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Physicians Mutual Preventive Benefits are part of their Medicare Supplement plans designed to enhance Original Medicare by covering additional healthcare expenses. Notably, certain plans include coverage for preventive health care services and may offer access to fitness programs like Silver&Fit.​

Preventive Health Care

Preventive health care is essential for early detection and management of health conditions. Because of this, Physicians Mutual provides benefits for preventive services in most of their Medicare Supplement plans, excluding Plan A. These benefits are not subject to high deductibles, ensuring that policyholders can access necessary preventive services without significant out-of-pocket costs.

The Preventive Benefits Rider

This Medicare Supplement portfolio is unique to the market. It offers a Preventive Benefits Rider that not only covers preventive care but adds the Silver & Fit program as well.
This wellness combination is not available from any other insurance carrier.

The rider offers extra benefits for physical exams, health screenings and routine blood work not covered by Orignal Medicare.

The Silver & Fit Program

This program provides useful benefits such as; memberships at one of thousands of participating fitness centers as well as discounts at premium fitness centers. Additionally they provide each member with a choice of one home fitness kit per year and assces to thousands of on-demand workout videos.

Watch our YouTube video for all the details

Silver&Fit Fitness Program

Staying active is vital for overall health, especially for seniors. The Silver&Fit program offers access to a network of fitness centers and resources to help seniors stay fit. While Original Medicare does not cover Silver&Fit, some Medicare Supplement and Medicare Advantage plans include similar programs. Physicians Mutual offers Silver&Fit benefits in specific states, often as part of their preventive benefits rider. Availability and terms can vary, so it’s important to review plan materials or consult with a licensed agent to determine if Silver&Fit is included in your area.

Considerations For Choosing a Plan

When selecting a Medicare Supplement plan with Physicians Mutual, consider the following:

• Plan Availability: Physicians Mutual offers various plans, including Plan A and Plan G. They also offer Innovative Plan G options which feature lower premiums with a deductible for the initial years.
• Preventive Benefits: Confirm whether the plan includes preventive health care services and understand any associated costs or limitations.​
• Fitness Programs: If access to fitness programs like Silver&Fit is important to you, verify the availability within your chosen plan and state.​Medicare Plan Finder
• Discounts: Physicians Mutual may offer discounts for non-tobacco users, automatic bank withdrawals, or household discounts when another adult aged 60 or older resides with you.

For personalized information and to explore plan options that best suit your healthcare needs and lifestyle, consider contacting a licensed Medicare agent.

If you are an agent who woul dlike to offer these plans; click here for online contract and become part of the Crowe team!

On Monday April 7,2025, the Medicare industry received some good news; CMS raises Medicare Advantage Pay. The Centers for Medicare & Medicaid Services (CMS) announced a 5.1% increase in payments to Medicare Advantage plans for the upcoming year, 2026. This number surpasses the initial projections. This adjustment is a response to rising healthcare costs within traditional Medicare, particularly inpatient hospital expenses. ​

Impact on Health Insurers

During the last 2 years, Medicare Advantage insurers have stated the federal payments did not keep up with rising medical costs they incur. They also had issue with CMS‘ stringent quality reviews, payment audits and marketing rules of the previous administration.

The adjusted payment amount provides the Medicare Advantage industry some room to breathe. It gives the Medicare industry hope for a positive interaction with the new administration moving forward.This is the most signifigant boost the payment rate in the last decade. The raise proposed by the last administration was said to be 4.33%.

Following the announcement, major health insurance companies experienced significant stock market gains:

• Humana: Shares rose by 14%.​
• CVS Health: Experienced a 7% increase.​
• Elevance Health: Saw an 8% gain.​
• UnitedHealth Group: Shares climbed by 6%.​

Click here to read how raise affects stock prices

These increases reflect investor optimism regarding the enhanced revenue prospects for insurers offering Medicare Advantage plans.​ Hopefully this upward trend will continue.

Underlying Challenges

Despite the positive market reaction, industry experts caution that the payment increase does not fully address the issue of escalating healthcare costs. Factors such as increased service utilization and wage inflation continue to add stress to the healthcare system. Providers facing inflation issues may find ways to pass additional costs onto employers and retirees if Medicare reimbursements do not cover their costs sufficiently.

There is also the issue of some CMS policies that are unpopular with the carries such as; the revised risk adjustment system. This system may be challenging to insurance carriers with it’s limits on their ability to acccurately code their member’s helath conditions. Possibly resulting in insufficient reimbursements for services.

Watch a quick YouTube video on the proposed 2026 final rule

Future Outlook

While the payment boost provides some financial relief, the sustainability of Medicare Advantage plans remains uncertain. Insurers may need to adjust supplemental benefits and premiums to align with actual costs. The broader challenge of controlling healthcare expenses persists, necessitating ongoing policy adjustments and industry strategies.​

Unfortunately, as people age, the risk for chronic conditions like heart disease, diabetes, and cancer increases. Although with the right preventive measures in place, many of these conditions can be delayed, managed effectively, or even avoided. That is why we will go over the importance of preventative services for Medicare beneficiaries.

Preventive Healthcare

The objective of Preventive healthcare is to maintain wellness and discover health issues before they become serious. It includes regular checkups, screenings, immunizations, counseling, and lifestyle intervention. These services are all designed to detect potential health problems early or prevent them from happening.

Why Preventative Service for Medicare Beneficiaries Matters

Early Detection

Some serious conditions, such as colorectal cancer or high blood pressure, may not show symptoms until they’ve progressed. That is why routine screenings are important. They can catch these conidtions early, when they’re easier to treat. This helps the beneficiary have a better qualityof life and save money on treatments.

Managing Chronic Conditions

Due to the fact that, over two-thirds of Medicare beneficiaries suffer from multiple chronic conditions, preventative care is essential. Preventive care helps manage these illnesses more effectively, avoiding emergency visits, hospitalizations, and complications. Annual wellness visits give beneficiaries an opportunity to review medications, coordinate care, and update personalized prevention plans.

Immunizations

Keep in mind; Flu shots, shingles vaccines, and COVID-19 boosters can be life-saving for older adults whose immune systems may not be as strong as younger individuals. Medicare Part B covers many of these vaccines. Staying up-to-date with immunizations can help prevent avoidable illness and hospital stays.

Mental and Cognitive Health

Preventive care also includes screenings for depression and cognitive impairment that are critical as people age. These services allow early interventions that can improve quality of life and help individuals maintain independence.

Health Education and Lifestyle Support

Through programs like smoking cessation counseling and diabetes self-management training, Medicare supports healthier living. Lifestyle changes such as, eating healthier foods, excercising or quitting smoking can dramatically reduce the risk of future health problems.

Overcoming Barriers to Access

Despite the clear benefits, many beneficiaries don’t fully utilize preventive services. Reasons include lack of awareness, confusion about coverage, transportation challenges, or simply not knowing what’s available to them. That’s why education and outreach; especially from healthcare providers, caregivers, and community organization are so crucial.

In the event a client wants to have better coverage for an illness, agents should understand the benefitof ancillary products to avoid gaps in coverage.

Agents: Watch a quick YouTube video on why and how to sell ancillary products

Preventive healthcare isn’t just about avoiding illness. It’s about living better, longer, and keeping your independence. For Medicare beneficiaries, taking advantage of all the preventive services Mediare covers is one of the smartest health decisions they can make.

For individuals receiving SSDI (Social Security Disability Insurance), transitioning from SSDI and aging into Medicare is an important milestone. Although most Medicare beneficiaries become eligible at age 65, SSDI recipients qualify for Medicare after a 24-month waiting period. Understanding how SSDI benefits interact with Medicare eligibility helps ensure a smooth transition and access to essential healthcare services.

SSDI and Medicare

Social Security Disability Insurance (SSDI) provides financial assistance to individuals who are unable to work due to a qualifying disability. After receiving SSDI benefits for a period of 24 months, individuals become eligible for Medicare, regardless of age. This allows disabled individuals to access crucial medical care without waiting having to wait until they turn 65.

SSDI Recipients Medicare Milestones

24-Month Waiting Period: Most SSDI recipients must wait 24 months from the date they start to receive disability benefits before Medicare coverage begins.

Automatic Enrollment: After the waiting period, eligible individuals are automatically enrolled in both Medicare Part A and Part B.

Early Medicare: Individuals with specific conditions, such as End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis/Lou Gehrig’s Disease (ALS), automatically qualify for Medicare. They do not have to wait the standard 24-months.

SSDI Recipients and Medicare Coverage

Once enrolled, SSDI beneficiaries have access to Medicare benefits including:

Medicare Part A: Covers inpatient hospital care, skilled nursing facility stays, hospice care, and some home health services.

Medicare Part B: Provides coverage for outpatient medical services, doctor visits, preventive care, and (DME) durable medical equipment.

Optional Medicare Part D: These plans provide prescription drug coverage; are not part of Original Medicare and are offered by independent insurers. SSDI recipients can choose to enroll in these plans separately.

Medicare Advantage or Supplement Plan

SSDI recipients can choose to:

Keep Original Medicare (Parts A & B) and add a Medicare Supplement (Medigap) plan to help cover out-of-pocket costs. Plase note; Medigap options may be limited before age 65.

Enroll in a Medicare Advantage (Part C) plan, which often include additional benefits such as; prescrption drug coverage, dental, vision, otc, transportation and more.

Purchase a stand alone Medicare Part D plan those who choose to stay in Original Medicare either with or without a Medigap plan, may purchase a PDP plan to cover prescription medications.

Aging into Medicare

When SSDI recipients reach 65, they transition into the standard Medicare program. This gives them new coverage options and opportunities.

Medicare Supplement Open Enrollment Period

SSDI recipients under 65 have limited Medicare Supplement options because not all states require insurers to offer plans to those under 65. However, once the beneficiary turns 65, they enter a six-month Medicare Supplement Open Enrollment Period. During this time, they can choose any Medigap plan available in their state without medical underwriting. This is an important opportunity to purchase additional coverage without being denied due to pre-existing conditions.

Learn more about Medicare Supplement guaranteed issue rights

Medicare Advantage Plans

While SSDI recipients under 65 may have fewer Medicare Advantage plans available to them, turning 65 gives them access to more Medicare Advantage plans, often with enhanced benefits.

Lower Medicare Supplement Premiums

Medicare Supplement premiums for beneficiaries under 65 can be significantly higher due to their disability status. However, when they turn 65, they are eligible to enroll in a Medigap plan with standard premium rates.

Opportunity to Switch Plans:

SSDI beneficiaries who initially enrolled in a Medicare Advantage or Medicare Part D plan may find better options available at 65 that meet their healthcare needs or offer lower costs.

Employer or Retiree Coverage

Some SSDI recipients become eligible for employer-sponsored retiree health benefits at 65. If this is the case, they should evaluate how this coverage works with Medicare and whether they need any additional Medigap or Medicare Advantage coverage.

Learn more about Medicare and employer coverage

Prescription Drug Coverage

At 65, beneficiaries may have access to new Part D prescription drug plans that offer better coverage for their specific needs. Turning 65 is a great time to review all options and switch plans if needed. Please note; coverage changes each year and the Annual Enrollment Period is an important time to make necessary changes.

Agents watch a quick video on Sunfire and Connecture enrollment platforms

Medicare provides critical healthcare for SSDI recipients before age 65, but the process of aging into Medicare benefits requires careful planning. Understanding Medicare enrollment timelines, coverage options, and the opportunities available upon turning 65 can help SSDI beneficiaries maximize their benefits and avoid coverage gaps. Consulting a licensed Medicare agent can help ensure the best plan choices based on individual health needs and financial considerations.

For retirees, Required Minimum Distributions (RMDs) are an inevitable part of managing tax-advantaged retirement accounts, such as traditional IRAs and 401(k)s. While many focus on the tax implications of RMDs, fewer realize their potential impact on Medicare costs, Can RMDs increase Medicare premiums? More specifically, the Medicare Part B and Part D premiums. Understanding this connection can help retirees better plan their withdrawals and avoid increases in healthcare costs.

What Are RMDs

RMDs are mandatory withdrawals that individuals must take from their traditional retirement accounts starting at age 73 (as of 2024, per the SECURE 2.0 Act). The IRS determines the required withdrawal amount based on account balance and life expectancy. Because RMDs are considered taxable income, they can push retirees into higher income brackets, which can affect their Medicare premiums.

IRMAA’s (Income-Related Monthly Adjustment Amount)

Medicare Part B (medical insurance) and Part D (prescription drug coverage) premiums are income-based. This means higher-income individuals pay more due to the IRMAA. IRMAAs apply when modified adjusted gross income (MAGI) exceeds certain thresholds, as reported on tax returns from two years prior. In other words, RMDs taken in 2024 could impact Medicare premiums in 2026.

Can RMDs Increase Medicare Premiums

Because RMDs increase taxable income, they may push retirees above the IRMAA thresholds. This can lead to higher Medicare costs. For example:

In 2025, individuals with a MAGI over $106,000 (or $212,000 for married couples filing jointly) pay more than the standard Medicare Part B premium.

• In 2025, the base Part B premium is $185.00 per month, however those subject to IRMAA could pay as much as $594 per month depending on income.
• Similarly, Part D enrollees face IRMAA surcharges ranging from $12.90 to $81 per month, based on income.

Please note: taking large RMDs in a single year may increase Medicare costs, potentially taking away from retirement savings.

How to Lessen RMD Impact on Medicare Premiums

1. Qualified Charitable Distributions: Individuals over 70½ can donate up to $100,000 per year to a qualified charity from their IRA. This reduces taxable income without affecting RMD obligations.
2. Roth Conversions: Converting funds from a traditional IRA to a Roth IRA before RMD age can lower future RMD amounts. Roth withdrawals are not taxable or included in MAGI.
3. Strategic Withdrawals: Spreading withdrawals over multiple years or taking early withdrawals before RMDs begin can help manage taxable income levels.
4. Filing for IRMAA Appeals: If a significant life change (such as retirement, divorce, or loss of income) affects MAGI, individuals can request an IRMAA reduction.

Learn how to file an IRMAA appeal

While RMDs are an unavoidable part of retirement planning, their impact on Medicare costs must be considered. Understanding IRMAA thresholds and carefully planning withdrawals can help retirees control their Medicare premium costs. By using tax-efficient withdrawal strategies, retirees can minimize unnecessary healthcare expenses and maximize retirement savings.

Medicare provides essential health coverage for seniors and certain disabled individuals, but it doesn’t cover everything. That’s where Medicare Supplement plan (Medigap) come in. These policies help cover out-of-pocket costs like copays, coinsurance, and deductibles. Is a Medicare Supplement enrollment right for you? We will discuss who might be a good fit for one.

Medicare Supplements

Medicare Supplement policies are insurance plans provided by private insurance companies, designed to work with Original Medicare. They help cover the “gaps” in Medicare coverage, making healthcare costs manageable. However, beneficiaries cannot have a Medicare Advantage with a Supplement. Individuals must have Original Medicare to enroll in a supplement plan.

Who should consider a Medicare Supplement

Medicare Supplement plans are a great option for individuals who want more comprehensive coverage and predictable healthcare costs. Here are some reasons individuals may benefit from enrolling in a Medicare Supplement plan:

Lower Out-of-Pocket Costs

Original Medicare beneficiaries pay coinsurance, copays, and deductibles for medical services, which can add up. For those who prefer to minimize these expenses, a Medicare Supplement plan can significantly reduce out-of-pocket costs, providing greater financial security and predictable expenses.

Frequent Healthcare Users

For individuals with chronic conditions who require frequent doctor visits, or need ongoing medical treatments, Medicare Supplement can be an cost saving option. It covers costs that would otherwise be paid out-of-pocket, making medical expenses more manageable.

Travelers and Snowbirds

Unlike the network restrictions of Medicare Advantage plans, Supplement plans provide nationwide coverage. Some plans even offer foreign travel emergency coverage, making them ideal for those who travel frequently or live in multiple states throughout the year.

Flexibility in provider choice

Medicare Supplement plans allow enrollees to see any doctor or specialist who accepts Medicare assignment. There is no need for referrals or network restrictions. This is very attractive to those who want more freedom in their healthcare options.

Individuals who can afford the premiums

While Medicare Supplement plans reduce out-of-pocket costs, they come with monthly premiums in addition to the Medicare Part B premium. For individuals who can comfortably afford the premiums, a Supplement plan can provide peace of mind and financial protection against unexpected medical expenses.

New Medicare Enrollees

For most beneficiaries, the best time to enroll in a Medicare Supplement plan is during the six-month Medicare Supplement Open Enrollment Period, which begins when beneficiaries first enroll in Medicare Part B. During this time, beneficiaries have guaranteed issue rights. This means they can enroll in any Medicare Supplement policy available in their state without medical underwriting. Those who apply outside this period, may be subject to higher premiums or even denial based on health conditions. Please note; underwriting does not apply to those who live in one of the 4 guarantee issue states.

Who might not want a Medicare Supplement

Although Medicare Supplements are beneficial for many, they may not be a good choice for everyone. Those who might not benefit from a Medicare Supplement are:

• Enrolled in a Medicare Advantage Plan: Medicare Supplement cannot be used with Medicare Advantage.
• Individuals with employer or retiree coverage: Some employer-sponsored plans provide secondary coverage to Original Medicare, making a Medicare Supplement unnecessary.
• Those who rarely use medical services: Healthy individuals who don’t visit the doctor often may find the cost of a Medicare Supplement premium outweighs the benefit.

Watch a quick YouTube video Medicare Advantage vs Medicare Supplement

Beneficiaries should seek the advice of a licensed Medicare agent before enrolling in a plan. They can help compare plan option to ensure they make the best choice for the individual situation. Understanding healthcare needs and financial situation can help determine if a Medicare Supplement is the best plan choice.

Medicare Advantage (MA) plans are growing in popluarity as an alternative to Original Medicare, often attracting enrollees with low premiums, extra benefits, and all-in-one coverage. However, understanding the true Medicare Advantage Plan cost breakdown is crucial to avoid unexpected financial burdens. Here’s a detailed look at the key expenses associated with Medicare Advantage plans.

Premiums

Many MA plans advertise low or even zero-dollar premiums. However, enrollees must still pay the standard Medicare Part B premium ($185 per month in 2025) unless they qualify for financial assistance. Some plans may also charge an additional monthly amount for extra benefits, like dental comprehensive coverage.

Deductibles and Copays

Unlike Original Medicare, which has standardized costs, Medicare Advantage plans vary widely in deductibles and copay amounts. Enrollees of some MA plans must to meet an annual deductible before coverage kicks in, and they charge copays for doctor visits, hospital stays, and prescription drugs.

Out-of-Pocket Maximums

One advantage of MA plans is that they have an annual out-of-pocket maximum, unlike Original Medicare. In 2025, the maximum amount a MA plan CMS allows MA plans to charge for in-network services is $9,350. Please keep in mind, not all plans charge this amount for an out-of-pocket maximum; most plans have lower MOOPs. This is the most they are allowed to charge, the amount varies greatly by plan. Once this limit is reached, the plan covers all additional costs for the remainder of the year.

Out-of-Network Care

Most MA plans operate within a provider network. HMO plans require enrollees to use only in-network providers, while PPO plans allow some out-of-network visits at a higher rate. Please note; unless you are in a emergency situation, seeking care outside the network can lead to significant additional expenses.

Prescription Drug Costs

Many Medicare Advantage plans include Part D prescription drug coverage. The cost for prescrptions vary based on the plan’s formulary. Factors such as tiered formulary pricing and preferred pharmacy networks can influence out-of-pocket expenses for medications. Most plans also have a prescription deductible to meet for medications over a specific tier level.

Hospitalization and Specialist Care

While MA plans cover hospital and specialist care, costs can add up quickly. Some plans charge daily copays for hospital stays. Additionally, specialist visits usually have higher copays than PCP visits or require referrals, adding another charge.

Extra Benefits and Hidden Costs

Medicare Advantage plans often include extra benefits like dental, vision, and hearing coverage. However, these benefits may have limitations, such as caps on coverage or a restricted provider network, which can lead to unexpected out-of-pocket expenses.

Travel and Emergency Care Costs

Unlike Original Medicare, which offers nationwide coverage, most MA plans have geographic restrictions. If you travel frequently, you may face higher costs for out-of-network emergency care or require a plan with national coverage options.

Agents see how easy it is to compare MA plans with Sunfire and Connecture

Medicare Advantage plans can be a cost-effective option for some enrollees, but it’s essential to understand the full financial picture. By carefully reviewing plan details, including premiums, out-of-pocket limits, network restrictions, and prescription drug costs, enrollees can make informed decisions about healthcare coverage and avoid expensive surprises.

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Medicaid is a crucial government program providing healthcare coverage to millions of low-income individuals and families. Although it is so important, many people do not understand how it works, who qualifies, and what services it provides. This post will help with understanding the basics of Medicaid so individuals can better navigate the program.

What is Medicaid

Medicaid is a joint federal and state program designed to offer healthcare coverage to eligible low-income individuals, including children, pregnant women, elderly adults, and people with disabilities. Unlike Medicare, which is primarily for disabled individuals and those 65 and older, Medicaid eligibility is based on income and other factors.

Each state administers it’s own Medicaid program. The states must follow federal guidelines but have flexibility to expand coverage and determine eligibility criteria. In other words, Medicaid programs vary significantly from one state to another.

Click here to find coverage in each state

Who Qualifies for Medicaid

In general, Medicaid eligibility is based on income and size of household. Although, factors such as disability, age, and pregnancy are also condsidered when determining qualification. In states that have expanded Medicaid under the ACA (Affordable Care Act), individuals with incomes up to 138% of the federal poverty level (FPL) qualify for Medicaid coverage.

In general, Medicaid provides coverage for individuals who have income levels that meet state qualifications. Those who may qualify are:

• Individuals, families, children and elderly individuals with limited income
• Pregnant women
• Individuals with disabilities

Each state has an online portal or office where individuals can apply for Medicaid benefits. Usually they can go to their state’s health department or the federal Healthcare.gov website.

What Medicaid Covers

Medicaid provides comprehensive healthcare services that include the following:

• Hospital and emergency care
• Doctor visits and preventive care
• Maternity and newborn care
• Prescription medications
• Mental health and substance abuse treatment
• Long-term care services (this includes; nursing home care and home health services)
• Dental and vision care (coverage varies by state).

Although federal guidelines require the states to provide coverage for essential services, each state has the ability to cover additional services.

How to Apply for Medicaid

Each state has it’s own process to apply for Medicaid coverage. In general, it is pretty straight forward. We have listed some of the common steps for the application below:

Check Eligibility: Use the state’s Medicaid website or the federal Healthcare.gov website to verify qualification.

Gather Necessary Documents: Applicants will need proof of income, identification, Social Security numbers, and information about household members.

Submit an Application: There may be several ways to submit an application; online, in person, by mail, or over the phone. This depends on the state the enrollee is in.

Wait for Approval: Processing times vary, but applicants will receive notification about their status and coverage details.

Medicaid and Other Health Programs

Many Medicaid beneficiaries qualify for additional assistance programs, such as the Children’s Health Insurance Program (CHIP), which provides coverage for children in families with incomes too high for Medicaid but too low for private insurance. Many states also offer food and housing and utilities assistance programs.

There are also specific Medicare programs that provide Extra Help to beneficiaires.

Learn the difference bewtween Medicare and Medicaid

For those who qualify for both Medicare and Medicaid (dual-eligible individuals), Medicaid helps cover Medicare premiums, copays, and additional services that Medicare doesn’t fully cover, such as long-term care.

Medicaid plays an important role in ensuring access to healthcare for millions of Americans. Understanding the eligibility requirements, coverage options, and application process help individuals and families access the benefits available to them. Because Medicaid rules and benefits vary by state, it’s essential to check the local Medicaid office for accurate and up-to-date information.

Understanding Medicare agency contracting levels can help agents who may want to expand thier business set clear goals for themselves. The contracting process determines the level of authority, commissions, and support that an agency or agent receives when selling Medicare Advantage (Part C), Medicare Supplement (Medigap), and Medicare Part D prescription drug plans. This blog provides some general information about the different levels of Medicare contracts.

Please keep in mind, each carrier has different requirements for contract levels. They may also have different names for contract levels than what we have listed here.

Levels of Medicare Contracting

Medicare sales agencies typically operate under a hierarchical contracting structure. Each level comes with varying degrees of responsibility and commission structure.

Most carriers will pay street level commissions directly to the downline/sub agent with the override paid to the agency. Overrides range from $50.00 to $150 per sale. This varies by company and agency level.   Many agents know what the annual street level compensation is and will not work with an agency if they will be taking any part of the street compensation.

Agents

At the entry level, individual agents contract directly with an Medicare agency and in some cases, with the insurance carrier. There are two main types of agent contracts:

• Captive Agents: Work exclusively for one carrier and can only sell that carrier’s Medicare products.
• Independent Agents: Have the flexibility to contract with multiple carriers, allowing them to offer a variety of Medicare plans to clients.

Individual agents can either receive street commissions or be LOA to the agency they work under.

General Agencies (GAs)

General Agencies (GAs) operate as intermediaries between independent agents and higher-level marketing organizations, such as FMOs and NMOs. GAs typically provide agents with carrier access, sales support, and some marketing resources, they may not offer the same level of training and tools an FMO can provide. The GAs recieve an override commission for business their downline agents write.

Managing General Agencies (MGAs)

MGAs function at a higher level than GAs, to be an MGA, you must have a greater number of downline agents than a GA. They may provide additional administrative support and agent oversight. structures. MGAs may have direct contracts with carriers, allowing them to receive greater overrides on downline agent sales than a GA level contract. This may provide them financing to offer agents advanced sales tools and training.

Senior General Agencies (SGAs)

SGAs operate at an even higher level than MGAs, typically overseeing some MGAs and GAs. They have strong carrier relationships, access to exclusive products, and higher commission opportunities. SGAs should provide large-scale support, including compliance oversight, marketing assistance, and leadership training for agencies beneath them.

Field Marketing Organizations (FMOs)

FMOs serve as intermediaries between carriers and independent agents or smaller agencies. They provide training, marketing resources, compliance support, and higher commission opportunities. FMOs typically contract with multiple carriers and offer agents the ability to represent various Medicare plans.

Take a look at the programs Crowe offers agents & agencies

National Marketing Organizations (NMOs)

NMOs operate at a level above FMOs and work with a broad network of agents, agencies, and FMOs. These organizations have high-level contracts with carriers, allowing them to negotiate competitive commission structures and access exclusive sales resources. NMOs focus on large-scale distribution and typically offer robust technology and compliance support.

Insurance Carriers

At the top level of the hierarchy, insurance carriers (such as UnitedHealthcare, Humana, and Aetna) contract directly with NMOs, FMOs, and, in some cases, GA levels or individual agents. Carriers set the terms of contracts, commission structures, and compliance guidelines that all agents and agencies must follow when selling Medicare plans.

Keep in mind; all agents and agencies must also folow CMS guidelines.

Contracting Considerations

Commission Structure: Higher-level contracts often provide better commission overridess, but require meeting performance thresholds and a specific number of downline/sub agents.

Training and Support: FMOs and NMOs often provide valuable training, lead generation, and compliance assistance.

Carrier Relationships: Access to multiple carriers gives agents flexibility to offer the best plan options for clients.

Compliance Requirements: Medicare sales are highly regulated, and agencies must ensure they follow CMS (Centers for Medicare & Medicaid Services) guidelines.

Ready to join the team at Crowe – click here for contracting

Understanding Medicare sales agency contracting levels is crucial for agents and agencies looking to optimize their business. Whether operating as an independent agent, partnering with a GA, MGA, or working under an SGA, FMO, or NMO, choosing the right contracting level can significantly impact commissions, resources, and overall success in the Medicare market. Agents should carefully evaluate their options to align with an organization that best supports their business goals.

Health Savings Accounts (HSAs) offer a tax-advantaged way to save for medical expenses, but their benefits and rules change once you enroll in Medicare. Understanding HSAs and Medicare enrollment is crucial to avoid tax penalties and continue to benefit from the HSA.

How HSAs Work Before Medicare

An HSA is a tax-advantaged account that allows individuals with a high-deductible health plan (HDHP) to save and pay for qualified medical expenses. Contributions to HSAs are tax-free, in other words, any contributions lower taxable income. All investment growth and earnings are tax-free; indivduals can invest HSA money and will not pay taxes on any gains as long as the money is in the account. Additionally, money withdrawn for qualified medical expenses is tax-free. However, once an individual enrolls in Medicare, they can no longer contribute to an HSA.

Medicare Enrollment and HSA Contributions

Once enrolled in Medicare, the ability to contribute to an HSA stops. This includes enrollment in any part of Medicare, either Part A (hospital insurance) or Part B (medical insurance). Those who continue making HSA contributions after Medicare enrollment face tax penalties.

A few things to consider:

Medicare Enrollment Date Matters: HSA contributions must stop the month your Medicare coverage begins. If you enroll in Medicare mid-year, your contribution limit for that year will be prorated based on the number of months you were eligible to contribute before Medicare enrollment.

Retroactive Medicare Coverage: For those who enroll in Medicare after turning 65, Part A coverage may be retroactive for up to six months (but no earlier than the month you turned 65). This retroactivity can impact HSA contributions. Beneficiaries should stop contributing at least six months before applying for Medicare to avoid penalties.

Employer Considerations: Anyone working past 65 with employer-sponsored health insurance with an HSA option, may want to delay Medicare enrollment and continue contributing. However, once enrolled in Medicare, even retroactively, HSA contributions must stop.

Using HSAs After Medicare Enrollment

Although individuals can’t contribute to an HSA after enrolling in Medicare, they can still use the funds in their account. Benficiaries can use HSA funds tax-free for qualified medical expenses, including:

• Medicare premiums (except for Medicare supplement policies)
• Out-of-pocket medical costs such as copays, deductibles, and prescription drugs
• Long-term care services
• Some over-the-counter medications and medical supplies

Important: after age 65, HSA withdrawals for non-medical expenses are not subject to the 20% penalty that applies to those under 65. Although, those withdrawals are taxed as income.

Transition from HSA to Medicare

To avoid tax issues and optimize benefits, consider the following:

Time Your Medicare Enrollment: Those who plan to work past 65 and want to continue HSA contributions, consider delaying Medicare enrollment if employer coverage allows it.

Stop Contributions in Advance: Individuals planning to enroll in Medicare, stop HSA contributions at least six months before applying to avoid penalties due to retroactive Medicare coverage.

Maximize Existing HSA Funds: Plan the use of HSA funds for healthcare expenses, including Medicare premiums and out-of-pocket costs.

HSAs provide valuable benefits, but their rules change upon Medicare enrollment. Proper planning helps maximize savings and avoid unexpected tax penalties. Individuals approaching Medicare eligibility should consider consulting a financial or tax advisor to help ensure a smooth transition.

Medicare agents – watch some free training videos on our YouTube channel

If you are ready to contract with Crowe; click here for contracting

Understanding how HSAs and Medicare interact can help individuals make informed decisions that optimize healthcare savings and coverage.

As a licensed insurance agent, the goal is to help clients get the best coverage for their healthcare needs. In doing this, they are protected against financial loss. One product that can provide significant value to clients is hospital indemnity insurance. This coverage is an excellent addition to many health plans, particularly for individuals on Medicare Advantage plans or high-deductible health plans. In the post below, we answer the question; why offer hosptial indemnity insurance.

Hospital Indemnity Insurance

Hospital indemnity insurance is supplemental insurance that provides cash benefits to policyholders when they are hospitalized due to an illness or injury. Unlike traditional health insurance, which pays service providers, hospital indemnity insurance provides a lump sum or dialy benefit amount to the policyholder. Policyholders can decide how they use the money.

Benefits for clients

1. Fills coverage gaps: Many health insurance plans, including Medicare Advantage, have copays, deductibles, and out-of-pocket expenses that can add up quickly. Hospital indemnity insurance helps cover these costs, reducing financial strain.
2. Flexibility in use: Beneficiaries can use the cash benefits from a hospital indemnity policy any way they like. They can pay medical bills, household expenses, or travel costs associated with treatment.
3. Affordable premiums: Compared to major medical insurance, hospital indemnity plans are relatively affordable, making them accessible to many clients.
4. No network restrictions: Policyholders receive payment for a stay in any hospital, without worrying about network limitations.
5. Customizable plans: Many hospital indemnity policies let clients choose coverage amounts and additional riders. This can include; skilled nursing facility coverage or outpatient services.

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Why agents should offer hospital indemnity insurance

1. Enhanced client protection: Offering hospital indemnity insurance demonstrates that you are proactive in helping clients manage potential healthcare costs that may not be covered by their primary insurance.
2. Increase client retention: When clients see the value in additional coverage, they are more likely to trust and stay with an agent who prioritizes their financial well-being. It is also helps build good client relations when all their coverage is provided by one agent.
3. Expand sales opportunities: Adding hospital indemnity insurance to your portfolio increases cross-selling opportunities, allowing you to provide more comprehensive solutions while expanding your revenue.
4. Stand out amoung competitors: Many agents focus solely on traditional health plans. Offering supplemental policies sets you apart and positions you as a more knowledgeable, full-service advisor.
5. Help seniors with Medicare Advantage Plans: Many Medicare Advantage plans have large hospital copay amounts. A hospital indemnity plan tailored to these costs provides clients with peace of mind.

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How to introduce Hospital Indemnity Insurance to clients

Educate clients on coverage gaps: Explain how their existing health plan leaves them with a large out-of- pocket payment in the event of a hospital stay.

Provide real-life scenarios: If possible, use examples of how hospital indemnity insurance has helped individuals manage medical expenses.

Offer a needs-based approach: Assess each client’s unique situation and recommend hospital indemnity insurance as part of a holistic healthcare strategy.

Explain affordability: Break down the cost versus benefit so clients see the value of a small monthly premium compared to potential hospital expenses.

Some tips to maintain your book of business

Hospital indemnity insurance is a great way to protect clients against unexpected healthcare costs. As an agent, offering this coverage not only enhances your client’s financial security but also strengthens your reputation as a trusted advisor. Adding hospital indemnity insurance to your product offerings helps you provide a more complete approach to healthcare planning while expanding your business opportunities.

As a Medicare insurance agent, maintaining a strong reputation and ensuring client satisfaction is essential for success. While providing the best possible service, agents must also be proactive in preventing client complaints that could damage their credibility, lead to compliance issues, or impact their business. We will explain how to avoid client complaints and build better client relationships.

Explain plan details and costs clearly

Many complaints arise from misunderstandings about plan coverage, costs, or network restrictions. To avoid this, agents should take the time to explain plan details, including premiums, deductible and co-pays. Do not forget to include out-of-pocket plan limits.

Remember to emphasize any network restrictions as well as provider availablity. This is extremely important for Medicare Advantage plans. It is helpful to provide a summary of benfits so clients can review them before enrolling in a plan.

Ensure clients enroll in the correct plan

Sometimes complaints occur if the client feels they were enrolled in a plan that does not fit their needs. The best ways to avoid this are; conduct a thourough needs assessment. Be sure you consider all medications, docotors and expected healthcare useage. Comparing mulitple plans and explaining the pros and cons of each helps the client make an informed decision.

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Be transparent coverage changes

Because Medicare plans can change every year, clients may be unhappy if they experience unexpected costs or coverage changes. To prevent this; be sure you procactively inform them of any modifications to their current plan, Remind them to take a look at their annual notice of change (ANOC). Offer an annual review during AEP to ensure thye are still in the best plan for their coverage needs.

Follow CMS compliance guidelines

The CMS has strict marketing and sales guidelines. Agents must avoid misleading or high-pressure sales tactics, use only approved marketing materials and be sure to obtain consent before discussing any pans. It is also important to never make unverified claims about coverage, benefits or plan costs.

Provide ongoing support

Clients appreciate agents who are accessible and responsive. To maintain trust; return calls and emails promptly. Offer assistance after enrollment, such as claims questions and benefit explanations. It is always a good idea to follow up to make sure clietns are happy and understand hw to use their plan benefits.

Handle issues and complaints professionally

Even with the best practices, complaints may still come up. When they do; be sure you listen attentively to the client’s concerns without interruption. It is important to acknowledge their frustration and provide a solution oriented repsonse. If it is necessary, escalate issues to the appropriate carrier rep or Medicare support services.

Document interactions

Keeping records of client communications, plan discussions, and enrollments helps protect agents and clients in case of disputes. Maintain notes from meetings, make note of any special concerns. Keep written enrollment confiramtions and copies of signed documents, authorizations especially the SOA.

Stay updated on Medicare rules and plans

Medicare regulations, plan offerings, and compliance rules change regularly. Stay informed by attending carrier training and webinars. Complete all annual certifications including AHIP. Join industry groups and network with other agents to stay updated on all industry and CMS rules.

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Medicare agents play an important role helping clients navigate complex healthcare decisions. By being transparent, compliant, and client-focused, agents can minimize complaints, enhance client satisfaction, and build a strong reputation in the industry. Providing top-notch service not only leads to long-term client relationships but also increases referrals and business growth.