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As a Medicare agent, mastering all the different enrollment periods is crucial to ensure smooth enrollment for your clients. It also helps you stay compliant and that is also very important. Understanding IEP vs ICEP is essential to anyone in Medicare sales. Although these two sound similar, they serve distinct purposes and apply to different parts of Medicare.

IEP (Initial Enrollment Period)

First we will go over The IEP. Most agents know that this is the first window of time when someone is eligible to enroll in Original Medicare; specifically Parts A and B.

• Who is eligible to apply: Individuals turning 65 who worked and paid Medicare taxes for a period of at least 10 years (40 quarters) or their spouse or ex-spouse. Those who are under 65 with a qualifying disability, ESRD or ALS are also eligible to enroll.
• Timing: For those who are turning 65; The IEP spans 7 months: it begins 3 months before their 65th birthday, includes their birth month and ends 3 months after the month they turn 65.
• Timing: Individuals who are under 65 and qualify due to a disability; the IEP begins 3 months before the 25th month of their disability benefit entitlement.

Example: If a client turns 65 in May, their IEP runs from February 1st to August 31st.

What beneficiaries can do during IEP

1. Enroll in Medicare Part A and/or Part B
2. Enroll in a Medicare Part D plan (if they have Part A and/or Part B)
3. If they enroll in both Part A & Part B, they may also opt for either a Medicare Advantage (Part C) plan or a Medicare Supplement (Medigap) plan.

ICEP (Initial Coverage Election Period)

When an individual is first eligible for Medicare, the ICEP can specifically be used to enroll in a Medicare Advantage (Part C) plan.

• Who can use the ICEP: Individuals who are first enrolling in both Medicare Part A and B, and want to join a Medicare Advantage plan.
• Timing: Usually, the ICEP coincides with the IEP. However if an individual delays Part B enrollment (e.g., due to employer coverage), the ICEP does not start until they have both Part A and Part B and ends the last day of the month before their Part B coverage begins.

Example 1 (standard case): Client enrolls in A & B to begin July 1. Their ICEP runs from April 1 to June 30.

Example 2 (delayed Part B): Client took Part A at 65; delayed Part B until they retired at 67. Their ICEP begins when they enroll in Part B and ends the last day of the month before Part B becomes effective.

What beneficiaries can do during ICEP

1. Enroll in a Medicare Advantage (Part C) plan, with or without drug coverage (MAPD or MA-only).

Differences at a Glance

Feature	IEP	ICEP
Purpose	Enroll in Parts A, B, and D	Enroll in a Medicare Advantage (Part C) plan
Who It’s For	All newly Medicare-eligible individuals	Those first enrolling in both Part A & B and considering MA
Timing	7-month window around Medicare eligibility	Coincides with IEP, unless Part B is delayed
Applies to	Original Medicare + Drug Plans	Medicare Advantage Plans

Why Understanding IEP vs ICEP Matters to Agents

Confusing IEP and ICEP could lead to enrollment mistakes, missed opportunities, and compliance issues. Knowing when each applies ensures:

• You recommend the right plans at the right time.
• You help clients avoid penalties for delayed Part D enrollment.
• You position yourself as a knowledgeable and trusted resource.

Watch a YouTube video on Medicare enrolment periods

Important: Always ask clients if they’ve enrolled in both Part A and B before discussing Medicare Advantage options. This small question helps determine whether they’re in their ICEP.

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As a Medicare agent, you’re always looking for ways to support your clients; especially those who have difficulty affording their medications. One of the most overlooked tools in your toolkit is the State Pharmaceutical Assistance Program (SPAP) and the Special Enrollment Period (SEP) it can trigger. This SEP can be a great opportunity for individuals with lower income levels. This post answers the question: what is an SPAP SEP and how you can use it effectively to provide clients the benefits they need and remain complaint.

What Is an SPAP

State Pharmaceutical Assistance Programs (SPAPs) are state-specific programs. Each state designs them to provide assistance to qualified residents; usually low-income seniors or people with disabilities, to pay for prescription drugs. Benefits may include help with:

• Part D premiums
• Deductibles
• Copays and coinsurance
• Coverage gaps (including the “donut hole”) Please keep in mind; the coverage gap was eliminated in 2025.

Important: Not all states offer SPAPs, and those that do have varying eligibility criteria. For example, Connecticut’s PACE, New York’s EPIC or New Jersey’s PAAD and Senior Gold, are a few of the better-known programs.

The SPAP SEP

Once a client becomes eligible for or enrolls in an SPAP, they qualify for an SEP (Special Enrollment Period). Eligible individuals can use the SEP to:

• Enroll in a Medicare Part D plan (if they haven’t yet)
• Switch from one Part D plan to another

The SPAP SEP is useful for:

• Individuals who miss their Initial Enrollment Period (IEP)
• Clients in unsuitable plans with high out-of-pocket costs
• Individuals who are newly eligible for financial help anytime during the year

Timing Rules For SPAP SEPs

• Trigger: The SEP is triggered by eligibility for or enrollment in an SPAP.
• Usage: Individuals can use this SEP only once per calendar year.
• Window: Clients have two full months after the month of SPAP enrollment/eligibility to make a change.

Example: If an individual is approved for their state’s SPAP in April, they can enroll in or switch Part D plans through June 30.

Why This SEP is Important to Agents

Some agents are unsure of how SPAPs work with Medicare timelines. Using the SPAP SEP can:

• Help your clients access more affordable drug coverage outside of AEP (the Annual Enrollment Period)
• Allows agents to proactively help clients who receive an SPAP approval notice
• Position an agent as a knowledgeable advisor who ensures clients receive the best coverage for their budget

Understanding SPAPs also gives you a competitive edge; especially when working in states that offer generous or well-known assistance programs.

Best Practices for Agents

1. Know Your State’s SPAP: Research the program(s) available in each state you are licensed in. Make sure you are aware of income limits and how the program coordinates with Part D.
2. Know the application process. Be sure you can provide assistance to clients to access the SPAP application and what they need to complete it.
3. Educate Your Clients: Many beneficiaries don’t know these programs exist. Include SPAP information in your annual reviews, especially when you have clients with low-income or high drug-costs.
4. Be aware of SEP Opportunities: If a client is approved for SPAP mid-year, this is an opportunity to review their current drug coverage and potentially move them to a plan that better suits their needs.
5. Coordinate with SHIPs: Partnering with your local State Health Insurance Assistance Program (SHIP) can help your clients apply for SPAPs and get extra help if needed.
6. Stay Compliant: Always document the SEP reason when submitting applications or plan changes, and be sure the client’s enrollment in the SPAP can be verified.

The SPAP SEP is an important but underutilized option for helping Medicare clients reduce prescription drug costs and access more suitable coverage. By understanding and using the guidelines correctly, you can serve clients better and potentially improve your retention and referral rate in the process.

Watch a YouTube video on 2025 SEP Changes for DSNP

Note: It is a good idea to bookmark your state’s SPAP website and use it as a resource when appropriate. Being the agent who knows the programs that can make a real difference in people’s lives builds long-term relationships and trust.

Individuals enrolled in Original Medicare probably have a pretty good understanding of Medicare Part B and what it covers. Many Medicare beneficiaries are surprised when they receive an unexpected bill; these unexpected costs may come from excess charges. Some of you may not have heard of excess charges. We will answer the question; What are Part B excess charges and hopefully help some of you avoid them.

Medicare Part B Excess Charges

Medicare Part B excess charges occur when a doctor or healthcare provider does not accept Medicare assignment and charges more than the Medicare-approved amount for a covered service.

Here’s how it works:

• Medicare sets an “approved amount” for every Part B service.
• Doctors who accept Medicare assignment agree to accept this amount as payment-in-full.
• Providers who don’t accept assignment can charge up to 15% over the Medicare-approved rate.
• The extra 15% is called an excess charge; the beneficiary must pay that amount out of pocket, unless they have supplemental coverage that pays it.

Example of a Part B Excess Charge

Let’s say a beneficiary has met his annual deductible and receives a procedure from his doctor; the Medicare-approved amount for the procedure is $200.

• If the doctor accepts assignment, they’ll charge $200. Medicare pays 80% of the cost ($160). The beneficiary pays the remaining 20% ($40).
• If the doctor does not accept assignment, they can charge up to 15% more: $200 + $30 = $230. Medicare will still pay 80% of the approved $200 ($160), but the beneficiary owes not only their 20% ($40) they also have to pay the excess charge of $30, therefore their total out-of-pocket cost is $70.

When Do Excess Charges Apply

Excess charges only apply to Medicare Part B services and only when:

1. It is a service that Part B covers.
2. The provider does not accept Medicare assignment.
3. The provider charges more than the Medicare-approved amount.

Important: Not all states allow excess charges. For example, Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont have laws that prohibit excess charges for Medicare beneficiaries.

How to Avoid Excess Charges

1. Use Participating Medicare Providers
   Always ask the provider if they accept Medicare assignment before receiving care. This ensures the beneficiary does not pay more than the Medicare-approved amount.
2. Consider a Medicare Supplement Plan (Medigap)
   Individuals who are worried about excess charges, consider a Medigap Plan. The Plan G or Plan F (if you were eligible before 2020) both cover 100% of Medicare Part B excess charges. This provides protection from surprise bills.
3. Check State Rules
   Those who live in states that bans excess charges don’t need to worry about them; providers in those states can’t legally charge more than the Medicare-approved rate.

Unfortunately, some agents or beneficiaries overlook Medicare Part B excess charges when discussing Medicare coverage. That cost can surprise even savvy Medicare beneficiaries. However, with the right knowledge and the right plan, beneficiaries can avoid them altogether.

Click here to watch a quick YouTube video on Medicare Enrollment Periods

Please note; It is important to verify the provider accepts Medicare assignment and beneficiaries may want to consider supplemental coverage for full protection.

Success Strategies for Medicare Agents: How to Grow, Compete, and Thrive

The Medicare market continues to expand, with millions of Americans enrolled and thousands more becoming eligible every day. Although, with opportunity comes competition. Whether you’re new to the field or a seasoned agent looking to stay ahead, success in Medicare sales requires planning and effort. We will go over a few success strategies for Medicare agents that we hope will help your business reach it’s full potential.

Five Essential Success Strategies For Medicare Agents

1. Build a Strong Online Presence

Today’s consumers do their homework before making decisions; especially when it comes to healthcare. A professional, credible online presence isn’t optional; it’s essential.

• Website: Create an easy to use website that clearly explains your services, displays your contact info, and includes a few helpful blog posts or answers to FAQs. watch a video Improve Your Website Traffic With Blogs.
• Google Business Profile: It is important to claim and optimize your business listing so you show up in local searches. When possible have satisfied clients leave a review of your services.
• Social Media: Focus on platforms where your audience is active; in many cases, Facebook is a great place to connect with seniors who are looking for information. Post educational content, reminders about enrollment periods, and success stories.
• Email Marketing: Build and maintain a list of clients and potential clients who opt in to stay top-of-mind throughout the year with helpful updates and tips.

An active digital footprint helps establish your brand, help establish you as a trusted resource and expands your reach far beyond your immediate network.

2. Stay Educated – Commit to Continued Learning

Medicare is constantly changing. New plans, rule changes, and compliance updates roll out constantly. The most successful agents stay current and compliant by:

• Renewing AHIP certification annually
• Attending carrier training webinars
• Joining industry associations or local networking groups
• Subscribing to Medicare and healthcare newsletters
• Complete compliant sales and communication training courses

The more you know, the more confident and credible you become. Clients appreciate the guidance of a knowledgeable agent.

3. Use Up-To-Date Tools

Time is your most valuable asset. The right tools help you stay organized, work efficiently, and grow your business without burning out.

• CRM systems such as; AgencyBloc, BOSS for agents, or other systems help track leads, manage follow-ups, and retain client information securely.
• Quote and enrollment platforms like SunFire or Connecture, simplify side-by-side comparisons and digital applications.
• Automated email sequences can educate leads and onboard new clients with minimal manual effort.
• Calendar tools allow clients to book appointments online, reducing back-and-forth communication.

Automating routine tasks frees up your time and allows you to focus on what really matters: serving your clients and growing your book.

4. Invest in Marketing and Branding

In a crowded field, your personal brand sets you apart. What do people think of when they hear your name? Trustworthy? Knowledgeable? Accessible?

• Logo and branding adds professionalism, consistency and recognition across all communications channels.
• Clear messaging that speaks directly to your ideal client (e.g., veterans, low-income seniors, new-to-Medicare enrollees).
• Lead generation strategies like paid search, Facebook ads, community events, or referral partnerships.

Marketing is not a one-time effort; it’s an ongoing investment. If you’re not actively expanding your visibility, you’re losing ground.

5. Focus On Client Retention

Acquiring a client is just the beginning. Retaining them is where long-term income and reputation are built.

• Annual policy reviews help ensure clients are enrolled in the plan that best fits their current needs. Every year you have an opportunity to prove your value and build your client relationships.
• Birthday cards, holiday greetings, or “thank you” notes add a personal touch and help maintain contact.
• Client newsletters keep them informed and engaged throughout the year.
• Referral requests: A happy client is often your best source of new business, do not hesitate to tactfully ask for them.

Long term clients provide renewal income, referrals, and stability to your business.

Are you ready to work with a partner who supports you; click here for Crowe contracting

Success as a Medicare agent isn’t just about selling policies; it’s about building relationships, staying visible, and continuously learning your craft. By embracing digital tools, strengthening your brand, staying informed, and nurturing client loyalty, you can create a sustainable and thriving Medicare business that continues to grow.

For many people trying to navigate Medicare, understanding how and when out-of-pocket costs apply can be overwhelming. The terminology “first dollar Medicare services” may cause confusion for some individuals. We will explain what it actually means and how they work in the context of Medicare services.

First Dollar Coverage

First dollar coverage refers to insurance benefits that begin immediately. The enrollee is not required to, pay a deductible, copay, or coinsurance before the carrier provides coverage for a medical service. This coverage literally begins from the “first dollar” of a medical bill providing the highest level of financial protection.

With Original Medicare (Parts A and B), this kind of coverage is not included by default, although it may be accessed through either supplemental plans or Medicare Advantage plans in some circumstances.

Original Medicare: No First Dollar Coverage

Medicare is divided into Part A (hospital insurance) and Part B (medical/outpatient insurance).

Original Medicare enrollees are responsible for the following out-of-pocket costs:

• Deductibles: Part A ($1,632 per benefit period in 2025); Part B ($240 annual)
• Coinsurance: 20% for most Part B services after the deductible
• Copays: Varies depending on the service or provider

Please note; although Medicare covers a significant portion of approved healthcare costs, it does not offer first dollar coverage when used on its own. Beneficiaries are responsible for cost-sharing amounts unless they purchase supplemental coverage.

First Dollar Coverage for Medicare Services

In general, there are two ways Medicare beneficiaries receive first dollar coverage:

1. Medicare Supplement (Medigap) Plans

The Medigap plans listed below cover most or all out-of-pocket costs after Original Medicare pays its share.

• Plan F: Offers true first dollar coverage. This plan covers both Part A and Part B deductibles as well as all coinsurance and copays for approved medical expenses as well as excess charges.
• Plan C: Similar to Plan F but doesn’t cover excess charges. Important: Plans F and C are not available to individuals who were eligible for Medicare after January 1, 2020.
• Plan G: Covers all approved Medicare expenses; except the Part B deductible, making this plan very close to first dollar coverage.

Beneficiaries enrolled in a Plan F shouldn’t have to pay anything out-of-pocket for Medicare covered services.

2. Some Medicare Advantage (Part C) Plans

Medicare Advantage plans are an alternative to Original Medicare. Some Medicare Advantage plans offer enrollees:

• $0 monthly premiums
• $0 copays for primary care, lab work, preventive services, or telehealth
• Reduced out-of-pocket costs through annual limits

Although technically they are not considered “first dollar” coverage, some plan benefits can effectively eliminate upfront costs for specific services, depending the plan design.

Keep in mind: Medicare Advantage plans may include networks, referrals, and prior authorization requirements.

Watch a quick YouTube video on Medicare enrollment periods

Examples of First Dollar Medicare Service

• Example 1: A Medigap Plan F enrollee visits the emergency room. The bill is fully covered; no deductible, no copay, no coinsurance. This is real first dollar coverage.
• Example 2: A Medicare Advantage plan enrollee has a $0 copay for a primary care visit. Although the plan may have a deductible for other services, this specific visit is a first dollar service.
• Example 3: A individual with Original Medicare and no supplemental coverage uses the services of a specialist. This individual must meet the Part B deductible and then pay 20% for all approved charges. In other words, this is not first dollar coverage.

Why First Dollar Coverage Matters

• Predictable healthcare costs
• Easier budgeting for individuals on fixed incomes
• Reduces the risk of surprise bills
• Encourages timely medical visits and screenings

Possible Downside

• Higher monthly premiums (especially with Medicare Supplement Plans)
• Less flexibility (if beneficiaries opt for a Medicare Advantage Plan) they must use specific provider networks.
• Limited plan availability for more recent enrollees (Medicare Supplement Plan F and Plan C enrollment restrictions).

First dollar Medicare services are about financial peace of mind. While Original Medicare doesn’t provide this level of coverage on its own, many beneficiaries learn that Medicare Supplements or Medicare Advantage plans reduce or eliminate the high price of medical care.

Beneficiaries who like predictable expenses and minimal out-of-pocket costs, may opt for a plan that offers first dollar coverage. As a licensed Medicare agent, it is important to understand your clients healthcare needs and budget to offer plan choices that provided the best benefit options.

Although there are millions of people on Medicare, many find it a confusing subject especially since there are so many different parts to it. For individuals approaching 65 or anyone who or just wants to understand more about how this insurance works, here’s a brief answer to the question; what is Original Medicare and what does it cover.

What Is Original Medicare

The federal government established Original Medicare, a federal health insurance program, in 1965. The following individuals may qualify for Medicare benefits:

• People age 65 or older
• Certain younger people with qualifying disabilities
• People with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease)

There are 2 parts of Original Medicare: Part A and Part B.

Medicare Part A

Medicare Part A is sometimes referred to as hospital insurance. It provides coverage for:

• Inpatient hospital care (once the enrollee is formally admitted)
• Skilled nursing facility care (following a qualifying hospital stay)
• Home health care (limited and medically necessary services)
• Hospice care for individuals with a terminal illness

For most people, Part A is free,there is no premium payment as long as eiither the beneficiary or thier spouse worked and paid Medicare taxes for a minimum of 10 years.

Please note: Although Part A covers hospital stays, it doesn’t cover long-term care such as; nursing homes, custodial care or unlimited days in a hospital or facility. There are limits to what it pays; beneficiaires must pay a portion of their expenses (cost-sharing), such as deductibles and coinsurance and copays.

Medicare Part B

Medicare Part B is also known as medical insurance. It provides coverage for the following:

• Doctor visits and outpatient medical care
• Preventive services such as; wellness visits, flu shots and cancer screenings
• Durable medical equipment (DME) this include things like; walkers, wheelchairs, oxygen as well as some diabetes supplies and more
• Lab tests and diagnostic imaging
• Mental health services
• Some home health care

Unlike Part A, beneficiaries do pay a monthly Part B premium. Fo rmost people, this is a standard amount although higher-income beneficiaries may pay an additional cost.

Click here to learn more about Part B eligibility

Part B coverage includes an annual deductible (this amount is adjusted annually). Typically beneficiaries pay 20% coinsurance for most covered services; in other words, Medicare pays about 80% of the cost leaving enrollees responsible for the remaining 20%.

What Original Medicare Doesn’t Cover

Original Medicare provides coverage for many medical expenses; although, they do not cover everything. Some important things to know about what Medicare does not cover:

• Prescription drugs (beneficiaries must enroll in separate Part D plan)
• Routine dental, vision, and hearing care
• Long-term custodial care
• Most care received outside the U.S.

In order to fill some of these coverae gaps, many people purchase additional insurance. Some of the plans people choose are; Medicare Supplement (Medigap) plans, Stand-alone PDP (prescprion Drug) plans, Medicare Advantage (Part C) plans. Beneficiaries also may opt for ancillary coverage like dental, vision and hearing or cancer heart attack and stroke plans.

Medicare agents; learn how to sell ancillary products with Medicare – watch a quick video.

Original Medicare provides valuable health coverage for millions of Americans, but it’s important to understand what it cover and what it doesn’t. Knowing the basics helps beneficiaries make informed decisions and avoid unexpected costs.

Navigating the world of Medicare can be overwhelming, especially when it comes to choosing the right supplemental coverage. That’s why it is important to understand what Medigap standardized benefits are and how they work.

Medigap is a type of private insurance that helps beneficiaries cover the “gaps” in Original Medicare (Parts A and B). Medigap plans cover things like; deductibles, coinsurance, and copays. What many people don’t realize is that Medigap policies are standardized, meaning the benefits for each plan type are the same, no matter which insurer you choose.

What “Standardized” Means

Starting in 1992, federal law requires all Medigap policies to adhere to standardized benefit structures, designated by letters: Plans A through N. The only real difference in plans is the premium each carrier charges for the plan. Although insurance companies charge different premiums, the benefits for each plan letter must be identical no matter who the provider is. In other words, every Plan N has to provide the exact same coverage for medical expenses no matter what company offers it.

Standardization makes it easy for beneficiaries to compare plans without worrying about differences in coverage. They can simply compare cost and company ratings to find the best options.

Examples of Medigap Plan options

• Plan A: This is the most basic plan option. It provides coverage for Medicare Part A coinsurance and hospital costs, Part B coinsurance, and the first three pints of blood.
• Plan G: The most comprehensive plan available to those who turned 65 after 1-1-2020. It covers all Medicare approved expsnes with the exception of the Part B deductible.
• Plan N: Offers lower premiums than Plan G and covers a portion of the copays for doctor visits and hospital visits. The enrollee will still have a small copay for Medical services. This plan does not cover the Part B deductible or excess charges.

Some States Have Different Medigsp Standards

Although most states follow the federal standardization model, Massachusetts, Minnesota, and Wisconsin have their own versions of standardized Medigap plans. These states use their own benefit structures however, they still follow the principle of offering consistent benefits across insurers within their states.

Please Note

• Plan C and Plan F are no longer available to beneficiaries who became eligible for Medicare on or after January 1, 2020. These plans provided coverage for the Medicare Part B deductible, which new legislation phased out to cut back on the overuse of services.
• Beneficiaries must have both Medicare Part A and Part B to enroll in a Medigap plan. There is a premium for Medigap plans in addition ot the Part B premium.
• Medigap works with Original Medicare, beneficiaires cannot use a Medigpa plan with a Medicare Advantage (Part C) plan.

Why Standardization is Important

Standardization simplifies decision-making for Medicare beneficiaries. It eleiminates the need to decipher insurnace benefits accross multiple insurance companies; instead, the focus is on price, company reputation, and rate increase history.

Watch a quick YouTube video on Medicare Supplement Underwriting

This helps foster competition between companies based on cost and service quality instead of confusing plan designs.

Choosing a Medigap plan doesn’t have to be a guessing game. With standardized benefits, benficiaries can make apples-to-apples comparisons between insurers and choose the coverage that meets both healthcare and financial needs.

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As Medicare beneficiaries consider supplemental coverage to fill the gaps left by Original Medicare (Parts A and B), many turn to Medigap plans. Among them, The HDG (High Deductible Plan G) stands out for the comprehensive benefits it provides at a lower monthly premium, but with a catch: a high annual deductible. If your client is considering a HDG Plan, understanding the pros and cons of HDG Plans will help them make an informed decision.

What Is HDG

HDG or High Deductible Plan G provides the same benefits as standard Medigap Plan G; one of the most comprehensive Medigap options, but only after the beneficiary meets an annual deductible. Each year, CMS decided what that deductible amount will be; in 2025, the deductible is $2,800.

Once the beneficiary pays the deductible for the year, the plan pays 100% of covered Medicare expenses, just like a standard Plan G.

Pros of HDG

1. Low Monthly Premiums

The biggest selling point of the HDG plans is their affordability upfront. The premiums for HDG Plans is typically much lower than standard Plan G, in some cases, less than 1/3 of the price, making this a great option for healthy enrollees or individuals living on a fixed income who want to be prepared for unexpected health issues.

2. Full Coverage

Once the beneficiary meets the annual deductible, HDG covers:

• Part A coinsurance and hospital costs
• Part B coinsurance/copays
• Blood (first 3 pints)
• Skilled nursing facility coinsurance
• Part A hospice care coinsurance/copays
• Medicare Part A deductible
• Part B excess charges
• Foreign travel emergency care (up to plan limits)

3. Good Option for Health Individuals

Those who rarely seek medical care may not reach the annual deductible; in other words, out-of-pocket spending could stay well below the cost of a standard Plan G’s premium.

4. Standard Benefits

Just like all other Medicare Supplement plans; HDG is standardized. Therefore, after the deductible is met, the benefits are the same regardless of insurer. The only thing to compare are the premiums and service quality, not the coverage.

Cons of HDG

1. High Upfront Costs

Individuals who require frequent care (doctor visits, outpatient services, hospital stays) pay out-of-pocket until they reach the $2,800 (in 2025) deductible. For some, this could all happen early in the year, and the savings from lower premiums may not offset that.

2. Not Ideal for Some Budgets

For individuals on a tight or fixed income, facing unexpected out-of-pocket expenses could be difficult to manage before the deductible is met, even if the plan is technically cost-effective over time.

3. Premiums Aren’t Fixed

Although the premiums are much lower than standard Plan G, HDG premiums (like all Medigap plans) can still increase annually, leading to less savings over time. It may be a good idea to check the rate history of the insurer before choosing a plan.

4. Deductible Increases

Each year, CMS sets the annual deductible and it usually has a slight increase each year. This unpredictability can cause some issues with long-term budgeting when compared to standard plans.

Who May Be a Good Fit For HDG

• Healthy individuals with few healthcare needs
• Younger Medicare beneficiaries (e.g., age 65-70) not expecting major procedures
• Those comfortable with financial risk with the means to pay the deductible if necessary
• Budget-conscious individuals looking for low monthly expenses

Medicare HDG provides similar peace of mind to regular Plan G. It is just delayed until after the deductible is met. It’s a good option for those who can afford some out-of-pocket risk in exchange for lower premiums. As with all coverage options, it’s not a one-size-fits-all solution.

A licensed Medicare agent can help run the numbers and explore quotes tailored to an individual’s specific needs.

In the world of sales, one truth stays constant: people are much more likely to buy from those they know and trust. For that reason, agents who focus on local marketing are often more successful than those who sell exclusively over the phone or online. Although digital ads and lead vendors can be great tools, nothing builds long-term credibility and referrals like mastering local Medicare marketing and establishing yourself as the local Medicare expert.

So how can you, as a Medicare agent, have an impact on your local market? Take a look at some helpful tips below and grow your book of business.

Establish Yourself In The Community

Before you begin a marketing campaign in your community, make sure your branding reflects the local area. Use localized messaging in your advertising, website and even your business cards.

• Feature city or county names in your taglines (“Your Fairfield County Medicare Plan Enrollment Specialist”)
• Include popular landmarks or maps in mailers and flyers
• Mention that you work with several local plans and providers

Consider: Creating a dedicated landing page for each major city or zip code you serve. This can help improve website SEO and build credibility with local clients.

Community Involvement

People trust people they see regularly and are familiar with; especially when it comes to something as personal as healthcare. Make sure you show up where potential clients are. Here are a few suggestions:

• Volunteer at local food pantries
• Offer to help at local senior centers or events
• Sponsor a booth at community health fairs
• Provide free Medicare 101 presentations at libraries, churches, or senior centers

These events are not about a sales pitch; they’re about establishing yourself as a member of the community and a trusted, local resource.

Local Online Marketing

You don’t need a massive ad budget to be seen online. The important thing is to show up in local searches.

• Google Business Profile: Claim and optimize your listing. Add real client reviews, update your service area, and post updates.
• Facebook and Nextdoor: Participate in local discussions, share useful tips, and post your events and the services you provide.
• Local SEO: Include keywords like “Medicare agent in (City)” or “Help with Medicare plans near (ZIP code)” in your website content.

Additionally: Write blog posts about Medicare topics and include a local area in the name, such as: “Top Medicare Advantage Plans in (Your City)” or “What Seniors in (You County) Should Know About the Medicare Part B Giveback”.

Watch a Quick YouTube video on how to improve your website traffic with blogs

Build Relationships with Local Professionals

Other area professionals who serve your target audience can be excellent referral partners. Keep in mind; this relationship should work both ways:

• Independent pharmacists
• Local doctors
• Home health agencies
• Senior housing communities
• P&C Insurance agents
• Financial planners
• Social workers

Offer to co-host events, provide educational materials, or train their staff on Medicare basics or benefits. Providing free services to thier clients allows them to build trust and opens doors.

Mail or Flyers with Local Feel

Direct mail is sometimes an effective tool; especially when it feels personal. Do not end up in the waste basket:

• Use your photo (this helps you become recognizable) and a friendly message
• Reference a local community or event (“Join us at the Danbury Library Medicare Seminar!”)
• Offer a free consultation with your contact info

Be Available Year-Round

Some agents make the mistake of marketing only during AEP (Annual Enrollment Period), then disappear the rest of the year. However ther are many other opportunities to provide service to Medicare beneficiaries and grow your book:

• Offer help with SEPs (Special Enrollment Periods), or Medicaid, LIS (Extra Help).
• Follow up with clients after enrollment to ensure their questions or concerns are taken care of; provide ongoing support.
• Host workshops or Q&A sessions in a familiar location on a consistant basis.

Staying visible and providing helpful advice provides opportunities to earn referrals naturally; outside of AEP.

Final Thoughts

Local marketing isn’t about using aggressive sales tactics or decptive advertisements; it’s about connection and trust. Once an agent is established as a familiar, reliable, and helpful presence in the community, they don’t just get referrals, they build lasting relationships.

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Master your local market by showing up, serving with integrity, and positioning yourself as a reliable Medicare resource.

In this post, we discuss how agents can use the Advanced Diabetes Supply Agent Resource. As a Medicare agent, your clients rely on you for guidance not just on policy selection but for access to healthcare resources. For clients living with diabetes, managing their condition requires a constant supply of testing materials, continuous glucose monitors (CGMs), insulin pumps, and education. One valuable partner in supporting these clients is Advanced Diabetes Supply (ADS).

Advanced Diabetes Supply

Advanced Diabetes Supply is a specialized medical supply company focused exclusively on diabetes care. They are one of the nation’s leading suppliers of diabetes testing supplies and equipment, including:

• Continuous glucose monitors (CGMs) like the Dexcom G7 and FreeStyle Libre systems
• Insulin pumps and pump supplies
• Blood glucose meters, lancets, and strips
• Diabetes-friendly nutritional products – Click here for a Diabetes friendly food list

ADS also works with both Medicare and private insurance carriers, making them an excellent partner for agents looking to streamline care and support for their clients.

Watch a YouTube video to learn more about ADS – US Med program information

Why Recommend ADS to Clients

1. Expert Navigation of Insurance Coverage

Many clients struggle to understand what diabetes supplies are covered by Medicare or private insurance. ADS has a dedicated team that works directly with insurance providers to verify benefits and get authorizations; minimizing the stress and the wait for necessary supplies for your clients.

Important: If you have Medicare clients managing diabetes, ADS knows exactly how to process their CGM or testing supply orders in accordance with Medicare guidelines.

2. Home Delivery and Reorder Reminders

ADS ensures timely home delivery of diabetes supplies and provides helpful reorder reminders; an invaluable service for clients who may forget or have difficulty accessing a pharmacy.

3. Excellent Customer Service

Your client’s well being is important to you. That is why the ADS patient-centric service model is a great way to ensure clients are taken care of. Their trained representatives are knowledgeable, friendly, and make it easy for clients to get the support they need without confusion or delays.

4. Fast Enrollment Process

Agents can refer clients to ADS with a simple process:

• Fill out a referral form (available on the ADS website)
• Provide the client’s basic insurance and medical information
• ADS handles the rest—including contacting the physician, obtaining prescriptions, and setting up shipments

How to Refer Your Clients to Advanced Diabetes Supply Agent Resource

You can guide your clients to ADS in a few easy steps:

1. Visit: www.northcoastmed.com
2. Call: ADS’s dedicated phone line for new referrals: 1-866-422-4866
3. Fax: Completed referral forms to 1-866-551-2909
4. Email: For agent-specific questions or to request referral tools, contact their provider support team

Many agents also keep brochures or digital referral kits on hand to explain the benefits of using ADS.

Better Client Relationships

Helping clients manage chronic conditions like diabetes doesn’t stop at policy enrollment. By referring them to trusted resources like Advanced Diabetes Supply, you build stronger relationships and improve health outcomes; while reducing coverage confusion and service delays.

As a proactive, service-minded agent, adding ADS to your toolkit is a smart move that benefits both your clients and your business.

Agents who would like more information; contact us at 203-796-5403. We will provide contact information for an ADS representative.

Because so many people confuse the terms Medicare and Medicaid, we will discuss Medicare vs Medicaid and explain the difference between the two terms. Although the terms are often mentioned in the same sentence, these programs serve different populations, have different eligibility rules, and provide different types of coverage.

Medicare

Medicare is a federal health insurance program. In general, beneficiaries of Medicare are:

• Individuals who are 65 and older
• Those under 65 with specific qualifying disabilites
• People who have beendiagnosed with either ESRD (End-Stage Renal Disease) or ALS

The Parts of Medicare

1. Part A – Hospital insurance (covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care)
2. Part B – Medical insurance (covers outpatient care, doctors’ visits, preventive services, and durable medical equipment)
3. Part C – Medicare Advantage Plans (offered by private insurers as an alternative to Original Medicare, often including vision, dental, and drug coverage)
4. Part D – Prescription drug coverage

Medicare Cost

Medicare is not entirely free. Most people get Part A premium-free, but they pay a monthly premium for Part B. They also may pay a premium for Part C and/or Part D. There are also optional Medicare Supplement plans available which also have a monthly premium. Medicare costs include things like deductibles, co-pays and coinsurance. The out-of-pocket amounts differ depending on the plan or plans chosen.

Medicaid

Medicaid is a program that is put in place by both federal and state governments. Individuals who receive this coverage are:

• People with low income who meet the income threshold amount (this varies by state)
• Certain pregnant women and children who meet the income level required
• People with disabilities with income that falls into the state requirement
• Some seniors, including those who also qualify for Medicare

Because Medicaid is administered by each state, the programs vary by state, including eligibility requirements and the services that the program provides.

Medicaid generally covers

• Hospital and doctor visits
• Long-term care (nursing home care)
• Home and community-based services
• Preventive care, mental health services, and more

In many cases, Medicaid covers services that Medicare does not; such as long-term custodial care.

Medicaid Cost

In most cases, Medicaid is either free or very low cost for eligible individuals. States may charge small copays for some medical services.

Medicare vs Medicaid – Key Differences

Feature	Medicare	Medicaid
Who It Serves	Primarily people 65+ or those with qualifying disabilities	Low-income individuals and families
Administered By	Federal government	State governments (with federal oversight)
Cost to Participants	Monthly premiums, deductibles, copays	Usually free or low-cost
Long-Term Care	Limited (short-term rehab only)	Covers long-term care, including nursing homes
Prescription Drugs	Must purchase Part D or Medicare Advantage coverage	Included in most Medicaid programs

Can Individuals Have Both

The short answer is, yes! Some individuals qualify for both programs. These are called “dual eligibles.” For these people:

• Medicare typically pays first
• Medicaid may help cover Medicare premiums, deductibles, and services that Medicare does not cover (like long-term care)

Seniors with limited income or disabled individuals who qualify as dual-eligible receive comprehensive coverage at little to no cost.

Additionally; Medicare and Medicaid both play crucial roles in our healthcare system. They each serve a different purpose and population. Understanding who qualifies and what each program covers helps agents, individuals and families make informed healthcare decisions.

For assistance with eligibility or enrollment, consider contacting:

• Medicare.gov or 1-800-MEDICARE
• Click here for each state’s Medicaid office
• A local State Health Insurance Assistance Program (SHIP) for free counseling

When it comes to providing assistance to our clients, knowing all the services available to them is crucial. One important service we need to know about is the Medicare PACE program(Program of All-Inclusive Care for the Elderly).

Designed to help older adults meet their healthcare needs in the community instead of a nursing home or other facility, PACE is a unique and vital option for many Medicare and Medicaid beneficiaries. It provides a way to age with dignity and maintain independence.

In this post, we’ll break down what PACE is, who qualifies, what services it covers, and why it’s an important part of our healthcare system.

What Is the PACE Program

PACE is a program that provides comprehensive medical and social services to some elderly individuals living in the community who require assistance. A skilled team of healthcare professionals work with beneficiaries to coordinate their care. The bulk of the participants are dual eligible (on Medicare & Medicaid). The main objective of the program is simple: to help seniors stay in their homes and communities as long as possible while they receive high-quality, coordinated care.

Typically, PACE programs combine medical care, therapies, transportation, home care, and even meals; providing beneficiaries a full-service healthcare solution under one umbrella.

Who Is Eligible for PACE

To enroll in a PACE program, individuals must meet the following criteria:

• Be 55 years of age or older
• Live in a PACE service area (programs are not available everywhere)
• Be in need of nursing home level of care (the state of residence must certify this)
• Have the ability to live safely in the community with the help of PACE services

PACE is available to individuals who are eligible for Medicare, Medicaid, or who meet the criteria listed above. Some individuals pay nothing for PACE services, while others may have to pay a monthly premium.

Some Services PACE Covers

PACE offers a wide range of services, including but not limited to:

• Primary and specialty medical care
• Prescription drugs
• Nursing services
• Hospital and emergency care
• Home care and personal care
• Physical, occupational, and recreational therapies
• Social services and case management
• Adult day care
• Meals and nutritional counseling
• Transportation to medical appointments

In general, if a participant needs a service for their care and well-being, PACE either provides it or arranges for the beneficiary to receive it.

How PACE Works

Each participant in a PACE program has an team of health professionals who work together to coordinate care. This team includes doctors, nurses, social workers, physical therapists, and other specialists. Each individual has a plan tailored to thier needs. The team will adjust the care plan as needed.

PACE organizations receive a fixed monthly payment for services. If the beneficiary is on Medicare and Medicaid, the beenficiary pays nothing for this program. If the individual does not qualify for Medicaid, they are responsible to pay the monthly premium for long-term care portion of the program. They will also have to pay a premium for Part D drug coverage.

In general, beneficiaries receive all their healthcare services through the PACE organization. Many of the services are received at a PACE center, where participants see doctors, join therapy sessions, enjoy meals, and socialize.

Why PACE is Important

PACE programs offer an alternative to traditional nursing home care, promoting autonomy, better health outcomes, and a higher quality of life. The program may delay or even prevent the need for long-term nursing home placement. This benefits both individuals and healthcare systems focused on reducing the high cost of institutional care.

Because PACE focuses on preventive care and early intervention, participants often experience fewer hospitalizations and better management of chronic conditions.

How to Apply for PACE

For individuals who may be eligible for the PACE program; find out if there’s a program near you or contact Medicare or your state’slocal Medicaid office for more help.

For seniors who want to stay in their homes and communities, and for families looking for assistance with comprehensive care, PACE is a powerful option. Although it’s not available everywhere, the service area is growing. This is defintely worth considering for anyone who meets the criteria.