The Medicare Advantage market has experienced substantial growth in recent years, with Medicare C-SNP market growth one of the fastest-growing segments. C-SNPs cater to individuals with specific chronic illnesses, offering tailored benefits and care coordination. As healthcare costs rise and the over 65 population grows, C-SNPs are becoming the plan of choice for both beneficiaries and insurers.
What Are C-SNPs
Medicare Advantage Special Needs Plans (MA SNPs) provide targeted care and services to specific beneficiaries. Within this category, C-SNPs focus on beneficiaries with qualifying chronic conditions such as diabetes, cardiovascular disease, or chronic lung disorders. C-SNPs offer enhanced care management, specialized provider networks, and condition-specific benefits. These plans go beyond what traditional Medicare or standard MA plans provide.
Growth of the C-SNP market
Several factors are fueling the growth of the C-SNP market:
Chronic disease prevalence – Due to the aging U.S. population, the number of individuals with chronic conditions is rising. According to the CDC, six in ten adults have at least one chronic disease. This has increased the demand for tailored healthcare solutions.
Regulatory support – CMS continues to promote C-SNP expansion, offering increased flexibility in plan design and benefits to better meet the needs of chronically ill beneficiaries.
Increased insurer participation – As health plans recognize the financial and clinical benefits of offering C-SNPs, more insurers are entering the market. This leads to greater competition and plan innovation.
Improved care coordination – C-SNPs focus on the management or chronic conditions and care coordination, which aligns with the healthcare industry’s push towards value-based care.
Enhanced supplemental benefits – Many C-SNPs offer non-medical benefits, such as meal delivery, transportation, and in-home support services. This makes them attractive to eligible beneficiaries.
Challenges of C-SNPs
Regulatory issues – C-SNPs must meet stringent CMS requirements, including annual Model of Care (MOC) approvals and strict care coordination standards.
Enrollment requirements – Because C-SNPs require beneficiaries to have a qualifying chronic condition, plan enrollment may be more complicated than traditional MA plans.
Provider networks – Ensuring access to specialists and chronic disease management programs may be difficult in rural or underserved areas.
Watch a quick YouTube video on changes to DSNP & LIS members
The Future of C-SNPs
The future of the C-SNP market seems promising, with continued growth in personalized healthcare solutions and care coordination. As CMS allows flexibility in benefit design and insurers look for growth strategies, C-SNPs have an opportunity to become an even bigger part of the Medicare Advantage market.
Even with some challenges ahead, the potential for improved patient outcomes and cost efficiency make C-SNPs an important part of Medicare’s future.
In a memo dated March 20, 2025, CMS withdrawals DST SEP change. CMS announced the withdrawal of the changes to the enrollment process that were set to take place on April 1,2025. In other words, there will be no changes to the DST SEP policy that is currently in place.
Why this is good news
The reversal of this decision is great news for both agents and their clients. Because it takes the burden off of already stressed clients who have had to deal with a weather related or other FEMA declared area emergency. This means, the current SEP will not change. Beneficiaries do not have to self-enroll using 1-800-Medicare to use this SEP.
As per the CMS memo of March 20, 2025, insurance carriers will accept enrollment applications submitted by licensed agents. This helps Medicare beneficiaries avoid both stress and confusion. It also allows agents to ensure the process is completed correctly and in a timely manor.
Medicare DST SEP
The DST SEP is an enrollment election period for qualified Medicare beneficiaries . CMS provides this SEP to those who miss a valid election period due to weather-related emergencies or FEMA declared disasters.
Only areas where state or local government officials declare an emergency or disaster can use this SEP. This SEP starts the date the incident occurs and continues for two months after it starts or the extension period begins. It can be in place for up to a year after the incident.
Please note: Beneficiaries can either enroll in or disenroll from a Medicare plan using the DST SEP. New coverage goes into effect the first day of the month following the submission of the application.
Eligibility for the DST SEP
To qualify for this SEP, the beneficiary must live in the area the disaster occurred in. In addition, they must have missed a valid election period (AEP, IEP or OEP, or an SEP) because of the emergency.
In some cases, individuals use the SEP if they require help from a family member or caregiver who is impacted by a disaster. This can prevent them receiving the assistance they need during an enrollment period.
Watch a quick YouTube video on the changes to DSNP SEPs
A couple more reasons to use the DST SEP: When a disaster causes the inability to access Medicare plan information or submit an application. Another example is; when a disaster impacts a healthcare facility or provider. This can hinder the beneficiary’s access to information necessary to make an informed enrollment decision.
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CMS has strick regulations in place for anyone offering Medicare plans over the phone. Agents who do not adhere to the rules could face strict penalties. Penalties can include; loss of contracts, monetary fines and damage to your professional reputation. To ensure compliance and build trust with potential enrollees, here are some tips for conducting compliant Medicare phone sales.
Obtain permission to contact
CMS rules strictly regulate how and when agents can contact potential enrollees. If you are calling about Medicare Advantage or PDP plans, to remain compliant; be sure to have documented permission to contact before making outbound calls. Do not cold call or use leads that did not provide consent for the call. Follow all CMS guidelines regarding unsolicited communications, this includes text messages and voicemails.
Comply with Do-Not-Call (DNC) regulations
Agents must respect consumer preferences regarding contact. To comply; make sure you use phone leads that are cross checked with the National Do-Not-Call Registry. Even when you do this, keep in mind the FTC updates the list constantly and you face a fine if you contact someone who is on that list.
Use approved scripts and disclosures
When discussing Medicare plans, agents must adhere to CMS-approved scripts and include required disclaimers.
Agents must clearly state that they do not represent or work for Medicare, but rather the specific carriers and plans they are contracted with. There are standard disclaimers that must be read to prospects. This includes: “We do not offer every plan avialable in your area”. It is always important to provide acurate plan information and do not mislead or pressure the consumer.
Watch a quick YouTube video on updates to the one-to-one consent rule
Avoid prohibited sales tactics
Medicare has strict guidelines against high-pressure sales tactics. Agents should not mislead beneficiaries into thinking they must enroll in a plan immediately (high pressure sales). They must not make unsupported claims about plan benefits or when comparing plans. Always allow the prospect to ask any questions they have and be sure they understand what is said.
Follow call recording and documentation rules
CMS requires that all Medicare Advantage and Part D sales calls be recorded in their entirety. In order to be complaint; calls must start with a disclosure that the conversation is being recorded, the prospect must give permission for this.
Agents must keep call recordings for a period of no less than 10 years as required by CMS and the carrier. It is important to document all client sales interactions; this protects both the agent and the client. A SOA is an important part of this process.
The SOA (Scope of Appointment)
When conducting a Medicare sales call, agents must adhere to the agreed-upon topics. Do not discuss additional products that are not included in the SOA. If the client wants to talk about other products, you must collect a new SOA that covers them. In order to be compliant, agents should keep the SOA for a period of 10 years.
Learn more about SOAs
Provide clear and accurate information
Misinformation or omitting critical details can lead to compliance violations. Make sure you know what the beneficiary is looking for. Discuss current coverage, doctors, medications and their needs and budget.
To maintain integrity, explain benefits, costs and network limitations clearly. Ensure enrollees understand the differences between the plan types (Medicare Advantage, Supplements & PDPs).
Ensure post-enrollment compliance
Your responsibility does not end after enrollment. To ensure your client is happy with their choice, make followup calls and discuss any questions or concerns they have. Make sure they understand their new plan benfits and how to use them. This helps keep clients happy and also helps avoid rapid disnerollments and chargebacks.
If you are ready to join the team at Crowe; click here for online contracting
Staying compliant in Medicare phone sales is crucial to protecting consumers and maintaining your credibility as an agent. By following CMS regulations, using approved scripts, and respecting consumer rights, agents can foster trust and ensure ethical sales practices. Always refer to the latest CMS guidelines or seek guidance from a your upline.
Due to the recent changes in DSNP SEPs, many agents are asking questions about the different levels of Medicare DSNPs. Medicare Dual-Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage plan designed specifically for individuals who qualify. These plans offer specialized benefits tailored to meet the unique healthcare needs of dual-eligible individuals. However, not all D-SNPs are the same, and understanding the different types can help beneficiaries make informed decisions about their coverage.
We provide an overview of the DSNP models below:
CO-D-SNPs (Coordination Only D-SNPs)
CO D-SNPs meet the minimum CMS requirements for D-SNPs. All plans meet state requirements and hold a contract with state Medicaid agencies in the states they operate in. These plans also coordinate the delivery of Medicare and Medicaid services to their members. Because these plans do not qualify as HIDE or FIDE, beneficiaries cannot use the DSNP SEP to enroll in one of these plans. However, they can enroll in these plans during another valid election period.
Learn more about the DSNP SEP
AIP D-SNPs (Applicable Intergrated Plans) – Coordination Only EAE
AIP D-SNP is a fully integrated DSNP with exclusively aligned enrollment or a highly integrated DSNP plan with exclusively aligned enrollment and cover certain Medicaid benefits. To qualify as a AIP DSNP, plans must be either FIDE or HIDE SNP with EAE or a CO D-SNP with EAC that covers primary and acute care. It must also cover Medicare cost sharing and at least one of these home health services; medical supplies, equipment appliances or nursing facility services.
AIP D-SNPs must implement unified plan level appeals as well as grievance procedures.
Click here for full definition of DSNPs
HIDE SNPs (Highly Intergrated D-SNPs)
The HIDE SNPs provide Medicaid benefits to members either through the plan or an affiliated Medicaid managed care plan. Coverage includes LTSS (long term services and support), behavioral health care or both. Plans have a contract for Medicaid coverage with the state Medicaid agency. This may be accessed through the DSNP, the DSNP’s parent organization or another organization owned by the DSPs parent company. This contract must cover the entire service area.
FIDE SNPs (Fully Integrated D-SNPs)
These plans provide Medicare and Medicaid benefits under one entity that holds a Medicare advantage contract and a contract with the state Medicaid agency. FIDE SNPs must cover both Medicaid primary and acute care as well as LTSS, This includes at least 180 days each year of nursing facility coverage.
What is EAE
EAE is exclusively aligned enrollment which happens when states require DSNP enrollment be limited to only those who are fully dual eligible. Individuals must also receive coverage of Medicaid benefits through the DSNP or a Medicaid managed care plan owned by the same parent company as the DSNP. When a plan is exclusively aligned, it facilitates coverage integration ensuring better care for enrollees.
Why we need alignment
Alignment provides assurance that Medicare and Medicaid work together to provide comprehensive, coordinated coverage for dual eligible individuals. This provides members with a well organized system of care that improves health outcomes.
Watch a quick YouTube video on the new DSNP enrollment
How it works with D-SNPs
Aligned FIDE SNPs – these plans align Medicare and Medicaid under 1 carrier as 1 entity. Members access benefits with only 1 ID card. This helps members avoid confusion and ensures members easily get all the benefits they need.
Aligned HIDE SNPs – HIDE plans align Medicare and Medicaid under 1 carrier using 2 separate entities, possibly requiring members to use 2 different ID cards. In some cases, this may be confusing for members.
Unaligned HIDE SNPs – Unaligned plans operate as 2 separate managed care plans. The Medicare plan is managed by the Insurance Carrier while the Medicaid coverage is managed by the state Medicaid organization. This can result in at least 2 ID cards and in some cases, more.
Find out about other SEPs for Medicare enrollment
Choosing the Right D-SNP Plan
When selecting a D-SNP, it is crucial to consider the level of Medicaid eligibility, the extent of additional benefits, and the coordination of services. Since plan availability varies by state, beneficiaries should use licensed Medicare agents to review their options carefully to find a plan that best meets their needs.
For more information on Medicare D-SNP options in your state, consult Medicare.gov or your local Medicaid office.
Long-term care (LTC) insurance provides a solution for covering the costs of nursing homes, assisted living, and in-home care. However, due to rising premiums and strict underwriting, many individuals are seeking alternative insurance products to ensure they have financial protection for future care needs. Below, we explore some of the most viable alternatives to LTC insurance.
Hybrid Long-Term Care Insurance Policies
Hybrid policies combine LTC benefits with life insurance or annuities. These policies provide a death benefit if the beneficiary does not fully use the LTC benefits. This makes them a good option for those concerned about losing money on unused coverage.
Life Insurance with Long-Term Care Riders: These policies allow policyholders to use part of their death benefit to cover long-term care expenses.
Annuities with Long-Term Care Benefits: Some annuities offer enhanced payouts if funds are used for qualified long-term care expenses.
Short-Term Care Insurance
Short-term care (STC) insurance provides coverage for a limited time period. In most cases, up to one year. These policies are more affordable and have less strict underwriting than traditional LTC insurance. This makes them a good option for those who can’t afford a LTC policy. They are also an option for individuals who may not qualify for LTC coverage.
Critical Illness Insurance
Critical illness insurance pays out a lump sum upon the diagnosis of specific serious medical conditions. Policies cover conditions such as cancer, stroke, or heart attack. While critical illness insurance does not cover all long-term care costs, it can provide financial relief to help with medical expenses or caregiving services.
Learn more about critical illness insurance from Physicians Mutual
Life Insurance with Accelerated Death Benefits (ADB)
Some life insurance policies include an ADB rider. This rider allows policyholders to access a portion of their death benefit early if they develop a chronic or terminal illness. The ADB provides financial support for long-term care expenses without the need for a separate LTC policy.
Health Savings Accounts (HSAs)
HSAs allow individuals with high-deductible health plans to save money tax-free for medical expenses, including certain long-term care services. These funds can be a valuable resource to help cover the cost for care.
Please note: Although individuals can’t contribute to an HSA once they’re enrolled in Medicare, beneficiaries can still use funds already in an HSA to pay for qualified medical expenses.
Reverse Mortgages
A reverse mortgage enables homeowners aged 62 and older to convert home equity into cash, which they can use for long-term care expenses. While this option provides cash for expenses, it reduces home equity and can impact heirs’ inheritance.
Medicaid
For those who meet income and asset requirements, Medicaid provides comprehensive long-term care coverage, including nursing home care and home-based services. State-specific programs may also offer additional resources for long-term care support.
Choosing the best alternative
The best alternative to traditional LTC insurance depends on an individual’s financial situation, health, and long-term care needs. Consulting with a financial advisor or insurance professional can help individuals evaluate their options and develop a plan to ensure their coverage needs are met.
Agents who want to offer any of these products, click here for online Crowe contracting
Although traditional LTC insurance is a viable option for some, alternative insurance products provide flexibility and affordability. By exploring various coverage options and financial tools, individuals can secure financial protection and peace of mind for their long-term care needs.
Choosing the right Medicare Supplement (Medigap) plan is an important decision for individuals managing healthcare costs. In this post, we will answer the question; why enroll in a Plan N.
Medicare Supplement Plan N can be a great plan option due to its balance of affordability and comprehensive coverage. Individuals considering their Medicare Supplement options may find the Plan N is the perfect fit for their healthcare needs.
Lower monthly premiums
One of the biggest advantages of Plan N is its cost-effectiveness. Although Plan N provides many of the same benefits as other Medigap plans, its premiums are generally lower than Plan G. This makes it a good option for individuals who want solid coverage without paying a high premium for benefits they may not use too often.
Comprehensive coverage
Plan N covers many out-of-pocket costs that Original Medicare does not, including:
- Medicare Part A hospital coinsurance and hospital costs for up to 365 days after Medicare benefits are exhausted
- Medicare Part B coinsurance (except for small copays)once the annual Part B deductible is paid
- First three pints of blood
- Part A hospice care coinsurance
- Skilled nursing facility (SNF) care coinsurance
- Limited foreign travel emergency coverage (80% up to plan limits)
Out-of-Pocket costs
Plan N offers lower premiums in exchange for reasonable cost-sharing amounts. This includes:
- Up to a $20 copay for doctors visits
- Up to a $50 copay for emergency room visits (this copay is waived if the enrollee is admitted)
These low out of pocket amounts costs are predictable and manageable.
Please note: Unlike Plan G, Plan N does not cover Medicare Part B excess charges. Although, this is usually not an issue for beneficiaries who visit doctors that accept Medicare assignment, as they agree to charge only the Medicare-approved amount.
Plan N is a great choice for individuals who:
- Want the freedom to use any provider that accepts Medicare assignment
- Want to save on monthly premiums and still have great coverage
- Do not mind paying a nominal copay for medical services
Freedom to choose any provider that accepts Medicare assignment
Unlike Medicare Advantage plans, which have network restrictions, Medigap Plan N allows beneficiaries to see any doctor who accepts Medicare assignment. This is beneficial for individuals who seek care in more than 1 state and want greater flexibility in choosing healthcare providers. This is especially helpful if the individual uses several providers to treat medical conditions or illnesses.
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Protection from high hospital costs
Hospital stays can be expensive, but Plan N covers Part A coinsurance and hospital costs beyond Medicare’s limits. This ensures that beneficiaries do not face excessive out-of-pocket costs for extended hospital stays allowing beneficiaries to focus on recovery.
Alternative to more expensive Medigap plans
For those who want comprehensive coverage without the higher Plan G premiums, Plan N provides a good balance between affordability and comprehensive coverage.
Why enroll in Plan N
Medicare Plan N is a good choice for:
- Individuals who want lower monthly premiums
- Those who are comfortable with small copays for doctor and ER visits
- Beneficiaries who may use more than one Medicare-approved provider
- People looking for nationwide coverage without restrictive networks
Medicare Supplement Plan N is a great choice for those who want a balance of affordability and comprehensive coverage. With lower premiums, predictable cost-sharing, and strong hospital coverage, it offers a practical solution for many Medicare beneficiaries. Beneficiaries should consult with a licensed Medicare agent before enrolling in any Medicare Plan to ensure the plan aligns with healthcare and financial needs.
The Best Plan Pro quoting tool provides both final expense and simplified issue life quotes. With this tool, agents can provide clients with a quick and accurate quote within minutes. Find otu how easy it is to quote, underwrite and enroll. All from your own computer!
Quoting
Best Plan Pro gives agents the flexability to show all carriers availabel or only carriers they are appointed with or narrow it down to a select few.
Once you enter the client’s health information; birthdate, sex, height, weight, medications, health conditions and smoker status, the system will show only plans they qualify for. This saves time and aggrevation for agents and clients alike.
Run quotes for multiple face value amounts to compare prices and coverage. Additonally, you can run quoes based soley on a specific monthly budget amount.
Click here to watch a Best PlanPro demo
Additionally; all client information and quotes are saved in the systems buildt in CRM.
Underwriting
Best Plan Pro offers a state of the art underwriting tool, offering more than just general health groupings: best, non-tobacco, etc. This system uses health conditions and prescription information to provide an accurate quote.
Agents no longer need to waste time trying to figure out which carrier will offer a level policy based on a health conditions. Sales Plan Pro instantly runs the health conditions and medications against all carriers to find the ones that offer level vs. graded/modified vs. GI.
Enrollment
Once the cleint decides on the plan type that best fits their needs, agents can easily enroll them from their computer. This system automatically takes you to the carirers site so you can proceed with an online enrollment.
How to get this fantastic software
Although the normal price for this software is $60 a month, agents whoare cotnracted with either Crowe or Pinnacle are eligible to recieve a deep disocunt of $19.95 per month. Addtionally; agents who write 5 or more cases get this tool at no cost!
To get the discount code, either email lifesales@pfsinsurnace.com or stephanie@croweandassocites or call 203-796-5403. You must be either a Crowe or Pinnacle agent to recieve this discount!
If you are ready to join the team at Crowe; click here for online contract.
See what else Crowe and Associates has to offer our agents.
Because diabetes affects millions of Americans, understanding Medicare diabetes coverage is extremely important to both agents and those affected by diabetes. For diabetics, proper management and access to supplies is essential to maintaining health and quality of life. Fortunately, Medicare provides comprehensive coverage for diabetes-related services and supplies. It’s important to understand what Medicare covers and how to maximize benefits.
Medicare Part B
Medicare Part B covers a variety of diabetes-related supplies and services, including:
Blood Sugar Testing Supplies – This includes blood glucose monitors, test strips, lancets, and control solutions. Medicare generally covers up to 300 test strips and lancets every three months for insulin-dependent beneficiaries and up to 100 for non-insulin users.
Continuous Glucose Monitors (CGMs) – Medicare covers therapeutic CGMs and related supplies for qualifying individuals who meet specific criteria.
Insulin Pumps and Insulin for Pumps – Medicare covers insulin pumps as durable medical equipment (DME) and the insulin used in these pumps.
Medical Nutrition Therapy (MNT) – Beneficiaries with diabetes may receive MNT services, including nutritional assessment and counseling.
Diabetes Screenings – Medicare covers two diabetes screenings per year for beneficiaries at risk of developing diabetes.
Diabetes Self-Management Training (DSMT) – A critical education service that helps patients learn how to manage their diabetes effectively.
Medicare Part D: Prescription Drug Coverage
While Medicare Part B covers insulin used in pumps, Medicare Part D (Prescription Drug Plans) covers most other types of insulin, as well as oral diabetes medications, needles, syringes, and certain related supplies. Coverage may vary based on the specific Part D plan, so it’s important to review formulary lists and copayment amounts before enrolling in a plan.
Medicare Advantage (Part C) and Supplemental Coverage
Medicare Advantage (MA) plans must cover everything Original Medicare (Part A and Part B) covers but often include additional benefits, such as expanded prescription drug coverage, wellness programs, and cost-sharing assistance for diabetes management. Some plans may also offer broad access to CGMs and other advanced diabetes care.
How to get Medicare covered diabetes supplies
It is important to always use suppliers and pharmacies that are part of your Medicare plan’s network. Check with the plan provider for specific requirements and preferred providers. Beneficiaries must obtain a prescription from their doctor for blood sugar testing supplies.
Click here to download Medicare coverage of diabetes supplies, services & prevention programs
Medicare provides extensive support for individuals with diabetes, but navigating coverage details can be complex. Understanding what’s included under Medicare Part B, Part D, and Medicare Advantage plans helps beneficiaries make informed decisions and access necessary supplies for effective diabetes management.
Medicare insurance agents have two primary contract structures to choose from: Street-Level and Licensed Only Agents (LOA) contracts. Both options have distinct advantages and drawbacks, depending on an agent’s career goals, experience level, and desired level of independence. Understanding the differences between street level vs LOA contracts can help agents make an informed decision about which path is right for them.
Street-Level Medicare agent contract
A Street-Level contract is a contract for independant agents. With this contract, agents receive full street commissions directly from the carriers; their upline does not take any portion of the amount. They own their book of business. In other words, if they wan tot change uplines, they keep all their clients. The upline has no claim to their business. Agents with street-level contracts typically have greater flexibility in how they operate their Medicare business.
Watch our free YouTube training and informational videos
LOA Medicare agent contract
An LOA (Licensed only Agent) contract requires the agent to assign all or part of their commission to their upline agency. In return, the agency may provide office space, leads,marketing assistance, training and sometimes a base salary. LOA agents are considered part of an agency rather than independent brokers.
Key Differences Between Street-Level and LOA Contracts
| Feature | Street-Level Contract | LOA Contract |
|---|---|---|
| Commission Ownership | Agent receives full commission and renewals | All or part of the commissions is assigned to the agency |
| Book of Business | Agent owns book of business – it goes with him | Agency owns book – if agent leaves he loses all clients |
| Income Potential | Higher long-term earning potential through renewals | May include salary and/or lower commission splits |
| Administrative Responsibilities | Agent handles compliance, contracting, and renewals – costs are on him | Agency may handle many back-office tasks and may provide E&O |
| Training & Support | Limited agency-provided training; agent must be more self-sufficient | Strong agency support, mentorship, and resources |
| Marketing Assistance | Must handle personal lead generation and marketing | Agency often provides leads and marketing tools |
| Flexibility & Independence | Full control over business operations – flexible schedule | Must follow agency schedule, guidelines and sales processes |
| Transitioning to Independence | Easy to build and maintain a personal book of business and maybe an agency | Difficult to transition as the agency owns the clients – you start from 0 if you leave |
Street level vs LOA Contracts Pros and Cons
Find out what the street level cmmissions are for 2025
Street-Level Pros
- Full commission ownership, including renewals
- Control over carrier selection and sales strategy
- Higher income potential over time
- Flexibility to build a personal brand and business
Street-Level Cons
- Must handle marketing, lead generation, and compliance independently
- No agency-provided salary, need your own funds to get started
- Find a good upline or get no upfront support or guidance
- Must be wellorganized with a strong business acumen and self-discipline
LOA Pros
- Agency-provides training, support, and mentorship
- Less administrative burden, allows agents to focus on sales
- Access to agency-generated leads and marketing resources
- Possible salary or base compensation for stability
LOA Cons
- No ownership of commissions or book of business
- Limited control over carriers and product offerings
- Earnings may be less than independent agents
- Difficult to transition to independent status; loss of clients
See what Crowe can offer agents
Deciding which contract is right for you
Choosing between a street-level and LOA contract depends on your career goals, level of experience and work ethic.
- New agents who need training, leads, and support may benefit from an LOA contract.
- Experienced agents who want to maximize long-term income and control their business may be better off with a street-level contract.
- Agents who prefer stability may appreciate the structured environment of an LOA contract, while those who are entrepreneurial may thrive with a street-level contract.
Crowe offer our agents the freedon of Street level contracts with the support of an LOA contract.
Click here for Crowe online contract
Both street-level and LOA Medicare contracts offer unique benefits and trade-offs. Agents should carefully evaluate their financial goals, desire for independence, and need for support before making a decision. Whether choosing the independence of a street-level contract or the structured support of an LOA contract, the key is to select the option that aligns with long-term career aspirations in the Medicare insurance industry.
Some individuals who moved from employer-sponsored health insurance and are eligible for Medicare may wonder how COBRA works with Medicare. Understanding the rules and coordination between these two programs is essential to avoid gaps in coverage and potential penalties.
What is COBRA
COBRA (Consolidated Omnibus Budget Reconciliation Act) allows eligible employees and their dependents to continue their employer-sponsored health coverage for a limited time when they experience a qualifying event, such as job loss, reduction in work hours, or retirement. In most cases, COBRA coverage is available for up to 18 months. In some circumstances, beneficiaries may be eligible to extend this coverage.
How COBRA Works with Medicare
The way COBRA and Medicare work together depends on which coverage individuals have first and their specific situation.
1. If you have COBRA and become eligible for Medicare
If the beneficiary is enrolled in COBRA and then becomes eligible for Medicare (usually at age 65), COBRA coverage may end. Employers are not required to continue COBRA once an individual enrolls in Medicare. However, dependents covered under COBRA may still maintain their coverage. It is important to enroll in Medicare on time to avoid late enrollment penalties.
Click here to learn more about how Medicare works with other insurance
2. If you have Medicare and then become eligible for COBRA
Beneficiaries already enrolled in Medicare and then become eligible for COBRA due to job loss or another qualifying event can enroll in COBRA. However, COBRA acts as secondary insurance to Medicare, meaning Medicare will pay first for covered services, and COBRA will cover remaining costs according to the plan.
3. Can you delay Medicare and keep COBRA
Relying solely on COBRA instead of enrolling in Medicare when first eligible can lead to serious consequences. Medicare considers COBRA secondary to Medicare-eligible individuals, so delaying Medicare enrollment may result in penalties and a coverage gap when COBRA ends.
It is important to note; Medicare does not consider COBRA creditable coverage even if it provides the same coveage the employer provided. In othe rwords, beneficiaries could end up with a coverage gap leading to lifetime penalties for Part B. This depends on the amount of time beneficiaries go without creditable coverage.
Things to consider
- Medicare Enrollment Deadlines: Individuals who are eligible for Medicare should enroll during their IEP (Initial Enrollment Period) to avoid penalties. COBRA does not count as creditable coverage to delay Medicare Part B enrollment. However, it is usually considered creditable Part D coverage.
- COBRA Costs: In most cases, COBRA coverage is expensive because beneficiaries must pay the full premium, including the employer’s share.
- Medigap and Medicare Advantage Options: Once COBRA ends, beneficiaries may want to enroll in a Medicare Supplement (Medigap) and PDP plan or a Medicare Advantage plan to fill the coverage gaps left by Original Medicare.
Learn about Medicare OEP, SEPs and Late Enrollment Penalties watch a quick YouTube video
COBRA and Medicare can work together, but understanding how they coordinate is crucial for making informed healthcare decisions. For individuals on COBRA who are approaching Medicare eligibility, it’s advisable to consult with a licensed Medicare agent to ensure you avoid LEPs and coverage gaps.
Agents do you need a scope of appointment – click here
Because some agents are unsure of the PAP ACC and MCD SEPs, we will go over them and try and clear up any confusion. It is important to know; both CMS and the carriers monitor the use of these SEPs. They are reporting any inappropriate use of these SEPs. We hope this post provides information that makes is easier to use these SEPs properly. This will help prevent delays with your client’s application processing.
What is a PAP SEP
A PAP (Pharmaceutical Assistance Program) SEP is an enrollment period for individuals who qualify to enroll in the state’s pharmaceutical assistance program (SPAP). To qualify for the SPAP program, beneficiaries must meet specific income and asset requirements.
Click here to see a list of states where the SPAP is available
Who can use a PAP SEP
The PAP SEP begins when the individual enrolls in the SPAP. If an individual enrolls in the SPAP program, they receive one oppportunity annually to use this SEP. They can use it to enroll in or change their Medicare Advantage or PDP plan. Anyone automatically enrolled in a PDP plan by their SPAP cannot use this SEP.
If an individual receives notice that they no longer qualify for SPAP benefits, they can use the PAP SEP. The SEP begins the month they lose the SPAP and continues for two months after they are notified of the loss (whichever comes later).
What is an ACC SEP
The ACC SEP is a Medicare Advantage Special Enrollment Period for those who request plan information in an accessible format. Beneficiaries cannot use the ACC SEP as an election period on it’s own. The beneficiary must have been eligible for another valid election period before they can use this SEP. The ACC SEP ensures beneficiaries who requested information in an accessible format receive additional time to submit an application for a vailid election period. This helps them get enrollment requests processed by extending the deadlines for application submissions.
Accessible format is a way of receiving health coverage information in a way that can be understood by individuals with disabilities. This format includes large print, Braille, audio recordings, or digital text that can be read by screen readers. This allows beneficiaries to access and understand important medical inforamtion and make appropriate plan choices.
Find out about the CT MSP income limits 2025
Who can use an ACC SEP
The ACC SEP is available to any Medicare beneficiary who did not recieve the materials they needed to make an informed enrollment decision in an accessible format at the same time standard material is provided.
Important: This is not a “stand-alone” election period. Indviduals must have been eligible of another valid election period but didn’t have the information they needed in an accessible format to make an informed decision in time. This SEP starts at the end of an election period in which the beneficiary submits a request for accessible formatted materials. The SEP is ineffect for at least as long it takes for the beneficiary to recieve the materials.
Watch a YouTube video on new rules for Dual and Drug help in 2025
What is an MCD SEP
The code MCD is for Medicaid and can only be used by individuals who have a change in Medicaid status of some type. Individuals who are newly eligible for Medicaid, lose eligibility Medicaid, or who’s Medicaid status changes can use the MCD SEP. Qualified individuals can use this SEP once within 3 months of the qualifying event or notification of change (whichever is later).
Who can use the MCD SEP
The MCD SEP applies to Medicare beneficiaires who:
Become eligible for any type of assistance through the Title XIX program. This includes partial duals who receive cost sharing assistance under Medicaid.
Those who lose eligibility for assistance or have a change in the level of assistance they qualify for. This applies even if they stop receiving Medicaid benefits or still qualify for LIS (Low Income Subsidy).
This SEP gives individuals one chance to make a change within 3 months of a qualifying event or when they receive a notice of the changes, whichever is later. The effective date for enrollments is the first day of the month after the carrier recieves the enrollment request.
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Please remember: Agents must use the correct SEP code to ensure carriers can process enrollments in a timely manner. Using an incorrect code could cause a delay or denial by the carrier. In some instances, it can result in the agent receiving corrective action from carriers and/or CMS.
If you are a Medicare agent, you know that 2025 has been a challenge finding plans that offer the benefits our clients are looking for. That is why we want you to take a look at the Connecticare Medicare Advantage Plans 2025. The plans offer some great coerage with many great supplemental benefits.
Connecticare Medicare Advantage Plans 2025
Connecticare is offering 5 Advantage plans in 2025 this includes 1 D-SNP. Each plan is available statewide in all counties of CT.
It is important to note: these plans also provide coverage in NY with Emblem providers.
Here are some of the plan highlights:
All the plans include SilverSneakers to help members stay active. Plans also include a $0 Teledoc copay amount and over $150 in member rewards ad a comprehensive formulary.
If you are an agent who is ready to join our team; click here for contract
Choice Plan 3 (HMO-POS)
This plans has a $0 monthly premium. It also has a $0 co-pay for PCP visits and a $35 specialist co-pay. The cost for anual physicals, screenings and immunizations is $0.
Although hearing services are not covered on this plan, it provides a $0 preventative dental benefit that covers cleanings, exams, flouride treatments and standard x-rays every 6 months. It also proides up to $2,000 of comprehensive dental coverage. A free eye exam is included each year and up to $400 for eyewear and $50 per month for mail order OTC items.
Passage Plan 1 (HMO-POS)
The Passage Plan 1 also offers members a $0 premium plan with several great benefits. PCP visits are $0 and the specialist co-pay is only $35.
This plan offers some very generous benefits that include; a hearing benefit for hearing servies and hearing aids of $3,000 annually. The dental benefit covers 1 exam, cleaning, flouride & standard x-rays at no cost every 6 months. The dental coverage includes a comprehensive dental benefit of $2,000. Additioanlly, they also provide a $0 eye exam each year and $550 of eye wear coverage. There is a $75 monthly OTC allowance for plan members. As you can see, this plan includes a fantastic benefit package.
Click here to download a copy of the full 2025 Connecticare First Look
Flex Plan 3 (HMO-POS)
The Flex Plan 3 has a low monthly premium. In the counties of Hartford, Litchfield ,& Tolland, the premium is $29 per month. In the counties of Fairfield, New Haven, New London & Windham; the preium is $36 per month.
This plan has a low PCP co-pay of $5 per visit and a $50 specilaist co-pay amount. Although this plan doe snot include a hearing benefit, it does provide1 dental exam with cleaning, flouride and standard x-rays every 6 months. The plan also offers dental riders for $27 a month for $2,000 or $35 a month for $3,000 of comprehensive coverage. Vision coverage includes a $0 eye exam and a $300 eye wear allowance annually. The OTC benefit for this plan is $50 per quarter.
Watch a YouTube video of the plan benefits
Choice Plan 2 (HMO-POS)
The Choice Plan 2 is another great plan option offering members a $0premium, a $0 co-pay for PCPs and a very low $10 specialist co-pay.
Addtional plan benefits include a $3,000 annual hearing benefit that covers hearign exams and hearing aids. A dental beenfit that covers 1 exam, cleaning, flouride & standard x-rays every 6 monthsas well as $3,000 in coverage for comprehensive services. Additioanlly, the plan provides a $50 monthly OTC benefit.
Important: prescrption drugs are not covered on this plan.
Choice Dual (HMO-POS D-SNP)
In order to enroll in this plan, members must be QMB+, SLMB+, and FBDE eligible. The premium for this plan is $0; as are all doctors visits including; specialists, lab services, in-patient hospital and more.
Learn about the CT MSP income limits 2025
Hearing benefits for each year are $2,500. The plan provides a $0 eye exam as well as a $500 annual eye wear allowance. The dental benefit is $0 for preventative services (cleanings, exam, fouride & stnadard x-rays) every 6 months and includes $3,000 for comprehensive benfits.
Are you a Crowe agent who wants to add Connecticare products; click here for contract
As you can see while other plans have scaled back their benefits, Connecticare has increased benefits. This carrier provides some great plan options and is worth taking a look at for your clients coverage.