in Medicare Advantage or Part D After the GEP

Yes. After enrolling in Medicare during the GEP, you have a Medicare Advantage and Part D enrollment window from April 1 to June 30 each year.

During this time, you can:

• Join a Medicare Advantage (Part C) plan
• Enroll in a standalone Part D prescription drug plan

Missing your Initial Enrollment Period doesn’t mean you’re out of options. The Medicare General Enrollment Period offers an important second chance to gain coverage, but acting promptly is key.

If you’re unsure whether you qualify for the GEP or a Special Enrollment Period, consider speaking with a licensed Medicare agent who can help you understand your enrollment options and avoid unnecessary penalties or coverage delays.

Agents, stay up-to-date on the our latest webinars an agent events.

UnitedHealthcare UCard Benefits 2026

UnitedHealthcare continues to innovate member experience for Medicare Advantage enrollees, and the 2026 UCard remains a standout feature. More than an ID card, the UCard is designed to simplify access to multiple plan benefits, making it easier for members to stay healthy, shop for everyday essentials, and manage their care in one place.

What Is the UCard

The UnitedHealthcare UCard combines functions that traditionally required multiple cards or portals. For eligible 2026 plans, it may serve as:

• Your medical ID card for doctor visits and to fill prescriptions at your local pharmacy
• An over-the-counter (OTC) benefit card
• A healthy food and grocery card (on select plans)
• Access your gym membership
• A rewards and incentive card
• A payment tool for certain utilities and transportation on qualifying plans

By integrating benefits, UnitedHealthcare aims to reduce confusion and help members use the services available to them more easily.

Accessing Your UCard Benefits

Members can check their UCard balance and benefits in a few convenient ways:

• UnitedHealthcare UCard Hub – Log in to view balances, track reward earnings, and see eligible spending categories.
• UHC Mobile App – Scan products, check approved retailers, and track benefit usage in real time.
• UCard Customer Support Line – Speak with a representative for help activating or understanding benefits. Members will find the customer support number on the back of their UCard.

Members can also review benefit details in their plan documents or contact a licensed Medicare agent for assistance.

Watch a YouTube video on the Discontinued Medicare Advantage Plan Special Enrollment Period

Where Can Members Use the UCard

UCard spending benefits can be used at thousands of participating retail and online locations. Depending on the plan and benefit type, members may access approved products and services at:

• Major supermarket chains
• National pharmacy chains
• Big-box retailers
• Convenience and dollar stores
• Local participating grocers
• Online retailers that partner with UHC

At checkout, members simply swipe the card like a debit card for qualified purchases. Items not covered will need a separate form of payment. For select plans offering utility or transportation assistance, members may use funds through approved vendors or billing arrangements.

Why the UCard Matters

The UCard simplifies Medicare Advantage benefits by eliminating multiple cards and making it easier for members to actually use what they’re entitled to. This system supports better health outcomes, encourages preventive care, and adds everyday convenience.

Are you a licensed Medicare agent; join our team at Crowe – click here for online contract

Agents; click here for updated events and information.

Canceling Medicare Part B – What You Need to Know

Medicare Part B helps cover doctor visits, outpatient services, preventive care, and durable medical equipment. It’s a cornerstone of healthcare for many older adults. Although, there are some situations when cancelling Medicare Part B is the best option for you

Whether due to employer coverage, cost concerns, or personal circumstances, canceling Part B is a decision that needs careful consideration. Here’s what you should know before making the move.

Why Someone Might Cancel Part B

Most people keep Part B once they enroll, but in certain situations, canceling may make sense, such as:

• Returning to Employer Coverage
  If you or your spouse returns to work and gains coverage through a credible employer health plan, you may choose to cancel Part B to avoid paying the monthly premium.
• Cost Concerns
  Individuals on a fixed budget may reconsider Part B due to premium costs. However, this should be carefully weighed against healthcare needs.
• VA Benefits Only
  Some veterans rely solely on VA benefits and opt to drop Part B, though this comes with some risk if VA access is delayed or preferences change later.

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How to Cancel Medicare Part B

Canceling Part B isn’t as simple as clicking a button online. The Social Security Administration requires a signed request, and often a Form CMS-1763 must be completed. Typically, you will need to:

1. Contact Social Security by phone or visit your local office to request cancellation.
2. Complete Form CMS-1763 in person or by phone with a Social Security representative.
3. Confirm your disenrollment once processed.

This extra step is intentional; Medicare wants to be sure beneficiaries understand the consequences before dropping coverage.

Watch a YouTube video on Medicare Enrollment Periods

Important Considerations Before Canceling

Canceling Part B can have long-term implications. Here are key points to consider:

• You May Pay a Late Enrollment Penalty Later
  If you cancel and don’t have other credible coverage (like large-group employer insurance), you may face a permanent surcharge if you re-enroll later.
• Limited Re-Enrollment Windows
  You can’t re-enroll anytime. Most people must wait for the General Enrollment Period (January 1 – March 31), with coverage beginning July 1; potentially leaving gaps.
• Future Coverage Access
  If your health needs change unexpectedly, getting back into Medicare Part B isn’t immediate.
• Medigap Implications
  Canceling Part B can impact your ability to retain or buy a Medicare Supplement plan, since Part B is required to maintain Medigap coverage.

When Not to Cancel Part B

Avoid canceling Medicare Part B if:

You do not have other credible employer-based coverage
Your VA benefits are your only backup and you want broader provider access
You plan to enroll in a Medicare Advantage or Medigap plan; both require Part B

If you’re unsure, speak with a licensed Medicare agent before making changes.

Canceling Medicare Part B is possible, but it’s not a decision to take lightly. With potential penalties, waiting periods, and the importance of ongoing medical access, it’s essential to make sure you have another qualifying form of coverage in place first.

Stay up-to-date on the our latest webinars an agent events.

If your circumstances have changed and you’re considering this step, be sure to talk with a Medicare expert who can help you understand the rules and avoid costly gaps in coverage.

Medicare Excess Charges: What They Are & How to Avoid Them

When navigating Medicare, many beneficiaries are surprised to learn about a lesser-known cost called Medicare excess charges. While not everyone will encounter them, knowing how they work, and how to avoid them, can help protect your wallet and ensure you receive the most value from your healthcare coverage.

What Are Medicare Excess Charges

Medicare excess charges occur when a healthcare provider charges more than the Medicare-approved amount for a service under Original Medicare Part B. In most cases, providers who accept Medicare agree to bill only the amount that Medicare approves. However, some providers do not accept Medicare assignment, meaning they can legally charge up to 15% more than the approved rate. This extra amount is known as the excess charge.

For example, if Medicare approves $200 for a service and pays 80% ($160), you’re responsible for the remaining 20% coinsurance ($40). If the provider adds a 15% excess charge ($30), you would owe $70 total instead of $40.

When Do Excess Charges Apply

Excess charges apply only to Medicare Part B services when a provider:

Accepts Medicare but
Does not accept Medicare assignment

These providers still treat Medicare patients, but they can bill above the standard Medicare fee schedule.

Learn about Medicare High Deductible G Plans – Watch a YouTube video

Where Excess Charges Do Not Apply

You do not need to worry about excess charges if:

• You see a doctor who accepts Medicare assignment
• You receive care in a Medicare-participating facility
• You live in a state that bans excess charges (see below)
• You have a Medigap Plan G or Plan F (these plans pay excess charges)

States That Prohibit Medicare Excess Charges

Some states have passed laws to protect Medicare beneficiaries. In these states, providers cannot charge more than the Medicare-approved amount:

• Connecticut
• Massachusetts
• Minnesota
• New York
• Ohio
• Pennsylvania
• Rhode Island
• Vermont

If you live in one of these states, you are fully shielded from excess charges.

How to Avoid Medicare Excess Charges

Here are simple steps to ensure you don’t pay more than necessary:

1. Choose providers who accept Medicare assignment
2. Confirm billing practices before receiving care
3. Consider a Medigap plan (especially Plan G or Plan F) if you’re on Original Medicare
4. Use Medicare’s provider finder tool to verify assignment status

What About Medicare Advantage Plans

If you’re enrolled in a Medicare Advantage (Part C) plan, excess charges typically do not apply, as long as you stay within the plan’s network. Medicare Advantage plans negotiate rates with providers directly, separate from Original Medicare rules.

Medicare excess charges aren’t common, but when they do occur, they can add up. The good news is that with the right knowledge and a little planning you can easily avoid them. Whether you choose Original Medicare with a Medigap plan or enroll in Medicare Advantage, being proactive about your provider choices helps ensure your healthcare is both high-quality and cost-effective.

Agents, if you are ready to join the team at Crowe; click here for online contracting

Stay up-to-date on agent events and information – click here.

Using Medicare Advantage Trial Rights: What Beneficiaries Need to Know

Choosing Medicare coverage is a major decision. For some beneficiaries, enrolling in a Medicare Advantage (MA) plan feels like a smart move comprehensive benefits, low or $0 premiums, and added perks like dental, vision, and fitness programs. But what happens if you try Medicare Advantage and realize it’s not the right fit? That’s where using Medicare Advantage Trial Rights can be a valuable safety net.

Medicare built specific protections that allow certain beneficiaries to “test” a Medicare Advantage plan without being locked in forever. Understanding these rights can give you confidence when making your coverage decision.

What Are Medicare Advantage Trial Rights

Medicare Advantage Trial Rights are special protections that allow eligible beneficiaries to switch back to Original Medicare (Part A and Part B) and purchase a Medigap (Medicare Supplement) plan if they decide MA isn’t working for them. These rights prevent beneficiaries from being denied Medigap coverage or charged more due to health conditions during this trial period.

Who Qualifies for Medicare Advantage Trial Rights

You may qualify if:

1. You are new to Medicare and you first enrolled in a Medicare Advantage plan.
If you joined an MA plan when you first became eligible for Medicare at age 65, you have a 12–month trial period. If you decide within that year that MA is not for you, you can switch back to Original Medicare and have Medigap guaranteed issue rights.

2. You dropped a Medigap plan to enroll in Medicare Advantage for the first time.
If you previously had a Medigap plan and switched to an MA plan for the first time, you again have 12 months to change your mind. If you return to Original Medicare, you have the right to get the same Medigap plan you had before (if it’s still available) or a comparable plan.

Watch a YouTube video – Medicare Advantage vs. Medicare Supplements

Why Trial Rights Matter

Trial rights offer peace of mind. Medicare Advantage plans work well for many people, but provider networks, prior authorization rules, and cost-sharing structures may not suit everyone. Trial rights allow beneficiaries to explore coverage options without long-term risk.

For example, someone who values nationwide access to doctors or has upcoming health procedures might discover that Original Medicare plus Medigap better suits their needs. With trial rights, they can make the switch confidently.

If you an agent who is ready to join Crowe team; click here for online contracting

How to Use Your Trial Rights

If you decide to switch back from Medicare Advantage to Original Medicare:

Contact Medicare or your plan to disenroll
Apply for a Medigap plan, citing your trial right
Choose a standalone Part D prescription drug plan (PDP) if needed

Timing is key; make sure you act within your 12-month window to secure guaranteed Medigap eligibility.

Medicare Advantage can be a great choice, but it’s not one-size-fits-all. Medicare Advantage Trial Rights give beneficiaries a valuable opportunity to try MA coverage with a safety net. If you’re unsure which route is best, speak with a licensed Medicare professional who can help evaluate your health needs, budget, and coverage preferences.

Understanding your rights empowers you to make confident, informed decisions about your Medicare journey.

Agents, stay up-to-date on the our latest webinars an agent events.

Deductibles and Other Medical Costs: What They Mean for Your Healthcare Budget

Healthcare terms can feel confusing, especially when it comes to how much you’ll actually pay for medical services. One of the most important pieces to understand when choosing insurance, or reviewing your current coverage, are deductibles and other medical costs.

These costs directly impact what you spend before your insurance steps in and how much you’re responsible for throughout the year. Understanding them helps you plan better, compare plans accurately, and avoid unexpected medical bills.

What Is a Deductible

A deductible is the amount you must pay for covered healthcare services before your insurance begins to share the costs.

For example, if your deductible is $2,500, you pay the first $2,500 of covered medical expenses yourself. After you meet your deductible, your insurance typically starts paying a portion of costs (often through coinsurance).

Think of the deductible as your first layer of financial responsibility in your insurance plan.

What Are Out-of-Pocket Costs

Out-of-pocket costs are expenses you’re responsible for when receiving care. They may include:

• Deductibles
• Copayments (fixed dollar amounts per service)
• Coinsurance (a percentage of the cost of services)
• Non-covered services

When comparing plans, look not only at the deductible but also the overall cost-sharing structure. A low-deductible plan may have higher premiums but lower out-of-pocket expenses when you receive care and vice versa.

Understanding the Out-of-Pocket Maximum

Most health insurance plans also include an out-of-pocket maximum (OOPM). This is the most you’ll pay in a policy year for covered services. Once you reach that limit, your insurance covers 100% of eligible expenses for the remainder of the year.

This limit is an important financial safeguard, especially for individuals with chronic conditions or unexpected medical events.

Watch a Video on Medicare IRMAA & Part B SEP Rules

Why Your Deductible and OOP Spending Matter

Knowing your deductible and out-of-pocket maximum helps you:

• Budget healthcare expenses
• Select a plan that fits your needs
• Avoid surprises when receiving care
• Plan ahead for prescriptions, specialists, or procedures
• Understand how preventive services are covered (This is key; many preventive services are covered before deductible!)

Tips for Choosing the Right Plan

When evaluating health plans, consider:

• How often you visit doctors
• Whether you take ongoing prescriptions
• Expected medical needs (e.g., planned surgery, therapies)
• Monthly premium cost versus potential annual expenses
• Your comfort level with risk and unexpected bills

People who expect regular medical care may benefit from lower deductibles and higher premiums. Those who rarely seek care may prefer a lower-premium, higher-deductible option.

Deductibles and out-of-pocket costs aren’t just insurance jargon; they are vital components of your financial health plan. Understanding them helps you to make smarter decisions and choose coverage that protects both your health and your wallet.

If you are an agent who is ready to join the team at Crowe – click here for online contract.

If you ever feel uncertain about comparing plans or estimating potential costs, don’t hesitate to ask questions. Being informed is the first step to confident healthcare decisions. That is why working with a licensed insurance agent is so important.

Agents stay updated on agent events and information

The Value of Medicare Agents and the Service They Provide

When individuals approach Medicare eligibility, they often discover just how complex healthcare decision-making can be. With dozens of plan types, varying costs, evolving coverage rules, and aggressive advertising from every direction, choosing the right Medicare coverage can feel overwhelming. That’s where licensed Medicare agents bring tremendous value.

Medicare agents act as trusted advisors, providing clarity, guidance, and personal advocacy. Their goal isn’t just to help someone enroll in a plan; it’s to ensure clients understand their benefits and feel confident in their healthcare choices year after year.

Simplifying a Complicated System

While Medicare is an essential program, it isn’t always easy to navigate. Beneficiaries have questions such as:

• Original Medicare or Medicare Advantage?
• What’s the difference between a Medigap plan and a Medicare Advantage plan?
• Do I need a Part D prescription drug plan?
• What are my costs? What doctors can I see? Will this plan cover my prescriptions?

A Medicare agent breaks this information down into clear, understandable terms. They help clients compare plan options side-by-side, explain key terms like premiums, deductibles, and maximum out-of-pocket costs, and ensure beneficiaries avoid costly mistakes such as missing enrollment deadlines or choosing plans that don’t fit their needs.

Personalized Guidance

Every Medicare beneficiary has unique needs; health conditions, prescription needs, doctor preferences, budget considerations, and lifestyle factors. Independent Medicare agents take the time to understand these factors and recommend plans that offer the best fit, not just the best marketing.

Many agents represent multiple carriers, allowing them to provide unbiased comparisons and advocate for the plan that truly serves the client best.

Watch a quick YouTube video comparing Medicare Advantage vs. Medicare Supplements

Year-Round Support and Advocacy

Medicare decisions don’t end at enrollment. Plans can change their provider networks, drug formularies, premiums, and benefits from year to year. Agents ensure beneficiaries stay informed and help them:

• Review plans annually during the Annual Enrollment Period
• Understand billing and claims issues
• Navigate carrier customer service challenges
• Access additional benefits and programs that can reduce healthcare costs

This ongoing support is one of the most valuable services agents provide and it’s often at no cost to the beneficiary, since agents are typically compensated by the insurance carriers.

If you are ready to join Crowe team; click here for online contracting

Protection Against Misinformation

Medicare marketing is everywhere, and not all of it is accurate. Agents serve as a reliable source of truth, cutting through misleading ads and high-pressure sales tactics. They are licensed, trained, and required to follow strict compliance rules designed to protect Medicare beneficiaries.

A Partner in Your Healthcare Journey

Medicare agents don’t just enroll people in plans, they build long-term relationships. They offer peace of mind, help clients understand their benefits, and stand by their side when questions or challenges arise.

Agents, stay up-to-date on the our latest webinars an agent events.

For many seniors, working with a Medicare agent means having a trusted professional who knows their needs, understands the system, and is committed to helping them access the best possible care.

Why Selling GTL Advantage Plus Plans Is a Smart Move for Insurance Agents

As the Medicare and senior insurance markets continue to evolve, one product category remains consistently valuable; hospital indemnity insurance. When it comes to hospital indemnity coverage, Guarantee Trust Life (GTL) stands out as a trusted leader with its Advantage Plus plan. Why offer GTL Advantage Plus plans; it’s a strategic growth opportunity for agents serving Medicare Advantage clients.

Let’s explore why selling GTL Advantage Plus plans can strengthen your business and protect your clients.

A Solution to Medicare Advantage Cost-Sharing Gaps

Many Medicare Advantage plans come with low or $0 premiums, but they also include deductibles, copays, and out-of-pocket costs that can surprise clients during hospital stays. GTL Advantage Plus helps close that financial gap by offering cash benefits paid directly to the policyholder when they are confined to a hospital or receive certain outpatient services.

For your clients, this means:

• Financial help when hospital bills add up
• Funds they can use for medical or non-medical needs (transportation, bills, groceries, etc.)
• Peace of mind knowing their Medicare Advantage cost-sharing is covered

For you, this means providing real value and building deeper trust with your customers.

Flexible and Feature-Rich — Built for Today’s Market

GTL Advantage Plus stands out because of its flexibility and robust benefit options, including:

• Daily hospital confinement benefits
• Observation stay coverage
• Ambulance and emergency room benefit options
• Skilled nursing facility benefits
• Cancer and lump-sum benefit riders
• Short, simple application process and easy underwriting

This flexibility makes the plan easy to fit into a wide range of client needs and budgets.

Easy Sell With Medicare Advantage — Without Replacing Coverage

Hospital indemnity insurance is one of the easiest products to cross-sell during Medicare Advantage discussions. You’re not asking clients to replace coverage; you’re enhancing what they already have.

This means smoother conversations and higher client satisfaction. Plus, GTL plans often pair naturally with popular MAPD designs, making the value immediately clear.

Watch a YouTube video on GTL product sales

Strong Commissions & Year-Round Sales Opportunities

Selling GTL Advantage Plus isn’t just good for clients; it’s good for your business. Advantages include:

• Competitive commissions
• Sales opportunities outside of AEP (work year-round!)
• Fast approvals and efficient e-applications
• Strong retention and persistency

Agents can use the Advantage Plus plan to keep revenue flowing consistently, not only during busy enrollment seasons.

Are you ready to join the team at Crowe – click here for online contract.

Trusted Company & Agent-Friendly Support

GTL has been serving policyholders since 1936; a testament to its financial strength and service commitment. Agents benefit from:

• Reliable claims processing
• Friendly agent support
• Great technology tools
• A reputation that builds client confidence

When you represent GTL, you align with a company that values agents and provides the tools needed to succeed.

Stay updated on agent events and information – click here

Relocating to a new state can be exciting, but if you rely on Medicaid for your healthcare, the process requires careful planning. Medicaid is a state-administered program, meaning benefits cannot be transferred directly from one state to another. Maintaining Medicaid when you move is essential for those who rely on that extra assistance. However, with preparation, you can make the move without losing coverage.

Understanding How Medicaid Works

While the federal government sets the foundation for Medicaid, each state runs its own program with unique eligibility rules, income limits, and coverage options. Because of this, Medicaid benefits do not automatically carry over when you move. You must close your case in your current state and reapply in your new one.

The good news: there are no residency waiting periods to apply. Once you’ve established your new address, you can submit your Medicaid application right away. In some states, nursing home residents must meet a short length-of-stay requirement (for example, 30 days) before applying for long-term care Medicaid.

Avoiding Gaps in Coverage

Many people worry about a lapse in care when switching states. While coverage in your old state ends once you move, most states offer Retroactive Medicaid; up to three months of backdated coverage for eligible medical expenses before your application month. This helps bridge the gap while your new application is being processed.

Watch a YouTube video on OEP, SEPs and Late Part B Enrollments

How State Rules Differ

Although income and asset limits vary by state, the differences are usually not drastic. If you qualify in one state, you’ll likely qualify in another. However, there are exceptions. For instance, in 2025:

• New York allows a single Medicaid (age 65+ or disabled) applicant up to $32,396 in countable assets.
• Florida limits countable assets to $2,000 for long-term care Medicaid.
• California has no asset limit for Medicaid (Medi-Cal).

If your new state has stricter limits, you may need to spend down or restructure assets to regain eligibility.

Beyond finances, states also define medical need differently. Each sets its own criteria for a “nursing home level of care.” One state might require help with two daily living activities, while another requires three. If your new state’s requirements are stricter, you may no longer meet the functional criteria.

Steps for a Smooth Transition

1. Research Early: Contact the Medicaid office in your new state before moving. Learn about income limits, medical requirements, and available programs.
2. Gather Documentation: You’ll need proof of residency, income, and identity to apply.
3. Time Your Move: Consider moving near the end of the month so your old coverage ends as your new one begins.
4. Get a Functional Assessment: If you need long-term care, have your care level assessed before canceling your old Medicaid.
5. Seek Professional Help: A Certified Medicaid Planner can guide you through financial restructuring and application preparation.

Click here for help finding a certified Medicaid planner

Medicaid isn’t portable between states, but with smart timing and preparation, you can relocate without losing essential healthcare benefits. Close your old case properly, apply quickly in your new state, and stay informed about eligibility differences. Working with a Medicaid planning professional can make the transition smoother and protect your coverage during your move.

If you are ready to join the team at Crowe; click here for online contracting

Stay up-to-date on agent events and information – click here

HMO POS Medicare Plans: Flexibility Within a Network

There are many types of Medicare advantage plans to choose from; including HMO POS Medicare plans mentioned. HMO POS stands for Health Maintenance Organization–Point of Service. While it sounds complicated, the carriers designed these plans to provide a balance between affordability and flexibility.

Let’s break down what that means and how it might benefit Medicare beneficiaries.

What Is an HMO-POS Plan

An HMO-POS Medicare Advantage plan is a type of Medicare Advantage (Part C) plan that combines the cost-saving structure of a traditional HMO with some of the flexibility of a PPO (Preferred Provider Organization).

Like a standard HMO, members typically have a primary care physician (PCP) who coordinates their care. They also provides referrals for specialists within the plan’s network. However, the “POS” or Point of Service, feature lets members seek care outside the network in certain situations, though often at a higher cost.

How It Works

Here’s how an HMO-POS plan typically operates:

• In-Network Care: You’ll get the highest level of coverage when you use doctors, hospitals, and specialists within the plan’s network.
• Out-of-Network Care: You may be able to see an out-of-network provider, but you’ll usually pay more for those services.
• Referrals: In most cases, beneficiaries need a referral from their primary care doctor for specialist visits; even if they’re going out-of-network.
• Cost-Sharing: Costs for out-of-network care are higher and may include additional copays or coinsurance, depending on the service.

This design gives members the ability to stay within a coordinated network for predictable costs while maintaining the option to go outside the network if they need extra flexibility.

Watch a video on the Discontinued Medicare Advantage Plan Special Enrollment Period

Benefits of an HMO-POS Plan

• Lower Premiums: Many HMO-POS plans offer competitive premiums compared to PPO plans.
• Coordinated Care: Having a primary care provider manage your overall care helps ensure treatments and prescriptions work together effectively.
• Flexibility for Travel or Specialists: Members who occasionally need to see an out-of-network specialist or receive care while traveling appreciate the added flexibility.

Things to Consider

While HMO-POS plans offer more freedom than a traditional HMO, it’s still important to review the plan’s rules and costs:

• Out-of-network care is not always covered for every type of service.
• You’ll need to confirm what types of care the POS option allows outside the network.
• Costs can add up if you frequently go out-of-network. These plans are best for those who primarily stay within one area but want a flexibility.

If you are ready to join Crowe team; click here for online contracting

Is an HMO-POS Medicare Plan Right for You?

If you value affordable premiums and coordinated care but want the option to seek care outside your plan’s network, an HMO-POS Medicare Advantage plan may be a great fit. It offers the best of both worlds — structure when you want it, and flexibility when you need it.

Before enrolling, compare the provider networks, out-of-network rules, and total costs to make sure the plan meets your healthcare needs and lifestyle.

Agents, stay up-to-date on the our latest webinars an agent events.

HMO-POS Medicare Advantage plans give beneficiaries a smart blend of structure and freedom; ideal for those who want reliable care coordination with the occasional option to step outside the network.

Medicare SSBCI vs. VBID: What’s the Difference

Two major innovations in the Medicare Advantage (MA) program; special supplemental benefits for the chronically Ill (SSBCI) and the Value-Based Insurance Design (VBID) Model, both aim to improve outcomes for beneficiaries with chronic conditions. However, they differ in purpose, eligibility, benefits, and future outlook. Here’s what you should know about Medicare SSBCI vs VBID and how they compare.

What Is SSBCI

The Special Supplemental Benefits for the Chronically Ill (SSBCI) program was created under the Bipartisan Budget Act of 2018. It allows Medicare Advantage plans to offer non-traditional, non-medical benefits designed to help people with serious chronic illnesses maintain or improve their health and daily function.

To qualify, a beneficiary must:

1. Have one or more complex chronic conditions,
2. Be at high risk of hospitalization or other negative outcomes, and
3. Require intensive care coordination.

Unlike standard Medicare benefits, SSBCI may cover services such as healthy groceries, home air-quality equipment, pest control, transportation, or home modifications. These benefits address social factors that affect health, such as nutrition, housing, and access to care.

Watch a YouTube video on the prescription payment program

SSBCI benefits are optional, meaning not every MA plan offers them. Plans also decide what types of benefits to include and who qualifies. CMS is increasing oversight to ensure these benefits are supported by evidence showing they can improve or maintain a member’s health or function.

SSBCI represents a shift in Medicare Advantage toward whole-person care; addressing more than just medical needs.

What Is VBID?

The Value-Based Insurance Design (VBID) Model, launched by the CMS Innovation Center, allowed participating Medicare Advantage plans to align cost-sharing and benefits with the clinical value of care. The goal was to lower barriers to high-value care (like preventive services or chronic disease management) while discouraging unnecessary spending.

VBID gave participating plans flexibility to reduce copays, expand supplemental benefits, and even test hospice care integration within MA. These features often targeted individuals with chronic illnesses, low income, or those living in underserved areas.

However, VBID was a demonstration model, not a permanent part of Medicare. In 2025, CMS announced it will end the VBID Model after determining that program costs to Medicare were higher than anticipated. While the model is ending, many of its design ideas; like targeted cost-sharing and flexible benefits, are expected to influence future MA benefit structures.

SSBCI vs. VBID: A Quick Comparison

Feature	SSBCI	VBID
Purpose	Provide non-medical benefits to chronically ill MA members to improve health and function	Align benefit design with clinical value; lower cost-sharing for high-value care
Eligibility	MA enrollees with complex chronic conditions and intensive care coordination needs	Enrollees in participating MA plans, often with chronic or low-income status
Benefits	Groceries, home modifications, air-quality equipment, transportation, pest control	Reduced copays, targeted benefits, flexibility for chronic condition care
Scope	Permanent MA program option; varies by plan	CMS Innovation Model; limited participation
Status	Active and expanding with stronger oversight	Ends after 2025 due to high program costs
Impact Goal	Address social determinants of health	Improve outcomes by rewarding high-value care

Why It Matters

Both programs reflect a growing focus on integrated, person-centered care in Medicare Advantage.

• For beneficiaries: SSBCI can provide meaningful extra help for daily living and health support, but eligibility rules apply. Not everyone in an MA plan will qualify.
• For VBID participants: The model’s end may change how some plan benefits are structured in 2026, but many innovations are expected to remain.
• For all MA enrollees: When comparing plans, look beyond premiums and copays. Review whether a plan offers SSBCI or other supplemental benefits that fit your personal needs.

Always review your plan’s Summary of Benefits and Evidence of Coverage to see if SSBCI options are available, and confirm your eligibility with the plan.

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SSBCI and VBID have both pushed Medicare Advantage toward smarter, more holistic care. While VBID will conclude in 2025, SSBCI continues to grow; helping address many factors that shape health outcomes. Together, they represent Medicare’s evolving goal: not just to pay for medical care, but to help beneficiaries live healthier, more independent lives.

Humana Medicare 2026 OTC Benefits: How to Use and Access Them

Many Humana Medicare Advantage (Part C) plans include an over-the-counter (OTC) allowance to help members save on everyday health items. Fortunately, Humana Medicare 2026 OTC benefits provides members more ways to maintain their health while managing out-of-pocket costs.

What the OTC Benefit Covers

Humana’s OTC benefit allows members to buy non-prescription health and wellness products at no cost, up to a set allowance. Covered items typically include:

• Pain relievers and cold medicines
• Vitamins and supplements
• Dental care items like toothbrushes and toothpaste
• First-aid and wound-care supplies
• Digestive aids and bladder-control products

Depending on the plan, members may receive a monthly or quarterly allowance to spend. Some plans offer rollover options, while others require that unused funds be used within the benefit period.

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How to Access Your OTC Benefit

1. Confirm Eligibility – Log into your MyHumana account or review your Summary of Benefits to confirm your plan includes an OTC allowance. You can also call the Member Services number on your Humana ID card.
2. Know Your Allowance – Find out how much you receive and how often it renews. Available benefits vary by plan and region.
3. Shop for Eligible Items – You can use your OTC funds in several ways:
   • Humana Spending Account Card – Many plans load your allowance onto a prepaid card you can use at participating retailers.
   • Mail Order or Online Catalog – Some plans require ordering through CenterWell Pharmacy’s OTC catalog or online store.
4. Use It Before It Expires – Most allowances expire at the end of each benefit period or at year-end. Check your balance often to avoid losing unused funds.

Tips to Maximize the Benefit

• Review Plan Changes Annually: OTC benefits and amounts can change each year. Always read your Annual Notice of Change (ANOC) each fall.
• Shop Early and Smart: If mail order is required, place orders early to allow for shipping time.
• Combine Benefits: Some Humana plans that include Healthy Options or grocery allowances encourage clients to take advantage of all available extras.
• Keep Receipts: If questions arise, documentation helps confirm eligible purchases.
• Ask for Help: Members can contact Humana Member Services or their licensed agent for guidance.

Why This Benefit Matters

Humana’s OTC benefit helps reduce the cost of everyday health items, adding value to Medicare Advantage coverage. For 2026, these allowances highlight Humana’s focus on affordability and wellness. When clients understand and use these benefits fully, they save money, improve their health, and feel more satisfied with their plan.

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